It’s treatment and politics in this edition of HIV Weekly with reports on:

• Testosterone and muscle in men taking HIV treatment.
• Testing for allergy to abacavir.
• Treatment for lipodystrophy.
• Adherence and depression.
• Tuberculosis treatment.
• A campaign to halt the deportation of failed HIV-positive asylum seekers from the UK to countries where they can’t get HIV treatment.
• Proposed changes to UK public health law.
• Australian immigration policy.

Anti-HIV treatment

HIV and tuberculosis

Tuberculosis (TB) is the main cause of illness and death in people with HIV. Even in countries like the UK where there is easy and free access to HIV treatment, TB is one of the most commonly seen AIDS-defining illnesses.

Treatment for TB normally usually consists of six months of therapy with a combination of antibiotics. For the first two months, four antibiotics are normally used, with treatment continuing for a further four months with two antibiotics.

But American researchers have found that HIV-positive TB patients were significantly more likely than HIV-negative patients with TB to experience a TB relapse after six months of treatment.

They also found that HIV-positive patients who received over six months of TB treatment were much less likely to experience a TB relapse than HIV-positive patients who received only six months of TB therapy.

What’s more, the American researchers also established that people who took HIV treatment at the same time as TB therapy had a better response to TB treatment and were significantly less likely to die.

Using anti-HIV drugs and TB treatment together can involve drug interactions and a risk of an unpleasant condition called an immune reconstitution inflammatory syndrome. Because of this, there are special recommendations about how HIV and TB drugs can be safely used together.

The British HIV Association (BHIVA), the professional body for doctors who care for people with HIV, recommends that TB should be treated first if your CD4 cell count is above 200.

If your CD4 cell count is between 100 and 200, then BHIVA recommends that you start your HIV drugs two months after starting your TB drugs. If you have a very weak immune system, with a CD4 cell count below 100, BHIVA recommends that you start anti-HIV treatment as soon as possible after starting TB drugs. Some doctors recommend waiting up to two months to limit the risks of side-effects, drug interactions, and the occurrence of immune reconstitution syndrome.

The American researchers acknowledge such recommendations but write, “our results…provide compelling evidence to warrant the initiation of [HIV treatment] during tuberculosis treatment in selected patients.”

HIV policy in the UK

Australia and HIV-positive migrants

The Australian Prime Minister, John Howard, has said that people with illness like “HIV and leprosy” shouldn’t be granted visas to live in Australia. At the same time, Australia’s health and immigration ministers have suggested that HIV-positive people granted entry to Australia should have to report to health authorities within a month of their arrival in the country or risk losing their visa.

These plans have been condemned by the International AIDS Society (IAS). Their conference is in Sydney this July. They have confirmed that the conference will go ahead, but want it to act as a focus of activism against the plans of the Australian government.

There are no restrictions of people with HIV entering Australia for short visits, but people wanting to migrate to Australia have to have an HIV test. A positive test result is not an automatic bar to entry, and applications are currently considered on a case-by-case basis.

Several countries completely ban entry for people with HIV, and people with HIV are only allowed into the USA if they obtain special permission in advance. When condemning the latest developments in Australia, the IAS noted how completely ineffectual banning entry for HIV-positive people was as a means of infection control – the USA has the highest HIV prevalence of any rich country.

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