HIV and sex

Most gay men living with HIV in the UK say they have experienced problems with sex, a new report has shown.

In 2007, 1217 gay men with HIV completed a survey about their experiences of living with the virus.

Almost three-quarters (70%) reported some kind of sexual problem in the previous year.

The most common problems were lack of confidence, poor self-image and loss of libido.

Fear of rejection and concerns about transmitting HIV were also common.

Disclosure to sexual partners was a cause of worry, especially for men who had been diagnosed with HIV less than five years ago.

Approximately a third of men said their problems had become worse in the previous twelve months. An equal proportion told researchers they’d welcome the opportunity to participate in some kind of group therapy to improve their self-image and self-esteem.

For more information, you may find our HIV & sex booklet helpful.

Infectiousness

Only half of people taking HIV treatment in the US meet the criteria for non-infectiousness set out in the Swiss statement in 2008, according to the results of new research.

In the past few years, there has been a lot of excitement about the use of HIV treatment as prevention.

Results of a large study published in 2011 showed that antiretroviral treatment can reduce the risk of HIV transmission by 96%.

The debate about the impact on HIV treatment and infectiousness was kick-started in 2008 when a group of senior HIV doctors in Switzerland issued what came to be known as the 'Swiss statement'.

The doctors argued that, in certain circumstances, people taking HIV therapy should not be considered infectious to their sexual partners.

The criteria set by the doctors were:

• Adherent to treatment and receiving regular medical care.
• A viral load below 40 copies/ml (‘undetectable’) for at least six months.
• No sexually transmitted infections.

However, researchers in the US found that only 49% of the people who took part in their study who were taking antiretroviral therapy met these requirements.

A third of participants had a detectable viral load at least once during the study period; approximately a third of people took fewer than 85% of their doses of HIV treatment; and approximately a fifth were diagnosed with a sexually transmitted infection during the study.

The researchers commented: “The Swiss Statement unambiguously specifies the circumstances under which a person with HIV should be considered non-infectious. Unfortunately, these conditions do not reflect the realities of many people living with HIV.”

Take a look at our Transmission and viral load resource, designed to support conversations around sexual transmission and HIV treatment. For more detailed information, visit our HIV treatment as prevention factsheet or our online Preventing HIV resource.

Lubricants

An analysis of 13 sexual lubricants has shown that they can cause irritation in the vagina and rectum. However, this was not shown to increase the risk of HIV transmission.

The advice always to use condoms and water- or silicone-based lubricants is a cornerstone of HIV prevention. (Oil-based lubricants can damage latex, the material many condoms are made of.)

But there was concern when research emerged in 2010 suggesting that lubricants can damage cells in the vagina and rectum, possibly increasing their susceptibility to infection with HIV.

Laboratory research was therefore performed to look more closely at this question. It involved 13 commonly used sexual lubricants. All were water- or silicone-based.

The findings show that even though some lubricants could potentially cause cell damage, this didn’t increase the risk of infection with HIV.

“Despite the lack of increased HIV infection in...tissue,” the researchers write, “these results convey the importance of using condoms in conjunction with compatible lubricants.”

For more information on research into condoms and lubricants, visit our online Preventing HIV resource.

HIV and hepatitis C

Telaprevir (Incivo) improves treatment response in people with HIV & hepatitis C (co-infection) who are taking hepatitis C therapy, final study results show.

Liver disease caused by hepatitis C is a major cause of serious illness and death in people who are co-infected with HIV and hepatitis C.

Standard treatment for hepatitis C consists of pegylated interferon and ribavirin. Therapy normally lasts for 48 weeks. People who have an undetectable hepatitis C viral load 24 weeks after completing this treatment are said to have a sustained virological response (SVR) – in other words they’ve been cured of hepatitis C.

However, current treatment for hepatitis C doesn’t always work and can cause unpleasant side-effects.

Telaprevir is a new drug recently approved for the treatment of hepatitis C in people with mono-infection (people who have hepatitis C but not HIV). It needs to be taken in combination with pegylated interferon and ribavirin.

Now a study has shown that the drug also improves treatment outcomes in people with co-infection.

The study involved 60 people, who were randomised to take telaprevir or a placebo, plus standard hepatitis C therapy.

Overall, 74% of people taking telaprevir achieved an SVR compared to 45% of those in the placebo group.

Telaprevir can interact with anti-HIV drugs, so participants could only take specified antiretrovirals.

Outcomes in the telaprevir arm varied slightly according to which anti-HIV drugs participants were taking. Just over two-thirds (69%) of people taking efavirenz (Sustiva, also in Atripla) had an SVR, compared to 80% of those treated with ritonavir-boosted atazanavir (Reyataz).

Side-effects were more common among people taking telaprevir. The most frequent were headache (34%), feeling sick (34%), rash (29%) and dizziness (21%).

Telaprevir didn’t cause any complications with HIV infection. 

Other hepatitis news

An important conference on liver disease has been taking place in the US.

Several studies have looked at the safety and effectiveness of experimental hepatitis C treatments. Most of the people involved in these studies have hepatitis C mono-infection.

Overall, the results have been extremely promising, showing that effective treatment consisting of drugs that work directly against hepatitis C is now a real prospect. In one study, good results were seen in people with characteristics normally associated with a poor response to hepatitis C therapy.

Most of the drugs are in the early stage of development but, encouragingly, results suggest that they will be effective for people taking treatment for the first time and those whose earlier course of therapy didn’t work.

Other research has looked at how best to manage side-effects caused by existing treatments, for example, the anaemia associated with ribavirin and the protease inhibitor boceprevir.

For more news from the conference, visit www.aidsmap.com/conferences.