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[HATIP #24], March 1 2004
A regular electronic newsletter for health care workers and community-based organisations on HIV treatment in resource-limited settings. It is supported by and produced in collaboration with St Stephen's AIDS Trust and the International HIV/AIDS Alliance.

Its publication is also supported by Positive Action of GlaxoSmithKline, Boehringer Ingelheim and the Access 4 Trust.
   Last updated: 19.10.05
In this edition
1. About HIV & AIDS Treatment in Practice

2. News links from www.aidsmap.com

3. Treating HIV & AIDS: A training toolkit: CALL FOR EVALUATION PARTNERS

4. MAIN ARTICLE: Preventing mother to child HIV transmission with nevirapine: time for a rethink?


HATIP is published in partnership with the St Stephen's AIDS Trust and the International HIV/AIDS Alliance.

2. NEWS LINKS FROM WWW.AIDSMAP.COM
A selection of news stories which have appeared since 05/02/2004.


Adherence, not baseline CD4 cell count, linked to CD4 cell gain on HAART

  • Patients with the highest levels of adherence experience the best improvements in their CD4 cell counts, irrespective of baseline CD4 cell count, according to a Canadian study published in the March 1st edition of the Journal of Acquired Immune Deficiency Syndromes. The authors of the study say that their findings may raise confidence in delaying treatment until the CD4 cell count falls near to 200 cells/mm3.



Men who have sex with men in India have high HIV prevalence and multiple risk factors for HIV

  • HIV prevalence is significantly higher among men who have sex with men in India than among men reporting only sex with women, according to a study published in the March 1st edition of the Journal of Acquired Immune Deficiency Syndromes. The study also revealed that the majority of men reporting sex with men were married, and that HIV-positive men who reported having sex with men were also likely to report multiple risk factors for HIV, including drug use, multiple sex partners and exchanging sex for money.



Dublin Declaration promises HIV treatment for all in Eastern Europe & Central Asia by 2005

  • A two-day, 55-nation conference on HIV/AIDS throughout Europe and Central Asia ended yesterday in Ireland, having made more than 30 resolutions intended to tackle inequalities in treatment and prevention between Western Europe and Eastern Europe & Central Asia – the geographic region experiencing the world's fastest HIV infection rate, with 250,000 new infections in 2003, according to UN figures released last week. There could be as many as 1.8 million people living with HIV in the region, an increase from 30,000-40,000 in 1998.



More details on where US treatment cash will go

  • Further details have emerged on the programmes that will be supported to deliver antiretrovirals by the President’s Emergency Plan For AIDS Relief, announced yesterday by US Global AIDS Coordinator Randall Tobias.



US unveils details of Bush AIDS treatment plan

  • The US administration is to release US$350 million of funds in the first wave of support for treatment, care and prevention programmes in Africa and the Caribbean, US Secretary of State Colin Powell announced on Monday.



World Bank launches guide to HIV drug procurement

  • The World Bank has published a guide to procurement of drugs and other medical supplies for use in HIV treatment and care, targeted at people responsible for making procurement decisions. Although intended primarily for World Bank staff, the guide is likely to prove useful to many involved in planning antiretroviral programmes.



d4T fat wasting risk rises with baseline triglycerides

  • The risk of developing lipoatrophy (fat wasting) during treatment with d4T (stavudine, Zerit) appears to be highest in individuals with high baseline triglyceride levels, in persons aged 40 or over, and in individuals who receive the Zerit immediate release formulation of the drug, according to an analysis of two studies which compared Zerit immediate and prolonged release formulations.



Dual HIV-1 infection associated with rapid disease progression

  • Infection with two strains of the same HIV-1 subtype can lead to very rapid disease progression, US researchers warn today in the February 21st edition of The Lancet.



Expensive micronutrient formula associated with CD4 increases

  • A broad-spectrum micronutrient formula developed by a California HIV practitioner has been shown to significantly increase CD4 cell counts - by 25% over 12 weeks - when used as an adjunct therapy to HAART. However, treatment with the formula was not shown to result in significant improvements in peripheral neuropathy, which had been the primary point of the study, presented last week at the Eleventh Conference on Retroviruses and Opportunistic Infections in San Francisco.



Unprotected sex with regular partner may provoke an immune response that can protect against HIV

  • Unprotected sex between monogamous heterosexual partners causes an immune response that may be able to inhibit infection with HIV, according to a laboratory study published in the February 14th edition of The Lancet. The investigators, from Guy’s, King’s and St Thomas’s hospitals in south London, believe that their findings could have important implications for future HIV vaccine research, but are emphasising that their findings do not suggest that individuals should have lots of unprotected sex as a way of protecting themselves against infection with HIV.



Diabetes and high glucose levels more common in HIV-positive men on HAART

  • HIV-infected men using antiretroviral therapy have higher rates of hyperglycaemia (high blood glucose) and diabetes compared with HIV-negative men, according to an American study presented on February 10th at the Eleventh Conference on Retroviruses and Opportunistic Infections in San Francisco.



Prurigo, scourge of HIV-positive in tropics, may be controllable with insecticide

  • A skin condition that occurs frequently in people with HIV in sub-Saharan Africa is caused by insect bites rather than an infectious agent, and is a strong indicator of HIV infection, according to researchers from the United States and Uganda. The findings were reported on February 11th at the Eleventh Conference on Retroviruses and Opportunistic Infections in San Francisco.



UN guidelines published for HIV counselling and testing in sexual and reproductive health services

  • Two respected international organisations have published guidelines for the integration of a key aspect of HIV prevention into reproductive health services.



South Africa’s antiretroviral rollout stalled

  • Delays in the drug procurement process and lack of training for doctors are postponing the rollout of antiretroviral therapy (ART) in South Africa, the country’s government admitted last week.



NNRTI-based HAART effective and safe for primary HIV infection

  • A HAART regimen based on the non-nucleoside (NNRTI) efavirenz is a virologically and immunologically effective and safe treatment for primary HIV infection, according to a small UK study published in the February edition of HIV Medicine. Although the investigators admit that the long-term benefits of treating primary infection are not known, they noted significant improvements in immune function during treatment, suggesting that NNRTI-based treatment of primary infection results in immune reconstitution.



Gene most commonly seen in Africans greatly increases efavirenz levels

  • Hard on the heels of the bad news regarding nevirapine monotherapy to prevent mother-to-child transmission, reported here, three studies presented on the last day of the 11th Conference on Retroviruses and Opportunistic Infections in San Francisco could have major global implications regarding the use of the non-nucleoside class as a whole.



Transmission of drug-resistant HIV: what are the implications for treatment?

  • Although drug resistance may linger for months or even years when individuals become infected with a drug resistant virus, evidence from a large European study does not suggest that these individuals have a poorer response to first line treatment.



Vaccine research: back to the drawing board?

  • The major presentations on HIV vaccines at the Eleventh Conference on Retroviruses and Opportunistic Infections in San Francisco were dominated by one question. Is it reasonable to press ahead with large-scale clinical trials, such as the one now underway in Chon Buri and Rayong provinces, Thailand? Or should the emphasis and funding for vaccine research shift more strongly back to basic immunology and experiments in animal models?



Lancet article destroys the thesis that injections a major cause of HIV in Africa

  • There is no compelling evidence that unsafe injecting practices are responsible for the bulk of HIV infections in southern Africa, a team of investigators conclude in an article in the February 7th edition of The Lancet.



Confusion continues at CROI over triple nuke therapy (amended)

  • Triple nucleoside combinations came under more scrutiny this week at the Eleventh Conference on Retroviruses and Opportunistic Infections, with still little consenus about why so many of these combinations are suboptimal. But the confusion has not prevented an ongoing trial of the experimental once-daily combination of Trizivir (zidovudine/ lamivudine/ abacavir) with Viread (tenofovir) from continuing, despite only mediocre short-term results.



Premature and low birth weight babies becoming more frequent in HAART-treated mothers

  • The frequency of premature deliveries and very low birth weight babies being born to HIV-positive mothers has increased significantly since the introduction of HAART in Europe, according to findings from the European Collaborative Study presented on Tuesday at the Eleventh Conference on Retroviruses and Opportunistic Infections in San Francisco.



Opportunities and challenges on the route to effective microbicides

  • A plenary presentation at the Eleventh Conference on Retroviruses and Opportunistic Infections in San Francisco by Dr Robin Shattock from St George’s Hospital Medical School, London, UK, expressed cautious optimism about the development of microbicides. Dr Shattock reviewed recent scientific developments and set the scene for next month’s Microbicides 2004 conference in London, for which he co-chairs the Basic Science track committee.



PEP for sexual exposure to HIV not 100% effective

  • One per cent of individuals receiving post-exposure prophylaxis (PEP) after a possible sexual exposure to HIV went on to become infected with the virus, according to a study conducted in California and presented as a poster to the Eleventh Conference on Retroviruses and Opportunistic Infections in San Francisco.



Superinfection occurs at 5% a year in recently infected gay men not on therapy

  • The Eleventh Conference on Retroviruses and Opportunistic Infections in San Francisco opened yesterday with a bang, as a group of investigators from Los Angeles and San Diego provided long-awaited information on the incidence of sexually-acquired superinfection, concluding that, amongst their cohort of 78 recently infected individuals not on therapy, the annual rate of superinfection was 5%.



BMJ exposes serious weaknesses in case for compulsory HIV/TB tests for UK immigrants

  • Proposals to introduce mandatory HIV and TB screenings for immigrants to the UK are not based on adequate evidence and have practical and ethical problems, according to an editorial in the February 7th edition of the British Medical Journal.



Hormonal contraceptives increase shedding of HIV infected cells in the cervix

  • The use of hormonal contraception leads to a small but significant increase in the shedding of HIV-infected cells in the cervix, even though both cervical secretion and blood HIV viral load levels remained unchanged, according to a prospective study involving over 200 HIV-positive women in Kenya. The study was conducted between August 1996 and September 1998, and is published in the January 23rd edition of AIDS.



Allergic reaction to abacavir reported after treatment break, one year after starting the drug

  • A woman has developed a hypersensitivity reaction to the nucleoside analogue abacavir after restarting the drug after a treatment break. Investigators reporting the case in the January 23rd edition of AIDS believe that this case is unique as the woman had no symptoms of allergy to abacavir before treatment interruption, and because of the length of time the woman had been taking the drug prior to the development of the hypersensitivity.


3. TREATING HIV & AIDS: A TRAINING TOOLKIT - CALL FOR EVALUATION PARTNERS
NAM, the publisher of www.aidsmap.com and this electronic newsletter HIV & AIDS Treatment in Practice, has launched a major new resource, Treating HIV & AIDS: A Training Toolkit.

This project is a response to the scaling-up of antiretroviral therapy in
resource-limited settings, and was developed with the support of doctors providing training on ARVs in Botswana, Kenya and South Africa.

The training toolkit is designed to provide basic training on HIV
treatment and care for health care workers in resource-limited settings, to support the safe and effective introduction of antiretroviral therapy.

The training toolkit contains modules on:

  • Introduction to HIV and AIDS

  • Preparing the patient for treatment

  • Monitoring Tests

  • A Basic Package of Care

  • Introduction to anti-HIV Therapy

  • Changing Treatment

  • Drug Combinations: training module for each drug combination suitable for use in resource-limited settings

  • Tuberculosis and HIV

  • Treatment in Pregnancy

  • Infant Feeding


Further modules will be added during the course of 2004. Register today and receive alerts when new material is added or existing modules are updated.

This project was developed with financial support from Action Aid's Supporting the International Partnership Against AIDS in Africa programme.

We are seeking to identify a number of partners to carry out evaluation of the training toolkiit with a variety of audiences in countries in Africa AND Asia.

If you are planning to use the materials in your training activities, you can help us to evaluate the training toolkit. We are particularly interested to learn about your experiences of adapting material for use in your setting, and also want to test case studies and role plays in development for inclusion in an updated version of the toolkit.

Please contact Keith Alcorn at NAM (keith@nam.org.uk) for further information.



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