New anti-HIV drugs

HIV services in the UK

The Department of Health has said that due to new commissioning and contractual arrangements, some English NHS trusts “may no longer find it viable to continue to provide HIV treatment services independently”.

In some parts of the country, private companies and other organisations are now providing sexual health services for the NHS. This is likely to happen more and more under NHS reforms.

But this usually involves sexual health services being provided separately from HIV treatment services, rather than both sexual health and HIV services being provided together. This separation can create problems for HIV services, which until now have often relied upon the staff, premises and facilities they have shared with sexual health services.

A stand-alone HIV treatment service may have higher running costs.

In a letter to NHS commissioners (available on the Department of Health website), the deputy NHS chief executive acknowledges the possibility for disruption. Some existing HIV treatment services may close, with patients needing to transfer to new providers and new arrangements, perhaps in a different location.

This is likely to be a particular risk for some smaller clinics where relatively few people with HIV are treated alongside a larger number of people seeking sexual healthcare.

People with HIV using treatment services should be consulted about possible changes, the letter says.

For more information on the changes to the NHS and ways to get involved, visit our website to read Overhauling health: NHS reform, HIV and patient power.

HIV and ageing

Thanks to effective antiretroviral therapy many people with HIV can expect to live well into old age.

As a result, conditions commonly associated with ageing – for example cardiovascular disease – are becoming an increasingly common cause of serious illness and death in people with HIV.

There is also some concern that the diseases of ageing may be occurring earlier in people with HIV than in the general population.

New research seems to support this theory. Doctors in the US found that falls are as common in middle-aged people with HIV (individuals aged between 45 and 65) as in elderly HIV-negative individuals.

In a three-month period, 30% of people in their study experienced a fall. Multiple serious health conditions increased the risk of falls, as did the use of certain medications, such as antidepressants.

The doctors recommend that middle-aged people should have their risk of falls assessed as part of their routine HIV care.

Another study showed the possible negative impact of HIV on daily function (cooking, washing, cleaning, socialising, shopping and personal finance) can be worsened by ageing.

Depression was especially associated with poorer daily functioning.

The researchers believe this underlines the importance of screening people with HIV for depression and providing the appropriate treatment.

Anal cancer

Low-grade cell changes associated with anal cancer frequently progress in gay men with HIV, new research shows.

Although it is rare, rates of anal cancer are much higher in people with HIV compared to HIV-negative individuals. The highest rates of anal cancer are seen in gay men living with HIV.

Anal cancer is caused by certain strains of the human papillomavirus (HPV). HPV is a common infection, some strains of which can cause genital warts.

HPV can cause cell changes in the anus that can become cancerous. These cell changes are graded according to their severity.

Spanish researchers have found that after one year, 33% of HIV-positive gay men with low-grade pre-cancerous cell changes in the anus experience progression to high-grade changes and 5% developed anal cancer.

Some doctors now believe that all HIV-positive gay and bisexual men aged over 30 should be screened for pre-cancerous anal cell changes on an annual basis. For more information on the screening debate, visit our website to read Everything okay down there?

HIV and hepatitis C

The presence of bacteria from the gut in the blood (bacterial translocation) may be an explanation for the accelerated course of liver disease seen in people who are co-infected with HIV and hepatitis C.

Liver disease caused by hepatitis C is now an important cause of serious illness and death in people who have HIV and hepatitis C co-infection.

Bacterial translocation is known to be associated with an increased risk of some liver diseases. Infection with HIV has also been associated with bacterial translocation.

Researchers in Madrid wanted to see if bacterial translocation was associated with the pace of liver disease in people with co-infection.

Their study involved 255 people with co-infection and 100 people with neither infection.

They found that 96% of the co-infection group had intestinal bacteria in their blood, compared to just 7% of the control group.

Levels of gut bacteria were higher among people with HIV who had a CD4 cell count below 350 compared to people with a CD4 cell count above this level.

Higher levels of intestinal bacteria in the blood were associated with an increased risk of liver fibrosis (hardening of the liver).