Adherence and depression
Doctors in the US looked at the factors associated with adherence to HIV treatment.
Their headline finding was that African American people were about a third less likely to take 90% or more of their doses than people of other ethnic backgrounds (this level of adherence is considered necessary for treatment to be most effective). This is likely to be because of the difficult socioeconomic circumstances faced by many HIV-positive African Americans.
But a surprise finding of the research was that people with depression were 5% more likely to have high levels of adherence than people in the study who were not depressed.
The researchers think that this could be due to the beneficial effects of treatment with antidepressants.
People with depression who were taking antidepressants were twice as likely to take their HIV treatment as prescribed than people with depression who were not taking antidepressant therapy.
Depression is relatively common in people with HIV. You can access professional help and support through your HIV clinic, your GP or other local services. You can find out more about this subject in our booklet HIV, mental health and emotional wellbeing.
Cervical cancer
Cervical cancer is related to infection with certain strains of the human papillomavirus (HPV), a very common and often symptomless infection, which can lead to the development of cell changes and lesions that sometimes lead to cancer. In women with HIV, cervical cancer is considered to be an AIDS-defining illness.
New cases of the other AIDS-defining cancers – Kaposi’s sarcoma and non-Hodgkin’s lymphoma – have fallen dramatically since effective HIV treatment became available. Antiretroviral therapy has also been shown to improve outcomes in people who have these cancers.
Doctors in South Africa wanted to see if HIV treatment also had benefits regarding cervical cancer.
They therefore monitored 1123 women between 2003 and 2009. All had at least two cervical smears, a type of screening to identify signs of cells changing.
Only 2% of women were taking HIV treatment at the start of the study, but this increased to 17% as the research progressed.
Taking HIV treatment reduced the risk of developing pre-cancerous cervical lesions by 38%.
It also had benefits for women who had pre-existing lesions, more than doubling the chances of regression (an improvement in symptoms).
Routine HIV care should involve regular cervical screening. This means that any abnormal cells can be spotted early and appropriate treatment can be provided. In the UK, women with HIV are recommended to have cervical screening (sometimes called a Pap smear or smear test) annually. Talk to your HIV clinic or GP to arrange screening.
Starting HIV treatment
The researchers monitored the viral load of over 1100 people who started HIV treatment between 2000 and 2009. Clinical trials often exclude people who inject drugs because of concerns they will not take treatment as prescribed. Unusually, many of the people in this study had a history of injecting drug use.
Overall, 68% of people had an undetectable viral load six months after starting treatment. This included a third of people who injected drugs.
For people with no history of injecting drug use, a combination that included ritonavir-boosted atazanavir was about 50% more likely to suppress viral load than a combination based on efavirenz.
Atazanavir/ritonavir appeared to be an especially good option for injecting drug users, doubling the chances of viral suppression compared to efavirenz.
The researchers therefore think that a combination based on ritonavir-boosted atazanavir may be a good choice for people who inject drugs or who struggle with adherence.
Want to talk to a healthcare professional about HIV treatment, but not sure where to start? Try our online Talking points tool before your next appointment.
Hepatitis C
Standard treatment for hepatitis C consists of pegylated interferon and ribavirin. Treatment for hepatitis C aims to cure the condition, but this doesn’t always work and treatment can cause side-effects.
As with HIV drugs, hepatitis C drugs are grouped into different classes, or types. Two new hepatitis C protease inhibitors have been approved, but these have to be taken with the current standard treatment. However, a number of other new drugs are in development.
A major side-effect of pegylated interferon is depression. Doctors in the US have published an article stressing that people taking this therapy should be screened for depression. They also recommend that people with depression should receive treatment with antidepressants.
Research into new hepatitis C drugs means that treatment that doesn’t involve interferon may soon be a reality.
A study presented to the recent International Liver Congress showed that a combination of three hepatitis C drugs (ribavirin taken with a protease inhibitor currently called BI 201335; and a non-nucleoside polymerase inhibitor currently called BI 207127) achieved a sustained virological response (considered to be a cure) in 68% of people with genotype 1.
The response rate for people with cirrhosis was up to 57%. This is an important result for this group, as people with advanced liver disease are urgently in need of treatment options.
Ribavirin can also cause side-effects, most notably anaemia. New research involving people taking the two new hepatitis C protease inhibitors showed that this can be managed by reducing the ribavirin dose.