HIV treatment – adherence
New research underlines the importance of taking your HIV treatment properly.
To get the best results from HIV treatment, it should be taken exactly as prescribed, every day, in the right dose, at the right time. This is often called adherence.
The aim of effective HIV treatment is to reduce the amount of HIV in the blood (viral load), to a level which is so low it can’t be detected by standard tests.
Doctors in the US looked at the health of HIV-positive people who also had diabetes or high blood pressure.
All the patients were taking HIV treatment, but people with a detectable viral load had poorer control of their diabetes or blood pressure.
Both of these conditions can increase the risk of cardiovascular disease, which is an increasingly significant cause of serious illness and death in people with HIV.
Some doctors think that uncontrolled HIV replication can also cause damage leading to an increased risk of heart disease, stroke, and some other serious illnesses.
A total of 70 people with diabetes and 291 people with high blood pressure were included in the study.
An increasing viral load was associated with poorer control of both diabetes and high blood pressure.
“We suspect that adherence accounts for our findings, and that poor adherence to antiretroviral therapy correlates with poor adherence to therapy for other medical comorbidities, explaining the relationship between poor control of both conditions,” suggest the researchers.
There’s a lot of support available if you are having difficulty taking your HIV treatment, or difficulty managing other health conditions. Talk to your doctor, or someone else in your healthcare team, to find out about support and advice available to you.
For more information, a good place to start is the NAM booklet on adherence.
HIV treatment – CD4 cell gains
Researchers in the US looked at changes in the CD4 cell counts of people starting HIV treatment according to their baseline body mass index, or BMI (click here to access the NHS online tool for assessing BMI).
The biggest increases in CD4 cell count were seen in people with a BMI between 25 and 30 kg/m2 – normally classified as overweight.
Successful HIV treatment suppresses viral load to very low levels. This allows the immune system to strengthen, indicated by an increase in CD4 cell count.
But levels of immune restoration vary. Despite having an undetectable viral load, the CD4 cell counts of some people remain relatively stable or increase very slowly.
Research conducted before effective HIV treatment became available showed that body weight, especially weight loss was associated with poorer longer-term prognosis. However, little is known about the impact of weight on immune restoration in the modern era.
Researchers therefore looked at the CD4 cell increases of 915 people who started HIV treatment between 1998 and 2008.
They were divided into categories according to their BMI: (underweight – below 20 kg/m2; healthy weight – 20 to 25 kg/m2; overweight – 25 to 30 kg/m2; obese – 30 to 40 kg/m2).
There was a relationship between CD4 cell increases during the first year of HIV treatment and BMI at baseline.
The biggest increases were seen among people in the overweight category, and those classified as underweight or obese had significantly smaller gains in their CD4 cell counts.
The researchers are unclear about the reasons underlying their findings. However, they speculate that underweight or obese patients may be more likely to have other health conditions that can impact on their immune system.
But no information was available on the patients’ social and economic circumstances – factors which can be associated with both weight and overall health.
Also, BMI is a far from perfect measure of body composition – some people who are classified as under or overweight have good levels of lean muscle and are very healthy.
There’s good evidence that maintaining a healthy weight, through good nutrition and exercise, is an important factor is good general health. You can find out more about nutrition in our recently updated Nutrition booklet.
HIV and cardiovascular disease
Despite the findings of the previous study, it’s important to note that being overweight can increase the long-term risk of cardiovascular disease, an increasingly significant cause of illness and death in people with HIV.
A combination of waist circumference and triglycerides has been used for over ten years to identify HIV-negative people with an increased risk of illnesses such as heart disease and stroke.
In the latest research doctors found a consistent relationship between higher waist circumference, elevated triglycerides and factors known to increase the risk of cardiovascular disease – for example high blood pressure and diabetes.
A waist circumference of 90cm for men and 85cm for women was associated with higher cardiovascular risk. The triglyceride levels were 2.0mmol/l for men and 1.5mmol/l for women.
“The combination of waist circumference and triglycerides was shown to discriminate high-risk and low-risk HIV-infected men and women,” write the authors, “the present findings suggest a utility of waist circumference combined with triglyceride levels as a simple clinical tool for discerning…cardiovascular risk.”
HIV treatment in children
Children taking once-daily efavirenz often have low blood levels of the drug, a new study suggests.
This could mean that there isn’t enough of the drug to effectively fight HIV, possibly leading to the development of drug-resistant virus.
Researchers in Uganda found that the majority of children treated with efavirenz (Sustiva) had sub-therapeutic levels of the drug in their blood. Efavirenz was being dosed according to 2006 World Health Organization (WHO) guidelines, at 200, 250, 300 and 350mg for children weighing 10 to 15kg, 15 to 20kg, 20 to 25kg and 25 to 30 kg, respectively; capsules of 200 and 50mg were used, or unscored 600mg tablets that were cut in the pharmacy.
The researchers believe their findings have implications for the use of efavirenz in children in both richer and poorer countries and advocate paediatricians move to implementing WHO’s 2010 dosing guidelines for efavirenz.
The guidance issued in 2010 recommends the following efavirenz doses for children:
- Liquid: 19.5mg/kg per day
- Tablet: 15mg/kg once a day
- Weight more than 40kg: 600mg once daily
For more information on HIV treatment and care for children, you may find the NAM booklet, HIV and children helpful.