Older women living with HIV in the UK

The age profile of people living with HIV in the UK is changing and this is particularly marked in women. In 2006, 14% of women with HIV in the UK were over 45 years old and 44% under 35. By 2016, 52% were over 45 and 15% under 35.

A recent study of HIV-positive women aged over 45 found some striking differences between the experience of different ethnic groups.

Women of black African ethnicity were, on the whole, better educated: about half of them had been to university compared with a quarter of both white British and black Caribbean women. They were also slightly more likely to be employed. Despite this, they were more likely to be living below the poverty line. 

Black African and Caribbean women experienced greater social isolation and reported more symptoms of depression and anxiety than white women. However, they were less likely to have been diagnosed with depression or to have it treated.

Psychological distress had a potential impact on health – older women with moderate or severe psychological distress were 75% more likely to have missed clinic appointments in the last year and more than twice as likely to have missed doses of their antiretroviral therapy in the last week.

For more information, read NAM's booklet 'HIV, mental health & emotional wellbeing'.

Almost everyone cured with hepatitis C drugs

There are different ‘genotypes’ (strains) of hepatitis C, numbered 1 to 6. In the UK, the most common genotypes are 1 and 3. Until recently, it was important to identify which genotype you had, as it could influence the risk of disease progression; a drug that worked well with one genotype would not necessarily be effective with another.

This is changing: newer medications can treat all genotypes of hepatitis C, so you don’t necessarily need to have the genotype identified before starting treatment.

For example, Epclusa is a once-daily single-pill treatment that combines two medications: sofosbuvir and velpatasvir. An alternative is Maviret, which combines glecaprevir and pibrentasvir.

These pills are curing almost everyone who completes the course of treatment (though they do not prevent reinfection), and drop-out rates are low. In over 5000 people who took the treatments in normal healthcare settings in North America and Europe, 93% of everyone who started treatment were cured of hepatitis C (a sustained virological response at 12 weeks). Of those who completed the 12-week course, 98.5% were cured.

People who have both HIV and hepatitis C do just as well as those who only have hepatitis C. In this study, 4% of people were also living with HIV.

For more information, read NAM's booklet 'HIV & hepatitis'.

Clusters of health problems

Non-HIV health problems tend to cluster together in particular patterns, according to a recent study of people living with HIV in England and Ireland. The researchers identified health conditions that are more likely to occur together in the same person than would be expected by chance alone. The six most important clusters were:

• cardiovascular (angina, heart attack, high blood pressure, kidney disease, etc.)
• sexually transmitted infections and hepatitis C
• mental health (depression, anxiety, panic attacks)
• cancers
• metabolic problems (abnormal cholesterol, lipodystrophy, high blood pressure)
• chest and other infections (cytomegalovirus, pneumonia, dizziness, lung diseases, chest infections).

While some of these clusters are well known and group together health problems with a common cause, other patterns are less well established. For example, depression was associated with sleeping problems and irritable bowel syndrome. In older people, more severe cardiovascular disease was associated with greater severity of mental health, metabolic and asthma scores. Panic attacks were associated with lung diseases (asthma, bronchitis and chronic obstructive pulmonary disease – COPD). On the other hand, people with worse cardiovascular disease tended to have fewer sexually transmitted infections.

For more information, read 'Other health issues' in NAM's booklet 'A long life with HIV'.

HPV vaccination for gay and bi men

HPV stands for human papillomavirus. Infection with HPV is often harmless, but some strains can cause genital and anal warts, while other strains can lead to anal, cervical, oral or throat cancer.

There are vaccines to prevent HPV and these have been given to girls aged 12 and 13 for several years. Last year, the NHS finally bowed to pressure and announced that it would also vaccinate boys of the same age group. That is the best way to ensure that the next generation of men – especially men whose sexual partners are men rather than women – do not get HPV.

After some foot dragging, the NHS has also launched a programme to offer HPV vaccination to adult gay and bisexual men. It’s offered in sexual health clinics to men up to the age of 45. The reason for the age limit is that the younger you are when vaccinated, the more likely it is to have a benefit. 

The pilot programme in 42 sexual health clinics has gone well. Just under half of gay and bisexual men in the age band who attended the clinics got their first vaccine dose (adults need to have three jabs done in total). While some men came in specifically for the vaccine, most men were vaccinated when they went to the clinic for another reason, like a regular HIV test or because of STI symptoms.

HPV vaccination has already led to big falls in HPV infections and potential cancers in young women, and there’s no reason to think it won’t prevent many cases of warts and cancers in men.

For more information, read NAM's factsheet 'Human papillomavirus (HPV) and genital warts'.