HIV and mental health

UK researchers have found that HIV-positive gay men often show symptoms of post-traumatic stress disorder.

This condition can develop after someone experiences an event which they perceived as being life-threatening or dangerous. It typically involves emotions of fear, helplessness or horror.

Post-traumatic stress disorder (PTSD) is well-recognised in patients who have other potentially life-threatening illnesses.

The UK study involved 100 HIV-positive gay men. They completed a questionnaire that enquired about symptoms of post-traumatic stress disorder.

A third of patients met the criteria to be diagnosed with the disorder.

Common traumatic events included being diagnosed with HIV, being ill because of the virus, being close to someone who had died because of HIV, starting HIV treatment, experiencing side-effects, and disclosing to others.

Experiencing HIV-related symptoms was associated with feelings of physical threat, leading to the development of PTSD.

For all the other situations, emotional distress – feelings of fear, helplessness, or horror – was associated with the symptoms of PTSD.

But the study didn’t take into consideration other important factors that can cause emotional distress and trauma – for example social circumstances, other stressful life events, or the experience of stigma.

Nevertheless, the researchers believe that symptoms of post-traumatic stress disorder are common in gay men with HIV, and that these are linked to “fear, helplessness, or horror as opposed to shame, humiliation, or guilt”.

If you are experiencing any form of emotional distress or a mental health problem, then it’s good to know that a lot of support is available to you. A good place to start finding out about these issues is the NAM booklet, HIV, mental health and emotional wellbeing.

HIV and anal cancer

A topical cream provides a good treatment for pre-cancerous anal lesions.

In UK research, use of imiquimod cream was associated with the disappearance or downgrading of lesions in 61% of HIV-positive gay men.

Rates of anal cancer are increasing in people with HIV. Before cancer develops, pre-cancerous lesions appear in the anus. These are graded according to their severity.

The sooner these pre-cancerous cell changes are diagnosed the better, as this means that treatment can be provided to reduce the risk of progression to anal cancer.

Other research has shown that imiquimod cream can help clear pre-cancerous cervical lesions.

UK researchers wanted to see if it was a possible treatment for anal lesions in people with HIV.

The study involved 64 HIV-positive gay men, all of whom had high-grade anal lesions.

These men were randomised to receive imiquimod cream or a placebo for four months. After this time all those who had lesions that had not resolved were offered imiquimod and they were followed for a further four months.

Overall, treatment with imiquimod was associated with the disappearance or downgrading of lesions in 61% of men.

Few HIV treatment centres in the UK currently screen their patients for pre-cancerous anal cell changes. However, the investigators believe that it is time to adopt a more proactive policy. They emphasise the benefits of detecting and treating the disease, and that “imiquimod can play a valuable role in the management of anal intraepithelial neoplasia”.

HIV and lung cancer

US researchers have found that recurrent bouts of bacterial pneumonia increase the risk of lung cancer for patients with HIV.

They believe that this is because the pneumonia is causing inflammation.

Although it is rare, lung cancer is more common in people with HIV than those in the general population.

Many people with HIV smoke, and smoking has been consistently identified as the main risk factor.

However, US researchers looked at the medical records of over 320,000 people with HIV over a 25-year period.

There were 853 cases of lung cancer during this time. Their calculations showed that those who had recurrent bacterial pneumonia were about 63% more likely to develop lung cancer than other patients.

They found an association between recurrent pneumonia and lung cancer in younger patients – but not in those aged over 50.

The researchers didn’t have information on the smoking habits of the people in their sample. But on the basis of other research they assumed that about 70% of patients smoked.

When they factored this estimate into their calculations, the association between pneumonia and lung cancer was weakened to such an extent that it could just be chance.

Nevertheless, the researchers believe there may be evidence that lung infections increased the risk of lung cancer for people with HIV.

HIV treatment and prevention

A minority of women who are taking HIV treatment occasionally had detectable levels of viral load in their genital fluids, a small study has shown.

The finding may have implications for discussions about the potential infectiousness of people who are taking HIV treatment.

The US research involved 59 women. Viral load in blood and genital fluids was monitored at the same time at a number of study visits.

Overall, viral load in genital fluids (‘genital shedding’ of HIV) was observed at 13% of study visits.

On 40% of occasions, this shedding occurred when the women had an undetectable viral load in their blood.

The researchers found that about 7% of women with an undetectable viral load in their blood persistently shed HIV in their genital secretions.

It is unclear if this shedding was at levels that involved a significant risk of either sexual or mother-to-child transmission of the virus.

But the researchers warn that an undetectable viral load in blood doesn’t necessarily mean that a woman will have undetectable virus in her genital secretions – and this could involve a risk of transmission of the virus.