HIV and heart attack
More research shows the importance of being on antiretroviral therapy and maintaining a high CD4 cell count for people living with HIV. Researchers in the US found that, during the study period, people with HIV were more likely to die after hospitalisation due to a heart attack than people in a matched HIV-negative control group. But this wasn’t the case for people who had a high CD4 cell count.
There’s now a lot of research showing that people with HIV have an increased risk of cardiovascular disease. The reasons aren’t clear, but seem to include traditional risk factors such as smoking and diet, the damage that HIV can cause and the side-effects of some anti-HIV drugs.
Researchers wanted to see if outcomes differed between HIV-positive and HIV-negative patients hospitalised because of acute coronary syndrome – heart attack or angina (chest pains).
Their study involved over 86,000 people hospitalised due to these conditions between 1996 and 2010. In all, 226 of the study participants were living with HIV.
Compared to the HIV-negative individuals, the people with HIV were younger and more likely to be men.
After taking into account other factors associated with cardiac outcomes (such as cholesterol levels and age), the researchers found that the people with HIV had twice the mortality risk of HIV-negative individuals one year after hospitalisation and the risk was 2.5 times higher after three years.
Compared to HIV-negative people, the mortality risk was five times greater for HIV-positive people with a CD4 cell count below 200.
But there was no difference in mortality risk between HIV-negative patients and HIV-positive individuals with a CD4 cell count above 500.
The absolute risk of death was highest for individuals who were not taking HIV therapy.
The investigators conclude that the higher mortality risk seen in people with HIV was down to immune suppression and not taking antiretroviral treatment.
There’s a lot you can do to look after your heart, including being careful about what you eat, taking regular exercise and giving up smoking. Talk to your GP or HIV team if you would like support with making changes. This month, the UK’s Department of Health is encouraging people to take part in their stop smoking campaign ‘Stoptober’: https://stoptober.smokefree.nhs.uk
Efavirenz and mental health
Investigators showed that thoughts of suicide, attempted suicide and rates of suicide were higher among people who started HIV treatment including efavirenz compared to people taking other HIV treatment regimens.
Efavirenz is one of the drugs recommended for people starting HIV treatment. It’s well known that it can cause sleep and mood disturbance as a side-effect. There have been case reports of suicide among people taking the drug, but the frequency compared to other therapies hasn’t been determined.
Researchers therefore compared rates of suicidal thought, attempted suicide and suicide between people starting treatment with efavirenz and people starting treatment based on another drug in several randomised control trials.
The study period was 2001 to 2010 and the study population included over 5000 people, followed for an average of three years.
A total of 47 events were recorded in the group taking efavirenz, compared with 15 in the efavirenz-free group, during the comparison period.
The investigators then focused on attempted suicide and suicide: there were 17 events among the people taking efavirenz compared to five in the other group.
Researchers concluded that suicidal thoughts and suicide were generally uncommon, but that there was an increased risk associated with younger age, history of injecting drugs, and treatment with efavirenz. However, by far the most important risk factor was a prior mental health problem.
There is a lot of mental health support available to people with HIV. So if you’re low or depressed for any reason it makes good sense to speak to your doctor or another member of your healthcare team. Help will be available and it will make a difference. For more information, you may find our booklet ‘HIV, mental health and emotional wellbeing’ helpful. It’s available in UK clinics and HIV organisations, or you can read it online at www.aidsmap.com/booklets
Multidrug-resistant TB in the UK
Multidrug-resistant TB is a growing international health problem and involves infections that are resistant to the key first-line anti-TB drugs, isoniazid and rifampicin.
Treatment for multidrug-resistant TB is recommended to last for 24 months and involves a combination of antibiotics.
There were 204 confirmed cases of multidrug-resistant TB in the UK between 2004 and 2007. The number of cases diagnosed each year climbed over this period. Overall, 16% of people with MDR-TB were living with HIV.
Fewer than three-quarters of people (71%) successfully completed therapy at month 24 or later. This was below the World Health Organization target of 75% and the UK target of 85%.
Reasons for unsuccessful outcomes included stopping treatment, TB-related death, dropping out of care or leaving the UK.
People with HIV were less likely than others to successfully complete treatment.
Find out more about TB in our HIV & TB booklet: www.aidsmap.com/booklets
Other news
HIV and hepatitis C virus (HCV) co-infection
Immune activation is associated with liver fibrosis in women with HIV and hepatitis C co-infection. The study shows the importance of good control of HIV in people with co-infection. Read more >>
HIV prevention
US research shows that many people living with HIV aren’t receiving recommended counselling about HIV prevention as part of their routine care. Read more >>
Long-lasting anti-HIV drugs
New classes of antiretrovirals that are dosed just once a month are currently in development. A mathematical model suggests they could have a positive impact on outcomes and quality of life, especially among people who have problems with adherence. Read more >>
Editors' picks from other sources
NHS England is finally taking expert advice – from the patients
from The Guardian
A people's panel to hear patients' views is forcing doctors to re-evaluate their approach to medicine.
Long-acting HIV antiretrovirals may be revolutionary. But will they be worth it?
from The Body Pro
Once-a-month HIV antiretroviral dosing is no longer a fanciful dream. Long-acting antiretrovirals are currently in development, and the first glimpses of early safety/efficacy data are not terribly far away. So it's not outlandish for us to start thinking about where these drugs might fit in.
Why is no one on the first treatment to prevent HIV?
from New Yorker (blog)
Adoption of the drug has been slow. According to Dawn Smith of the CDC, at least half a million Americans are good candidates for PrEP – meaning that they are at high risk for contracting HIV through sexual activity – yet only a few thousand Americans are receiving the treatment.