Since the very start, gay men have been significantly affected by the HIV epidemic in the US. New figures show that this hasn’t changed and that the rate of new HIV infections amongst gay and bisexual men in the US is up to 44 times greater than that seen in other groups in the US population.
The figures also showed that rates of syphilis are far higher amongst gay men, and many of these men will have HIV.
It’s important to look after your sexual health. Sexually transmitted infections can be unpleasant, and some can make you very unwell if left untreated.
There’s also good evidence to show that they can increase the risk of HIV transmission. New research from South Africa involving men with HIV and genital ulcers showed that HIV was present in the ulcers of almost half the men. This study is discussed in more detail later
Sexually transmitted infections can increase the risk of HIV transmission to sexual partners – even if you have an undetectable viral load. Often, these infections don't cause any obvious symptoms.
So if you’re sexually active, it makes good sense to have regular sexual health check-ups at a specialist sexual health (GUM) clinic. In the UK they are confidential and free of charge - you can look up your nearest clinic on our website.
Hospital admissions still high for people with HIV
American research has shown that hospital admission rates remain high for people with HIV.
Thanks to HIV treatment, many people with HIV can expect to live a near-normal lifespan.
The number of HIV-related deaths and hospital admissions fell dramatically after effective HIV treatment became available, but there’s some evidence that these have now stabilised.
HIV can still have a major impact on health, and increased rates of illnesses such as heart, kidney and liver disease have been seen in people with HIV. In addition, many people with HIV also have other serious infections, such as hepatitis B or C. Rates of smoking are also high among people with HIV, and this can increase the risk of some long-term health problems.
US researchers monitored the hospital admission rates for almost 2500 HIV-positive patients between 1999 and 2006.
Approximately a third were hospitalised at some point, and the rate of admission to hospital didn’t change over the course of the study.
Stomach problems and infections were major reasons for admissions.
But there were some indications that the reasons why people with HIV were being admitted to hospital were changing.
For example, the number of admissions because of heart disease went up. Liver disease caused by hepatitis C was also an increasingly important reason for people going into hospital, as was surgery.
The investigators found that people with a CD4 cell count above 350 – the current threshold for starting HIV treatment in the UK – were less likely to be admitted to hospital than those with a weaker immune system.
Taking HIV treatment was also shown to be associated with a reduced risk of admission to hospital.
For more information on going into hospital visit www.namlife.org.
HIV and bone health in boys
HIV has been associated with lower bone mineral density, which may possibly lead to an increased risk of fracture.
Some anti-HIV drugs can also affect bone density, so this can be monitored if you are taking HIV treatment.
Less is known about bone density and bone mineral content in HIV-positive children than in adults.
Therefore, researchers monitored bone density and mineral content in about 250 HIV-positive children and adolescents. The results were compared to those obtained from a control population of HIV-negative boys and girls of the same age.
The researchers found that by the time they reached mid-puberty, HIV-positive boys had significantly lower bone mineral density and content than HIV-negative boys.
However, no significant differences were seen in bone density or mineral content between HIV-positive and HIV-negative girls.
When the researchers looked at the impact of anti-HIV drugs on bone density, they found that taking nevirapine (Viramune) was associated with increased density, but that Kaletra (lopinavir/ritonavir) was associated with reduced density.
Many children with HIV are now living long and healthy lives thanks to antiretroviral therapy, and the long-term significance of this study’s findings aren’t clear. Regular check-ups can make sure that any health problems or treatment side-effects can be spotted early, allowing for the use of the most appropriate treatment.
Sexual health
HIV is often found in the genital ulcers of men, according to a study conducted in South Africa.
A number of studies have shown that there is a higher risk of HIV transmission if one or both sexual partners have genital ulcers.
Ulcers can provide a portal of entry for the virus, and the inflammation associated with them can result in the presence of a large number of CD4 and other immune cells which are targeted by HIV. In HIV-positive individuals, the virus may be present in the ulcers.
The latest research has shown that almost 50% of HIV-positive men with genital ulcers have detectable levels of HIV present in such ulcers.
A higher viral load, larger lesions, multiple ulcers, and weeping ulcers were all associated with an increased risk of HIV being detectable in genital lesions.
There’s been a lot of debate about the impact of HIV treatment on infectiousness.
There’s a consensus that antiretroviral therapy reduces levels of HIV in both the blood and genital secretions and that this can reduce the risk of HIV transmission.
The extent of this reduction is not certain.
However, it is agreed that viral load in genital secretions is increased by sexually transmitted infections.
This conclusion is supported by the current research.
One patient who was taking HIV treatment and who had an undetectable viral load in his blood nevertheless had detectable levels of HIV present in his genital ulcers.
For more information on transmission of HIV, visit the new transmission section of www.aidsmap.com.
HIV and travel
There was a lot of celebration when the US ended its HIV travel ban earlier this year.
But a small number of countries still forbid even short visits by people with HIV.
Travellers planning a short visit to China have to sign a declaration saying that they are HIV-negative. Those planning longer stays are required to have an HIV test.
The country’s health ministry has been working to remove the ban in time for a trade expo in Shanghai this May.
But the latest events show that the ban is still in place and sometimes enforced.
You can find out more information about HIV entry restrictions and other useful tips if you are planning to travel on www.namlife.org.