Big differences in life expectancy around the world

A new analysis shows that the life expectancy of people living with HIV is very different between Europe, North America and African countries. The analysis pools the results of eight previously published studies on life expectancy, with over 150,000 people included.

Data were collected between 1996 and 2011. In recent years, life expectancy has improved but the figures include results from earlier in the epidemic. For people beginning treatment today, life expectancy is likely to be longer.

In studies from Europe and North America, people beginning HIV treatment at the age of 20 were expected to live to the age of 63. People starting treatment at age 35 were expected to live to 67. Results were the same for men and women.

In studies from Africa, men beginning HIV treatment at the age of 20 were expected to live to the age of 43 and women to the age of 53. For people starting treatment at age 35, men were expected to live to 57 and women to 65.

The major reason why people living with HIV in African countries have shorter lives is that only a minority have been able to get HIV treatment and continue to get it, without interruption.

Although the World Health Organization has recommended HIV treatment for all people with CD4 counts below 500 (since 2013) and treatment for all people living with HIV, regardless of CD4 count (since 2015), African countries have been slow to adopt these guidelines.

And even when official policies have changed, what actually happens in clinics may not always reflect official guidelines. There may not be enough money, drugs or staff to provide treatment to all people living with HIV.

A quarter of HIV-positive African people are living in a country where the policy is that people should delay treatment until their CD4 cell count falls below 350, despite clear evidence that earlier treatment reduces the risk of death and illness. These countries include Nigeria, where less than a quarter of the 3.4 million people living with HIV are receiving HIV treatment.

Outside of Africa, two countries with very large numbers of people living with HIV, Russia and India, have also been very slow to recommend HIV treatment for all.

Hepatitis C

There continues to be a lot of interesting research on hepatitis C:

• Statins (drugs used to lower cholesterol levels) also have benefits for the liver. In a study of men with hepatitis C and HIV co-infection, people who took statins were less likely to go on to have cirrhosis of the liver.
• Successful treatment of hepatitis C reduces tiredness and fatigue, which are common problems for people who have hepatitis C. Hepatitis related damage to the liver appears to contribute to tiredness.
• Despite massive improvements in HIV treatment between 1996 and 2010, people with hepatitis and HIV co-infection continued to have relatively high rates of end-stage liver disease. This was probably due to hepatitis B and C not being effectively treated.
• Now that more effective drugs are available, more effort needs to go into improving access to hepatitis C treatment for people who inject drugs, a conference heard.

For more information on hepatitis for people living with HIV, read NAM’s booklet 'HIV & hepatitis'. The booklet was highly commended in the British Medical Association’s Patient Information Awards this week.

Higher rate of mental health problems in gay men living with HIV

A study from Australia highlights the burden of depression, other mood disorders, anxiety and related problems in gay men living with HIV. The study looked at the number of men needing to go to hospital for these issues. Focusing on gay men, it made a comparison between HIV-negative and HIV-positive men.

The researchers found that, each year, 14 in 1000 gay men who do not have HIV went to hospital for one of these mental health problems. In contrast, 54 in 1000 gay men living with HIV did so.

Compared to men in the general population, rates were three times higher for HIV-negative gay men and ten times higher for HIV-positive gay men.

Men who drank heavily were more likely to have problems. Among the HIV-positive men, men who had previously had a low CD4 count or treatment for dementia (which can occur at very low CD4 counts) were more likely to need hospital treatment.

The study shows the importance of getting help with mood or anxiety problems. There’s a lot that can be done to stop things getting worse and to improve the situation.

You can find out more in NAM’s booklet, 'HIV, mental health & emotional wellbeing'. The booklet was highly commended in the British Medical Association’s Patient Information Awards this week.

PrEP for pregnant partners of men with HIV

Women who do not have HIV and are in a relationship with a man living with HIV can use pre-exposure prophylaxis (PrEP) during pregnancy and breastfeeding, American doctors reported. They described the cases of 27 women they offered PrEP to.

Several of the male partners were not on treatment, had a viral load that was detectable, or their partners did not know their viral load. There was therefore a risk of HIV being passed on. During pregnancy, protecting the mother from HIV also protects the baby, as recent infection results in a high viral load that would make mother-to-child transmission more likely.

There were also women whose partners had an undetectable viral load, making HIV transmission highly unlikely. In these circumstances, taking PrEP is not really necessary to prevent transmission, but may provide extra reassurance.

PrEP seemed to work well and did not cause any complications.

For more information on having a baby, read NAM’s factsheet on 'Options for conception'.