Weight gain on HIV treatment: drug combinations, not single drugs, need to be focus of quest for cause
Weight gain after starting antiretroviral treatment probably has multiple causes but appears strongly linked to specific drugs, and to combinations of drugs, Dr Andrew Hill of the University of Liverpool told the 17th European AIDS Conference (EACS 2019) in Basel, Switzerland. He highlighted some of the problems with the ways in which the phenomenon has been studied so far and called for greater inclusion of women and black people in clinical trials of new drugs and currently prescribed agents, so that side effects of antiretroviral drugs can be studied in different population groups.
Metabolic syndrome – including obesity – developed significantly more frequently in people who received dolutegravir, tenofovir alafenamide (TAF) and emtricitabine compared to other regimens in the South African ADVANCE study, Dr Michelle Moorhouse reported at the conference.
People with suppressed viral load who switched to an integrase inhibitor-based regimen experienced only small gains in weight and do not appear to gain more weight than HIV-negative people or people who continued taking other regimens, two large cohort studies presented at the conference reported.
The integrase inhibitors dolutegravir (Tivicay, also in Triumeq and Dovato) and raltegravir (Isentress) cause changes in the structure of fat cells that may promote obesity, and can cause insulin resistance, studies of cells sampled from people living with HIV and monkeys exposed to the drugs have found.
Further evidence on the efficacy of two-drug antiretroviral regimens as simplification options for people with suppressed viral load on three-drug regimens was presented at the conference. However, German HIV specialist Professor Hans-Jürgen Stellbrink of the University of Hamburg sounded a note of caution about two-drug treatment during a discussion session at the conference, warning that “we're practising evolutionary biology on the virus by treatment, exerting the maximum selective pressure on the virus, and what I’ve learnt over 33 years is not to reduce that selective pressure on the virus.”
The conference heard about another case of a PrEP user who caught HIV despite being apparently adherent to PrEP. These cases are likely to keep on happening, Dr Hans Benjamin Hampel of Zürich University Hospital told EACS 2019, and we perhaps need to move beyond trying to establish which – if any – cases of PrEP failure have watertight evidence of 100% adherence.
The 96-week results of the DISCOVER trial, which compared the efficacy and safety of two different formulations of the antiretroviral drug tenofovir when used as daily PrEP by gay and bisexual men, were announced at the conference.
Antiretroviral treatment containing the older formulation of tenofovir (TDF) did not increase the risk of chronic kidney disease in previously untreated people with HIV at low risk for kidney disease, a large American cohort study reported at the conference.
A study presented at the recent conference comparing reported drug use among HIV-positive men attending clinics in England, Spain, Greece and Italy, has found higher rates of drug use in England than in other countries and considerably higher usage of the drugs used in chemsex (sexualised drug use) – methamphetamine, GHB/GBL, mephedrone and ketamine.
PREVENIR, the French open-label study looking at PrEP use in gay and bisexual men in the Paris region, has found that 16% of study participants either told clinicians they were stopping PrEP or disappeared from the study within a year, and that 32% had discontinued PrEP after 30 months.
The tenth edition of the European AIDS Clinical Society Guidelines was launched at the conference. Its expansion in size – from 109 pages in the ninth print edition first published two years ago to 283 pages today, plus numerous online-only supplementary tables – is evidence of the complexity of needs it seeks to address. In particular, as the average age of people with HIV increases, much of its new material has been developed with the needs of the ageing person with HIV in mind.
Anal cancer: Australian study of precancerous tissues in gay men shows little increased risk in positive men, almost no cancer cases
An Australian study of gay men recruited in community settings in Sydney, Australia has found a very high prevalence of HSIL (high-grade squamous intraepithelial lesions – precancerous changes in the cells of the anal lining that may indicate a risk of developing cancer). Yet in three years of follow-up, only one man out of 617 progressed to anal cancer, the conference heard.
The 90-90-90 targets for HIV diagnosis, treatment and viral suppression will be missed in much of eastern Europe due to poor access to HIV treatment, the conference heard on its opening day.
In his first public speech since announcing that he is living with HIV in September, Wales rugby star Gareth Thomas spoke of the need to confront HIV stigma at the conference. He spoke at a symposium organised by Gilead Sciences on the conference's opening day.