Editorial

The National Institutes of Health in the US is to carry out a trial involving 9,000 HIV-positive adults and children in countries around the world. The study has a very important aim: to establish when HIV treatment should be started.

There’s currently a consensus that there’s no real benefit from starting treatment until somebody is already ill because of HIV, or has such a low CD4 cell count that they have a real risk of developing an AIDS-defining illness in the near future.

But this could be changing. Some of the world’s leading HIV doctors are now arguing that treatment should be started much earlier – at a CD4 cell count of 350 rather than 200. You can read about their reasons for this below. What’s more, a study has found that people who start HIV treatment with higher CD4 cell counts have a much better chance of seeing their CD4 cell counts return to normal in the long term.

HIV treatment which seems powerful enough to offer indefinite suppression of HIV is available in once-daily doses, and doesn’t cause the unpleasant or disfiguring side-effects of previous drug combinations.

But some things haven’t changed and aren’t likely to. Starting HIV treatment is a major event – and the doctors who argue for the earlier initiation of treatment stress that the patient must be involved in discussions about their treatment options and agree to them. And rightly so.

HIV treatment

HIV and hepatitis C

HIV prevention

French researchers have found that HIV-positive gay men were more likely to have unprotected sex with their HIV-negative regular partners if they did not disclose their  HIV status.

Binge drinking was also associated with unprotected sex, but unlike some previous studies, they research did not show any relationship between an undetectable viral load and unprotected sex.

Sexual health

Most cases of the bacterial infection, Shigella,  in gay men in San Francisco were sexually transmitted, researchers have found. Shigella causes diarrhoea. They found that direct oral – anal contact (“rimming”) was associated with an increased risk of Shigella.

The research also found a role for HIV in the epidemiology of Shigella. The researchers believe that men with HIV were shedding more Shigella and for longer, and that the immune suppression caused by HIV made men with HIV more susceptible to infection with the bacteria. An editorial called the conjunction of Shigella, gay men and HIV “a perfect biological storm.”

Drug use

Frequent use of the recreational drug, methamphetamine (crystal), has been associated with infection with drug-resistant HIV in gay men.

The study involved 287 gay men who had recently been infected with HIV. They were asked about their drug use and sexual behaviour in the six months before their infection with HIV and had resistance tests.

Methamphetamine was used by 28% of the men at least once during the previous 30 days. Drug-resistant HIV was present in 26% of the men. The researchers found that men who reported frequent use of methamphetamine (weekly or more) had the highest rate of drug resistance and that frequent use of methamphetamine was associated with resistance to NNRTI drugs.

They speculate that HIV-positive gay men on “meth binges” lasting between 24 – 72 hours are having unprotected sex with other men on methamphetamine and transmitting resistant virus.

Methamphetamine has been identified as a major challenge to HIV prevention in the US. But studies from the UK suggest that few gay men use the drug, and that although men who use the drug do report unsafe sex, so do gay men who use other drugs. 

Dispersal of HIV-positive asylum seekers

The British HIV Association (BHIVA) and the National AIDS Trust (NAT) have published advice for healthcare and voluntary sector professionals about the dispersal of HIV-positive asylum seekers.

The advice was published in response to concerns about the health of HIV-positive asylum seekers being put at risk through dispersal. It provides information on government policy about the dispersal of asylum seekers with HIV and provides guidance for consultants, GPs and voluntary sector staff. A copy can be downloaded, here.