Vitamin D and HIV treatment

Low levels of vitamin D are associated with poorer long-term increases in CD4 cell count in women starting HIV treatment, according to new research.

Vitamin D is very important to overall health. Not having enough of the vitamin can increase the risk of a number of longer-term health problems, such as cardiovascular disease.

There is now a lot of research showing that many people with HIV have low levels of vitamin D. The exact consequences of this aren’t clear. But one study involving men who were starting HIV treatment showed that this was associated with lower increases in CD4 cell count.

Researchers wanted to see if this was also the case for HIV-positive women.

Their study involved over 200 women who were starting HIV therapy when their CD4 cell count was below 200.

Vitamin D levels were monitored just before participants started treatment. The researchers then looked at CD4 cell increases 6, 12 and 24 months after treatment was started, and analysed the increases in relation to vitamin D levels.

The vast majority of women had low vitamin D levels, and the researchers found this was associated with reduced chances of having a CD4 cell increase of 200 or more two years after starting treatment.

Vitamin D levels are monitored as part of routine HIV care. This allows any possible problems to be spotted early. You can find out more about the tests you will have as part of your routine health monitoring in NAM’s booklet, CD4, viral load & other tests.

Supplements may help maintain vitamin D levels. You can find out more about having a healthy diet, containing the vitamins you need, in NAM’s booklet, Nutrition.

Bone health

Dutch researchers have found a high prevalence of low bone mineral density in gay men, regardless of whether or not they are HIV positive.

Low bone mineral density is more common in people with HIV than in the general population. The exact causes aren’t certain. However, they seem to include the damage caused by HIV and the side-effects of some anti-HIV drugs.

But traditional risk factors such as smoking, low body weight and alcohol use may also be important.

Doctors in the Netherlands noticed that many gay men who had been recently infected with HIV had low bone mineral density. This led them to speculate that this problem may have been present before they became HIV positive.

To test this theory, they designed a study comparing bone mineral density between three groups of gay men: 41 men with primary HIV infection (that is, they had been infected within the last few months); 106 with long-term HIV infection, and 30 HIV-negative men.

All were aged between 20 and 55. They were well matched, but the HIV-negative men were somewhat heavier and had a higher BMI (body mass index).

Prevalence of low bone mineral density was similar between the three groups: it was present in 20% of men with primary infection, 22% of those with chronic HIV and 13% of the HIV-negative men.

The researchers think that lifestyle factors such as smoking, drinking and recreational drug use are possible explanations for their findings.

Bone health is monitored as part of routine HIV care. This allows any potential problems to be spotted early so that appropriate treatment can be provided. You can find out more about the tests you will have as part of your routine health monitoring in NAM’s booklet, CD4, viral load & other tests.

 There’s a lot you can do to look after the health of your bones. This includes exercising regularly, stopping smoking and a good diet. You can find out more about having a healthy diet, and looking after the health of your bones, in NAM’s booklet, Nutrition.

Starting HIV treatment with a high viral load

Some new research suggests that the anti-HIV drug abacavir may work as well for people starting HIV treatment with a viral load above 100,000.

Abacavir (Ziagen, also in Kivexa) belongs to a class of anti-HIV drugs known as NRTIs. It is one of the drugs used in first-line HIV treatment for people who are starting treatment for the first time.

But the drug is not recommended for some groups. In the past, this included people with a viral load above 100,000. Some research showed that the drug worked less well in these people compared to the main alternative drug, tenofovir (Viread, also in Truvada, Atripla and Eviplera).

However, results of two studies looking at the safety and effectiveness of some experimental anti-HIV drugs also found that abacavir works just as well as tenofovir in people starting treatment with a high viral load.

Similar proportions of participants taking combinations containing abacavir or tenofovir with a viral load above 100,000 achieved an undetectable viral load.

Your HIV doctor will discuss the pros and cons of abacavir, tenofovir and other anti-HIV drugs with you before you start or change treatment. You can find out more about different HIV treatments in NAM’s booklet, Anti-HIV drugs.

Injecting drug use and hepatitis C

Sharing equipment used to prepare drugs for injection is a possible source of hepatitis C transmission, new research has shown.

Hepatitis C is spread by contact with infected blood. Injecting drug use is a major mode of transmission.

The virus can contaminate equipment used at all stages of the injecting process.

Health promotion campaigns emphasise the importance of safer injecting and not sharing needles or syringes.

Now researchers have found that the virus can contaminate and survive for long periods in other equipment used during the injecting process. This includes water, water bottles and filters.

The researchers suggest that health promotion campaigns should stress that hepatitis C can be transmitted by sharing equipment at all stages of the injecting process.

Other hepatitis news

A number of very promising new drugs for the treatment of hepatitis C are in development.

Researchers are examining the safety and effectiveness of these drugs; which patients to prioritise for treatment; and treatment strategies.