HIV Weekly, 6 January 2010
Welcome to the first HIV Weekly of 2010. This is the time of year when many people plan to make changes to their lives. For example by tackling money worries, stopping smoking, eating a healthier diet, or by exercising.
Coincidentally, some of the news published over the Christmas and New Year period underlines the importance of good general health for people with HIV.
There’s a lot of help available to you from your HIV clinic and HIV support agencies if you are thinking of making changes to your life.
Or why not start your year by making sure you know about the resources we have available to you if you are living with HIV, or if you are a professional working in the HIV sector?
HIV and cardiovascular health
Cardiovascular diseases such as heart attack and stroke are now an important cause of illness and death in people with HIV.
There’s a lot of debate about the reasons for this, but recently published research suggests that HIV may be a significant cause.
HIV treatment reduces risk of death from all causes
Rates of HIV-related illnesses and deaths plummeted once effective, combination HIV treatment became available in 1996.
Many doctors are now optimistic that people with HIV will be able to live a nearly normal lifespan – with the right treatment and care.
But the overall risk of early death is still higher in people with HIV compared to the general population.
The very large study involved over 62,000 patients from Europe and the US. They started HIV treatment between 1996 and 1998 and were then monitored for five years.
Mortality rates were compared between those who started HIV treatment and those who did not.
Taking combination HIV treatment reduced the risk of death from any cause by 52%.
Treatment was especially beneficial for patients with a low CD4 cell count. But a reduced risk of death was also seen if treatment was started when an individual had a CD4 cell count around 350 – the current threshold for starting therapy.
Those who started HIV treatment at CD4 cell counts around 500 had the lowest overall risk of death. New US treatment guidelines now recommend HIV treatment with CD4 cell counts up to this level.
Quality of life has an impact on length of life for those taking HIV treatment
Taking HIV treatment can have a big impact on the health and life-expectancy of people with HIV. But not everyone with HIV does equally well on HIV treatment.
The research involved 560 people who started HIV treatment in the Netherlands between 1998 and 2000. They completed questionnaires about their health-related quality of life in a number of important areas. These included experiences of pain, physical functioning and perceptions of personal health.
Patients were monitored until the spring of 2008.
Those with the worst health-related quality of life had the highest mortality rate (20%). This compared to just 4% among those with the best quality of life.
HIV-related conditions were the most important causes of death, but 20% were attributed to cardiovascular diseases and non-HIV-related cancers.
Pain and a reduction in the ability to perform daily tasks could be important early warning signs of illness, the researchers suggest.
They recommend that doctors should take into account a patient’s health-related quality of life when deciding when to start HIV treatment.
More effective HIV treatment means less resistance
Resistance can develop if levels of anti-HIV drugs in the blood are too low to effectively fight the virus. This can happen if the drugs aren’t being processed properly, if they have a weak anti-HIV effect, or if a person doesn’t take their treatment properly.
Resistance was a major problem when combination HIV treatment became available. The drugs available at this time were not especially powerful, HIV could easily develop resistance to them, and they were often difficult to take (up to three times a day) and in many cases caused unpleasant side-effects.
Since then, better, more powerful, safer and easier-to-take drugs have become available.
The Canadian research showed the implications of these improvements in HIV treatment and care.
New cases of resistance fell from a peak of 571 in 1996 to only 71 in 2008.
This reduction in new resistance happened despite a massive increase in the number of people taking HIV treatment.
US travel ban now lifted
HIV-positive UK passport holders will now be able to enter the US by filling out a green “visa waiver” form.
South Korea has also removed its entry ban for people with HIV.
These moves have been widely welcomed. But some countries still restrict or ban entry for people with HIV. A list of countries and entry restrictions can be found here.
"I call for global freedom of movement for people living with HIV in 2010", said the director of UNAIDS, Michel Sidibé.