HIV treatment as prevention
The research involved approximately 2500 couples in total, including around 250 couples who were serodiscordant (one had HIV, one did not) either at the start or during the study. They were followed for approximately three years.
There were no cases of HIV transmission from the HIV-positive partner when they were taking antiretroviral therapy.
In recent years, there has been a lot of interest in the use of HIV treatment in prevention. In particular, a large study in 2011 found that treatment that suppressed viral load to undetectable levels reduced the risk of HIV transmission by 96%.
Last month, experts in the UK published a position statement on the use of HIV treatment to prevent transmission.
HIV and hepatitis
HIV, hepatitis B and hepatitis C are all transmitted in similar ways.
There has been a lot of research into co-infection with HIV and hepatitis B or HIV and hepatitis C. However, little is known about the consequences of infection with all three viruses.
Doctors in Spain therefore looked at the medical records of over 6000 people with HIV and hepatitis C co-infection and identified those who also had chronic hepatitis B infection.
They found that 6% were infected with all three viruses. Mortality rates were over 50% higher among people with all three viruses compared to those who were only infected with HIV and hepatitis C and rates of liver-related death were much higher.
There is a highly effective vaccine for hepatitis B. It is recommended that everyone with or at risk of HIV should be given this vaccine. In the UK, the hepatitis B vaccine is available for free from HIV and sexual health clinics.
HIV and treatment for hepatitis B
Several anti-HIV drugs also work against hepatitis B. It is recommended that antiretroviral therapy for people with HIV and hepatitis B should include drugs that are active against both viruses.
New research shows that treatment that includes tenofovir (Viread) combined with either FTC (emtricitabine, Emtriva – called Truvada when in a combination pill with tenofovir) or 3TC (lamivudine, Epivir) has the best chance of suppressing hepatitis B.
The study involved people with HIV and hepatitis B co-infection. Almost all were taking HIV treatment, and the majority were taking tenofovir in combination with either FTC or 3TC. Some were taking just one drug that worked against hepatitis B and some none at all.
Study participants were monitored for an average of 2.8 years. Treatment with tenofovir and FTC or 3TC was associated with better rates of hepatitis B suppression.
The study also showed the importance of successfully treating HIV. Rates of hepatitis B suppression were lower when a patient had a low CD4 cell count or a detectable HIV viral load.
For more information on HIV and hepatitis co-infection, read or download our HIV & hepatitis booklet from www.aidsmap.com/booklets.
Side-effects – kidney problems
With good access to HIV treatment and care, many people living with HIV now have an excellent life expectancy.
But like all medicines, the drugs used to treat HIV can cause side-effects. Infection with HIV is associated with an increased risk of kidney disease and some antiretroviral drugs also affect kidney function.
All had normal kidney function when they entered the study and this was then monitored at regular intervals for approximately 4.5 years.
During this time, 2% of the study participants developed kidney dysfunction, including 0.6% who developed chronic kidney disease.
They found that the longer a patient was treated with tenofovir (Viread, also in the combination pills Truvada, Atripla and Eviplera) or atazanavir (Reyataz), the higher their risk of developing kidney dysfunction. Other research has shown that these drugs are associated with kidney problems.
In this study, treatment with lopinavir/ritonavir (Kaletra) was also associated with an increased risk of both kidney dysfunction and chronic kidney disease.
This is the first study to show an association between Kaletra and kidney disease. However, some doctors think that the finding could be because people taking Kaletra – an older antiretroviral drug – had had HIV for longer and were more likely to have suffered kidney damage before starting HIV therapy.
Encouragingly, there was good evidence that kidney health improved once treatment with the drug causing the side-effects was stopped.
Kidney function is monitored as part of routine HIV care. This means that any problems can be spotted early and appropriate treatment and care and be provided.
If you have questions about HIV treatment, side-effects, or the tests your clinic uses to monitor your health, why not plan to talk to your doctor about it next time you have an appointment? For more ideas and to help you prepare for that conversation, try our online tool Talking points: www.aidsmap.com/talking-points
Bone health
There is now a lot of evidence showing that HIV infection is associated with thinning of the bones. It is part of an overall syndrome of premature ageing that some researchers think could be associated with HIV.
The exact causes of bone problems in people with HIV aren’t clear, but could include a combination of lifestyle factors such as smoking, the damage caused by untreated HIV infection and the side-effects of some anti-HIV drugs.
Thinning of the bones can increase the risk of so-called fragility fractures. These tend to affect the vertebrae, hips and wrists.
Now doctors have found that the characteristics associated with frailty in older people in the general population increase the risk of fragility fractures in HIV-positive men aged between 45 and 65.
The research involved 40,000 patients who received HIV care between 1997 and 2009. The patients had an average age of 46 and were monitored for an average of six years. There were a total of 588 fragility fractures.
Factors associated with a poorer overall prognosis – a good indicator of frailty – increased risk of fragility fractures.
The researchers now want to see if this is also the case for HIV-positive women.
Editors' picks from other sources
Updated guidance on HIV transmission, the law and the work of the clinical team now published
from HIV Justice Network
This document is aimed at those working in HIV medicine, especially clinicians, and aims to provide information and guidance on managing issues related to sexual transmission of HIV. It applies generic ethical and professional principles but with a particular emphasis on providing a confidential environment in which sensitive matters can be discussed. The guidance sets out the roles and responsibilities of health care professionals when caring for individuals living with HIV.
Updated NICE guidelines revise treatment recommendations for people with fertility problems
from NICE press release
The guidelines include recommendations for couples with HIV. They are essentially unchanged from the consultation version, stating that sperm washing may no longer be necessary for couples where the man has HIV and the woman does not. As long as the man is on effective antiretroviral treatment and unprotected sex is limited to days when his partner is ovulating, “sperm washing may not further reduce the risk of infection.” However the guidance does not support the use of pre-exposure prophylaxis (PrEP) by the HIV-negative partner.
Updated US HIV treatment guidelines include stronger recommendation for acute infection
from HIVandHepatitis.com
Among the key changes are additional information about the most recently approved antiretroviral agents and a recommendation that newly infected people with HIV should be offered combination ART. The guidelines continue to recommend treatment for all people with HIV, both to reduce the risk of disease progression and for the prevention of HIV transmission.
Violence as a cause or consequence of HIV for women in England
from Sophia Forum
This report highlights the experiences of women living with HIV in England in relation to gender-based violence. It documents the findings of a study to explore the potential for a national investigation into violence as a cause or a consequence of HIV for women in England.