HIV treatment bulletin Volume 4 Number 7 August / September 2003



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	C O N T E N T S EDITORIAL TREATMENT ALERT EMEA public statement on early virologic non-response in patients with HIV infection treated with tenofovir in combination with lamivudine and abacavir CONFERENCE REPORT XII International HIV Drug Resistance Workshop, Los Cabos, Mexico, 10-14 June 2003 Transmission of drug resistance – at 11% in Europe and 17% in the UK HIV coinfection, reinfection and superinfection Single-dose nevirapine resistance in over 75% of mothers Transmission of drug resistant virus does not revert to wild-type and does not appear ‘less fit’ Standard genotype assays miss 75% of mutations when present in less than 35% of plasma sample Low-level resistance and minority populations: cross resistance between nevirapine and efavirenz occurs even in the absence of genotypic mutations Persistent effect of d4T and 3TC, but not NNRTIs in the presence of associated genotypic mutations Replicative capacity results complicated by minority wild-type virus Tenofovir, resistance and K65R and concomitant nucleosides Response to STI is determined by virus rather than immunological response Why resistance rarely develops with viral suppression <50 copies/ml Long-term persistence of distinct mutations in genital tract CONFERENCE REPORT The 5th International Workshop on Adverse Drug Reactions and Lipodystrophy, 8-11 July 2003, Paris Underlying mechanisms: adipocytes and cytokines More mitochondrial DNA depletion IMT and cardiovascular risk Reduced bone mineral density in HIV-positive women Treatments and clinical effects Rosiglitazone reversed peripheral lipoatrophy in HIV-patients with insulin resistance Additional benefits of exercise with metformin Mitochondrial toxicity with AZT and d4T – and benefits of switch to abacavir Facial fat loss – measuring and treatment Uridine treatment for mitochondrial toxicity Breast enlargement in men and testosterone treatment Severe efavirenz psychotic events Treatment interruption can improve lipodystrophy CONFERENCE REPORT 2nd IAS Conference on HIV Pathogenesis and Treatment, 13-16 July 2003, Paris Nevirapine and MTCT: The single-dose backlash Triple nucleoside combinations fail patients again Nucleoside-sparing regimens Dual boosted PIs in salvage therapy BMS reports on atazanavir efficacy and safety in treatment experienced patients Unsupervised treatment interruptions are associated with increased risk of AIDS or death Uridine as a potential treatment for NRTI related mitochondrial toxicity Long term exposure to nucleoside analogues and peripheral nerve function Step-wise intervention eases diarrhoea linked to PI nelfinavir (Viracept) therapy First results from ESPRIT: CD4 response to IL-2 is associated with higher nadir and baseline CD4 and younger age Lessons learned from early HAART in acute HIV infection CD4 cell reconstitution is significantly slower in older patients Pharmacology studies at the 2nd IAS conference Studies highlight problems of rectal disease in HIV-positive patients TREATMENT ACCESS Appointment of industry executive to supervise US AIDS initiative provokes criticism ANTIRETROVIRALS T-20 launched in UK US guidelines updated US approval of FTC (emtracitabine) RESISTANCE Resistance summary of new PIs: atazanavir and tipranavir SIDE EFFECTS Bone mineral metabolism and HIV-infection Protease inhibitors and Kaposi’s sarcoma (KS): KS relapse seen after switch from PI to NNRTI OTHER NEWS UK highest rate of new infections at over 5000 cases Medicines Control Agency slated by Commons committee ON THE WEB Conference reports and abstract Medscape articles Newletters and reports MEETING ANNOUNCEMENTS PUBLICATIONS AND SERVICES FROM i-BASE



	*h-tb* HIV Treatment Bulletin HTB is a monthly journal published in print and electronic format by HIV i-Base. As with all i-Base publications, subscriptions are free and can be ordered directly from the i-Base website: http://www.i-Base.info by sending an email to: subscriptions@i-Base.org.uk HTB is a not-for-profit community publication that aims to provide a review of the most important medical advances related to clinical management of HIV and its related conditions as well as access to treatments. Some articles are reproduced from other respected sources and copyright for these articles remains with the original authors and sources, as indicated at the end of each article. We thank those organisations for recognising the importance of providing widely distributed free access to information both to people living with HIV and to the healthcare professionals involved in their care. We also thank them for permission to distribute their excellent work and we encourage HTB readers to visit the source websites for further access to their coverage of HIV treatment. Articles written and credited to i-Base writers, as with all i-Base originated material, remains the copyright of HIV i-Base, but these articles may be reproduced by community and not-for-profit organisations without individual written permission and reproduction is encouraged. A credit and link to the original author, the HTB issue and the i-Base website is always appreciated.	Editor in Chief: Paul Blanchard Editor: Simon Collins Associate Editor: Graham McKerrow Commissioning Editor: Polly Clayden Medical Consultants: Dr Sanjay Bhagani, Royal Free Hospital, London. Dr Karen Beckerman, Bellevue Hospital, New York. Dr Gareth Hardy, Chelsea and Westminster Hosp, London. Dr Saye Khoo, University of Liverpool Hospital. Prof. Clive Loveday, International Laboratory Virology Centre. Dr Graeme Moyle, Chelsea & Westminster Hosp, London. Dr Stefan Mauss, Düsseldorf. Dr Stephen Taylor, Birmingham Heartlands Hospital. Dr Gareth Tudor-Williams, Imperial College, London. HIV i-Base Third Floor East Thrale House 44-46 Southwark Street London SE1 1UN T: +44 (0) 20 7407 8488 F: +44 (0) 20 7407 8489 HIV i-Base is a registered charity no 1081905 and company reg no 3962064. HTB is also known as DrFax