HIV update - 1st October 2014

HIV and ageing

Across the world, over 4 million people aged 50 years or over are living with HIV, a United Nations report shows. The largest number of older people with HIV are living in African countries – 2.5 million people.

Older people therefore make up a growing proportion of the total 35 million people who are living with HIV. The main reason for the growth is the success of HIV treatment in keeping people alive and healthy. Another reason is that an increasing number of people acquire HIV when they are over 50, showing that HIV prevention programmes cannot ignore this age group.

The research also indicates that medical and social services will need to adapt to address the often complex needs of older people living with HIV. This is especially important because living with HIV has been associated with an increased risk of diseases associated with old age.

More evidence of this was recently published, from researchers in the Netherlands. They compared the health outcomes of around 500 people living with HIV over the age of 45, and those of 500 people who do not have HIV. Those in the HIV-negative group were ‘matched’ with those living with HIV, meaning that they were of a similar age (average 52 years), gender (most were men), sexuality (most were gay) and nationality (most were Dutch).

Many of those living with HIV had been diagnosed for ten years or more. Almost all were taking HIV treatment and had an undetectable viral load.

People living with HIV were more likely to have a disease associated with ageing:

  • 45% had high blood pressure, compared to 31% of those without HIV.
  • 4% had had a heart attack, compared to 2%.
  • 3% had peripheral arterial disease (build-up of fatty deposits in the arteries restricting blood supply to leg muscles), compared to 1% of those without HIV.
  • 4% had kidney problems, compared to 2%.

This appears to be partly due to having HIV and to damage to the immune system. People who had previously had a CD4 cell count below 200 for a longer period were more likely to have these diseases. Scientists think this may accelerate the ageing process.

But it also seems to be due to differences in lifestyle. Those living with HIV were more likely to smoke, less likely to be physically active or get any exercise, and more likely to have too much fat around their stomach (a high waist-to-hip ratio).

When members of a person’s family had previously had heart disease or diabetes, this also raised the risk of these problems occurring. Changes to lifestyle can be especially important when there is a family history of heart disease.

Vaccination to protect against anal cancer

A small Irish study suggests that around half of gay men living with HIV could benefit from vaccination against human papillomavirus (HPV). This virus can be passed on during sex; infection can sometimes lead to anal cancer and other cancers, or – more frequently – genital or anal warts.

HPV can also cause cervical cancer, and for this reason girls in the United Kingdom receive the vaccination when they are aged 12 or 13. This policy has been in place since 2008, but boys are not vaccinated. Within a few decades, rates of HPV are likely to be so low in women that few heterosexual men will catch HPV. But gay men will not be protected.

A UK government committee is due to announce soon whether they think HPV vaccination should be offered to school-age boys as well as girls. This would benefit those boys who are gay. And the committee is also considering whether to offer vaccination to adult gay men, as almost none are vaccinated.

But there are some concerns about vaccinating adult gay men. One is that rates of HPV infection are so high that almost all sexually active men will have already got it by the time vaccination is offered. Vaccination would therefore be pointless.

But the Irish study is more encouraging:

  • While 77% of gay men living with HIV already had at least one type of HPV, 47% had one of the types of HPV that sometimes cause cancer. In other words, half did not yet have cancer-causing HPV and so would benefit from vaccination.
  • While 61% of HIV-negative gay men had at least one type of HPV, 36% had one of the types of HPV that sometimes cause cancer. In other words, two-thirds did not yet have cancer-causing HPV.

Testing for hepatitis C

There are two types of blood test which are used to detect infection with hepatitis C:

  • A test for antibodies to hepatitis C
  • A test for hepatitis C RNA (viral load).

Recent research shows how long the window period for the antibody test is – in other words, for how long after infection the test may not give accurate results. The study was done with gay men living with HIV in the Netherlands.

It found that, on average, the antibody test gave a positive result 74 days after hepatitis C was caught. The test took more than three months to work for 41% of people, and more than four months to work for 27% of people.

This shows that the test for hepatitis C RNA (viral load) – which has a much shorter window period – should be used when a person could have recently acquired hepatitis C recently. For example, if a person knows that they have had risky sex with someone who has hepatitis C, or if other medical tests show problems with the way their liver is working.

Hepatitis C treatment works best when it is started early, soon after infection.

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