HIV treatment – resistance testing
It’s possible to be infected with a strain of HIV that is resistant to one or more anti-HIV drugs, and about 10% of new infections across Europe involve drug resistance.
Because of this, all patients are recommended to have a test to check for resistance just after they are diagnosed with HIV, and again before they start treatment. Drug resistance identified by these tests should be taken into account when choosing which anti-HIV drugs to start treatment with.
In this study, the results of 10,000 patients starting HIV therapy were monitored by researchers to see what impact transmitted resistance had on the chances of reducing viral load to undetectable levels and keeping it there.
A year after starting treatment 4% of patients with no resistance had a detectable viral load.
However, almost four times as many patients (15%) infected with virus that was resistant to the drugs they were taking had a detectable viral load after a year.
The researchers conclude that their findings “confirm present treatment guidelines for HIV, which state that the initial treatment choice should be based on resistance testing in treatment-naive patients.”
HIV and ageing – poor lower-limb strength common
Problems with balance and a deterioration of muscle strength in the lower limbs (locomotor performance) are associated with ageing.
Many people with HIV are now living into older age, and health problems associated with ageing are increasingly common in this group.
Therefore researchers monitored locomotor performance in over 300 patients with HIV. The study was undertaken between 2007 and 2009.
Most of their patients were men and their average age was 48. They’d been living with HIV for a long time, and 83% were taking HIV treatment. Their average CD4 cell count was high – over 500.
The patients’ locomotor performance was assessed using a number of tests.
These showed that the majority of patients had poor lower-limb strength.
Longer duration of infection with HIV and low muscle mass were associated with reduced strength in the lower limbs.
The researchers recommended that lower-limb strength should be assessed in routine HIV care. The test they used – the amount of time needed to stand up from a sitting position five times – can be easily performed in a clinic.
Symptoms and illnesses – fracture rates higher in patients with HIV
Low bone mineral density is common in people with HIV, and this can lead to an increased risk of fractures.
Researchers looked at the rate of fractures for patients with HIV between 2000 and 2008, and compared it to that of the general population.
Fracture rates increased among people with HIV, especially in the period 2000 to 2002. However, rates remained steady in the general US population.
Fractures in people with HIV were associated with older age, a low nadir (lowest ever) CD4 cell count, diabetes, co-infection with hepatitis C, and substance abuse.
The researchers recommend HIV-positive patients should have their risk of fractures and falls assessed as part of their routine care.
Symptoms and illnesses – MRSA rates fall in people with HIV
Rates of community-acquired MRSA (methicillin-resistant Staphylococcus aureus) infections in patients with HIV seem to be falling, according to research in the US.
Cases of the antibiotic-resistant infection increased in HIV-positive patients from 2002 to 2007, but then fell sharply over the next two years.
A total of 226 cases of MRSA were diagnosed in 168 HIV-positive patients during the eight years of the study.
The infection was associated with a lower CD4 cell count, and rates were higher among gay men and injecting drug users than in other HIV risk groups.
Infection rates peaked in 2007, but by 2009 they had fallen, as had MRSA cases in the general US population.
Lower rates of MRSA were seen in patients who were taking HIV treatment. This is the first time that a study has suggested that treatment with anti-HIV drugs reduces the risk of MRSA infection.