HIV update - 6th February 2019

A round-up of the latest HIV news, for people living with HIV in the UK and beyond.

HIV and the ageing process

Many people ask whether HIV speeds up the ageing process. In other words, do people living with HIV have a decline in physical function and develop age-related conditions at younger ages than their peers? 

There is still a lot that we don’t know about this, but a new study adds some interesting data.

The researchers wanted to compare ‘chronological age’ (the number of years a person has lived) with ‘biological age’. There is no agreed definition of biological age but the researchers tried to measure this by using a set of ten biomarkers. A biomarker is a biological molecule found in blood, other body fluids, or tissues that is a sign of a body process, a condition or a disease. In this case, the ten biomarkers all reflect age-related changes in body function or composition.

They looked at three groups of people:

  • People living with HIV (mostly gay men), over the age of 45, in London and Amsterdam. Their estimated biological age was 13 years older than their chronological age.
  • People of the same age who had very similar lifestyles to those living with HIV but were HIV negative. Their biological age was six years older than their chronological age.
  • Dutch blood donors – an unusually healthy group of people. Their estimated biological age was seven years younger than their chronological age.

One reason for the greater biological ageing of people with HIV in this study is likely to be viral infections and lifestyle factors (which would be similar in the first and second groups).

But despite those living with HIV currently having an undetectable viral load, they seem to have a more advanced biological age than their HIV-negative peers. It’s likely that some of this is due to damage to the immune system in previous years.

The researchers also found that one particular anti-HIV medication – the protease inhibitor saquinavir which was mostly used in the 1990s – was associated with increased ageing. But they were surprised to find that other older anti-HIV drugs were not linked with ageing in their data.

For more information, read NAM's factsheet 'HIV and the ageing process'.

Laws on non-disclosure of HIV status

Around the world, many countries continue to oblige a person living with HIV to disclose their status to a sexual partner before sex, regardless of the risk of HIV transmission or the protective measures taken. In these jurisdictions, HIV transmission does not need to occur: a person can be prosecuted for exposure (putting another person at risk of HIV) in the absence of transmission. 

Moreover, the law in many countries has not kept up with the scientific knowledge that people who have an undetectable viral load are uninfectious and pose no risk to their sexual partners.

Two new studies have looked at the impact of such laws on people living with HIV in Canada and Sweden.

The Canadian researchers focused on women, especially Indigenous women. It was important for minority women to be oversampled as the prevalence of both HIV and prosecutions is higher in Indigenous people.

The study showed that women were largely unfamiliar with and poorly informed about laws pertaining to non-disclosure. They felt that they were under surveillance by the criminal justice system when it came to their sex lives, as this woman explained:

“So how many people do you have in that room? You have the lawyer that’s witnessing the paper that you’re signing that you’ve disclosed. You have the doctor to say, ‘Yeah, you’re under a viral load’. You’ve got the forensic scientist there getting any evidence. You know, everybody is watching.” 

Women asked how they could be expected to prove that they had disclosed their status:

“Okay, so say I had a sexual partner. I just met this guy. And my CD4 count is 880. I’m undetectable. But I’ve got to tell him before we get into bed. Do I need to make him sign a document and lock it up and have it witnessed by the neighbour?”

Women said that if there was conflict in a relationship, a partner or ex-partner could threaten to report them to the police as not having disclosed their status. They pointed out that the law requires women to disclose their status in all kinds of situations – even to an abusive partner or a rapist. The non-disclosure law therefore put women in a more vulnerable position and at greater risk for violence.

In Sweden, doctors are obliged to give people living with HIV written ‘rules of conduct’. These outline the patient’s obligations, including disclosure of HIV status to sexual partners and using condoms. Since 2013, doctors can give an ‘exemption’ to people with an undetectable viral load from disclosing their status to sexual partners, but the researchers found that not all the gay men living with HIV they interviewed had been told about this.

Many described being given the ‘rules of conduct’ as an inherently stigmatising and negative experience, with a sense of being treated like a criminal. They also complained that they were given different messages by different doctors and nurses, with some clinicians appearing to be reluctant to explain that undetectable equals untransmittable” (U=U). The implied message was that men should continue using condoms as a precaution. One man said:

“After multiple ifs and buts [the nurse] finally explained the thing with low infectiousness. I recently thought about this and it was very moralising. “Well, don’t forget that there is still a risk of transmission”. All I really wanted was a clear answer. But she hardly wanted to give me that information.”

Men had often found out this information for themselves from other people living with HIV, HIV organisations or academic literature. Finding this out provided a relief from anxiety.

“There was a security within myself that the virus cannot be transmitted, and reasonably I should be able to have sex on equal terms, as if I didn’t have the virus.”

For information on the law in England and Wales, read NAM’s illustrated leaflet ‘Transmission and the law.’ For more information on the law in Scotland, read a leaflet produced by Terrence Higgins Trust, National AIDS Trust and HIV Scotland, ‘Prosecutions for HIV & STI transmission or exposure - a guide for people living with HIV in Scotland’.

Fatty liver disease

Non-alcoholic fatty liver disease is a major emerging health challenge for people living with HIV, according to a group of Dutch doctors.

Non-alcoholic fatty liver disease occurs when fat accumulates in liver cells, in people who do not drink heavily. In some people fat accumulation will cause no symptoms but in a minority of people, fat accumulation leads to more serious liver damage in the form of non-alcoholic steatohepatitis, fibrosis or cirrhosis, resulting in declining liver function.

Liver fat build-up is linked to being overweight and having a cluster of metabolic problems like high blood fat levels and type 2 diabetes (known as metabolic syndrome). Losing weight, regular exercise and a balanced diet can lower your risk of developing fatty liver disease. 

It’s possible that immune activation caused by HIV and a history of treatment with the first generation of antiretroviral drugs may place people living with HIV at higher risk of fatty liver disease.

For more information read NAM's factsheet 'Fatty liver disease and HIV'.