Good health consists of more than good test results

Health for HIV-positive people means a lot more than good CD4 cell counts and undetectable viral loads, and there was a lot of news last week about the side-effects of anti-HIV treatment. Treatment side-effects are now one of the major causes of ill health in people with HIV, and finding out how often they occur and what their causes are have become a top research priority. But the risk of side-effects needs to be seen in context. Some of the news on aidsmap.com last week showed that factors unrelated to HIV treatment were the cause of what had been thought to be therapy-related adverse events, and others showed that illness caused by HIV and other infections such as hepatitis C were the underlying cause of what had been thought to be side-effects.

Good sexual health is important to people with HIV and some groups of HIV-positive people have high rates of sexually transmitted infections. An interesting study reported on aidsmap showed that the herpes simplex virus-2 (HSV-2) is shed orally by HIV-positive men more often than HIV-negative men, and never involved symptoms.

A very encouraging study was also reported showing that the amount of HIV-related illness experienced by HIV-positive children has fallen dramatically since the introduction of effective HIV treatment.

Side-effects

All medicines – even simple, over the counter remedies like aspirin, and so-called natural products – can cause unwanted secondary effects. These are generally called side-effects.

It is well known that anti-HIV drugs can cause side-effects. Side-effects can be short-term or long-term. Common side-effects that occur shortly after starting HIV treatment include headache, feeling or being sick, and diarrhoea. Will power or other medicines such as headache pills, anti-sickness pills and anti-diarrhoea medicines can help get you through these side-effects, the severity of which usually lessen after a few weeks, and often the side-effects will go away completely.

Anti-HIV drugs can, however, also cause longer-term side-effects, for example lipodystrophy, changes in body fat shape and increases in levels of blood fats and sugar, a risk factor for heart disease, stroke and diabetes.

There is also concern that anti-HIV drugs can be toxic to the internal organs of the body, particularly the liver and kidneys as these play a vital role in processing anti-HIV drugs and other medicines. A number of news items on aidsmap in the last week reported recent studies looking at the reasons for kidney failure in people with HIV and the effect of some anti-HIV drugs on the kidneys.

Sexual health

Good sexual health is important to everybody, but is especially so for people with HIV as sexual problems can cause emotional and psychological distress, and sexually transmitted infections can not only cause unpleasant symptoms and illness, but can increase the risk of onward HIV transmission. For more information on HIV and sexual health, click here.

Herpes simplex virus-2 (HSV-2) is a sexually transmitted infection that can periodically cause painful blisters to develop on the sexual organs, anus or face. Some studies have also suggested that having herpes increases the risk of HIV transmission.

Now a study has shown that men often shed HSV-2 orally at the same time as from the genitals or anus, and that oral shedding of HSV-2 never involves symptoms. What’s more, HIV-positive men shed HSV-2 more frequently than HIV-negative men, even if they had a good CD4 cell count, undetectable viral load and were taking potent anti-HIV treatment.

Although HSV-2 cannot be cured, attacks can be treated or prevented by using the anti-viral drug aciclovir.

Children, HIV treatment and opportunistic infections

Potent anti-HIV treatment can mean a longer and healthier life for HIV-positive children. But HIV and HIV treatment has been less intensively studied in children than adults and there are fewer HIV drugs approved for the treatment of HIV in children, and even fewer of these drugs are available in specialist paediatric formulations.

A study has found that since potent HIV treatment became available, the amount of HIV-related illness in HIV-positive children and adolescents has fallen dramatically. Particularly steep declines were seen in the number of cases of severe infections, but the American researchers who conducted the study noticed that less severe infections, such as urinary tract infections, still frequently occurred in HIV-positive young people, even if they had a normal immune system.