Anti-HIV treatment

Illnesses and side-effects

HIV and hepatitis C

hepatitis C is now an important cause of illness and death in people with HIV.

Treatment exists for hepatitis C and about 33% of HIV-positive people who’ve had hepatitis C for over a year or are cured of hepatitis C after receiving a course of this treatment.

Better results are seen in HIV-positive people who receive treatment for hepatitis C soon after they are infected with it, with about 66% being cured.

Now research suggests that hepatitis C treatment has benefits even if it doesn’t cure the infection. French doctors found that the risk of developing a set of very serious, even fatal, conditions called ‘decompensated liver disease’ was reduced in HIV/hepatitis C patients who received anti-hepatitis C treatment.

And Spanish researchers found a high rate of death amongst HIV/hepatitis C-infected patients who had decompensated liver disease, showing the importance of treating hepatitis C before it is able to do serious damage to the liver.

Post-exposure prophylaxis

If a person is exposed to HIV they can reduce their chances of this leading to infection with the virus by taking anti-HIV treatment for a month. This kind of treatment with anti-HIV drugs is called post-exposure prophylaxis (PEP for short). It’s not a kind of ‘morning after pill’ for HIV, and although it’s not 100% effective very few people who receive PEP after exposure to HIV go on to become infected.

Recently efforts have been made by the Terrence Higgins Trust to inform gay men about the availability of PEP.

It’s crucial to get PEP as soon as possible after any exposure to HIV. To have the best chance of working it needs to be started within 24 hours. It might still have a chance of success if taken after 72 hours, but some experts think this is already too late.

PEP education campaigns have focused on HIV-negative gay men, but a new piece of British research shows that it’s also important that HIV-positive people know about PEP.

The research showed that some gay men who’d potentially been exposed to HIV only obtained PEP after their HIV-positive sexual partners told them it was available.

This raises some important issues.

There have recently been some prosecutions for the reckless sexual transmission of HIV. The cases involved people who didn’t tell their partners they were HIV-positive before having unprotected sex with them, leading to infection with HIV. Advising somebody to obtain PEP after unprotected sex or a condom accident will help reduce the risks of HIV infection occurring, and some lawyers think it might help a defence should transmission occur. But this hasn’t yet been test in court.

The second issue concerns sharing anti-HIV drugs. It can be very worrying thinking that you might have exposed somebody to infection with HIV. If you know somebody who needs PEP it might be tempting to give them your own anti-HIV drugs. But this could involve risks. For example, some anti-HIV drugs, most notably abacavir (Ziagen) and nevirapine (Viramune) can cause potentially dangerous allergic reactions.

The best place to get PEP is from a specialist sexual health or GUM clinic. If PEP is needed when these clinics are closed, go to the Accident and Emergency department.

Correction

The October 24^th edition of HIV Weekly mistakenly said that abacavir was in the combination pill, Combivir. This was wrong. Abacavir is in the combination pills Kivexa and Trizivir.