Editorial

Optimistic but realistic

Here goes, I’m going to write something bold and potentially controversial: I don’t think HIV will kill me. I’m now confident that HIV treatment will mean that I live a normal life-span.

But despite this optimism, let’s remember, there’s no cure or vaccine for HIV and there was a lot of sobering news this week about the very real limitations of currently available HIV treatment – see the research presented to a recent resistance conference, and reports of a rare side-effect apparently caused by tipranavir/ritonavir. And news from California also further demonstrated the extent to which the law is becoming involved in HIV.

The news is divided into the following sections:

Resistance: TMC125 works well against resistant virus and the “jury is still out” on Kaletra monotherapy studies; resistance to tenofovir (Viread) may develop easier in subtype C; low-level HIV replication during HIV treatment due to primary resistance is associated with a poorer outcome.

Eradication studies: Funding made available in US for studies looking at ways of eradicating HIV.

New drug formulation: New formulation of Kaletra approved in Europe.

Side-effect warning: Warning issued that tipranavir (Aptivus) boosted by ritonavir may be associated with rare occurrence of bleeding in the brain.

HIV and the law: Court in California makes important ruling.

Resistance

Eradication studies

Potent anti-HIV treatment can mean a longer and healthier life – in fact some doctors are now optimistic that, provided a person has their HIV diagnosed before the virus has done too much damage to their immune system, they take their treatment properly to avoid resistance, can tolerate their treatment and take good care of their health, then they should be able to live a normal life-span.

But the fact remains that currently available treatment can’t cure HIV. This is partly because, although the drugs now available can control HIV in the blood, they cannot eradicate “reservoirs” or HIV in places like the organs and brain or get rid of virus that has integrated into human DNA.

However, funding has been made available in the US for studies to explore various strategies which might lead to eradication of HIV. One of them involves the use of sodium valproate, a drug normally used to treat disorders such as epilepsy and manic depression, to flush out viral reservoirs. Others will look at how some HIV-positive people’s genetics mean they can live long and healthy lives without the need for HIV treatment; the effect of  HIV on the gut; and HIV’s activity in the brain.

New drug formulation

Kaletra (lopinavir/ritonavir) is a ritonavir-boosted protease inhibitor recommended for use in combination with other anti-HIV drugs for people who have never taken anti-HIV treatment before.

Formal European approval has been granted for a new formulation of the protease inhibitor Kaletra . The dose consists of two tablets each containing 200mg of lopinavir and 50mg of ritonavir twice a day. Unlike the previous soft-gel formulation of Kaletra it does not require refrigeration.

Side-effect warning

Tipranavir (Aptivus) is a ritonavir-boosted protease inhibitor that is approved for use for people who have taken a lot of anti-HIV drugs before and have limited treatment options. It has a particularly potent anti-HIV effect when combined with T-20 (enfuvirtide, Fuzeon).

Like all anti-HIV drugs, tipranavir can cause side-effects. The side-effects most commonly associated with tipranavir are diarrhoea, feeling sick, and stomach cramps. The drug can also cause increases in blood fats and sugars and it is recommended that people taking the drug have their liver function monitored.

Tipranavir may also be associated with an increased risk of bleeding within the skull, according to a warning issued by its manufacturers, Boehringer Ingelheim. The warning was issued after 14 of the 6840 people who took tipranavir boosted by ritonavir in clinical trials developed bleeding within the skull. Sadly, eight of these people died. Most of the people who developed bleeding in the skull had pre-existing risk-factors such as lesions on the brain, head injury, recent brain surgery, problems with blood clotting, high blood pressure, alcohol abuse, or the use of other medicines known to cause the risk of bleeding.

The bleeding developed an average of 525 days after treatment with tipranavir/ritonavir was started.

HIV and the law

In recent years a number of people in the UK have been sent to prison for recklessly infecting their sexual partners with HIV. You can read a summary of the criminal law and HIV transmission here.

Exposing another person to HIV, or infecting them with the virus is also a crime in many other countries, including some states of the USA. Now a court in California has ruled that a woman who was infected with HIV can sue the man who infected her for damages, even though the man didn’t know he had HIV at the time.