A survey conducted by the British HIV Association – the professional organisation of the UK’s HIV doctors -  has found that  around 40% of people diagnosed with HIV when they already have a very low CD4 cell count are not starting HIV treatment within six months of their diagnosis. This seems quite worrying as treatment guidelines clearly state that everybody who is ill because of HIV, or who has a CD4 cell count of 200 or below should start treatment because of the very real risk of HIV causing a potentially life-threatening illness.

Being diagnosed with HIV is life-changing and for many a distressing, even traumatic event. Many people need time to adjust to finding out that they have an infection that they will have for the rest of their life. Starting HIV treatment can also involve major psychological and practical adjustments.

It could well be the case that many recently diagnosed people with CD4 counts low enough to warrant the initiation of HIV therapy just don’t feel ready to start treatment yet. In such circumstances, antibiotic and anti-viral drugs can be used to reduce the short-term risk of developing AIDS-defining illnesses, and the benefits of HIV treatment should be explained and the patient supported until they are ready to start treatment. And let’s not forget that even though treatment could well mean that a person with HIV lives a normal lifespan, taking HIV treatment is a life-time commitment.

Anti-HIV treatment

TB

Tuberculosis (TB) is the biggest cause of illness and death amongst people with HIV around the world and one of the most common AIDS-defining illnesses in the UK. In most cases, taking a combination of antibiotics for six months can completely cure TB, even if a person has HIV.

Symptoms of TB include a cough that won’t go away, weight loss, chills and fevers, and night sweats. Some people also have pain in their chest and cough blood.

Doctors in London have found that they can detect more cases of TB if they ask people about their risks of TB when they register and have a health check at their first appointment.

Doctors in Hackney, a high TB area, asked their new patients if they had any symptoms that are associated with TB; if they had had any contact with people who were known to have TB; and if they came from a country where TB was common. Many cases of TB in cities like London have occurred in people who have recently come to live in the UK from countries where there is a lot of TB.

If TB was suspected, other tests, including a skin test for TB and a chest X-ray were carried out. Some people also provided with a TB vaccination, but people with HIV should be given this vaccine because it is a so-called live vaccine and can cause a TB-like illness.

The doctors conducting the TB checks detected many more cases of ‘active’ and ‘latent’ TB than doctors who didn’t, and they think that offering routine TB checks could help identify patients with the disease in other UK cities.

Sexual health

A study conducted in the three UK cities with the largest gay populations – London, Manchester and Brighton – has found that many HIV-positive gay men are having unprotected sex.

Approximately a third of HIV-positive men reported unprotected sex, and around a third of these men said that they didn’t know if the man they had unprotected sex with was HIV-positive, negative, or untested.

The findings of the study are very similar to the 2005 UK Gay Men’s Sex Survey.

Having unprotected sex with a person whose HIV status you don’t know could involve a risk of HIV transmission. Some people in the UK have been sent to prison after ‘recklessly’ infecting their sexual partners. Unprotected sex – with a person of any HIV status - can involve a risk of sexually transmitted infections.

Although choosing to have unprotected sex with other HIV-positive people (often called ‘serosorting’) means that  there is no risk of HIV transmission, and provides an opportunity for a more fulfilling sex life for some, there are health risks.

Sexual transmission of hepatitis C virus has been reported between HIV-positive gay men who had unprotected sex, and there have been a small number of cases of superinfection – or reinfection – with another strain of HIV.

Condoms provide effective protection against HIV and sexually transmitted infections.

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