Anti-HIV treatment
Side-effects
All medicines, including the drugs used to treat HIV, have unwanted side-effects.
Anti-HIV drugs can cause both short-term and long-term side-effects, and some of the longer-term side-effects can involve a risk of serious health problems, like heart disease.
Researchers in Switzerland have found that 20% of people with HIV aged over 40 have a hardening or narrowing of the arteries compared to only 4% of people of people of a similar age in the general population. This could mean that people with HIV have an increased risk of heart disease.
Smoking, age, diabetes, and high levels of blood fats were risk factors for arterial problems.
Not smoking, regular exercise, and eating a good diet can help reduce the long-term risks of illnesses like heart disease and stroke.
HIV disease progression
Although it is now well established that treatment with a potent combination of anti-HIV drugs can mean a longer, healthier life, there are still a lot of unanswered questions about the best way to use these drugs.
They developed the tool after looking at the outcome of over 4,000 people who started anti-HIV treatment between 1997 and 2005.
Current viral load, CD4 cell count, changes in CD4 cell count, haemoglobin (red blood cell count), body mass index, a history of injecting drug use and use of anti-HIV drugs before starting therapy with a potent combination of antiretrovirals were all independent risk factors for disease progression of death.
You can calculate your risk here.
Tuberculosis treatment
Worldwide, tuberculosis (TB) is the leading cause of illness and death in people with HIV.
There are about 200 cases of TB in people with HIV in the UK every year.
TB can be cured. Treatment consists of a combination of special antibiotics. Normally four drugs are taken for two months, with treatment continuing for a further four months with two drugs.
Like anti-HIV drugs, medicines used to treat TB have to be taken very rigorously to work. Missing doses can lead to drug-resistant TB developing, which is much harder to treat and involves a greatly increased risk of death.
A study suggests that using moxifloxacin instead of ethambutol in TB treatment could cut the duration of treatment from six to four months. This could mean that some patients find it easier to take all their treatment and have a better chance of being cured.
Response to HPV infection
Many people with HIV are infected with human papilloma virus (HPV). This virus causes anal and genital warts, and some strains of HPV can cause anal and cervical cancer. Both these cancers occur with greater frequency in people with HIV compared to the general population.
Vaccinations against the strains of HPV most associated with cervical cancer have recently become available. But so far they are only recommended for adolescent girls who have not yet become sexually active. Trials into the safety and effectiveness of the vaccinations in people with HIV are currently underway.
Many people naturally clear infection with HPV and researchers have found that skin prick testing can accurately predict which HIV-positive women will have a good immune response to HPV.
Skin prick testing, or cutaeneous anergy or Mantoux testing, looks at the body’s ability to mount a specific type of immune response. If bumps emerge on the skin in response to the test, then it shows that the immune system is responding.
Researchers found that HIV-positive women who had no response to skin prick tests for candida, tetanus and mumps were much more likely to have pre-cancerous cell changes in the cervix. This was irrespective of CD4 cell count or viral load.
The researchers are hopeful that skin prick testing could be further developed to help identify HIV-positive women whose immune system will not clear HPV infection and may therefore have a long-term risk of cervical cancer.