HIV Weekly - 27th February 2013

HIV and ageing – physical function

Many of the classic features of ageing are seen in middle-aged HIV-positive people who have reduced physical function.

Improvements in treatment and care mean that the life expectancy of most people living with HIV in the UK is now excellent.

But there’s some evidence that some people with HIV are experiencing accelerated or premature ageing. This can result in increased vulnerability to diseases usually associated with old age, such as cardiovascular disease and cancers.

The exact reasons for this apparent accelerated ageing aren’t clear, but may include lifestyle factors such as smoking, the damage caused by HIV, and possibly the side-effects of some anti-HIV drugs.

In the general population, ageing is associated with loss of muscle mass, accumulation of visceral fat (fat around the internal organs), increased subcutaneous fat, loss of strength and reduced bone mineral density. Hormonal changes appear to have an important role in the ageing process.

Researchers in the United States wanted to see if these classic features of ageing were also associated with reduced physical function in middle-aged HIV-positive people.

Their study involved people aged between 45 and 65. All were taking HIV therapy and had a low viral load.

A range of tests was used to assess physical function. The researchers matched 33 people with low physical function to people with greater levels of physical capacity.

They found that poor physical function was associated with reduced muscle mass, a low BMI (body mass index), reduced bone mineral density, and lower levels of growth hormones.

There is a lot you can do to improve your health and give yourself the best chance of living a long and healthy life. Stopping smoking, eating a good diet and exercising regularly will all help to prevent many of the characteristics of ageing identified in this research.

HIV and ageing – cataract formation

Research conducted in South Africa has shown that having had a low nadir (lowest ever) CD4 cell count is associated with increased lens density in the eyes, a good marker of cataract risk.

Sight problems become more common with old age. These can include cataracts – clouding of the lens inside the eye leading to decreased vision.

It is possible that the accelerated ageing that some doctors think is associated with HIV may include the premature formation of cataracts. Earlier research showed that a low CD4 cell count after starting HIV treatment increased the risk of needing surgery for cataracts.

Researchers in South Africa therefore compared lens density – an accurate predictor of cataract risk – between 242 people living with HIV and an equal number of age-matched controls.

All were aged over 30 and none had a history of serious eye disease. Most (88%) of the HIV-positive study participants were taking antiretroviral therapy; the average CD4 cell count was approximately 450 and 84% had an undetectable viral load.

Overall, there was no difference in lens density between the HIV-positive people and the HIV-negative control group.

However, closer analysis of the results showed that increased lens density was associated with a nadir (lowest ever) CD4 cell count below 200.

The researchers believe their findings emphasise the importance of starting HIV treatment before HIV has caused too much damage to the immune system.

It makes good sense to have regular eye examinations so that any problems can be spotted early. Free NHS eye tests are available from high-street opticians if you are in receipt of some benefits, or if you have a family history of serious eye problems. If you are experiencing any problems with your vision you should mention these to your HIV doctor as soon as possible.

Infectiousness

Viral load in genital secretions varies significantly during the menstrual cycle, new research shows.

The study involved 67 women of childbearing age. All had the sexually transmitted infection HSV-2 (herpes simplex virus-2) and none were taking HIV treatment.

Vaginal swabs were used to monitor viral load in genital secretions over two menstrual cycles.

The menstrual cycle was divided into three phases: ovulation; the end of ovulation to the onset of the menses (the start of a period); end of menses to the onset of ovulation.

HIV was detected in between 48 and 60% of samples depending on the phase of the menstrual cycle.

Viral load varied through the phases of the menstrual cycle. It was highest around the time of the menses, and then fell steadily, reaching a low point at the time of ovulation.

These variations could have a big impact on infectiousness. The researchers calculated that the risk of transmission was 65% higher when viral load was at its peak compared to when it was at its lowest level around ovulation.

Get set for HIV treatment

NAM is launching a new interactive tool – Get set for HIV treatment. It is designed to help people think through how they feel about starting treatment, and identify any questions or concerns they might have. It explains the factors that determine the need to start treatment and will help people decide whether they are ready to take that step.

The tool takes users through a series of questions related to their health, lifestyle, and feelings about treatment. It provides people with an individual report, based on the answers given, which they can use to find out more information, or share with a healthcare worker, support organisation, or family and friends to talk over the issues raised.

Caspar Thomson, NAM’s Executive Director, said

“Taking HIV medication is a life-long commitment and we know that starting treatment can cause much anxiety for people living with HIV. Get set for HIV treatment has been designed to help anyone who has questions or concerns to think through the different issues associated with their decision."

Visit the tool today at www.aidsmap.com/getset