Anti-HIV treatment

Most people taking potent anti-HIV treatment can expect to live a long and relatively healthy life. But currently available HIV drugs cannot cure HIV and many find them difficult to take properly or experience side-effects.

There is a lot of research underway with the aim of developing either completely new anti-HIV drugs, or easier to take and more tolerable versions of existing drugs.

One drug anti-HIV drug that has recently been reformulated is the protease inhibitor, Kaletra (lopinavir/ritonavir).

When Kaletra was first developed, the dose was three orange capsules twice a day. The capsules needed to taken with food to work properly and also needed to be stored in the fridge.

The makers of Kaletra have developed a new tablet formulation of the drug which is easier to take. The drug was reformulated into a tablet form and the dose is two orange tablets twice a day. The Kaletra tablets can be taken with or without food and do not need to be kept in the fridge.

A study conducted in America by the makers of Kaletra shows that people switching from the capsule to tablet form of Kaletra prefer the tablet version of the drug. Fewer people reported experiencing diarrhoea with the Kaletra tablets than the capsules and people said that their adherence to the tablet formulation was better than their adherence to the capsules. Overall, 80% of people said that they were ‘very’ or ‘extremely’ satisfied with the Kaletra tablets, but only 60% reported these levels of satisfaction with the Kaletra capsules.

Another study conducted by the makers of Kaletra  has apparently found that the drug does not cause high blood pressure.

It is well known that some anti-HIV drugs can cause increases in levels of blood fats, possibly increasing the long-term risk of health problems like heart disease. High blood pressure is one of the factors known to increase the risk of heart disease.

The researchers looked at the results of two studies and found that Kaletra was no more likely to increase blood pressure than either efavirenz (Sustiva) or nelfinavir (Viracept).

HIV and sex

Most people with HIV in the UK became infected with the virus through sex and remain sexually active after their HIV diagnosis.

British HIV doctors have developed a set of guidelines about the sexual and reproductive needs, rights and responsibilities of people with HIV. Comments on the draft guidelines have been invited and should be submitted by December 6^th to bhiva@bhiva.org.

The draft guidelines are quite wide-ranging and cover the following topics: contraception; condom use in the era of the criminalisation of HIV transmission; screening for and the management of anal and cervical cancer; assisted conception; and sexual dysfunction.

Researchers are showing an increasing interest in the sexual choices and decisions that people with HIV make. A theme that emerged in recent years is so-called ‘serosorting’ – the deliberate selection of a sexual partner of the same HIV infection status. For people with HIV, this can be motivated by a wish not to risk infecting a partner with HIV. Another reason might be a wish to have unprotected sex with other HIV-positive people. This can be pleasurable and intimate, but there can be health risks including sexually transmitted infections, infection with hepatitis C and possible reinfection with another strain of HIV.

Recent research in California suggests that a significant number of both HIV-positive and HIV-negative gay men are deliberately choosing sexual partners who say that they are of the same HIV status.

Not only were the men in the study deliberately choosing other men of the same HIV infection status as their partners, but the researchers found that HIV-positive men who had HIV-positive partners were often having unprotected sex as were HIV-negative men with HIV-negative partners.

It’s not only scientific researchers who are interested in the sexual behaviour of people with HIV. In many countries, the UK included, the reckless or deliberate sexual transmission of HIV has become criminalised.  In Melbourne, Australia, police may set up a special task-force to investigate the sex lives of a number of gay men suspected of “deliberately spreading” HIV through the city’s gay community. The police were “inadvertently” given access to the medical records of 17 men whilst they were investigating another man for reckless or deliberate HIV exposure and transmission. 

If you act very quickly (today) you can comment on the UK Department of Health’s policy consultation of the confidentiality of sexual health and HIV medical records, and the Crown Prosecution Service is seeking comments from the public on its draft guidance on prosecutions for the reckless transmission of HIV and sexually transmitted infections. The deadline for comments in November 3^rd.