Access to NHS HIV treatment and care
Free NHS treatment for HIV is to be made available to non-documented migrants and non-UK nationals in England. Until now, these groups have not automatically been entitled to free HIV treatment, unlike treatment for other infectious and sexually transmitted diseases.
The Department of Health announced the change of policy, citing the public health benefits of treatment and its ability to prevent transmission of the virus.
Last year, a major study showed that HIV treatment cut the risk of sexual transmission of the virus by 96%.
Anne Milton, the public health minister and a former nurse, said: “This measure will protect the public and brings HIV treatment into line with all other infectious diseases. Treating people with HIV means they are very unlikely to pass the infection on to others.” However she added: “Tough guidance will ensure this measure is not abused.”
The new rules are likely to come into force in October and will initially only apply to England.
For more information on the current situation, visit the Access to health care section of our website.
HIV and hepatitis C
Hepatitis C now causes more deaths in the US than HIV.
Researchers looked at mortality figures for the period between 1999 and 2007 and compared death rates for hepatitis B, hepatitis C and HIV.
Hepatitis B-related mortality remained broadly static.
However, there was a substantial increase in the number of deaths caused by hepatitis C. This was accompanied by big falls in HIV-related mortality due to improvements in HIV treatment. In 2007, more deaths were caused by hepatitis C than by HIV.
Many of the deaths were in the 'baby boomer' generation, people born between 1945 and 1964. The researchers think that hepatitis C testing should be targeted at this generation, a substantial proportion of whom experimented with drugs in their youth. A separate analysis showed that routine testing for this generation would be cost effective.
HIV, hepatitis B and hepatitis C all share modes of transmission. Therefore, guidelines recommend that everyone with HIV should be tested for viral hepatitis at the time of diagnosis with HIV. Routine vaccination for hepatitis B is recommended for all HIV-positive people. Regular testing for hepatitis C should be a part of routine HIV care, especially for people who have ongoing risk factors for the infection.
Boceprevir (Victrelis) and telaprevir (Incivek/Incivo) are protease inhibitors for the treatment of hepatitis C genotype 1. They are taken in combination with standard hepatitis C therapy – pegylated interferon and ribavirin – and have been shown to substantially improve rates of cure.
But the new drugs are expensive.
US researchers looked at the cost effectiveness of the drugs. They showed that therapy with the cheaper of the two drugs – boceprevir – could be cost effective. This was especially true for people with more advanced liver disease and when treatment was provided to people who had a gene mutation (IL-28B) associated with a better chance of hepatitis C treatment response.
Cognitive impairment
The study also found a high prevalence of cognitive impairment in people with HIV – 40%. It showed that increased waist circumference increased the risk of this problem.
It’s long been recognised that treatment with some anti-HIV drugs can cause disturbances in the way the body metabolises and stores fat. This can involve increased levels of blood lipids such as cholesterol and/or changes in body shape, including fat accumulation or fat loss. The collective name given to this syndrome of side-effects is lipodystrophy. It is most associated with older anti-HIV drugs, which are no longer used in routine HIV treatment.
Some doctors are also concerned that people with HIV remain at increased risk of cognitive impairment. The exact prevalence of cognitive problems in people with HIV is controversial, and so too are the causes. But in HIV-negative people these can include factors such as metabolic disturbances and diabetes.
US researchers therefore undertook a study involving 130 people with HIV. Their cognitive function was assessed using standard tests, and these showed that 40% had some form of impairment.
Risk factors for impairment included older age, longer duration of infection with HIV, waist circumference and diabetes. However, diabetes was only a risk factor for older people.
The researchers believe their findings have implications for HIV treatment strategies, and stress the importance of avoiding drugs that cause central fat accumulation.
They suggest that this could be causing inflammation that was increasing the risk of cognitive problems.
MRSA infections
US researchers looked at rates of MRSA (meticillin-resistant Staphylococcus aureus) in three groups of HIV-positive people: women, Hispanic people and people who had recently been released from prison.
Infection rates were compared to those seen in the general population.
Overall, 11% of people with HIV in the study had the MRSA bug. This compared to just 4% of HIV-negative people.
People with HIV who had recently been released from prison were especially likely to have the MRSA bug (16%).
The researchers found no evidence that HIV-related factors such as CD4 cell count, viral load, use of antibiotics and HIV treatment increased the risk of infection with MRSA.
Instead, a recent history of incarceration, area of residence and type of housing were significant.
The researchers therefore concluded that HIV itself is not a risk factor for MRSA. Rather, they believe that the infection is spreading in “social networks” of people. They suggest that people who have recently been in prison should be screened for MRSA.
For more detailed information on MRSA, visit the NHS website: www.nhs.uk/conditions/MRSA