Side-effects

Like all medicines, anti-HIV drugs can cause side-effects.

The side-effects caused by the anti-HIV drugs used today are generally mild, but in some people they can cause unpleasant symptoms or even health problems.

It is already known that a person’s genes can affect their risk of developing the side-effects caused by some drugs. For example, the allergic reaction that a small number of people develop after starting treatment with abacavir (Ziagen, also in the combination pills Kivexa  and Trizivir ) is linked to a particular gene and people should be tested to make sure they don’t have it before starting treatment with the drug.

Now researchers have found the kidney problems that a small number of people develop after starting treatment with tenofovir (Viread, also in the combination pills Truvada  and Atripla ) could also be linked to a single gene.

The Spanish research involved 115 patients who were taking tenofovir. A total of 19 of these people developed kidney problems. They found that people with a single genetic change had a five-fold increase in their risk of developing kidney problems. Other factors were older age and lower body weight.

HIV and hepatitis C

A large number of people with HIV are also infected with hepatitis C. This is often called co-infection.

Treatment is available that can cure hepatitis C. But it doesn’t always work. Liver disease is now an important cause of illness and death in people with HIV and hepatitis C co-infection.

It is thought that a reason why hepatitis C can cause severe illness in people with HIV, and is hard to treat, is because of the immune damage that HIV can cause.

Encouragingly, however, some research has shown that the recovery of the immune system after starting HIV treatment can slow the rate of liver damage caused by hepatitis C.

It is currently recommended that HIV treatment should be started when a person’s CD4 cell count is around 350. A group of people who are especially encouraged to start treatment at this time are those who are co-infected with hepatitis C.

Spanish researchers wanted to see if starting HIV treatment at higher CD4 cell counts slowed liver damage in patients with hepatitis C.

Their research involved 119 co-infected people. All had a liver biopsy to assess how much damage hepatitis C had caused. At the time of the liver biopsy, 78% of people were taking HIV treatment and the average CD4 cell count was 549.

They found that liver damage was much less advanced in people taking HIV treatment.

As a result they recommend that people co-infected with HIV and hepatitis C should start HIV treatment as soon as possible, regardless of their CD4 cell count.

HIV treatment and the bones

Bone problems are more common in people with HIV than in the general population.

It’s thought that there are a number of reasons for this, including the direct effect of HIV, low body weight, and the side-effects of some anti-HIV drugs.

French researchers have found that even if people with HIV are more likely to develop problems such as low bone density (osteoporosis), they don’t have an increased risk of fractures.

Their research involved over 1200 people taking long-term HIV treatment. These people were monitored for an average of seven years. This showed that the proportion of people experiencing a bone fracture was the same as that seen in the general French population.

Two factors increased the risk of fracture. The first was co-infection with hepatitis C. The researchers think that this could be because liver disease lowers levels of vitamin D, which is an important vitamin for bone health. The other factor was drinking too much alcohol, resulting in injury.

Treatment and prevention

One of the hottest topics in HIV over the last year has been the effect of HIV treatment on prevention.

Early last year senior HIV doctors in Switzerland issued a statement saying that people who were taking HIV treatment and who had had an undetectable viral load for at least six months, who took their treatment properly, and who didn’t have any sexually transmitted infections were not infectious to their regular, heterosexual partner.

More research has been conducted since then, and this seems to show that the risk of HIV transmission from someone taking HIV treatment who has an undetectable viral load is very small. However, it’s also shown that some risk may still be present.

Now the French National AIDS Council has issued its own statement on HIV treatment and infectiousness.

It recommends that health messages should say that HIV treatment does reduce the risk of transmission – but they should also state that some risk may remain.

Swine flu and HIV

Health authorities in the US have issued interim guidance about the diagnosis, treatment and prevention of swine flu in people with HIV.

This advice cautions that it is possible that people with HIV who have a low CD4 cell count may have a higher risk of complications caused by swine flu.

It notes that symptoms of swine flu are the same as those caused by normal flu – cough, sore throat, runny nose and sneezing, fever, headache and muscle pain.

Swine flu can be treated with the antiviral drugs zanamivir (Relenza) and ostelamivir (Tamiflu).

Recommended methods of prevention include covering the mouth and nose when coughing or sneezing, frequent hand-washing, and minimal contact with people who have the infection.