HIV update - 2nd April 2014

Predicting kidney problems

American doctors have developed a risk score to predict which men living with HIV have the highest risk of developing chronic kidney disease.

Without HIV treatment, people with HIV can develop kidney disease. Some antiretroviral drugs have also been linked with increased rates of kidney disease, including tenofovir (Viread, also in the combination pills Truvada, Atripla and Eviplera).

Tools which can help people living with HIV and their doctors assess the risk of kidney problems would be useful when choosing which antiretroviral drugs to take.

Based on analysis of over 20,000 male patients in the United States, the researchers identified risk factors for kidney disease. They then developed a simple way for doctors to score an individual’s risk.

Kidney problems were more likely to occur in men who were over the age of 40, had high levels of glucose or triglycerides (fat) in their blood, had protein in their urine, had high blood pressure, had hypertension or had a low CD4 cell count.

For example, a young man with none of these risk factors was estimated to have a less than 1.5% risk of having kidney disease in the next five years, whether or not he took tenofovir.

In contrast, a man in his fifties with high blood pressure, hypertension and raised triglycerides would have a much higher risk of kidney problems – 19% if taking tenofovir, or 11% with other drugs. With the information from the risk score, his doctor could help him choose an HIV drug combination that does not include tenofovir.

To help you prepare for your next appointment with your doctor, you may find our Talking points tool helpful. Visit www.aidsmap.com/talking-points

HPV and anal cancer

A study has identified the behaviours associated with infection with human papillomavirus (HPV) in gay men living with HIV. A very small proportion of men who have HPV go on to have anal cancer.

As expected, the study shows that receptive anal sex is associated with acquiring anal HPV. However, this study has more reliable methods than most previous research into the topic.

In a group of 369 HIV-positive gay men, 21% of men acquired a new strain of HPV each year, including 13% who acquired a strain of HPV sometimes associated with cancer.

Three sexual behaviours were linked to acquiring anal HPV – having receptive anal sex at least once a week; having receptive anal sex with eight or more men in the past six months; and being rimmed (the anus being stimulated by a partner’s tongue). The last factor has not been identified in previous studies.

But how likely is it that someone who has HPV will go on to have anal cancer? Is it important that all cases of HPV get treated?

In answering these questions, it’s first of all important to remember that only a few strains of HPV have been linked with cancer. Some strains appear to cause anal or cervical cancer; other strains only lead to anal or genital warts; and there are some other strains which have not been linked with health problems.

Moreover, a second recent study shows that many pre-cancerous anal cell changes caused by HPV improve without treatment, and only a few lead to cancer. Researchers based their analyses on over 2800 HIV-positive people who had pre-cancerous anal cell changes (high-grade anal intraepithelial neoplasia) caused by HPV.

The researchers estimate that, without treatment, between 1 and 2% of people progress to having anal cancer within two years.

In contrast, up to 64% of people find that the cell changes improve or disappear within two years – again, without treatment.

This suggests that the best policy for a person with pre-cancerous anal cell changes may be to continue to have the situation carefully monitored, rather than to immediately have treatment.

Lesbian transmission

An extremely rare case of female-to-female sexual transmission of HIV has been reported in the United States. A woman in Texas appears to have acquired HIV from her female partner, who had been diagnosed with HIV several years before.

In almost all cases in which lesbians have acquired HIV, the infection actually occurred through sharing drug injection equipment or during sexual relations with men. However, the women in this case deny these behaviours.

Importantly, genetic analysis shows that the two women have virtually identical viruses.

Most sexual practices between women carry virtually no risk of HIV transmission. However, the couple reported sharing sex toys – this can lead to one person’s body fluids, including blood, being inserted into another person’s body, making transmission possible.

The women also reported sometimes having rough sex in which bleeding occurred – concentrations of HIV are higher in blood than in vaginal fluids. It’s also worth noting that the woman with diagnosed HIV was not taking HIV treatment.

Since the beginning of the HIV epidemic, only six cases of female-to-female sexual transmission have been reported.