Compiled by Robert Fieldhouse
Reverset: once-daily nuke
A ten-day study of the investigational nucleoside analogue Reverset suggests the drug is potent and tolerable. Thirty people who had never used HIV treatment before received one of three doses of Reverset, once daily, or a placebo for 10 days.
Those receiving the highest dose of Reverset experienced the greatest decrease in their virus. The drug may also prove active against virus resistant to the older nucleoside analogues. A separate study investigated adding Reverset to failing HAART and the drug showed significant activity, with no serious side-effects reported.
Nothing for the weekend, sir?
A small US study suggests it may be possible for those taking NNRTI-based HAART to take weekends off therapy.
Researchers from New England enrolled 30 people for the FOTO study - so called because people spent ‘Five days On and
Two days Off’ therapy.
Twenty-four-week data was available for 27 patients. People were taking a range of combinations, including both protease inhibitors and NNRTIs. All ten being treated with an efavirenz-based combination, and all seven receiving nevirapine-based HAART, remained with a viral load below 50 copies at week 24. This study is still in its infancy and involves a small number of people. Longer term follow-up in a larger number of people with HIV is needed before it may be possible for people to safely adopt this approach.
Efavirenz-rifampicin dosing
Until now, anyone taking the TB drug rifampicin alongside the NNRTI efavirenz, may have been advised to increase the dose of efavirenz from 600mg to 800mg daily. Early data from a new study of 80 people with HIV and TB in Thailand has suggested that in people with low body weight, there is no need to increase the dose of efavirenz. The average body weight of individuals in the study was 50kg, so interpretation of the data should be with caution; best to discuss this with your doctor.
Three-year data on tenofovir
Combining tenofovir with 3TC and efavirenz appears to be just as effective as using d4T, 3TC and efavirenz over the long-term, but with the advantage of much less short- and long-term side effects.
At week 144, very similar proportions of people had a viral load below 50 copies (73 per cent of those receiving tenofovir, and 69 per cent of those receiving d4T) and CD4 cell count rises were similar in each arm; 283 at week 144 on d4T and 263 on tenofovir. Peripheral neuropathy and lipodystrophy were more common in those treated with d4T, as were elevations in the blood fats triglycerides and LDL ‘bad’ cholesterol.
Lopinavir-ritonavir resistance rarely seen
A five-year study of the protease inhibitor (PI) lopinavir-ritonavir taken in combination with d4T and 3TC has failed to find any resistance to the boosted PI, even when the viral load became detectable again. Those participants with a detectable viral load above 400 copies between week 12 and 48 were offered a resistance test. But no resistance to lopinavir-ritonavir or tenofovir was found, even when people had detectable virus. Manufacturer Abbott Laboratories has submitted the once-daily drug for approval in the US.
Stop smoking
New information from the US Veterans’ Aging Cohort Study (VACS) has examined the role of smoking on quality of life and health of people living with HIV between 1998 and 2000. They found that compared to those who had never smoked, ex- and current smokers were more likely to report symptoms of cough and have lung disease; the death rate was also higher.
Correction
We would like to point out that Professor Lorraine Sherr is in fact a clinical psychologist at the Royal Free Hospital, not the Chelsea and Westminster Hospital as
we reported last month.
