Neither drug companies nor doctors take responsibility for antiretroviral side effects and toxicities experienced by patients, Dr Andrea Antinori told the Aids Impact Conference. For most HIV positive people in the west, side effects are the first symptomatic consequence of having HIV and many doctors do not explain the problems of taking HIV drugs to their patients. Most people stop taking treatments because of side effects, not because of the failure of drug regimes. “Intolerable regimes are doomed to failure,” she added.
Anti-HIV drug prices are “out of control”, according to Mauro Guarinieri, chairman of the European Aids Treatment Group. Existing HIV drugs are still too expensive for over 90 per cent of people around the world and few new drugs are coming onto the market at an affordable price. “The drugs are in the north, but the majority of people with HIV are in the south,” he added.
As few as five per cent of patients in a trial of HIV drugs in Botswana have not adhered to their drug regimes, according to new research. The study should silence sceptics who have questioned the wisdom of giving antiretroviral drugs in resource-poor settings, said Dr Chloe Orkin of London’s Chelsea and Westminster Hospital. “The only way to begin is to begin,” she added.
A new study from the University of Toronto has found that men who have large or pierced penises are more vulnerable to condom breakage during sex. Dr Dan Allman told the Milan meeting that the research found that men with a pierced penis and those with a larger erect member reported more condom breakage but circumcision made no difference.
FTC (emtricitabine, Emtriva ®) is the latest new HIV drug, likely to be available here by the end of the year. Several studies presented in Paris found that FTC - taken as one pill once a day with or without food - is a much more powerful drug than its predecessor, 3TC (lamivudine, Epivir®). and does better than d4T over 60 weeks when combined with efavirenz and ddI in antiretroviral-naive patients. Unfortunately, if your HIV has developed resistance to 3TC it will already be resistant to FTC. EJB
One in 10 HIV infections caught in 17 European countries during 2001-2002 were of virus resistant to at least one drug - a three per cent increase on the previous two-year period, Dr Dawid van der Vijder of Amsterdam told the IAS Conference. He added that between 1996 and 2002 1.7 per cent of new infections - 28 out of a total of 1,633 studied - were of HIV that was multi-drug resistant, that is to two or more classes of drugs. The proportion of transmitted virus resistant to at least one drug declined from 15 per cent in 1996-98 to seven per cent in 1999-2000. This was because most of the resistance observed in the early period was a legacy of substandard drug regimes such as solo AZT, so consisted of AZT resistance (which also confers resistance to d4T and abacavir). However, the three per cent increase in 2001-2002 was largely made up of resistance to non-nucleosides. GC
A brand new class of drugs attack yet another point in the HIV replication lifecycle. CCR5 antagonists block the ‘co-receptor’ molecule that sits on the surface of immune cells and is the ‘docking site’ for the most infectious varieties of HIV. The first CCR5 antagonist, Schering-C, is in safety studies, as is the snazzily-named 873140 (ONO-4128). Anthony Fauci, director of the US National Institute of Allergy and Infectious Diseases, was very gung-ho about CCR5 antagonists at the opening press conference, saying: “These are the drugs of the future.” EJB
Clinicians are observing a higher than expected rate of kidney problems among patients taking the anti-HIV drug tenofovir (Viread®).
Dr Maria Harris of Vancouver told the IAS Conference in Paris that 10 per cent of patients taking tenofovir for more than six months had raised levels of a substance called creatinine in their blood, which indicates damage to the kidneys. She added that 11 out of 563 patients - two per cent - showed more serious problems. Nine ‘showed acute tubular injury’ and two were hospitalised. Two per cent of patients had to discontinue their tenofovir. GC
A study from France has found that since 1997, no newborn baby treated with HIV drugs has died before the age of 18 months, compared with 12 per cent of those newborns born before this date (and not treated). Although HAART for newborns is not always warranted, when it is, babies given HAART when they are less than six months old do not suffer the early-onset, severe form of childhood HIV infection previously seen. EJB
People with certain blood groups could be more vulnerable to infection with HIV, a British scientist told the IAS Conference. Professor Robin Weiss said that people with group O - the commonest, comprising 40 per cent of the population - may be more vulnerable to sexually-transmitted HIV. This is because an immune reaction to the virus from people with the other three blood groups - A, B or AB - may set up more inflammation in the genital membranes. GC
Researchers from Holland examining 32 children who took anti-HIV therapy over a three-year period found that out of five children on a combination that included stavudine (d4T), three had severe fat loss in the legs, arms and face and one had mixed lipodystrophy syndrome (fat loss in the limbs, fat gain in the abdomen). EJB
