Prognosis and outcomes
Analysis of the results of two large clinical trials showed that people who were taking HIV treatment and who had an undetectable viral load and a CD4 cell count above 500 had exactly the same mortality risk as HIV-negative people in the general population.
Combination antiretroviral therapy was first introduced in the mid 1990s. There were immediate falls in rates of HIV-related illness and death.
Since then, there have been major improvements in HIV treatment and care and this has brought about further improvements in the life expectancy of people taking antiretroviral therapy.
Analysis of outcomes in people with HIV enrolled in observational studies suggests that people who are doing well on HIV treatment – often defined as an undetectable viral load and a CD4 cell count above 500 – now have a normal life expectancy.
The results of two big HIV treatment strategy trials allowed researchers to examine in detail the mortality risk of people taking antiretroviral treatment.
The studies were the SMART treatment interruption trial and the ESPRIT trial, a study of the benefits of IL-2.
The researchers restricted their analysis to people in the control arms who took continuous triple-drug HIV treatment.
Over 3250 people were monitored for an average of three years.
During this time, there were 62 deaths. There were only two AIDS-related deaths.
Overall, participants in this study had a mortality rate that was slightly above what would be expected for the general population.
The researchers then looked at mortality rates according to CD4 cell count. They found these were elevated for people whose counts were between 350 and 499.
However, people with a CD4 cell count above 500 had mortality rates that were identical to those expected in the general HIV-negative population.
There have been major developments in HIV treatment since these trials were started (2000 to 2002). So it’s possible that the outlook for people living with HIV is even better than suggested by these results.
However, the researchers are cautious about how their results are interpreted in the context of current debates about the best time to start HIV treatment – at a higher CD4 cell count of around 500, or a lower CD4 cell count of around 350. They believe this question can only be answered by a properly conducted randomised controlled trial.
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The search for a cure
The study above adds to the evidence showing that most people taking antiretroviral therapy will live a long and healthy life.
But what about a cure for HIV?
Delegates heard that there were some “lights at the end of the tunnel”.
Results from two small studies have shown that very early treatment might lead to the ability to control HIV without the need for medication.
French researchers found that 14 people were “in remission”, having been off HIV therapy for an average of 7.5 years. In all these cases, the people involved had started treatment within ten weeks of acquiring HIV and were on treatment for an average of three years.
A separate study showed that very early treatment limited the size of the reservoir of HIV-infected cells.
These studies suggest that a so-called 'functional cure' (control of HIV without the need for lifelong medication) may be possible – but only if treatment is started almost immediately after infection with HIV and then continues for a prolonged period of time.
Only a very small number of people are diagnosed so promptly. The vast majority of people living with HIV are diagnosed later and usually only start treatment after they have had HIV for a number of years.
An obstacle to developing a cure appears to be the reservoir of cells with long-term HIV infection. These can’t be eradicated with current antiretroviral therapy.
There’s only been one report of cure in someone with long-term or chronic HIV infection – Timothy Brown, the ‘Berlin patient’ – who was cured of HIV after a bone marrow transplant from a donor with genetic resistance to HIV infection.
This isn’t a therapy that can be widely used. However, the case has opened up some useful avenues for future research.
Nevertheless, there was a consensus among the researchers in Paris that there’s still a long way to go before a cure for HIV becomes a reality.
Sexual health
As in previous years, rates were especially high in gay men and young heterosexual people.
Overall, there were a little over 448,000 diagnoses, a slight increase on the year before. With over 200,000 diagnoses, chlamydia was the most common infection.
The figures showed that the overwhelming majority of syphilis and gonorrhoea cases in men involved gay men.
The report highlighted sharp increases in gonorrhoea diagnoses among gay men, from 4578 diagnoses in 2010, to 7465 in 2011 and 10,205 in 2012. Part of this increase is thought to be due to the use of more sensitive diagnostic tests, but researchers think that unprotected sex continues to be a factor. There’s particular concern about this upsurge in gonorrhoea diagnoses because of the increasing prevalence of drug-resistant strains of the bacteria.
The report also showed that rates of many STIs in heterosexual people were especially high in people aged between 15 and 24 years.
Rates of STIs were also higher in people of black ethnicity compared to other ethnic groups.
But the report also showed that new diagnoses of genital warts had fallen in women aged between 15 and 19. This might be because of the introduction of a vaccination programme for young women designed to provide protection against infection with the strains of the human papillomavirus (HPV) associated with a high risk of cervical cancer. Other strains of HPV are associated with genital warts and it may be that the introduction of HPV vaccination has also provided some protection against them.
Editors' picks from other sources
Spared death, aging people with HIV struggle to live
from New York Times
Not long ago, it would have seemed unthinkable: HIV is becoming a disease of the middle-aged. Nearly half of New Yorkers with HIV are now 50 or older, ages many never dreamed of reaching. They are the people who were told that they would be dead by 30, who watched their friends or lovers die, who lived to see sufferers on their death beds return to health almost overnight.
Nigerian same-sex marriage prohibition bill: civil society, human rights defenders and others call for its immediate withdrawal!
from AMSHeR
The Nigeria House of Representatives has passed a bill titled "Same Sex Marriage Prohibition Bill". The Bill prohibits marriage between persons of same sex, as well as criminalizing organisations and persons who directly or indirectly aid or abate such a union. Moreover, the bill's definition of marriage includes any two people of the same sex living together – this renders all Nigerians of the same sex living together as potential targets of the law.
Michael Douglas says cunnilingus gives you cancer – but is he right?
from The Guardian
Michael Douglas, who was diagnosed with throat cancer in 2010, says oral sex was the cause. But what's the risk? Is oral sex linked to mouth and throat cancers? Is there a difference between the genders? And what can be done?