HIV update - 10th October 2018

A round-up of the latest HIV news, for people living with HIV in the UK and beyond.

Sexually transmitted infections and viral load

A study of gay men in Thailand has found that people who are diagnosed with HIV and start HIV treatment are no less likely than others to have an undetectable viral load if they are diagnosed with a sexually transmitted infection (STI).

This confirms the generalisability of the “Undetectable = Untransmittable” (U=U) message. It shows that the original Swiss Statement on undetectability and transmission, issued ten years ago, was too cautious when it said that it did not apply to people who have STIs.

During two years of follow-up, men who had STIs were no more likely to have a detectable viral load than other men. This included testing of viral load in samples of blood, semen and rectal secretions.

However, having an STI at the time of HIV diagnosis – while the person was not taking HIV treatment – was associated with a much higher viral load, especially in semen.

This study reaffirms that an STI infection will not turn someone who cannot transmit HIV into someone who can.

For more information, read 'Sexually transmitted infections' in NAM's 'HIV & sex' booklet and the factsheet 'Viral load'.

People living with HIV underestimate the harm of smoking

People with HIV who smoke greatly underestimate the impact of smoking on life expectancy, according to a Danish study.

Current smokers living with HIV, asked to estimate their life expectancy, anticipated their life expectancy to be 3.65 years lower than people with HIV who had never smoked. However, epidemiological research carried out in Denmark indicates that smoking reduces life expectancy by 12 years in people living with HIV.

In comparison, the overall estimation of life expectancy by people living with HIV was accurate. Danish research estimates that HIV infection will reduce life expectancy by five years compared to the general population. People living with HIV perceived their life expectancy to be almost four-and-a-half years shorter than people in the general population asked to estimate their life expectancy.

The researchers say that doctors need to do more to communicate the harm of smoking to people living with HIV.

For more information, read NAM's factsheets 'Smoking' and 'Life expectancy for people living with HIV'.

Loneliness linked to cognitive impairment

A Canadian study looking at cognitive impairment and dementia in older people with HIV has found that loneliness contributes to these problems. People who said that they often felt lonely were more likely to score poorly on a series of tests of their memory and thinking skills. They were also more likely to say that they thought they had problems in those areas.

People who were often lonely also had more symptoms of depression, stress and anxiety and poorer quality of life.

For more information, read NAM's factsheet 'Cognitive impairment and HIV' and booklets 'A long life with HIV' and 'HIV, mental health & emotional wellbeing'.

Broadly neutralising antibodies

Researchers have for the first time used infusions of antibodies to produce prolonged suppression of HIV viral load without antiretroviral therapy (ART) in the majority of a group given them. The study is the first demonstration that dual antibody therapy can work as a form of ART.

In the small study, nine out of eleven people with HIV, given three infusions of two so-called broadly neutralising antibodies (bNAbs), were able to stop their ART for an average of five months. Two of those people were still off ART and maintaining viral undetectability (one with a few ‘blips’) at the end of the trial, more than seven months after the last antibody infusion. 

The other seven maintained undetectable viral loads for an average of 14 weeks and stayed off ART for an average of 16 weeks.

Two people, however, had viral loads that rapidly reappeared after the last antibody infusion and almost immediately restarted ART. It turned out that both had pre-existing resistance to one of the antibodies used and that resistance to these antibodies is widespread. Up to two-thirds of people with HIV might have pre-existing resistance to these two antibodies.

This study is a proof that the concept of treatment with broadly neutralising antibodies can work. But they may need to be given in combinations of three or more antibodies (as with conventional antiretroviral drugs). And researchers need to find other antibodies which HIV finds it more difficult to develop resistance to.