UNAIDS, UK both issue draft confidentiality guidelines for patient record sharing
Two new documents highlight the tensions between the optimal clinical care of an HIV-positive individual and the critical need for maintaining confidentiality. UNAIDS has produced draft guidelines for lower- and middle-income countries that aim to help protect patient confidentiality during the scale-up of HIV testing and treatment. In the United Kingdom, the British Association of Sexual Health and HIV (BASHH) and the British HIV Association (BHIVA) have also produced draft guidelines on protecting patient confidentiality in the era of electronic information sharing.

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First-line treatment choices proving challenging for African ART programmes
African countries are facing serious financial and practical dilemmas over implementing recent WHO guidelines urging a shift away from d4T-based combinations for first-line antiretroviral treatment, the 2007 HIV Implementers’ Meeting heard last week in Kigali, Rwanda.

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Offer second HIV test late in pregnancy to women with high HIV risk
Two instances of mother-to-child transmission of HIV occurred in the United Kingdom because the mothers either became infected with HIV during pregnancy, or had their HIV screen during the ‘window period’ before the body has yet produced antibodies to the infection. The cases are reported in the June 22nd edition of the British Medical Journal and the authors, from the hospital in Coventry which treated the women, recommend that women from groups with a high risk of HIV should be offered a second HIV test at the 32nd week of pregnancy.

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Four-year analysis of tenofovir finds “favourable safety profile”
The largest safety analysis so far of tenofovir disoproxil fumarate (Viread) has shown low rates of serious adverse events (SAEs) and demonstrated a “favourable safety profile” for the drug. Serious adverse events were observed in 6% of the Expanded Access Program (EAP) patients and considered related to tenofovir in 2%; kidney-related SAEs were seen in 0.5%. The report, by a multinational study team, was published in the June edition of AIDS.

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Global MDR and XDR TB control needs extra $2.15 billion by end of 2008, says WHO
The World Health Organization (WHO) said on Saturday that national governments and donors will need to spend a total of $2.15 billion between now and December 2008 in an ambitious programme of measures to contain the growing threat of multidrug-resistant and extensively drug-resistant tuberculosis (TB).

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WHO issues clarification on pharmacovigilance funding
The World Health Organization’s (WHO) HIV department has asked aidsmap.com to clarify the status of funding for its antiretroviral pharmacovigilance programme, details of which we reported in an article WHO to monitor ARV side-effects worldwide on June 18th. We incorrectly reported that funding had already been agreed for this initiative.

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TB treatment and HBV: risk factors for liver toxicity in South Africans on antiretroviral therapy
Liver toxicity appears to be fairly infrequent and non-severe among HIV-positive individuals on antiretroviral therapy in South Africa. According to a retrospective cohort study of 868 South Africans, severe hepatotoxicity occurred at a rate of 7.7 episodes per 100 person years – comparable with findings of studies in other areas. Tuberculosis treatment and hepatitis B were the greatest risk factors for episodes of severe toxicity. The findings were published in the June 2007 issue of AIDS.

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Near-global nelfinavir (Viracept) recall 'very difficult situation'
The World Health Organization (WHO), drug companies, drug regulators, NGOs and national governments have been working together to minimise the disruption of antiretroviral therapy to individuals affected by the near-global recall of nelfinavir (Viracept).

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Million more AIDS deaths forecast in South Africa by 2010
Even the fastest rate of treatment scale up in South Africa will be unable to prevent around one million AIDS deaths between now and 2010, according to projections from Massachusetts General Hospital presented on Saturday at the HIV Implenters’ Meeting in Kigali, Rwanda.

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Antiretroviral therapy results bringing dilemmas for private sector
Productivity among workers in the private sector who receive antiretroviral therapy through employee health schemes may not always return to pre-illness levels, according to findings from Kenya. Jonathan Simon of Boston University told the HIV Implementers’ Meeting in Kigali, Rwanda, that companies may have to look at earlier initiation of treatment if they want to see workers return to full productivity.

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Does the scale of the epidemic in South Africa call for compulsory HIV testing?
The scope of the HIV disaster that South Africa is facing may justify a move towards compulsory (though confidential) HIV testing, according to Dr Francois Venter, one of the country’s leading clinicians.

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WHO to monitor ARV side-effects worldwide
World Health Organization (WHO) is establishing an HIV pharmacovigilance programme in order to map more accurately the incidence of side effects caused by antiretroviral drugs, and to determine whether there are differences in the incidence of particular side effects between countries, Professor Charles Gilks of WHO said on Saturday at the 2007 HIV Implementers’ meeting in Kigali, Rwanda.

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Link between diabetes and antiretrovirals may particularly affect resource-poor settings
An understanding of the links between antiretroviral drugs and diabetes is growing, with previous data particularly implicating protease inhibitors (PIs). Now, a Swiss study, published in the July 1st edition of Clinical Infectious Diseases has found that other HIV drugs, often used in resource-poor settings, may also increase the risk in populations that may already have a high risk of diabetes.

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Dutch study and Canadian editorial call for earlier intiation of ART
Restoring CD4 counts to ‘normal’ levels is possible within seven years if individuals begin antiretroviral therapy at CD4 counts above 350 cells/mm3, according to a Dutch study published in the June 1st issue of the Journal of Acquired Immune Deficiency Syndromes (JAIDS). An accompanying editorial calls for a “broader re-evaluation of the ideal time to start therapy, incorporating outcomes other than survival, such as the level of immune reconstitution” and the effect on HIV transmission.

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South African AIDS Conference signals new unity, chance for progress
South Africa has crossed a Rubicon in the past few months in relation to HIV and the ball is now in civil society’s court to achieve progress, Mark Heywood of the AIDS Law Project told the closing session of the Third South African AIDS Conference in Durban on June 8th.

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Public service strike disrupting HIV care in South Africa
South Africa’s public service strike is leading to treatment interruptions for some people with HIV, the Southern African HIV Clinicians Society said yesterday in a statement, as the Department of Health moved to sack public sector workers who have been out on strike for twelve days.

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