HIV Weekly - May 16th 2006

Anti-HIV treatment can mean a longer, healthier life for children with HIV.

It’s well known that taking anti-HIV drugs can involve problems. They can have unpleasant side-effects and have to he taken very rigorously to work properly and to avoid HIV becoming resistant to them.

What’s more, many adults and children received treatment with only one or two anti-HIV drugs before potent triple drug combinations became available. This led to them becoming resistant to some drugs in the nucleoside reverse transcriptase inhibitor (NRTI) class of drugs that form the basis of most anti-HIV treatment combinations.

An added complication of anti-HIV treatment for children is that they need different doses of drugs to those used in adults, but some anti-HIV drugs are not available in special formulations for children.

Because of all these problems, treatment breaks - more formally called structured treatment interruptions - have been considered as a way of making the long-term use of anti-HIV drugs in both adults and children more manageable.

However, treatment breaks guided by viral load have been shown to increase the risk of developing drug resistance, and a big study recently showed that adults who took treatment breaks guided by their CD4 cell count had an increased risk of getting sick or even dying.

Another treatment strategy that has been used for people who have taken a lot of anti-HIV drugs but still have a detectable viral load is treatment simplification. This involves stopping treatment with one of the classes of anti-HIV drugs used in potent antiretroviral therapy. The idea is to reduce the number of side-effects and make treatment more tolerable and easier to take.

Doctors in America looked at the outcome of 26 children who stopped treatment with a protease inhibitor, but continued taking their NRTIs. All the children had extensive experience of anti-HIV treatment and many of them had a lot of resistance to anti-HIV drugs. At the time they simplified treatment, they had an average viral load of 10,000 and a CD4 percentage of 27% - high enough to prevent them from developing an AIDS-defining illness.

All the children continued to take simplified treatment for six months. At the end of six months there was no increase in viral load, and although average CD4 cell percentage had fallen slightly, this fall was not considered dangerous.

Majority of the children (21) were still taking simplified treatment a year later. Once again, viral load remained stable, and although average CD4 cell count had fallen further, it was still above the danger level. Similar results were seen in the eleven children who continued to take two-drug NRTI treatment for two years.

Although the doctors think that simplifying treatment might be an option for children with similar characteristics to the ones in their study, they warn that further studies are needed to confirm that this approach is safe.

It is now known that treatment with anti-HIV drugs, particularly protease inhibitors, can cause diabetes, a potentially dangerous illness resulting from the body not being able to control the amount of sugar in the blood.

Now doctors in America have seen three cases which lead them to think that some HIV-positive people who are not taking antiretroviral drugs might have a small risk of developing diabetes.

The doctors think that uncontrolled HIV replication could be the cause. They also suggest that infections such as cytomegalovirus (CMV) which can cause illness and death in people with very low CD4 cell counts, and the impact of HIV on the body’s immune system and hormone levels could have played a role. The doctors also noted that all patients were African American men, raising the possibility that race and gender may also play a role.

More studies are needed to confirm these findings, but if untreated HIV and a very high viral load does lead to an increased risk of diabetes, it seems to be very rare and the very small risk needs to be balanced against the ability of anti-HIV treatment to improve health and extend life. People taking anti-HIV drugs have regular tests to check levels of fat and sugar in their blood and anti-HIV treatment so doctors can minimise the risk of side-effects and conditions such as diabetes developing.

Many HIV-positive people enjoy occasional and moderate alcohol consumption with no apparent ill effect. Indeed, there’s some evidence that drinking a small amount of alcohol a day - such as a glass or red wine or a glass of beer - may actually be beneficial, stimulating appetite, acting as a relaxant, and possibly lowering the amount of LDL ‘or ‘bad’ cholesterol in the blood.

Excessive drinking can, however, be harmful. It can damage the liver and having a healthy liver is particularly important for people with HIV as it plays a vital role in breaking down medicines used to treat HIV and other infections. Drinking too much alcohol can also slow down recovery from illness and infections and has been associated with mental health problems. ‘Binge’ drinking can increase the risk of accidents and violence.

A recent study involving monkeys with a simian immunodeficiency virus (SIV), which is very similar to HIV, has found that those exposed to alcohol over the long term had lower levels of immune cells in their gut. Monkeys that had never been exposed to alcohol had higher amounts of key CD4 and CD8 immune system cells in their guts.

In addition, the monkeys exposed to alcohol had higher SIV viral loads shortly after infection with the virus.

The study’s American researchers conclude that long-term alcohol consumption lowers the number of key immune cells in the gut.

It remains to be seen if the findings of this study extend to HIV and it’s important to remember that many people with HIV enjoy modest alcohol consumption with no ill-effects.

Most people around the world become infected with HIV after having unprotected sex. When used correctly, condoms provide excellent protection against the transmission of HIV and most other sexually transmitted infections.  They are also a good way of preventing pregnancy.

But the risk of HIV transmission, and the use of condoms to prevent it, has obvious consequences for couples who want to conceive.

A form of assisted conception called sperm washing has been used for several years. It involves the removal of HIV from the male partners sperm which is then used to artificially inseminate his partner. So far, no woman or her baby has been infected with HIV after this method of assisted conception was used. However, a theoretical risk exists, as genetic material used by HIV to infect cells may still be present after HIV’s RNA - or HIV viral load - is removed.

A new test which is capable of detecting a single copy of HIV RNA/DNA has been developed by Japanese researchers. Using the new test they were able to ensure that none of the sperm used to inseminate 47 women had any HIV RNA/DNA in it. A total of 20 women conceived and 27 babies were born. None of the women or babies were infected with HIV.