Starting HIV treatment
New research shows the importance of considering viral load when making decisions about the best time to start HIV treatment.
They found that people who had a viral load above 100,000 copies/ml were less likely to experience a fall in their viral load to below 50 copies/ml.
Overall, 82% of people who had a viral load below 100,000 copies/ml had an undetectable viral load one year after starting treatment. This compared to 73% of people who had had a viral load above 100,000 copies/ml.
In the UK, people with HIV are recommended to start HIV treatment when their CD4 cell count falls to around 350 or if they are ill because of HIV. However, earlier treatment is recommended in some circumstances – including the presence of a high viral load.
The latest research supports this recommendation.
The results were similar for people taking different treatment combinations. There is some evidence that abacavir (Ziagen, also in the combination pill Kivexa) is less effective in people with a high viral load. However, in this study, the effect of a high viral load remained the same when the investigators focused on people taking tenofovir (Viread, also in Truvada, Eviplera and Atripla).
If you want to know more about viral load or starting HIV treatment, then you may find the NAM booklets CD4, viral load & other tests and Anti-HIV drugs useful.
HIV care in the UK
The recommendations are very broad ranging and cover everything from initial diagnosis to care on hospital wards.
They also acknowledge the wider impact of living with HIV, making recommendations concerning psychological health and sexual and reproductive health.
Most HIV care in the UK is provided by the National Health Service (NHS) and is among the best in the world. However, the NHS in England is currently undergoing a major restructuring and professionals involved in HIV care wanted to ensure that these current high standards were maintained into the future.
Most people with HIV in the UK can expect to live well into old age and are therefore at greater risk of developing the health conditions associated with ageing, for example cardiovascular disease. The new recommendations take this into account, recognising that people with HIV will probably need to see specialists in disease areas other than HIV.
The maintenance of patient confidentiality receives a lot of attention in the recommendations.
You can read the recommendations on the BHIVA website. You can also find out more about the recommendations in the autumn edition of HIV treatment update.
New anti-TB drug
The anti-tuberculosis (TB) drug bedaquiline has been recommended for fast-track approval in the US.
TB is the single biggest cause of serious illness and death in people with HIV around the world.
The infection is a global health problem, and there is particular concern about increasing rates of drug-resistant TB. New anti-TB drugs are therefore urgently needed.
Bedaquiline has been specially developed for the treatment of drug-resistant TB. It was shown to be safe and effective in clinical trials, improving treatment response rates.
The drug interacts with the anti-HIV drug efavirenz (Sustiva, also in Atripla).
On our website you can find information for people living with HIV and TB (for example the HIV & TB booklet and three leaflets in our illustrated series The basics) and information for healthcare workers in resource-limited settings.
Editors' picks from other sources
Highest-ever HIV diagnoses in gay men
from BBC News
The number of gay and bisexual men being diagnosed with HIV in the UK reached an "all-time high" in 2011, according to the Health Protection Agency (HPA). It said there had been a "worrying" trend since 2007, with more and more new cases each year.
Migrants Disproportionately Affected by HIV and AIDS in High-Income Countries, Says International Organization for Migration
from International Organization for Migration press release
Migrants and mobile populations are at particularly high risk of HIV infection all over the world, as they frequently face marginalization, exclusion and various barriers to accessing health promotion and care. In addition, there is also a lack of awareness of migrants’ vulnerability to HIV in high-income countries.
The impact of welfare cuts: living with HIV just got harder
from New Statesman
The aim, to get people with HIV back to work, is laudable, but the means are devastating. Government figures show that a shocking 44 per cent of people with HIV who have completed a "Work Capability Assessment" have had their support cut off, and charities warn that it is causing destitution.
Clinton reveals ‘blueprint’ for reaching an ‘AIDS-free generation’
from Washington Post
The world can control the AIDS epidemic in four or five years and set it on a trajectory to become a small, if permanent, problem, according to US Secretary of State Hillary Rodham Clinton. An “AIDS-free generation” could be reached by starting more infected people on AIDS drugs, circumcising men in high-prevalence countries and making sure that every HIV-positive pregnant woman is treated.