HIV, tuberculosis, and viral hepatitis: drugs, diagnostics, vaccines, immune-based therapies, and preventive technologies in development

This year i-Base is partnering with Treatment Action Group (TAG) to produce a pipeline report on treatments for HIV (antiretrovirals, immune-based treatments and vaccines), hepatitis B and C and tuberculosis.

For the first time this report includes a chapter on paediatric antiretrovirals.

The publication was launched at the IAS conference in Vienna.

Pipeline report 2010 PDF 1.7 Mb

Read each section online

• Introduction & executive summary
• Antiretroviral pipeline
• Immune-based therapies and preventive technologies
• Hepatitis C treatment pipeline
• Tuberculosis pipeline

The July 2010 update to this widely used guide includes information about the most important aspects of HIV treatment. It is written and reviewed by HIV-positive people and it uses everyday language to explain medical terms.

• Read this guide online
• Order a free printed copy
• Download PDF 830 Kb

Changes to this edition include:

• Differences between the current UK and US guidelines about starting treatment at higher CD4 counts.
• The START study is discussed in the context of earlier treatment.
• The test for recent infection (within six months) is now also referred to as RITA rather than STARHS in the new programme by the Health Protection Agency (HPA). This test is recommended for anyone who is newly diagnosed, especially if they think they have a recent infection.
• A new reference about the benefit of carrying a few days additional meds in you travel is included in the adherence tips.
• Information on new drugs or new formulations and the ARV chart has been updated.
• The information on HIV treatment during pregnancy includes not to panic if you become pregnant when on efavirenz and that AZT is being used less frequently.
• The information on alcohol now includes a reference to the risk of alcohol use reducing adherence.

The latest issue of HTB is now online.

It includes over 25 reports from recent conferences including the recent BHIVA /BASHH conference in Manchester, summaries from the PK workshop in Italy (thanks to the Liverpool drug interaction report) and final reports from CROI held earlier in the year.

We also include news that the large international START study is now open and on the reliance on prompt enrollment into the pilot phase of the trial.

Other news coverage connects the global economic problems with the implications for HIV treatment and prevention programmes.

We include articles about Uganda and Malawi that have both be widely covered in mainstream press, for the discrimination based on sexuality, specifically agsinst gay men, lesbians and transgender people.

Protecting these human rights and refusing to be complicit in this discrimination is inextricably connected with global programmes to provide great equality in access to medical treatment. Where HIV programmes have the opportunity to challenge this, they should use it.

It is timely that, as this issue of HTB went to press, the two men in Malawi had their prison sentences overturned. A concerted campaign will need to insist on similar prinicpals in the future if this single act of compassion is to impact on widespread legislation that continues to maintains broader discrimination.

Over 140 community organisations sign letter to US guideline panel…

The following statement from a broad range of community organisations and advocates was released on 4 May 2010. It highlights the importance of the START trial to obtain the best quality of evidence to inform treatment decisions.

It also highlights that this is a safe study for all participants, and that it will answer important questions that will benefit hundreds of thousands of other HIV-positive people, in both rich and poor countries.

i-Base is a signatory to this letter and is proud to be supporting this important research.

A ‘late breaker’ presentation at the recent joint BHIVA/BASHH conference in Manchester  included a report of a rapid increase in the number of cases of Lymphogranuloma venereum (LGV) reported to the Health Protection Agency (HPA) over winter 2009/10. [1]

Diagnoses were 91% higher for November 2009 to January 2010 than in the previous three months (88 vs 46 cases), and 115% higher than that seen in the same period in 2008/09 (41 cases).

Since 2004, outbreaks amongst MSM have occurred in major cities in Europe, with 1,070 cases in the UK, mainly in London and to a lesser extent in Brighton and Manchester.

Individuals report high risk sexual behaviour and links to sex toys and sex parties have been described.

Unlike other forms of Chlamydia trachomatis, LGV is invasive. Most cases seen in the UK have presented with proctitis but symptoms vary according to the site of infection and may include ulcers and inflamed and swollen lymph nodes in the groin (inguinal syndrome). If left untreated symptoms can become more severe and cause lasting damage to health. Treatment with three weeks of doxycycline BD 100 mg is recommended by BASHH.

The March/April 2010 issue of HIV Treatment Bulletin is now online.

This issue includes our first set of reports from the 17th Conference on Retroviruses and Opportunistic Infections (CROI).

Read this issue online.

Download PDF.

A non-technical summary from CROI covering 12 key areas of research is also available as an HTB Supplement.

Read the non-technical report.

Two new BHIVA guidelines are now online in draft for comment.

• Infant feeding in the UK: draft guidelines online for comment

• Legal issues on HIV transmission and the law for healthcare workers: draft guidelines online for comment

Comments can be made online and the draft document downloaded from the BHIVA website.

Deadline for comments for both documents is Friday 21 May 2010.

The cancellation of air travel to and from the UK may have resulted in some HIV-positive travellers having insufficient ARVs to cover their extended stay.

People in London can contact the  Chelsea and Westminster Hospital who are aware of the problem. The advice from C&W is that any foreign nationals who are short of medication can contact this clinic and get an appointment with any specialist HIV doctor.

The C&W will not charge for consultations and will charge for medications at cost price, for up to two weeks. The pharmacy will dispense one week of medication, and charge for this medication. If the patient is still unable to leave the UK after the first week, the pharmacy will then dispense the second weeks supply and again charge the patient the cost price for the medication.

Patients should be able to get a similar service from other clinics in the UK, but this will require each clinic to have at least one doctor who is insured to issue private prescriptions, as they will not be covered by the NHS insurance.

Other clinics should not charge a consultancy fee to see foreign patients, although this is at their discretion.

The British Association for Sexual Health and HIV has an online directory of clinics in the UK. The link on their home page includes a search facility by town or postcode.

Chelsea and Westminster Hospital

Kobler Clinic
Ground Floor
St Stephen’s Centre (next door to Chelsea and Westminster Hospital)
369 Fulham Road
London
SW10 9NH

Telephone appointments:
020 8846 6699

Map and clinic opening times

A non-technical summary from the recent 17th Retrovirus conference has been produced to cover some of the most interesting studies.

This supplement to the March/April issue of HIV Treatment Bulletin will also be distributed separately as a community report.

Covering twelve areas of research and touching on over forty studies, the electronic versions (online and PDF file) include hyperlinks to the original studies on the conference website.

• Introduction: what is CROI?
• HIV treatment reduces transmission: a new theme that is here to stay
• ARVs before and after exposure: PrEP, iPrEP and PEP
• Microbicides – gels to protect against infection
• New drugs and formulations
• Studies with current drugs
• Below and above 50 copies/mL – intensification, blips and rebounds
• HIV and heart disease
• Bone health
• HIV and the brain
• Coinfections: TB and hepatitis C
• Any news of a cure?

Read the online version.

Download PDF file.

DHICE Project (Databases for HIV: Integration, Collaboration, Engagement)

DHICE is a new project to encourage collaborative working practice between different HIV cohort projects in the UK.

Memory Sachikonye, based at i-Base, is the Community Liaison Co-ordinator with the project. Memory works with database coordinators and community organisations to:

• Identify and document patient concerns relating to database research, including the use of personal information, and to work to resolve any issues if they arise.
• Increase the involvement of community members in study design and management (e.g. through steering committee membership etc).
• Raise the profile of HIV research in the community, especially cohort studies that are database projects.

The 17th Conference on Retroviruses and Opportunistic Infections (CROI), one of the most important annual HIV meetings, was held this year from 16-19 February. As with previous meetings, this conference publishes extensive webcasts, and these are already online.

Making this scientific content available without login or subscription is itself a significant achievement. It is a model for broadening access to medical research to a degree that is currently unmatched by any other meeting.

The webcasts this year include oral presentations and audience questions, poster discussions, the opening lectures and the pre-meeting set of training workshops for young investigators.

The conference website also includes a searchable abstract database.

Full coverage from the meeting will follow in the next issues of HTB, HTB South and ARV4IDUs.

Until then, we encourage readers to view lecture lectures directly via the above links.

Slides from a community talk given to the CROI feedback meetings organised by BHIVA can be downloaded below.

BHIVA CROI community slides reduced PDF (4MB)

As you may have noticed the i-Base website has had a major makeover.

Please bear with us over the next few days while the upgrade continues. We aim to do this within the next few weeks.

Comments/feedback are welcome. Please email simon.collins@i-Base.org.uk.

Important notes

• 5 March – Some issues of HTB (mainly 2003-2005) still need to be added online as web pages.
• 3 March – while the Google search engine updates the links for the new site, some searches are bringing older links or links for content that is on the site, but which links to the home page. Please bear with us….
• 2 June – Russian ARV4IDUs is now posted in the new format.
• If you have problems using the online subscription forms please email your subscription request or change to your details to subscriptions@i-Base.org.uk.

Updated 4 May 2010

The following reports from the 12th European AIDS Society Conference held in November 2009, Cologne are included in the January/February issue of HTB.

• Screening for anal cancer recommended for HIV-positive men
• Once-daily darunavir/r monotherapy is suboptimal as initial regimen in treatment-naïve people
• Central fat accumulation remains a significant problem in patients starting HAART after 2005 with higher incidence in women compared to men
• Alendronate improves bone mineral density in HIV-positive people with osteoporosis at 96 weeks
• Pilot PK study of two generic paediatric formulations of lopinavir/ritonavir vs originator products
• TMC278 does not show teratogenic potential in animal models
• No clinically relevant interactions between TMC278 and oral contraceptives (norethindrone plus ethinylestradiol)
• Etravirine pregnancy data from five cases: no dose adjustment required
• Selected PK and drug interaction summaries at EACS

More reports from IAS 2009 held in Cape Town in July in HTB September/October 2009. Also in this issue of HTB:

• Raltegravir (Isentress) granted an expanded licence from the European Union Commission.
• Detention and removal of HIV-positive people in the UK.

In the July/August issue of HTB we reported results from the DART trial pesented at the 5th IAS conference.DART is an important study comparing clinical and laboratoy based monitoring sponsored by the MRC. We encourage readers to see full details from the many posters and presentations posted on the study website.

http://www.ctu.mrc.ac.uk/dart

We compiled the following Q&As in response to the increased number of calls and emails about swine flu.

Updated: September 1 2009

Artist Marta Marcé has produced a limited edition print inspired by her recent commission for the Infection and Immunity Clinic at The Royal London Hospital in Whitechapel.

Proceeds from the print, priced at £125, are kindly being donated by the Hospital to i-Base as part of the Vital Arts programme at Barts and the London NHS Trust.

• How to purchase the print
• Barts and the London NHS Trust Vital Arts Programme

We would like to thank St Barts and the Royal London Hospital for their generous support.

A resource on how clinical trials work, why they are important, understanding the results and the role of the advocate in research.

• Download PDF 399 Kb
• Read this guide online in our training manual

This guide is also available in Italian, Portuguese, Russian and Spanish.

Community involvement in HIV research is important. Advocates have always argued for active patient and community representation and involvement at all stages of our health care, including research.

This includes being involved on the type of research and the design of trials. It helps make sure that:

• Trials are run properly
• All patients receive at least the current standard-of-care treatment
• We are able to follow both enrolment and how the trial is run
• We are able to monitor and follow early results
• As patients and advocates we have a good idea on how latest treatment advances may affect the standard of care in the future.

• Read HTB South online
• PDFs
• Subscribe – it’s free

HTB-South is an edition of HIV Treatment Bulletin that focuses on research and news that has particular relevance to southern Africa countries.

HTB-South is produced four times a year in partnerhip with the Southern African HIV Clinician’s Society. The print edition is distributed to the 17,000 members of this organisation. It is also published online.