Shigella outbreak warning
Shigella, or shigellosis, is a type of dysentery caused by the Shigella family of bacteria. The bacteria are present in faeces (poo), and are spread through oral contact with the infection – for example, from not washing your hands after going to the toilet.
Most cases in the UK are linked to travel overseas, but there has been a noticeable increase in cases amongst gay and bisexual men. It can be spread through sexual activities such as rimming, as well as by unwashed hands. Having high numbers of sexual partners, using drugs during sex and injecting drugs are risk factors for infection.
Symptoms are severe, prolonged diarrhoea – often with blood or mucus in it – and stomach cramps. They can be accompanied by a fever, nausea and vomiting (feeling and being sick), and normally develop one to three days after infection. The illness can be serious for people with HIV whose immune system is weakened (who have a low CD4 cell count) or who also have hepatitis C. It can be treated with antibiotics.
Gay and bisexual men with these symptoms are advised to see their GP or a sexual health clinic. Mention you are concerned about shigella and ask to have a test.
Many men diagnosed with shigella were also diagnosed with another sexually transmitted infection (STI) or HIV. Using condoms is an effective way to protect yourself and sexual partners from acquiring STIs and HIV. Avoiding oral-anal contact, washing your hands thoroughly and showering after sex will reduce the risk of shigella.
Public Health England and the Terrence Higgins Trust are running a campaign to raise awareness about the risk of shigella amongst gay and bisexual men. You can find out more about shigella, its treatment, and how to protect yourself and other from it, in NAM’s factsheet on shigellosis and at www.tht.org.uk/Shigella.
Pill burdens and adherence
HIV treatment in the UK is highly effective and, for many people, involves only one pill, once a day.
Over the years, there has been debate as to whether people are more likely to take their HIV treatment in the right way (often called ‘adherence’) if they can reduce the numbers of pills and doses (the pill ‘burden’) to as few as possible.
The trials had been comparing treatment combinations taken once daily and twice daily. None of the trials looked at the fixed-dose combination pills that allow one-pill, once-a-day, dosing, but are more expensive than the same drugs taken as separate pills.
People on combinations with a significantly higher number of pills had poorer adherence than those on regimens with fewer pills, and were less likely to achieve an undetectable viral load, the aim of HIV treatment.
People taking once-daily treatment had better adherence than people on combinations taken twice a day, but there wasn’t a significant difference in the numbers who had an undetectable viral load.
The researchers suggest that these findings can help health systems trying to reduce costs. As long as people’s drug combinations don’t involve more than two or three pills, prescribing anti-HIV drugs as individual pills shouldn’t have a serious effect on the outcomes of treatment.
Find out more about adherence in NAM’s booklet Adherence & resistance and about the anti-HIV drugs currently available in the UK in our online resource My drugs chart or our booklet Anti-HIV drugs.
HIV and bone problems
Thinning of the bones (osteopenia and osteoporosis) is a recognised complication of HIV. The causes appear to include traditional risk factors such as diet and smoking, but also the damage caused by HIV and the side-effects of some anti-HIV drugs, especially tenofovir (Viread, also in the combination pills Truvada, Atripla and Eviplera).
However, it has not always been clear whether this loss of bone density results in an increased risk of fractures. Now, researchers in Denmark report that the risk of fracture is increased for people with HIV, even when traditional risk factors are taken into account.
The risk of fracture was three times higher for young and middle-aged men and four times higher for women in those age ranges, but evened out for people over 60, as the risk of osteoporosis increases with age for everyone, especially for women.
The researchers recommend that assessment for fracture risk is included in routine HIV care. In the UK, it is recommended that bone health is assessed when someone is first diagnosed, and then every three years after that for people on treatment or aged over 50. This means that problems can be spotted early to allow you and your doctor to discuss possible options.
Both exercise and nutrition can play an important role in preventing and addressing bone problems for people with HIV. Talk to your HIV clinic or GP about what you can do to protect your bone health.
Links between HIV and hepatitis C transmission
HIV and hepatitis C can both be acquired through contact with blood and there is also an ongoing epidemic of sexually transmitted hepatitis C among gay men living with HIV. Many people with HIV also have hepatitis C, which can cause serious health problems.
Researchers in Switzerland have been looking at transmission ‘networks’ of HIV and hepatitis C. They found that there was significant overlap between the transmission routes for HIV and for hepatitis C, allowing them to identify people with HIV who were also at greater risk of getting hepatitis C.
This information could help health services target prevention information and support services to people most at risk of hepatitis C infection.
Interested in hepatitis and HIV? Visit our hepatitis C topics page for more resources, feature articles and news about hepatitis and HIV co-infection. We’re also working with ELPA, the European Liver Patients Association, on a hepatitis information website for patient advocates and professionals working in hepatitis in Europe – check it out at www.infohep.org
HIV testing and support
Finding out you have HIV can be hard, but being diagnosed is an essential step in being able to look after your health.
A study in Glasgow has looked at HIV testing rates amongst gay men. The study found that men who had a greater fear of receiving an HIV-positive diagnosis were more likely not to have had a test recently, or at all. Similarly, men who felt their friends weren’t having tests were less likely to get tested, and men aged under 25 or over 45 were less likely to have had a recent test.
The researchers suggest that the fear of being diagnosed with HIV should be challenged, as should the perception that having an HIV test is not seen as necessary or the norm amongst some groups of gay men.
The study also found that men who had unprotected anal sex were more likely than others to have tested, but that men with particularly risky sexual behaviour (e.g. unprotected sex with multiple partners of unknown HIV status) were not especially likely to have tested recently.
Read about the advantages of knowing your HIV status in NAM’s leaflet Better off knowing. Find out more about HIV testing on aidsmap.com. Find a testing centre in the UK using our HIV test finder.
Editors' picks from other sources
Happy people, safer sex
from Eurekalert Medicine & Health
In a new study, researchers report that HIV-positive men whose moods improved in a given week were more likely to have safe sex than they would in a normal week. In weeks where moods were worse than usual, they were more likely to have unprotected sex.
Is crystal meth behind London's rising HIV levels?
from Channel 4 News
Crystal meth use in the UK is extremely low. But the drug's popularity among gay men in London, where it is increasingly used at sex parties, means that some believe it could lead to a rise in HIV infections.
Amendment to ban HIV positive people entering UK not considered for immigration bill
from Pink News
A group of Tory MPs proposed a ban on HIV positive immigrants entering Britain, a move that was labelled "the most draconian policy enforced on people with the virus" by campaigners. In the event, the amendment to the Immigration Bill was not considered by MPs and the amendment will not become law.
Graphene condoms: super thin and tough, but is that enough to make people have safer sex?
from The Conversation
Given that social reasons influence sexual behaviour, new technology such as the graphene condom won’t necessarily improve attitudes toward using condoms. But emphasising pleasure could be a new narrative that encourages some to weigh up the pros and cons a bit differently.