Cardiovascular disease

Cardiovascular disease is a significant cause of illness and even death in people with HIV.

A number of reasons have been suggested for the increased rates of health problems including heart disease and stroke that are seen in people with HIV.

These include the side-effects of some anti-HIV drugs, a suppressed immune system, and the direct effects of HIV.

Understanding of the possible causes of cardiovascular disease in people with HIV has been advanced by recently published American research.

It involved a wide variety of people with HIV, including some who had an undetectable viral load without ever taking HIV treatment, referred to as ‘elite controllers’.

The researchers found that people with HIV, regardless of their use of HIV treatment, viral load, or CD4 cell count were more likely to have hardening of the arteries than HIV-negative individuals. Hardening of the arteries can indicate an increased risk of cardiovascular disease.

They think that the very low levels of HIV replication that can occur even when a person has an undetectable viral load may be the reason for this.

Control of HIV without HIV treatment

Thanks to effective treatment, people with HIV can expect to live a long and healthy life.

Some people with HIV remain free of symptoms of HIV and have a high CD4 cell count and/or an undetectable viral load in the long-term without the use of anti-HIV drugs. People who maintain a high CD4 cell count (above 500) for eight years or more are often called long-term non-progressors. Those who have a very low viral load (although not undetectable) without HIV treatment were called HIV controllers.

French researchers, however, have found that these individuals are few and far between.

Of the 110,000 HIV-positive patients in France only 202 were long-term non-progressors and only 101 were HIV controllers. Furthermore, only ten patients had both a high CD4 cell count and very low viral load without HIV treatment.

Interaction with herbal remedy

The herbal remedy Ginkgo biloba interacts with the anti-HIV drug efavirenz.

Researchers are warning that people who are taking efavirenz (a key first-line drug also in the combination pill Atripla) should not take Ginkgo biloba because it can reduce blood levels of efavirenz leading to an increase in viral load.

Both efavirenz and Ginkgo biloba are processed by the body using the liver. It was already known that Ginkgo biloba has interacted with other medicines processed in this way.

Doctors spotted the interaction because a man with excellent adherence to his HIV treatment experienced an increase in his viral load. The only other drug he was taking was Ginkgo biloba. Using stored blood samples the doctors noticed that the man’s viral load started to increase when he started taking Ginkgo biloba.

Because of the risk of interactions, it’s important to tell your HIV doctor or pharmacist about any medicines you are taking, including those that have been prescribed by another doctor, those you have bought over the counter, herbal and alternative treatments, and recreational drugs.

Immune suppression and the risk of non-AIDS-related cancers

It’s now recommended that HIV treatment should be started when your CD4 cell count is around 350.

Starting treatment at this time reduces the risk of developing a number of serious illnesses that are not usually thought to be HIV-related. This includes some cancers.

Researchers recently wrote to the medical journal AIDS highlighting research that shows the link between a weak immune system and the development of cancers.

Criminal HIV transmission

Terrence Higgins Trust (THT) and the National AIDS Trust (NAT) have published a guide providing information on prosecutions for HIV transmission.

It explains the legal basis for the prosecutions and the circumstances in which an offence may have been committed.

The new leaflet also provides information about where to obtain help and support about this issue.