Treatment slowing the world HIV epidemic
The importance of HIV treatment in controlling the global epidemic has been demonstrated by new figures. These show that antiretroviral treatment is now reducing the number of HIV-related deaths in low- and middle-income countries, just as it did in Europe and North America in the late 1990s.
Treatment with combinations of anti-HIV drugs can mean a longer and healthier life, and doctors are increasingly optimistic that their use will mean that many people with HIV will be able to live a normal lifespan.
By lowering viral load, HIV treatment also reduces the risk of HIV transmission. The exact extent to which it does this is hotly debated.
New figures looking at the world HIV epidemic in 2008 have shown that HIV-related deaths fell dramatically between 2001 and 2008. This coincided with the increasing availability of HIV treatment in the countries most affected.
There was also a fall in the number of new infections at the same time.
But much still needs to be done.
Sub-Saharan Africa is still the most heavily affected region of the world, and there are continuing HIV epidemics amongst gay men in western countries such as the UK.
And there are still HIV-related deaths and cases of mother-to-child HIV transmission.
Some of the best HIV care in the world is provided in the UK in specialist National Health Service (NHS) clinics. If you are entitled to NHS care, then you’ll be able to access treatment and care at these clinics for free.
To get the most from HIV treatment and care it’s very important that you attend your clinic for regular check-ups, take any treatment properly, and do your best to live a generally healthy life.
HIV and older age
Thanks to the success of HIV treatment, many people with the virus are now living into older age.
The research involved 149 patients in the Paris area. They were monitored for four years, their average age at the start of the research being 65.
Half the patients had cardiovascular disease, 25% kidney problems, and 20% bone problems or arthritis, and one in six had some form of cancer.
During the four years of the research, 14% of the patients died. HIV-related illnesses did not cause any of these deaths.
Cardiovascular disease was an important cause of death, as was liver disease.
HIV and the bones
Low bone density is a problem for many people with HIV. Thinning or weakening of the bones can increase the risk of fractures. These problems are normally associated with older age, especially for women.
However, HIV itself, and treatment with some anti-HIV drugs, have been shown to reduce bone density.
Furthermore, they also found that this meant that 16% of their patients had a risk of fractures that was sufficiently high to warrant treatment with a drug that will reduce the risk of fractures.
The 150 men in the study had an average age of 48. They were doing well on HIV treatment.
Low bone mineral density was common.
Patients with higher levels of the male hormone testosterone were less likely to have this problem.
Treatment with a ritonavir-boosted protease inhibitor was associated with low bone density. There were also indications that tenofovir (Viread) was causing subtle changes in the bone metabolism.
Taking your HIV treatment
You’ll get the most benefit from your HIV treatment if you take all, or nearly all, of your doses correctly.
Italian researchers looked at very low levels of HIV viral load in patients taking HIV treatment. All the patients in their research had an undetectable viral load when this was measured using the tests routinely used in clinics.
They found that people who took short breaks from their treatment were the most likely to have a viral load above 10 copies/ml. In contrast, the majority of people who missed the occasional dose still had a viral load below 10 copies/ml.
These findings suggest that, for the majority of people, current drug combinations are quite forgiving of the occasional missed dose. But people who miss doses several days in a row have a much higher risk of drug resistance and treatment failure.
There’s a lot of help available at your HIV clinic to support you to take your HIV treatment properly.
For more information on taking HIV treatment you may find the NAM booklet Adherence and Resistance helpful. It is available free to people with HIV in the UK , as well as on our website and through HIV clinics and organisations in the UK.
HIV and pregnancy
It’s possible for an HIV-positive mother to have an HIV-negative baby.
The use of HIV treatment during pregnancy, appropriate intervention during labour, and not breast feeding can reduce the risk of transmission to an infant to very low levels.
There are special guidelines to make sure that HIV-positive pregnant women receive the right treatment and care and the risk of them passing on HIV to their infants is reduced as much as possible.
Nevirapine (Viramune) is widely used during pregnancy. But there have been concerns that it can cause liver problems. This risk is highest if a woman has a CD4 cell count above 250 cells/mm3 when she starts taking the drug.
The findings of the research underline why it’s very important for HIV-positive pregnant women to have regular monitoring at their clinic.