HIV cure needs to be a priority
HIV treatment can mean a longer and healthier life and many doctors are optimistic that treatment with the currently available drugs will mean that many people with HIV will be able to live a near-normal lifespan.
But HIV treatment cannot cure a person of HIV. Even when a person has an undetectable viral load, very low levels of HIV can still be present in the blood and there are so-called “reservoirs” of the virus that even the most intensive HIV treatment cannot reach.
To make sure the money and expertise for this is available, there needs to be a public-private partnership with both drug companies and governments committing to the research, say leading HIV researchers.
HIV disease progression
Without treatment, most people with HIV will experience a gradual weakening of their immune system and develop serious HIV-related illnesses within eight to twelve years of their infection with the virus.
The rate of HIV disease progression can vary enormously between individuals.
The European researchers found that Africans lost fewer CD4 cells – key immune system cells – each year than patients of European ethnic origin.
And a separate US study showed that the a much higher proportion of African-American patients than patients of other ethnic backgrounds were what’s called “long-term non-progressors”, meaning their CD4 cell count had remained high and they had developed no HIV-related illness despite not being on treatment.
Both sets of researchers think there could be genetic reasons for this.
However, HIV treatment is recommended for all people once they develop HIV-related illnesses or when their CD4 cell count falls below 350.
Side-effects
All medicines can cause side-effects and the drugs used to treat HIV are no exception.
Researchers have been concerned that HIV treatment might increase the risk of cardiovascular disease, including illnesses such as heart disease and stroke.
Italian researchers have found more evidence supporting this theory.
They found that it is HIV itself rather than anti-HIV drugs that causes damage to the smooth lining of veins and arteries (endothelial dysfunction). This can be an important early warning sign of cardiovascular disease.
Their research involved people starting HIV treatment for the first time. Some started treatment based on a non-nucleoside reverse transcriptase inhibitor (NNRTI), and some with treatment that included a protease inhibitor. The researchers compared these people with ten HIV-positive individuals who weren’t taking anti-HIV drugs.
After a year of HIV treatment, there had been subtle improvements in the health of the veins of people taking HIV treatment. These improvements occurred even though the level of cholesterol increased in many people taking anti-HIV drugs.
But researchers found that evidence of damage to the veins and arteries was still present in people not taking HIV treatment.Monitoring the success of HIV treatment
Routine HIV care involves regular blood tests. Two key tests are CD4 cell count and viral load.
Measuring viral load is especially important if you are taking HIV treatment. The aim of HIV treatment is an undetectable viral load. HIV treatment needs to be changed quickly if successive tests show that viral load is detectable, otherwise resistance to HIV drugs can develop.
American researchers have found that it is possible to measure levels of some HIV drugs by analysing hair samples. Their research also showed that the results of this test could successfully predict if a person had an undetectable viral load. The test also served as a good indicator of adherence levels.
However, the researchers think that the test is likely to be most useful in poorer countries where blood collection is difficult and expensive.
Visits to the HIV clinic in countries like the UK will still therefore involve regular blood tests to monitor not only how HIV is affecting you, but also to check your general health.
HIV and sex
Most cases of HIV in the UK were acquired as a result of sex, and most people with HIV remain sexually active after their diagnosis.
UK researchers conducted in-depth interviews with 42 HIV-positive gay men who had recently had unprotected anal sex.
All the men were aware that HIV could be passed on to someone else through unprotected sex and said they would never want to be responsible for this happening.
The stigma that surrounds HIV, and the risk of rejection or reprisals, meant that many men were reluctant to disclose their HIV status to their sexual partners.
This meant that men often had unprotected sex with men whose HIV status they did not know. Many assumed that a partner having unprotected sex with them in a venue such as a sauna was an indication that the person was also HIV-positive.
Disclosure of HIV status on internet dating profiles was thought to be safer and involve less of a risk of hurtful rejection, disappointment or reprisal.
Although some men deliberately sought sexual partners who were also HIV-positive (serosorting), many men were very hostile to the idea.
When asked about the risk of sexually transmitted infections, the men’s answers indicated that they generally thought these weren’t serious and were treatable. There was some awareness of the risk of hepatitis C infection from unprotected sex. Many men thought that the risk of superinfection had been deliberately exaggerated by doctors.
Only about a third of men had a good understanding of criminal HIV transmission. Although some men now disclosed their HIV status because of the risk of prosecution, other men reported taking extra precautions not to disclose because of their concerns about potential prosecution.