Daily health issues: alcohol
There’s been a lot of debate about the effect of alcohol on HIV disease progression and outcomes in people on HIV treatment. Research into these questions has produced conflicting results.
Given this uncertainty, researchers in Switzerland looked at the impact of alcohol consumption on virological outcomes in 3000 people who were starting HIV treatment. The effect of alcohol on the CD4 cell count of these people – and 2000 individuals who didn’t start therapy – was also monitored.
The majority of participants reported that they drank alcohol. However, only 2% had levels of alcohol consumption that represented a serious risk to their health.
Overall, 8% of participants starting HIV treatment experienced virological failure, meaning their viral load never became undetectable or rebounded to detectable levels after suppression.
But there was no evidence that drinking alcohol increased the risk of this outcome. Treatment was interrupted without medical supervision by 14% of people in the study. The researchers found that people with levels of alcohol consumption that were potentially dangerous to their health were twice as likely to stop taking their treatment than people who didn’t drink or who had only modest levels of alcohol consumption.
Drinking alcohol did not affect CD4 cell count in either the participants who started HIV treatment or those who remained treatment naive. “Our data contribute valuable knowledge to the controversy whether alcohol has an influence on HIV surrogates or not,” the researchers conclude.
If you are concerned about your alcohol intake or any other drug use, help is available. Your HIV clinic is a good place to start. They won’t judge you about your alcohol or drug use and will be able to offer practical advice and support and also refer you to specialists who can help. The LGBT charity London Friend runs a drug and alcohol service called Antidote – you can call them on 020 7833 1674 or find out more on their website: www.londonfriend.org.uk/get-support/drugsandalcohol
Cardiovascular disease
There is only modest evidence that a low CD4 cell count increases the risk of cardiovascular disease for people with HIV, results of a large study show.
Cardiovascular disease is now a leading cause of serious illness and death in HIV-positive people. This is probably due to a number of factors, including the ageing of the HIV-infected population, lifestyle factors such as smoking, the side-effects of some anti-HIV drugs, and the damage caused by untreated HIV infection.
Studies looking at the association between a low CD4 cell count and the risk of cardiovascular disease have yielded conflicting results.
Researchers have looked at this question again in a large study involving over 33,000 participants. The investigators looked at the association between immune suppression – a lowest-ever and current CD4 cell count below 200 – and the risk of cardiovascular disease outcomes, including coronary heart disease, heart attack and stroke.
Their first analysis showed that immune suppression was associated with an increased risk of all cardiovascular disease outcomes. However, after taking into account other possible risk factors, most of these associations were no longer significant.
A current CD4 cell count below 100 continued to be associated with stroke. But the researchers think that this is because of misclassification of some strokes by doctors. The association between a low CD4 cell count and stroke was weakened when rigorous criteria for the diagnosis of stroke were adopted.
The researchers conclude: “We do not find strong evidence that individuals with a low CD4 count are more likely to experience a new [heart attack] or coronary heart disease event. Although stroke appears to occur more commonly in those with low CD4 counts, some of this association may be explained by misclassification of events.”
HIV and cancer: lymphoma
Cancers are an important cause of serious illness and death in people with HIV, and the most common type of malignancies are lymphomas.
Rates of the AIDS-defining cancer non-Hodgkin’s lymphoma fell dramatically after the introduction of effective HIV treatment. Researchers in the US wanted to identify the spectrum of lymphomas now seen in people with HIV and to see if infection with HIV was associated with poorer outcomes.
Their research involved 23,000 participants who received care between 1996 and 2010. A total of 476 people (2%) were diagnosed with lymphoma. Approximately half the diagnoses involved people who were already taking HIV treatment.
Over the course of the study, the average age at the time of lymphoma diagnosis increased. The researchers think that this was due to the general ageing of the HIV-infected population.
Average CD4 cell count at the time of diagnosis also increased from 85 to 166.
HIV-positive people with most types of lymphoma continued to have poorer survival rates than HIV-negative lymphoma patients in the general US population. Factors associated with an increased risk of death were older age, a lower CD4 cell count and a higher viral load.
HPV vaccination
Some senior British sexual health doctors believe that there is a “strong” case for providing human papillomavirus (HPV) vaccination for younger gay men.
Persistent infection with certain ‘high-risk’ HPV types is associated with an increased risk of ano-genital cancers. Vaccines have been developed that provide a very high degree of protection against infection with these HPV types. These vaccines work best if administered before an individual become sexually active. Vaccination campaigns in the UK have prioritised school-age girls. Despite having high rates of HPV-related anal disease, vaccination is not currently recommended for gay men in the UK.
But researchers believe this should change. They highlight studies involving HIV-negative gay men showing that the vaccine produced a good immune response and was effective at preventing infection with high-risk HPV strains. Vaccination also had other benefits, reducing the incidence of pre-cancerous anal lesions.
There is also evidence showing that vaccination would benefit the vast majority of sexually experienced younger gay men. Research has shown that no more than 13% of gay men are infected with the HPV types associated with the highest risk of cancerous cell changes. But up to 3% of men became infected with these strains each year, showing the value of vaccination.
Research has also shown that the HPV vaccine can produce a strong immune response in HIV-positive gay men – the group with the highest risk of anal cancer. US research has shown that the vaccination of younger gay men would be cost-effective.
The researchers therefore believe that there is a strong argument for extending HPV vaccination coverage to include gay men aged 26 and younger.
Hepatitis C treatment outcomes
Many HIV-positive people are co-infected with HCV. Liver disease caused by HCV is a leading cause of death in these patients.
HCV can be treated and cured. But treatment outcomes are poorer in co-infected people, especially if they are infected with the harder-to-treat HCV genotypes 1 or 4. Genetic characteristics also influence HCV treatment outcomes, which are best in people with a genetic mutation called IL28B-CC.
Now researchers in Spain have identified a number of other genetic characteristics associated with improved HCV treatment outcomes. Their study involved 205 co-infected people with genotype 1 or 4 infection who were treated with pegylated interferon and ribavirin.
Overall, 36% of participants achieved a sustained virological response (SVR), considered a cure. The SVR rate was higher (56%) among participants with the IL28B-CC mutation. Several other genetic characteristics were associated with a better treatment response. Indeed, a SVR was achieved by approximately three-quarters of the participants with the most favourable genetic profile and by just 7% of people with the genes least favourable to good treatment outcomes.
Only 14% of participants had the set of genes associated with the best outcomes; 6% had the profile associated with the poorest treatment response. Nevertheless, the researchers hope their findings would provide a basis for further research looking at the impact of patients’ genetics on HCV treatment outcomes.
Interested in hepatitis and HIV? Visit our hepatitis C topics page for more resources, feature articles and news about hepatitis and HIV co-infection. We’re also working with ELPA, the European Liver Patients Association, on a hepatitis information website for patient advocates and professionals working in hepatitis in Europe – check it out at www.infohep.org
Editors' picks from other sources
The HIV and HepC mix
from scotfreehiv (blog)
My heart sank. I’d just put the phone down. A friend’s routine test results had shown up Hepatitis C. Again.
Lighthouse West London 'will be sold'
from Kensington & Chelsea Chronicle
Terrence Higgins Trust has said it plans to put the Lighthouse building in Ladbroke Grove, on the market, due to financial pressures. "Lighthouse means a great deal to those of us who lived through the early years of the HIV epidemic or who have a personal connection with the building," said Paul Ward, deputy chief executive of Terrence Higgins Trust. "However our focus must now be on the future of the building."
HIV defines me, whether I like it or not
from Living with HIV (blog)
I had convinced myself that HIV would not, had not impacted on my life. I was to carry on living pretty much like I had before. I would not be different because of it. I would the same old me. But course HIV defines me, at least parts of me.
Blaming the Rise of HIV on 'Gay Sex Parties' Is Dangerous and Irresponsible
from Huffington Post
While the hysterical term 'gay sex parties' makes for a good headline, it irresponsibly diverts attention from what's really going on. HIV is not an issue restricted to the fringes of society; we all have a responsibility to protect ourselves and each other.