The conference the media forgot

In August the attention of the world’s media was briefly caught by the International AIDS Conference in Toronto.

Last week another important conference took place – the snappily named 46th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC) -  but it attracted little media attention.

That’s not to say that it wasn’t of interest to people with HIV as lots of new information was presented on promising new drugs, novel ways of making the most of existing treatments, and side-effects.

So far aidsmap.com has filed 13 reports from the conference (and there’s a lot more to come), and you can read a summary of most of the news reported so far in this edition of HIV Weekly.

New anti-HIV combinations and comparisons

Potent anti-HIV therapy normally consists of two nucleoside analogue reverse transcriptase inhibitors (NRTIs or “nukes”) plus either a “boosted” protease inhibitor of a non-nucleoside reverse transcriptase inhibitor (NNRTI).

But there is concern that some NRTIs can cause long-term side-effects, such as fat loss or peripheral neuropathy so researchers have been looking at how safe and effective combinations of drugs that don’t include drugs from this class are.

The drug company BMS make the protease inhibitor, atazanavir, (Reyataz) and the NNRTI, efavirenz (Sustiva), and they conducted a study in which this combination of drugs was given to 61 people taking anti-HIV drugs for the first time. The results were encouraging. After a year, approximately two-thirds of people had a viral load below 50 copies/ml (usually described as an undetectable viral load). The immune system strengthened, with average CD4 cell count increasing by approximately 250 cells/mm³.

But the researchers noticed that levels of blood sugars and blood fats increased –by an average of 30% and total cholesterol by about a third. But much of the cholesterol increase was HDL cholesterol, so called “good cholesterol.”

New drugs in development

Side-effects

HIV and hepatitis

Many HIV-positive people are also infected with hepatitis C virus. Treatment is available for hepatitis C, but tends to be less effective in HIV-positive people than those who only have hepatitis C.

A small study, involving 70 with HIV who had just been infected with hepatitis C found that providing treatment at this acute phase of hepatitis C infection produces good results. After 24 weeks of hepatitis C therapy, 72% had an undetectable hepatitis C viral load and 24 weeks later, 61% still had undetectable levels of hepatitis C. Doctors call this a “sustained virological response” and the proportion of HIV/hepatitis C-infected patients who achieved this outcome in this study was much higher than the rate normally seen when hepatitis C therapy is provided to HIV-positive people.

Researchers have also found that people with HIV and hepatitis C might have a second chance of achieving a good response to hepatitis therapy if their treatment does not clear the infection first time round. This study found that approximately 66% of people who needed to take a second course of anti-hepatitis C treatment had an undetectable hepatitis C viral load after 24 weeks therapy.

Resistance

HIV can mutate to become resistant to antiretroviral drugs. This drug resistant HIV can be transmitted and a study has found that 16% of HIV-positive people who have never taken anti-HIV drugs entering a drug company’s clinical trials in the US had drug resistant virus. Having HIV that has drug resistance when you haven’t taken any anti-HIV drugs is called primary resistance.

A similar prevalence of primary resistance has previously been observed in the UK.

Some have drawn simplistic conclusions from trends in primary drug resistance, claiming that they show that there’s complacency about the seriousness of HIV due to effective antiretroviral therapy or that HIV prevention work is a failure.

But trends in the increase in drug resistance can be tied to the expanding use of anti-HIV drugs: for example only 2% of people had primary resistance to NNRTIs in 2000. This reflects the limited use of this class of drug before this time, but by 2005, when NNRTI use was widespread, the prevalence of primary resistance had increased to 11%.

Interestingly, the latest study also found that there were no significant differences in overall rates of primary resistance between gay men and heterosexuals.

HIV and the law

There has been another conviction for the reckless transmission of HIV in the England and Wales, bringing the total of convictions so far to nine.

The 43 year-old man pleaded guilty of infecting his 49 year-old female partner.

It is vital that anybody who is accused of the reckless transmission of HIV obtains expert legal advice as soon as possible. Many of the convictions so far came after defendants were presented with “scientific” evidence which lead to them pleading guilty. However, in August a case showed that genetic testing of HIV cannot prove in itself that HIV was transmitted from one person to another.

The Crown Prosecution Service is currently conducting a consultation exercise with the public on these prosecutions.