• HIV treatment: People are staying on their first anti-HIV drug combination for longer.

• Side-effects and interactions: Graves’ disease, a disorder of the thyroid gland seems to be a rare immune restoration inflammatory illness; debate continues about whether atazanavir/ritonavir and antacids interact; and anti-HIV drugs that get into the brain don’t impair brain function.

• Treatment for wasting: A steroid can boost lean muscle in men with HIV-related wasting, but has side-effects.

   

  Very last call for testimonies for inclusion in the next edition of Living with HIV. If you would like your experiences of life with HIV included then your contribution needs to be submitted by Wednesday March 29^th.

HIV treatment

The aim of anti-HIV treatment for people who have never taken it before, is to get viral load

The aim of anti-HIV treatment for people who have never taken it before, is to get viral load suppressed to undetectable levels in the blood and to keep it there. This substantially reduces the risk of HIV developing resistance to antiretroviral drugs. Suppressing your viral load will allow your immune system, measured by counting the key CD4 cells in your blood, to recover, therefore reducing the risk of illness and death.

To have the best chance of this happening, the combination of anti-HIV drugs that you take needs to be powerful, tolerable, and easy to take. When combination HIV therapy first became available it often included weaker drugs which HIV could become resistant to relatively easily. Some drugs also caused unpleasant side-effects and were difficult to adhere to – often involving as many as three separate doses with food restrictions a day. This has gradually changed, and the HIV drugs that are recommended for first-line treatment today are much more powerful, have fewer side-effects and often only need to be taken once a day.

A large international study involving almost 4,000 individuals has confirmed that this is the case and has found that the risk of the first anti-HIV combination failing fell by half between 1996 and 2002.

Researchers found that the risk of viral load rebounding fell from 28% in 1996 to 12% in 2002. They further established that people who had a lower risk of treatment failure had a lower viral load below they started treatment, were older and had had a prior AIDS-defining illness.

The type of HIV drug used also reduced the risk of treatment failure. People who took a single protease inhibitor such as indivinavir, nelfinavir (Viracept) or hard-gel saquinavir had a higher risk of treatment failure than those who took a ritonavir-boosted protease inhibitor or the non-nucleoside reverse transcriptase inhibitor, efavirenz (Sustiva).

Side-effects and drug interactions

Treatment for wasting

The use of potent antiretroviral treatment has lead to a substantial decline in the amount of HIV-related illness experienced by HIV-positive people. Nevertheless, unintended weight loss, often called wasting syndrome, still remains relatively common amongst HIV-positive people, and the unintentional loss of just 3% of body weight is associated with an increased risk of illness and even death.

Paying attention to nutrition can help preserve weight or promote weight gain, but often weight gained through increased eating is in the form of fat – and increased levels of body fat are not associated with increased survival.

Anabolic steroids have been used to promote the development of lean muscle in people with HIV, but the studies that found this only involved a small number of patients.

American researchers therefore looked at the use of the steroid oxandrolone by 262 HIV-positive men. All the men had HIV-related wasting. The study was conducted between 1996 and 1998, and the men had an average CD4 cell count of 250 and an average viral load of 120,000. No details of the use of anti-HIV treatment by the men in the study were provided.

The researchers found that men who took 40mg of oxandrolone a day for twelve weeks gained more lean muscle than men who took a dummy placebo pill. Gains in muscle were sustained after twelve weeks when the dose of oxandrolone was lowered to 20mg a day.

However, treatment with the steroid did have side-effects including increased levels of bad LDL cholesterol and problems with liver function.