NAPWA

HIV-related news in brief from the June-July 2003 edition of Positive Living.

News briefs

Medical cannabis on trial in NSW

NSW Premier Bob Carr has announced plans for a trial of medical cannabis in his state. The trial, which has been given in-principle support by the Prime Minister, will make cannabis, in inhaler or tablet form, available to people with chronic pain, nausea or wasting brought on my serious diseases including HIV/AIDS, cancer and MS. People with drug convictions (except for personal use), on parole, under 18 or pregnant will not be able to participate. NAPWA President David Menadue applauded the announcement, saying that there is a “real and pressing need” for medical cannabis and calling on other states to follow NSW’s lead.

Superinfection ‘may occur often’

A report in the May 2 issue of AIDS suggests that HIV superinfection may be more widespread than is generally believed. Discussing the case of a Californian man who became superinfected with a wild-type strain[HIV strain] Any subgroup of the HIV species. Because HIV mutates very easily, there are many different strains (and may be multiple strains within a single person). of HIV from the same viral subtype[HIV subtype or clade] A genetically distinct subtype of HIV within a defined HIV group. Group M has nine known subtypes -- A, B, C, D, F, G, H, J and K. as his original, drug-resistantHIV which has mutated and is less susceptible to the effects of one or more anti-HIV drugs is said to be resistant., strain, the author says that the case “indicate[s] that HIV superinfection, even with the same viral subtype, may occur more often than we previously thought.” The researchers conclude that additional studies are needed to examine how superinfection affects the immune systems of PLWHAs and any role it plays in treatment failure. —AIDS 2003; 17(7):F11–F16.

Sth African drug program ‘affordable’

An as-yet-unreleased South African government cost study has concluded that a nationwide program to provide antiretroviralsA medication or other substance which is active against retroviruses such as HIV. is affordable and feasible, according to unidentified sources quoted in a Wall Street Journal report. The study estimates an initial cost of around 8000 rand (A$1590) per person per year of life saved, although that cost would be expected to drop sharply within a few years. The South African cabinet, which has long argued that antiretrovirals are too expensive and too toxic, is yet to consider the report.

Puberty delayed in HIV children

HIV-positive children who were infected at birth may enter puberty later than HIV-negative children, according to new US research. In a six-year study, researchers examined the sexual maturity of 983 children who had been HIV-positive since birth, finding that both boys and girls with significant immune suppression tended to reach puberty up to a year later than those who were either HIV-negative or who were positive but had little or no immune suppression. —JAIDS 2003; 33:56–65.

HIV heart transplant success

An HIV-positive man in the US who received a heart transplant more than two years ago is still alive and well, according to a report in the New England Journal of Medicine. Robert Zackin, who in 1994 had zero T-cells, was close to death in 2000 after a serious reaction to a drug used to treat Kaposi’s Sarcoma. He received a heart transplant in January 2001 and has now returned to full-time work and is exercising regularly. The revelation has already sparked discussion about the ethics(In clinical trials) The process of determining that a proposed clinical trial conforms to a wide range of moral, scientific and ethical standards, to ensure that participants in the trial are not abused, mistreated or unfairly taken advantage of. Before a clinical trial can go ahead, it must be given approval via an independent ethics process. of giving HIV+ people transplants, but his treating doctor says Zackin’s success proves that people with HIV can get good results from organ transplants. — Reuters

In Zambia, life expectancy hits new low

Increasing mortality from HIV/AIDS has cut average life expectancy in Zambia to just 33 years, down from 44 years a decade ago, according to the southern African country’s Central Statistical Office. Around 20 percent of Zambia’s 9.8 million people are HIV-positive, with 500 new infections and 200 deaths per day.

Treatments briefs

Efavirenz more durable, nevirapine more tolerable

The non-nucleoside drugA type of anti-HIV drug that works by inhibiting a stage of the HIV life cycle called reverse transcription. Non-nucleosides work in a similar way, but are chemically different. efavirenz is significantly more durable than nevirapine, according to a study presented to the annual conference of the British HIV Association in Manchester in April. In a study involving 625 patients, researchers found that a quarter of those on nevirapine experienced treatment failure within 15 months of starting the drug, while it took 28 months for the same proportion of efavirenz patients to fail. In a separate paper presented at the same conference, however, a study of 483 patients found that the incidence of severe central nervous system side effects in patients taking efavirenz was much greater that previously reported.

Atazanavir nears approval in US

An advisory panel to the US Food and Drug Administration (FDAThe U.S. Department of Health and Human Services agency responsible for ensuring the safety and effectiveness of all drugs, biologics, vaccines, and medical devices, including those used in the diagnosis, treatment, and prevention of HIV infection, AIDS, and AIDS-related opportunistic infections. The FDA also works with the blood banking industry to safeguard the nation's blood supply. The Australian equivalent is the Therapeutic Goods Administration (TGA).) last month unanimously recommended approval for atazanavir, a new protease inhibitor from Bristol Myers-Squibb. Atazanavir, to be marketed under the brand name Reyataz, has generated considerable interest due to its convenient once-a-day dosing and because in clinical trials it has not exhibited the same tendency to raise blood cholesterolAn essential component of cell membranes and nerve fibre insulation, cholesterol is important for the metabolism and transport of fatty acids and the production of hormones and Vitamin D. Cholesterol is manufactured by the liver, and is also present in certain foods. High blood cholesterol levels have been linked to heart disease and may be a side effect of some anti-HIV medications. levels as existing PIs. The panel expressed concern at reports of liverA large organ, located in the upper right abdomen, which assists in digestion by metabolising carbohydrates, fats and proteins, stores vitamins and minerals, produces amino acids, bile and cholesterol, and removes toxins from the blood. and heartbeat problems associated with atazanavir, but felt that the drug presented a significant benefit.

‘No benefit’ from treatment breaks

A Swiss/Spanish study published in the May 26 Archives of Internal Medicine has concluded that treatment interruptions are of no benefit in helping the immune system control HIV, but neither are they associated with higher rates of AIDS-related infections or drug resistance. In 133 patients enrolledThe act of signing up participants into a study. Generally this process involves evaluating a participant with respect to the eligibility criteria of the study and going through the informed consent process. in the study, just 8 percent continued to have undetectable viral loadA measurement of the quantity of HIV RNA in the blood. Viral load blood test results are expressed as the number of copies (of HIV) per milliliter of blood plasma. after 96 weeks of treatment interruption. The researchers did note that CD4 levels remained strong and that only one patient developed drug resistance. — AIDSmap

Heavy alcohol use and HAARTHighly Active AntiRetroviral Therapy ??? aggressive treatment of HIV infection using several different drugs together.

Two American studies of HIV in drug and alcohol users have found that people on antiretroviral therapy who drink alcohol more than three or four times a week tend to have higher viral loads and lower CD4 counts than those who drink less or not at all. The researchers suggest several factors could be responsible, including poor drug absorption, interactions, and adherence, and conclude that heavy alcohol use could “block the effectiveness” of HAART. — AIDSmap

TDM helps improve treatment success

The Dutch ATHENA study has suggested that people taking protease inhibitors are more likely to maintain an undetectable viral load and avoid toxicity-related side effects if therapeutic drug monitoring (TDM) is used to adjust dosage levels to ensure the right levels of drug are being absorbed into the bloodstream. 147 patients taking either nelfinavir (Viracept) or indinavir (Crixivan) participated in the study, and were randomly assigned to either TDM or non-TDM arms. Patients were followed for a year, with significantly more of the patients in the TDM arm maintaining low viral load at both six and twelve months, particularly among those taking nelfinavir. Indinavir patients using TDM were also significantly less likely to discontinue their treatment due to drug toxicity.

• More stories from the 'News Briefs' series