HIV treatment

HIV, CD4 counts and changes in the virus

Measuring CD4 cell counts is an important way of monitoring the health of people’s immune system, and of making decisions about when to start or change treatment. People lose a huge number of CD4 cells at the time they are infected with HIV, but their cell count then recovers to some extent, at least. Generally, people will then have several years before their CD4 cell count drops to a point where it is recommended they start treatment.

An American study has looked at people fairly recently infected with HIV. It found that, over a period of about 17 years (1985 to 2001), people had increasingly lower CD4 cell counts at the time they were diagnosed, and that they needed to start treatment sooner after diagnosis.

The researchers felt this showed that HIV was adapting to the human immune system and becoming stronger. However, the reduction in CD4 counts on diagnosis did not continue after 2001.

Treatment as prevention

The potential for treatment to be an effective means of preventing further HIV infections has been supported by some key people in the HIV field, following on from the Swiss statement. This says that people on HIV treatment, if they meet certain conditions, can be considered uninfectious. Now the largest HIV voluntary sector organisation in Germany, Deutsche AIDS-Hilfe, has issued a paper largely supporting this statement.

The German paper describes sexual transmission, where the HIV-positive partner is adhering to effective combination therapy, has had an undetectable viral load for the last six months and has no sexually transmitted infections, as ‘unlikely’ and describe this as being as effective as using condoms. They add that it is also important that there is no other damage to either person’s mucous membranes.

Both the German and Swiss organisations say their statements are relevant to stable, long-term relationships where one partner has HIV. After the couple has made a decision, based on good information and advice, regular viral load testing and sexual health check-ups are recommended.

There have been cases where HIV has been detectable in semen but not in blood. However, Deutsche AIDS-Hilfe argues that this a realistic HIV prevention approach, and that individual couples will make decisions about the level of risk they are willing to take.

A new service for Londoners with HIV

Here at NAM we know the important role written information plays in supporting people living with HIV to take decisions about their treatment and care.

Evidence suggests that the more people are involved in decisions about their treatment, the better their health and wellbeing. 

Since 1987 NAM has specialised in providing written information, such as these email newsletters, patient information booklets, HIV Treatment Update, and online resources like our websites, aidsmap.com and NAMlife.org.

Sometimes, though, there’s nothing that can beat a face-to-face discussion. 

Now, across the capital, there is a new free service providing just that:  the HIV Health Support Service.   

NAM has teamed up with the Terrence Higgins Trust to offer free one-to-one information and advice sessions about any aspect of HIV treatment and health. A Health Trainer is now available, near you, to offer you face-to-face, telephone or online support to help you improve your health and to live well with HIV. 

Perhaps there are questions you have always wanted to ask your healthcare team but didn’t get the chance to? Or treatment and health issues you have never quite understood?  Or maybe there have been topics you have read about in HTU you would like to know more about? Or services you would like to use but don’t know how? If so, a Health Trainer can help.

The HIV Health Support Service can be reached via THT Direct. Please call 0845 12 21 200 and ask to see a health trainer. Alternatively, you can use the online service at www.tht.org.uk/askthetrainer.