More from Toronto

It may be over a week since the Sixteenth International AIDS Conference in Toronto finished, but so many important studies were presented at the event that nearly all the news on aidsmap last week was from the conference, and you can expect even more next week.

Treatment interruptions

Anti-HIV drugs

Access to HIV treatment

It is recommended that anti-HIV treatment should be started before a person develops symptoms of HIV infection or has such a weak immune system that they have a real risk of developing an AIDS-defining illness. But in the UK approximately a third of people with HIV do not have their infection diagnosed until they are already very ill because of HIV or at very real risk of becoming so. Certain groups of people are more likely to have their HIV diagnosed late, particularly Africans.

But a study conducted in east London and presented to the Toronto conference showed that once HIV had been diagnosed, people from all groups, regardless of their sex, sexuality or race, were equally likely to access HIV treatment when they needed it.

HIV and hepatitis C

Since effective antiretroviral therapy became available and reduced the amount of illness and death caused by HIV, liver disease caused by hepatitis B virus and hepatitis C virus has become a major cause of illness and death in HIV-positive people in countries like the UK.

Although treatment is available for hepatitis C, it works less well in HIV-positive people than people who only have hepatitis C.

The importance of successfully treating hepatitis C if you also have HIV was underlined by a study presented to the International AIDS Conference. It found that coinfected people who did not have a response to anti-hepatitis C therapy were much more likely than people who only had hepatitis C to go on and develop end-stage liver disease. It also found that people who had a low CD4 cell count and severe liver damage before they started anti-hepatitis C treatment were more likely to go on and develop serious liver problems.

However, if a person with HIV and hepatitis C did respond well to anti-hepatitis C therapy, their risk of liver disease was no worse than that seen in people with only hepatitis C who responded to treatment.

Recreational drug use

A lot of research conducted amongst gay men in the US has found a link between the use of the recreational drug, methamphetamine, and risky sex.  Several studies were presented to the Toronto conference on this subject.

There was also some research presented on methamphetamine use by HIV-positive people.

One study suggested that some people were using methamphetamine to “self-medicate” for mental health problems. 

Another study found that people who used methamphetamine were not adhering properly to their HIV medication, or were missing appointments with their doctor. In addition, healthcare workers were sometimes failing to notice that people had a problem with methamphetamine use despite what the patient thought were obvious signs.

If you are concerned about the use of any drug, including alcohol or tobacco, speak to a member of your HIV healthcare team. They won’t “tell you off” or report you to the police, but they will be able to direct you to services that will be able to help you to understand and address the behaviour you are worried about.

Complementary and alternative therapies

A micronutrient supplement can increase the CD4 cell counts of people taking anti-HIV treatment, a study has found.

Studies in countries with poor access to anti-HIV treatment have already shown that supplementation with vitamins and minerals can boost immune function and reduce the risk of illness and death.

In the latest study, 40 HIV-positive people taking anti-HIV drugs in the US were randomised to receive either a complex micronutrient supplement or a placebo in addition to their HIV treatment. The researchers found that people who received the supplement experienced an average increase of 64 cells in their CD4 cell count after three months, but there was an average fall of 6 in the CD4 cell counts of people who received the dummy pill.

No side-effects were associated with the use of the supplement, but its use did not improve peripheral neuropathy, a painful side-effect that can be caused by d4T (stavudine, Zerit) or ddI (didanosine, Videx).

But the use of complementary and alternative therapies can involve risks, as a study presented to the Toronto conference showed. It was conducted in London, and found that 10% of patients on potent anti-HIV treatment were either taking a complementary or alternative therapy that could cause side-effects or dangerously interact with their HIV medication.

If you are taking any medicines or drugs other than those prescribed by your HIV doctor make sure that you tell a member of your HIV healthcare team.