HIV Weekly - April 11th 2006

Almost all the news in this edition of HIV Weekly comes from the recent conference of the British HIV Association (BHIVA), which took place in Brighton between March 30^th and April 1^st. It’s not one of the biggest HIV conferences of the year, but the studies presented to the BHIVA conference often show the real experience of HIV and HIV treatment in the UK.

• Mother-to-child transmission of HIV: Study finds a very low rate at a London hospital, but suggests that if mothers started HIV treatment sooner in pregnancy, more infections might have been prevented.
• HIV treatment in children: Doctors are becoming more skilled at treating HIV in children, but many children are now highly treatment experienced and have limited future treatment options.
• HIV treatment: UK HIV patients stay on their first combination for almost seven years, and side-effects are often the reason for changing treatment; Kaletra monotherapy proves effective for treatment-experienced people in clinical practice.
• HIV and hepatitis: People who have both HIV and hepatitis C may not do quite so well one HIV treatment, possibly because their ability to tolerate anti-HIV drugs is limited.
• HIV and sexual health: Some HIV-positive gay men have been infected with syphilis on multiple occasions, but treatment for syphilis seems to work just as well in HIV-positive and HIV-negative people. There’s also an in-depth news feature looking at syphilis treatment for people with HIV.
• Criminalisation of HIV transmission: An HIV-positive gay man pleads guilty to recklessly infecting his partner with HIV. There’s also an in-depth news feature looking at the criminalisation of HIV transmission.

Mother-to-child transmission of HIV

HIV can be passed on from a mother to her baby in the womb, during birth, and by breastfeeding. The overall risk of mother-to-child transmission of HIV is thought to be about 8%, but it is possible to reduce this risk to very low levels using the following strategies:

• Using anti-HIV drugs during pregnancy to lower the mother’s viral load. Anti-HIV drugs are also given to the newborn baby immediately after birth and for a month after.
• Using a caesarean delivery if the mother has a detectable viral load at the time of delivery. If the mother has an undetectable viral load, then she may have a choice of having a vaginal birth.
• By not breastfeeding – HIV-positive women in the UK should never breastfeed.

Doctors from King’s College Hospital in south London looked at how many HIV-positive babies had been born at their hospital between 1993 and 2004, and why this happened in each case.

There were a total of 296 pregnancies in 274 HIV-positive women during this period, and six babies were born with HIV. Four of these six babies became infected with HIV in the womb.

The King’s College Hospital doctors suggest that this finding could have implications for when HIV treatment should be started during pregnancy. Current UK treatment guidelines recommend that women who are not on potent anti-HIV treatment for their own health should start taking a multi-drug HIV treatment combination at the beginning of the third trimester of their pregnancy. If a woman has a low viral load (below 10,000) she has the option of only taking one anti-HIV drug – AZT (zidovudine, Retrovir). The south London doctors suggest that their findings show that HIV treatment should be started sooner, during weeks 22 or 23 of pregnancy.

HIV treatment in children

Anti-HIV treatment can mean a longer, healthier life for HIV-positive children. But less is known about HIV in children than in adults; there are fewer anti-HIV drugs available for HIV treatment in children; and less is known about the effectiveness and safety of HIV treatment in young people.

Doctors told the Brighton conference that they are getting better at treating HIV infection in children. The number of children dying as a result of HIV fell from 14 per 100 patient years in 1996, to 3 per 1000 patient years in 2004/05. Of the 18 children who died in 2003 – 05, seven were diagnosed with HIV when they were already very ill, and of the remaining eleven, only one took more than a few months of anti-HIV treatment prior to death.

The researchers also found that more children taking HIV treatment were managing to get an undetectable viral load. However, many children had taken a lot of anti-HIV drugs. A third of ten to 14 year-olds and over 40% of older children had taken drugs from all three of the main classes of anti-HIV drugs and many children had resistance to drugs, meaning that they have very limited future treatment options.

HIV treatment

HIV and hepatitis

Liver disease caused by hepatitis B or hepatitis C is now a major cause of illness and even death in people with HIV.

Evidence presented to the Brighton conference seems to show that HIV-positive people who are also infected with hepatitis C virus have a slightly higher risk of dying than people who only have HIV. 

Their study included people who had taken a lot of anti-HIV drugs before and were enrolled on the OPTIMA (Options in Management with Antiretrovirals) study. A total of 311 people were included in their analysis, 72 (23%) of whom had hepatitis C.

Over the two years of their study period, the researchers noticed that 25% of people who had both HIV and hepatitis C died compared to 16% of people who only had HIV. However, when the researchers did further analysis, controlling for injecting drug use, they noticed that the risk of death between HIV/hepatitis C coinfected people and those only infected with HIV ceased to differ significantly.

The researchers did notice, however, that people with both HIV and hepatitis C spent less time taking anti-HIV treatment, resulting in a risk of death that was increased by 37%. This might sound like a lot, but it wasn’t enough of an increased risk to be statistically significant.

There was no difference in the amount of new AIDS-defining illnesses which HIV/hepatitis C coinfected patients and people who only had HIV developed (both groups approximately 25%).

The doctors suggest that people who have both HIV and hepatitis C may be less able to tolerate anti-HIV drugs therefore meaning that they have a slightly increased risk of death.

HIV and sexual health

Sexually transmitted infections can be unpleasant and damage your health, and good sexual health is important for everybody. For people with HIV sexual health can be even more important. If your immune system is weak, then some sexually transmitted infections can be harder to treat. Having an untreated sexually transmitted infection can make it more likely that you will pass on HIV to another person during sex.

In recent years, there have been a number of outbreaks of the sexually transmitted infection syphilis across the UK (as well as in Europe, the US and Australia). In many of these outbreaks, HIV-positive gay men have been disproportionately affected.

Research conducted in Manchester and presented to the BHIVA conference in Brighton showed that a number of HIV-positive men who contracted syphilis and received treatment for the infection, are becoming reinfected with it on a second or even a third occasion.

The researchers also found that treatment for syphilis works just as well in HIV-positive and  HIV-negative people. You can read an analysis of treatment approaches to syphilis in people with HIV here.

Criminalisation of HIV transmission

Since 2003, a number of HIV-positive people have been sent to prison in England and Wales after being convicted of recklessly infecting their sexual partners with HIV.

Last week, the first case involving two gay men reached the courts. The 47 year-old man pleaded guilty and will be sentenced at a later date. The prosecutions for grievous bodily harm have been brought under Offences Against the Persons Act 1861, Section 20.

You can read about what these convictions mean for people with HIV by clicking here.

If you click here you can read an analysis of the background to the prosecution of HIV transmission, how HIV organisations have responded and what the future may hold.