Treatment as prevention – UK draft recommendations
The guidelines also say that anti-HIV drugs should be offered to anyone who is concerned about the risk of transmitting HIV to partners – even if they do not have a steady partner who is HIV-negative.
One of the hottest topics in HIV is the use of treatment as prevention. Research has shown that it can reduce the risk of transmission by 96%.
The guidelines highlight that these studies were mostly conducted in heterosexual couples, so the evidence mainly relates to vaginal sex, not anal sex.
The role of condoms in preventing HIV and other sexually transmitted infections is stressed in the guidelines.
HPV vaccination – US guidelines
There are about 100 different types of HPV and it is very common. For most people HPV has no symptoms and in most cases the body gets rid of the infection on its own.
However, some types of HPV cause genital warts and other types are associated with certain cancers, including cervical cancer and anal cancer. People with HIV are more likely to develop cancer as a result of HPV infection than people who are HIV negative.
The vaccine offers a high degree of protection against strains of the virus (HPV 6, 11, 16 and 18) which are associated with genital cancers and cancers of the head and neck.
The new guidelines recommend that all gay and bisexual men and HIV-positive men aged under 26 should receive the vaccine.
All boys and young men aged 11 to 21 – irrespective of their HIV-infection status – are also recommended to receive the vaccine.
US guidelines already recommend the vaccine for girls and young women aged 11 to 26.
In the UK, the only people routinely offered HPV vaccination through the NHS vaccination programme are girls aged 12 and 13, though older girls aged up to 17 can also be vaccinated.
HPV vaccination – gay men
The publication of the revised US guidelines coincided with the publication of a study showing that the vaccine was of benefit for HIV-positive gay men who had been successfully treated for the pre-cancerous cell changes that can be caused by certain strains of HPV.
There is currently very limited information about the benefits of Gardasil for older gay men.
However, gay men have a higher risk of pre-cancerous anal cell changes and anal cancer than other groups. The risk is higher still for HIV-positive gay men.
Doctors in New York successfully treated 202 middle-aged gay men for high-grade HPV-related pre-cancerous anal cell changes.
They monitored the men for the recurrence of pre-cancerous lesions according to whether they had received the Gardasil vaccine.
A total of 88 men (44%) received the vaccine.
Results showed that the vaccine reduced the risk of high-grade pre-cancerous cell changes recurring in the first two years after vaccination. This was even the case for men who were infected with high-risk strains of HPV.
The researchers believe their findings could be of public health significance: “If our results are confirmed by a randomized, placebo-controlled trial, then indications for vaccination and the age of the target population should be expanded.”