HIV and illness

The life expectancy of people with HIV has improved dramatically in recent years.

Treatment with anti-HIV drugs means that many people with HIV can expect to live a long and healthy life, with a prognosis that is near normal.

Taking HIV treatment means that not only is it highly unlikely someone will become ill because of HIV, but it also reduces the risk of some other serious illnesses such as heart, kidney and liver disease.

HIV itself is thought to cause inflammation and other disturbances to the body's systems that can lead to these illnesses. Therefore, it’s recommended that people should start taking HIV treatment when their CD4 cell count is around 350, and people with other risk factors for heart, kidney and liver problems are especially encouraged to start treatment at this time.

But US research has now shown that many patients taking HIV treatment are still much more likely to have blood abnormalities indicating inflammation, an increased risk of blood clots, or kidney problems than people in the general population.

The researchers say that more studies are needed to find out why this is the case.

Routine HIV care should involve regular tests to monitor the health of your heart and other organs. The early identification of problems means that appropriate treatment can be provided.

For more information on tests used to monitor your health, you may find our booklet CD4, viral load and other tests helpful. 

CD4 cell count and lymphoma risk

Taking HIV treatment has been shown to reduce the risk of developing AIDS-related and non-AIDS-related cancers.

One AIDS-related cancer is non-Hodgkin’s lymphoma.

Rates of this cancer have dropped dramatically since effective HIV treatment became available.

However, the cancer is still more likely to occur in people with HIV than in the general population. What’s more, researchers have found that patients with HIV who develop this cancer are about 40% more likely to die from it than HIV-negative individuals with the malignancy.

More encouragingly, the researchers found that HIV-positive patients with non-Hodgkin’s lymphoma whose CD4 cell count was above 200 were no more likely to die because of it than HIV-negative patients with the cancer.

The researchers therefore stress that protecting the immune system reduces the risk of death from this cancer. They believe their findings support starting HIV treatment before the virus has done too much damage to the immune system.

Alcohol and HIV disease progression

General advice about healthy living applies to people with HIV. A good diet, exercise, and not smoking are all important parts of a healthy lifestyle.

Many people enjoy drinking alcohol, and it is generally considered that low levels of alcohol consumption do not have any impact on the risk of HIV disease progression.

In the UK the NHS recommends that men should not drink more than 3 to 4 units a day, on a regular basis. For women the recommendation is lower – no more than 2 to 3 units a day. A unit of alcohol is equivalent to a third of a pint of beer, lager or cider, half a standard glass (175ml) of wine, or a 25ml measure of spirits.

But American researchers have found that HIV-positive individuals who have just two alcoholic drinks a day have faster disease progression than those who have lower levels of alcohol consumption.

Their research involved 231 HIV-positive drug users. Their alcohol consumption and CD4 cell counts were monitored over a 30-month period.

Individuals who drank two or more alcoholic beverages a day were about three times more likely to experience a drop in their CD4 cell count to below 200 than those who didn’t drink at all, or who consumed smaller amounts.

The researchers think this is because alcohol has an adverse effect on the immune system.

They also found that patients taking HIV treatment who consumed two or more alcoholic drinks a day were more likely to have a detectable viral load. They believe this was because drinkers had poorer adherence.

But the findings need to be treated with some caution. The study contradicts a lot of earlier research that found that moderate drinking has no impact on disease progression.

In addition, the study was conducted in a population of drug users, so it’s far from certain if its findings can be applied to be people with HIV generally.

Regardless of the findings of this study, it’s good to know that a lot of support is available if you are concerned about your use of alcohol or drugs. Your healthcare team at your HIV clinic are a good place to start.

The June issue of HIV Treatment Update (HTU) will include a feature article on alcohol.