Do HIV-negative gay men trust U=U?
A new study shows that Australian gay men who don’t have HIV remain to be convinced that “undetectable = untransmittable” (U=U). The survey was done in 2016, a time when there had already been several Australian campaigns promoting the benefits of HIV treatment, but before the international "undetectable = untransmittable" campaign had taken off.
Among HIV-negative gay men who weren’t taking pre-exposure prophylaxis (PrEP), just 18% agreed that “A person with an undetectable viral load cannot pass on HIV”. A similar statement, with less definitive language was not much more popular – 20% agreed that “An HIV-positive person on treatment is unlikely to transmit the virus”.
Men were also asked, “How comfortable would you be having anal sex without a condom with casual partners in the following scenarios?” and were asked to respond for a number of partner types. Men were generally uncomfortable with the idea of having condomless sex, especially with a casual partner who had HIV (3% would feel comfortable doing so). It made little difference if the HIV-positive partner had an undetectable viral load – 6% would feel comfortable having sex with him.
The type of casual partner who these men were most likely to feel comfortable having sex with would be a man described as HIV negative (31% would feel comfortable). This is a risky strategy for HIV-negative men, as there is always the possibility that a partner has recently acquired HIV but has not yet been diagnosed.
Men were much more confident in the effectiveness of PrEP – 78% agreed that “PrEP is effective in preventing HIV infection” and 65% agreed that “An HIV-negative person who is on PrEP is unlikely to get HIV”.
Men who were currently using PrEP were more comfortable with the idea of having condomless sex, but comfort levels were not particularly high. Their preferred partner for condomless sex would be another HIV-negative PrEP user (72% would feel comfortable).
Less than half of current PrEP users would be comfortable having condomless sex with an HIV-positive partner with an undetectable viral load (48%), although the respondent would be protected by two extremely effective prevention methods.
It seems that HIV-negative gay men are more comfortable making sexual choices based on what they think their partner’s HIV status is, rather than information about an undetectable viral load.
Kidney problems linked to HIV treatment
Kidney function can decline with age in all people. It is also affected by hepatitis C infection, by type 2 diabetes, by high blood pressure and by injecting drug use.
HIV infection and inflammation caused by HIV may also lead to kidney damage. Due to genetic variations, black people are particularly vulnerable to HIV-related kidney damage.
Some antiretroviral drugs may concentrate in the kidneys, or inhibit creatinine secretion in the kidneys, leading to damage to the kidney tubules. It’s already known that there is a greater risk of problems in people taking tenofovir disoproxil fumarate (Viread, also included in the combination pills Truvada, Atripla, Stribild and Eviplera), atazanavir (Reyataz) and lopinavir (included in the combination pill Kaletra).
The researchers looked at data from a cohort of over 2000 American men with HIV and HIV-negative men with similar risk factors for HIV infection to better understand which of these factors are most important. Data were collected over an eleven-year period.
The key measure used to monitor kidney function is the glomerular filtration rate (GFR). A GFR above 90 is normal kidney function, whereas a GFR between 30 and 60 is moderate kidney disease (42% of the men in the cohort) and below 30 indicates severely decreased kidney function (4% of the men).
During the follow-up period, eGFR (estimated GFR) declined by a median of 0.3% each year in HIV-negative men and 0.8% in HIV-positive men.
Moreover, 15% of all men experienced a median annual decline of 3% or more. Men who were taking HIV treatment were three times more likely to have a rapid decline than HIV-negative men or HIV-positive men who were not taking HIV treatment. The longer men had been taking tenofovir disoproxil fumarate or atazanavir, the greater the risk of a rapid decline.
Other risk factors, including high blood pressure, type 2 diabetes, co-infection with hepatitis C and being over the age of 60 also raised the risk of a rapid decline in kidney function. Nonetheless, HIV treatment was the single most important risk factor.
The researchers say that their findings confirm the importance of considering anti-HIV drug choices carefully in people with other risk factors for kidney disease, as well as the need to regularly monitor kidney function in all people taking HIV treatment.
For more information, read NAM’s factsheet ‘Chronic kidney disease and HIV’.
Many drug interactions in older people with HIV
Many older people living with HIV need to take several other medicines to treat other health conditions. This may be necessary for the person’s health, but taking multiple medications can occasionally cause problems.
The more drugs you take, the greater the risk of experiencing drug interactions and side-effects. A drug interaction is when one medicine affects how another medicine works. For example, taken together, one medicine may lower blood levels of the other medicine. Before starting a new medicine, it’s a good idea to ask your doctor or pharmacist: Could the new drug interact with the other drugs I am already taking? What side-effects should I watch for?
An Italian study has found that over half of HIV-positive people aged 50 and over were taking medications that would require careful monitoring or dose adjustment or – in some cases – should definitely not be taken together. Data were collected from the medical records of 744 people.
Potential interactions were checked using the University of Liverpool’s online tool to check for interactions. On this website you can enter the names of the medications you are taking and the results are provided with a traffic-light system. If the result is green, there shouldn’t be any problem. If the result is amber, it’s important to have this checked by a doctor or pharmacist as some extra care may need to be provided. If it’s red, this combination of drugs is contraindicated, meaning that you definitely should not take these drugs together.
On average, the study participants were taking two non-HIV medications each. Moreover, 47% of people had an amber warning and 6% a red warning.
There were significant numbers of interactions in people taking blood thinners (taken to prevent blood clots which can stop blood flow to the heart), calcium channel blockers (which lower blood pressure and relieve chest pain), treatment for an enlarged prostate, drugs for bone problems and drugs to reduce anxiety or help people sleep.
The greatest risks of a red warning were in people taking antacids and other acid-lowering medications (used to relieve indigestion, heartburn, stomach ulcers and gastric reflux). This often happened when they were used with either atazanavir or rilpivirine, despite prominent contraindications in the prescribing information for each drug.
There was a greater risk of either amber or red warnings in people taking anti-HIV drugs from the protease inhibitor class.
For practical advice, read NAM’s factsheet, ‘Multiple medications and drug interactions’. You can also check for interactions by using the University of Liverpool’s online tool or by downloading the Liverpool HIV iChart app for iPhone or Android.
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