Living with HIV – money, food and housing
The study involved men in San Francisco who were homeless or in insecure housing.
CD4 cell count and viral load were monitored at three-monthly appointments. At these appointments the men were asked about their physical and mental health. The men also completed a questionnaire to see which factors might be affecting their health.
The men were asked about their housing status, basic subsistence needs (food, hygiene and clothing), drug and alcohol use and adherence to HIV treatment.
Many of the men had drug or alcohol problems. Only 18% of study participants with a CD4 cell count below 350 were taking HIV treatment. There was a high prevalence of mental health problems.
Having unmet subsistence needs (difficulties obtaining housing, clothing or food, or meeting basic hygiene needs) was the biggest single factor associated with poorer physical health.
“These observations indicate that unmet subsistence needs are having critical influences on the health of impoverished persons both with and at risk for HIV/AIDS,” comment the authors. “Advances in HIV medicine will not be fully realized by unstably housed persons until opportunity and choice limited by social and structural barriers are overcome.”
Need help with money, housing or finding support? Staff at your HIV clinic will be able to direct you to local sources of support and help.You can also search for local services online at www.aidsmap.com/e-atlas.
Lipodystrophy
Doctors found that people who experienced reductions in visceral fat accumulation (hard fat around the internal organs) also had some metabolic improvements. This could mean that their risk of heart attack and stroke was reduced.
HIV treatment has been associated with a collection of side-effects called lipodystrophy. This can involve fat accumulation, fat loss, or a combination of the two. Lipodystrophy is most associated with some older anti-HIV drugs that are no longer used in long-term routine care in the UK.
The fat accumulation associated with lipodystrophy can be distressing. But there are also concerns that it may increase the long-term risk of cardiovascular disease.
The drug tesamorelin has been shown to reduce visceral fat accumulation in people with HIV-related lipodystrophy.
Researchers looked at the results of a clinical trial conducted during the drug’s development to see if reductions in visceral fat levels also had metabolic benefits.
They found that people who benefited from tesamorelin therapy also had improvements in their triglyceride levels and that there was no deterioration in their ability to process sugars.
HIV and hepatitis
Many people with HIV also have hepatitis B and/or hepatitis C (often referred to as co-infection). Liver disease caused by these viruses is now an important cause of death in people with HIV and hepatitis co-infection.
However, there has been uncertainty as to which infection is causing the most liver-related disease and death.
Researchers from the large Multicenter AIDS Cohort Study (MACS) therefore looked at rates of liver-related death in 680 men with chronic hepatitis B or C.
Equal proportions were infected with hepatitis B and hepatitis C, and approximately 70% were also infected with HIV.
The rate of liver-related death was twice as high in people with hepatitis B compared to people with hepatitis C.
For the people with HIV, a CD4 cell count below 200 increased the risk of liver-related death, as did older age. Patients with hepatitis co-infection are especially encouraged to start HIV treatment before their CD4 cell count falls below 350 and sometimes sooner.
Rates of hepatitis C-related deaths were similar in the periods before and after effective HIV treatment became available.
However, there was a slight decline in hepatitis B-related deaths after the introduction of anti-HIV drugs such as 3TC, FTC and tenofovir. These drugs also work against hepatitis B.
There is an effective hepatitis B vaccine and it is recommended for everyone with HIV. Liver health is monitored as part of routine HIV care. You can find out more about HIV and hepatitis B and hepatitis C co-infection in the NAM booklet HIV & hepatitis.