HIV Weekly - 9th January 2013

Smoking

Made a New Year’s resolution to stop smoking? The findings of recent research could provide some inspiration.

Doctors in Denmark have found that, where HIV treatment is freely available, smoking has a bigger impact on the life expectancy of people living with HIV than HIV-related factors.

The research involved 2921 people who received HIV care between 1995 and 2010.

Many were smokers – 47% were current smokers and 18% were former smokers. Rates of smoking were much higher than those seen in the general Danish population.

Overall, people with HIV were more likely to die than people in the general population.

This increased mortality rate was especially high among people living with HIV who were smokers.

The risk of non-HIV-related death, including death related to cardiovascular disease, was especially high for smokers.

And smoking had a big impact on life expectancy.

The life expectancy of a non-smoker with HIV was 78 years. It fell to 69 for former smokers, and was just 62 for current smokers.

The researchers calculated that people lost five years of life due to their HIV infection. But twelve years were lost because of smoking.

“The loss of life-years associated with smoking was larger than that associated with HIV,” write the investigators. “Our finding of lower mortality among previous compared to current smokers emphasizes the importance of counseling HIV patients on smoking cessation.”

HIV therapy: treatment-experienced people

The aim of HIV treatment is an undetectable viral load.

But not everyone can achieve this goal, especially if they have taken a lot of different HIV treatments in the past and have developed drug-resistant virus.

In these circumstances, the aim of treatment is likely to be achieving increases in CD4 cell count. This will help protect the immune system, reducing the risk of serious illness.

New research involving heavily treatment-experienced patients shows that even modest reductions in viral load can have important benefits for the immune system.

It involved over 2400 people who had been on each of the three main classes of anti-HIV drugs but nevertheless had a detectable viral load.

The researchers found a clear relationship between viral load and CD4 cell count.

Reductions in viral load were accompanied by increases in CD4 cell count.

“Any degree of viral suppression is likely to bring benefits in terms of CD4 count and hence risk of clinical disease,” the investigators comment.

Adherence – taking your treatment as prescribed – is an important factor affecting the success of HIV treatment. The researchers suggest that people who are not taking their treatment properly should be advised that improvement in adherence is likely to have benefits for their immune system.

Want to have an open conversation with your doctor about HIV treatment, but not sure where to start? Our online Talking points tool is designed to help you prepare for appointments and support that conversation.

HIV and hepatitis C

A large number of people living with HIV also have hepatitis C. This is often referred to as ‘co-infection’.

Treatment for hepatitis C is available. It’s based on drugs called pegylated interferon and ribavirin. Treatment can cure hepatitis C, but it doesn’t always work and it can cause side-effects.

Depression is common in people with long-term health conditions and this includes HIV and hepatitis C. Depression is also one of the more common side-effects associated with pegylated interferon. It’s therefore recommended that all patients should be screened for depression before and during hepatitis C treatment and, when appropriate, be given antidepressants.

However, a small study conducted in Brighton suggests that depression does not affect the success of hepatitis C therapy.

It involved 38 people with HIV and hepatitis C co-infection. Three people were diagnosed with depression before starting treatment and 32 people became depressed while taking hepatitis C therapy.

But depression did not affect treatment outcomes. All but three of the depressed patients achieved a sustained virological response (SVR) – a cure.

Treatment with antidepressants had no impact on the likelihood of the hepatitis treatment being successful.

“No significant influence was found for depressive disorder at baseline or emerging during treatment on viral response,” comment the investigators. “Antidepressant exposure did not appear to influence viral response.”

For more information on HIV and hepatitis co-infection, or on depression, visit our booklet pages at www.aidsmap.com/booklets.

Hepatitis C treatment and injecting drug users

Injecting drug users are one of the groups most affected by hepatitis C. However, they are less likely than other patient populations to be offered treatment for hepatitis C. Doctors often fear that issues with addiction and a general lack of stability will mean they do not complete their therapy or have poor adherence.

New research shows that this isn’t necessarily the case.

Doctors looked at the outcomes of hepatitis C therapy among approximately 3000 drug users enrolled in 34 different studies.

They found that treatment outcomes were better among people who received therapy for addiction and general support while they were taking hepatitis C treatment. Support from teams involving a number of health specialists was shown to be especially beneficial.

Some 53% of drug users who received support achieved an SVR (a cure) – that’s comparable to the response rate seen in other patient groups.

HPV vaccination

New US research suggests that vaccination against human papillomavirus (HPV) could be highly effective at preventing pre-cancerous anal cell changes in HIV-positive gay men.

Anal cancer is more common in gay men living with HIV than any other group. It’s associated with high-risk strains of HPV. Vaccines are available that provide a high level of protection against these strains of HPV.

However, they don’t work in people who are already infected with these strains and some doctors doubt that vaccinating HIV-positive gay men would have any real benefits.

The latest research involved 363 people. Approximately a third had high-grade pre-cancerous anal lesions. Almost all these lesions were associated with strains of HPV for which there are effective vaccines.