A survey conducted by the British HIV Association – the professional organisation of the UK’s HIV doctors -  has found that  around 40% of people diagnosed with HIV when they already have a very low CD4 cell count are not starting HIV treatment within six months of their diagnosis. This seems quite worrying as treatment guidelines clearly state that everybody who is ill because of HIV, or who has a CD4 cell count of 200 or below should start treatment because of the very real risk of HIV causing a potentially life-threatening illness.

Being diagnosed with HIV is life-changing and for many a distressing, even traumatic event. Many people need time to adjust to finding out that they have an infection that they will have for the rest of their life. Starting HIV treatment can also involve major psychological and practical adjustments.

It could well be the case that many recently diagnosed people with CD4 counts low enough to warrant the initiation of HIV therapy just don’t feel ready to start treatment yet. In such circumstances, antibiotic and anti-viral drugs can be used to reduce the short-term risk of developing AIDS-defining illnesses, and the benefits of HIV treatment should be explained and the patient supported until they are ready to start treatment. And let’s not forget that even though treatment could well mean that a person with HIV lives a normal lifespan, taking HIV treatment is a life-time commitment.

Anti-HIV treatment

Women doing better than men

Taking potent anti-HIV treatment can mean a longer and healthier life and HIV treatment works well, regardless of a person’s race or gender.

It is well known that women who aren’t taking HIV treatment tend to have higher CD4 cell counts and lower viral loads than men. Despite this, women and men experience the same rate of HIV disease progression if they don’t receive anti-HIV drugs.

Now a study has shown that women actually have a much better response to HIV treatment than men. Spanish researchers looked at the CD4 cell counts and viral loads of just over 2,600 men and women a year after they started, or changed, HIV treatment. They found that women who were starting HIV treatment for the first time had a much higher CD4 cell count after a year of HIV drugs than men who were commencing HIV treatment. Women also tended to have a lower viral load after twelve months than men.

The researchers then looked at the twelve-month response to treatment in men and women who had taken anti-HIV drugs before and were starting a new treatment combination. They found that women tended to have a higher CD4 cell count, and were much more likely than men to have an undetectable viral load.

Other studies have shown no difference in treatment response between the sexes, so it will be interesting to see if the results of this study are repeated elsewhere.

Many not starting treatment when guidelines say they should

It is recommended that everybody who is ill because of HIV, or whose immune system has been weakened by HIV (indicated by a CD4 cell count of 201 – 350), should start HIV treatment.

But a study by the professional organisation of the UK’s HIV doctors has found that only 30% of people with a CD4 cell count between 201 – 350 started anti-HIV treatment in 2006.

The study also found that 40% of people diagnosed with HIV with a CD4 cell count of 200 or below (which shows that a person has a real risk of developing a potentially life-threatening AIDS-defining illness) didn’t start HIV treatment within six months of their HIV diagnosis.

According to one of the doctors who conducted the study, it could be that some HIV doctors weren’t following official guidelines. Alternatively, some people could be declining HIV treatment, despite their doctors’ recommendation, because of fears about the side-effects of HIV treatment, or denial about their health status or the very real health risks that a low CD4 cell count indicates. The researchers also think that it is possible that some people were not returning to their HIV clinic after their diagnosis because they feared that their uncertain immigration status could lead to financial charges. 

Test shows risk of heart and kidney disease

Anti-HIV drugs can cause side-effects in both the short- and longer-term. Although many of these side-effects can be unpleasant, they can often be lived with, don’t involve any serious health risks and usually go away over time.

But some side-effects can be more serious. A small number of people taking anti-HIV drugs experience kidney problems, and in some cases kidney failure. And it has been shown that treatment with a protease inhibitor can increase the long-term risk of heart disease. Most of the time, the risk of serious side-effects can be avoided or reduced, and people taking anti-HIV treatment should be monitored closely for the warning signs of side-effects.

A new study suggests that people with HIV were much more likely than age-matched HIV-negative people to have small amounts of the protein, albumin, in their urine. Albumin in urine is a well-known risk factor for kidney and heart disease.

Risk factors for having albumin in urine were older age, high blood pressure, a low CD4 cell count, and a high viral load.

New drug shows promise

A single dose of an experimental anti-HIV drug can reduce viral load by 90% for two or three weeks.

The drug is based on an antibody that stops HIV binding to immune cells. It is called PRO 140. Maraviroc, a drug that is doing well in clinical trials, and is expected to be approved soon, stops HIV binding to the same part of immune cells – the CCR5 receptor.

In the future PRO 140 could be used with a drug that works against another part of HIV – the nucleoside analogue elvucitabine, meaning that a combination of drugs would be available that only require once-weekly dosing. This might make adherence easier for some people.

TB

Tuberculosis (TB) is the biggest cause of illness and death amongst people with HIV around the world and one of the most common AIDS-defining illnesses in the UK. In most cases, taking a combination of antibiotics for six months can completely cure TB, even if a person has HIV.

Symptoms of TB include a cough that won’t go away, weight loss, chills and fevers, and night sweats. Some people also have pain in their chest and cough blood.

Doctors in London have found that they can detect more cases of TB if they ask people about their risks of TB when they register and have a health check at their first appointment.

Doctors in Hackney, a high TB area, asked their new patients if they had any symptoms that are associated with TB; if they had had any contact with people who were known to have TB; and if they came from a country where TB was common. Many cases of TB in cities like London have occurred in people who have recently come to live in the UK from countries where there is a lot of TB.

If TB was suspected, other tests, including a skin test for TB and a chest X-ray were carried out. Some people also provided with a TB vaccination, but people with HIV should be given this vaccine because it is a so-called live vaccine and can cause a TB-like illness.

The doctors conducting the TB checks detected many more cases of ‘active’ and ‘latent’ TB than doctors who didn’t, and they think that offering routine TB checks could help identify patients with the disease in other UK cities.

Sexual health

A study conducted in the three UK cities with the largest gay populations – London, Manchester and Brighton – has found that many HIV-positive gay men are having unprotected sex.

Approximately a third of HIV-positive men reported unprotected sex, and around a third of these men said that they didn’t know if the man they had unprotected sex with was HIV-positive, negative, or untested.

The findings of the study are very similar to the 2005 UK Gay Men’s Sex Survey.

Having unprotected sex with a person whose HIV status you don’t know could involve a risk of HIV transmission. Some people in the UK have been sent to prison after ‘recklessly’ infecting their sexual partners. Unprotected sex – with a person of any HIV status - can involve a risk of sexually transmitted infections.

Although choosing to have unprotected sex with other HIV-positive people (often called ‘serosorting’) means that  there is no risk of HIV transmission, and provides an opportunity for a more fulfilling sex life for some, there are health risks.

Sexual transmission of hepatitis C virus has been reported between HIV-positive gay men who had unprotected sex, and there have been a small number of cases of superinfection – or reinfection – with another strain of HIV.

Condoms provide effective protection against HIV and sexually transmitted infections.

New from NAM

Criminal HIV transmission

This new title from NAM provides evidence-based, up-to-date information in clear, layman’s language on aspects of HIV that may relate to the investigation, prosecution, and defence of criminal HIV exposure/transmission cases.

It’s primarily aimed at people who work within, or are in contact with, the criminal justice system. But the book is also likely to be useful for those who work at HIV support organisations, as well as HIV-positive individuals with an interest in criminal HIV transmission.

The book cost £14.95 for professionals, but is available at the discounted rate of £9.95 to voluntary organisations.

For more information or to order a copy of the book, please contact NAM by phoning 0207 8400050 or emailing info@nam.org.uk

Booklets

NAM's information booklets anti-hiv drugs, hiv & mental health, hiv & hepatitis and hiv & women have recently been updated.

Please order your free copies today.

You can also download them at:

http://www.aidsmap.com/cms1187580.asp

Please note we do charge professionals for these booklets, but don't forget, if your clinic is giving them out to patients you can order them for free. Overseas postage costs apply To find out more email info@nam.org or phone 020 7840 0050.