Sexual health
Good sexual health is especially important for people with HIV. Untreated infections can cause unpleasant symptoms and in some cases they can lead to long-term health problems.
They can also increase viral load in the genitals, increasing the chances of HIV transmission. Research into the effect of treatment on infectiousness has shown the importance of good sexual health.
A symptom of bacterial STIs can be genital discharge. This can prompt people to seek a sexual health check-up and treatment.
But researchers in South Africa showed that only 12% of women with an STI that can cause discharge had this symptom.
The finding underlines the importance of regular sexual health check-ups for anyone who is sexually active, even if you are not experiencing any symptoms. In the UK, sexual health screening and treatment is free and confidential through NHS sexual health clinics, and may be available through your HIV clinic.
For more information on good sexual health, visit our website to read or download our booklet HIV & sex. If you work in an HIV organisation or clinic in the UK, you can also order print copies of this booklet free of charge. Contact us at info@nam.org.uk or on 020 7837 6988 for more information.
Measles immunisation
A measles vaccine has been available since the 1960s, but its effectiveness is reduced in people with a damaged immune system. A US study has now found that a booster dose of the vaccine can protect HIV-positive children from infection with measles.
The study involved 193 children with HIV, aged between 2 and 19 years. All of them were on effective HIV treatment, and had a CD4 cell percentage above 15% and a viral load below 30,000 copies/ml. They had previously received one or more dose of the combined measles, mumps and rubella (MMR) vaccine.
The children were given a booster vaccination, and 65 of them were given a second booster four years later. The proportion of children with antibodies at levels that protected them from measles went from 52% after their MMR vaccination to 89% eight weeks after the booster. The factor associated with the vaccination being effective was having a viral load under 400 copies/ml.
There had been concerns about the safety of the measles vaccination when given to children with a low CD4 cell count. The study also showed that the vaccination is safe to use in children with HIV. Only four children had moderate to severe side-effects (three cases of fever, one of fatigue) after the first booster, and none in the sub-set who had the second booster.
Revaccination provided long-term benefits. Eighty weeks after revaccination, the investigators found that 80% of children had protective levels of measles antibodies.
The author of an accompanying editorial welcomed the findings. But she cautions that, while the results provide evidence for the effectiveness of a booster for children on effective HIV treatment, measles continues to be a serious risk for HIV-positive children in areas with poor diagnosis and treatment of HIV and lack of uptake of measles vaccination.
For more information on treatment and care for children, you can read or download our booklet HIV & children from our website.
Treatment as prevention
The use of HIV treatment (antiretroviral drugs) to prevent HIV infection has been in the news a lot recently. We reported last week from the evidence summit held in London on Controlling the HIV epidemic with antiretrovirals.
More news from this international meeting has revealed that, over the next three years, up to 33,000 people may take part in 22 studies looking at pre-exposure prophylaxis (PrEP). PrEP involves the use of anti-HIV drugs by HIV-negative people to avoid becoming infected with HIV, by taking the drugs before possible exposure to HIV. Current thinking is that PrEP would be most useful for people at frequent risk of being infected with HIV.
The summit heard about a range of trials in countries around the world, which will look at whether it is practical to roll out a prevention programme involving PrEP. There are a number of issues that need to be taken into account, including the additional burdens on healthcare systems (both financial, because of the cost of additional drugs, and practical, with the need to monitor the health of people on PrEP) and ethical concerns – particularly in countries where HIV treatment is not readily accessible to those who need it for their health.
A trial is currently being planned in the UK. It may eventually involve 5000 men who have sex with men, but is likely to start, later this year, with a smaller group of about 300 participants.
Attendees at the summit spent time discussing the practical and philosophical challenges to rolling out treatment as prevention. But there are also huge opportunities. Dr Kevin Fenton, the Director of the US National Center for HIV, closed the summit by saying: “Now, more than ever, it is possible to change the course of the HIV epidemic, by combining HIV prevention interventions, including antiretroviral therapy (ART) for treatment and prevention.”
Visit our conferences news pages for more information on the summit.
Editors' picks from other sources
Zimbabwe: Tsvangirai avoids HIV testing
from Bulawayo 24
Prime Minister Morgan Tsvangirai was one of the many high-profile politicians who chose not to participate in a voluntary and symbolic HIV testing and circumcision initiative by members of parliament in Zimbabwe last week.
Theratechnologies sinks on HIV drug setback
from Reuters
Shares in Theratechnologies plummeted after the company withdrew an application for a drug to reduce excess abdominal fat in HIV-infected patients with lipodystrophy, due to safety concerns.
The stupid question: “Are you clean?”
from My Fabulous Disease
This irritating question has become typical on internet dating sites and in nightclubs as strangers negotiate a hookup. It is not only insulting to people with HIV, it also has no real value. And as Mark S. King explains, it also creates the perfect scenario for a new HIV infection.
'Breast Best' Policy Challenged in South Africa
from Voice of America
In September last year, South Africa’s health minister Aaron Motsoaledi implemented a drastic and highly contentious measure. He announced that the government would no longer provide a free six-month supply of formula milk to HIV-infected mothers. Instead, its health facilities would encourage the women to exclusively breastfeed for at least the first six months of their babies’ lives.