HIV Weekly - 22nd August 2012

HIV treatment as prevention

A new study found consensus among HIV specialists about the use of HIV treatment as prevention.

US researchers surveyed clinicians in New York and Washington DC and found that 95% of doctors and other healthcare workers who prescribe anti-HIV drugs agree that treatment reduces infectiousness.

Three-quarters of prescribers said they would be willing to prescribe early HIV treatment for the purposes of prevention to people who had an HIV-negative partner.

There is now good evidence that people with HIV who are taking treatment that suppresses their viral load to undetectable levels are unlikely to infect their sexual partners.

A study involving heterosexual couples, where one patient was HIV-positive and the other HIV-negative, showed that treatment reduced the risk of transmission by 96%.

The findings of the latest research are especially interesting because the study was conducted before the publication of these results that show just how effective treatment as prevention can be.

UK HIV treatment guidelines recommend discussion of early HIV treatment for the purposes of prevention for people who don't yet need treatment for their own health (e.g. with a CD4 cell count above 350) but who have an HIV-negative partner.

For more information on HIV treatment as prevention, visit our online factsheet, or for more detailed information take a look at our Preventing HIV resource.

HIV clinical trials

A group of senior HIV doctors have written an opinion piece questioning if some clinical trials are in the best interest of patients.

The doctors believe that many studies looking at switching or simplifying HIV treatment are unlikely to have any meaningful benefits for participants – and could even have negative outcomes.

No drug can be approved for use unless clinical trials have shown that it is safe and effective. These studies involve many hundreds or even thousands of people and compare the experimental treatment to either the current standard of care or a placebo.

Current HIV treatment is very effective. The overwhelming major of people taking antiretrovirals in the UK have an undetectable viral load and are doing well on treatment.

This means it can be hard to recruit people to take part in studies.

Researchers have tried to overcome this problem by recruiting people who are doing well on their current treatment to studies that are looking at the possible advantages of switching one or more drugs, or simplifying treatment, for example by taking fewer drugs.

These drugs can have benefits, including fewer side-effects, fewer pills and reduced cost.

However, in their opinion piece the doctors stress that the benefits of the potential benefits of these studies must outweigh the possible risks.

They do not believe that 'switch studies', which seek to show that a new treatment is just as likely as an existing therapy to suppress viral load, are justified.

The doctors also question the value of studies that show that a new drug leads to minor improvements in some test results.

Before a trial goes ahead it has to be approved by an ethics committee. The doctors believe that these committees should rigorously evaluate the potential risks and benefits of switch and simplification studies.

The authors also stress that people should be fully informed about the potential advantages and disadvantages of joining a study, and what the aims of the study are. If the research is unlikely to result in any direct benefits for participants then this must be made explicit.

For more information on taking part in clinical trials, take a look at our factsheets: Clinical trials and Thinking about joining a clinical trial?

HIV and shingles

A low CD4 cell count and a detectable viral load are risk factors for shingles, new research shows.

Shingles is caused by herpes zoster virus. Its symptoms include painful blisters and nerve pain.

Earlier research conducted soon after effective HIV treatment was first introduced showed that HIV-positive people were much more likely to develop shingles than people in the general population.

Doctors in Baltimore wanted to see how common shingles was in the era of modern HIV treatment and to see if any risk factors predicted its occurrence.

They found that shingles was still approximately ten times more common in people with HIV compared to the general population.

A CD4 cell count below 500 and a detectable viral load were both risk factors for shingles. This suggested to the researchers that starting HIV treatment could reduce the risk of the disease.

However, they found that a small proportion of people developed shingles soon after they started HIV therapy – this was probably as a result of so-called immune restoration inflammatory syndrome, or IRIS.

Shingles is often associated with older age. There was no evidence of this in the present study. Nevertheless, the researchers recommend that people should be monitored for the condition as they age.

For more information on shingles, visit the NHS Choices website: www.nhs.uk/conditions/shingles

HIV and faith

Religious beliefs do not prevent African people in London from testing for HIV or starting antiretroviral therapy, a new study shows.

African people are one of the groups most affected by HIV in the UK. They are more likely than the other communities most affected by HIV to have religious beliefs.

Researchers wanted to find out what role religion had in the lives of black African people who were diagnosed with HIV in London between 2004 and 2006.

They found that 99% had a religious identity. Almost two-thirds of women and 37% of men went to religious services at least once a week.

People who attended weekly services were more than twice as likely to believe that faith alone could cure HIV, than people who attended services less frequently (38 vs 15%).

However, a belief in the curative powers of faith did not prevent people from starting HIV treatment.

“It seems that most individuals are able to reconcile their faith in the ability of God to heal HIV infection and the knowledge that they themselves will still need to take antiretroviral therapy to remain well,” write the authors.

Faith can be a source of support and comfort, but the researchers also found that 40% of people feared that they would be stigmatised or discriminated against if members of their faith community learnt about their HIV status.

Visit our website for more information on HIV and UK African communities.