HIV Weekly - 15th January 2014

HIV care for people with low CD4 cell counts

Attending HIV clinic visits is important for everyone with HIV. Getting the right treatment and care means people with HIV can live a normal life span, but this depends on regular health monitoring.

Research in the US has confirmed that attending regular HIV clinic appointments is particularly important for people with a low CD4 cell count. The study found that people with higher CD4 cell counts were more likely to achieve an undetectable viral load, the goal of HIV treatment. For people with lower CD4 cell counts (under 200), attending all their HIV clinic appointments was an important factor in attaining an undetectable viral load.

The researchers suggest that developing a strong relationship with a healthcare team is especially important for people with low CD4 cell counts, who may be dealing with illness, more complicated treatment regimens and other issues in their lives.

In the UK, it's recommended people with HIV start treatment before their CD4 cell count falls below 350, to control HIV before the immune system is so damaged there is a risk of serious illnesses. If you are diagnosed with HIV when your CD4 cell count is already below 350, you will be encouraged to start treatment as soon as possible. Many people do well on treatment, and can lead long and healthy lives.

You can find out more in the NAM factsheets Diagnosed with HIV at a low CD4 cell count, and You and your doctor.

Computerised counselling helps adherence

A study done in the US has found that using a computer-based counselling service helped people adhere to HIV treatment.

With HIV treatment, many people with HIV can expect a normal life expectancy. This is most likely for people who take their treatment at the right time and in the right way – often referred to as ‘adherence’.  Adhering to HIV treatment also reduces the risk of passing on HIV to sexual partners, as your viral load is more likely to be suppressed to an undetectable level (usually defined as below 50 copies/ml).

Participants in this study used a counselling course called Computer Assessment and Rx Education for HIV-positive people (CARE+). This computer-delivered programme provided counselling on adherence to HIV treatment (and how adherence affects viral load, telling people about HIV, drug use, and safer sex and condom use. The adherence and viral load levels of the participants were compared to people who didn’t use the counselling element of the programme.

People taking part in the counselling programme had significantly larger falls in viral load, and saw improvements in their adherence – with adherence rates 13% higher for this group than for the control group by the end of the study.

In addition, those people using the counselling element also made changes to their sexual behaviour, reducing the risk they would pass on HIV. They were more likely to use condoms consistently and in the right way than people who hadn’t taken part in the counselling.

People found the intervention easy to use and felt it helped them as much, if not more, than face-to-face counselling.

If you are having problems with any aspect of living with HIV, including adhering to HIV treatment or avoiding onward transmission, talk to staff at your HIV clinic. Read more about adherence, including some tips to help you, in NAM’s booklet Adherence & resistance. You can also find out more about counselling in the booklet HIV, mental health & emotional wellbeing. 

HIV testing on admission to hospital

A south London hospital has found that offering an HIV test to everyone being admitted to the hospital’s acute medical unit (AMU) is feasible and highly cost-effective in an area of high HIV prevalence.

Although the outlook for people diagnosed with HIV has improved enormously in the UK, people still experience serious illness and there are still HIV-related deaths. This is often as a result of people being diagnosed ‘late’; that is, when HIV has already seriously damaged their immune system.

Croydon University Hospital offered an HIV test to all patients aged between 16 and 79 being admitted to its AMU (‘opt-out’ testing). Staff on the ward administered 4122 tests during the study period (21 months), 33% of admissions during that time.

There were 20 HIV diagnoses during the study. Of these, six people had no symptoms that would have suggested they had HIV, and would not have been diagnosed at this stage without this scheme. Six people who were identified as contacts of the patients were also tested, with two testing HIV positive.

With one exception, everyone who tested positive on the scheme is receiving HIV care and eleven people are on HIV treatment. Two people already knew their HIV status but had dropped out of care; they are now receiving care at Croydon’s HIV clinic.

The HIV tests were done by existing staff on the ward, often nurses, with the support of HIV specialists. The scheme cost the hospital no additional money other than laboratory costs, and some serious health problems were avoided or resolved as a result of the diagnoses.

Read more about HIV testing on aidsmap. You can find out more about undiagnosed HIV infection and late diagnosis in a briefing paper on these topics produced by NAM for the HIV Prevention England programme.  

New diagnoses, viral load and transmission

About a third of young people new to HIV care in the US have high viral loads, resulting in a high risk of HIV transmission to their partners, researchers have found.

This was particularly true of young men who have sex with men (MSM). Just under a third of the MSM in the study had a viral load over 50,000 copies/ml, compared to 22% of young heterosexual people.

Although there was concern about the high risk of onward transmission, the researchers also think that this finding could be a sign that more young people, especially young MSM, could be being diagnosed soon after becoming HIV positive (a period known as primary HIV infection, when viral load is very high).

The researchers say their findings support the importance of targeting young people in HIV testing strategies and of encouraging people who are diagnosed with HIV to seek prompt HIV care.

You can find out more about primary HIV infection in NAM’s factsheet, or see an illustrated factsheet on Very recent infection.