Patients may not need lab tests to survive
Patients in poor countries that cannot afford to do CD4 and viral load tests may do nearly as well on HIV therapy without the test as patients who have them, a mathematical-modelling study has found. Professor Andrew Phillips told the BHIVA Conference that over 20 years, according to his predictions, 64% of patients given HIV treatment but not lab tests could expect to survive compared with 67% who had the tests. The five-year survival rates were 82% and 83% respectively. Studies from South Africa have shown that as long as patients are helped to maintain good adherence, drug failure and resistance is rare in Africa, even in the absence of viral load testing.

UK HIV transmission shows no sign of decrease
New diagnoses of HIV fell last year, but only because of fewer diagnoses amongst immigrants, the Health Protection agency (HPA) reports. It finds that diagnoses amongst gay men and amongst heterosexuals who acquired HIV in the UK held steady last year. The figures show that 6840 people tested positive last year, 500 less than the previous year and down from a peak of 7800 in 2005. However neither the 2630 cases in gay men nor the 690 cases diagnosed in heterosexuals with home-caught infections showed any decline
on 2006.

Truvada works out cheaper than Combivir
Despite a higher list price, the combination pill Truvada® (tenofovir + FTC) works out cheaper than the previous standard first-line therapy Combivir® (AZT + 3TC), because it produces fewer side effects and therefore fewer therapy dropouts, a Spanish study has found. The team found that 48 weeks of Truvada therapy, if all healthcare costs were added together, would cost €46,464 (£36,789) per patient compared with €56,198 (£44,376) on Combivir. Furthermore 13% more patients would be undetectable after six months’ treatment.

UK guidelines recommend treatment at 350
The new UK HIV treatment guidelines recommend that “the initiation of therapy should be discussed with all patients with a confirmed CD4 cell count <350, and should be started as soon as the patient is ready,” and reiterate the importance of starting before the CD4 count reaches 200. The wording of the new BHIVA guidelines is softer than that of the European Guidelines, issued last year, which state flatly that treatment is ‘recommended’ for CD4 counts under 350 and ‘should be started without delay’ for patients under 200.

Prezista liver warning
One in two hundred patients starting the HIV drug darunavir (Prezista®) has experienced acute liver damage, the US Food and Drug Administration has warned doctors. Patients with hepatitis B or C or patients with AIDS on other medications are at higher risk. The FDA warned that patients starting Prezista should be monitored closely for signs of liver problems.

Another new drug looks good – for some
Promising results have been published for a drug of yet another new class: the maturation inhibitors. Bevirimat stops HIV from assembling itself into new viral particles. In March its manufacturers Panacos announced that patients given a two-week course of bevirimat had experienced an average fourfold drop in their HIV viral load. This is not especially impressive; but Panacos then found that response to bevirimat was conditional upon specific differences in a component of HIV, the gag protein, which can be tested for with resistance tests. Patients who didn’t have gag mutations experienced an 18-fold drop in their viral load which is, according to Panacos, “a greater mean viral load reduction than in any other HIV drug with a published functional monotherapy study.” He said the more than 50% of patients had the kind of HIV that showed they would benefit from bevirimat.