HIV care
Most HIV care is provided through specialist outpatient clinics. Regular follow-up appointments are important, so that doctors can monitor the effect of HIV on your health. HIV clinics can also act as a gateway to other medical services and sources of social support.
US doctors wanted to see how many people were receiving proper levels of HIV care.
They therefore looked at the medical records of approximately 5000 people, diagnosed with HIV between 2001 and 2009.
A fifth had never established contact with a clinic after their diagnosis.
Only 43% of people in the study attended their clinic for regular follow-up appointments, and large numbers were also “lost to follow-up”, meaning they stopped attending appointments and their clinic didn’t know what had happened to them.
Overall, only 20% had consistently high levels of engagement with specialist care.
The researchers were very worried by these findings and believe initiatives are needed that help people to access HIV care and to keep on coming back for regular appointments.
HIV and hepatitis C
Many people living with HIV also have hepatitis B and/or hepatitis C (often referred to as ‘co-infection’). Liver disease caused by hepatitis is now a significant cause of serious illness and death in people with these co-infections.
Researchers wanted to see if hepatitis C increased the risk of death for HIV-positive people who had very weak immune systems.
They looked at the medical records of over 2000 people who were diagnosed with AIDS between 1998 and 2009.
Approximately a fifth of people in the study were co-infected with hepatitis C, but 21% of them had cleared the infection.
Chronic hepatitis C co-infection was associated with a 50% increase in the risk of death. Past infection had no impact on mortality risk.
Some 20% of deaths in co-infected people were due to liver disease. This compared to just 4% of deaths in people with AIDS who were not co-infected.
The researchers found that many people were unaware they had a co-infection.
HIV care guidelines say that everyone with HIV should be regularly tested for hepatitis C. HIV treatment works well in people with co-infections, and hepatitis C can also be treated. You can find out more about these subjects in the booklet HIV & hepatitis.
Adherence – taking your HIV treatment
The aim of HIV treatment is an undetectable viral load. To achieve this, it’s necessary to take your treatment correctly, taking nearly all your doses at the right time and in the right way.
Taking your treatment correctly is often called adherence. The best results are seen in people with high levels of adherence. Poor adherence can mean that viral load becomes detectable. This can result in HIV becoming resistant to the drugs used to treat it.
Doctors wanted to see which type of poor adherence involved the greater risk of viral load becoming detectable – unplanned treatment breaks or ‘holidays’, or missing occasional doses.
They therefore monitored the adherence of approximately 1100 people who took HIV therapy between 1997 and 2008.
Their results showed that both taking treatment breaks and missing occasional doses were associated with an increase in viral load. However, treatment breaks were associated with a bigger risk.
Missing occasional doses was more likely to lead to an increase in viral load for people taking an NNRTI compared to those taking a boosted protease inhibitor. An NNRTI is a type of HIV treatment called a ‘non-nucleoside reverse transcriptase inhibitor’ or ‘non-nuke’; drugs in this class include efavirenz (Sustiva, also in the combination pill Atripla) and nevirapine (Viramune). A protease inhibitor is another type of HIV treatment, usually ‘boosted’ with a small dose of another drug called ritonavir (Norvir).
Further analysis showed the importance of maintaining high levels of adherence. This showed that taking fewer than 93% of doses, or treatment breaks lasting over 48 hours were both associated with a significant risk of an increase in viral load.
The booklet Adherence & resistance is a good place to start if you are looking for information on these subjects. It’s important to ask for help if you are having problems taking your treatment properly. Staff at your HIV clinic will be able to help.