news BHIVA
13th annual conference of the British HIV Association with the British Infection
Society
Doctors make plea for new drug classes
We still need new drugs, new classes of drugs and new strategies to battle
HIV, a top HIV doctor told a special symposium at BHIVA.
Dr Mark Nelson, of the Chelsea and Westminster Hospital said: “HIV is
still a killer. It kills individuals and continues to kill individuals. In
countries throughout the world people continue to die from HIV and Aids.
“Mono and dual HIV therapies have been proven to fail, triple therapy
does work and we don’t need to change the treatment paradigm,”
Dr Nelson said.
But with high levels of drug resistance it’s not just which mutations
a patient’s individual virus has but also the number of those mutations.
“New drugs in new classes will be essential for patients with triple
class resistance,” Nelson argued. “But sequential mono-therapy
[single therapy] doesn’t work.”
The more advanced the HIV in someone, the more likely they are to have a higher
proportion of virus with the CXCR4 receptor rather than the standard CCR5
receptor. Nelson dubbed these ‘bad virus’ and ‘good virus’
respectively because patients with the CCR5 virus are generally treatment
naive and relatively easy to treat. Patients with the aggressive CXCR4 virus
are difficult to treat and much more likely to die within two to three years.
“Rates of Aids-defining events and death are much more frequent in people
who start HAART later, with a CD4 count less than 350, than those with a CD4
count above 350. It took doctors 10 years to work out that they needed to
give their patients triple therapy for the treatments to work,” said
Nelson.
“If Freddie Mercury had been given AZT, ddI and 3TC together rather
than one after another, he might just be alive today,” he said.
Similarly, if George Orwell had received his TB drugs together rather than
separately he may well have lived to see 1984.
“Do we learn from the mistakes of the past?” Nelson asked while
reminding his audience that it was the drugs which failed the patient and
not the other way around. “Failure is an event not a person,”
Dr Nelson said: “Failure is when your best isn’t good enough.”
“Lack of passion worse than lack of
expertise”
The NHS is always in crisis, PN’s treatments editor and treatments advocate
Robert Fieldhouse told doctors at a key BHIVA symposium.
But the crisis in HIV had driven forward new research and new treatments,
he added.
Describing himself as “an inpatient man with HIV”, Fieldhouse
said late diagnoses of people with the virus was behind most of the 500 HIV-related
deaths each year in the UK. “Early treatment relies on early diagnosis,”
he said.
But Fieldhouse wondered if this would make people start HIV treatments earlier
or whether they would be fearful of the drugs’ short-term toxicities.
A recent report from THT found 80 per cent of HIV doctors reporting an increased
workload in the last year. They also raised fears about the growing challenge
of poorly funded social care for people living with virus.
“Lack of expertise is a bad thing, but lack of passion is even worse,”
Fieldhouse said.
Pointing out that worldwide sales of antiretrovirals are expected to top $10
billion a year by 2015, he commented: “There’s a lot of people
making a lot of money out of this disease.”
“I hope someone like me will have four or five sequential treatment
combination options,” he added.
Fieldhouse called upon people living with HIV to get more involved in their
own care and campaigning and hoped more people with HIV would become NHS commissioners
of HIV services. He also called on pharmas to help fund smoking cessation
course for people with HIV – the second most important issue for many
people with the disease.
Doctor wins accolade
Until last month, Dr Laura Waters was one of the leading HIV research doctors
at the Chelsea and Westminster Hospital.
At Edinburgh Dr Waters won a prize for her oral presentations about HIV co-receptor
CCR5 and CXCR4 tropism and a new type of viral load testing using dried blood
spots posted directly to the lab. Laura began her new job as an HIV consultant
at St Mary’s Hospital last month.
Half
of HIV positive Londoners work
A study by Professor Jonathan Elford (right) of London City University, and
colleagues at Homerton University Hospital shows just under a half of Londoners
living with HIV are in employment.
In a separate study, Professor Elford’s team found 38 per cent of gay
men, 16 per cent of black African men and 13 per cent of black African women
living with HIV reported having unprotected sex in the previous three months.
Gay men will continue to account for the majority of new HIV infections acquired
in the UK for the foreseeable future, the research concluded.
Elford is pictured with Cheikh Traore, health inequalities programme lead
at the London Assembly.
TB is biggest killer of people with HIV
Tuberculosis remains the biggest killer of people with HIV across the world,
according to the World Health Organisation (WHO).
Dr Kevin de Cock, director of the organisation’s HIV and Aids department
told the BHIVA conference that most TB occurred in HIV positive people but
much or most TB transmission is from HIV negative people.
Twenty per cent of people co-infected with both HIV and TB are likely to die
within in a year, Dr de Cock explained.
There are an estimated 40 million people with HIV around the world and as
many as nine million cases of TB.
More than 400,000 cases are multi drug resistant TB and 27,000 cases are extremely
drug resistant TB.
Many patients who come forward for treatments late in the UK are co-infected
with both TB and HIV, said Dr Mark Lipman, of London’s Royal Free Hospital.
And rates of co-infection are much higher in non-UK born patients than in
others.
Dr Lipman said diagnosing TB in HIV positive patients can be difficult and
advised doctors to treat HIV and TB together, not separately.
There were more than 80,000 cases of TB in Britain in 2005, with 105 in north-east
London alone between 2003 and 2005, said Dr John Moore-Gillon of Barts Hospital.
Barts was seeing 200 new cases a year. Health care workers were at particular
risk of catching the disease.
Only a small proportion of people who become infected with TB in this country
will go on to get active TB.
“Most people with TB don’t realise they have a problem and diagnosis
of the disease carries great stigma in immigrant communities,” said
Dr Moore-Gillon.
“Most people with TB are not HIV positive and most people with HIV do
not have TB,” he added.
Underground and undiagnosed TB is a big problem among failed asylum seekers
in the UK, especially since they are not entitled to treatment. Dispersal
of asylum seekers around the country is making matters worse.
New York in the 1980s and early 1990s had a huge TB problem and it was greatly
relieved by a massive investment of a $1 billion.
“We need greater investment into TB testing, monitoring and control
in Britain now, before we have a serious epidemic out of control like in some
cities in Eastern Europe and the former Soviet Union,” Dr Moore-Gillon
added.
Is
BHIVA Diva moving on?
Professor Margaret Johnson, of London’s Royal Free Hospital, hinted
she would be stepping down as chair of BHIVA at the autumn conference.
Dr Johnson said there were 63,500 people living with HIV in the UK and a third
didn’t know their status. One in 20 gay men at GUM clinics had HIV and
didn’t know it, she said, and one in five HIV-related deaths were due
to diagnosis too late for treatments to work.
Professor Johnson is pictured with Ruth Lowbury (left), CEO of the Medical
Foundation for Aids and Sexual Health (MedFASH), and PN columnist and MedFASH
project manager Russell Fleet (right).
news on the side
Reaction rarer in Africans
Latest studies into the potentially fatal abacavir hypersensitivity reaction
show between five and eight per cent of people have the gene responsible.
Dr Phillip Hay, of St George’s Hospital, London, explained the reaction
was likely to happen within the first week on therapy if at all. Testing showed
the reaction was less common among blacks or Hispanics than whites.
Rough sex leads to hep C
New cases of sexually transmitted hepatitis C among gay men with HIV in the
UK are rising rapidly, according to Dr Murad Ruf, of the Health Protection
Agency. There were 60 new cases in 2002 and 67 in the first six months of
2006. Hepatitis C is spread by blood and is usually not present in seminal
fluids, Dr Ruf explained, and it was likely most new cases could be put down
to ‘rough sex’.
Therapy fails few
Less than three per cent of patients who start antiretroviral therapies (ARVs)
stop taking their drugs because they are not working, Dr Tim Chadborn of the
Health Protection Agency said. In a study of 1,100 people who started ARVs
in 2004 and 2005, over 80 per cent achieved viral loads below 50 and had a
CD4 count above 200 after a year on therapy.
Payment by results for all
Payment by results has been around in the NHS for a number of years, said
Bob Dredge, a Keele University research fellow and former Department of Health
civil servant, but till now HIV treatments were exempt. From 2008 all hospitals
will be paid a fixed sum for each course of treatments with rewards for efficiency
and lower costs. But HIV doctors and patients are concerned the tariff system
will restrict access to more expensive HIV treatments.
Fraud arrests ‘imminent’
Ugandan President Yoweri Museveni has ordered the arrest and prosecution of
his former health minister Jim Muhwezi and two deputy ministers over allegations
they misused a $4 million grant from the Global Fund to Fight Aids, TB and
Malaria.
The Fund suspended all grants to Uganda in 2005 over the scandal which involved
allegations that monies for HIV campaigns were diverted to charities run by
the President’s wife Janet.
Uganda had won international praise for widespread condom distribution, health
information and HIV prevention campaigns that led to HIV prevalence rates
dropping from over 30 to less than 10 per cent in the 1990s, but the government
has come under criticism in recent years for concentrating on US funded abstinence
campaigns.
Wages spent on HIV drugs
HIV positive patients at private clinics in Mumbai spend over 60 per cent
of their monthly income on their antiretroviral drugs, according to a study
published in the journal Clinical Infectious Disease. The research highlights
the high price of HIV drugs in comparison with low wages in the Indian city,
where professional salaries are often less than $100 a month and generic HIV
combinations cost on average $44 a month. India has the most people living
with HIV in the world at more than 5.7 million.
Workers hit hardest by HIV
The International Labour Organisation (ILO) estimates more than 36 million
of the 40 million people worldwide living with HIV are of working age. Most
live in Africa and all employment sectors are affected. The cumulative loss
to the labour force from HIV by 2005 reached 28 million lives the ILO said,
and it could jump to 74 million workers’ lives lost by 2015.
Disability reviews loom
The Department for Work and Pensions (DWP) has informed us they will be carrying
out a sample review of cases on people awarded Disability Living Allowance
(DLA) or Attendance Allowance (AA). A few thousand people living with HIV
in the UK are in receipt of DLA or AA given under ‘special rules’
provisions in the early 1990s when they weren’t expected to live for
more than six months.
Bid to end biased reporting
The National Aids Trust (NAT) and National Union of Journalists (NUJ) have
launched Guidelines for reporting HIV to help counter inaccurate and stigmatising
coverage of HIV in the media. Many newspaper articles, not just in the tabloids,
misrepresent people living with the disease and the guidelines are intended
both for people living with the virus who wish to complain about biased or
inaccurate reporting as well as journalists to avoid future errors.
www.nat.org.uk •
www.nuj.org.uk
Entitled to free NHS care?
The National Aids Trust (NAT) and Terrence Higgins Trust (THT) have produced
advice for people living with HIV who may or may not be entitled to free NHS
treatments and care. Although testing and treatments for TB and sexually transmitted
infections is available on the NHS free to all in the UK, bizarrely, people
with HIV who are failed asylum seekers, or visitors to Britain, can still
be charged for HIV treatments, despite human rights legislation and public
health risks.
www.nat.org.uk •
www.tht.org.uk
