HIV treatment side-effects

HIV and hepatitis

Liver disease caused by hepatitis B and hepatitis C has become one of the major causes of illness and death in HIV-positive people since effective anti-HIV drugs became available. All HIV-positive people are recommended to be receive hepatitis B vaccinations (unless they are naturally immune).

Although the hepatitis B vaccine is perfectly safe for HIV-positive people to receive, a higher proportion of HIV-positive people may not develop protection from the vaccine or may lose the protective effects of their vaccination over time.

Hepatitis B vaccination consists of three injections into muscle over a period of months.

An international study involving American and Irish patients found a very low rate of success for the vaccination. The study involved just under 200 patients. The researchers that an HIV viral load below 400 copies/ml predicted the success of vaccination. CD4 cell count, even a high CD4 cell count, was not associated with the vaccine providing protection.

The researchers recommend that patients who do not initially develop protection from their course of vaccination should receive boosters.

HIV and cancer

An American study has found that treatment with potent anti-HIV drugs does not reduce the risk of developing precancerous cell changes in the anus in HIV-positive gay men.

Doctors in the UK and many other countries where effective anti-HIV drugs are in widespread use have observed an increase in the number of cases of anal cancer in recent years, particularly amongst HIV-positive gay men.

Anal cancer is not an AIDS-defining cancer (these are non-Hodgkin’s lymphoma, Kaposi’s sarcoma and cervical cancer) but it is seen much more frequently in HIV-positive men (and women) than HIV-negative individuals.  

Infection with certain strains of the virus that causes anal and genital warts, human papilloma virus (HPV) has been strongly associated with an increased risk of developing precancerous and cancerous cell changes in the anus.

The American researchers found that 95% of HIV-positive gay men in their study had anal infection with HPV and that 50% had precancerous cell changes in their anuses.

Earlier research which found that treatment with anti-HIV drugs did not protect against the risk of developing precancerous changes were supported by the San Francisco research. As were studies which no relationship between precancerous cells and CD4 cell count.

Other factors found to be associated with precancerous cells included a history of HIV-related illness and infection with herpes simplex virus-2 (HSV-2). An earlier study found that the presence of other sexually transmitted infections in the anus increased the risk of anal cancer.

The American researchers suggest that starting anti-HIV treatment earlier than currently recommended by treatment guidelines may be of benefit for people with precancerous cells or anal HPV infection.

HIV prevention