Clap clinic doctors in San Francisco are using a new method of tracing the contacts of patients diagnosed with syphilis - they are sending them emails. A study confirmed that the internet these days seems to be the main way gay San Franciscans are hooking up. One-off ‘quickies’ may not result in phone numbers being swapped. But since most gay contact sites require users to register with their email address, contact tracers are now sending the bad news in mail messages. Their main challenge, they now report, is wording the messages so that they are not regarded as spam and deleted unread.
Doctors have criticised the UK government for lack of any action plan to curb the spread of hepatitis C. Professor Graham Foster of the Royal London hospital said: “There is much disappointment. Absolutely nothing is happening.” An estimated 200,000 people have hep C in the UK. Of these only a quarter know they are infected and only one per cent receive treatment. 5,900 cases were diagnosed last year, up from fewer than 1,000 in 1994. See article.
The new protease inhibitor drug tipranavir is being made available on a limited basis to UK patients who need it because they have failed previous treatment regimes. The criteria for getting the drug are that patients must have a CD4 count below 50, an HIV viral load over 10,000, and need tipranavir because without it they have no viable drug combinations left to benefit from. Tipranavir is just starting a large phase III trial comparing its performance with other PIs. This has now fully enrolled, so the only way to get it will be on this ‘named patient’ or compassionate release basis. The main ‘selling point’ of tipranavir is that test tube studies predict it will work in patients whose HIV has acquired resistance to all other PIs. One such study found that 90 per cent of HIV resistant to all other PIs was still susceptible to the drug.
Half of patients tested for HIV at a Glasgow GUM clinic told their doctors that they don’t want to know the results. The survey has raised fears that people with HIV will remain ignorant of their status and may lead to more new infections. 74 per cent of homosexual men, 55 per cent of heterosexual men and 46 per cent of heterosexual women told the clinic they did not want to know the outcome of the tests. 216 new cases of HIV were diagnosed in Scotland in 2002.
Success in HIV therapy is dependent on starting before your CD4 count falls below 200 and on good adherence. But up till now it has been unclear how much contribution these factors independently make. A large study has now found that there is no relation between CD4 count and treatment success until the CD4 count at the start of therapy falls below 200. But poor adherence increases the risk of death whatever the CD4 count at the start. In people with CD4 counts over 200 poor adherence increases the risk of death from four per cent to seven per cent, and among those starting with less than 200 it increases it from 13 per cent to 20 per cent.
The largest HIV therapy trial ever conducted has announced its first results. 4,150 people are on the ESPRIT trial, which tests the immune-boosting chemical interleukin-2 (IL-2). 60 per cent of participants have completed three eight-week ‘cycles’, taking small injections of IL-2 under the skin twice daily for five days, then waiting seven weeks till the next course. Their average CD4 count increase was 240, and one third of patients reached the hoped-for aim of the study which was to achieve at least either a doubling of their CD4 count or to get it over 1,000. Researchers are only calling the result ‘reasonable’ because some hoped the CD4 count rises would be much greater. But these are early days for a trial that is not due to finish till 2007.
