HIV Weekly - 15th December 2010

Stem cell transplant cures man of HIV

German doctors are confident that a man’s HIV infection was cured after a stem cell transplant.

The patient received bone marrow from a donor who was naturally resistant to HIV. The donor’s genetic profile meant that his cells don’t have the CCR5 co-receptors that HIV latches on to so that the virus can infect cells.

The case was first reported in 2008. Now, researchers have published a follow-up report in which they state: “It is reasonable to conclude that cure of HIV infection has been achieved in this patient.”

Chemotherapy before the transplant and then intensive treatment with immunosuppressive drugs appears to have eliminated the patient’s own immune cells. This meant that his immune system could be repopulated by cells from the donated bone marrow. 

But the treatment was extremely unpleasant – it’s not going to be routine therapy to cure people with HIV.

Nevertheless, the patient is the first person ever to be officially pronounced cured of HIV, and his case provides important evidence for future research.

The full news story is available on our website. For more information on research into a cure, visit this article in the HIV treatment update archive.

HIV care – missed appointments associated with poorer outcomes

Even though there is no readily available cure for HIV, with the right treatment and care many people with HIV will live a near-normal lifespan.

However, new research has shown that people who miss appointments soon after starting treatment have a much poorer prognosis.

It was conducted in South Africa and involved approximately 4500 people who started HIV treatment between 2004 and 2008.

About a third of patients missed clinic visits to either collect their medication or for medical check-ups. The more appointments a patient missed during the first few months of treatment, the greater their risk of dying or being totally lost to care.

There’s a lot of help available if you are having difficulty keeping appointments or taking your treatment properly. It makes good sense to speak to someone at your clinic about your situation, or a local HIV organisation.

To find an organisation local to you, visit the e-atlas on our website. Alternatively, the helpline run by the Terrence Higgins Trust, THT Direct, can help you identify local services.

Side-effects – blood fat increases after starting HIV treatment

All medicines can cause side-effects, and the drugs used to treat HIV are no exception.

Many anti-HIV drugs can cause increases in blood fats (lipids) such as cholesterol and triglycerides. High levels of blood fats can increase the long-term risk of serious illness such as heart disease and stroke.

Researchers have found that a pair of drugs currently recommended for people starting HIV treatment is associated with lower increases in blood fats than some other drug combinations. However, this study included few people taking abacavir-based treatment.

The study focused on the impact of drugs from the nucleoside reverse transcriptase (NRTIs) class of anti-HIV drugs on levels of blood fats.

Most treatment combinations include two of these drugs.

Lower increases in fats were seen in patients taking tenofovir and FTC (usually combined in a pill called Truvada), or tenofovir and 3TC (lamivudine, Epivir) had smaller increases in their lipid levels than people taking other combinations.

For more information on the side-effects of HIV treatment, you can read our Side-effects booklet on our website.

Printed copies of these booklets are available free to clinics and organisations in the UK – contact us on 020 7837 6988 or info@nam.org.uk for more information.

Side effects – triglyceride levels and neuropathy

Separate research showed why it’s important to keep an eye on lipid levels.

It demonstrated that high levels of triglycerides were associated with a painful condition called neuropathy – nerve damage in the feet and lower legs.

A low CD4 cell count and a high viral load are risk factors for neuropathy. It can also be caused by some older anti-HIV drugs, treatment with statins, and drinking too much alcohol. It can also be caused by some older HIV drugs, such as d4T (stavudine, Zerit) and ddI (didanosine, Videx).

American researchers found that about a quarter of their HIV-positive patients had neuropathy.

Higher triglycerides significantly increased the risk of the condition.

Lipid levels should be regularly monitored as part of routine HIV care, and this means that increases in triglycerides can be spotted and addressed.

The Side-effects booklet is also available to download as a PDF from our website in English, French, Dutch, German, Hebrew, Norwegian, Polish, Russian, Spanish and Swedish.    

Hepatitis C

About a third of HIV-positive patients in Europe are also infected with hepatitis C.

There’s an ongoing epidemic of sexually transmitted hepatitis C among HIV-positive gay men in several European cities.

European doctors and activists have issued guidance about the management of acute hepatitis C in people with HIV.

The acute phase of hepatitis C is the first six months or so after exposure to the virus first occurs.

It’s important to promptly detect the infection. This means that patients can be properly monitored, and if necessary start treatment for hepatitis C. This treatment is much more likely to succeed if it’s provided soon after a person contracts the virus.

The guidance recommends that everyone with HIV should be tested for hepatitis C at least once. People who have an ongoing risk of the infection should also be tested at regular intervals.

Information about how hepatitis C is transmitted should be provided to patients.

Many infections are related to injecting drug use. But sexual transmission in HIV-positive gay men seems to be associated with fisting, group sex, drug use, and unprotected sex.

Monitoring hepatitis C viral load and liver function can show how the body is dealing with the infection and indicate if a person needs to start treatment.

A feature article, Staying free of hepatitis C, appeared in HIV treatment update earlier this year and is now available on our website.

Contact us on 020 7837 6988 or info@nam.org.uk to find out about subscribing to HIV treatment update (free to people affected by HIV).

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This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.

NAM’s information is intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member of your healthcare team for advice tailored to your situation.