HIV and swine flu

People with HIV will be a priority group for swine flu vaccination, the UK Department of Health has announced.

It’s expected that a vaccine for swine flu will be available by the autumn. People with underlying health conditions, including HIV, will be given the vaccine first.

The vaccine will be available from GPs, and it will be necessary to have two doses.

Like any other flu, swine flu can cause complications for people with conditions such as lung disease, heart disease or diabetes.

People with HIV do not seem to have any greater risk of contracting swine flu, and the illness it causes is no more serious in people with HIV than it is in the general population.

However, if your CD4 cell count is below 200, then there’s a risk that flu can cause more serious complications.

If you have flu-like symptoms and are concerned, you can call the National Pandemic Flu Service on 0800 1 513 100 or use their website to assess your symptoms. Alternatively you could contact your doctor for further advice.

If you do have a low CD4 cell count, then you should contact your clinic if your flu symptoms won’t go away or get worse despite taking anti-flu treatment. Your doctor will be able to monitor your health and see if your symptoms are being caused by other illnesses.

HIV disease progression

Untreated HIV seems to cause damage to the immune system at a faster rate than previously thought.

A small US study has found that the interval between infection with HIV and the need to start HIV treatment is about 18 months – much shorter than expected.

All the patients in the study had their HIV diagnosed soon after they contracted the infection. Their average CD4 cell count at this time was 556, which is considered normal.

Current HIV treatment guidelines recommend that a person should start HIV treatment when their CD4 cell count is around 350, or if they become ill because of HIV.

Half the people in the study met these criteria within 18 months of becoming infected with HIV.

It’s very important that everyone with HIV goes to a specialist HIV clinic, where you will have regular tests to see how HIV is affecting your health. These will help you and your doctor make decisions about your treatment and care, including when to start HIV treatment.

For more information on starting treatment, you may find our information booklets useful. They are available free to people with HIV in the UK , as well as on our website .

Taking your HIV treatment – alcohol has a negative effect

You’ll get the most benefit from your HIV treatment if you take it correctly.

Missing just a few doses of your treatment every month can reduce the effectiveness of your treatment and can lead to drug-resistant HIV developing.

A lot of factors can affect a person’s ability to take their treatment, but researchers have found that those who drink alcohol are about 50% less likely to take their treatment properly than those who don’t.

The research also showed that the more alcohol a person drank, the worse their adherence.

Drinking a lot of alcohol has also been shown to damage the immune system, and the researchers think that addressing alcohol use amongst people with HIV could affect “disease progression and, theoretically, life expectancy.”

HIV and the bones

There’s a lot of uncertainty about the impact of HIV, and the drugs used it treat it, on bone health.

Two recently published studies have shown that HIV treatment reduces the density of bone. This could increase the risk of longer-term health problems such as increased risk of fractures.

The older HIV drugs AZT (zidovudine, Retrovir, also in Combivir  and Trizivir) and d4T (stavudine, Zerit), were associated with bone loss.

Treatment combinations containing efavirenz (Sustiva, also in the combination pill Atripla) and Kaletra (lopinavir/ritonavir) were also both associated with bone loss.

Routine HIV care includes tests to monitor the health of bones.

Hepatitis C treatment

Many people with HIV are also infected with hepatitis C virus. This virus can seriously damage the liver, and liver disease is now an important cause of illness and death in people with HIV.

Treatment is available for hepatitis C, but it doesn’t always work and can cause unpleasant side-effects.

Researchers have found a gene that’s associated with a successful response to hepatitis C treatment. Patients who had this gene were many times more likely to do well on hepatitis C treatment than those who didn’t.

Although the gene was equally distributed across the patient population, amongst white patients the presence of the gene was the single most important factor affecting the success of hepatitis C treatment. However, for patients of black or Hispanic race, traditional factors, such as hepatitis C viral load and liver damage, were more important.

The research involved people who were only infected with hepatitis C – it remains to be seen how important the gene is for people with HIV who also have hepatitis C.

The July edition of HIV Treatment Update included 'Combinations and conundrums: the challenges of hepatitis C treatment'.

You can subscribe to HIV Treatment Update via our website, or you contact us on info@nam.org.uk or 020 7837 6988. Subscriptions are free for people living with HIV in the UK.