HIV treatment – outcomes
New US research shows further evidence of the effectiveness of modern HIV treatment.
Conducted at the Johns Hopkins University HIV clinic in Baltimore, it showed that 79% of their patients had an undetectable viral load (this means the amount of virus in the blood is below the level standard tests can measure – usually 40 to 50 copies/ml).
The study involved over 5000 people who received care at the clinic between 1996 and 2010.
Effective HIV treatment first became available in 1995/96, but was often difficult to take, caused unpleasant side-effects, and was usually based on unboosted protease inhibitors.
In 1998, only 44% of patients taking treatment had an undetectable viral load.
But improvements in HIV treatment and care helped increase this to 79% by 2002.
In 2010, the average viral load of the clinics’ patients, including those not yet taking HIV treatment, was just 200 copies/ml, and only 17% of patients had a viral load above 500 copies/ml.
The researchers think these results are “remarkable”, especially as many of their patients face complex social and economic problems.
HIV treatment – new strategies
Since triple-drug HIV treatment first became available in the mid 1990s it’s been based on a ‘backbone’ of two NRTI drugs (nucleoside reverse transcriptase inhibitors). But there’s mounting evidence that drugs in this class cause many of the side-effects associated with HIV treatment.
Therefore, researchers are interested in the effectiveness and safety of so-called 'NRTI-sparing' combinations that include newer, and apparently safer, anti-HIV drugs.
The latest research involved over 100 people. They were all starting HIV treatment for the first time and were given raltegravir and ritonavir-boosted darunavir.
Overall effectiveness of the combination was “acceptable” – 74% of participants had an undetectable viral load after six months, and 61% after twelve months.
But poorer results were seen in people who started treatment with a higher viral load. Indeed, 75% of people whose viral load wasn’t suppressed to undetectable levels had had a viral load above 100,000 copies/ml at the start of the study.
Resistance to raltegravir developed in five people – all had relatively low viral loads, between 60 to 700 copies/ml.
The researchers believe this is an important finding, and note that new treatment guidelines now set a viral load of 200 copies/ml as the benchmark for the virological failure of treatment.
TB – development after starting HIV treatment
Tuberculosis (TB) is the single most important cause of illness and death in people with HIV.
Even in richer countries such as the UK and US it is one of the most common AIDS-defining illnesses.
People who are not taking HIV treatment should be regularly screened for TB and checked for symptoms.
Antiretroviral therapy allows the immune system to strengthen and this provides protection against TB and other infections.
They examined the medical records of approximately 38,000 people. TB developed in 0.4% of these individuals.
A CD4 cell count below 200, a history of injecting drug use, and non-white race were all associated with TB.
The researchers hope their findings will encourage the screening of those at highest risk.
For more information on TB, visit our Tuberculosis and HIV topics pages, which bring together our TB resources, features, news and news from other sources.
Living with HIV – partner abuse common
US research suggests that many HIV-positive men who have sex with men are abused by their partners.
The study included 168 men.
Just over half said they had been abused by a partner in the previous twelve months – and over three-quarters said they had been abused by a partner at some point.
Psychological abuse was the most commonly reported form of abuse, with 51% saying they’d experienced this in the past year.
Recent physical abuse was reported by a fifth of the men, and 10% said they’d experienced HIV-specific abuse.
The investigators noted that these levels of abuse are similar to those reported by HIV-positive women.
Physical abuse was associated with anxiety and depression.
But a surprising finding was that psychological abuse wasn’t associated with an increased risk of mental health problems.
This was a very small study, and the men who participated were often coping with difficult social circumstances.
But the researchers believe their findings point to a need to do more work to support men who are being abused by their partners, and conclude: “collaborative efforts with clients, providers, and public health officials will be needed to address partner abuse in a comprehensive manner. Given the extent of partner abuse and its deleterious effects, work on such interventions cannot begin too soon.”
If you are affected by abuse, you don’t have to cope on your own. Talk to someone you trust, or contact a local HIV organisation for support. In the UK, the charity Broken Rainbow offers support for lesbian, gay, bisexual and transgender people experiencing domestic abuse. You can contact their helpline on 0300 999 5428.