Late diagnosis
Further research has been published showing that many people with HIV are diagnosed ‘late’.
Researchers in Barcelona looked at the CD4 cell counts and health of people diagnosed with HIV in the city between 2001 and 2009.
People were classified as having been diagnosed late if they needed to start HIV treatment straight away, according to current treatment guidelines (a CD4 cell count below 350 or ill because of HIV).
Overall, 56% of people diagnosed were diagnosed late.
But some doctors think that HIV treatment should be started when a person’s CD4 cell count is around 500, and US guidelines now recommend treatment when a person’s CD4 cell count is around this mark – if this criterion was used then 70% of people were diagnosed late.
Starting treatment at a CD4 cell count of around 350 compared to a CD4 cell count of 200 has been associated with a reduced risk of HIV-related illnesses and some other serious diseases, such as heart, liver and kidney disease as well as some cancers.
But it’s important to stress that HIV treatment can still work well in people diagnosed with lower CD4 cell counts.
HIV and hepatitis C – testing
Some rapid tests for hepatitis C often have inaccurate results when used in patients with HIV.
However, the rapid OraSure test, licensed in the US for rapid hepatitis C screening, is just as accurate and reliable as traditional blood tests.
Large numbers of people with hepatitis C don’t know they are infected. Three rapid antibody tests using either blood samples or oral fluid have been developed.
Researchers wanted to see if they were as accurate as the blood tests used in clinics to screen patients for hepatitis C antibodies.
They therefore analysed the performance of the rapid tests on over 1000 stored blood samples obtained from injecting drug users.
About 50% of the samples were positive for hepatitis C antibodies and the OraSure test provided the most accurate results.
The other two tests were particularly inaccurate in people with HIV.
About 9% of results in HIV-positive people were false negatives. If they’d been screened for hepatitis C using these tests, the infection would have remained undiagnosed.
It’s recommended that all people with HIV should be tested for hepatitis C at the time of their HIV diagnosis.
Routine HIV care should then involve an annual test for hepatitis C, and more frequent screening is recommended for people with a high risk of hepatitis C infection.
Monitoring liver function can also help detect hepatitis C infections.
Prompt diagnosis of hepatitis C is important, especially as the infection is most likely to be cured if treatment is provided early.
You can find out more about hepatitis C in NAM’s booklet HIV & hepatitis. It is available on our website in English, French, German, Italian, Portuguese, Russian and Spanish.
HIV and the criminal law
The criminalisation of HIV transmission is causing anger, fear and confusion in people with HIV, and is a barrier to honest discussions with healthcare providers, new research shows.
The research was conducted in Canada, a country which has prosecuted and imprisoned people for not disclosing their status before having unprotected sex.
The law on HIV exposure and transmission in Canada is confusing and inconsistently applied – some people have been tried and/or convicted for having sex with a condom or having oral sex.
Researchers wanted to see what impact this was having on both people with HIV and their service providers.
They found that it was causing a lot of fear and uncertainty and service providers reported that it was hampering honest discussions about sexual risk-taking and sexual health.
The researchers call for the development of proper guidelines for prosecutors.
Such guidelines already exist in the UK, where they also cover other sexually transmitted infections.
Last week a man was sent to prison for 14 months (see news report in Northampton Chronicle & Echo) for passing on genital herpes to his girlfriend. He knew he had the infection, but thought it had gone away.
The man pleaded guilty. Transmission would have been very difficult to prove and the sentence has been widely condemned by sexual health doctors and lawyers who specialise in this area (see comment in the Guardian).
It’s very important to get expert advice as soon as possible if you become involved in a police investigation into the transmission of HIV or any other infection. In the UK, the Terrence Higgins Trust helpline, THT Direct, can put you in touch with experts in this field who can provide information, advice and support.
For more information on HIV and criminal law, visit www.aidsmap.com/law.