A panel of HIV experts has recommended that the US Food and Drug administration licence the new protease inhibitor (PI) atazanavir. Atazanavir, which manufacturers Bristol-Myers Squibb will sell in the US under the brand name Reyataz, is the first new PI licensed for two years - the last one being Abbott's Kaletra (lopinavir/ritonavir). The primary advantage of atazanavir is that it does not raise levels of lipids (fatty substances such as cholesterol and triglycerides) in the blood - and may possibly be able to reverse lipodystrophy. It also needs to be taken only once a day. It is not likely to be licensed in Europe till December.
Two of the big-hitting anti-HIV medications currently available have, last month, been removed from the list of drugs recommended for first-line therapy. In the most recent set of BHIVA treatment guidelines, d4T and Trizivir were no longer recommended as first-line therapy. However, tenofovir was expressly encouraged for use as initial therapy.
A study has shown high levels of a kind of cholesterol prolonged the time a group of Spanish patients suppressed HIV on drug therapy. HDL (high-density lipoprotein) is called 'good cholesterol,' because it prevents heart attacks and promotes the health of the immune system. Eight patients, who had viral loads under 200, had their blood lipids measured. It was discovered that those who had the highest levels of HDL cholesterol had the longest average times without their drugs failing. The investigators commented: "Our findings imply that the HDL particle may have some antiviral properties based on its structure or function. An HDL antioxidant effect could inhibit HIV replication, or HDL could induce a direct immune response against HIV." This opens up the possibility of modifying diet to induce higher HDL cholesterol or a higher ratio of HDL to total cholesterol.
A tribe near Lake Victoria, Uganda, appears to be immune to HIV - despite having sex with partners who are HIV-positive. "It strengthens the case that the immune response can protect against infection, so if you can make that immune response with a vaccine you can protect people," said Professor Andrew McMichael, from the University of Oxford.
Diarrhoea still plagues people with HIV - though the cause may be HIV drugs as often as the condition itself. Dr Uzma Siddiqui told the American Gastroenterological Association: "Patients are not being hospitalised as often, and they manage the condition by themselves, so it is not being brought up and nobody is looking for it. And when we look at patients' charts, there is no mention of it. But diarrhoea continues to be a major problem for these patients." She found that twice as many patients with HIV considered themselves to have had diarrhoea over the previous month as HIV negative patients - 38 vs. 19 per cent. But when a more objective measure was considered - the number of patients who reported three or more bowel movements a day - diarrhoea was five times more common in people with HIV, with 26 per cent reporting this compared with 5 per cent of HIV negative people. "Physicians caring for HIV positive patients should ask them about diarrhoea and help them with medical management of it,"said Dr Siddiqui.
The WHO's long-held position that dirty needles cause just 2.5 per cent of African HIV exposures is actually "very conservative," according to the WHO's Tommy Thompson. Referring to four separate studies which claimed dirty needles were responsible for 8, 15, 41 and 45 per cent of exposures in Africa respectively, Yvan Hutin, the study author, acknowledged the figure was probably too low. He said it would be wise to consider an education debate on unsafe needles.
