CD4 counts only need to be done once a year

Annual CD4 count tests may be enough for people taking HIV treatment who have a suppressed viral load and a CD4 count above 250 cells/mm³, according to a new study. It showed that people in this situation had a very low risk of experiencing a drop in their CD4 count below 200 cells/mm³ or of developing a serious HIV-related illness.

The CD4 count is one of the key tests for people living with HIV. A consideration of the CD4 count is crucial in monitoring health before beginning HIV treatment and in making a decision about when to start it.

In contrast, when a person is taking HIV treatment, the viral load test is more important in monitoring health.

So how often should people taking treatment have their CD4 count monitored? Current UK guidelines suggests every six months, whereas American guidelines recommend every twelve months.

Researchers examined data on around 1500 people in twelve Asian countries. At the beginning of the four-year study, all had an undetectable viral load, a CD4 count above 200 cells/mm³ and were taking combination therapy.

Each year, fewer than 1% of participants saw their CD4 count drop to dangerous levels (below 200 cells/mm³). And only 0.5% had a serious HIV-related illness.

These rates were no different in those who had their CD4 count tested every six months, or every twelve months. In other words, more frequent CD4 counts did not help people stay in better health.

The researchers say there are two main benefits to less frequent CD4 counts. Firstly, the approach is less expensive. Secondly, some people with HIV become unnecessarily anxious when they see fluctuations in their CD4 count. Usually, the level returns to normal at the next test.

To find out more about CD4 counts, you can read our booklet ‘CD4, viral load & other tests’.

Insulin resistance, hepatitis C and cannabis

Insulin resistance means that the body is unable to use the hormone insulin and is unable to convert glucose in the bloodstream into energy. Insulin resistance can lead to type 2 diabetes.

There are high rates of insulin resistance and diabetes in people living with hepatitis C and also in people living with HIV. Not getting much exercise, being overweight and having an unhealthy diet increase the risk of developing diabetes

Now a study has shown that people who use cannabis have a lower risk of insulin resistance.

Researchers followed around 700 people with HIV and hepatitis C co-infection for up to five years. Just under half smoked or used cannabis and these individuals had a lower risk of developing insulin resistance, regardless of how often they used cannabis.

This may be due to the way in which the substances present in cannabis (cannabinoids) affect metabolism. The researchers say that forms of medical cannabis, such as pills or vaporisers, could be tested in clinical research.

Opioid substitution treatment boosts adherence

People who inject drugs have better adherence to HIV treatment when they are also receiving opioid substitution therapy, a Canadian study shows.

Opioid substitution treatment involves giving people who are addicted to heroin or other drugs alternative substances, such as methadone and buprenorphine. These relieve cravings for heroin, allow the person to avoid using heroin and to stop injecting. The treatment can help people have a more stable life and link them with healthcare.

The researchers looked at adherence rates in around 1800 people living with HIV who injected drugs over a five-year period. Around half the participants had used opioid substitution treatment at least once.

Adherence to HIV treatment was 68% better when individuals were receiving opioid substitution treatment.