NAM is launching a new, weekly email bulletin that will provide people with, or affected by, HIV with a concise, plain English digest of the very latest HIV news.

The new digest will put news stories into their context and 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 will also be included.

The bulletin will be edited by Michael Carter, NAM’s patient information and news editor.

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Is HIV evolving to become less virulent?

The story which attracted most mainstream media attention this week was a Belgian laboratory study which suggested that HIV-1 - the type of HIV most prevalent around the world - has weakened over the past 20 years.

Comparing samples of HIV obtained in the mid-1980s to some recently collected samples, the researchers in Antwerp found that the newer samples of HIV appeared to reproduce less well and to be more sensitive to some anti-HIV drugs.

However, the findings do not yet have any real significance to how HIV is treated and as Keith Alcorn told BBC News, “HIV is still a life-threatening infection.”

It is well known that some diseases - such as syphilis - have become less virulent.

HIV Prevention

'POZ parties'

Sex parties where HIV-positive gay men meet to have unprotected sex could help reduce the onward transmission of HIV to uninfected men, but could have other health implications, according to research conducted in New York.

So called ‘POZ parties’ are thought by the New York researchers to be ‘serosorting’, the selection of sexual partners on the basis of their HIV status.

New York researchers conducted interviews with over 100 men attending POZ parties in the city in 2003. They found that the main reasons men attended the parties were because they didn’t have to worry about disclosing their HIV status, the ability to have sex without restrictions, and being able to have sex without fear of infecting somebody else.

However the investigators write that negative health implications could include a risk of sexually transmitted infections, (indeed, the researchers found that a third of men attending the parties had had a sexually transmitted infection in the last year) and superinfection with another potentially resistant strain of HIV.

It is not known how often superinfection occurs or how serious its implications could be. The few cases of superinfection reported so far in gay men involve men who were either in the early months of HIV infection or were taking a break from treatment.

Unprotected sex between groups of HIV-positive gay men at sex parties have been associated with the spread of LGV, syphilis and hepatitis C virus in recent years.

HIV treatment

Treatment breaks

Three studies were looking at the value and safety of breaks from HIV treatment, often called structured treatment interruptions, this week.

The first one looked at how long it took mitochondrial function to improve in people taking a break from treatment. Mitochondria carry energy in cells. Some anti-HIV drugs in the nucleoside analogue class (NRTI) can damage mitochondria and this damage in fat and nerve cells has been associated with lipodystrophy and peripheral neuropathy.

Italian researchers looked at levels of mitochondria in CD4 and CD8 immune system cells to see if levels of mitochondria were affected by taking a break from treatment. They found that mitochondria in CD4 cells were unaffected by the break, but that levels increased significantly in CD8 cells after six months. This suggests that breaks in HIV treatment need to last at least six months for side-effects associated with mitochondrial toxicity to improve.

A second study found that treatment breaks did not mean that anti-HIV treatment worked better in people who had taken a lot of anti-HIV drugs before. In addition the researchers found that 66% of people taking a break experienced an HIV-related illness.

It has been suggested that a break from treatment might have benefits for patients who have been heavily treated with anti-HIV drugs before they start a new treatment regimen. In particular, it is thought that a break from anti-HIV drugs might help reverse resistance.

French researchers looked at the effects of a 24-week treatment break in 23 heavily treated patients. They found that although resistance was reversed in most of the patients, that two-thirds of people developed an AIDS-defining illness after their treatment was resumed.

A third study found that levels of efavirenz (Sustiva) can linger for up to eight weeks after it is stopped in some people who clear the drug very slowly from the body.

Slow clearance of the drug is associated with a rare gene. It is currently recommended that people who are going to take a break from efavirenz switch to the protease inhibitor Kaletra for 14 days before the break is started. However, researchers from Liverpool University believe this would not be long enough for some patients and recommend that levels of efavirenz in the blood should be monitored in people who are interrupting its treatment to see how long treatment with Kaletra should be continued for.

HIV-associated illnesses

HIV and hepatitis C virus coinfection