HIV treatment and heart disease
There was concern in June 2022 when a large study unexpectedly reported that a widely used group of HIV medications called integrase inhibitors were linked with higher rates of serious heart disease and stroke. As we reported at the time, the results were puzzling (scientists couldn’t identify a likely biological explanation). Experts said that they would need to see whether other studies had similar results before suggesting any change to HIV treatment guidelines.
Two further studies have now been done. In February, Swiss researchers reported that their analysis did not show a higher rate of heart disease and stroke in people taking integrase inhibitors. And this month a large international study has come to the same conclusion.
The HIV medications in question are integrase inhibitors, which are the mainstay of modern HIV treatment across the world. They include dolutegravir (Tivicay, also included in Triumeq, Dovato and Juluca) and bictegravir (included in Biktarvy). Two slightly older integrase inhibitors are raltegravir (Isentress) and elvitegravir (included in Stribild and Genvoya).
For the new study, the researchers collected data on people taking HIV treatment in Europe and North America between 2013 and 2023. They looked for major cardiovascular events: stroke, heart attack, or clinical intervention for a cardiac problem.
Their first analysis included nearly 20,000 people taking HIV treatment for the first time. Their second analysis included just over 75,000 people who changed their HIV treatment combination, including almost 8000 who switched to an integrase inhibitor.
After careful statistical adjustment for other factors that could also have an impact on heart health, the researchers did not find any significant difference in the risk of a major cardiovascular event between people taking an integrase inhibitor or people taking other HIV medications. This was true both in people taking HIV treatment for the first time and in people changing their medications.
These results are reassuring, especially as integrase inhibitors are generally seen as a particularly safe and effective group of HIV medications.
Picture this – living with HIV
Visibility is a powerful tool in the fight against HIV stigma, so when we decided to refresh the photography on our website, we turned to the HIV community asking for volunteers to represent themselves and their lives.
Read about our photo shoot in our blog post.
Vaccines against gonorrhoea and mpox
The UK’s Joint Committee for Vaccination and Immunisation has recommended that people in the United Kingdom at increased risk of contracting gonorrhoea should be offered the 4CMenB vaccine (Bexsero) to reduce their risk. The recommendation is particularly relevant for gay and bisexual men, and anyone else who has recently had gonorrhoea or ‘high-risk’ sexual behaviour with multiple partners.
Assuming the NHS follows the expert committee’s recommendation, this will be a world first. The vaccine that will be used was actually originally developed to protect against meningitis B. The bacteria that cause meningitis B and gonorrhoea (Neisseria meningitidis and Neisseria gonorrhoeae) are closely related. An additional benefit of vaccinating young people against meningitis B has turned out to be reduced rates of gonorrhoea.
While vaccination is expected to lower rates of gonorrhoea in people who take it by around 30% or 40%, it does not offer 100% protection.
The committee also recommended that mpox vaccination should be continued for gay and bisexual men and transgender people at highest risk of mpox (previously known as monkeypox). This includes people who have recently had a sexually transmitted infection, have multiple partners, use sex-on-premises venues or take part in group sex.
Cancer and HIV
Rates of some, but not all, cancers are higher in people living with HIV than other people. Changes to your lifestyle, including stopping smoking, eating a healthy diet and taking HIV treatment, can reduce your risk of developing cancer.
Find out about cancer and HIV in our recently updated page.
People who control HIV without treatment
It’s rare for people’s immune systems to be able to inhibit the replication of HIV without antiretroviral medication. But a surprising study from South Africa and Zambia found more people in this situation than expected.
In a group of just over 4000 people, most had taken HIV treatment, as they had been advised to. But 984 had not taken any HIV treatment, and it turned out that 126 (13%) of them maintained a viral load below 2000 copies for at least a year. Scientists describe people with this level of viral control in the absence of treatment as 'viraemic controllers'. A related term, 'elite controllers', refers to people who maintain a viral load below 50 copies without treatment.
Compared to other studies of people living with HIV in Europe and North America, the prevalence of viraemic controllers in this African cohort was at least three-fold greater. Whether the higher number of controllers is due to the genetic make-up of the local population or related to the virus’ subtype is yet to be uncovered.
Support us this World AIDS Day
It's been 35 years since the first World AIDS Day in 1988, and there have been so many advancements in the prevention and treatment of HIV in that time. But, while many countries have made great strides towards meeting UNAIDS targets for diagnosis and treatment, HIV remains a significant global public health issue.
At aidsmap, we believe everyone has the right to quality information regardless of their background or location. This World AIDS Day – 1 December – please consider a donation to support our work and help achieve our vision of a world where HIV is no longer a threat to health and happiness.
HIV cure
The Daily Mail recently reported that a “cure for HIV could be months away”. They were reporting on a very early study testing a gene-editing therapy called EBT-101.
In fact, only three people have received EBT-101 so far. While the first results show that these three people haven’t had any serious adverse effects, no information about whether the treatment helps control HIV is available.
People taking part in the study will be asked to stop their regular HIV medication, to see if they can maintain viral control without it. We don’t expect to hear the results of that experiment until next year. Even if it shows that the therapy has benefits, there will still be a long road ahead to test EBT-101 in a larger number of people, determine if it has long-term side effects and secure the approval of regulatory authorities.
HIV advocate Richard Jefferys complained to the Daily Mail. “The headline of this article is hugely, egregiously wrong and unconscionably toys with the hopes of people with HIV and everyone seeking a cure for HIV,” he wrote. “It's encouraging that this research is progressing, but there is as yet zero evidence that this approach can cure HIV in people, let alone within months.”
Editors' picks from other sources
Threats to Ukrainians with HIV | POZ
The Russian invasion poses challenges – both minor and existential – to those living with the virus.
How Sydney beat back HIV – and what other cities can learn | The Telegraph
Thirty years after it became the epicentre of Australia’s AIDS crisis, transmission of the virus has been ‘virtually eliminated’.
How a Denver health clinic is trying to stop the spread of HIV | Colorado Sun
Two years ago, Vivent Health created its own housing department and voucher programme, with a team of case managers who help move people off the streets and into apartments, or provide monthly rent assistance to protect them from eviction and foreclosure.