HIV Weekly - 28th August 2013

HIV and hepatitis C co-infection: monitoring

A third of people with HIV and hepatitis C virus (HCV) co-infection and liver cirrhosis are not having routine abdominal ultrasounds, Canadian research shows.

Many people living with HIV also have hepatitis C (often referred to as co-infection). Liver disease caused by hepatitis C is an important cause of serious illness and death in people with this co-infection.

HCV can cause liver fibrosis and cirrhosis.

Regular monitoring with blood tests and scans such as abdominal ultrasounds helps doctors and the people in their care to make decisions about treatment and care.

Most treatment guidelines recommend that people with hepatitis C-related liver cirrhosis should have an abdominal ultrasound every six to twelve months, to help assess their risk of developing liver cancer.

Researchers in Canada wanted to see if people with hepatitis C and HIV co-infection were receiving this recommended standard of care.

Their study population included 144 people with biopsy-confirmed cirrhosis and 220 people with blood test results suggesting the presence of liver cirrhosis. They received care at 16 centres across Canada between 2003 and 2012.

Over a third of participants in the study (36%), who had confirmed cirrhosis, never had an abdominal ultrasound. Nor did 50% of people with suspected cirrhosis.

Two study participants developed liver cancer without ever having had an abdominal ultrasound.

People with drug abuse problems and those living in poverty were significantly less likely to have ultrasound examinations compared to other people.

Factors associated with having ultrasound screening included taking HIV treatment and problems with alcohol abuse.

People who received care at hospitals with routine prompts to perform ultrasounds were twice as likely to be screened as people whose clinics didn’t have such procedures.

Find out more in our HIV & hepatitis booklet, available in UK clinics and on our website at: www.aidsmap.com/booklets

Anal HPV infection among young gay men

The majority of young gay men have anal human papillomavirus (HPV) infection, US research shows.

Research involving 94 gay men aged between 18 and 30 years showed that 70% were infected with HPV and that 37% were infected with types of HPV associated with anal cancer.

Persistent infection with some types of HPV can lead to cell changes and lesions in the anus. If left untreated, some lesions may develop into cancer.

Rates of anal cancer are very low, but they are higher in gay men – especially if they have HIV – compared to other groups.

Gardasil is a safe vaccine that provides a very high level of protection against four HPV types, including HPV 16 and 18, the types most associated with anal and genital cancers.

Guidelines in the US recommend that all males aged between eleven and 21 years should receive this vaccine, as should gay men up to the age of 26. There’s pressure to extend vaccine programmes in the UK to include young gay men.

The vaccine works best if administered before someone becomes sexually active. To help inform vaccination strategies, researchers in Seattle monitored the prevalence and incidence of anal HPV infection among a cohort of young gay men over a twelve-month period.

All the men were sexually experienced, and almost all had engaged in insertive or receptive anal sex.

Anal HPV infection was detected in 70% of men at some point during the study, and HPV 16 and/or 18 was found in 37%.

There was a high incidence of new infections among the men who were negative at baseline.

A higher number of anal sex partners was associated with an increased risk of anal HPV infection.

Half the participants were infected with an HPV type covered by Gardasil at some point during the study.

The researchers believe their findings have implications for HPV vaccination strategies: “Given the very high prevalence of HPV infection among young men who have sex with men, many (if not most) have been exposed to infection from one of their first few partners, a finding that highlights the desirability of immunizing young men who have sex with men before they become sexually active.” But they also believe their results show that men who are sexually experienced would still benefit from vaccination, as none of the men were infected with all four types covered by Gardasil.

Almost all the men in the study said they’d be interested in receiving Gardasil if it were freely available.