Get it checked out

Sexually transmitted infections are, at the very least, unpleasant and inconvenient. But research shows that for people with HIV, an untreated sexually transmitted infection can potentially have much more serious implications than stained underwear or lengthy waits at a sexual health clinic.

In this edition of HIV Weekly you’ll read of a study that showed that men who had active herpes infection in their rectums had more HIV present in both their blood and their rectums, meaning that HIV may be more likely to experience HIV disease progression, and, if they have unprotected sex, to transmit HIV to their partner.

People with HIV can and do enjoy sex. But don’t ignore pain, blisters, sores, rashes or discharge on or from the genitals and anus, as these could be symptoms of an infection. Go to your local sexual health clinic – your HIV clinic might even have a specialist sexual health service. It’s important to get the cause of your symptoms diagnosed and treated so don’t be put off by press reports of long waits for an appointment – you may find that you will be seen quickly and that the service you receive is friendly, efficient, supportive and understanding. Even if you don’t have symptoms and have a lot of sexual partners, it makes good sense to have regular check-ups, as sometimes sexually transmitted infections have no obvious symptoms at all.

Condoms, when used properly, provide excellent protection against the transmission of HIV, sexually transmitted infections and pregnancy.

HIV treatment

Resistance

It is usually recommended that once you have become resistant to an anti-HIV drug that you should immediately stop treatment with it and the other drugs you are taking, and that treatment should only be restarted, with a completely new set of drugs, once you have had a resistance test showing which drugs will still work for you.

But doctors sometimes recommend that people who have resistance to 3TC (lamivudine, Epivir) continue treatment with it. This is because some research had shown that the way that HIV evolves to become resistant to 3TC means that it is less “fit” and cannot replicate as effectively.

But a new study has cast doubt on the value of this treatment approach. It involved approximately 130 people who had become resistant to 3TC and experienced a sustained increase in their viral load from undetectable levels to over 1000 copies/ml. They were randomised to either change to a completely new set of drugs, or to continue to take 3TC as part of their HIV treatment. Doctors compared the two groups of patients over a year.

They found that there was no benefit from remaining on 3TC. Viral load fell by equal amounts in the two groups of patients, and CD4 cell increases were also comparable. However, although all the patients who stopped 3TC treatment had lost the mutation in HIV’s genetic structure associated with resistance to the drug, this was only the case with one patient who remained on treatment with the drug.

Yet, although the doctors found no general benefit for 3TC-resistant patients remaining on treatment with the drug, they do not rule out this treatment strategy for people with very limited HIV drug options. You can read more about the use of 3TC, and other approaches to treatment in this situation, here.

HIV and hepatitis C

Many HIV-positive people are also infected with hepatitis C virus. This virus affects the liver and since anti-HIV treatment became available, hepatitis C has become one of the leading causes of illness and death amongst people with HIV.

Sexually transmitted infections

Good sexual health is important to everybody, but is especially so for people with HIV. This is because sexually transmitted infections can be harder to diagnose and treat if a person has HIV, particularly if they have a weak immune system.

Untreated sexually transmitted infections can also increase the risk of HIV being transmitted, and research has shown that herpes simplex virus-2 (HSV-2) has a significant association with an increased risk of HIV transmission.

Now research conducted in Peru has shown that men who have active herpes in their rectums have more HIV their blood and also shed more HIV in their rectums. The researchers suggest that may “increase HIV infectiousness and disease progression.”