HIV update - 30th September 2015

Big improvement in life expectancy of older people living with HIV

Several studies have shown that, thanks to modern HIV treatment, the life expectancy of many people living with HIV in richer countries is now close to normal. But this primarily applies to people who are diagnosed and begin HIV treatment with a relatively high CD4 cell count, before significant damage has been done to their immune system.

What about the life expectancy of older people living with HIV? In some countries, up to half of people living with HIV are over 50. Diseases of ageing (such as cancers and heart disease) are an important cause of health problems in people with HIV and these diseases may develop at a younger age in people who have HIV.

Researchers have taken a closer look at the situation for people over the age of 50 living with HIV in Denmark. They have examined how the situation has changed over the last twenty years.

In the late 1990s, soon after the introduction of combination therapy, a 50 year old could expect to live to the age of 62.

Improvements in HIV treatment and care have added an extra decade to this life expectancy. Now a 50 year old can expect to live to 73.

This is a big improvement, but people living with HIV still have poorer outcomes than those in the general population – a 50 year old without HIV can expect to live to 80.

The researchers also looked at a subgroup of people living with HIV who were doing well on HIV treatment and didn’t have any significant health problems when they entered the study. They found that a 50 year old with these characteristics could expect to live to 76, compared to 84 in the general population.

Some of the differences with the general population may be due to HIV-related health problems, but it’s also possible that lifestyle factors play a part too. In other words, Danish people living with HIV may – on average – be more likely to have smoked, drunk heavily or have a poor diet than other Danes. The researchers weren’t able to make statistical adjustment for these kind of factors.

Hepatitis C rates increasing

The sexual transmission of hepatitis C has been increasing among gay men living with HIV in recent years, a new analysis concludes.

The researchers identified all the relevant studies that have been done on the topic and pooled their results. They found 25 studies, half conducted in European countries, a few from the United States, a few from Asia and two from Australia. All looked at men in big cities in rich countries and excluded individuals who injected drugs. Over 13,000 individuals were included in this analysis.

The annual rate of new hepatitis C infections in gay men living with HIV has increased. In 1991, 4 in every 1000 men acquired hepatitis C each year. By 2010, this had increased to 11 in every 1000 men. In 2012, the last year with data, it was 13 in every 1000 men.

These rates are not as high as those in people who inject drugs (around 130 per 1000 people each year), but are of concern. They are far higher than in gay men who don’t have HIV.

Especially worrying was that in two studies of gay men who had already had hepatitis C and had it successfully treated, 110 per 1000 got a new hepatitis C infection each year.

Several practices were linked with hepatitis C infections:

• receptive anal sex without a condom
• 'traumatic' sex that could cause abrasions, cuts or bleeding
• fisting
• sex while using crystal meth
• snorting drugs.

You can out more about preventing hepatitis C in NAM’s illustrated leaflet, How hepatitis C is passed on during sex

Treatment is helping couples live with HIV

A greater understanding of the impact of HIV treatment on prevention is changing the experience of being in a relationship with a partner of a different HIV status, according to Australian research. Antiretroviral medications appear to be having unexpected effects – loosening the association of serodiscordant relationships with ‘risk’ and helping couples to experience their relationships as normal and safe.

The same researcher previously interviewed couples on the same topic in 2009 and found scepticism about the idea that HIV treatment could make a person non-infectious. But in 2013 and 2014 she found that couples readily discussed the implications of having an undetectable viral load. 

One woman explained the benefit of knowing about treatment as prevention:

“It helps you to be able to relax and enjoy your sex life, enjoy your relationship with your partner. It’s one less thing to worry about.”

Many of the interviewees did not want the risk of HIV transmission to define their relationship:

“I can’t see how I can have a loving relationship with Jasmine and be preoccupied with fear about becoming HIV-positive… it just seems incompatible.”

Because HIV treatment is changing the perception of HIV as being extremely infectious, it is opening up new possibilities for couples in which one person has HIV and the other does not, the researcher believes. It can help restore a sense of social and sexual belonging to people living with HIV, she says.