The HIV epidemic in London
A total of 31,000 people were receiving HIV care in London in 2011. But there were only 159 new AIDS diagnoses and 169 HIV-related deaths.
Late diagnosis of HIV continues to be a major problem, and doubtless contributed to the above morbidity and mortality figures.
UK HIV treatment guidelines recommend that most people living with HIV should start HIV treatment when their CD4 cell count is around 350.
However, 44% of people newly diagnosed with HIV in 2011 had a CD4 cell count below this figure, and a quarter had a CD4 cell count below 200, showing they were at high risk of developing serious HIV-related disease.
Approximately a fifth of HIV infections in the UK capital are thought to be undiagnosed, meaning that a significant number of people are not accessing the care they need to stay well. This also undermines the beneficial effects of HIV treatment as a method of preventing HIV transmission. Other research shows that up to 50% of all new HIV transmissions may originate in people who are unaware that they have HIV.
Gay men and African people remain the groups most affected by HIV in London. But the report also highlighted increased numbers of new heterosexual diagnoses due to transmission in the UK.
Falling HIV mortality in China
Free HIV treatment started to be rolled out across China in 2009. Researchers looked at the impact of expanded access to treatment on mortality figures until 2009.
They found that mortality rates fell substantially. The research also showed the importance of starting treatment before HIV has done extensive damage to the immune system.
However, comparison with matched HIV-negative individuals in the general population showed that even with treatment, mortality rates were still higher in people with HIV.
But the researchers believe that improvements in HIV treatment and care will further reduce the mortality risk for people living with HIV in China.
Access to hepatitis C treatment in Europe
Estimates were for 2010. This was the last year of dual therapy with pegylated interferon and ribavirin. In 2011, two new HCV protease inhibitors were approved and can improve treatment response rates.
France had the highest treatment rate. In 2010, approximately 7% of people with hepatitis C accessed treatment. However, only 0.8% of Italian patients received treatment in the same year.
Perhaps because of cost, hepatitis C treatment rates were low in Russia (0.3%), Poland (0.4%) and Romania (1%).
They were also low in a number of richer European countries, including Belgium, Finland and Ireland (each 1-1.5%).
The uptake of treatment was better in the UK (3.4%), Germany (4.3%) and Sweden (4.3%).
AZT and CD4 cell count
AZT (zidovudine, Retrovir) is now rarely used in routine long-term HIV therapy in the UK. However, it remains a mainstay of treatment in parts of Africa and other resource-poor settings. Viral load monitoring isn’t routinely available in many poorer countries. Decisions about changes in HIV treatment are therefore usually made on the basis of CD4 cell count and symptoms.
If AZT is associated with poorer CD4 cell gains, it could mean that some people are changing treatment unnecessarily.
Researchers looked at increases in CD4 cell count among 72,500 people starting HIV treatment in four African countries. Twenty-seven percent received therapy with AZT.
Five years after starting treatment, people taking AZT had smaller CD4 gains compared to people taking another drug.
This difference persisted when the researchers limited their analysis to the people who had an undetectable viral load.
Editors' picks from other sources
My four-year battle with tuberculosis
from Huffington Post (blog)
During the two years of difficult treatment, I remember thinking, "Isn't there any other way? Aren't there better drugs that don't take as long? Isn't there something that could prevent this disease in the first place?"
UNAIDS publishes updated, detailed guidance on HIV criminalisation
from HIV Justice Network
The Joint United Nations Programme on HIV/AIDS (UNAIDS) has published its long-awaited updated guidance to limit the overly broad use of criminal laws to regulate and punish people living with HIV who are accused of HIV non-disclosure, exposure and/or transmission. The guidance aims to ensure that any application of criminal law in the context of HIV achieves justice and does not jeopardise public health objectives.
Wales: HIV patients are at risk of being identified because of new prescribing system
from Wales Online
A new monthly prescribing system designed to reduce waste of medicines is severely compromising the lives of people with HIV in Wales, critics say. "Either you are forced to opt for home delivery or you pick up the medication every single month," a patient said. With inconvenient hospital pharmacy hours, this could force people to disclose their condition to their employer.
US: No postings yet for HIV-positive Marines, sailors since policy change
from Stars and Stripes
More than nine months have passed since the US Navy decided to open up overseas and large-ship platform assignments to HIV-positive sailors and Marines, but not a single sailor has gotten such a posting.