Symptoms and illnesses
Fluctuating symptoms have a major impact on the lives of many people with HIV, new UK research shows.
Tiredness, depression, diarrhoea and nerve pain were widely reported and were often associated with difficulties performing day-to-day tasks or working.
People with HIV in the UK were invited to participate in an online survey about their recent experiences of five symptoms commonly seen in people with HIV.
Many people receiving state health-related benefits are currently having their eligibility assessed. There is concern that these assessments are not adequately able to take into account the effect of fluctuating or variable symptoms.
About 250 people participated in the study, and the majority reported at least one symptom. The most common was tiredness, which was experienced by over 50% of people, and nerve pain – the least common – was reported by a third of participants.
Significantly, many people said their symptoms fluctuated – they didn’t have them all the time – and were unpredictable.
Most people reported having multiple symptoms – for example, three quarters of patients with depression also had fatigue and 57% also reported difficulty sleeping.
Fluctuating symptoms affected the ability of some people to work.
One participant said: “How do you work round this kind of thing unless you work for yourself or for an extremely understanding employer?”
The research was conducted by UK HIV organisation NAT, which says the findings have implications for the work assessment tests that people claiming health-related benefits have to undergo.
“Assessment should consider the impact of fluctuation and the cumulative impact of multiple, lower-level symptoms on people living with HIV,” they comment.
For more information on changes to the benefits system in the UK, visit our website to read the feature ‘What’s happening to benefits?’. You can download the NAT report ‘Fluctuating symptoms of HIV’ (PDF) from the NAT website.
HIV treatment – new drug does well in people starting treatment
An NNRTI is a type of antiretroviral drug, commonly used in HIV treatment. It stands for non-nucleoside reverse transcriptase inhibitor.
Etravirine is a powerful NNRTI. It works against most strains of HIV that have resistance to the older NNRTIs – efavirenz and nevirapine (Viramune).
The drug is licensed to be taken twice daily, and is approved for use by people with previous experience of HIV treatment.
But researchers wanted to see if a once-daily dose was safe and effective in people starting antiretroviral therapy for the first time.
Researchers compared etravirine to the widely used NNRTI efavirenz (Sustiva, also in the combination pill Atripla).
Equal proportions of people experienced a sustained fall in their viral load to undetectable levels. But etravirine was less likely to cause the mood and sleep problems often associated with efavirenz.
Their research involved 157 people. They were randomised to receive either etravirine or efavirenz, which was taken in combination with two NRTIs (nucleoside reverse transcriptase inhibitors, another type of antiretroviral drug).
After a year of treatment, 76% of people taking etravirine had an undetectable viral load compared to 75% of those taking efavirenz.
Four of the people taking etravirine had a detectable viral load – in most cases this was below 200 copies/ml, and none developed drug-resistant virus. However, three of the seven people taking efavirenz who had a detectable viral load developed resistance.
Only 6% of patients taking etravirine had mood or sleep problems after a year of therapy compared to 22% of patients treated with efavirenz.
For more information on the different types of anti-HIV drugs and how they work, you may find the section of our website ‘Ways of attacking HIV’ useful.
HIV treatment and prevention – viral load in rectal secretions
Men with a blood viral load above 1000 copies/ml were much more likely to have detectable virus in their rectal secretions.
The researchers believe their findings have important implications for the use of HIV treatment as prevention.
On the basis of their findings, the US researchers think that effective treatment will also significantly reduce the risk of transmission for MSM.
The study involved 80 men, and approximately three-quarters were taking HIV treatment. About two-thirds had an undetectable viral load in their blood.
Viral load was also monitored in rectal secretions. Overall, 38% of men had detectable virus in their rectal secretions at least once.
Levels of HIV in the blood and rectum were closely related. A blood viral load above 1000 copies/ml indicated an increased likelihood of having detectable rectal viral load.
Bacterial sexually transmitted infections such as chlamydia and gonorrhoea did not increase viral load in the rectum.
The researchers conclude: “our findings indicate that a low plasma HIV viral load is associated with a low HIV load in rectal secretions…these findings support the use of HIV treatment as an effective means of reducing HIV transmission among MSM in the United States by reducing the amount of virus shed in body sites where transmission occurs.”
Condoms are an effective method of protecting yourself and your sexual partner from HIV and other sexually transmitted infections. For more information on research into condoms, treatment as prevention and lots more, visit the ‘Preventing HIV’ resource on our website.
HIV and hepatitis – hepatitis E
Hepatitis E infection originates in pigs and a major mode of transmission in Europe and North America is via contaminated meat. It is also transmitted through faecal-oral contact, for example, in contaminated water.
The virus can cause disturbances in liver function and tends to lead to short-term illness with the same pattern of symptoms as hepatitis A before the virus is cleared. However in some people hepatitis E infection may lead to acute liver failure. This risk appears highest in pregnant women.
Cases of the infection have been detected in HIV-positive people.
Swiss researchers wanted to see if infection with hepatitis E was a cause of unexplained changes in liver function in people with HIV.
Their research involved people who had persistent elevations in ALTs (alanine aminotransferase) – a key measure of liver function. None had hepatitis B or hepatitis C.
A total of 735 people were included in the study and 19 (2.6%) had hepatitis E.
Antibody tests for hepatitis E didn’t work as well in people with a CD4 count below 150.
Even though the prevalence of hepatitis E infection was low, the authors conclude, “when investigating unexplained, elevated ALT level in HIV-infected patients, we propose that hepatitis E virus infection should be considered.”
The World Health Organization produces a factsheet on hepatitis E, available on its website: www.who.int/mediacentre/factsheets/fs280