US guidelines say that everyone with HIV should take treatment
New US treatment guidelines recommend that all HIV-positive people start antiretroviral therapy.
Treatment is especially recommended for people with a CD4 cell count below 500; people at risk of transmitting HIV to others; people with hepatitis B co-infection; and those with kidney disease
The previous guidelines issued in 2009 recommended treatment should be started when a patient’s CD4 cell count was in the region of 350 to 500.
But the latest guidelines now recommend treatment for all patients. They base the recommendation on studies showing that any HIV replication is associated with an increased risk of illness and death.
The impact of HIV treatment on infectiousness also helped shape the new US recommendation. A major study showed treatment that suppresses viral load reduces the risk of HIV transmission by 96%. The updated guidelines say that this information should be discussed with all patients.
The draft 2012 British guidelines have taken a more cautious approach. The routine CD4 threshold for starting treatment is 350. However, earlier treatment is recommended for people who are ill because of HIV; people with hepatitis B or C; and those at risk of passing on HIV to others.
Want to talk to your doctor about HIV treatment? Try our ‘Talking points’ tool before your next appointment: www.aidsmap.com/talking-points
Treatment as prevention – detectable viral load in semen
The research involved 101 men who were receiving care in Boston. All the men had been taking HIV treatment for over three months.
A total of 83 men had an undetectable viral load in their blood. A quarter of these had detectable levels of the virus in their semen. The average viral load in semen for these patients was 200. The researchers think that a viral load of this level is potentially infectious, but the risk would be low.
Recent diagnosis with a sexually transmitted infection was strongly associated with detectable viral load in semen, as was the presence of certain immune system cells.
A separate French study of heterosexual men in stable relationships showed that approximately 7% of men with an undetectable viral load in their blood had detectable viral load in their semen.
It’s already well known that sexually transmitted infections (STIs) can increase viral load. If you’re sexually active, regular sexual health check-ups are a sensible part of looking after your health, even if you have no symptoms. If you’re in the UK, testing and treatment for STIs at an NHS clinic is free. Find your nearest clinic at www.aidsmap.com/e-atlas.
HIV and lung cancer
HIV was shown to increase the risk of lung cancer, even after taking into account other known risk factors such as smoking.
Lung cancer is rare in people with HIV, but rates of the cancer are higher than those seen in the general population.
The exact reasons for this are unclear. Some doctors think it’s because many people with HIV smoke. Others attribute the risk to the immune damage caused by HIV, or the high prevalence of lung disease in HIV-positive people.
To get a clearer understanding of the causes, researchers from the US studied 37,000 HIV-positive people and 75,000 HIV-negative people in a matched control group.
They found that incidence of lung cancer was 70% higher in the HIV-positive people compared to the control group.
The researchers found that HIV itself was a strong independent risk factor for the cancer.
However, smoking and previous history of lung disease were also important factors.
If you smoke, there is lots of support available to help you give up. Talk to your HIV clinic, your GP or HIV support organisation, or visit a website like http://smokefree.nhs.uk for advice and support. You can do it!
Safety of HIV treatment during pregnancy – tenofovir
Taking tenofovir (Viread, also in Truvada, Atripla and Eviplera) during pregnancy doesn’t affect infant size or weight at birth, a large study shows.
The researchers were reassured by the findings of the study, which they believed showed the safety of tenofovir treatment during pregnancy. However, they did find that exposure to tenofovir in the womb was associated with differences in some aspects of growth when infants reached one year of age.
Over 2000 HIV-negative infants of HIV-positive mothers were included in the study. Just over a fifth of babies were exposed to tenofovir during their mother's pregnancy.
At birth, there was no difference in either size or weight between the infants exposed to tenofovir and those who were exposed to other anti-HIV drugs.
Overall growth after one year was good. But some aspects of the weight and size of the infants exposed to tenofovir were slightly lower than would be expected.
The investigators were surprised by this finding and were unsure of its significance.
Taking HIV treatment during pregnancy is a very effective way of reducing the risk of HIV being passed on from mother to baby, but people understandably have concerns about the effect it could have.
If you’re planning a pregnancy, or are already pregnant, talk to your doctor or someone else in your healthcare team about the best treatment and care options for you and your baby. You can find out more about conception and pregnancy in our booklet HIV & women.