HIV and diabetes
The life expectancy of many HIV-positive people is now near normal. But even in the best circumstances, this life expectancy is still a few years shorter than that of HIV-negative people.
This could be because people with HIV seem to have an increased risk of some serious non-HIV-related illnesses, such as diabetes.
Approximately 1000 people who started HIV treatment between 1999 and 2000 were monitored for ten years to see how many of them developed diabetes and what the risk factors for the condition were.
There were 111 new cases of diabetes. Diagnoses peaked between 1999 and 2000 and then fell steadily.
Established risk factors were associated with the development of diabetes. These included older age and being overweight.
In addition, some factors associated with HIV treatment were also significant.
Diabetes was associated with treatment with some older anti-HIV drugs that are now known to cause certain long-term side-effects. These include d4T (stavudine, Zerit), AZT (zidovudine, Retrovir) and indinavir (Crixivan).
Both d4T and AZT have been associated with fat loss from the face, limbs and buttocks (lipoatrophy), and this side-effect was also predictive of diabetes.
Reassuringly, there was no evidence that newer anti-HIV drugs increased the risk of the condition.
For more information on diabetes, read our online factsheet.
HIV treatment – side-effects
All drugs, including those used to treat HIV, can cause side-effects.
The side-effects caused by modern HIV treatment appear to be mild and often lessen or go away completely over time. However, anti-HIV drugs can also cause longer-term side-effects.
Lipodystrophy is one of the more distressing long-term side-effects. The drugs most widely used in the UK today are not thought to cause lipodystrophy. But a lot of people developed lipodystrophy when taking older anti-HIV drugs.
Lipodystrophy can involve fat loss, fat gain, or a combination of the two. The fat gain seen in lipodystrophy is visceral fat, which causes the belly to feel taut and pushed out. This is different to the squeezable fat gained if people put on weight through over-eating or lack of exercise. It’s already been mentioned that older drugs, which are part of the group of drugs called NRTIs, are associated with fat loss. However, fat gain seems to be caused by treatment with drugs from a different group, the protease inhibitors. In addition, there are also concerns that some anti-HIV drugs may contribute to thinning of the bones (osteoporosis).
A small Spanish study has found that HIV treatment based on the integrase inhibitor raltegravir (Isentress) has a more neutral impact on fat gain and bone metabolism than therapy that includes a ritonavir-boosted protease inhibitor.
The research involved 74 people who were taking successful treatment based on a ritonavir-boosted protease inhibitor. The average duration of this treatment was approximately three years.
Half the patients were randomised to stop taking their protease inhibitor and to switch to raltegravir. One year later, fat accumulation and bone density was monitored in these patients and the other people who continued to take a protease inhibitor.
The people who remained on protease inhibitor therapy gained significantly more hard visceral fat than those who changed to raltegravir. Visceral fat levels remained stable in this latter group.
The researchers found this “striking” and think it might suggest that protease inhibitor treatment increases the risk of fat accumulation in the long-term.
People who were taking a protease inhibitor also had a greater risk of bone loss.
The researchers believe their findings could have implications for HIV treatment strategies: “Raltegravir might be considered a safe treatment option in certain patients, especially in the HIV-infected aging population, because of its already known lipid effects and now because of its potential beneficial bone effects.”
A separate study found that people taking HIV treatment have an increased risk of types of fracture normally associated with low bone mineral density. However, the most important risk factor for such fractures was the presence of other long-term illnesses. No relationship was found between an increased risk of fractures and specific anti-HIV drugs.
If you have concerns about side-effects, whether you’re currently taking HIV treatment or thinking about starting, it’s a good idea to talk to your doctor about them. It’s important to find the best treatment for you.
Our new online tool, Talking points, is a good place to start when preparing for a conversation with your doctor about HIV treatment. Try it out before your next appointment: www.aidsmap.com/talking-points
Living with HIV – relationships
Many people with HIV have intimate relationships with partners who are HIV-negative. These are often called ‘serodiscordant relationships’ because of this difference in HIV-infection status.
The presence of HIV can mean these relationships are subject to additional stresses and strains on top of those routinely experienced in a relationship.
The HIV-positive partners often described how they wanted to tell their partner of their HIV status (disclosure). However, in some cases this was met with hostility, abuse and rejection.
Nevertheless, not disclosing was thought to have a significant negative impact on the relationship.
Fears about the risk of HIV transmission were common, and occasionally relationships ceased to be sexual.
Many people had heard about the use of HIV treatment as prevention, but there was uncertainty about its effectiveness or how to incorporate it into discussions about sex with their partner. However, some people thought that the use of treatment in this way could make conception easier.
Encouragingly, around a third of the respondents said they were able to deal with HIV within their relationship and it did not have a long-lasting negative impact.
A number of couples had accepted and integrated HIV as just one element in their everyday lives and were apparently happy in their relationships.
HIV and sexual health
LGV is a bacterial infection and is caused by a strain of chlamydia. It was rare in the UK until about 2003. However, since then the infection has been seen more often and most of the cases have involved HIV-positive gay men.
Diagnoses of LGV increased from 180 in 2009 to 530 in 2010. The vast majority of cases (83%) involved HIV-positive gay men.
Researchers think this is because HIV-positive gay men are having unprotected sex with other HIV-positive men. This is often called ‘serosorting’. Doctors are warning that it can have implications for health – including the risk of contracting sexually transmitted infections like LGV and also hepatitis C virus.
Indeed, there were over 200 new cases of sexually transmitted hepatitis C in HIV-positive people between 2008 and 2010.
2010 also saw the largest number of new HIV diagnoses ever recorded in gay and bisexual men in the UK. Just over 3000 men were diagnosed in 2010, and it is estimated that around a quarter of them had become infected in the previous six months.
The Health Protection Agency recommends that men who have sex with men, black Africans and people who inject drugs should test for HIV at least once a year. You can arrange an annual sexual health check up that includes an HIV test at any sexual health clinic.
It’s a good idea for anyone who is sexually active to have regular sexual health check-ups. In the UK you can access sexual health clinics free of charge. Visit www.aidsmap.com/e-atlas to find clinics local to you.