Behind the headlines
By Marcus Low
Medical research findings are often sensationalised and overstated in the mainstream media. We debunk three cases of HIV-related misreporting that caught our eye in recent months.
Reports of HIV cure are misleading
In October, a number of mainly British newspapers and websites reported that we are on the brink of finding a cure for HIV. The reports were based on a trial called the RIVER (Research in Viral Eradication of HIV Reservoirs) trial – currently being conducted by the CHERUB Collaboration in the United Kingdom.
All 52 study participants in the RIVER trial are receiving antiretroviral therapy. Half of them are also receiving a vaccine and an extra drug called vorinostat. The hope is that vorinostat will ‘wake up’ dormant HIV hiding in the body that the immune system (primed by the vaccine) would then kill. The trial is one of a number of trials exploring potential strategies to cure HIV.
In reaction to the RIVER trial, the media made much of the fact that HIV was undetectable in one study participant’s blood. However, HIV becomes undetectable in the blood of most people who are stable on antiretroviral treatment. The researchers don’t know yet whether HIV is hiding elsewhere in the specific person’s body and whether it will remain undetectable when that person stops taking ARVs. The researchers were quick to issue a clarification stating, ‘Our study will report in 2018, and until then we will not know if the intervention has had an effect.’
‘An important clarification is that all participants involved in the study will be expected to have no HIV in their blood because they are receiving antiretroviral therapy – these are the standard drugs we use to treat HIV.
This does not mean they have been cured as some headlines have suggested. This does mean that their immune systems will recover and that they will not transmit the virus. We look forward to reviewing the final results of this ground-breaking study, but until then should emphasise that we cannot yet state whether any individual has responded to the intervention or been cured.’ – Researchers conducting the RIVER trial,
What is really happening with tenofovir resistance?
In January 2016, it was widely reported that people, especially in sub-Saharan Africa, are becoming resistant to the key antiretroviral drug tenofovir. Tenofovir is part of the standard first-line antiretroviral combination used to treat HIV in South Africa and many other countries.
An alarmist article on the BBC website reported, ‘HIV was resistant to the drug Tenofovir in 60% of selected cases in some African countries.’
The BBC – and other media houses – didn’t do enough to place the 60 percent figure in its proper context. In fact, the study (called TeNoRes) only looked at a very limited sub-set of people living with HIV – people who failed first-line antiretroviral treatment. Among this sub-group, 60 percent were resistant to tenofovir. This number is high, but not all that unexpected since people who fail first-line treatment almost by definition have some level of drug resistance. The study excluded the many people who are currently taking first-line treatment or who have not yet started taking treatment.
‘Although this study is important in providing data for the nature of acquired drug resistance, the choice of first-line regimens should be based on levels of drug resistance among individuals who have yet to start ART, known as pre-treatment drug resistance,’ Nathan Ford and colleagues wrote in The Lancet, commenting on the TeNoRes study. ‘Although updated data are needed, available data up to 2013 suggest that rates of transmitted tenofovir resistance remain low, at 0.4% in sub-Saharan Africa.’ (emphasis added)
Efavirenz liver side effects in context
In August, media widely reported a University of Cape Town study showing that the first-line antiretroviral drug efavirenz has been associated with severe liver damage in some very rare cases. While we do not object to the study being reported in the media, it is extremely important that reporting should be properly contextualised given South Africa’s history of AIDS denialism and fear-mongering about the side effects of life-saving antiretroviral therapy. Alarmist reporting could lead to people living with HIV endangering their lives by stopping, or not starting, antiretroviral therapy.
The study, published in the highly respected journal AIDS, described 81 cases of efavirenz-related liver injury. As a description of these liver injuries, the study makes an important contribution to our understanding of efavirenz. It is important to note, though, that this was not a study aimed at establishing how prevlalent such efavirenz-related injuries are.
Even so, newspapers in the Independent group reported: ‘About 4 million HIV-positive South Africans who rely on the states [sic] single dose antiretroviral treatment (ART) are at risk of grave liver damage and death due to elements contained in one of the drugs.’
The four million figure is wrong on two counts. Firstly, it is not true that four million people in the public sector are taking efavirenz. While the total number of people taking treatment in the public sector may be heading toward four million, a substantial number of them are taking second-line treatment, which does not contain efavirenz. Secondly, and more importantly, saying that everyone taking efavirenz is at risk, is sensationalist fear-mongering. It fails to place the very small risk associated with efavirenz in the context of its life-saving benefits. While only a minute percentage of people taking efavirenz will experience these liver side effects, close to 100 percent will experience the life-saving benefits of the drug.