HIV and tuberculosis

Tuberculosis (TB) is the biggest single cause of serious illness and death in people with HIV globally. Even in richer countries like the UK, TB is one of the most common AIDS-defining illnesses.

New research shows that people with HIV who have had active TB have an increased risk of having it again. 'Active' TB is TB that causes illness, as opposed to 'latent' TB. This  where someone has been infected with TB, but their immune system keeps it under control; they are not ill because of TB and they are not infectious.

The study was conducted in Tanzania and included approximately 1000 people with HIV, 8% of whom had had active TB.

People with a history of active TB were three times more likely to develop it again during the study period than people who had not previously had active TB.

The researchers think their findings have important implications for HIV care.

They recommend that screening for TB should not neglect people who have had active TB in the past.

For more information on HIV & TB, visit our website to read our HIV & TB booklet, our illustrated TB basics, or for information aimed at people working in resource-limited settings, visit our HIV & AIDS treatment in practice pages.

Multivitamins

Taking high-dose multivitamins has no benefit for people taking HIV treatment and can even cause serious liver side-effects, according to new research.

Many people take multivitamins to support their health and supplement their diet.

Some research has shown that high-dose multivitamins have benefits for people living with HIV who are not taking antiretroviral therapy.

Doctors wanted to see if there were also benefits for people who were taking anti-HIV drugs.

They designed a study involving approximately 3500 people in Tanzania who were starting HIV treatment.

These participants were randomised to receive either a standard multivitamin tablet or high-dose multivitamins.

The researchers compared changes in CD4 cell count and viral load between the two groups, as well as rates of disease progression and death. The study also looked at the safety of high-dose multivitamin treatment.

The study was intended to last for 24 months. However, it was stopped early. This was because an interim analysis of the results showed that taking high-dose multivitamins had no benefits.

Rates of disease progression were similar between those taking high-dose and standard-dose vitamins. This was also the case for CD4 cell count and viral load.

There was also a significant safety issue with the use of high-dose multivitamins.

People who were taking the high-dose tablets were much more likely to experience a potentially dangerous disturbance in their liver function than people taking standard-dose multivitamins.

The researchers concluded, “in the absence of clear evidence of the benefit of high-dose micronutrient supplementation [...] in adults receiving HAART, it is prudent to follow current recommendations to promote and support dietary intake of micronutrients at recommended daily levels.”

For more information on healthy eating, you may find our Nutrition booklet helpful.

HPV-related disease

Cidofovir cream is an effective treatment for high-grade pre-cancerous genital and anal lesions in people with HIV, new research has shown.

Rates of anal and cervical cancer are higher in people with HIV than the general population.

The underlying cause of these cancers is infection with high-risk strains of the human papillomavirus (HPV), some strains of which can also cause genital warts.

HPV can cause cell changes, which develop into lesions and these can become cancerous.

Researchers wanted to see if cidofovir cream was an effective therapy for high-grade pre-cancerous cell changes in the anus and cervix.

Earlier research involving people with HIV had shown that the cream was an effective and safe treatment for genital warts.

The latest study involved 24 men and nine women.

The participants were instructed to apply the study cream sparingly in a thin layer over the affected area with a gloved finger once daily and to wash the cream off six to eight hours later. Individuals received up to six two-week cycles of treatment. Treatment response was evaluated after each treatment cycle.

In just over half the participants, the lesions responded to treatment – they either disappeared or were reduced in size.

Disease remained stable in 20% of participants, but progressed in 6% and one person developed anal cancer.

Nevertheless, the researchers were very encouraged by these results and called for more research into this treatment.

Our regular publication HIV treatment update has featured articles on screening for anal cancer and on prevention and treatment of cervical cancer.

HIV and the criminal law

In countries all over the world, people have been investigated, prosecuted and, in some cases, convicted of crimes related to ‘exposing’ a sexual partner to HIV, or passing HIV on to a partner, in particular if they haven’t disclosed their HIV status before having sex.

What people have to do to avoid liability varies from country to country, but often only having protected sex (using a condom) is considered sufficient protection from HIV exposure or transmission. Now, with more known about the effect of treatment as prevention, having an undetectable viral load can also be a defence in some countries.

A commission in Norway has just released new recommendations on HIV and the criminal law.

It recommends that exposure to HIV should remain a criminal offence, as should transmission of the virus, if a person hasn’t told their sexual partner that they have HIV.

The report does say that use of condoms can be a defence. But it says that having an undetectable viral load won’t prevent prosecutions.

The report has been greeted with dismay and there are fears that its recommendations could make prosecutions easier.

For more information on HIV and the criminal law, visit www.aidsmap.com/law.