Non-HIV-related illnesses and the effect of treatment
However, they found that starting HIV treatment reduced the risk of many of these diseases. The study adds to the growing body of evidence showing the wide range of benefits of antiretroviral therapy.
With the right treatment and care, many HIV-positive people have an excellent prognosis. Rates of HIV-related illnesses have fallen dramatically since the introduction of effective HIV treatment. Serious non-HIV-related illnesses such as cardiovascular, liver and kidney disease are now important causes of serious illness and death in patients with HIV.
Spanish doctors wanted to see how common non-HIV-related illnesses were in people who’d been recently diagnosed with HIV. They therefore looked at the medical records of over 5000 patients, most of who were diagnosed after 2004.
The participants were monitored for a little over two years.
Rates of HIV-related and non-HIV-related illnesses were similar.
The most common non-HIV-related illnesses were mental health problems such as depression, liver disease, cancers, kidney disease and cardiovascular disease.
However, rates of non-HIV diseases fell after 2007. At the same time, people were beginning HIV treatment at higher CD4 cell counts.
The researchers therefore believe that starting HIV treatment reduces the risk of non-HIV-related illness. This was especially the case for mental health problems and kidney disease.
Adherence – taking your HIV treatment
Taking your HIV treatment properly – usually called adherence – is the single most important factor under the control of a person for the success of his or her treatment.
Most people in the UK now take their treatment once – or at most twice – a day. Some people take one pill, once a day, and it’s unusual for someone to have to take more than four or five pills in any one dose.
This latest research on the effect of dosage on adherence involved over 2000 people receiving HIV care in Milan during 2010.
Most people (57%) were taking their treatment once daily. The remaining participants were taking twice-daily therapy. The average number of pills in each dose was approximately four.
Adherence rates didn’t differ between those taking once- or twice-daily treatment. Nor were they associated with the number of pills.
Unsurprisingly, people who reported the highest levels of adherence were the most likely to have an undetectable viral load. They also reported better health than other participants.
Taking a larger number of pills was associated with poorer self-rated health. The researchers suggest this is because “many of the patients receiving more complex regimens had more advanced disease and/or were harbouring virus with more drug-resistance mutations”.
Hepatitis C treatment – adherence matters
Higher levels of adherence are associated with the outcome of hepatitis C therapy in people who are co-infected with HIV and hepatitis C, the latest research shows.
Many people who have HIV also have hepatitis C. Liver disease caused by hepatitis C is an importance cause of serious illness and death in co-infected people.
Hepatitis C can be treated and cured. Standard therapy consists of 48 weeks of pegylated interferon and ribavirin. However, this treatment can cause unpleasant side-effects and doesn’t always work.
Doctors in the US wanted to see if levels of adherence to hepatitis C therapy affected treatment outcomes.
They therefore studied the records of 333 co-infected patients. They found that higher rates of adherence were associated with both early and sustained responses to treatment.
However, they found that levels of adherence declined with length of treatment and that methadone therapy was a risk factor for poor adherence.
The doctors therefore stress the importance of providing adherence support to people during the entire course of hepatitis C treatment.
You can find out more about hepatitis C and the treatment options available in NAM’s booklet, HIV & hepatitis. And the article ‘Full speed ahead to curing hepatitis C’, which appeared in edition 211 of NAM’s HIV treatment update, looks at some of the new treatments coming into use.
Helpline support
The key helpline service with respect to HIV will now be the Sexual Health Line, run by the private company Serco. Its telephone number is 0800 567 123. It is open from 9am to 8pm (Monday to Friday) and from 11am to 4pm (Saturday and Sunday).
However, a number of other longstanding helpline services have lost their funding.
The I Do It Right helpline, operated by the Black Health Agency and designed to provide HIV support to African people in England, has now closed.
THT Direct (0808 802 1221) has also lost its government funding. It will continue to operate, but its opening hours have been reduced to Monday to Friday, 10 am to 8 pm.
Previously, THT Direct was open over the weekend and until 10pm in the week. With opening hours now concentrated during office hours, there are fears that it will make it harder for volunteers to contribute alongside paid staff.
Many THT Direct volunteers have personal experience of HIV and have had a particular role in providing emotional support to callers (including newly diagnosed people and those considering taking an HIV test or post-exposure prophylaxis).
You can find out about HIV support and other services near you by using NAM’s e-atlas.
HIV and the criminal law
In countries all over the world, people have been investigated, prosecuted and, in some cases, convicted of exposing a sexual partner to HIV, or passing it on to a partner, because they haven’t disclosed their HIV status before having sex. What people have to do to avoid liability varies from country to country, but only having protected sex (using a condom) is often considered protection from criminalisation of HIV exposure or transmission. Now, with more known about the effect of treatment as prevention, having an undetectable viral load can also be a defence in some countries.
The law on HIV exposure and transmission in Canada is confusing and inconsistently applied – some people have been tried and/or convicted for having sex with a condom or having oral sex.
Now the Canadian Supreme Court has ruled that either using a condom or having an undetectable viral load are not in themselves enough to protect someone from the law if they have sex without disclosing their HIV status. For sex without disclosure not to be regarded as a crime, people will have to comply with both conditions.
You can see how the Canadian HIV/AIDS Legal Network has responded to the Supreme Court’s ruling in the Editors’ picks below.
Editors' picks from other sources
25 years of NAT (National AIDS Trust)
from You Tube
To mark NAT's 25th birthday year, this short film looks at how the HIV epidemic has evolved over the last quarter of a century and the part NAT has played in improving the lives of people living with HIV and educating the public.
Dirty dentists putting patients at risk of infection
from The Telegraph
Patients are being put at risk of infection by dentists who fail to clean surgical equipment properly, research reveals.
TAG at 20 - On a Darkling Plain —The Years of Despair
from TAG
A summary of the first two decades of the Treatment Action Group’s work to speed up AIDS research, looking at the clinical science of AIDS before the discovery of highly active antiretroviral therapy (HAART), and how TAG responded to the needs of people with AIDS.
Unjust Supreme Court Ruling on Criminalization of HIV Major Step Backwards for Public Health and Human Rights
from Canadian HIV/AIDS Legal Network
The Canadian HIV/AIDS Legal Network expresses shock and dismay at the Supreme Court of Canada's ruling that says that even the responsible use of a condom does not protect a person living with HIV from rampant prosecution.