Hepatitis C and quality of life

A recent conference heard that Spain is making dramatic progress towards eliminating hepatitis C in people living with HIV because of widespread use of direct-acting antivirals – the proportion of people living with HIV who have chronic hepatitis C has fallen dramatically from 22% in 2015 to 12% in 2016. Treatment cures people of infection and stops the virus from being passed on.

And curing hepatitis C also results in significant improvements in people’s quality of life, a study of over 3000 people shows. Every six months, participants completed questionnaires to assess their health-related quality of life, answering questions about energy levels, pain, emotional wellbeing, mental health and whether their health had impacted their ability to do things. All participants had been cured of hepatitis C during clinical trials of treatment that included the drug sofosbuvir.

After starting treatment participants saw significant improvements in all aspects of health-related quality of life, especially scores for ‘vitality’ and ‘general health’. The greatest improvements were seen in people who had co-morbidities (such as depression or type 2 diabetes), sleep problems, tiredness or liver cirrhosis before starting treatment.

Scores began rising at the end of treatment and continued to increase after achieving a sustained virological response (cure) until they were around the normal levels for people in the general population. The improvements were maintained through three years of follow-up.

For more information, read NAM’s booklet ‘HIV and hepatitis’.

Adherence to treatment for other health conditions

People living with HIV who take medication for other health conditions are less likely to miss doses of their HIV treatment than the other medication, according to a small study. Thanks to effective HIV treatment, people living with HIV can expect to survive well into old age and often need treatment for other health problems such as cardiovascular disease and depression.

Swiss doctors ran a survey with patients who were taking treatments for other conditions. Of the 105 people who took part, the average age was 56, three-quarters were men and almost all had an undetectable viral load.

Whereas 87% said that they had not missed any doses of their HIV treatment in the past four weeks, only 75% said that they had been fully adherent to the other treatments they took.

This might be because people did not always think that their good health depended on the other medicines that they took, whereas they did think this about their HIV treatment. The necessity of antiretroviral therapy was rated much higher (4.5 out of 5) than treatment for other long-term health problems (2.9 out of 5).

And participants had more concerns about the other drugs they took (4.1 out of 5) than they had for HIV treatment (2.9 out of 5). The researchers say this might be because people are often given less information and support about their other conditions than they get for HIV.

Immediate HIV treatment lowers the risk of death

An analysis from China adds to the evidence of the benefits of HIV treatment. People who start HIV treatment early and do so very soon after being diagnosed with HIV have a lower risk of death in the year following HIV diagnosis than people who don’t take treatment.

The study followed over 35,000 people who were diagnosed with HIV between 2012 and 2014. All of those included in the study had a CD4 cell count of over 500, which means they were diagnosed in good time and had a well-preserved immune system.

Around 5% started HIV treatment within 30 days of being diagnosed, while 16% started treatment later, and 79% did not start HIV treatment.

Deaths were uncommon, and were not generally due to HIV-related disease. The most common cause of death was heart disease.

Whereas 2.4% of those who did not start HIV treatment died within a year of diagnosis, this was the case for 1.0% of those who took treatment immediately. This amounts to a 63% reduction in the risk of death.

This is likely to be due both to the direct benefits of HIV treatment for the immune system and because people taking treatment had regular medical appointments, allowing other health problems to be identified and treated.

News from the 16th European AIDS Conference (EACS 2017)

This recent conference included several interesting studies which are relevant to people living with HIV in the UK. As a subscriber to HIV update, you should receive our email conference bulletins automatically.

You can also read the bulletins online. They include analyses of how the 56 Dean Street clinic has reduced HIV diagnoses in gay men, a European study showing that many people with HIV still expect to die prematurely and a survey of pre-exposure prophylaxis (PrEP) use in Europe.

The conference heard about a new drug for people with highly drug-resistant HIV (fostemsavir) and HIV maintenance treatment with two drugs, a boosted protease inhibitor and lamivudine. There was a lot of news on hepatitis C, including the success of Spain and Switzerland in treating large numbers of people and preventing onward transmission.