HIV Tedavi Bülteni Türkiye (HTB Turkey) is a Turkish-language publication produced by an independent group of Turkish doctors, activists and health care workers.

HTB Türkiye.4_Nisan_2012 PDF (1.5 Mb) 4th Edition – April 2012

For back issues see the HTB Turkey pages on the i-Base website.

In April 2012, the British HIV Association (BHIVA) published two new clinical guidelines:

1. Treatment of HIV-1 positive adults with antiretroviral therapy (2012)
2. Management of HIV infection in pregnant women (2012)

The new adult treatment guidelines is the first significant revision for four years and sets out recommendations on the treatment that HIV doctors provide for their patients, and highlight the role of treatment as prevention.

The new guidelines for the treatment of pregnant women living with HIV will help enable more women to have the same experience in childbirth as women who are HIV negative.

BHIVA will produce implementation and audit tools to be used alongside these guidelines.

Links and PDF downloads

Treatment of HIV-1 positive adults with antiretroviral therapy (2012)

http://www.bhiva.org/TreatmentofHIV1_2012.aspx

http://www.bhiva.org/documents/Guidelines/Treatment/2012/120430TreatmentGuidelines.pdf (PDF)

Management of HIV infection in pregnant women (2012)

http://www.bhiva.org/PregnantWomen2012.aspx

http://www.bhiva.org/documents/Guidelines/Treatment/2012/120430PregnancyGuidelines.pdf (PDF)

PRE-PRESS reports

Hyperlinks below to early reports for the next edition of HTB are published online in draft.

New reports will also be added to this page and hyperlinked next week.

Introduction

This year the BHIVA spring conference was held in Birmingham and as usual it included both important national research and impressive international speakers. In addition to more than 40 oral presentations, the meeting included case studies and over 230 posters.

The selection of below only highlights some of these studies. For further details please contact the researchers directly.

The abstracts from the conference are available free online as PDF supplements to the April edition of HIV Medicine.

http://onlinelibrary.wiley.com/doi/10.1111/hiv.2012.13.issue-s1/issuetoc

As with previous years, some of these sessions will be available as webcasts and some of the slide presentations can already be viewed or downloaded from the conference website.

http://www.bhiva.org/Presentations120418.aspx

Reports in this issue include:

• Half of gay men in London interested in daily PrEP to reduce risk of HIV
• Recent infections common in UK; 30% gay men aged 15-25 infected within a year of diagnosis
• One third of HIV positive people at five UK clinics have symptomatic depression: link to adherence and viral suppression – 40% cases are untreated
• Hodgkins Lymphoma: survival normalises to HIV negative rates despite more advanced disease at diagnosis
• Promising outcomes from laser ablative treatment of AIN2/3 to prevent anal cancer
• KS in the HAART era includes patients with high CD4 and suppressed viral load: importance of KS chemotherapy for some patients in addtion to ART
• 3rd vs 4th generation HIV testing: almost half of UK clinics out of step with national guidelines
• Case reports of complications from ketamine use in two MSM on ritonavir-based combinations
• Intranasal and topical corticosteroids and risk of Cushing’s symptoms in HIV patients on ritonavir-based combinations
• Outcomes from switches to atazanavir/r in London
• Intimate partner violence towards HIV positive women in the UK

The new and updated April 2012 edition of this non technical guide to HIV treatment is now available.

Read this guide online

Download PDF version

Order print copies

Print copies are free but bulk orders are only free to postal addresses in the UK and Ireland.

This guide includes information about the most important aspects of HIV treatment.

It is written and reviewed by HIV positive people and health professionals.

If HIV is new to you, many of the issues relating to treatment can be scary. This booklet should help you feel more in control of this aspect of your health care.

We update this guide every 12-18 months because information about HIV can change quickly. This is the 15th edition.

Information is based on the most recent draft UK guidelines (March 2012 draft). These include significant changes from the previous guidelines.

• www.bhiva.org

When appropriate we have also used European (November 2011) and US guidelines (March 2012).

• www.europeanaidsclinicalsociety.org
• www.aidsinfo.nih.gov

All guidelines stress that HIV treatment should be individualised.

The Conference of Retroviruses and Opportunistic Infections (CROI) is the most important annual HIV conference.

Our first reports are mow published in HIV Treatment Bulletin (HTB) online and in print.

Exciting and important new breakthroughs including for: cure research, pipeline drug. children’s studies including new formulations, PrEP: close to 100% protection? HIV reinfection and new hepatitis C drugs.

Much of the conference is available as web casts and references in HTB also link to the study abstracts. Further coverage will continue in the next issue, with pre-press articles available online.

CROI reports

• Cure research takes centre stage: proof of concept for activating the latent reservoir

• Quad fixed-dose integrase combination: phase 3 studies at week 48

• Dolutegravir studies continue to show promise

• Tenofovir prodrug: 10 day monotherapy study sets dose at 25 mg for easier coformulation

• Paediatric formulations of ARVs: including an exciting new class

• Lower malaria risk in children receiving lopinavir/ritonavir-based compared to NNRTI-based ART

• High prevalence of d4T-associated lipodystrophy including lipoatrophy in children

• Lopinavir/ritonavir monotherapy in children

• Stopping treatment after early ART in infants

• PrEP: PK modeling of daily TDF/FTC (Truvada) provides close to 100% protection against HIV infection

• Risk of HIV reinfection may be similar to risk of initial HIV infection

• Case report: homozygous CCR5 delta-32 protection overcome by infection with X4 virus

• No association between atazanavir and MI or stroke in D:A:D study

• Hepatitis C coinfection studies

• Herpes Zoster vaccine safe and effective in HIV positive people

• High dose flu vaccine improves antibody responses in HIV positive people

• High dose flu vaccine improves antibody responses in HIV positive people

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

This issue largely features our first coverage from the Conference of Retroviruses and Opportunistic Infections (CROI), which this year attracted over 4000 delegates to Seattle.

Much of the conference is available as web casts and references in HTB also link to the study abstracts. Further coverage will continue in the next issue, with pre-press articles available online.

Read HTB online.

Download PDF version.

CONTENTS

Editorial

• Volume 13 Number 3/4 March/April 2012

Special reports

• Supplement: i-Base Introduction to Combination Therapy

Conference reports

• 19th Conference on Retroviruses and Opportunistic Infections (CROI), 5–8 March 2012, Seattle

• Cure research takes centre stage: proof of concept for activating the latent reservoir

• Quad fixed-dose integrase combination: phase 3 studies at week 48

• Dolutegravir studies continue to show promise

• Tenofovir prodrug: 10 day monotherapy study sets dose at 25 mg for easier coformulation

• Paediatric formulations of ARVs: including an exciting new class

• Lower malaria risk in children receiving lopinavir/ritonavir-based compared to NNRTI-based ART

• High prevalence of d4T-associated lipodystrophy including lipoatrophy in children

• Lopinavir/ritonavir monotherapy in children

• Stopping treatment after early ART in infants

• PrEP: PK modeling of daily TDF/FTC (Truvada) provides close to 100% protection against HIV infection

• Risk of HIV reinfection may be similar to risk of initial HIV infection

• Case report: homozygous CCR5 delta-32 protection overcome by infection with X4 virus

• No association between atazanavir and MI or stroke in D:A:D study

• Hepatitis C coinfection studies

• Herpes Zoster vaccine safe and effective in HIV positive people

• High dose flu vaccine improves antibody responses in HIV positive people

Antiretrovirals

• Dolutegravir Expanded Access Programme

• FDA approves etravirine for treatment-experienced children 6 to 18 years of age and new scored 25 mg tablet for paediatric dosing

Guidelines

• US HHS adult treatment guidelines updated (March 2012)

Side effects

• FDA reject capsaicin patch for HIV-related neuropathy

PK and drug interactions

• FDA warning of drug interactions between boceprevir and some HIV protease inhibitors

Treatment access

• Global action over the challenge to India’s patent laws

• Why global health activists are fired up about Novartis

• Obama’s global, domestic & HIV research budget backslides on existing commitments

Other news

• Free comic book for HIV positive children about CD4, viral load and ARV treatment

On the web

• Free full text online articles

PDFs

• Volume 13 Number 3/4 March/April 2012 PDF

The i-Base guide to HIV, Pregnancy and Women’s Health has been translated into Portuguese by the Lisbon based activist group GAT.

This is now available as a PDF format.

Download PDF file. (700 Kb)

Other i-Base guides in Portuguese are available at the link below.

http://i-base.info/category/translations/portuguese/

The long-awaited update of the BHIVA adult treatment guidelines are now posted online in draft format and are available for comment until 5 March 2012.

This is the first update since 2008.

The guidelines are also based on a new approach to evaluating, reviewing and grading evidence to meet NICE criteria.

Read the story and link to BHIVA guidelines.

The latest edition of HTB (the last for 2011) is now online, in advance of the print edition.

Print copies will be distributed at the end of the week and should be with subscribers (subscription is free!) by next week.

Read this edition of HTB online.

Download PDF file of this issue.

Welcome to the first issue of HTB for 2012, which includes an updated design thanks to comments from last years survey.

The last issue of 2011 highlighted serious concerns for global health, and the Treatment Access news in this issue continues this theme, with an indication that funding uncertainties will continue throughout the year.

This includes further changes at the Global Fund and responses to the suspension of Round 11 grantsan outcome-that became likely when donor pledges last year failed to match even the minimum working budget.

Fortunately these sobering events are balanced by more positive news.

The  FDA recently approved new indications and formulations of three important antiretrovirals. Tenofovir is now available as an oral powder and lower dose pills for an indication in children of two years and older. Raltegravir is available in a 100 mg scored chewable tablet and a 25 mg chewable tablet for children older than 2 and weighing greater than 20 kg. Finally, an oral suspension of darunavir was approved with two bands of dosing recommendations (age 3 to 6 years; and, older than 6 years) that, as with adult dosing include separate recommendation for naïve and experienced patients.

Our conference coverage in this issue comes from a meeting on HIV and women’s health, and from a biannual workshop on HIV persistence and cure research.

The report from Richard Jefferys both summarises the latest state-of-the-art in this field and comments on the complexity of interpreting these early data.  The excitement is that the slow momentum from numerous research groups carries our ultimate hope to for a future that may offer alternatives to our current life-long reliance on ARVs.

Finally, and closer to home, BHIVA have published both new monitoring guidelines and the draft for the 2012 UK treatment guidelines. As this is the first update since 2008, with only a few weeks to comment it is important that the writing committee receive feedback promptly if this to be considered for the final document.

EDITORIAL

• Volume 13 Number 1/2 January/February 2012

SPECIAL REPORTS

• Supplement: HIV testing and risks of sexual transmission

CONFERENCE REPORTS

2ND INTERNATIONAL WORKSHOP ON HIV & WOMEN, 9-10 JANUARY 2012, BETHESDA, USA

• Similar efficacy and a few gender related differences in side effects with rilpivirine vs efavirenz at 96-weeks
• The effect of BMI on efficacy, safety and tolerability of lopinavir/r in women
• Hormonal contraception and higher risk of non-AIDS-defining events in Nashville cohort
• Poorer adherence and loss to follow up in Kenyan women who are pregnant when enrolled to ART programmes

5TH HIV PERSISTENCE WORKSHOP ON HIV RESERVOIRS, 6-9 DECEMBER 2011, WEST INDIES

• Workshop report and commentary

ANTIRETROVIRALS

• Nevirapine prolonged release (PR) once-daily formulation available in the UK
• Etravirine 200 mg formulation available in UK
• Tenofovir label extended to paediatric indication
• FDA approve US paediatric dose for raltegravir
• FDA approve paediatric dose for darunavir
• Efavirenz dose increase to 800 mg QD with rifampin in patients >50 kg

GUIDELINES

• Draft BHIVA ARV treatment guidelines online for comment until 5 March
• BHIVA guidelines for the routine investigation and monitoring of adult HIV-1-infected individuals 2011
• Draft BHIVA pregnancy guidelines online for comment until 5 March

PAEDIATRIC CARE

• Delaying ART in childhood can reduce long-term CD4 count in adulthood

TB COINFECTION

• Need for expanded access to two promising MDR TB drugs

PK AND DRUG INTERACTIONS

• Interactions between nevirapine and antimalarials (artemether and lumefantrine)
• Interactions between antiretrovirals and complementary and African traditional medicines
• Drug interactions between sirolimus (rapamycin) and ARVs
• Contraceptive failure with etonogestrel implants and efavirenz: case reports

OPPORTUNISTIC INFECTIONS AND COMPLICATIONS

• No increased risk of non-AIDS deaths from cumulative use of ART in EuroSIDA cohort

TREATMENT ACCESS

• FDA approval of generic ARVs
• Disastrous warning for global HIV programmes in 2012
• Janssen block Patent Pool access to darunavir, rilpivirine and etravrine
• UNITAID continues funding the Patent Pool, paediatric HIV medicines and malaria
• Michel Kazatchkine resigns from Global Fund: Gabriel Jaramillo, Brazilian banker, to serve as general manager
• Call to Action on Global Fund restriction to new funding to 2014
• Analysis of why the Global Fund cancelled Round 11
• Reaction to the Global Fund’s decisions on Round 11 and grant renewals
• Activists oppose Gates Foundation funding study using low dose d4T

TRANSMISSION AND PREVENTION

• NICE guidance on increasing the uptake of HIV testing

OTHER NEWS

• London Commissioning: new announcements

BOOK AND FILM REVIEWS

• Testosterone: A man’s guide: practical tips for boosting physical, mental and sexual vitality; by Nelson Vergel

ON THE WEB

• 2011 HIV Persistence Workshop
• A Call for Comprehensive Responses to HIV in People Who Use Drugs
• Achieving a cure for HIV infection: do we have reasons to be optimistic?

FUTURE MEETINGS

• 2012 conference listing

PDFS

• Volume 13 Number 1/2 January/February 2012 PDF

In the January/February 2012 edition of HIV Treatment Bulletin we reviewed a guide to testosterone replacement therapy.

This is the second edition of a book by the US activist Nelson Vergel. It is a users guide to testosterone by an HIV positive man who has researched the subject over many years for his own care.

The non-technical sections include helpful tips about what not to do as well as the best approaches. This looks at how to assess potential testosterone deficiency, including what to measure (free vs total), when and how, and the impact of age on target ranges including fluctuation in levels throughout the day. The information is in the context of supplementary approaches being dependent on working with your doctor, not only to ensure that an appropriate dose and formulation are used (oral supplementation being the least useful), but that routine monitoring guides the safety of this approach.

Read the full review.

Although you can stay negative by abstinence, this guide is written for people who have sex.

It includes information on:

• How HIV risk is more than just about condoms.

• How and when different tests can be used.

• What test results mean, especially in relation to the time since your last potential risk.

• The importance of making your own decisions about your sexual health.

Three appendices cover more complex and technical information about how HIV tests work is only available in the online and PDF versions of this guide. This information is still in easy to understand language.

Your feedback on this guide helps us develop new resources and improve this resource. All comments are really appreciated.

The latest edition of HTB (the last for 2011) is now online, in advance of the print edition.

Print copies will be distributed at the end of the week and should be with subscribers (subscription is free!) by next week.

Read this edition of HTB online.

Download PDF file of this issue.

Contents

EDITORIAL

• Volume 12 Number 11/12 November/December 2011

CONFERENCE REPORTS

13TH EUROPEAN AIDS CONFERENCE (EACS), BELGRADE, SERBIA, 12–15 OCTOBER 2011

• European guidelines (EACS) – 2011 update

• Raltegravir achieves superiority over efavirenz after four years

• Higher plasma levels of tenofovir and darunavir but not efavirenz in older patients

• Ritonavir levels reduced with high fat meal

• Transplacental transfer of raltegravir and delayed plasma clearance in preterm neonates

2ND INTERNATIONAL WORKSHOP ON HIV AND AGEING, BALTIMORE, MARYLAND, 27–28 OCTOBER 2011

• Statin blocks negative impact of PIs on bone formation in vitro

• HIV linked to frailty in middle-aged IDUs, especially with poor HIV control

51ST INTERSCIENCE CONFERENCE ON ANTIMICROBIAL AGENTS AND CHEMOTHERAPY (ICAAC) CHICAGO, 17–20 SEPTEMBER 2011

• Monitoring kidney function change with cobicistat

• Intracellular raltegravir concentrations better with twice-daily than once-daily dosing

ANTIRETROVIRALS

• Rilpivirine (Edurant) and rilpivirine/FTC/tenofovir FDC (Eviplera) approved in Europe

• FDA updates US label for darunavir for serious rash

• FDA updates US label for raltegravir due to serious rash

• Lopinavir concentrations suboptimal at reduced dose of lopinavir/ritonavir 200/50 mg twice daily

• Switching to 50mg ritonavir dose for selected protease inhibitors

• New formulations, acquisitions and company announcements

• US guidelines (DHHS) update recommendations for first-line combinations (October 2011)

PAEDIATRIC CARE

• Efavirenz under-dosing in children

• Treatment response and duration of first line treatment in European infants

OPPORTUNISTIC INFECTIONS

• US guidelines for management of older people living with HIV

• New studies on HIV and the diseases of ageing

• Risk of cataract surgery higher in HIV-positive compared to HIV-negative people

• CD4 count <200 independently associated with 5-fold increased risk of fracture

TREATMENT ACCESS

• Global Fund cancels Round 11 and introduces new rules for grant renewals

• FDA approval of generic ARVs

• We need the Patent Pool to work

BASIC SCIENCE AND IMMUNOLOGY

• Exercise as immune-based therapy

• Mapping the long genetic road to broadly neutralising antibodies

• Monkey viral reservoir study goes for gold

• Immune pressure on HIV

• Lymphocyte production capacity in HIV: links to immune activation & immune reconstitution on ART

TRANSMISSION AND PREVENTION

• International PrEP study (VOICE) discontinues use of tenofovir vaginal gel due to lack of efficacy

• UK Health Protection Agency (HPA) recommends universal HIV testing in the high incidence regions of the UK

OTHER NEWS

• Iranian doctors now freed

• New York court rejects AIDS denialist case against leading HIV community activist and journalist

• UK ban on HIV-positive doctors and dentists set to be overturned

BOOK AND FILM REVIEWS

• We Were Here

ON THE WEB

• Cure research: report from research workshop

• Free full text online articles

FUTURE MEETINGS

• Future meetings

The UK-CAB is running of short anonymous online survey for people who get their HIV care at clinics in London.

The survey should only take five minutes and is important to understand whether the guidelines have been followed.

Take the online survey

The survey is open to all HIV positive people who get their care at a London clinic.

Preliminary reports suggest that this will save £5 million within the first year.

Importantly, this money is ring-fenced for HIV care and services. It will offset the reduced NHS budget that forces clinics to run increased services (patient numbers for HIV increase each year) for the same budget as the previous year.

Information about how to report individual cases and experiences.

Background

From April 2011, HIV prescribing at London clinics has be based on new guidelines based on the outcomes of a tender process to encourage drug manufacturers to offer discounted prices in relation to the volume of their medicines used.

Crucially, the guidelines are based on offering the best and most individualised care, and not the cheapest possible treatment.

The primary outcomes were:

i) To use abacavir/3TC (Kivexa) rather than tenofovir/FTC (Truvada) for people starting treatment for the first time. This recommendation was determined by clear clinical criteria for when this option would be appropriate.

ii) To recommend atazanavir/ritonavir as the preferred boosted protease inhibitor (PI). This would be for people starting treatment when an NNRTI was not appropriate or using PIs in a second drug combination. Additionally, some people using older PIs would be encouraged to change to atazanavir if this was clinically appropriate. Atazanavir is a widely prescribed PI that has the advantages of being once-daily, having a low pill count and only requiring 100 mg booster dose of ritonavir daily.

All previously used individual drugs and combinations can still be used when these are clinically appropriate. The small percentage of people who are being asked to change to newer meds can also choose to remain on current drugs.

Further information

London guidelines – tender outcome in April 2011