HIV Weekly - 18th December 2013

Prognosis and outcomes – success of HIV treatment in South Africa

The roll-out of antiretroviral therapy in South Africa has had “astounding” benefits. A mathematical model showed that, so far, individual life expectancy has risen by up to 13 years thanks to treatment, and that HIV therapy has saved over 20 million life-years cumulatively.

Improvements in HIV treatment and care mean that most people living with HIV in the UK and similar countries now often have the same life expectancy as people who don’t have HIV.

Recent research showed that people in South Africa who start treatment promptly now also have an excellent life expectancy, but the ‘real-world’ benefits of expanded antiretroviral therapy in the country are largely unknown.

An international team of researchers therefore calculated the benefits for the 2,200,000 people who started antiretroviral therapy in South Africa between 2004 and 2011.

They developed a model based on the known characteristics of people who started HIV therapy in this period. These individuals had an average CD4 count of between 112 and 178 cells/mm³ and almost half had a viral load above 100,000 copies/ml. The model also assumed that treatment would reduce AIDS-related mortality rates by between 56 and 96% and three-quarters of patients would have an undetectable viral load six months after starting treatment.  However, only 2.4% would have access to second-line treatment and between 29 and 45% would drop out of care over three years.

Starting HIV therapy had a big impact on individual life expectancy. Without treatment, patients were expected to live for only two more years. But treatment increased baseline life expectancy by an average of 11 to 13 years.

Current treatment policies would save a total of almost 18 million life-years. But this could be doubled to 36 million if diagnosis rates increased, access to second-line therapy improved, and more people were retained in care (had regular contact with healthcare services).

Overall, the findings really do show that increased access to HIV therapy in resource-limited countries is having massive benefits.

For more on studies of prognosis and outcomes, read our recent article ‘How much longer have I got?’. It’s part of the final issue of HIV treatment update, available online here: www.aidsmap.com/htu

HIV and hepatitis C co-infection

Research involving men with HIV and hepatitis C (HCV) co-infection shows that people who started HIV therapy reduced their risk of developing serious liver disease.

A large number of people living with HIV have hepatitis C co-infection, and liver disease related to hepatitis C is now a leading cause of serious illness and death in this group.

Treatment is available for hepatitis C, but the current therapies don’t always work and can cause unpleasant side-effects. Newer, more effective treatments are in the pipeline and strategies that delay the need for treatment could mean that people can wait until these become available before starting therapy.

Researchers in the US therefore looked at the impact of starting HIV treatment on the risk of progression to serious liver disease in a cohort of 46,000 men who received care between 1996 and 2011.

Just over two-thirds of men in the study started HIV treatment. Overall, 6% of study participants developed serious liver disease. But starting HIV treatment was shown to reduce the risk of this outcome by between 28 and 41%.

“Our results suggest a significant benefit of ART [antiretroviral therapy] for co-infected patients, and serve to inform therapeutic strategies as caregivers face the continuing challenges of chronic hepatitis in HIV-infected individuals,” conclude the researchers.

Sexual health

New research shows that male sex workers in England have high rates of some sexually transmitted infections (STIs).

The research involved over 627,000 men who attended sexual health and genitourinary medicine (GUM) clinics in England during 2011.

Overall, 411 (0.08%) reported they were sex workers. The researchers think this is an underestimate and that a large proportion of men did not disclose their sex work to clinic staff.

The researchers were also surprised that only 56% of male sex workers reported sex with another man.

There was evidence that male sex workers were paying close attention to their sexual health and visited clinics twice as often as other men (average of 4 vs 2 visits per year).

Men who sold sex were three times more likely to be diagnosed with HIV compared to other men, three times more likely to be diagnosed with chlamydia, and twice as likely to be diagnosed with gonorrhoea.

Male sex workers were also more likely to return to the clinic with chlamydia or gonorrhoea.

Overall, the study shows that male sex workers have high rates of STIs. It’s important to tell staff about the kind of sex you are having or other factors that could increase your risk of STIs. This means you can be offered the right tests and receive appropriate support.

Christmas and the New Year

The festive season is almost upon us.

The NAM Christmas factsheet, available on our website, provides some useful tips to ensure that you have an enjoyable and trouble-free Christmas and New Year.

NAM extends the best wishes of the season to all the readers of HIV weekly.

The next HIV weekly will be published on 8 January.