Friday 18 October 2013 Contents Anti-HIV drug in development shows promise
Judith Feinberg of the University of Cincinnati at EACS 2013. Photo by Liz Highleyman / hivandhepatitis.com
Although currently available is safe and highly effective, researchers believe there
is still benefit in developing new drugs that attack HIV in different ways.
Cenicriviroc was compared with , one of the most frequently used anti-HIV drugs, in a
trial involving people starting HIV treatment for the first time. The study also compared two
Cenicriviroc is in the anti-HIV drug class of
from locking on to CD4 cells by blocking CCR5 co-receptors, found on the surface of the cells.
Cenicriviroc also blocks CCR2 receptor cells, which cause inflammation in the body. This class
of drugs only works for people who have a type of HIV called CCR5-tropic.
The new drug was shown to be as effective as efavirenz (Sustiva, also in the combination pill
Atripla) in suppressing viral load, with fewer particular, lipid levels (, or
blood fats) reduced in people on cenicriviroc, while they increased in people on efavirenz.
However, some people taking cenicriviroc had raised creatine levels, which can indicate muscle
The positive results mean that investigators can go on to develop cenicriviroc further, including
the production of a fixed-dose combination pill also containing (3TC, Epivir). This
combination pill is intended to provide an alternative to Truvada) and will be tested
in combination with another potent antiretroviral.
The trial had a relatively high drop-out rate, which researchers thought was due to the fact that the
dosing regimen for all three arms was quite complex, involving a larger number of pills than
most HIV treatment regimens require these days. However, since this trial, a new formulation of
cenicriviroc has been developed, which means it can be taken as a single pill.
Related links Numbers of people with drug-resistant HIV in Europe increasing
Novel treatment strategies and a wider range of anti-HIV drugs provide new options for people
whose treatment choices are limited. One reason for this may be if their strain of HIV is resistant
– where a particular drug or class of drugs no longer works effectively against that
strain of HIV – can occur because someone is on an HIV treatment that isn’t working. It is also
possible to be infected with a strain of HIV that is already resistant to one or more anti-HIV drugs.
Having drug-resistant HIV can cause a number of problems. HIV replication may not be
will increase, and further resistance – to a wider range of drugs – can
develop. This is particularly problematic in places where treatment choices are already limited.
To avoid this situation, many – including those published by the European
AIDS Clinical Society (EACS) – recommend that drug-resistance tests are done before people
start HIV treatment. However, this does not always happen, with countries in eastern Europe less
likely to do pre-treatment resistance tests despite having higher rates of resistance.
Previous estimates of drug resistance in Europe have looked mainly at the proportions of HIV-
positive populations with resistant virus, without taking into account the fact that actual numbers
of people living with HIV continue to rise. This means that the caseload of people whose HIV
treatment and care may require more careful management is growing.
Related links New drugs offer a 'revolution' in hepatitis C treatment
Heiner Wedemeyer, Hannover Medical School, at EACS 2013. Photo by Liz Highleyman, hivandhepatitis.com
Infection with the unlike HIV, is . However, it has always been
on the HCV genotype involved. Prospects of a cure have recently improved significantly with the
Heiner Wedemeyer, from Hannover Medical School, Germany, described the new drugs as “a
The first DAAs in use – – still need to be
used in combination with pegylated interferon and ribavirin, the previous standard therapy. They
can shorten the length of treatment and increase cure rates, but have their own side-effects,
complicated dosing and potential interactions with other medications.
HCV drugs in development are easier to take and are better tolerated, with cure rates rising
further. The ultimate aim is to develop an HCV treatment that does not include pegylated
interferon, avoiding the drug’s side-effects and the need to take it by injection.
Such new regimens should significantly increase the number of people able to tolerate HCV
treatment, increase cure rates, and reduce the number of people who go on to develop serious
As with anti-HIV drugs, hepatitis C treatments fall into several ‘classes’ of drug, and these new
drugs work by attacking HCV at different stages of its lifecycle. Interferon-free regimens will,
again like HIV treatment, need to involve a combination of drugs from different classes. New
regimens are much less complicated – usually once a day – and better tolerated.
Although trial results – of some of these new drugs, in particular – are promising, there are still
challenges. Cure rates are still low in some groups of patients, depending on their genotype and
any prior liver damage, for example. Drug interactions may cause difficulties. And finally, cost may
be a barrier. Wedemeyer cautions that physicians may have to advocate to get access to these
treatments for as many people as possible.
Related links HPV, pre-cancerous changes and anal cancer
(HPV) causes genital warts and can also lead to cervical
and anal cancer. People with HIV seem to be at higher risk of pre-cancerous and cancerous cell
suggest that women should be routinely screened for these changes in the anal canal.
HIV care guidelines currently recommend that women have -cancerous
cell changes in the cervix, but there has never been agreement on the benefit of anal screening
The French study involved 319 women, who had both anal and cervical screening and were
tested for HPV. It found that 57% of the women were infected with at least one type of HPV
associated with a higher risk of cancerous changes. Infections with high-risk HPV types and pre-
cancerous lesions (of differing grades) were more commonly found in the anus than the cervix.
Women with a previous history of cervical lesions were more likely to have anal lesions. Women
reporting anal intercourse were not more likely to have anal lesions.
The researchers suggest these findings indicate that routine anal screening for women with HIV
men, but whether this happens tends to depend on national or local recommendations and
The study suggests that the key risk factor for these cell changes was a low ‘nadir’ (lowest-ever)
consistent with the findings in other studies looking at pre-cancerous
The length of time someone has had an undetectable viral load also seems to play a role, with
this and other studies finding that a longer period of viral suppression is linked to a lower risk of
anal cancer. However, the study does not determine whether earlier HIV treatment reduces the
Related links New EACS HIV treatment guidelines: mobile app available
The European AIDS Clinical Society (EACS) has published updated 2013 guidelines for
treatment of adult HIV infection, co-morbidities and HIV/hepatitis co-infection.
You can download a mobile app version of these guidelines for iPhone, iPad or Android device
from the Apple Store or from the Google Play store, by searching for ‘EACS Guidelines 7’.
The app costs €22 (£18.66; US$29.99).
Aidsmap.com will publish a news report on expert discussion of the new guidelines after the
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