HIV and criminal law

The biggest HIV news in the last week was the conviction of a man in Scotland for infecting his partner with HIV.

He was also convicted for having unprotected sex with three other women without telling them he had HIV, even though none of these women became infected with the virus.

This is a legal first in the UK.

The convictions were for the Scottish offence of reckless and culpable conduct. There have now been three convictions for reckless HIV transmission in Scotland.

Scotland has a different legal system to England and Wales. In England, you can only be prosecuted if unprotected sex occurs without disclosure and HIV transmission takes place.

The latest case received a lot of stigmatising coverage in the press.

There’s now a lot of evidence that shows HIV treatment can mean that people with HIV can live a near-normal lifespan. There was no mention of this in articles on the case which routinely described HIV as ‘deadly’.

The woman who was infected by the man in this case was pregnant at the time of her diagnosis. After learning that she had HIV she terminated the pregnancy.

HIV treatment during pregnancy, an appropriately managed birth, and not breastfeeding can reduce the risks of mother-to-child HIV transmission to very low levels. Once again, press coverage made no mention of this.

National AIDS Trust (NAT) has a trained group of HIV-positive volunteers called Press Gang who respond to inaccurate coverage of HIV in the media. For information about joining Press Gang, visit the NAT website.

If you are have any questions about HIV and criminal law, a good place to seek support is the Terrence Higgins Trust helpline, THT Direct. It can be contacted on 0845 12 21 200.

When to start HIV treatment – HIV’s early effect on the immune system

There’s a lot of debate about the best time to start HIV treatment.

Current UK guidance says that anyone who is ill because of HIV should start treatment. It is also recommended that people with a CD4 cell count of around 350 cells/mm³ should start treatment.

It is especially recommended for people who have other serious health conditions such as hepatitis B or C, kidney disease or a high risk of cardiovascular disease.

Some doctors favour starting treatment at higher CD4 cell counts. Indeed, US guidelines issued at the end of last year favour treatment at CD4 cell counts between 350 and 500 cells/mm³ and don’t rule out starting treatment at even higher CD4 cell counts.

Some new research points to who may benefit from earlier treatment.

It shows that HIV can cause some very subtle changes to the immune system soon after infection.

CD4 cell counts are routinely measured as part of HIV care. But they are only one of a large number of immune system cells.

Some of these are so-called memory cells. These are cells that the immune system created in response to past infections that are then stored by the body and wake up when they are needed. The body also produces new, or naive, cells to fight infections.

Researchers found that people with larger number of naive and memory CD8 cells had slower HIV disease progression.

Other important factors associated with prognosis were activation of the immune system and the overall number of HIV-infected cells.

The researchers recommend that tests for these markers should be included in routine HIV care.

They also believe that their research “indirectly” supports starting HIV treatment earlier.

Disappointment about new drug

The makers of the experimental entry inhibitor vicriviroc have announced that they will not be seeking a licence for its use by treatment-experienced patients.

Vicriviroc is a CCR5 inhibitor. It stops HIV binding to human cells. Maraviroc (Celsentri) belongs to this class of antiretroviral and is approved for use by people starting HIV treatment for the first time as well as those who have taken anti-HIV drugs in the past.

There had been hopes that vicriviroc would also become an option for treatment-experienced patients.

But its owners, Merck, have announced that studies involving that group of patients showed that vicriviroc didn’t have the required potency.

Vicriviroc in combination with the protease inhibitor atazanavir (Reyataz) boosted by ritonavir is still being evaluated in patients starting HIV treatment.

TB a big issue for HIV-positive migrants

Worldwide, the biggest single cause of illness and death in people with HIV is tuberculosis (TB). The impact of TB is especially severe in southern African countries.

But even in richer countries such as the UK and France, TB is one of the most common AIDS-defining illnesses.

French researchers have found that new cases of TB in people with HIV doubled between 1997 and 2008.

HIV-positive migrants, especially from sub-Saharan African countries, were disproportionately more likely to have TB as well.

Many patients have their HIV diagnosed late when the immune system is severely damaged by HIV. Late diagnosis of HIV is the underlying cause of most of the serious HIV-related illness as well as AIDS deaths that are seen in the UK and other European countries.

TB should alert a doctor that a patient may have HIV, and HIV tests are recommended for all patients diagnosed with TB. The French researchers found that in about a third of cases, HIV and TB were diagnosed at the same time.

The risk of TB fell the longer a patient received HIV care.

The researchers recommend that HIV-positive patients with a high risk of TB, including migrants from countries with high levels of TB, should receive both anti-HIV drugs and antibiotics that can reduce the risk of TB developing.

For more information on TB you may find the NAM booklet HIV & TB helpful. It is available free to people with HIV, as well as on our website and through clinics and organisations in the UK.

Sexual health

Good sexual health is important for everyone, but especially so for people with HIV.

There are high levels of sexually transmitted infections among patients with HIV.

Such infections can cause unpleasant symptoms, and some can lead to serious, long-term health problems.

There’s also good evidence that untreated sexually transmitted infections can increase the risk of HIV transmission.

It’s recommended that people with HIV who are sexually active should have regular sexual health check-ups.

Now professionals working in the field of sexual health in England and Wales have published a set of standards for sexual health services.

Key standards include:

• Treatment by trained and competent staff.
• Confidential and non-judgmental advice.
• At the very minimum, tests for chlamydia, gonorrhoea, HIV and syphilis.
• Results within 14 days.
• Rapid referral to other services if needed.