Treating chlamydia may help to spread it
A conference at Stockholm University recently has heard that rises in the prevalence of chlamydia in western countries may, paradoxically, be driven by higher rates of screening and treatment. Delegates heard that chlamydia infection tends to have a ‘natural history’: after infection, immunity slowly builds up to the bug until, after about a year, it is strong enough to start purging chlamydia from the body – a process usually over within three years. Treating chlamydia interrupts this development of natural immunity so people are vulnerable to re-infection. This is not an argument against treatment in individual cases, but may explain why national screening programmes haven’t resulted in a fall in cases.

TB is beating us, says Soros
Billionaire George Soros and other public health advocates told the World Conference on Lung Health in Cape Town recently that global programmes to fight TB are ineffective and lead to the development of multi-drug-resistant MDR-TB. “TB is a treatable disease but it has become a death sentence,” said Soros, chair of the Open Society Institute. “Global leaders should move away from empty rhetoric and commit to real programmes.” TB kills 1.6 million people annually, and there are 420,000 cases of MDR-TB a year, most of them caused by failing to ensure people complete their treatment. Only 2% of people with MDR –TB get the pricier drugs needed to beat it, and cases of virtually untreatable XDR-TB continue to be reported, most recently from India.

Rilpivirine on track to beat Sustiva
Results presented at the recent European AIDS Conference show that rilpivirine (TMC278), the second drug in a new group of non-nucleoside HIV drugs (NNRTIs) being developed by Tibotec, was as effective against HIV as efavirenz (Sustiva®) but had fewer of Sustiva’s side effects such as rash, dizziness and abnormal dreams. In the trial 80% of patients new to HIV treatment achieved an undetectable viral load regardless of whether they took efavirenz or one of three doses of rilpivirine. However rilpivirine patients were much less likely to experience rash, dizziness or bad dreams. However the incidence of depression and insomnia were similar between the two drugs.

Black HIV patients get far more kidney disease
People with HIV of African ancestry are far more prone to kidney failure, a US study has found. Rates of End-Stage Renal Disease (ESDR) were eight times more common in African-Americans than in white patients, making this life-threatening condition nearly as common as diabetes. “We can think of few risk factors for ESRD, other than HIV, that are modified to this extent by race,” researcher Andy Choi said. He added, “Our hope is that these results help establish kidney disease as a research priority in the HIV-infected community.”

Roche won’t license needle-free T20 device
Drug companies Roche and Trimeris are withdrawing an application for approval to market the Biojector® 2000 needle-free injection advice for their HIV drug Fuzeon® (T20, enfuvirtide). “While the device has shown potential benefit for some patients, we don’t believe it’s the ideal alternative delivery option for all treatment-experienced patients,” said Michelle Zupancic, Roche’s Vice President for HIV. Roche’s own studies have shown that four our of five patients prefer the Biojector to needles. Roche said that patients who are currently using the Biojector through an existing program or clinical trial may continue to do so, but European advocates pointed out that the device was almost unobtainable in Europe. “People need bio-injector and it should be accessible,” said the French treatment advocacy organisation TRT-5.

Another novel HIV drug makes progress
Modestly promising new results have been published for bevirimat (PA-457), an HIV candidate drug form yet another new class, the maturation inhibitors. These interfere with the making of new viral particles at the last stage of the HIV life cycle. The development of bevirimat has been slow because the original formulation didn’t deliver enough drug to the body. A new study found that a new 300mg tablet produced viral load falls of more than 100-fold in five out of 10 patients with multi-drug-resistant HIV whose regimens were failing, when it was given for 14 days. Manufacturers Panacos are still working on the optimal dose to take onto large trials in 2008.