Andrew Freedman

British HIV Association guidelines for the treatment of HIV-1-infected adults with antiretroviral therapy 2008

This summary document is an update to the full British HIV Association (BHIVA) Treatment Guidelines published in HIV Medicine in July 2005 (Volume 6, Supplement 2). Only the ‘What to start with’ and ‘Treatment-experienced patients’ sections have been completely rewritten. The tables of recommendations (Tables 1–7) have also been updated to include new data. Please refer to the full guidelines for more information.

British HIV Association guidelines for the treatment of TB/HIV coinfection 2011

1.0 Summary of guidelines 2.0 Introduction 3.0 Aims of TB treatment 4.0 Diagnostic tests 5.0 Type and duration of TB treatment 6.0 Drug–drug interactions 7.0 Overlapping toxicity profiles of antiretrovirals and TB therapy 8.0 Drug absorption 9.0 When to start HAART 10.0 Directly observed therapy (DOT) 11.0 Management of relapse, treatment failure and drug resistance 12.0 Pregnancy and breast-feeding 13.0 Treatment of latent TB infection – HAART, anti-tuberculosis drugs or both? 14.0 Immune reconstitution inflammatory syndrome (IRIS) 15.0 Prevention and control of transmission 16.0 Death and clinico-pathological audit 17.0 Tables 18.0 Key points 19.0 References

British HIV Association guidelines for the management of coinfection with HIV-1 and hepatitis B or C virus 2010

Table of

BHIVA treatment guidelines for tuberculosis (TB)/HIV infection 2005

AL Pozniak, RF Miller, MCI Lipman, AR Freedman, LP Ormerod, MA Johnson, S Collins and SB Lucas, on behalf of the BHIVA Guidelines Writing Committee Chelsea and Westminster NHS Healthcare Trust, London, UK, Centre for Sexual Health and HIV Research, Department of Primary Care and Population Sciences, Royal Free and University College Medical School, University College London, London, UK, Royal Free Hospital, London, UK, Cardiff University School of Medicine, Cardiff, UK, Blackburn Royal Infirmary, Blackburn, Lancashire, UK, HIV i-Base, London, UK, Department of Histopathology, GKT School of Medicine, St Thomas’ Hospital, London, UK

Early and prolonged antiretroviral therapy is associated with an HIV-1-specific T-cell profile comparable to that of long-term non-progressors.

Background Intervention with antiretroviral treatment (ART) and control of viral replication at the time of HIV-1 seroconversion may curtail cumulative immunological damage. We have therefore hypothesized that ART maintenance over a very prolonged period in HIV-1 seroconverters could induce an immuno-virological status similar to that of HIV-1 long-term non-progressors (LTNPs). Methodology/Principal Findings We have investigated a cohort of 20 HIV-1 seroconverters on long-term ART (LTTS) and compared it to one of 15 LTNPs. Residual viral replication and reservoirs in peripheral blood, as measured by cell-associated HIV-1 RNA and DNA, respectively, were demonstrated to be similarly low in both cohorts. These two virologically matched cohorts were then comprehensively analysed by polychromatic flow cytometry for HIV-1-specific CD4+ and CD8+ T-cell functional profile in terms of cytokine production and cytotoxic capacity using IFN-γ, IL-2, TNF-α production and perforin expression, respectively. Comparable levels of highly polyfunctional HIV-1-specific CD4+ and CD8+ T-cells were found in LTTS and LTNPs, with low perforin expression on HIV-1-specific CD8+ T-cells, consistent with a polyfunctional/non-cytotoxic profile in a context of low viral burden. Conclusions Our results indicate that prolonged ART initiated at the time of HIV-1 seroconversion is associated with immuno-virological features which resemble those of LTNPs, strengthening the recent emphasis on the positive impact of early treatment initiation and paving the way for further interventions to promote virological control after treatment interruption.

British HIV Association guidelines for the treatment of HIV-1-positive adults with antiretroviral therapy 2012: BHIVA guidelines for the treatment of HIV-1-positive adults with antiretroviral therapy 2012

The overall purpose of these guidelines is to provide guidance on best clinical practice in the treatment and management of adults with HIV infection with antiretroviral therapy (ART). The scope includes: (i) guidance on the initiation of ART in those previously naïve to therapy; (ii)support of patients on treatment; (iii) management of patients experiencing virological failure; and (iv) recommendations in specific patient populations where other factors need to be taken into consideration. The guidelines are aimed at clinical professionals directly involved with and responsible for the care of adults with HIV infection and at community advocates responsible for promoting the best interests and care of HIV-positive adults. They should be read in conjunction with other published BHIVA guidelines.

Selection of drug‐resistant HIV‐1 during the early phase of viral decay is uncommon in treatment‐naïve patients initiated on a three‐ or four‐drug antiretroviral regimen including lamivudine

Therapy failure due to drug resistance development is a common phenomenon in HIV‐infected patients. However, when the drug pressure leads to the earliest selection of drug‐resistant HIV‐1 populations is still unclear. In this study, the extent to which selection of the HIV‐1 reverse transcriptase M184I/V mutations occur during the initial phase of viral decay in treatment‐naïve HIV‐1 infected patients receiving antiretroviral therapy (ART) was examined. Plasma virus from three cohorts of treatment‐naïve patients initiating quadruple (n = 43), triple (n = 14) or dual (n = 15) lamivudine‐containing ART were analyzed for M184I/V during the first 6 months of therapy using direct sequencing and a sensitive selective real‐time PCR method. Among quadruple ART patients, who all were treated at primary HIV‐1 infection, only one patient developed M184V after 6 weeks of therapy, having had wild‐type virus at baseline. No mutations were found in chronically infected patients on triple ART. In patients on dual therapy, M184I/V mutants were found frequently. Selection of M184I/V mutants was found to be rare during the initial phase of viral decay after initiation of ART in adherent patients given a three or four‐drug combination, in contrast to those receiving a less potent regimen. The results suggest that triple and quadruple lamivudine + PI or PI/r containing ART given to treatment‐naïve adherent patients is potent enough to prevent development of resistance during the first months of therapy. J. Med. Virol. 81:1–8, 2009.

Evaluation of HIV testing recommendations in specialty guidelines for the management of HIV indicator conditions.

European guidelines recommend HIV testing for individuals presenting with indicator conditions (ICs) including AIDS‐defining conditions (ADCs). The extent to which non‐HIV specialty guidelines recommend HIV testing in ICs and ADCs is unknown. Our aim was to pilot a methodology in the UK to review specialty guidelines and ascertain if HIV was discussed and testing recommended.

Future Hospital update from Wales

As we head into winter, this seems like a good opportunity to look back and reflect on yet another busy year for the NHS in Wales. While we have not had to contend with junior doctor strikes or the direct effect on our health service of this summers political high drama, there is still a great deal to report. First of all, Dr Alan Rees, the inaugural RCP vice president for Wales stepped down from this role when his term ended in August 2016. He will be missed a great deal by everyone at the RCP, especially the team in Wales! Our own Welsh general election took place in May, resulting in a Labour minority government. It was a big night for all of the parties, not least for UKIP, which won seven seats, and propelled the former Conservative MP Neil Hamilton into a leadership role within the Senedd group. Plaid Cymru became the official opposition, while the Liberal Democrats lost all but one seat; their leader, Kirsty Williams, resigned and was invited to sit in the new Labour cabinet as education secretary. Dr Alan Rees, former RCP vice president for Wales …