HIV update - 7th January 2015

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

Smoking doubles the risk of death for people with HIV

Two years ago, a study from Denmark showed that smoking has a bigger impact on the life expectancy of people living with HIV than HIV itself. An individual living with HIV who has never smoked could expect to live five years fewer than someone in the general population. On the other hand, someone living with HIV who smokes would live twelve years fewer.

Now the same researchers have analysed data on deaths and smoking in around 18,000 people in Europe and North America over a 14-year period. Everyone in the study was living with HIV and taking anti-HIV drugs.

They have found that smoking doubles the risk of death. Each year, 8 in every 1000 smokers died. Among non-smokers, 4 in every 1000 people died.

The increase in deaths was mostly due to cardiovascular disease (heart attacks, strokes, etc.), lung cancer, other cancers, and liver disease.

The life expectancy of a 35-year-old HIV-positive man who smoked was on average eight years shorter than that of an HIV-positive non-smoker. And as people got older, smoking had even more impact.

But the study shows the benefit of giving up smoking and therefore the importance of interventions which help people to quit. The risk of death for ex-smokers was no higher than for people who had never smoked.

You can get more information and advice on quitting smoking in our resource Living with HIV.

How effective are condoms during anal sex?

It is often assumed that condoms are close to 100% effective in preventing HIV transmission. This is the case during laboratory tests – where there is no scope for human error – but what about in real life?

Research shows that heterosexual couples who say they have used condoms consistently have around 80% fewer cases of HIV infection than couples who say they have not used condoms at all.

And what about effectiveness during anal sex? A new study suggests that condoms do substantially reduce the number of infections, but that they are far from fail-safe.

Every six months, 7725 gay men were asked about their use of condoms since the last interview – whether they had used them all of the time, some of the time, or never. They also gave information on the number of times they had had sex and the number of partners they had who they knew had HIV.

The researchers calculated that men who said they had used condoms all the time had 70% fewer HIV infections than men who never used them.

This figure can be contrasted with the 96% fewer HIV transmissions seen when people living with HIV take HIV treatment.

The results also show the limitations of condoms as a way of preventing transmission and the need for alternative methods, such as pre-exposure prophylaxis (PrEP).

Elite controllers

About one in 200 people with HIV maintains an undetectable viral load and a high CD4 count without having to take anti-HIV drugs. These individuals are sometimes called ‘elite controllers’ and have long been of interest to scientists.

Researchers would like to better understand how these individuals’ own immune systems keep HIV under control. They’d like to find out whether treatments such as therapeutic vaccines could induce the same state in other HIV-positive people, enabling them to stop taking anti-HIV drugs.

But a new study has found that the health of elite controllers is in some ways poorer than the health of other people with HIV with high CD4 counts. Over the six-year study, elite controllers had almost twice as many nights in hospital than people who had an undetectable viral load and were taking HIV treatment. While elite controllers had lower hospital admission rates for some medical conditions, they went to hospital far more often for cardiovascular disease and for psychiatric conditions.

There are some limitations to the study – it did not collect information about all the factors which could have affected participants’ health. But it does raise the question of whether elite controllers would in fact benefit from taking anti-HIV drugs or other medications.

And while elite controllers have long been seen as a model for researchers developing a ‘functional cure’ for HIV (i.e. people still have HIV but can stay off therapy for prolonged periods) the study challenges the idea that elite controllers are the right model to aim for.