4 drug anti-HIV pill shows promise

A single pill containing 4 drugs to treat HIV infection has achieved promising results during trials, according to data presented at the 50th Interscience Conference on Antimicrobial Agents and Chemotherapy and reported in the Medscape HIV/AIDS journal.

Quad by Gilead Sciences contains elvitegravir, cobicistat, emtricitabine and tenofovir disoproxil fumarate and was highly effective in suppressing HIV and in helping patients boost their CD4 T cell counts. CD4 T cells are important in the body's response to HIV and tend to be targeted by the HIV virus itself. Boosting CD4 T cell counts is protective against many HIV related cancers and infections. Quad also apparently had better tolerance than the popular single pill 3 drug formulation Atripla.

Atripla has been a very effective and also very convenient way of delivering anti-HIV medications.

The study was carried out over 48 weeks. 71 patients were recruited, 48 given Quad and 23 were given Atripla. All the patients were new to HIV treatment with a HIV viral load of more than 5,000 and CD4 counts greater than 50. (HIV viral load is the amount of free HIV virus circulating in the blood and a normal CD4 count is between 400 and 1200)

At the end of the trial 90% of those taking Quad had HIV viral loads of less than 50compared to 83% of the Atripla group. Those taking Quad also experienced a rise in CD4 cells averaging 240 compared to 162 in those given Atripla.

The incidence of adverse reactions was similar in both groups but those taking Quad experienced fewer problems of the central nervous system.

Doctors welcomed the results of the trials. “These results suggest that Quad could be an important new option for people with HIV,” said lead author Dr Richard Elion from the Whitman Walker Clinic in Washington, DC.  “The challenge is to make treatment simple and compress the number of pills that need to be taken. The bottom line is that our study showed that use of an experimental booster [cobicistat] in this regimen that includes an experiment integrase inhibitor [elivitegravir] achieved similar results to Atripla with improved tolerability.”

Dr Elion went on to explain that the experimenta1 booster cobicistat, unlike ritonavir, was amenable to coformulation with other antiretroviral drugs.

A further study on cobicistat involved giving 50 patients cobicistat-boosted atazanavir, emtricitabine, and tenofovir and comparing results to 29 patients who were given the same combination with cobicistat replaced with ritonavir.

The study again showed promise with patients in the cobicistat group experiencing an average rise in CD4 cell counts of around 230 compared to 206 in the ritonavir group. 82% of those taking cobicistat met the primary objective of an HIV viral load less than 50, compared to 86% of the ritonavir group.

London is sex infection capital

London has been highlighted as the capital of sexually transmitted infections, as new data shows STIs are on the rise across the country.

There were almost half a million cases of STIs – such as gonorrhoea and chlamydia in 2009, an increase of 12,000 from the previous year.

The data from the Health Protection Agency shows under 25s, and gay men are particularly affected, as well as people living in the capital.

In previous years men have accounted for around 50,000 more infections than women, but this latest set of figures show that the gap has narrowed dramatically to around 10,000.

London hotspots

9 of the UK’s top ten ‘STI hotspots’ are in London. Hackney tops the list, followed by Lambeth, Southwark, Hammersmith and Fulham, Islington, Haringey, Wandsworth, Tower Hamlets and Westminster. Brighton and Hove takes the tenth place.

Experts from the HPA say that more people testing for sexually transmitted infections accounted for some of the rise as well as improved tests that are more sensitive to detecting infections. But there was also a warning that unsafe sex was to blame.

“These studies highlight the vulnerability of young women. Many studies have shown that young adults are more likely to have unsafe sex. Often they lack the skills and confidence to negotiate safer sex,” said the HPA’s Dr Gwenda Hughes.

Chlamydia, gonorrhoea and herpes

While sexually transmitted infections overall increased by 3% on the previous year, there were greater increases in the case of some specific infections.

Chlamydia increased by 7%, gonorrhoea by 6% and genital herpes (genital warts) by 5%.

Re-infection is a problem with one in 10 under 25s diagnosed becoming re-infected within a year.

Resistant strains

Experts have also expressed concern that some strains of gonorrhoea are becoming resistant to the most commonly used antibiotics. “We could see gonorrhoea becoming a very difficult infection to treat within the next five years,’ said the HPA’s Professor Cathy Ison.

For now the best advice remains to use a condom and to regularly test for sexually transmitted infections. Left untreated many can lead to serious complications and infertility.

Freedom Health offers a wide range of tests for sexually transmitted infections to suit your circumstances. See the overview of our services on our website http://www.freedomhealth.co.uk/sexual-health/std-sti-test-and-testing-clinic-london/175/

Genital Herpes (HSV2)  and HIV disease:  Why does it matter?

There is good evidence from population studies of people infected with both HIV1 and also HSV2 that infection with Herpes Simplex 2 virus will both increase the amount of HIV1 which is shed in gental secretions and also it increases the rate at which HIV 1 is transmitted.
Treatment designed to suppress Herpes simplex 2 (HSV2) is established to reduce the amount of HIV1 RNA in blood and also genital secretions such as semen and vaginal secretions.
The impact of co-infection (having infection with HIV and HSV2) of HIV1 and HSV2 is very significant indeed with HSV2 and HIV1 co-infected individuals having very much more HIV1 RNA (ie the infectiouness of the individual is increased) in their genital secretions and also in their blood. This obviously means that their potential for spreading HIV either through asymptomatic HSV shedding or symptomatic HSV2 lesions is greatly increased. In addition, treatment for the HSV2 part of the co-infection has no effect on the HIV1 directly but does reduce the HIV1 viral load.
HIV viral load increases are associated with an accelerated course towards the development of AIDS defining diagnoses (AIDS is not the same as being HIV positive). The way anti HSV2 medications reduce HIV1 viral load is thought to be through partly interupting the “HIV inducing effect” of HSV2.
Unfortunately, we also know that people with HSV2 genital lesions are much more likely to acquire HIV1 from an HIV infected individual – by a factor of up to six times more likely.
Up to 60% of people living in the “West” with HIV have Herpes Simplex 2 (HSV2) infections whereas in Sub-Saharan Africa the figure is thought to be up to 90%.
A study by Nagot and others published in the NEJM (Nagot N, Ouedraogo A, Foulongne V, et al. Reduction of HIV-1 RNA levels with therapy to suppress herpes simplex virus. N Engl J Med 2007;356:790-9) looked at HIV1 and HSV2 co-infected populations in Sub-Saharan Africa and treated trial subjects with valaciclovir, an anti-HSV2 drug.

HIV1 is shed from HSV2 lesions and most of the shedding (85%) occurs without the actual physical appearance of HSV2 genital ulcers.

The effects were to markedly reduce the re-occurence of HSV2 lesions, and to markedly reduce the amount of HIV1 in both blood and also genital secretions.

The significance of this is that reducing the HIV1 viral load in the genital tract by treating the additional HSV2 infection may reduce the transmissibility of HIV1 infections (and probably HIV2 although this was not within the studied populations).

A further possible scenario is that people with HSV2 but not HIV will be at theoretically reduced risk of HIV acquisition if they suppress the appearance of HSV2 lesions by long term suppressive treatments such as aciclovir or valaciclovir. Aciclovir has the great advantage of being very cheap and very well tolerated.

An interesting boost to the notion that as many people as possible should be tested for HIV so that they can discuss treatment possibilities was presented at the 17th Conference on Retroviruses and Opportunistic Infections (abstract 33).

Researchers form the San Francisco Dept of Public Health have found that increased HIV testing rates and also improved and increased uptake of the use of anti-hiv medications - (anti-retorviral drugs - or ARV's for short) has resulted in a reduction in the "community HIV viral load" on San Francisco. Viral load is the term used to describe the amount of HIV in a persons blood stream and or body fluids. The rationale behind the research is that because so many people with HIV have been correctly identified in the San Francisco area, many more have been offered treatment.

The aim of treatment with ARV's is to reduce an individual's viral load and thus his or her infectiousness. The success of the this public health initiative has resulted in a TOTAL drop of viral load in the community which in turn has benefited the community as a whole by a subsequent decline in new cases of HIV between 2004 and 2008.

This is good news as a whole and does give more credence to the drive to test and treat more people at an earlier stage. This also fits with the concept that interventions with treatment in the very early stages of new HIV disease may limit the infectivity of those persons and thus the inadvertent onward passage of HIV to others.