HIV treatment and care – undetectable viral load
It showed that only 28% of all HIV-positive people in the country have an undetectable viral load.
Reducing viral load to a very low level (referred to as ‘undetectable’ because it is below the level measured by standard tests) is an important indicator of successful HIV treatment. Someone with an undetectable viral load has a lower risk of becoming ill from HIV and a low risk of transmitting HIV.
The percentage of people with an undetectable viral load was so low partly because about a fifth of all US HIV infections are as yet undiagnosed. In addition, the research found that a large proportion of people who were diagnosed lost contact with their clinic. This meant they were unable to benefit from HIV treatment.
The study had some encouraging messages about the effectiveness of modern HIV treatment. This was taken by 89% of patients who continued to go to their clinic. 77% of them achieved an undetectable viral load.
But because so many people were not receiving care, only 28% overall had an undetectable viral load.
This finding may have implications for the use of HIV treatment as prevention. The proportion of US patients with an undetectable viral load is currently so low that it is unlikely to have a major impact on the future course of the epidemic.
It’s important to note that the US healthcare system is very different to that in the UK. Recently published figures from the Health Protection Agency show better rates of linkage to care and undetectable viral load on treatment in the UK.
But the study does underline the importance of going to your clinic for regular check-ups and starting HIV treatment when it is needed.
Need to find a clinic? Try searching our online database of services, the e-atlas. Want to prepare for your next appointment? Build your own checklist using Talking points.
HIV and work – healthcare workers
HIV-positive healthcare workers in the UK may be able to undertake surgery or dentistry, or deliver babies – provided they are taking HIV treatment and have a viral load below 200 copies/ml.
At the moment, HIV-positive healthcare workers are banned from performing “exposure-prone procedures”. These are any medical procedures in which injury to the healthcare worker could result in the worker’s blood contaminating a patient’s open tissue.
These procedures involve a combination of sharp objects and the worker’s hands being in a body cavity. Surgery is the most obvious example, but many dental procedures are also considered to be exposure prone.
The Department of Health has opened up a consultation on easing these restrictions for healthcare workers who are taking HIV treatment, have a viral load below 200 copies/ml, and are under the joint supervision of a consultant in occupational medicine and their usual doctor.
The chairman of the Expert Advisory Group on AIDS, Professor Brian Gazzard, said: "Our careful review of the evidence suggests that the current restrictions on healthcare workers with HIV are now out of step with evidence about the minimal risk of transmission of infection to patients and policies in most other countries. This risk can be reduced even further if the healthcare worker is taking effective drug therapy for HIV and being monitored by HIV and occupational health specialists."
You can read the English and Scottish consultation documents here and here. Consultation in Wales and Northern Ireland will open shortly.
Cardiovascular disease – reducing the risks
Treatment with the anti-diabetes drug metformin slows hardening of the arteries in patients with HIV, a study has shown.
The same research showed the benefits of an exercise programme and changes to diet for overall cardiovascular health.
It is now recognised that people with HIV have an increased risk of a number of serious non-HIV-related illnesses, one of which is cardiovascular disease. The exact causes are uncertain but could involve damage caused by HIV, lifestyle factors such as smoking, and the side-effects of some anti-HIV drugs.
Your risk of cardiovascular disease should be monitored as part of your routine HIV care.
US researchers wanted to see if treatment with metformin and/or changes to diet and exercise routines helped reduce the risk of cardiovascular disease.
Their study sample included 50 HIV-positive people, all of whom had increased blood lipids (fats), a recognised risk factor for cardiovascular disease.
Results showed that treatment with metformin slowed the formation of plaque in the arteries.
Changes to diet and exercising three times a week reduced levels of blood fats and also improved overall fitness.
These encouraging results show that it is possible to modify the risk of cardiovascular disease, even in people who already have an increased risk of such illnesses.
For more information on healthy eating, you might find our recently updated Nutrition booklet useful. You can find all our booklets online at www.aidsmap.com/booklets.