HIV, treatment and immune suppression

HIV prevents the body’s immune system from working properly. Normally, the immune system would fight off an infection, but HIV infects key cells (CD4 cells) in the body’s natural defences and stops them working properly. Although HIV can’t be cured, modern HIV treatment – often called combination therapy – is very effective and these antiretroviral drugs prevent peoples' immune systems from becoming weakened by HIV, allowing many people with HIV to live long and healthy lives.

Despite enormous improvements in treatments, however, there are still certain illnesses that people with HIV are more likely to get than HIV-negative people. These include diseases that not considered AIDS-related, such as liver disease, respiratory diseases and some cancers, and they are the major cause of death in people with HIV.

Recent research has suggested that the increased incidence of these illnessses in HIV-positive people is linked to a weakened immune system and inflammation caused by HIV replication. This research showed that the risk of death from any cause reduced significantly as people’s CD4 cell counts improved (by 32% for every additional 100 CD4 cells).

HIV treatment guidelines have changed in many countries, including the UK, to recommend that people start treatment earlier and try to limit the damage to their immune system by HIV replicating in their body. The findings of this research support the recommendation that people should start treatment when their CD4 count is around 350, or sooner if they are ill because of HIV.

Although cardiovascular disease (CVD) is not directly related to CD4 counts (an important indicator of immune health) death from CVD was associated with having a high viral load.

The links between HIV and stigma

Although many people with HIV in the UK have a lot to be optimistic about, there are still times when having HIV can be hard. Often, this can be due to the stigma that has been associated with HIV since it was first known about. Many people with HIV come from groups in society that are already viewed less favourably, such as gay men, migrants and injecting drug users. Sometimes, people feel blamed for having become HIV-positive, even by people who are meant to be looking after them.

Researchers have explored what makes people with HIV more likely to feel stigmatised. They found that people with more advanced HIV disease, or poorer health generally – including mental health – were more likely to experience stigma. Having less money and being young increased the likelihood that people felt stigmatised. And not having enough social support was associated with increased feelings of stigma.

The researchers recommended that action should be taken to provide both legal protection and practical help for people in efforts to reduce feelings of stigma. This might include addressing poverty through employment and welfare schemes and increasing access to social support. They also suggest that it is important for healthcare professionals working with people with HIV to understand what might contribute to stigma.

There are things you can do if you feel you have experienced discrimination because of your HIV status. If you feel that you are alone, try and remember that you are not. There’s a lot of help available to you.

HIV and children

Thanks to effective HIV treatment, most children with HIV in the UK are now entering their teenage years and adulthood.

Although research on younger children has shown that there are often developmental and cognitive problems, there has been little research into whether having HIV has an adverse effect on the educational development of older children and adolescents. A recent study in New York suggests that young people born to women with HIV are doing less well at school, and have poor reading and language skills.  

In addition to HIV, there was other factors likely to affect these young people’s educational attainment – most of them were from migrant or other minority racial and ethnic communities, and many lived in areas with under-performing schools. Missing a lot of school because of ill health also contributed, as did having been exposed to illicit drugs in the womb.

However, when the researchers took these factors into account, they found that HIV-positive children had poorer word recognition and writing skills, and that children on HIV treatment did less well than those not on treatment. Children who were HIV-negative, but had been exposed to HIV before birth, did better than the HIV-positive children but less well than would be expected for their age.

The researchers therefore highlighted the importance of providing educational programmes to address the needs of these young people.