HIV and life expectancy
There has been a huge increase in the life expectancy of people with HIV since the introduction of combination therapy in the 1990s.
There have been some studies suggesting that people in developed countries – particularly those diagnosed at a young age – may live into their 70s, a near-normal life expectancy.
However, a study in the US has now shown that, despite dramatic improvements, Americans with HIV are dying, on average, 21 years earlier than their HIV-negative peers. Women’s life expectancy is longer than men’s but has not improved as much as men’s, and black and Hispanic men with HIV die earlier than white HIV-positive men.
Other studies have shown that people with certain characteristics – such as injecting drug users, older people, those co-infected with hepatitis C and those who started treatment when they had a low CD4 count – have a shorter life expectancy.
Life expectancy is affected by a wide range of factors, both physical and socio-economic. There are often higher rates of smoking and drug use, hepatitis C co-infection and socio-economic problems amongst people with HIV. Access to health care is also an important factor and may mean that different outcomes to this type of study would be found in other developed countries.
Looking after your health will give you the best possible chance of living a long healthy life. Lifestyle factors such as a healthy diet, taking regular exercise and not smoking benefit everyone’s health, and are particularly important for people with HIV.
HIV clinics can help people look at their lifestyle and work out how best to reduce risks and improve their chances of being and staying well. HIV clinics and HIV organisations can also often offer support and advice in dealing with issues that may feel more difficult to tackle, such as financial worries, addictions and mental health problems.
There's lots of information about living well with HIV on NAM's website for people living with HIV in the UK: www.namlife.org.
HIV and treatment
It is now recommended that you should start HIV treatment when your CD4 cell count is around 350.
Starting treatment at this time, rather than waiting until your CD4 cell count is lower, not only reduces the risk of developing HIV-related illnesses, but also reduces the risk of some other serious illnesses as well, for example heart, kidney, and liver disease as well as some cancers.
Some doctors think that there might be benefits if people take a short course of HIV treatment soon after they are infected with HIV, in a period sometimes called primary infection. Trials have been looking at whether using treatment in this way will mean that health is improved in the long term.
A study published at the end of 2008 seemed to show that, for most people, there is nothing to be gained from taking HIV treatment as soon as possible after infection, rather than when their CD4 count falls below 350.
Trials have been looking at whether a short course of treatment very soon after infection would slow down the immune damage caused by HIV and enable people to maintain high CD4 counts, thereby prolonging the time they can stay off treatment later. This study, the largest of its kind, has concluded that this strategy doesn’t work.
The researchers concluded that the study doesn’t show any longer-term benefit in viral suppression from starting treatment in early infection. But they add that it does not help with the debate as to whether treatment should ever be interrupted once started.
Starting treatment at the right time can mean a much longer and healthier life – research has shown that starting treatment when your CD4 cell count is around 350 could mean that, even if you are in your 20s or 30s, you have a good chance of living into your 70s – that’s a near-normal prognosis.HIV treatment and resistance
HIV changes, or mutates, very slightly every time it reproduces. If HIV is able to reproduce when a person is taking anti-HIV drugs, then it can mutate to become resistant to these drugs.
This is why it’s very important to take your HIV treatment properly and to get and keep your viral load to undetectable levels.
Researchers in Europe set out to find out how much time someone can stay on a drug regimen once it stops working before resistance to that class of anti-HIV drug starts building up. They looked at the situation in people who had been on treatment for a long time, had taken several different drugs and were currently taking treatment including AZT or d4T.
The research discovered that some cross-resistance starts building up quite quickly after treatment failure, but further mutations can then develop fairly slowly. However, the rate resistance developed varied considerably between patients and more research is needed on how variations in resistance and the length of time on failing treatment affect people’s treatment options in the future.
Issue 179 of HIV Treatment Update included a feature article on Understanding Resistance. This edition can be downloaded as a PDF from aidsmap.com.
Preventing and curing HIV
Scientists have identified two new antibodies that seem to neutralise a wide range of HIV types, and block infection with the virus. This could be very useful in helping with the development of a vaccine against HIV.
It has not yet been possible to develop a vaccine for HIV, largely because the virus mutates so quickly. One vaccine was tried out in a large clinical trial, but didn’t effectively protect people from infection. These newly discovered antibodies seem to have a very strong neutralising effect; the next step is to look at ways of stimulating the development of these antibodies in animals and humans.
Scientists have looked at different ways of preventing HIV infection, including vaccines, microbicides (substances that stop HIV transmission during sex) and pre-exposure prophylaxis or PrEP (this means taking HIV drugs to prevent infection with HIV rather than to treat it).
How these last two might work in reality was discussed at the recent IAS conference in South Africa. That’s because some big international trials investigating them will start reporting over the next few years and – if they show promising results – governments might have to start thinking about how to fund and manage their use on a large scale.
There are also promising leads in research looking at ways of removing HIV from resting CD4 cells, which is a process that would need to happen for a cure for HIV to be developed. Developing a cure might work using the principle of getting rid of ‘reservoirs’ of HIV in the body, where HIV is found even if it is not actively attacking the immune system. Methods suggested have included finding ways of activating this virus, while at the same time giving treatment that would kill it. These methods have to be developed carefully to make sure they achieve this while not being too toxic to other parts of the body.
For more information on safer sex, visit the Sex section of namlife.org or NAM's booklet HIV & Sex.
There is more information on prevention methods globally in NAM’s book, Preventing HIV , and online at www.aidsmap.com .
Issue 185 of HIV Treatment Update included a feature article on PrEP. This edition can be downloaded as a PDF from aidsmap.com.
HIV in the media
The ads, for television and print, feature images of dictators – including Hitler – known for mass murder. The campaign designers say they were trying to highlight the continuing high number of deaths from AIDS because of the lack of condom use. But there is concern that – by perpetuating stigma and discrimination – the campaign will discourage people from being tested for HIV, and that the ads lack a clear public health message about safer sex.
If you are living with HIV in the UK, and want to help challenge stigmatising press coverage, you can join Press Gang - run by the UK's National AIDS Trust . As a member of Press Gang you would be alerted to inaccurate or stigmatising coverage of HIV and given advice on contacting journalists, making a complaint or sharing your story. Please contact press@nat.org.uk for more information.