HIV and inflammation
It's known that long-term HIV infection causes inflammation in different parts of the body, probably because of the immune system's response to the virus replicating.
This inflammation is thought to be one reason people with HIV may develop certain health problems, such as thickening of the arteries which can lead to heart (cardiovascular) disease.
In the past, research has indicated that this inflammation can happen even when someone is on HIV treatment and has a low viral load.
The findings of this study suggest that having an extremely low viral load is not linked to increased inflammation.
Previous research has relied on viral load tests that can detect viral load down to either 400 or 75 copies/ml. This study used ultra-sensitive tests that can measure viral load below 20 copies/ml. The researchers found that a viral load below that level was not associated with the markers linked to inflammation, suggesting a reduced risk of related health problems.
For more information on inflammation, you may find the article on our website How does HIV make us sick? helpful.
HIV and illness
Rates of pneumococcal disease are still high in people with HIV.
UK researchers found that rates of the disease were approximately 20 times higher in people with HIV compared to the general population.
Pneumococcal disease is caused by a bacterium called streptococcus pneumoniae. It can cause pneumonia as well as meningitis. Before HIV treatment became available, the infection was an important cause of illness and death in people with HIV. The infection is treated with antibiotics.
Between 2000 and 2009, almost 64,000 people received HIV care in the UK and 941 were diagnosed with pneumococcal disease. The mortality rate among these patients was 13%.
People with a low CD4 cell count who were not taking HIV treatment had the highest rates of the infection.
However, the researchers found that even in people taking antiretroviral therapy and with a CD4 cell count above 500, the rate of pneumococcal disease was seven times higher than that seen in HIV-negative people.
“Our study underscores the importance of early HIV diagnosis and the protective effect of antiretroviral therapy on invasive pneumococcal disease co-infection,” comment the investigators.
Vaccines against pneumococcal disease have been developed. The researchers also found that a newer vaccine, which is effective against 13 pneumococcal serotypes (PCV13), would provide greater levels of protection for people with HIV than the vaccine currently in use.
A recent edition of our publication HIV treatment update included a feature article on bacterial pneumonia. That feature is available online here.
Hepatitis C – treatment
German researchers also found that a very high hepatitis C viral load before the start of treatment was associated with an increased risk of relapse after the completion of treatment, even if the patient achieves an undetectable hepatitis C viral load on treatment.
Their study involved 255 people with hepatitis C genotype-1 infection. None were HIV-positive.
They received therapy with pegylated interferon and ribavirin for 48 weeks. Treatment response was assessed using both standard and ultra-sensitive hepatitis C viral load tests.
Detection of even very low levels of virus after four and twelve weeks of treatment was associated with an increased risk of relapse after the completion of therapy.
Two hepatitis C protease inhibitors have recently been approved, and several other drugs are currently in development. The investigators believe their results could help determine how these new drugs should be used, and call for “individualised treatment strategies”.
The researchers emphasise that only ultra-sensitive tests can accurately predict the risk of relapse.
Hepatitis C – prevention
Hepatitis C is a blood-borne infection. A major mode of transmission is injecting drug use.
Needle exchange programmes are key to hepatitis C prevention. However, transmissions are still occurring amongst injecting drug users. Possible explanations for this have been suggested by two studies.
Researchers found that hepatitis C can survive for up to seven days on objects such as syringes. However, disinfectants rendered the virus inactive. They also found that exposing the virus to a temperature of 65-70°C for approximately 90 seconds killed the virus.
A separate study showed that the virus was detectable on 83% of swabs (used for cleaning skin before injection) collected from injecting drug users. Levels of the virus on swabs were higher than levels in used syringes.
The researchers say, “it is noteworthy that blood was macroscopically visible on both alcohol swabs and cotton pads, even though swabs should be used before injection and pads after. Injections are often performed by a third party, and it is conceivable that a swab is used to stop bleeding before being used by a second person.”
They therefore suggest that transmission of the virus could occur if swabs were being used inappropriately. “The chaotic and rushed atmosphere of the injection setting, where swab sharing and mixing could take place, is…an important factor that should be considered.”
Human papillomavirus infection in men
Human papillomavirus (HPV) is a very common infection, which is transmitted sexually. Many sexually active people will be infected with HPV at some point in their lives and most people will have no symptoms. People often clear HPV infection without treatment.
Some strains of HPV cause anal and genital warts, and certain strains (often those that don't cause visible warts) can cause cell changes that may lead to anal or cervical cancer. Rates of anal cancer are higher in gay men than heterosexual men, and higher rates of anal cancer are seen in HIV-positive gay men.
Rates of anal HPV infection alone do not appear sufficient to explain the different rates of anal cancer in gay men and heterosexual men. For example, one study showed that the rate of anal HPV infection was four times higher in gay men. However, rates of anal cancer were 36 times higher.
An international team of researchers wanted to investigate whether it was the persistence of anal HPV infection that caused the increased risk of cancer.
The research found that, as well as overall rates of anal HPV infection being higher in gay men, anal HPV infection was indeed more likely to persist. Gay men were also more likely than heterosexual men to have new HPV infections during the study period, including those strains more likely to cause cancer.
Smoking was also associated with the persistence of the anal HPV infection.
Although rates of anal cancer are significantly higher in men who have sex with men, it is still a very rare cancer and there is a lot of debate about the value of screening gay men for pre-cancerous anal cell changes caused by HPV. If you have questions or concerns about your own situation, it’s a good idea to talk to your HIV doctor or someone else in your healthcare team.
A recent edition of our publication HIV treatment update included a feature article on anal screening. That feature is available online here.