HIV and ageing
Thanks to antiretroviral treatment, many patients with HIV can expect to live a long and healthy life. Indeed, some research suggests that with the right treatment and care some patients could have a normal lifespan.
But HIV-positive patients seem to develop diseases associated with ageing, such as cardiovascular disease and thinning bones, at an earlier age than people who are HIV-negative.
There’s a lot of debate about the exact causes, but the inflammation caused by HIV and the side-effects of some anti-HIV drugs are possible explanations.
New findings from US researchers have added to the debate.
It’s already well known that the functioning of the immune system deteriorates with age. This has led some researchers to speculate that the immune problems seen in people with HIV could, in part, be due to premature ageing of the immune system.
Naive CD4 cells are a subtype of CD4 cell needed to respond to new infections, and their number declines naturally as we age.
Now, detailed examination of ‘naive’ CD4 cells showed that they aged by up to 30 years within three years of a person contracting HIV.
The US researchers found that younger HIV-positive patients had significantly smaller numbers of naive cells than would be expected for their age.
Starting HIV treatment didn’t fully replenish the store of naive cells.
The researchers speculate that the increased rate of some cancers seen in people with HIV when compared to age-matched controls, as well as a higher rate of some infections, may be due to the immune defects detected by this study.
The December edition of HIV Treatment Update includes a report (‘The prescription for old age’) on the recent British HIV Association community symposium on ageing.
HIV Treatment Update is available free to anyone affected by HIV – and paid subscriptions are available to professionals. Contact us on 020 7837 6988 or info@nam.org.uk for more information, or browse the online archive for a flavour of the content.
HIV and hepatitis – liver transplants
Many people with HIV are co-infected with hepatitis B or hepatitis C. These viruses can increase the risk of liver cancer, and liver disease is now the leading cause of death in co-infected patients.
Treatment is available for both hepatitis B and hepatitis C and it can work well in people with HIV.
But some patients develop such severe liver damage that they require a transplant.
They compared these outcomes to those observed in HIV-negative patients. The doctors believe their results show that transplants for liver cancer can have good outcomes in patients who are doing well on HIV treatment.
All the HIV-positive patients were taking HIV treatment and had an undetectable viral load.
However, there was a higher rate of drop-out in people with HIV waiting for a transplant.
Survival rates were slightly lower for patients with HIV than for HIV-negative patients. People with HIV were also a little more likely to experience a recurrence of their cancer. But the rates weren’t significantly different from those observed in HIV-negative patients.
But the researchers stress that more needs to be done to make sure people don’t drop out while they are on the waiting list.
For more information on HIV and hepatitis co-infection, download our booklet HIV & hepatitis, which is available online in English, French, German, Italian, Portuguese, Russian and Spanish.
HIV and adolescents – high blood levels of atazanavir
HIV treatment can work well in children and young people. But less is known about the effectiveness and side-effect risks of such treatment in children and adolescents than in adults.
Atazanavir (Reyataz) is a protease inhibitor, and last year it was approved for the treatment of HIV-positive children. The power of the drug is boosted by taking it in combination with a small dose of another protease inhibitor, ritonavir (Norvir).
Like all medicines, atazanavir can cause side-effects, and these include a non-dangerous yellowing of the skin and eyes (jaundice) called hyperbilirubinaemia, which is caused by a build-up of a substance called bilirubin in the blood.
Now Spanish researchers have found that adolescents who have high blood levels of atazanavir are also likely to have high levels of bilirubin, and this problem appeared to be more common in adolescents than adults.
The researchers think that monitoring levels of atazanavir could help identify people with a higher risk of developing jaundice.
Although none of their patients stopped treatment because of hyperbilirubinaemia, the researchers nevertheless stress that the side-effect should be taken seriously.
They comment: “Physical appearance influences a major part of the self-esteem of an adolescent and so a symptom like jaundice can lead to body dissatisfaction and social adjustment problems because of visible physical differences.”
The October edition of HIV Treatment Update included personal stories from young people living with HIV in the UK and a feature article on the transition from adolescence to adulthood.
This edition is now available online, but if you would like to subscribe to future editions, please contact us on 020 7837 6988 or info@nam.org.uk for more information.