The pleasures of life…

Last Saturday night I went to see a play about the 12^th century lovers and philosophers, Peter Abelard and Eloise. A main character in the play was St Bernard of Clairvaux, one of the founders of a monastic order called the Cistercians who were noted for the severity of their rule – or way of life - that included harsh regulations about the amount of physical work its members should do and how much they could eat and drink. So harsh was the rule that many of the monks who founded the first Cistercian monasteries died of hunger, over-work or disease.

What the hell has this got to do with HIV you’ll be forgiven for wondering.

Well, monks and nuns have to take three vows: poverty, chastity and obedience. Sometimes it feels like there’s a lot of pressure on people with HIV to obey these rules as well: having HIV can cause or worsen financial hardship;  “abstinence” (despite evidence showing that it only has limited effectiveness) is the favoured HIV prevention method of the most powerful man in the world; and HIV-positive people are bombarded with advice about how they need to live their lives.

A lot of this advice makes good sense. But everybody needs some pleasure in their lives. Just because a study has found that binge drinking can accelerate HIV disease progression doesn’t mean that you can’t have a drink, indeed there may be benefits from having a couple of beers or a glass or two of wine everyday for your physical and mental health. You can eat a healthy and nutritious diet that is also pleasurable and occasionally indulgent. And if you do need to cut down on your drinking or stop smoking, it’s not going to make it any easier beating yourself up. Be kind to yourself and take what pleasures you can from life and ask for help when you need it.

You don’t have to live the life of a monk or nun following an HIV diagnosis.   

Lifestyle factors and HIV

Resistance testing

To make sure that the first combination of anti-HIV drugs that you take is as effective as possible, current UK HIV treatment guidelines recommend that everybody should have a resistance test to see if they are infected with HIV that is resistant to anti-HIV drugs. It is also recommended that everybody who is changing treatment because their viral load has increased should have a resistance test before their next combination of anti-HIV drugs is selected.

Guidelines recommend that resistance tests shouldn’t be performed until a person’s viral load is between 500 – 1000. If a test is conducted when viral load is lower than this, it’s thought that the results won’t be reliable.

But a new study has found that resistance testing may be successful in patients with very low viral loads – between 4 and 75 copies/ml. The doctors who conducted this study think that it could have important implications. Many people taking HIV treatment who have an undetectable viral load experience a “blip” when their viral load temporarily becomes detectable before falling back to becoming undetectable again. In addition, some other people experience very slow increases in their CD4 cell count after starting treatment.

Side-effects

Drugs used to treat some AIDS-defining illnesses seem are more likely to cause side-effects in HIV-positive people than in the general population, researchers have found. They conducted a review of studies looking at side-effects caused by three types of drugs used to treat serious infections and symptoms in people with HIV: sulfa-based antibiotics, like Septrin , that are used to treat PCP pneumonia and toxoplasmosis; anti-tuberculosis drugs; and anticonvulsant drugs, that can also be used to the pain associated with peripheral neuropathy and bipolar depression.

They found that each type of drug was not only more likely to cause predictable side-effects in HIV-people, but that these tended to be more severe and unusual.

Side-effects should always be promptly reported to a member of your healthcare team.

Lipodystrophy treatment

Some anti-HIV drugs can cause changes in body fat shape including fat accumulation around the stomach and back of the neck, and thinning of the face, buttocks and limbs. The term used for this set of side-effects is lipodystrophy.

It’s known that the drugs d4T (stavudine, Zerit) and to a lesser extent AZT (zidovudine, Retrovir) cause fat loss from the face, limbs and buttocks and their use is now avoided whenever possible. Facial fat loss can be corrected, the most common option being New Fill injections.

Surgery has been used to correct fat accumulation at the back of the neck, and exercise has been shown to have a limited benefit for fat accumulation around the stomach.

Now two studies have shown that treatment with recombinant human growth hormone can lead to reduction in fat accumulation without causing fat loss.

You can find out a lot more about lipodystrophy in the NAM booklet, Lipodystrophy .