Welcome to HIV Weekly, a weekly email bulletin that provides people with, or affected by, HIV a concise, plain English digest of a selection of the very latest HIV news.

This digest puts the latest HIV news stories into their context to equip you with the knowledge to understand what the latest research might mean for your HIV treatment and care.

Information on the latest NAM treatment information resources and those produced by other key organisations such as the UK Coalition and THT are also included.

HIV Weekly is edited by Michael Carter, NAM's patient information and news editor.

This week’s edition is, once again, dominated by news from the Thirteen Conference on Retroviruses and Opportunistic Infections (CROI), which was held in Denver in early February. CROI is one of the major HIV conferences of the year and this year’s conference was particularly interesting with lots of important information presented on all aspects of HIV.

This edition of HIV weekly is divided into five main sections.

• Treatment breaks: Taking a treatment interruption guided by CD4 cell count may not involve a risk of resistance to anti-HIV drugs. Could this be because a boosted protease inhibitor was being taken by most people in the study?
• Tipranavir: After a year, tipranavir is still out-performing other boosted protease inhibitors in highly treatment-experienced people and there’s more evidence that using it with the fusion inhibitor T-20 produces good results. The dose of tipranavir for children is identified.
• HIV treatment: Only patients who start anti-HIV treatment with a CD4 cell count above 350 have a realistic chance of experiencing an increase in their CD4 cell count to normal levels, a finding which could have implications for decisions about the best time to start HIV treatment. Children need to start HIV treatment before they experience extensive immune damage to have the best chance of experiencing immune recovery.
• Lipodystrophy: There’s evidence that traditional risk factors such as smoking and high blood fats are behind the increased risk of heart disease seen in some people taking HIV treatment.
• Illness: Potent anti-HIV treatment and chemotherapy for non-Hodgkin’s lymphoma can be used together safely and successfully. A study finds that even when anti-HIV treatment isn’t working well, it still reduces the risk of developing an AIDS-defining illness.

Treatment breaks

One of the biggest HIV news stories so far this year was the early termination of the SMART treatment interruption study after it was found that people who took a break from treatment were much more likely to become ill. The researchers coordinating the study concluded that CD4 guided treatment interruptions were unsafe after it was found that people who stopped taking treatment when their CD4 cell count reached 350 were not only more likely to experience AIDS-defining illnesses but other serious illnesses as well.

The SMART study is not the only examination of the safety and effectiveness of taking a treatment break on the basis of CD4 cell count. Results from another such study, called the Staccato trial, were also presented to CROI. In contrast to SMART, this trial had relatively encouraging results and found that 92% of people who took a break from treatment when they had a viral load above 500 copies/ml did not develop resistance to their anti-HIV drugs. Taking a treatment break with a detectable viral load is a recognised risk factor for the emergence of resistance.

Doctors from the Staccato study think that the reason so few people developed resistance in their study was because 80% were taking the saquinavir (Invirase) boosted by ritonavir. This drug, like all the ritonavir boosted protease inhibitors is very powerful and it is difficult for HIV to become resistant to it.

You can read an analysis of the future of treatment interruptions here.

New drug tipranavir

Tipranavir (Aptivus) is a ritonavir-boosted protease inhibitor which was recently licensed for use by people who have taken a lot of anti-HIV drugs before and have very limited treatment options.

There were a number of studies presented to CROI which provided more information on the potency of tipranavir and how best to use the drug.

Anti-HIV treatment

The aim of treatment with a powerful combination of anti-HIV drugs for people who have never taken anti-HIV therapy before is to suppress viral load to undetectable levels. Suppression of HIV allows the number of the immune system’s key CD4 cells to increase.

The recovery of CD4 cell count during anti-HIV treatment was the subject of several presentations to CROI. The findings of one of these studies could have implications for decisions about the best time to start anti-HIV treatment.

Lipodystrophy

Anti-HIV drugs have been associated with changes in body fat shape and increases in blood fats, which can increase the long-term risk of heart disease. The name given to these side-effects is lipodystrophy.

Results from a very large study presented to CROI showed that protease inhibitors that involve the biggest risk of heart disease.

Several other studies looking at the risk of heart disease in people taking anti-HIV drugs were also presented to CROI.

Illness