HIV treatment and infectiousness
There’s been more discussion of the impact of HIV treatment on infectiousness.
This is currently one of the hottest topics in HIV.
Debate on the issue was kick-started a few years ago with the release of the Swiss statement.
This said that in certain circumstances people taking HIV treatment who had an undetectable viral load were not infectious to their sexual partner.
It’s generated a lot of debate, and there’s a general consensus that successful HIV treatment does reduce the infectiousness of an individual. However, most doctors agree that there may still be a small risk of transmission.
San Francisco and the Canadian province of British Columbia are trying to increase HIV testing and the number of people taking treatment as a way of controlling the epidemic.
Doctors in San Francisco previously reported that this is having some success and the number of new HIV diagnoses in the city is falling.
Updated information from the city showed that the average viral load for all people with HIV in San Francisco has fallen substantially. There’s a link between viral load and infectiousness – the higher a person’s viral load, the more infectious they are.
This fall in so-called ‘community viral load’ was accompanied by a big fall in new HIV diagnoses, even though more people are testing.
But it’s uncertain if the fall in diagnoses is due to expanded HIV treatment. It could be due to reduced HIV risk behaviours.
But some transmissions would still occur – partly because people who’ve been recently infected with HIV have a very high viral load and are therefore potentially very infectious.
Symptoms and illness – neuropathy
A study suggests that peripheral neuropathy is still relatively common in patients with HIV.
Rates of the condition and its symptoms were monitored in patients who started HIV treatment between 2000 and 2007.
Neuropathy involves damage to the nerves. It can be caused by HIV, but it can also be a side-effect of some older anti-HIV drugs, such as d4T (stavudine, Zerit) and ddI (didanosine, Videx). It can cause symptoms such as numbness, pins and needles or a burning sensation. The nerves in the feet and lower legs are usually affected, and when this happens it’s called peripheral neuropathy.
US researchers found that three years after starting treatment a third of patients had evidence of reduced nerve sensation in their lower limbs, and 9% had the often painful symptoms of peripheral neuropathy.
Older age, a low nadir (lowest-ever) and a low current CD4 cell count, and treatment with anti-HIV drugs associated with nerve damage were all risk factors.
They also found some evidence that having diabetes increased the risk.
The researchers say that the association with ageing found in the study means that neuropathy is likely to continue to be a complication for people with HIV even if drugs that cause it are no longer used.
The association between diabetes and neuropathy also concerned the investigators, and they write: “This is a very serious finding given the increasing impact of insulin resistance and diabetes in the setting of HIV infection.”
HIV and hepatitis C – sexual transmission
There is an epidemic of sexually transmitted hepatitis C among HIV-positive gay men. Rougher sex (especially in a group), drug use, other sexually transmitted infections, and unprotected anal sex have all been identified as risk factors.
Treatment is available for hepatitis C and it works best if a person receives it soon after they’ve been infected (acute infection).
Researchers in Amsterdam studied 28 HIV-positive gay men successfully treated for acute hepatitis C infection.
Two patients were rapidly reinfected with hepatitis C, and a further seven individuals were reinfected with the virus within two years.
Separate German research found similarly high rates of reinfection.
The researchers stress the importance of regular discussions with patients about the risk factors for hepatitis C.
They also recommend regular testing for patients who are at risk of the virus.
HIV and hepatitis C – prognosis
Liver disease caused by hepatitis C is a leading cause of illness and death in patients who are co-infected with HIV and hepatitis C.
Liver cirrhosis – permanent scarring – can develop when a person has hepatitis C. It is described as ‘compensated’ when the liver can still function despite having undergone this damage.
Spanish researchers looked at survival rates for patients with HIV and hepatitis C who had cirrhosis.
Co-infected patients with compensated cirrhosis had survival rates that were as good as those recorded in patients who only had hepatitis C.
After three years, 87% of co-infected patients with compensated cirrhosis were still alive.
However, the prognosis of co-infected patients with decompensated cirrhosis (i.e. where the liver cannot cope with the damage it has experienced) was much poorer.
Only 50% were still alive after three years.
Poorer survival was also associated with stopping HIV treatment. Antiretroviral drugs don’t work against hepatitis C. However, they keep the immune system strong and this has benefits for the health of the liver.
The researchers stress how important it is for co-infected patients to stay on HIV therapy.
A low nadir (lowest ever) CD4 cell count was also associated with a poorer prognosis. One of the groups who are especially recommended to start HIV treatment early are patients co-infected with hepatitis C.