Editorial

Soon after I started taking anti-HIV therapy almost nine years ago, my viral load fell to undetectable.  It’s stayed there ever since. At the same time, my CD4 cell count has gradually increased from a low of around 250, and according to my latest set of tests, conducted in November, is now a whopping 1900.  I’m therefore looking forward to a long, and hopefully healthy life.

HIV-related illnesses no longer really worry me. But I’m still very much aware that having HIV can have seriously implications for my health. This was underlined by two recent studies – one of which found higher rates of lung cancer in people with HIV; and the other, a higher risk of cardiovascular illness in people with HIV and hepatitis C. Although I neither smoke (the main risk-factor for lung cancer, and a cause of cardiovascular disease) nor have hepatitis C, I still found these studies worrying as I think that they show how having long-term infections like HIV can have subtle effects on your health – for example, I’ve a chronic lung infection.

But don’t panic. It is important to remember that lung cancer is very rare in people with HIV. And there are things that you can do to look after your health.  For example by stopping (or not starting) smoking you can reduce your risk of contracting not only lung cancer, but cardiovascular disease as well.

Another recent study is also worth comment. It looked at unemployment amongst people with HIV in Australia. It found that both medical and social factors were associated with unemployment. Although many people with HIV find that they can carry on in their jobs as normal after their diagnosis, this isn’t always the case. One of the factors associated with unemployment was poor mental health – a reminder that people with HIV often live with multiple health concerns.

Illness

Cancers

There are two AIDS-defining cancers: non-Hodgkin’s lymphoma and Kaposi’s sarcoma.

But it’s becoming clear that some other cancers, which are not used to diagnose AIDS, and are not associated with immune suppression, occur more frequently in people with HIV than they do in the general population. The reasons for this aren’t yet fully understood.

Small studies have already shown that lung cancer occurs more frequently in people with HIV. Now, a much larger study has found that in both the periods before and after effective anti-HIV therapy became available, lung cancer occurred more frequently in people with HIV than in the general population.

Researchers think that the higher rates of lung cancer seen in people with HIV can, in part, be explained by higher rates of smoking. About 60 - 80% of people with HIV smoke. This is much higher than the 20 - 30% seen in the general population.  But the latest study, which took account of smoking duration and intensity, found that it couldn’t explain all the increased risk. The immune damage that people with HIV experience leads some to develop long-term or repeated lung infections, and the researchers think that this could contribute to the risk of lung cancer.

Cardiovascular disease

The amount of illness and death observed in people with HIV has fallen dramatically since potent anti-HIV therapy became available. But drugs used to treat HIV can cause side-effects, and some have been associated with an increased risk of cardiovascular disease.

It is also thought that living with a long-term infection, like HIV, can cause inflammation that can also increase the risk of cardiovascular illness.

Many people with HIV are also infected with hepatitis C virus, which can also cause chronic inflammation, which some studies have found to be associated with an increased risk of illness like heart disease, stroke and hardening of the arteries.

Now researchers have found that people who are infected with both HIV and hepatitis C are much more likely to experience cardiovascular problems than people who just have HIV. This increased risk remained when the researchers took into account factors that could affect the risk of cardiovascular disease, including gender, race, CD4 cell count, weight, HIV treatment, blood pressure and use of drugs and alcohol.

Living with HIV

Employment

Although many people with HIV remain in work after their diagnosis (or have returned to work after their health has improved with the use of potent anti-HIV therapy), there is a much higher rate of unemployment amongst people with HIV (as high as 66%) compared to the general population.

Australian researchers have found that both social and medical factors contribute to unemployment amongst people with HIV.  Medical factors predicted who was going to be out of work. Two-thirds of people who rated their health as poor were unemployed compared to only 30% of those who said their health was good. Researchers also found that people with a CD4 cell count of 200 cells/mm³ were more likely to be out of work than those with higher CD4 cell counts. Poor mental health was also predictive of unemployment.

But medical factors weren’t the only issues associated with unemployment. They also found that a lower level of education and older age (55% of the over-50s were out of work compared to 36% of the under-40s).

They also found that people who used HIV support groups had higher rates of unemployment, but they don’t suggest why this might be the case.

Information on working if you are HIV-positive can be found here. If you want to return to work, then Positive Futures might be a good place to explore your options.

Having children

It is possible to prevent mother-to-child transmission of HIV and successful potent anti-HIV therapy means that many people with HIV are looking forward to living a more-or-less normal lifespan. Methods of assisted conception, such as sperm washing, mean that it is able to remove the risk of HIV transmission. This means that people with HIV can have a child without health risks and live long enough to bring their children up

Two recent studies have shown that around 30% of HIV-positive women would like to have children. One of the studies was conducted in France, and it found that 33% of HIV-positive women and 20% of HIV-positive men said that they expected to have children. The other study was conducted in Canada and revealed that the proportion of women with HIV wanting to have children (26%) “approached” that seen in the general Canadian population (38%).

Drug use

Methamphetamine use is a major health and social concern. Studies have suggested that use of methamphetamine can worsen damage to the brain caused by HIV and increase HIV’s ability to replicate in the brain. Some studies have found higher levels of methamphetamine use amongst HIV-positive individuals than their HIV-negative peers and the use of the drug has also been associated with increased sexual risk taking in some (but not all) research.

Now two case reports have been published showing that methamphetamine use caused strokes in two healthy young women.

Sexual health

Good sexual health is important to everybody, particularly so for people with HIV. Sexually transmitted infections can increase the risk of HIV transmission occurring, and can also be harder to treat and more complicated in people with HIV, particularly if they have a low CD4 cell count.

A recently published study has found that HIV-positive gay men in London have more unprotected penetrative sex than any other group with HIV in the UK’s capital.

Researchers found that 40% of HIV-positive gay men reported unprotected anal sex in the previous three months, including 20% who said that they had unprotected sex with a man whose HIV status they did not know or who was HIV-negative. By contrast, 5% of Africans men and women with HIV said that they had unprotected sex where there was a risk of HIV transmission.

Neither the level of viral load, nor taking anti-HIV therapy was associated with the risk of having unprotected sex in either gay men or Africans.

Another study reported on aidsmap  this week was also concerned with sexual health. It found evidence of sexual transmission of MRSA in HIV-negative heterosexuals. Earlier studies have shown an increase in rates of MRSA amongst people with HIV, with a role for sexual risk taking. This latest study, and an earlier US study, also found that shaving pubic hair may be a risk factor for sexual transmission of MRSA.