We would be remiss if we didn’t honor last week’s passing of a great lady. She befriended our community when we were down, bereft of many friends. There’s no need to mention her name. The entire world knows who she was. Very early she demonstrated what utter fools we can be in our often smug wisdom by teaching us that nothing matters, not even life, if we turn away from the trials of our fellow beings. Goodbye, fair lady, may God bless you with rest.
-----
HIV
Good news about the new HIV med, Gilead’s elvitegravir. It is the second, after Merck’s raltegravir (isentress), in the new integrase inhibitor class. It’s proving to be ‘non inferior’ (or equal to) isentress in effectiveness. This novel class of meds might offer a lot of hope for HIV infection, especially those who are treatment experienced and developing resistances. Elvitegravir is near the end of its investigational process, lacking only peer review. Down the pike is ViiV Healthcare’s dolutegravir, the possible third med in this class. And by the way, there are whispers of a new boosting agent being studied, tentatively dubbed cobicistat. Try saying that while eating peanut butter.
More good news, Qutenza™ (8% capsaisin patch) is being heavily touted to ease the pain of shingles. We’ll see some of that same sort of market push to treat HIV related neuropathy in the near future. According to Medline, a 30 minute application of the patch provides results that last up to three months. Compounded from the active ingredients in chili peppers, you won’t see much right now about its uses for HIV. Just wait. The word is that it can cause some pain at the application site along with redness and itching. These symptoms are usually mild and ease after the patch is removed.
There’s one disturbing thing on the HIV front. A man in NY with a history of male sex partners, previously treated for syphilis, but not HIV+, tested HIV+ after a living donor kidney transplant. It can only mean the kidney infected the new host. The screening process has improved over the years in the medical establishment, but we believe this indicates there is considerable room for improvement.
HCV
There was a little noticed story in February. The FDA approved a finger stick test similar to that for diabetes. It is the only FDA approved point of care rapid test for the detection of the presence of HCV antibodies. By avoiding the need for a blood draw, this test offers a method to reach those who remain unaware as well as the 3 – 4 million new infectees every year. That should lead to earlier treatment, before the virus has done its major messing around with our livers. It’s a good thing.
Absolutely the best news this week comes out of Canada. Therapure Biopharma Inc. received a $350,000 grant from the National Research Council of Canada Industrial Research Assistance Program (NRC-IRAP). The company is currently developing hemoglobin, a natural blood protein, to serve as a drug carrier to improve the delivery of medications for Hepatitis C and Liver Cancer. It is expected to increase the supply of medication to the liver and reduce the drug's side effects. What could possibly be bad about that? We suspect it may lead to a whole new approach in near term treatments.
Ok, what do HCV and Epstein-Barr virus (EBV) have in common? Well, no one seems to know. According to Hepatitis Central, the two viruses should be completely distinct. EBV is an easily contracted virus most of us already carry in a dormant state. It’s a member of the herpes family. Research has demonstrated a unique connection between HVC and EBV. In the 08/99 edition of The EMBO Journal, EBV was detected in 37% of the tissues of hepatocellular carcinoma examined, most frequently in cases with HCV. EBV may act as a helper virus for HCV replication. Another connection between the two viruses appeared in the 12/10 Journal of Medical Virology. According to researchers, infection with HCV induces reactivation of EBV in B cells - an important cell in the immune system. Research into this odd connection, and how it works, may well lead to better understanding of both. There’s no reason to be nervous about this news. One virus doesn’t appear to have much effect on the other.
COINFECTION
We’re relieved to learn there is little crossover sexually transmitted infection of HCV between European/Australian and U.S. gay men. The reason for this is thought to be due to different genotypes. U.S. men are almost always either 1a or 1b, while Europeans fall into an unusual strain of genotype 4. Due to the highly charged nature of this subject, I always try to include the suspected links to sexual infection. They are, but may not be limited to: unprotected anal intercourse, fisting, multiple sex partners, group sex, use of sex toys, nasal drug use, and presence of other sexually transmitted diseases; coinfected men typically do not report injection drug use.
Telaprevir with pegylated interferon plus ribavirin reduced HCV viral load to undetectable in about 70% of HIV patients at weeks 4 and 12 in the first phase 2 study of HCV/HIV coinfected people. Hotly encouraged, Vertex Pharmaceuticals immediately announced it would launch phase 3 later this year. In early studies, boceprevir also demonstrated positive results in coinfection treatment. Interferon and ribavirin both have serious side effects. Telaprevir and boceprevir each do, too. So, each new med will contribute to greater rates of drop out. Our understanding is, however, that the adverse effects are fairly limited to rash and itch. Rash and Itch, they sound like evil twins, but we’re betting we’ll find ways to deal with them.
EASL 2011 (The International Liver Congress) convenes in Berlin March 30 – April 3.
“So much to do, so little done, such things to be.” ~ Elizabeth Taylor
