Nutritional supplements
Its results showed that taking multivitamins and selenium supplements slowed the pace of HIV disease progression among people with a CD4 cell count above 350 who were not taking antiretroviral therapy.
Modern HIV treatment is very effective and – on the whole – has only mild side-effects. In fact, many people doing well on HIV treatment now have a normal life expectancy.
But treatment is expensive. This means that expanding access to antiretroviral drugs is a strain on some health systems, especially those in resource-limited countries. Therefore, effective, cheap and safe interventions that delay the need to start HIV treatment are needed.
Researchers wanted to see if this was also the case for people with CD4 cell counts above 350.
Their study population comprised approximately 900 people. None were taking HIV therapy and at random they were assigned to take either a placebo (dummy pill); multivitamins (B, C and E); multivitamins plus selenium; or selenium alone. The researchers then compared rates of HIV disease progression over two years between the four study arms.
People who received the multivitamins either with or without selenium had significantly lower rates of HIV disease progression compared to people who received the placebo. Taking selenium alone had no benefits.
Taking multivitamins and selenium reduced the risk of CD4 cell count falling to below 350 – the threshold for starting HIV therapy in many settings.
Adherence rates were high and no significant side-effects were associated with the treatment.
The results therefore show that taking multivitamins and selenium can delay the rate of HIV disease progression. But these and other supplements aren’t a replacement for antiretrovirals.
Nutrition plays an important role in the health of the immune system and its ability to fight infection. In the UK, most people can get all the vitamins and minerals they need by eating a balanced, varied diet that includes plenty of fruit and vegetables. Find out more in our booklet, Nutrition, available in HIV organisations and clinics and on our website at www.aidsmap.com/booklets
HIV and tuberculosis
People with a very low CD4 cell count have an especially high risk of developing immune reconstitution inflammatory syndrome (IRIS) if they start HIV therapy within two weeks of treatment for tuberculosis (TB), new research shows.
Worldwide, TB is the single biggest cause of serious illness and death in people with HIV.
TB can be cured, but to reduce the risk of mortality, people with lower CD4 cell counts need to start antiretroviral therapy soon after commencing TB treatment. However, the risk of IRIS – a worsening of TB symptoms despite effective treatment – means that in most cases HIV treatment is delayed until two weeks after initiating TB therapy.
The latest research involved people with HIV and TB, all of whom were antiretroviral naive (had never taken anti-HIV drugs), and who had a CD4 cell count below 250. They were randomised to receive immediate or delayed HIV treatment.
The IRIS rate was twice as high among people who took anti-HIV drugs immediately. The risk was especially high for people with a very low CD4 cell count – below 50.
IRIS was managed using a surgical procedure in a third of patients.
The researchers believe their findings have implications for HIV and TB programmes in countries with lower levels of access to treatment, showing that people with very low CD4 counts have an especially high risk of IRIS and the need for facilities to properly manage the condition.
For information resources, features and news stories about tuberculosis and HIV, visit our Tuberculosis and HIV topics page.
Hepatitis C
Tiny particles of dried blood contaminated with hepatitis C virus (HCV) are potentially infectious for up to six weeks, according to new research.
Hepatitis C is transmitted via blood-to-blood contact and is much more infectious than HIV. Needle and syringe exchange programmes have been partially effective at reducing the rate of new hepatitis C infections among people who inject drugs.
Researchers wanted to see how long minute spots of blood contaminated with hepatitis C and dried onto inanimate surfaces remained infectious.
The spots were stored for six weeks at various temperatures.
Those stored at 4° and 22°C were potentially infectious for up to six weeks.
Antiseptics such as bleach were highly effective at killing the virus, but only if used at the recommended concentrations. Diluting the antiseptic reduced the effectiveness significantly.
Editors' picks from other sources
HIV care 'at risk from NHS changes', specialists warn
from BBC
A survey by the British HIV Association, released to mark World AIDS Day, found that a third of the 100 HIV clinicians questioned thought care for people with HIV was poorer since the NHS reorganisation in April this year.
How will AIDS be eradicated?
from New York Times
In the war on HIV, we have seen successes in some African nations and stubborn patterns of new infection in developed nations like the US. The New York Times invites seven experts, including the Executive Director of UNAIDS and Sir Elton John, to contribute to the debate.
Sweden divided over criminalising HIV unprotected sex
from AFP
HIV diagnosis in Sweden brings with it the risk of criminal prosecution – HIV-positive people are legally required to reveal their status before having sex. But now Sweden's use of criminal law in HIV cases, one of the most stringent in the world, is being challenged.
Pros and cons of Uganda’s new ARV therapy for pregnant women
from Inter Press Service
Uganda has gotten kudos as well as some criticism over its roll out of the new antiretroviral (ARV) therapy for pregnant women and their babies, known as Option B+. Recommended by the World Health Organization in June 2012, Option B+ consists of lifelong provision of ARV therapy to pregnant women regardless of their CD4 count.