HIV Weekly - 3rd March 2010

HIV and ageing

Much of the news in this edition of HIV Weekly is concerned with the diseases of ageing.

Rates of HIV-related illnesses have fallen dramatically since effective HIV treatment became available. Because of this, many doctors are now optimistic that many people with HIV will live a near-normal life span.

But there’s concern that HIV itself, and possibly some of the drugs used to treat it, can cause bone, cardiovascular, kidney and liver disease. These are illnesses that are often associated with ageing.

There’s much that can be done to reduce the risk and impact of many of these illnesses.

This includes:

• Regular clinic check-ups to monitor for early warning signs.
•  Starting HIV treatment if your CD4 cell count is around 350, or earlier if you have risk factors for any of the diseases of ageing.
• Taking a combination of anti-HIV drugs that takes into account your medical history.
• Doing your best to lead a healthy life by not smoking, eating a good diet, and exercising.

Cardiovascular disease

HIV treatment that reduces viral load to undetectable levels can cut the risk of hardening of the arteries, a study has shown.

An important factor associated with diseases such as heart attack and stroke is the hardening of the arteries (atherosclerosis).  The arteries generally harden as people age, but more rapid hardening has been seen in people with HIV.

But now US researchers have found that HIV treatment may help slow the progression of atherosclerosis.

They found that the arteries of people taking HIV treatment whose viral load was constantly below 400 hardened at a slower rate than patients whose viral load was higher.

Older age and being over-weight – both traditional risk factors for cardiovascular disease – were associated with more rapid hardening of the arteries.

Saquinavir/ritonavir and heart rhythm

Medicine regulatory authorities in the US have issued a warning that the boosted protease inhibitor, saquinavir (Invirase) with ritonavir (Norvir), can cause disturbances in the rhythm of the heart.

They are cautioning that patients with heart rhythm problems, or who are taking other drugs that can cause an irregular heartbeat, should not use saquinavir/ritonavir.

If you are taking saquinavir/ritonavir and are concerned about this side-effect, it’s recommended that you to speak to your HIV doctor about your concerns.

You should not stop taking this drug without talking to your doctor first.

Bone disease

Both HIV itself and some of the drugs used to treat it – especially tenofovir (Viread, also in  Truvada  and Atripla ) – have been associated with bone loss.

Bone loss often happens as people age and this can increase the risk of fractures.

Now two separate US studies have produced apparently contradictory results about the risk of fracture for people with HIV.

Most patients (79%) in the HOPS study were male, and researchers found that fractures were much more common amongst these HIV-positive patients than in the general US population.

Increasing age was identified as one of the factors associated with fracture. But so too were HIV-related characteristics, including a lowest-ever CD4 cell count below 200. Therefore, starting HIV treatment at the recommended level of 350 could potentially cut the long-term risk of bone problems and fracture.

However, separate research involving younger HIV-positive and HIV-negative women found that, although those with HIV had lower bone mineral density, this did not translate into an increased risk of fracture.

Brain impairment

Many people find the thought of HIV-associated brain impairment very frightening.

HIV-related dementia is now very rare, but some research suggests that milder forms of cognitive impairment are more common in people with HIV than in the general, age-matched population.

Now US researchers have found that patients whose lowest-ever CD4 cell count was below 50 have an increased risk of subsequently developing cognitive impairment.

Rates of cognitive impairment were lowest in patients who started HIV treatment when their CD4 cell count was 350 and above.

You can read more about HIV-related brain impairment in Issue 186 of HIV Treatment Update, available on our website.

Kidney disease

Untreated HIV can increase the risk of serious kidney problems, and one of the groups of people encouraged to start HIV treatment when their CD4 cell count is around 350 are those who have kidney disease or have other risk factors for it.

But some anti-HIV drugs have also been associated with kidney problems, most especially tenofovir (Viread, also in Truvada  and Atripla ), a drug that is widely used by people starting HIV treatment for the first time.

About 1 to 2% of people taking tenofovir develop kidney problems. Most research suggests that once treatment with the drug is stopped, kidney function quickly returns to normal.

In a newly published study, Australian researchers used a highly sensitive test, called estimated glomerular filtration rate, to measure kidney function and found that this doesn’t always happen.

This test showed that, in about 40% of patients, kidney function was still impaired over a year after treatment with tenofovir was stopped.

They found that patients who had a gradual decline in kidney function when taking tenofovir had the greatest risk of developing longer-term kidney damage.

The researchers recommend that patients taking tenofovir who develop kidney problems should quickly be changed to an alternative treatment.

Long sentence in Scottish case

A man has been sentenced to ten years in prison after infecting one female sexual partner with HIV, and for having unprotected sex without disclosure with three other women, none of whom contracted the virus.

The man was convicted of the Scottish offence of reckless and culpable behaviour.

HIV organisations have expressed alarm that the case has set a legal precedent in Scotland and that unprotected sex without disclosure, even if no HIV transmission occurs, can now be prosecuted.

In this BBC report, they point out faults in the logic of such a development.

About a quarter of all people with HIV are undiagnosed and therefore unable to disclose. Epidemiological evidence suggests that the source of many new HIV infections is people who are unaware that they have HIV, and that many of these individuals have only just been infected with HIV themselves.

The case has also been associated with some highly stigmatising press coverage.

In England and Wales, a prosecution can only be brought if a person knows that they have HIV, they do not disclose their status before having unprotected sex, and HIV transmission occurs.

If you have concerns about HIV transmission and the criminal law , a good place to seek support is THT Direct on 0845 12 21 200.