HIV and illness
Thanks to HIV treatment, many people with HIV can look forward to a long and healthy life.
After the introduction of effective HIV treatment in the mid 1990s, the amount of HIV-related illness and death fell dramatically.
But doctors have noticed that people with HIV seem to be at increased risk of developing illnesses such as heart, kidney and liver disease as well as some cancers. These diseases aren’t usually considered HIV-related.
To reduce the risk of these both HIV-related and non-HIV-related illnesses, it’s recommended that HIV treatment should be started when your CD4 cell count is around 350.
Some new research has provided further evidence showing the importance of starting HIV treatment at this time.
Two separate studies showed that a low CD4 cell count or a high viral load increased the risk of illnesses. A third study also found that a high viral load was a risk factor for death.
The first of these studies was conducted in France. It looked at how common serious non-AIDS-defining illnesses, serious side-effects, and AIDS-defining illnesses were in people taking HIV treatment.
Results of the study showed serious non-HIV related illnesses were much more common than either severe side-effects and AIDS.
Risk factors for non-HIV related illnesses were age over 60, a low CD4 cell count, and a viral load above 10,000.
The second study was conducted by doctors in Germany. It looked at the risk factors for AIDS-related lymphomas, a type of cancer, in people taking anti-HIV drugs.
Increasing age was a risk, so too was a CD4 cell count below 350, supporting current recommendations about the best time to start HIV treatment. The researchers also found that having a detectable viral load was also an important risk factor.
The researchers believe that this finding provides a further reason why every effort should be made to keep viral load to undetectable levels in people taking anti-HIV drugs.
Finally, American researchers have found that the amount of death amongst HIV-positive women fell dramatically once effective HIV treatment became available. However, the death rate levelled out after 2001 at a much higher level than that seen in HIV-negative American women of the same age.
High viral load was identified as one of the risk factors for death. But many of the others were related to the very difficult social circumstances that are common amongst HIV-positive women in the US, many of whom acquired the infection through injecting drug use.
Meeting the non-medical needs of people with HIV in the UK
Some the best HIV treatment and care in available in the UK and is provided by the NHS. If you are entitled to use the NHS for free, then all your HIV treatment and care will be free of charge.
But people with HIV also have complex social needs, and how well these are met is very patchy.
These include:
- Financial: No person with HIV in England lives in absolute financial poverty of destitution.
- Housing: All people with HIV in England have accommodation that meets government standards.
- Nutrition: That people with HIV in England have the knowledge and resources to eat adequately to maximise their health.
- Employment and education: Opportunities for people with HIV should be the same as those for everyone else in England.
- Information: Good quality, accurate and up to date information on all aspects of living with HIV should be readily accessible.
- Sexual health: People with HIV should be able to pursue safe, satisfying and pleasurable sex lives.
- Reproductive health: HIV-positive individuals and their partners should be able to make informed choices about the risk of transmission and methods of conception.
- Mental health: The government should commit itself to tackling the stigma and discrimination that can contribute to poorer mental health in people with HIV.
- Discrimination: Information, resources and support should be available to help people with HIV resist discrimination.
New anti-TB drug
The leading cause of death in people with HIV around the world is tuberculosis (TB). In the UK, TB is one of the most common AIDS-defining illnesses.
A combination of special antibiotics is used to treat TB. This treatment works well in people with HIV and can cure the TB.
But every year about 400,000 people around the world are diagnosed with a strain of TB that is resistant to key first-line anti-HIV drugs. This is called multidrug-resistant TB (MDR-TB).
A new drug has been developed that is very effective against drug-resistant TB. It is called TMC207. It is still being investigated in clinical trials. The results of an important study have just been published showing a very good treatment response. Some of the patients in the trial were HIV-positive.
TMC207 can interact with other drugs, and these will be investigated in further studies. Research to date showed that TMC207 didn’t have any severe side-effects, but this will also need to be explored further in studies.