Safety of HIV treatment
Thanks to effective antiretroviral therapy, the prognosis for many people with HIV is excellent.
However, even in the best circumstances, life expectancy is still about four years shorter than that for HIV-negative people.
The exact reasons for this are uncertain. However, the long-term side-effects of some anti-HIV drugs may include an increased risk of non-HIV-related illness such as cardiovascular disease. Some researchers have therefore been concerned that a lifetime of use could have damaging consequences.
But this doesn’t appear to be the case. Researchers monitored 12,000 people who started HIV treatment after 1996. Almost 1300 died during the course of the study.
Each additional year of HIV treatment (after year two) was associated with a 5% reduction in the risk of death from any cause, a 14% reduction in the risk of death due to an AIDS-related illness, and a modest decline in the risk of dying from a non-HIV-related illness.
Longer duration of HIV treatment significantly reduced the risk of dying from liver disease. There was an increased risk of mortality due to non-AIDS-related cancers, but the researchers think this is simply because people were living longer.
They conclude: “It is clear that death due to accumulating treatment toxicities is a very uncommon event.”
All the content from our reference guide, the HIV treatments directory, is freely available on our website. It includes hundreds of references to published research. www.aidsmap.com/treatmentsdirectory
Outcomes and prognosis
A separate study has also provided new information about factors affecting prognosis.
It involved over 2000 adults under the age of 65 taking HIV treatment in Denmark.
Premature death was associated with three factors:
- A detectable viral load and/or low CD4 cell count.
- Other illnesses or infections.
- Drug or alcohol abuse.
People who were doing well on HIV treatment and who did not have other infections or drug/alcohol problems had an excellent prognosis.
The researchers therefore conclude that “classic” risk factors were the reasons behind the poorer life expectancy of some people.
They do not believe that their results support the theory that people taking HIV treatment are experiencing “premature ageing”, characterised by the development of illnesses associated with older age such as heart, liver and kidney problems.
HIV and hepatitis B – outcomes
It showed that co-infection with hepatitis B worsened many HIV-related outcomes.
HIV and hepatitis B are transmitted in similar ways and therefore people are often infected with both viruses.
It is well known that HIV can hasten the course of hepatitis B disease. However, it’s less certain what impact hepatitis B has on HIV.
Researchers therefore monitored the risk of progression to AIDS or death according to hepatitis B infection status.
Their results showed that chronic hepatitis B infection doubled the risk of these outcomes.
There are some important messages from this study.
- Infection with hepatitis B is preventable – a vaccine is available, and it is recommended for all HIV-positive people. The immunity provided by the vaccine should be monitored as part of routine HIV care as booster doses are sometimes needed.
- The HIV treatment of people co-infected with HIV and hepatitis B should include drugs that work against both viruses – these include 3TC (lamivudine, Epivir, also in the combination pill Combivir) and FTC and tenofovir (usually combined in the pill Truvada, and also available in Atripla).
A separate study has shown that outcomes are also affected by hepatitis B genotype or strain.
It involved co-infected patients in Taiwan. The most common hepatitis B genotypes in the country are B and C.
Patients who were co-infected with genotype B were significantly more likely than those infected with genotype C to develop liver disease, die of liver-related causes, or develop strains of hepatitis B that were resistant to 3TC. They were also more likely to experience hepatitis flares when they started antiretroviral treatment.
However, genotype did not affect outcomes related to HIV.
Non-HIV-related illness
It’s already been noted that non-HIV-related illnesses are a key cause of serious illness and death in people with HIV.
The risk of these illnesses can be reduced, so monitoring for risk factors is an important part of routine HIV care.
It’s known that mild kidney problems can increase the risk of cardiovascular disease in HIV-negative people.
Spanish researchers have now established that this is also the case for people with HIV.
Their research involved 145 people who received HIV care in 2009/10. It showed that mild kidney problems were associated with hardening of the arteries – an important early warning sign of cardiovascular disease.
The researchers believe that their findings have immediate relevance to the care provided to people with HIV, recommending that regular monitoring of kidney function “might help to better identify subjects at increased risk of cardiovascular disease in order to initiate aggressive management of risk factors”.