A longer, healthier life

In the ten or so years that they have been widely used, potent combinations of anti-HIV drugs have transformed the prognosis of people with HIV in the UK and other richer countries. Confidence about the effectiveness of currently available anti-HIV drugs is growing all the time. What’s more, newer drugs are becoming available that are both easier to take and have fewer side-effects than the first generation of antiretrovirals. More powerful drugs from the existing classes of HIV medicines, and drugs that attack HIV in completely novel ways mean that many people who’ve taken lots of HIV drugs in the past and had few treatment may now be able to take a combination of drugs that effectively controls their HIV.

But HIV medicines don’t cure HIV and can cause side-effects, and such side-effects can involve an increased risk of long-term health problems, such as heart disease. But the key word here is risk, and risks can be reduced. In many cases, doctors can avoid using drugs that involve the biggest risk of heart disease and other side-effects. Medicines called statins can be used  to control blood fats. And regular exercise, a good diet, and not smoking can all play a real part in lowering the risk not only of heart disease, but also of some cancers.

A few things to give you heart?

Anti-HIV treatment

New drug coming soon

A drug from a completely new class of HIV medicines moved a key stage closer to formal approval in the US last week.

Experts in the US recommended that maraviroc (which now has the brand name, Celsentri) should received accelerated approval from the Food and Drug Administration, the government body that formally approves medicines for use.

Maraviroc belongs to a class of HIV drugs called entry inhibitors, or CCR5 antagonists. The currently available anti-HIV drugs work against HIV once it has entered immune system cells. Maraviroc works in an entirely different way, by preventing HIV from attaching itself to CD4 cells. You can find out more about the ‘life cycle’ of HIV here.

Maraviroc looks like it will be an important treatment option for people who have taken a lot of anti-HIV drugs in the past and are having difficulty finding drugs that work against their HIV. Clinical trials looking at the safety and effectiveness of the drug found that people who took it along with an ‘optimised’ combination of HIV drugs selected by resistance tests, were much more likely to experience a drop in their viral load to undetectable levels and have an increase in  their CD4 cell count than those who took a dummy pill with their optimised combination.

Formal approval of maraviroc is expected in the US in June (with approval in Europe and the UK shortly after). Until then, the drug is available on an expanded access scheme that will make it available to those who need it to put together an effective anti-HIV drug combination. For details, click here.

HIV and the heart

Anti-HIV therapy can mean a longer, and healthier life. In fact, many doctors are now optimistic that a person who is diagnosed with HIV before their immune system has been damaged too much by HIV, and takes their anti-HIV medication properly, will be able to live a more or less normal lifespan.

But anti-HIV drugs can cause unwanted side-effects, in both the short and long term. There has been some concern that these long-term side-effects could involve serious health risks of their own, in particular an increased risk of heart disease.

Two recently published studies have looked at this issue. The first found that, since potent anti-HIV therapy became available in 1996, the risk of heart attack has doubled for people with HIV compared to HIV-negative individuals of a similar age. What’s more, for HIV-positive women the risk of heart attack has tripled.

The factor associated with a particularly high risk of heart disease for people with HIV was having high blood fats and sugars. The researchers also noted that people with HIV were much more likely to smoke (a well recognised risk factor for heart disease) than the HIV-negative people they were compared with. A possible explanation for the particularly high risk of heart attack seen in HIV-positive women was the increased risk that they have, compared to HIV-positive men, of experiencing body fat changes whilst taking HIV drugs. Such changes have been associated with an increased heart attack risk.

Heart attack and HIV drugs was also the subject of another recently published study.

It was a very large study involving over 23,000 HIV-positive patients and it found that five years of treatment with a protease inhibitor increased the risk of heart attack by 50%.

But the study also found that very few people taking a protease inhibitor (about 0.6%) actually had a heart attack each year. “The risk of cardiovascular disease would be considered low or at most moderate”, according to an expert on heart disease, so “there does not seem to be an epidemic on the horizon – simply a risk that needs to be managed.”

Access to HIV treatment and care in the UK

A leaflet has been produced by the Terrence Higgins Trust and National AIDS Trust providing information for people who fear that they may not be entitled to free NHS HIV treatment and care.

Some groups of people, for example recent migrants to the UK, individuals of uncertain immigration status, failed asylum seekers and British passport holders who are not normally resident in the UK, can be charged for using NHS HIV services and anti-HIV drugs. There are concerns that this could mean that some people are putting their own health, or, if they are pregnant, that of their unborn child, at risk.

The leaflet explains who can get free NHS care, what happens if a person needs treatment but can’t afford to pay for it,  provides information on the confidentiality of medical records and offers some information on where to go if you need help and support.

HIV and hepatitis

Many people with HIV are also infected with hepatitis C virus. This is often called coinfection. Liver disease caused by hepatitis C is an increasingly important cause of illness and death in HIV/hepatitis C coinfected people.

Treatment is available for hepatitis C virus, and it is currently recommended that this should consist of pegylated interferon with ribavirin. Unfortunately, this treatment is less successful in clearing infection with hepatitis C in people who have HIV/hepatitis C compared to people who only have hepatitis C.

Blood problems, such as a low white blood cell count, or a low red blood cell count (anaemia) are common in people with HIV or hepatitis C and can be caused by the drugs used to treat both HIV and hepatitis C. Such blood disorders and other treatment side-effects can mean that a person has to either modify or change their hepatitis C therapy.

A new study has found that people who changed their hepatitis C treatment for any reason ran the risk of having a poorer response to hepatitis C treatment. The study was quite small, so the researchers were unable to say if changing doses or stopping treatment completely because of blood disorders was particularly risky, and they call for bigger studies to explore this.

Sometimes, drugs are used to counter the side-effects caused by anti-hepatitis C therapy, and the researchers also found that people who took EPO to increase their red blood cell count or G-CSF to increase their number of white blood cells had a better response to treatment.

HIV, hepatitis B and hepatitis C

A small number of people are not only infected with HIV and hepatitis C, but also hepatitis B virus as well. A recent study shows that treating either hepatitis B or hepatitis C does not cause the other hepatitis virus to become more active.

Adolescents with HIV

Thanks, in part, to successful HIV treatment, many children who were infected with HIV by their mother during pregnancy or childbirth are now surviving into adolescence. Researchers are eager to see how growing up with HIV from birth has affected the health and social well-being of these young people.

US researchers have found that adolescent girls who have had HIV since birth have lower rates of pregnancy than their HIV-negative contemporaries, but are more likely to have some potentially serious sexually transmitted infections, such as genital warts.

Overall, 27% of girls infected with HIV at birth were sexually active by the age of 19. The researchers found that sexually active girls were more likely to be living alone and less likely to be taking HIV treatment – even though their blood tests suggested that they needed to. This could imply that these girls did not have the social support they needed.

The study also found that many girls were not having the right tests and examinations to monitor their sexual health. Over 40% of the sexually active girls had never had a Pap smear to look for abnormal cervical cells – a key test to monitor for the warning signs of cervical cancer. When Pap smears were performed, a significant proportion of girls – around a third – were found to have abnormal cervical cells.

New from NAM

Criminal HIV transmission

This new title from NAM provides evidence-based, up-to-date information in clear, layman’s language on aspects of HIV that may relate to the investigation, prosecution, and defence of criminal HIV exposure/transmission cases.

It’s primarily aimed at people who work within, or are in contact with, the criminal justice system. But the book is also likely to be useful for those who work at HIV support organisations, as well as HIV-positive individuals with an interest in criminal HIV transmission.

The book cost £14.95 for professionals, but is available at the discounted rate of £9.95 to voluntary organisations.

For more information or to order a copy of the book, please contact NAM by phoning 0207 8400050 or emailing info@nam.org.uk

Booklets

NAM's information booklets anti-hiv drugs, hiv & mental health, hiv & hepatitis and hiv & women have recently been updated.

Please order your free copies today.

You can also download them at:

http://www.aidsmap.com/cms1187580.asp

Please note we do charge professionals for these booklets, but don't forget, if your clinic is giving them out to patients you can order them for free. Overseas postage costs apply To find out more email info@nam.org or phone 020 7840 0050.