Autumn can be a melancholy time of year, with the leaves falling and darkness gradually creeping into the afternoons. Illness and death feature quite prominently in this issue of HIV Weekly and it’s easy to understand why it would be tempting to avoid reading about such distressing subjects at such a gloomy time of year.

But it is important to remember that, even with effective HIV therapy, some people with HIV do still become ill and even die. And one way you can reduce your chances of getting ill if you are HIV-positive is to know  the risk factors for illness (and even death) as there may well be some changes you can make to your life that could have big health benefits. One such change could be taking your medicine properly – poor adherence was identified as a factor in 7% of recent deaths in HIV-positive people.

HIV and illness

The amount of illness and death caused by HIV fell dramatically in the UK after potent HIV therapy became available in the late 1990s. But some people with HIV do still become ill or even die.

Researchers in the UK gathered information on the deaths of 400 HIV-positive people in 2004-05.

The researchers found that many deaths occurred in people who seemed to be at a low risk of experiencing HIV-related illness. Approximately 50% of deaths occurred in people who had a CD4 cell count above 200 cells/mm³, and a third of the people who died had an undetectable viral load.

Furthermore, the researchers found that a third of deaths were not related to HIV, with about 10% of deaths caused by cancers that are not regarded as HIV-related.

There is concern that some anti-HIV drugs can cause long-term metabolic changes that can increase the risk of illnesses such as heart disease. Although 7% of deaths were due to cardiovascular disease, most were not HIV-related.

Liver disease caused by hepatitis B or hepatitis C caused approximately 6% of deaths.

Poor adherence to anti-HIV therapy was identified as the cause of death in 7% of deaths and 5% of deaths were attributed to a patient declining anti-HIV treatment.

Sexual health

New research shows that HIV-positive gay men are disproportionately affected by the sexually transmitted infection, gonorrhoea.

A third of all cases of gonorrhoea diagnosed in gay men in England and Wales in 2005 involved men who already had, or were newly diagnosed with HIV.

The research also showed that 27% of gonorrhoea was now resistant to the antibiotic ciprofloxacin, even though this drug ceased to be first-line treatment for gonorrhoea in the UK in 2003. The researchers identified having sex abroad as a risk factor for infection with drug-resistant gonorrhoea.

A further piece of recently published research found that the throat is the most common location for gonorrhoea infection in gay men, usually without symptoms.

Infection with gonorrhoea can increases the risks of HIV transmission. It has been shown that gonorrhoea can increase viral load in semen and the inflammation caused by gonorrhoea can increase the risks of an HIV-negative person being infected with HIV.

It makes good sense for HIV-positive people to have regular sexual health check-ups if they have more than one monogamous partner. In the UK, a sexual health check-up should include a throat swab to check for gonorrhoea.