Martin Flynn reports from Aids Impact and Robert James from the Mainliners Hepatitis conference
The Mainliners 7th International Conference on Hepatitis C took place on 12-13 June in Edinburgh.
The difference to the seriousness with which Scotland takes hepatitis C compared to England and Wales was striking. A total of £8 million ring-fenced money, including a new £2 million this year, has been set aside for the prevention of blood-borne viruses by the Scottish Executive.
Malcolm Chisholm, Minister for Health and Community Care in Scotland, was one of the keynote speakers. He said that 917 Scots tested hep C positive in the first half of 2002, giving a total of 14,452 - one person in 350. This compares with only 5,851 diagnoses of hepatitis C in England and Wales during the last decade - about one in 1,000 - though the actual rate is likely to be much higher. (3,634 Scots are known to have HIV - about one person in 1400.)
Gary Brook, consultant at Central Middlesex Hospital, went through the recently published BHIVA draft guidelines for co-infection of HIV and hepatitis C - see www.bhiva.org/guidelines.
The major issue he highlighted was the need for viral load testing for HIV rather than simple antibody testing if there was a suspicion of HCV co-infection. This was because a number of acute, sexually acquired new co-infections of hepatitis C and HIV have been picked up at HIV clinics recently - and regular antibody testing would have missed the HIV.
Andreas Thiel from the Justice Department of Hamburg in Germany dampened the mood with his description of the ending of the long-standing German prison needle exchange programme. In Lower Saxony the programme was ended with a simple communication that ‘needle-exchange programmes will be cancelled’, giving one month’s notice. “Politicans will not admit the reality that drugs are one of the major problems of prisons in Europe,” he said. RJ
New research was presented at the Aids Impact conference in Milan in July about sexual dysfunction problems in both men and women with HIV.
 Photo : martin flynn Aids Impact: Co-Chair Lorraine Sherr with HIV expert Robert Fieldhouse (left) and Russell Fleet of GMFA (right) |
A study from the Catholic University in Rome found that only a third of HIV positive people say they had a satisfactory sex life. Dr Rita Murri and her team questioned over 800 people and discovered that patients on NNRTI-containing regimens were less likely to report problems with sex than those on protease inhibitors.
The Aides group in France looked into the sex lives of 600 HIV positive people and found the same: over two-thirds said they had lower sexual satisfaction after diagnosis.
The Chelsea and Westminster Hospital, found that 45 per cent of 575 positive men reported difficulties getting an erection since starting HAART regimes, and 48 per cent reported a loss of sexual desire since being on antiretrovirals.
Another study in Rome, by Dr Rosa Brancatella, looked into the sex lives of HIV positive women and found that many had lost their sexual appetite since being diagnosed with the virus. Research from the University of Antwerp in Belgium found that sexual dysfunction in women with HIV is mainly driven by the impact of diagnosis and other psychological factors. Dr Christiana Noestlinger said many women suffered from low self esteem and feared infecting others. Fifty-three per cent of African women and 65 per cent of European women reported sex problems in the study. MF
Edwin J Bernard and Gus Cairns report from the International Aids Society conference in Paris
Scientists spent a lot of time talking about therapeutic vaccines at the IAS conference, but in the end, it was decided that it’s too early to know if they will work.
Unlike preventative vaccines, therapeutic vaccines are supposed to prime the immune system of people already infected with HIV in order to control the virus. They can be used alone or in combination with other therapies to enhance the immune system.
The most promising approach presented in Paris involved a combination of two different vaccines - ALVAC and Lipo-6T - with the addition of interleukin-2 (IL-2), which is a man-made version of a natural substance found in the body that makes CD4 cells replicate.
When people with an undetectable viral load and CD4 counts above 350 were given this dual vaccine/IL-2 combo, one in four patients were able to stop their anti-HIV drugs and maintain their CD4 count above 600 and their viral load below 10,000 for an average of nine months.
This sounds promising, but it is hard to know which part of the treatment works; another study presented in Paris showed that IL-2 on its own can keep CD4 counts above 500 for six months, although viral load was somewhat higher during the time off HAART. Hopefully, by the next major conference we’ll know more about this promising new strategy. EJB
Female to male transmission shock
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For some time now the majority of UK doctors have been avoiding using the protease inhibitor (PI) class of anti-HIV drugs for first-line therapy, due to higher pill counts and side effects and lower potency.
However presenters at the 2003 International Aids Society (IAS) Conference in Paris said that the new generation of protease inhibitors may become drugs of first choice.
The two newest drugs are atazanavir (brand name Reyataz®) and fosamprenavir (Celvir®), which are unlikely to be licensed till early and late 2004 respectively in the EU, but are becoming available at certain clinics for patients who need them.
Dr Constance Benson of the University of Colorado said that atazanavir raised lipids (blood fats) less than efavirenz, currently seen by many as the most potent anti-HIV drug. “Will these new protease inhibitors start the pendulum swinging back to PIs when considering when and how to start anti-HIV therapy?” she asked.
Dr Ben Young, from the same university, said that 15 per cent of his clinic’s newly-diagnosed HIV patients had virus resistant to the non-nucleoside drugs, so first-line PIs were likely to become more of a necessity.
Dr Simon Mallal of Perth, Australia, said that not all the lipid rises caused by protease inhibitors might cause heart disease.
“A lot of the rises we see when people are treated may be a return to lipid levels normal for patients of their age, sex and diet,” he said.
Another recent study has suggested that protease inhibitors may offer better protection against the Aids-defining cancer Kaposi’s sarcoma (KS) than non-nucleoside RTIs. Doctors have reported some cases of KS reappearing in patients who were switched from PIs to non-nukes.
Finally, Dr Mark Nelson of London’s Kobler Clinic has speculated that at least one of the new PIs, Kaletra, is so potent it could be used by itself. Swiss researchers gave solo Kaletra to eight patients new to HIV therapy. Seven out of the eight had undetectable viral loads 28 weeks after the start of their treatment. And in an Australian study, Kaletra was given as the only treatment to 15 patients, 11 of whom had previously taken protease inhibitors. Nine out of 12 achieved viral loads below 50. GC
 Photo : WHO/P. Virot |
A recent study from Rwanda and Uganda found that giving babies six months of a single HIV drug cut transmission of virus from their HIV positive mothers at least fivefold.
The SIMBA study was designed to investigate drugs for the baby as an alternative to exclusive bottle-feeding.
Researchers gave AZT and ddI to the mothers from three weeks before birth to a week after, to cut HIV transmission in the womb and during birth. This cut HIV transmission to newborns from the usual 17-20 per cent to around nine per cent.
But the six months of HIV drugs for the babies cut postnatal HIV transmission from an expected 10 per cent per year to less than two per cent - only three out of 358 babies became positive after birth over a five-month period.
Nine out of 10 mothers exclusively breast fed their babies, and in most cases would have continued to do after the study finished, so final HIV transmission rates cannot be established.
The cost for each course of treatment for the babies was $160, but may be reduced if this treatment becomes widespread.
The drugs given to the babies were either nevirapine or 3TC. Though there had been concerns in advance about giving these drugs to newborns, no serious drug-related side effects were observed. GC
Lipodystrophy affects the sexes differently, the Conference was told. Men with HIV tend to lose fat in their cheeks, face, arms, legs and buttocks. Women tend to gain fat in the cheeks and face. However, contrary to the belief that HIV positive women only gain fat, 20 per cent of women who gained fat in their breasts or belly also lost fat in their limbs. The study concluded that the prevalence of fat loss is underestimated in women. Also 28.3 per cent of HIV-infected women reported fat loss, compared with 4.2 per cent of HIV negative women. EJB
We reported in May (see PN July) that regimes consisting solely of three drugs of the nucleoside class were no longer being recommended by the British HIV Association as a treatment option of first choice.
Now a new study of the triple-nuke pill Trizivir® and another featuring the failure of a different combination of three nukes has cast doubt on the wisdom of using current triple-nuke options at all.
Dr Ron Gulick told the IAS Conference in Paris that two regimes containing Trizivir produced a very high rate of patients dropping out of the study due to drug side effects.
The study compared Trizivir alone with Trizivir plus efavirenz. Though the efavirenz-containing arm suppressed HIV better, both groups of patients experienced bad side effects. Also 46 per cent experienced non-trivial side effects, and one in eight patients dropped out of the study directly because of them.
Another study tried replacing the AZT in the Trizivir combo with tenofovir. But Dr Charles Farthing told the conference that this once-daily combo of 3TC, abacavir and tenofovir had performed unexpectedly badly, even though on paper the drugs should be potent.
Only just over a quarter of patients taking this combo managed to suppress their HIV. Some had to drop out of the study, but 58 per cent failed while actually taking the regime. GC
A transmission study of heterosexual HIV discordant couples in Lusaka, Zambia has found that women don’t have to be infected with another sexually transmitted infection in order to transmit HIV to their male partner, as was previously thought. This is in contrast to male-to-female HIV transmission, which is associated with chlamydia and gonorrhoea co-infection. The study found that HIV was detectable in the fluids from the cervix and vagina in a majority of women, whether they were chronically or recently infected with HIV. EJB