May/June 2014: Volume 15 Number 5/6

Spring in London began with a visit from the European Association for the Study of Liver (EASL) that held its 49th annual meeting here in April.

Although – as the name suggests – the meeting mostly focused on the liver, HIV/hepatitis C (HCV) coinfection was highlighted in several sessions and the exciting results from studies of the new oral HCV drugs seem to apply equally to HIV positive people.

Less of a reason to celebrate has been the news that a key new HCV drug sofosbuvir was launched at such an eye watering price that treating those in need would wipe out vast proportions of annual national health budgets – or, in the case of Egypt with 12 million HCV positive adults, would reach four times the country’s annual health costs, even at a discounted price. The NEJM described the price of new HCV meds as being as “as breathtaking as their effectiveness” and criticisms abound, not least from activists attending the conference who held a protest as the meeting kicked off.

Just prior to EASL 2014 the World Health Organisation (WHO) launched the first guidelines for the care and management of people with HCV. Our HCV reports cover the pricing controversy, summarise – with co-author Tracy Swan – the interferon free studies with the new, and review the new WHO guidelines.

BHIVA also held its annual meeting in April in collaboration with BASHH. Our reports include a look at recent UK data showing that three quarters of HIV positive people start treatment within two years of infection, an expanded analysis from the PIVOT PI/r-monotherapy study, HCV issues in the UK, including sexual transmission, and HIV positive attitudes to organ transplants from positive donors.

We also include our final reports from CROI 2014 – although there is always far more data than we can cover at this conference. These reports include pharmacokinetics of antiretrovirals in pregnancy, superior virological outcomes with efavirenz compared to lopinavir/r in Ugandan pregnant women, and some of the issues associated with starting ART in infants soon after they are born.

And Richard Jefferys provides an excellent catch up with pathogenesis and cure research presented at CROI 2014, including a caution that ART may have benefits for long term slow progressors.

Other news is a large study reports no increase in death rate in HIV positive people with renal dysfunction receiving tenofovir in Zambia.

The US adult treatment guidelines have been updated and new PrEP guidelines have been significantly expanded. PrEP is an increasingly important option in the US and tracking the approach and range of responses there is very relevant for our approaches in the UK.

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