HIV treatment advances
The days when being diagnosed as HIV-positive was synonymous with a virtual death sentence are no more, providing it is caught early.
© channel 4
The last ten years have seen incredible advances in HIV treatment and most doctors expect this trend to continue, leading to simpler, more effective drug regimes with fewer side-effects giving carriers of the virus longer and better lives.
New research suggests that HIV infection could even be nipped in the bud if treated soon enough after exposure. The post-exposure prophylaxis (PEP) drugs – as used by Kris in Hollyoaks after finding out his brother Malachy and girlfriend, whom Kris has slept with, are HIV-positive – are one such advance. Labelled the 'HIV morning after pill', it is the only treatment available for people who think they may have recently been exposed to the virus.
Despite the lack of acceptable data, doctors had assumed that if anti-HIV drugs were effective at keeping long-term positive people healthy, a short-course of treatment over one or two months would also stop the virus embedding itself in someone who has been sexually exposed.
PEP had been the 'best guess' treatment based on many years of successful experience of preventing the spread of the virus to health care professionals accidentally injured by contaminated needles.
In both cases though, the key was to prescribe the treatment within 48-72 hours of exposure. The two-to-three-day treatment window was always seen as crucial, tackling the virus before an affected person's immune system had a chance to respond, vital because HIV needs the immune system to reproduce itself.
And it appears the doctors had been guessing right all along. A 2004 study in Brazil has found that PEP does indeed work. Dr Mauro Schechter from Universidado Federal de Rio de Janeiro, and colleagues, distributed 'treatment starter packs' to 200 gay men attending sexual health clinics, who were told to self-medicate if they suspected they'd been infected. Overall, the study found that anti-HIV PEPs could cut infection rates by up to 70 per cent.
At the moment, anti-HIV treatment is normally a combination of three or four drugs (hence 'combination therapy') and although they won't eliminate the virus completely – their aim is virtual viral obliteration – most patients seem to be able to cope with what virus is left behind, as long as they keep with the programme.
The upside of this has been the millions of infected people in good health leading productive lives and the closure of Aids wards throughout the developed world, a far cry from just 10 years ago before these drugs were available when HIV was a near certain death sentence.
However, anti-HIV treatment is far from risk-free, even for people like Kris taking the drugs for a relatively short time. A very small number of patients do react very badly – some near fatally – to some of the drugs involved.
Also, as Kris discovers, there are often very unpleasant side effects, ranging from minor skin rashes and nausea to full-blown liver failure and chronic diarrhoea. But, if the treatment is interrupted, levels of HIV will shoot back up, leaving patients prey to highly dangerous conditions such as virulent forms of pneumonia and skin cancers. Positive people on anti-HIV treatment are on it for life.
In the longer term, most pharmaceutical combinations eventually stop working as the ever-mutating virus learns to deal with, and becomes resistant to, a particular drug. This becomes more likely when patients don't take their drugs properly or miss doses. This can be bad news because doctors naturally prescribe drugs with lesser side-effects first. And if resistance is acquired to several classes of drugs, eventually an infected person will have no treatment options left. Study after study has shown that patients who do best are those who complete their course of drugs.
one a day
One other key advance in November last year was the approval by the EU of the first one-a-day combination drug to treat HIV, at a time when infection rates in Europe are rising. The pill, called Atripla and marketed by Gilead Sciences, a US biopharmaceutical company, and Bristol-Myers Squibb, the US drug group, marks a significant change in the treatment of the disease.
Just a few years ago, patients were often forced to swallow up to 30 pills a day, and these frequently caused serious side-effects. In the past few years, there has been significant progress. GlaxoSmithKline's Trizivir, for example, an existing combination treatment, has to be taken just twice a day. The current leading treatment in Europe – Truvada and Sustiva – also involves two different pills.
Atripla is the first one-pill, one-a-day medicine. It combines the active ingredients of three widely used antiretroviral drugs (Sustiva, Emtriva and Viread) in one pill and has a good safety profile.
It was launched in the US in July 2006. Sales of the drug reached nearly $650m (£325m) in the first nine months of 2007 and industry analysts project that Atripla's annual sales will grow to $2.7bn by 2010, eventually peaking at close to $4bn.
Public awareness of Aids has fallen slightly in Europe as the disease has become a chronic, manageable condition thanks to scientific progress.
Mike Ward, an analyst at the life-sciences investment bank Nomura Code, said: "It used to be that a person would be diagnosed, and two years later they were dead. Now, it's a long-term condition, but still with a lot of managing involved."
Paul Carter, vice-president of international commercial operations at Gilead, said: "We're trying to work with policy-makers and opinion leaders in the HIV field to raise awareness that infection rates are increasing in Europe."
According to EuroHIV data from the European Centre for Disease Prevention and Control, the rate of new HIV infection in the European Union has over doubled since 1999, from 28.8 to 67 per million inhabitants, bucking the trend elsewhere in the world where infection rates have fallen.
It also found the UK HIV infection rate was more than double the European Union average – almost 149 cases per million inhabitants. Three-fifths of new HIV infections diagnosed in the UK last year were acquired abroad, with black Africans accounting for half the total number of new HIV infections in 2006. More than four-fifths (84%) of them contracted HIV in Africa. There has been a fivefold increase in HIV infections in black Africans since 1997.
The Health Protection Authority (HPA), which monitors infectious diseases in the UK, also raised concern about the "disturbing" rise in HIV among gay men. There were 2,700 new cases of HIV in this group last year, breaking the previous record high of 2,650 set in 2005. There were 31,100 gay men living with HIV in the UK last year – more than 40% of the 73,000 people infected.
Meanwhile, a vaccine is still a long way off. Dr Mike Youle of London's Royal Free Hospital believes that protection against HIV might one day involve tackling the virus as we now approach malaria. That disease is avoided by a course of treatment taken before, during and after visiting a malaria-prone region plus the use of spray-on insect repellent. For HIV, this might mean a vaccine, (which, like the flu vaccine, would only be effective in 50 per cent of cases), a pre-exposure prophylaxis taken prior to sexual contact and the use of condoms.
For people already infected however, a cure may never come about. But the fact that HIV can now be treated as a chronic condition gives cause for hope.
emotional support
Although James got some counselling when he was diagnosed, it doesn't compare to the services available now. Currently, anyone getting a test will benefit from seeing an experienced counsellor. You will be able to discuss every possibility, from dealing with a positive result to how to ensure you stay negative if you are clear. If you are positive, an expert will discuss what your next steps could be, helping you make an informed decision on your future.
As James found, the social and emotional issues involved in a contracting HIV are just as important as the health issues.
'Apart from dealing with having HIV, I had to consider whether to tell my family and friends. I told my best friend at work, and she was incredibly supportive, but she couldn't stop crying for months. She was devastated that this was happening to someone she loved so much. That made me realise I didn't want my parents to know, I didn't want them to have to deal with it.'
But contracting HIV isn't only about your health or the reaction of family and friends. There are many other issues to be considered – like if and when you have sex again.
'I felt my body was dirty, it was horrible,' said James. 'I didn't think anyone would want to sleep with me ever again. It was two and a half years before I had sex. It wasn't an easy decision – I had been dating someone for eight weeks but I was terrified of being rejected when I told him about my HIV status. I even went to the GP to get advice on how to tell my partner. I needn't have worried – he was completely supportive and we ended up staying together for eight years.'
how can I get PEP treatment?
Most importantly, remember you must start PEP within 72 hours of putting yourself at risk of HIV, though the sooner you start PEP the more likely it is to be effective. Contact your nearest GUM clinic and explain your situation – if they don't offer the service or you're calling out of hours, several A&E hospital departments offer the 30-day course of drugs – ask to speak to the 'on-duty HIV registrar' who will have experience in PEP and HIV.
Because HIV medication is expensive most clinics will not prescribe PEP unless they feel that there is a very real chance that infection will take place if they don't. PEP will not be given to someone who is already HIV positive and so you will be asked to have an HIV test. You must also agree to be tested after you have finished the course of PEP to see if it's worked. If you are HIV negative they will probably try to establish what your risk of infection is and this will depend on the likelihood of your partner being HIV positive and how risky the sex you had was. If you know that your partner is HIV positive, and he or she is willing to come to the clinic or hospital with you, it is often easier to convince the clinician that you're a worthy case. And remember, it's far from an easy option, with often debilitating side-effects including nausea, fever and rashes.
what drugs will they use?
The drugs used for PEP are a triple combination of anti-HIV drugs. These are commonly selected from:
Either
AZT (also called zidovudine) and 3TC (lamivudine) – also available in a combination pill called Combivir,
Or
Tenofovir and FTC (embtricitabine) – also available in a combination pill called Truvada
Plus one of the following:
lopinavir or fosamprenavir or saquinavir
help and info
Channel 4 is not responsible for the content of third party sites.
You might like to check out our features on getting tested for STIs, teenagers living with HIV, and the history of HIV/AIDS in the UK.
organisations
Crusaid
1-5 Curtain Road
London EC2A 3JX
Tel: 020 7539 3880
E-mail: office@crusaid.org.uk
Website: www.crusaid.org.uk
Crusaid works in the UK and internationally to improve the lives of people affected by HIV and AIDS and to prevent the spread of the virus.
Children with AIDS
Calvert House
5 Calvert Avenue
London E2 7JP
Tel: 020 7033 8620
E-mail: info@cwac.org
Website: www.cwac.org
Supports children and families infected and affected by HIV/AIDS.
The National AIDS Trust (NAT)
New City Cloisters
196 Old Street
London EC1V 9FR
Tel: 020 7814 6767
E-mail: info@nat.org.uk
Website: www.nat.org.uk
UK's leading HIV and AIDS policy development and advocacy organisation. The website has information on HIV prevention and testing, health and social care, discrimination, law and human rights.
Many useful publications can be downloaded for free.
Positively Women
347-349 City Road
London EC1V 1LR
Tel: 020 7713 0444
Helpline: 020 7713 0222 (staffed by HIV positive women: Mon-Fri 10am-1pm and 2pm-4pm)
E-mail: info@positivelywomen.org.uk
Website: www.positivelywomen.org.uk
Charity working to improve the quality of life of women and families affected by HIV, and offering peer support.
Condom Essential Wear
Helpline: 0800 567 123 (24 hours)
Website: www.condomessentialwear.co.uk
Provides confidential information and advice on all aspects of sexually transmitted infections and HIV prevention. The helpline serves as the first point of call for many people not already in touch with sexual health services.
Stop Aids Campaign
c/o UK Consortium on AIDS & International Development
Grayston Centre
28 Charles Square
London N1 6HT
Tel: 020 7324 4785
E-mail: info@aidsconsortium.org.uk
Website: www.stopaidscampaign.org.uk
A UK Consortium bringing together leading development and HIV/AIDS groups, working to raise awareness. PDF downloads available on UK government spending and facts and figures from the World Health Organisation.
Terrence Higgins Trust
314-320 Gray's Inn Road
London WC1X 8DP
Helpline: 0845 1221 200 (Mon-Fri 10am-10pm; Sat-Sun 12-6pm)
E-mail: info@tht.org.uk
Website: www.tht.org.uk
Offers a wide range of free and confidential services for people with HIV, including specialist advice and representation on welfare rights, housing and legal matters, practical help and befriending.
websites
AEGiS
www.aegis.com
Definitive web-based reference for HIV/AIDS-related information. The site features up-to-date information regarding the history, prevention and treatment of HIV/AIDS.
aidsmap
www.aidsmap.com
Information, news and resources for people with HIV and AIDS, community organisations and professionals. Features extensive information on treatments plus a searchable database of HIV clinics in the UK. The site is available in Spanish, Portuguese, French and Russian.
AVERT
www.avert.org
Contains HIV and AIDS statistics, information for young people, personal stories, information on becoming infected, a young and gay section, and free resources. Also contains an in-depth and interesting article on the origin of HIV and AIDS.
The Body
www.thebody.com
New York based organisation that offers a weekly e-mail newsletter on the latest research and information for the HIV community. Also links to a comprehensive list of HIV publications and to forums where you can submit questions to doctors.
Condom Essential Wear
www.condomessentialwear.co.uk
For more information on condoms, sexual health, how to protect yourself from STIs and how to find your nearest GUM Clinic.
The Guardian – AIDS and HIV
www.guardian.co.uk/world/aids
Numerous reports from the Guardian on HIV/AIDS.
HIV Post-Exposure Prophylaxis (HIV-PEP)
www.unaids.org/en/PolicyAndPractice/Prevention/HIVPEP/
United Nations Programme on HIV/AIDS looks at the efficacy of HIV-PEP drugs.
i-base
www.i-base.org.uk
Activist group committed to providing timely HIV treatment information to health care professionals and HIV-positive people. Covers important medical advances and houses up-to-date online articles.
International Men's Health Database
http://imhd.emhf.org
IMHD is a database of individuals and organisations that work with, or influence the health of men within their country and internationally. It is intended to be a key resource for health practitioners, academics, users of health services and policy makers. This is a public database giving free access to the information it contains.
Positive Nation
www.positivenation.co.uk
National HIV and sexual health magazine.
Project Inform
www.projinf.org
San Francisco based organisation provides information on the diagnosis and treatment of HIV and AIDS, with online articles on available drugs and their side effects. There is also a newsletter that anyone can subscribe to.
UK Coalition
www.ukcoalition.org/Weblinks/around.html
Lists many useful national and also local organisations for those who are HIV positive or have AIDS.
reading
 |
The No Nonsense Guide to HIV/AIDS by Shereen Usdin (Verso Books, 2003) |
 |
Encyclopaedic Dictionary of Aids-related Terminology by Jeffrey T. Huber (Haworth Press, 2000) |
 |
The Guide to Living with HIV by John G Bartlett and Ann K Finkbeiner (Johns Hopkins Press, 2001) |
|
The First Year-HIV: An Essential Guide for the Newly Diagnosed by Brett Grodeck (Marlowe, January 2008) |
 |
The End of Innocence by Simon Garfield (Faber, 1995) |
 |
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(September 2008)
