HIV Weekly - 2nd July 2009

Importance of regular appointments

Going to your HIV clinic for regular check-ups is an important part of your medical care. People who drop out of HIV care have a higher risk of illness and death, and can’t take advantage of HIV treatment that can mean a longer and healthier life.

French researchers have found that patients who stop attending their HIV clinic for over a year have an increased risk of serious illness and death when they do return compared to patients who remain in HIV care all the time.

The research involved over 1000 patients between 1997 and 2006. Of these patients, 135 stopped attending the clinic with 74 of these individuals subsequently returning.

Many of the patients had a very low CD4 cell count when they returned to care, and a quarter had an AIDS-defining illness. They also had a high rate of hospitalisation and 8% died compared to 5% of those who remained in HIV care.

Adherence – taking your HIV treatment

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

Missing just a few doses of your treatment every month can mean that there aren’t enough of your drugs in your blood to fight HIV, and this can lead to drug resistance.

There are a lot of reasons why people don’t take their HIV treatment properly. Simple forgetfulness is often the reason, but worries about other issues such as money, housing and looking after children can also be important factors, as can use of recreational drugs and alcohol.

New American research seems to show how important social factors are to good adherence. It showed that there were significant differences in levels of adherence between HIV-positive gay men of different races and ethnicities.

The groups with the lowest levels of adherence were more socially disadvantaged, having less educational attainment and a lower income.

Adherence help is available to everybody from their HIV clinic.

• NAM produces an information booklet called Adherence, which is available free to people living with HIV in the UK and is also distributed free through clinics and support groups in the UK. It can also be downloaded as a pdf.

The menopause and HIV treatment

Thanks to effective treatment, more and more people with HIV are living into old age.

CD4 cell count is often higher and viral load lower in younger women with HIV. This is because of the beneficial effects of oestrogen on the immune system. But oestrogen levels are lower in women who have gone through the menopause. This led to some concern that older women may not respond as well to HIV treatment.

There’s some good news from recently published research. Older women with HIV do just as well on HIV treatment as younger women.

French researchers compared the effectiveness of HIV treatment in 220 pre-menopausal women and 47 post-menopausal women.

A very similar proportion had an undetectable viral load a year after starting HIV treatment, and increases in CD4 cell count were also comparable.

Hepatitis B doesn’t affect how well HIV treatment works

Many people with HIV in the UK are also infected with hepatitis B. This is often called co-infection.

New US research has shown that HIV treatment works just as well in people with HIV who also have hepatitis B, as it does in people only infected with HIV.

The research involved 350 people never infected with hepatitis B; about 350 people who had cleared hepatitis B infection; and about 120 people with HIV and long-term hepatitis B.

They found that rates of HIV-related death were similar between the patients regardless of their hepatitis B infection status.

But people with hepatitis B did have an increased risk of death due to non-HIV-related illness, particularly liver disease and cardiovascular disease.

US travel ban

Travel to the US may soon be as straightforward for people with HIV as it is for HIV-negative people.

The US government is expected to issue draft guidelines that remove HIV from the list of diseases that prevent people from entering the US.

Once these regulations have been approved, people with HIV will be able to travel to the US without having to obtain permission in advance.

Until these new regulations come into force, people with HIV still need to obtain a visa before travelling to the US.