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By David Rowlands, Oct 3 2017 06:59AM

At last February’s Conference on Retroviruses and Opportunistic Infections (CROI), Dutch clinicians presented a so-far unique case of a man who had apparently become infected with non-drug-resistant HIV while taking pre-exposure prophylaxis (PrEP) consistently. Two previous cases of PrEP failure had been reported, but in both cases, the men concerned had been infected with multidrug-resistant HIV. This case, therefore, raised concerns that PrEP may not be 100% effective.


The case has now been published as a paper in The Lancet HIV journal. The report confirms the details presented at CROI but adds interesting data on an unusual course of seroconversion. Although there is no direct evidence for this, the researchers hypothesise that the PrEP might have stopped a localised HIV infection in rectal tissue spreading through the body, and the infection only became a typical, systemic infection when PrEP was stopped.


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Source of information aidsmap.com

By David Rowlands, Sep 28 2017 08:03AM

The majority of HIV-positive people in the UK are not receiving recommended monitoring of cardiovascular risk, according to the results of an audit conducted by the British HIV Association (BHIVA) published in BMC Infectious Diseases.


The audit also showed that only a small minority of people are receiving appropriate monitoring of bone mineral density and fracture risk. There was wide variation between clinics in monitoring rates for some conditions. But the survey also revealed some excellent practice, with monitoring of viral load and adherence to antiretrovirals exceeding national targets.


“There was high participation in the national audit and the data showed good practice in some areas,” comment the authors. “However, low recorded rates of monitoring of cardiovascular risk were noted and smoking status was not reported for one in seven patients, and less than half of current smokers were offered cessation support.”


Improvements in treatment and care means that HIV is now a chronic, manageable condition with many HIV-positive people having a normal or near-normal life expectancy.


Cardiovascular, liver, kidney and bone disease are now important causes of illness in HIV-positive individuals. The prompt identification of these conditions is important so that appropriate therapy can be initiated.


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Source of information www.aidsmap.com

By David Rowlands, Sep 13 2017 10:58AM

The cash-strapped NHS has struck up a 'pay as you cure' deal for a hepatitis C drug as it desperately attempts to save money.


Under the new deal, which is the first of its kind, the National Health Service will only pay for the medication if a patient is successfully cured.


For those who aren't cured by taking the medication, its manufacturer, who hasn't been identified, will cough up and pay the fee.


If it proves successful, the move by NHS England could be adopted for other costly treatments to reduce the nation's drug bill.


Currently, the health service spends more than £15 billion on the range of drugs it provides every year, according to official figures.


It comes amid repeated cuts to the NHS, which has seen various services scrapped in recent months, creating a 'postcode lottery' for many.


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By David Rowlands, Aug 17 2017 08:09AM

Work has begun to develop a digital value proposition tool for a novel rapid sexually transmitted infection (STI) test


Aquarius Population Health, a leading independent health economics consultancy, has recently been awarded an 18-month Innovate UK grant in collaboration with Atlas Genetics Ltd and the Applied Diagnostic Research and Evaluation Unit at St George’s University of London (total £2,000,000). The funding will be used to develop evidence for health services to support the introduction of a new rapid diagnostic test. In 30-minutes the test can diagnose multiple sexually transmitted infections including chlamydia and gonorrhoea – infections which could take up to a week to diagnose using the current laboratory testing systems.


Dr Mike Harvey and Dr Susie Huntington from Aquarius Population Health will be leading the work from Aquarius Population Health - mapping patient pathways within sexual health clinics and building a digital value proposition tool. Understanding the patient pathway facilitates thinking about new and better ways of delivering care and optimising resources for clinics. The digital value proposition tool will enable UK-based sexual health services to anticipate the potential benefits, costs and cost-effectiveness of adopting the new test. It will also quantify the impact on patients, sexual health services and on public health more broadly.


Dr Elisabeth Adams, Managing Director of Aquarius Population Health, comments:


“We are very excited to collaborate on this Innovate UK funded project. We’re convinced that our innovative digital value proposition tool will help sexual health clinics in their commissioning and adoption of this new technology.”


Dr John Clarkson, Chief Executive Officer of Atlas Genetics, comments:


“We are delighted to have been selected for this substantial follow-on contract. The work being done by this collaboration will enable us to better understand how best to integrate our io® system into UK sexual health clinical practice. Innovate UK’s commitment to introducing new, pioneering approaches to healthcare validates both our technology and our leading role in molecular diagnostics.”


Dr Tariq Sadiq, Director of The Applied Diagnostic Research & Evaluation Unit (ADREU), at St George’s University of London (SGUL), comments:


“This is a highly exciting and innovative approach to overcoming the substantial challenges to getting great technology adopted into the NHS by shedding light on potential routes through the complex landscape of factors and obstacles in our health systems.”


By David Rowlands, Jul 31 2017 08:09AM

• MAVIRET is a new 8-week, pan-genotypic treatment for adult hepatitis C patients without cirrhosis and who are new to treatment


• Marketing authorisation is supported by 97 percent cure rate across this group of patients (patients who achieve a sustained virologic response at 12 weeks post treatment (SVR12) are considered cured of hepatitis C)


• MAVIRET is a pan-genotypic treatment indicated for use in patients across all stages of chronic kidney disease


• AbbVie’s investigational, pan-genotypic HCV treatment is also under Priority Review by the U.S. FDA


AbbVie (NYSE: ABBV), a global biopharmaceutical company, today announced that the European Commission has granted marketing authorisation for MAVIRET®, a oncedaily, ribavirin-free treatment that combines glecaprevir (100mg), an NS3/4A inhibitor and pibrentasvir (40mg), an NS5A inhibitor (glecaprevir/pibrentasvir), for adults with chronic hepatitis C virus (HCV) infection across all major genotypes (GT1-6). “Maviret represents a new 8-week pan-genotypic treatment option for adult patients without cirrhosis and who are new to treatment, who comprise the majority of the estimated 214,000 people living with HCV in the UK. The treatment combines two distinct antiviral agents and has high efficacy against most HCV genotypes, including those commonly associated with resistance to treatment,” said Dr Alice Butler, Medical Director, AbbVie UK.


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By David Rowlands, Jul 24 2017 10:10AM

Hepatitis C


WHO prequalified the first generic version of sofosbuvir, a critical medicine for the treatment of hepatitis C. The development could expand access to treatment by increasing the number of quality-assured generic medicines on the market. Sofosbuvir, 400 mg tablet, is manufactured by Mylan Laboratories Ltd., India.


“This is a break-through medicine with a 95% cure,” said Dr Suzanne Hill, Director, Essential Medicines and Health Products at WHO. “The first WHO-prequalified generic of this product will give large procurers and countries the assurance of quality for an affordable product.”


HIV self-test


WHO prequalified the first HIV self-test in a move to increase HIV diagnosis and treatment. The product, OraQuick ® HIV Self-Test (manufactured by OraSure Technologies Inc.) uses oral fluid as a specimen and provides results in as little as twenty minutes.


“The prequalification of this product means that countries with poor laboratory infrastructure will be able to safely increase testing capacity, thereby facilitating treatment of people living with HIV,” said Dr Suzanne Hill, Director, Essential Medicines and Health Products, WHO.


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By David Rowlands, Jul 13 2017 08:38AM

The British HIV Association (BHIVA) today celebrates the availability of pre-exposure prophylaxis (PrEP) for HIV on the NHS in Scotland, and its availability (from 17 July) on the NHS in Wales as part of a three-year trial.


BHIVA Chair, Professor Chloe Orkin, said: “All those responsible for gaining access to this life-changing drug on the NHS for people in Scotland and Wales should be proud of their tremendous achievement. It has not been an easy path.


“While celebrating this progress, we remain vigilant regarding the NHS England PrEP impact trial, which is currently due to begin in August. Recent reports indicating the positive impact of PrEP on HIV transmission in London highlight why the trial must remain a top priority for NHS England.”


In the most recent update on the PrEP impact trial, Public Health England and NHS England reported that NHS England ‘expects to be able to confirm the award of the final contract [for the supply of drugs to the trial] by 31 July 2017, meaning trial drugs could be available from early August, in readiness for the trial to begin once ethics approval is received and trial sites are prepared.’




By David Rowlands, Jul 10 2017 09:24AM

The G20 Leaders’ Declaration carries an important section on antimicrobial resistance, and tuberculosis is identified as a priority for research and development.


On 7 & 8th July 2017, leaders of the G20 met in Hamburg, Germany, to address major global economic challenges and to contribute to prosperity and well-being.


Their Declaration, published on July 8, carries an important section on combatting antimicrobial resistance (AMR):


“AMR represents a growing threat to public health and economic growth. To tackle the spread of AMR in humans, animals and the environment, we aim to have implementation of our National Action Plans, based on a One-Health approach, well under way by the end of 2018.


We will promote the prudent use of antibiotics in all sectors and strive to restrict their use in veterinary medicine to therapeutic uses alone. Responsible and prudent use of antibiotics in food producing animals does not include the use for growth promotion in the absence of risk analysis. We underline that treatments should be available through prescription or the veterinary equivalent only. We will strengthen public awareness, infection prevention and control and improve the understanding of the issue of antimicrobials in the environment.


We will promote access to affordable and quality antimicrobials, vaccines and diagnostics, including through efforts to preserve existing therapeutic options. We highlight the importance of fostering R&D, in particular for priority pathogens as identified by the WHO and tuberculosis.


We call for a new international R&D Collaboration Hub to maximise the impact of existing and new anti-microbial basic and clinical research initiatives as well as product development. We invite all interested countries and partners to join this new initiative. Concurrently, in collaboration with relevant experts including from the OECD and the WHO, we will further examine practical market incentive options.”


I am pleased to see this Declaration. It is timely and welcome, because AMR is a major health threat, and it is estimated that by 2050, 10 million lives a year and a cumulative 100 trillion USD of economic output are at risk due to the rise of drug-resistant infections.


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By David Rowlands, Jul 3 2017 08:27AM

The Standards were developed by a Steering Group of people living with HIV, representatives of NGOs who provide peer support for people living with HIV and of the British HIV Association (BHIVA), National HIV Nurses Association (NHIVNA) and Children’s HIV Association (CHIVA). Targeted consultation was undertaken with groups of people living with HIV in London and Liverpool, the youth group leaders of the CHIVA Summer Camp, and with individuals from across the sector. From August to September 2016 the standards were then out for open consultation through e-forums including UK-CAB and NGOs across the UK.


Downlaod the document


By David Rowlands, Jun 7 2017 02:32PM

Six questions can identify HIV-positive gay men who are at elevated risk of having acute (recent) hepatitis C infection and who would benefit from further testing, according to a paper published in Eurosurveillance last week. The risk score was based on data from a Dutch cohort and has been validated with separate datasets from Belgium, the Netherlands and England.


Better targeted testing of hepatitis C for gay men living with HIV could reduce the number of tests done, lowering costs and facilitating implementation in settings such as sexual health clinics. There is a lack of recommendations on how to target hepatitis C testing.


Guidelines from the European AIDS Treatment Network recommend six-monthly testing of liver function and annual testing for antibodies, for HIV-positive gay men “at risk for contracting acute hepatitis C infection” – but don’t specify how clinicians should identify individuals who might be at risk.


Guidelines from the American Association for the Study of Liver Disease and the Infectious Diseases Society of America recommend that all HIV-positive gay men who have unprotected sex should have annual hepatitis C screening.


The six questions in the risk score concern self-reported behaviours:


Condomless receptive anal intercourse in the past six months (score 1.1)

Sharing of sex toys in the past six months (score 1.2)

Fisting without gloves in the past six months (score 0.9)

Injecting drug use in the past 12 months (score 1.4)

Sharing of straws to snort drugs in the past 12 months (score 1.0)

An ulcerative sexually transmitted infection in the past 12 months (score 1.4)


A man scoring a total of 2.0 or more would be recommended to be tested for acute hepatitis C.


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Source of information aidsmap.com

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