Taking antiretroviral treatment can mean that people with HIV are able to live a long and healthy life. Doctors are now hopeful that with the right treatment and care, a person with HIV will be able to live a near-normal lifespan.
But higher rates of illness and death are still seen in people with HIV compared to the general population. A lot of research is underway to find the reasons for this.
Some of the research reported in this edition of HIV Weekly shows the damage that untreated HIV can do. Starting HIV treatment before your CD4 cell count falls to around 350 reduces the risk of HIV-related illnesses and other serious diseases as well, such as those of the heart, liver and kidneys.
Risk factors for thrombocytopenia
Thrombocytopenia is a shortage of platelets in the blood. Platelets help the blood clot, and thrombocytopenia can have serious consequences and lead to major bleeds.
The condition can develop as a result of HIV infection. As many as 45% of people with very low CD4 cell counts and serious HIV-related illnesses developed thrombocytopenia.
Their research involved 2300 patients who were monitored between 2004-05. A total of 3% developed the condition.
The researchers then compared the characteristics of patients who developed thrombocytopenia to HIV-positive patients who didn’t.
A detectable viral load, co-infection with hepatitis C virus, and liver cirrhosis were all associated with thrombocytopenia.
Major bleeding events were more common in patients with thrombocytopenia, and they also had a higher overall mortality rate.
HIV itself increased the risk of thrombocytopenia, the researchers emphasise. This adds to the evidence showing the damage that untreated HIV can cause.
A side-effect of pegylated interferon, which is used to treat hepatitis C, can be a fall in platelets. Co-infected patients should have their platelet count carefully monitored to make sure the drug is safe to use.
A second study looked at the risk of thrombocytopenia during breaks from HIV treatment.
Interrupting HIV treatment is not recommended. A big international study showed that patients who took treatment breaks were more likely to develop both HIV-related and serious non-HIV-related illnesses.
They found that 25% of patients taking a treatment break developed the condition compared to 10% of those who did not.
Thrombocytopenia developed very quickly after treatment was interrupted – within an average of only nine weeks.
Once again, the study showed that a detectable HIV viral load increased the risk of thrombocytopenia, as did a CD4 cell count below 200.Rare heart condition associated with low CD4 cell count
Pulmonary arterial hypertension is a very serious heart condition. It is occurs when the small pulmonary arteries become blocked. This can lead to heart failure and death.
Before HIV treatment became available, the condition was seen more often in patients with HIV than in the general population.
Now French researchers have examined its risk factors in the modern HIV treatment era.
They monitored cases of pulmonary arterial hypertension that were referred to a specialist clinic between 2000 and 2008.
Overall, 7% of patients had HIV as the only risk factor for the condition.
Most (62%) of those diagnosed with pulmonary arterial hypertension were taking HIV treatment. Viral load was undetectable in half the patients and 79% had a CD4 cell count above 200.
HIV treatment was not an effective therapy for the condition. However, it did improve some aspects.
About two-thirds of patients were still alive five years after their diagnosis with pulmonary arterial hypertension.
A low CD4 cell count was an important factor linked to poorer survival.Cardiovascular disease risks common in young US women with HIV
Cardiovascular diseases such as heart attack and stroke are an important cause of illness and death in people with HIV.
There’s been a lot of debate about the reasons for this. But research suggests that a number of factors may be important. These include traditional risks factors, the damage that untreated HIV can cause, and possibly the side-effects of some anti-HIV drugs.
It’s recommended that HIV treatment should be started before a person’s CD4 cell count falls to around 350. This has been shown to help reduce the risk of heart disease. Regular check-ups at an HIV clinic can mean that changes in blood fats and sugars can be detected and prompt treatment provided.
HIV clinics can also offer advice on lifestyle factors that can help reduce the risk of cardiovascular diseases: for example diet, stopping smoking and exercise.
The women in the study were aged between 14 and 24 years.
These include obesity, smoking, a poor diet, not exercising, drug use, and a family history of cardiovascular illnesses or diabetes.
Compared to HIV-negative women of a similar age, those with HIV also had higher levels of some blood fats.
In addition, blood tests showed many women with HIV had inflammation that is associated with an increased risk of cardiovascular disease.
Herbal medicines widely used by people with HIV
Specialist HIV care and appropriate HIV treatment can mean that people with HIV can lead a long and healthy life.
It’s also important that people with HIV look after their general health.
Herbal and complementary therapies are quite widely used by people with HIV. They are not an alternative to HIV treatment, but some people use them to help reduce symptoms or improve their general wellbeing.
However, some herbal and alternative treatments can interact with some drugs used to treat HIV.
For that reason, it’s important that people with HIV tell their specialist HIV doctor and pharmacist about all other medicines and drugs they are taking. This includes those prescribed by another healthcare professional, bought from a chemist, recreational drugs – and herbal and alternative remedies.
The research showed that people feared their doctor would frown upon the use of herbal remedies, or even rebuke individuals for using them.
Others said that they feared asking busy doctors questions, or did not understand the answers they were provided with.
You can read more about complementary therapies on our mini-site namlife.org. There is also information on getting the most from the relationship between you and your doctor. Some people find it helps to talk to someone else at their clinic about their concerns, like a health adviser or a nurse. Some people find it helpful to talk to someone at an HIV organisation.