HIV treatment and infectiousness
The impact of HIV treatment on infectiousness is a very hot topic at the moment. Hardly a week goes by without a new study being published that offers new insights into this controversial area of HIV medicine.
HIV treatment reduces the amount of virus in body fluids. This includes genital fluids.
In 2008 senior Swiss HIV doctors issued a statement saying that in certain circumstances a person taking HIV treatment who had an undetectable viral load in their blood should not be considered infectious.
They based their findings on research involving heterosexual couples that showed there were no HIV transmissions when viral load was below a certain level.
Not everyone agrees with the Swiss statement, but there’s a consensus that HIV treatment can reduce infectiousness.
But there are concerns that even people who have an undetectable viral load in their blood may not always have an undetectable viral load in their genital fluids. A number of studies have shown this in women.
Now researchers believe they have identified the main reasons why this can happen.
Their study involved women starting HIV treatment. The researchers monitored viral load in blood, cervical fluids and vaginal secretions for six months.
Treatment reduced viral load in the blood and genital fluids. The researchers also found that the level of viral load in the blood tended to predict viral load in these genital fluids.
At the end of the study, after taking treatment for six months, 69 women had an undetectable viral load in their blood, but viral load was still detectable in the cervical fluids of 10% of these women and in the vaginal secretions of 32%.
The single most important factor associated with a detectable viral load in genital fluids was poor adherence to treatment.
Supporting people to take their treatment properly will mean that they get the most benefit from their anti-HIV drugs, say the researchers. They add that it will also have the additional benefit of reducing genital levels of HIV.
For more information on adherence, you can read or download our booklet Adherence & resistance on our website. Booklets can also be bought or are available free to people living with HIV in the UK and to organisations and clinics in the UK through our free booklet scheme. Contact 020 7837 6988 or info@nam.org.uk for details.
HIV and cancer
Researchers are also very interested in the relationship between HIV and the risk of certain cancers.
Thanks to effective HIV treatment, there have been big falls in the number of people developing the AIDS-defining cancers Kaposi’s sarcoma and non-Hodgkin’s lymphoma.
But a number of studies have shown that even in the era of effective HIV therapy, people with HIV have an increased risk of some other cancers.
Their study involved approximately 10,000 patients who developed an AIDS-defining illness between 1999 and 2006.
A total of 3200 of these people died. A non-AIDS-related cancer was the cause of death in 7% of patients.
The most common cancers were those of the lung (58 cases), liver (28), Hodgkin’s lymphoma (28), and head and neck (18).
The researchers noted that death rates associated with cancers caused by infections were especially high.
For example, some strains of human papillomavirus (HPV) can cause cell changes that lead to cancer, and rates of anal cancer were 240 times higher in people with HIV than in the general population. Many people with HIV are also co-infected with hepatitis C, and rates of liver cancer were eleven times higher in people with HIV than in HIV-negative people of the same age and sex.
The researchers conclude that people with HIV should be screened for non-HIV-related cancers.
There is lots of information and support available to you if you are living with cancer. In the UK a good place to start is the Macmillan Cancer Support Line, which you can call free on 0808 808 00 00.
Symptoms
Thanks to HIV treatment many people with HIV have a good prognosis and can expect to live a long and healthy life.
But new research has shown that many people are still experiencing symptoms.
The UK research involved 778 people with HIV and was conducted in 2005-06. Two-thirds of these individuals were taking HIV treatment.
Participants in the study were asked to say if they had experienced any of 26 physical or psychological symptoms in the past seven days.
A lot of people reported experiencing symptoms. The mean number of symptoms each patient reported was 18.
Lack of energy was reported by 71% of patients, tiredness by 68%, difficulty sleeping by 62%, poor concentration by 61%, worry by 70%, sadness by 66%, diarrhoea by 54% and sexual problems by 53%.
Psychological symptoms were associated with poor adherence to HIV treatment.
These symptoms were also associated with unprotected sex.
More attention should be given to symptoms, conclude the researchers.
Talking honestly with your doctor, or another health professional at your HIV clinic, can help to make sure that any symptoms you are experiencing are investigated.
The September edition of HIV Treatment Update included a feature article on How to talk to your doctor. For more information on subscribing to HIV Treatment Update (free for people living with or affected by HIV) please contact us by emailing info@nam.org.uk or calling 020 7837 6988.