Volume 10 Number 5/6 May/June 2009

The May/June 2009 issue of HTB which contains a wealth of conference reports including the recent BHIVA meeting in Liverpool, the PK workshop in Amsterdam and additional reports from Retrovirus/CROI earlier in the year.

Several issues recur and remaining unresolved. They are likely to be informed by additional research throughout the year.

Cardiovascular disease in the aging HIV population which has higher levels of risk factors than the general population (smoking, lipids, recreational drug use etc) is clearly important. Although the SMART study showed that suppressed viral load from ARV treatment is a protective factor, individual drugs evidently have different CVD profiles, notably abacavir and now lopinavir/r (Kaletra). We include CROI reports, a disturbing case study presented at GSKs satelitte meeting at the BHIVA conference, and the EMEA statement on this complex area.

The recommendations for when to start treatment will also continue to be informed by data likely to show a protective impact at higher CD4 counts. As the investigators from the START trial (which has now enrolled the first patients in the US) point out in their response to published results from a US cohort dataset, the risks as well as benefits will only become clear in a randomised clinical trial and it needs to be large enough to be powered to address risk of low incidence events.

Other reports from CROI focus on womens health and paediatric care, especially the difficulties of dosing, formulations and drug interactions.

Drug interactions are again highlighted in reports from the PK Workshop and from the Liverpool drug interaction site including a potential interaction between raltegravir and etravirine, and new interaction charts on ARVs and drugs to treat flu and swine flu.

Finally, we include two reviews by Richard Jefferys on studies looking at the role of the gut and microbial translocation.