HIV in the UK – Select committee
The report issued by the peers warns of “potentially huge cost implications…of failing to deal effectively with the epidemic”.
More than 80 HIV organisations, including NAM, gave evidence to the committee.
Prevention was highlighted as a key priority and the committee also wants to see HIV testing given prominence.
“We want to see a new emphasis on people getting tested,” said Lord Fowler, who chaired the committee. “It is ridiculous that we have about a quarter of people with HIV who don’t know they have it. It’s bad for them, and it’s bad for public health.”
The committee also made recommendations about the provision of HIV treatment.
These include:
- Clinics building stronger links with GPs so that some aspects of HIV care can be moved to primary care.
- Hospitals providing evening and weekend HIV clinics.
- Home delivery of drugs.
- Telephone and email consultations.
People not currently entitled to free HIV treatment in the UK should receive free treatment.
Peers also highlighted the use of HIV treatment as prevention, especially pre-exposure prophylaxis, as a research priority.
The committee’s recommendations are not binding on the government, but have been welcomed by HIV organisations.
Deborah Jack, Chief Executive of NAT (National AIDS Trust), said: "It is essential that HIV prevention is treated as public healthy priority by the Government and is a core element of new local public health strategies. The report covers more than 50 recommendations for action and it’s important for the Government to act on these – not in a piecemeal fashion – but with a cohesive strategy for HIV which brings all these elements together."
HIV treatment – taking your treatment
There is a consistent relationship between depression and poor adherence to HIV treatment, researchers have concluded after examining the findings of 95 different studies.
To get the best results from your HIV treatment you need to take almost every dose.
Simple forgetfulness is the main reason why most patients miss the odd dose of their treatment. This is unlikely to have any serious consequences.
However, missing a larger number of doses can mean that your treatment stops working properly, and that your viral load increases, possibly leading to the development of drug-resistant strains of virus.
If you are having difficulty taking your treatment, it’s important to tell your doctor, or another person in your healthcare team, so that help can be provided.
Researchers wanted to see if depression resulted in poorer adherence. They therefore looked at the results of 95 different studies that involved over 36,000 people.
Depression was very common – in some studies prevalence amogst study participants was as high as 36%.
There was a consistent relationship between depression and poorer adherence to HIV treatment, although the effect of depression on adherence was relatively mild.
The study wasn’t able to show why depression affected adherence. But the researchers suggested that it could be related to depression's impact on concentration, appetite, self worth and self care.
Treatments for depression work well in people with HIV, and a lot of support is available if you are experiencing emotional or mental health problems, including depression.
For more information on these subjects you can read or download NAM’s booklets ‘Adherence & resistance’ and ‘HIV, mental health & emotional wellbeing’ from www.aidsmap.com/booklets.
HIV treatment – drug interactions
Taking two or more different drugs together can result in a change to the effectiveness, or side-effects, of one or more of the drugs. This is called a drug interaction. A new US study has shown that a drug interaction means that HIV treatment and older anti-epileptic drugs should not be used at the same time.
Older epilepsy therapies (such as phenytoin, carbamazepine and phenobarbital) and many antiretroviral drugs are processed in the body by the same liver enzyme.
This interaction means that levels of anti-HIV drugs may be reduced. As a result, blood levels of anti-HIV drugs are too low to effectively fight the virus.
Epilepsy therapies are quite widely used by people with HIV; they are used to treat seizures, as well as neuropathy and mental health problems such as depression and bipolar mood disorder.
More modern anti-epileptics – for example sodium valproate – used in the UK are metabolised by the body in a different way to anti-HIV drugs. This means that there isn’t a risk of an interaction. However, the older anti-epilepsy drugs are still widely used in resource-limited settings.
Researchers compared the viral load of people taking HIV therapy and older anti-epilepsy drugs to the viral load of two other groups of people. The first group consisted of people taking HIV treatment with newer epilepsy therapies; the second comprised people who were only taking antiretroviral therapy.
Almost three-quarters of people taking the epilepsy drugs that interacted with HIV therapy had a detectable viral load six and twelve months after starting antiretroviral treatment.
In contrast, only a third of people treated with newer epilepsy therapies, or those only taking anti-HIV drugs, had a detectable viral load at these time points.
For more information on drug interactions you may find the ‘Drug interactions and pharmacokinetics’ section of our website useful. A helpful website for checking drug interactions is maintained by the University of Liverpool: www.hiv-druginteractions.org.
HIV and hepatitis – hepatitis delta
Hepatitis means inflammation of the liver, and this can be caused by viruses.
Hepatitis A, B, and C are well known. There are vaccines against hepatitis A and hepatitis B, which are recommended for anyone with HIV who doesn't have existing immunity.
Many people with HIV are co-infected with hepatitis B and/or hepatitis C, and the liver disease caused by these infections is a major cause of serious illness and death in co-infected people.
Other hepatitis viruses also exist – including hepatitis delta (sometimes called hepatitis D, or HDV). This is an aggressive virus, and it is estimated that as many as 20 million people worldwide are infected with hepatitis delta. The virus requires co-infection with hepatitis B – chronic hepatitis B carriers are at risk of hepatitis D and it is also possible to become infected with hepatitis B and D at the same time.
About 5% of people with hepatitis B are also infected with hepatitis delta.
Overall, 15% of people with HIV and chronic hepatitis B in the study were also infected with hepatitis delta. These patients had an increased risk of death during the study period, including death caused by liver disease.
Earlier research has shown that infection with hepatitis delta slows the pace of liver disease caused by hepatitis B. But this isn’t the case for people who are infected with a specific strain of hepatitis B – subtype D.
The latest research also found this association. Hepatitis B viral load was lower in people with hepatitis delta co-infection. The exception was in people with hepatitis B subtype D.
“Hypothetically, this…group of patients replicating both hepatitis B virus and hepatitis delta virus might experience enhanced liver damage,” suggest the investigators.
All HIV-positive people who are co-infected with hepatitis B should be tested for hepatitis delta as part of their routine care.
Treatment for hepatitis delta usually consists of twelve months of therapy with pegylated interferon alfa. There is also some evidence that the anti-hepatitis B drug adefovir (Hepsera), as well as the anti-HIV drugs tenofovir (Viread) and 3TC (lamivudine, Epivir), are active against the virus.
For more information resources, features and news on HIV and hepatitis, visit the ‘Hepatitis and HIV’ topics pages of our website.