- HIV prevention: A legal bid has been launched to force the UK government to provide more information about, and access to, post-exposure prophylaxis (PEP) for HIV. An aidsmap.com news feature takes a detailed look at PEP.
- Recreational drug use: Few gay men in the UK use the recreational drug methamphetamine, a large study has found. However, higher levels of use were found amongst HIV-positive gay men, particularly those with larger numbers of sexual partners.
- Anti-HIV treatment: A new study has further underlined the importance of proper adherence to HIV treatment, this time finding that it’s not just the number of doses that matters, but also the interval between doses. Use of the protease inhibitor Kaletra has been linked to an increase in blood pressure, but this was partly because of an increase in weight. And new formulation of Kaletra moves closer to approval in Europe.
- HIV and hepatitis C: People with HIV who also have hepatitis C do less well after starting anti-HIV treatment, possibly because they spend less time actually taking treatment than people who only have HIV.
HIV Prevention
Most people with HIV in the UK were infected with the virus as a consequence of unprotected sex. Using condoms correctly is an excellent way of avoiding passing on HIV and most other sexually transmitted infections. Other ways people reduce their risk of infecting somebody else with HIV is to have sex only with other HIV-positive people (sometimes called serosorting); to limit their number of sexual partners; or to avoid having sex altogether – something which most people would find very difficult or impossible.
Anti-HIV drugs can also be used to try and prevent infection with HIV if a person is exposed to HIV during sex. This is called post-exposure prophylaxis, or usually just PEP for short. UK guidelines recommend that PEP should be provided if there is a significant risk of HIV transmission occurring – for example after unprotected sex anal or vaginal sex or a condom “accident” where one of the partners is known to be HIV-positive.
A gay man is bringing a case against the UK government because he wants what he sees as barriers to the current provision of PRP removed. The issues involved in this case are examined in an aidsmap.com news feature.
It is important to remember that PEP is not 100% effective, and it isn’t a kind of “morning after pill.” To be effective, PEP should be provided within at most 72 hours of the possible HIV exposure occurring, but many doctors think that this is far too late, and think that for it to work in the best possible way it needs to be provided much sooner – possibly no more than four hours later.
If you think that one of your sexual partners may need PEP, then contact your local sexual health clinic or HIV clinic immediately. If these are closed, then go to the accident or emergency department or see if your hospital had an on-call HIV doctor.
Anti-HIV treatment consisting of three (occasionally, two) drugs is taken for a month as part as PEP. Although the drugs used for PEP can cause side-effects, they are considered to be safe. Avoid the temptation to give any anti-HIV drugs that you may be taking to your sexual partner for PEP. It might not be safe to do this, particularly if you are taking abacavir (Ziagen) or nevirapine (Viramune) as these drugs can cause a potentially fatal allergic reaction or severe side-effects.
Recreational drug use
The recreational drug methamphetamine (also known as crystal meth or Tina) has been linked to risky sex and an increased risk of becoming infected with HIV, as well as faster HIV disease progression in studies in the US.
A study conducted in 2004 in gyms in central London seemed to show high levels of methamphetamine use amongst gay men in the UK’s capital. This study, which involved 750 men, showed that 20% had used methamphetamine in the previous year.
This statistic was recently used in a television programme broadcast on BBC3 called, The Trouble with Gay Men . This programme characterised gay men in the UK as ignoring the risks posed by unprotected sex and recreational drug use.
However, new information published this week shows that the actual level of methamphetamine use amongst gay men in the UK is much lower than the figure indicated by the gyms study. The 2005 Gay Men’s Sex Survey conducted by the UK’s largest charity the Terrence Higgins Trust and Sigma Research was completed by over 15,000 gay men and found that 3% of these men had used methamphetamine in the previous year and that less than half of one per cent – fewer than 50 men completing the survey – were regular users of the drug.
But the survey did find higher levels of methamphetamine use in London, where 7% of gay men reported use of the drug in the previous twelve months. An even higher level of usage was found amongst the 520 HIV-positive gay men who completed the survey in London, with 150 (20%) saying they had taken methamphetamine. The highest usage of all was seen in HIV-positive gay men in London who had a lot of sexual partners (30 or more a year). Of these 158 men, 55 (35%) said they had used methamphetamine.
The use of methamphetamine, like any recreational drug can have a negative impact on your health. There has been a lot of research looking at methamphetamine use by people with HIV – it’s important to know that these studies have consistently found that methamphetamine means worse health and not doing as well on HIV treatment. Here are a selection of studies reported on aidsmap in recent years:
- A study found methamphetamine users have higher viral loads.
- A study found use of the drug worsens damage to the brain caused by HIV.
- Doctors in New York think that methamphetamine use may have been involved in a case of very rapid HIV progression.
- It is also thought that the protease inhibitor ritonavir (Norvir) can interact with methamphetamine. All the protease inhibitors are boosted by ritonavir with the exception of nelfinavir.
Anti-HIV treatment
HIV and hepatitis C
Liver disease caused by hepatitis B or hepatitis C virus is now one of the leading causes of illness and death amongst people with HIV in countries like the UK where anti-HIV treatment is available. Although treatment for hepatitis C is available, it is less effective in people with HIV than it is in people who only have hepatitis C.
There are also concerns that people with HIV who also have hepatitis C may do less well on anti-HIV treatment.
Although people with HIV/hepatitis C had similar CD4 cell counts and viral loads to people who only had HIV, doctors found that those with both infections were much less likely to experience a fall in their viral load below 500. They think that this could be because people with HIV/hepatitis C took less HIV treatment, being more likely to take a treatment interruption lasting for three months or more. In addition, people with both infections had a lower average increase in their CD4 cell count compared to those with only HIV.
What’s more, more people with hepatitis C died. Deaths because of liver disease accounted for some of these additional deaths, but the Danish doctors also noted that people with HIV/hepatitis C were also more likely to die of HIV-related causes than people who only had HIV.
Higher rates of injecting drug use amongst people with HIV/hepatitis C and poorer adherence to HIV treatment are put forward by the Danish researchers as possible reasons why coinfected people did less well.