HIV Weekly - 11th July 2012

Diarrhoea in people with HIV

Thanks to improvements in treatment and care, most people with HIV in the UK can expect to live a long and healthy life.

However, diarrhoea continues to be a common problem for people with HIV.

It is important to take diarrhoea seriously, as it can have a big impact on quality of life, and can cause people to stop or change their HIV treatment. Possible causes of diarrhoea include infections, the effects of HIV on the gut and the side-effects of some anti-HIV drugs.

Because diarrhoea is an ongoing problem for many people, doctors in the US recently made recommendations concerning the diagnosis and management of the condition.

The doctors propose that diarrhoea should be defined as three or more bowel movements each day, involving unformed or liquid stool. 

In the days before HIV treatment, infections were a major cause of diarrhoea. This was especially the case for people with a low CD4 cell count.

Infections should still be considered as a possible cause of diarrhoea. Stool samples therefore need to be checked in the lab to see if the person has an infection.

If these tests show that an infection is the cause, appropriate treatment should be provided, often an antibiotic.

Side-effects of HIV treatment are a common cause of diarrhoea. The condition has been associated with all the major classes of antiretrovirals, especially protease inhibitors.

There are some things you can do to reduce the effects of diarrhoea. Treatments such as Imodium can be used to control diarrhoea, but they aren’t a cure and can cause their own side-effects such as constipation.

If you’ve had diarrhoea for more than a few days then it makes good sense to see your GP or HIV doctor so that the causes can be identified.

HIV and heart disease

French doctors have found more evidence that the damage caused by HIV can increase the risk of heart attack.

In recent research, they showed that a detectable viral load and a low nadir (lowest ever) CD4 cell count were associated with an increased risk of heart attack. This was the case even after taking into account traditional risks for heart disease.

It’s now well established that the risk of cardiovascular disease is increased for people with HIV.

What’s less clear is the cause. However, these may include lifestyle factors, the side-effects of some antiretroviral drugs and the effects of HIV itself.

Because of this uncertainty, French doctors undertook what’s called a case-controlled study. They matched HIV-positive people who experienced a heart attack with HIV-positive people of the same sex and age who did not have a heart attack. The research involved people who received care between 2000 and 2009.

Smoking was the single biggest factor associated with heart attack. Other traditional causes of heart disease, such as high blood pressure and high cholesterol, were also significant.

The researchers also found that some HIV-related factors increased the risk of heart attack.

These included having a detectable viral load and a low nadir CD4 cell count.

Long-term treatment with a protease inhibitor was also a risk factor for heart attack.

The study therefore seems to confirm what’s already known: that cardiovascular disease in people with HIV has a number of causes.

Routine HIV care involves regular tests to monitor your risk of heart disease. It’s also important to know that there’s a lot you can do to look after and improve your cardiovascular health. This includes stopping smoking, eating a balanced, healthy diet, and exercising regularly. Members of your HIV healthcare team will be able to offer advice.

US approves HIV home testing

An HIV home test kit has been approved for sale in the United States for the first time. It will be sold in chemists and online. The OraQuick test’s sample is taken by swabbing an absorbent pad around the outer gums, adjacent to the teeth, and gives a result in twenty minutes.

The test’s packaging will include instructions, advice on what to do after getting the result and details of a 24-hour phone helpline. People whose initial test result appears to be positive will need to have this confirmed with another test, at a clinic or laboratory.

For the moment, home HIV tests remain illegal in the UK, but the government has promised to change this.

Many people hope that the increased availability of HIV testing will reduce the numbers of people with undiagnosed infection and so reduce new infections. But others fear that unless the test is priced and promoted in the most appropriate way, it will not reach those who are most in need.

Other concerns revolve around whether people who test positive at home will subsequently connect with health services and whether people will force sexual partners to test, perhaps before having unprotected sex.

But many other advocates feel that these fears may well be unfounded. They feel that the home test’s key advantage is that it puts testing into the hands of the individual, rather than being controlled by healthcare professionals.