Scepticism about the ‘elimination’ of HIV, but nevertheless, some reasons to be optimistic

Last week a study was published suggesting that it might be possible to eliminate pools of HIV-infected cells with eight years of HIV treatment. This hopeful conclusion was based on the results of a study involving seven patients who started HIV treatment soon after they were diagnosed with HIV. Other researchers, however, are much more sceptical. You can read details of the study and responses to it below.

But, even if we don’t have HIV treatment that is able to eliminate HIV, there’s now good evidence to show that the risk of dying of AIDS five years after starting HIV treatment is less than 1% for many.

Yet, as other items in this week’s edition make clear, side-effects, coinfections and mental health problems really do have an impact on the lives of people with HIV.

Causes for optimism yes, but tempered by realism.

Anti-HIV treatment

Side-effects

Although taking anti-HIV drugs can mean a longer, healthier life, they can cause unwanted side-effects.

Lipodystrophy is a set of side-effects that includes increases in blood fats and sugars and changes in body fat shape. Some people experience an accumulation of fat around the belly or at the back of the neck.  Others experience fat loss from the limbs, buttocks, and face, and some people experience a combination of both fat accumulation and fat loss.

Now doctors are suggesting that another kind of fat change might also be a symptom of lipodystrophy – fatty swellings in the pelvic region, or pubic lipomas.

Doctors in Italy checked their HIV-positive patients for lipodystrophy. They found that the risk of having pubic lipomas increased if a person was seriously overweight, and that those who had fat accumulation between the shoulders or at the back of the neck (so-called ‘buffalo hump’) were also more likely to have pubic lipomas.

Mental health

Higher rates of depression have been observed in people with HIV, indeed one survey of people with HIV in the UK found that around two-thirds said that they’d felt depressed at sometime in the previous year.

Now a study has found that 20% of HIV-positive people said they had thought seriously about suicide in the previous week. However, the study also found that very few of these people actually have plans to kill themselves or would kill themselves if they had the opportunity.

It’s worth noting that treatments for depression work well in people with HIV, and if you are depressed or thinking of harming yourself make sure that you ask your HIV clinic doctor or GP for help. It is available, and it will make a difference.

HIV and hepatitis C

Many people with HIV are also infected with hepatitis C virus. This is usually referred to HIV/hepatitis C coinfection.

Hepatitis C is transmitted by contact with hepatitis C-infected blood. In recent years, there have been reports of sexual transmission of hepatitis C, most notably in HIV-positive gay men.

Delegates to the recent conference of the British HIV Association (the professional organisation of the UK’s HIV doctors), were presented with data showing that one out of every 83 HIV-positive gay men in London and Brighton is newly diagnosed with hepatitis C each year.

Delegates were also told that some coinfected patients who have had hepatitis C infection for a long time were being diagnosed as having ‘acute’ or recent hepatitis C infection because they suddenly developed antibodies to the infection. The preferred method of testing for hepatitis C is viral load, or PCR testing.

Tuberculosis

Tuberculosis (usually shortened to TB) is the biggest cause of illness and death in people with HIV around the world. It is also one of the most common AIDS-defining illness seen in the UK.

Taking a combination of antibiotics normally for six months (although some patients may require a longer course of treatment) can cure TB, even if a person has HIV. But TB can become drug-resistant. TB that is resistant to two key drugs, isoniazid and rifampicin, is said to be multidrug-resistant TB (MDR-TB). It is harder to treat and is associated with an increased risk of death.

Recently, there has been a lot of concern about the emergence of strains of TB that have resistance not only to first-line drugs, but also a number of second-line drugs as well. Doctors call this extensively drug-resistant TB (XDR-TB) and many of the cases seen so far have involved people who are HIV-positive. There is a lot of concern about XDR-TB as people who have it become very ill, very quickly, and usually die. Good infection control, like opening windows in hospitals can help reduce the risk of TB, even XDR-TB, being passed on between patients.

Extremely drug-resistant TB (XXDR-TB) has resistance to every anti-TB drug, and doctors in Italy have reported two cases.  Both the patients, who were HIV-negative, died.

XXDR-TB emerged in these patients because they did not receive the right anti-TB treatment from their doctors. The provision of ‘sub-optimal’ TB treatment is one of the main reasons why drug-resistant TB has become such a problem around the world.

But drug-resistant TB can also develop if a person does not take their treatment properly. Anti-TB treatment normally involves four antibiotics for the first two months, with treatment for four more months with two antibiotics. As with HIV treatment, some people miss doses, allowing resistance to emerge. In addition, symptoms of TB often disappear after a few weeks of anti-TB treatment and some people assume that this means that they have been cured and so stop their treatment. This allows drug-resistant TB to develop.  It is therefore essential to take the full course of TB treatment.

Mother-to-child transmission of HIV

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