The drugs currently recommended for the treatment of gonorrhoea come from a class of antibiotics called cephalosporins. Two of these drugs are cefixime and ceftriaxone.

Cefixime is the most commonly used of these drugs. Researchers found that about 1% of gonorrhoea cases are resistant to the drug. But when they used a stricter definition of resistance, this figure leapt to 10%.

Resistant strains were especially likely to be detected in gay men, a third of whom had HIV.

Few gonorrhoea cases were resistant to ceftriaxone. But the researchers found that if an infection was resistant to one drug in the cephalosporin class it was often resistant to another drug as well.

Professor Cathy Ison of the HPA commented: “At the moment the drugs we use in the UK are still effective for treating gonorrhoea. But our lab tests show that the bacteria are becoming less sensitive to these drugs and the worry is that we could see gonorrhoea become a very difficult infection to treat within the next five years, as [it is] elsewhere in the world.”

The HPA also announced that there were 482,696 new diagnoses of sexually transmitted infections in 2009. Many of these were in young adults. New diagnoses of chlamydia, gonorrhoea and genital herpes increased between 2008 and 2009.

HIV and flu

The annual flu season is fast approaching, and separate studies have looked at the effectiveness of flu vaccines in people with HIV.

Swine flu
The first focused on the vaccine against swine flu (H1N1). There was a global pandemic of this infection in 2009/10. A vaccine against swine flu was quickly developed and people with HIV were one of the groups recommended to receive it.

US researchers looked at the response to the vaccine in 120 HIV-positive patients.

They all received the standard 15µg dose via an injection.

All the patients were taking HIV treatment, and their average CD4 cell count was over 500. Almost all of them had an undetectable viral load.

Tests showed that about a third of patients had already been exposed to swine flu and had antibodies against the infection.

Vaccination only produced protective levels of antibodies in 61% of the remaining patients.

Those who did not respond to the vaccine had lower current and ‘nadir’ (lowest ever) CD4 cell counts than those who did respond to it.

The researchers think the results show the need for alternative vaccination strategies for people with HIV. For example, the use of higher doses, or using the vaccine with other agents that boost its potency.

Encouragingly, the vaccine was shown to be safe. The most common side-effect was mild pain or inflammation at the site of the injection.

Seasonal flu vaccine
A separate study looked at responses to the seasonal flu vaccine in people with HIV.

The study involved 24 people with HIV and 31 HIV-negative people (‘controls’). The researchers compared antibody and immune responses to the vaccines between these two groups. They also examined response to the vaccine in patients with HIV according to their CD4 cell count.

All the HIV-negative people had a good response to the vaccine. They produced protective antibodies, and immune system cells to fight flu were also stimulated.

HIV-positive patients with a CD4 cell count above 350 also responded well to the vaccine. All developed antibodies to the infection. But flu-specific CD4 cells were only detected in 64% of patients.

A CD4 cell count below 350 was associated with both a poorer antibody and CD4 cell response to the vaccine.

The researchers recommend that all HIV-positive patients should have an annual flu vaccine, regardless of their CD4 cell count. They stress that it is important to build up immunity to flu when a person has a relatively intact immune system.

Visit the NHS website for more general information on the seasonal flu jab.

Treatment as prevention

Increasing the number of people taking HIV treatment seems to reduce the number of new HIV infections, Canadian research suggests.

One of the most exciting and controversial areas of HIV medicine is the use of HIV treatment as prevention.

The debate was kick-started in 2008 when a group of Swiss doctors issued a statement saying that – in certain circumstances – people taking HIV treatment who had an undetectable viral load were not infectious to their sexual partners.

HIV treatment reduces the amount of virus (viral load) in blood and other body fluids. The Swiss doctors pointed to research that showed that few new HIV infections originated in people with a viral load below a certain level.

Few have gone as far as the Swiss and said that people with an undetectable viral load are completely uninfectious. However, there is a growing consensus that people who take HIV treatment have their infectiousness reduced. And there are real hopes that that might have an impact on the spread of HIV.

Doctors in the Canadian province of British Columbia want to increase the number of people with HIV who take treatment as a way of controlling the epidemic. They have even estimated that in certain circumstances it could eventually eliminate new HIV infections.

Now new figures show that there were marked falls in the number of new HIV diagnoses in the province between 1996-99 and 2004-2009. These were periods when the number of patients starting treatment increased substantially.

The number of new HIV diagnoses fell during these periods, despite more HIV tests being conducted.
Jobs at NAM

We’re currently recruiting for a key role at NAM, based in London.

Visit the jobs page of our website for more information and to download an application form.

HIV Treatment Update – please tell us what you think!
HIV Treatment Update is NAM’s regular printed newsletter, bringing you analysis and discussion of the latest HIV news and developments.

We’re currently asking HTU readers what you think of the publication. You can complete the printed survey included in the July edition, or let us have your views by filling it in online here.

We really want to hear from you, so if you haven’t already, please fill in a survey today.

You can do it, Craig!
Craig arrived in Bordeaux last night, tired and sore, but on schedule!

He’s part way through his cycle ride from London to Vienna (2200 miles!), raising funds for NAM – so far he’s raised over £1300.

You can sponsor Craig and also keep an eye on his progress at www.justgiving.com/vienna.

Or if you would like to find out more about raising money for NAM, visit our fundraising webpages or contact us at info@nam.org.uk or 020 7840 0050.

EHRC Inquiry into Disability Harassment
The Equality and Human Rights Commission is holding a formal inquiry into disability harassment.

If you’ve been bullied or harrassed because of your HIV status, or know of it happening to others, you might like to give evidence and help stop it happening.

The deadline is Friday 10 September. You can find out more and submit your evidence here.

For more details, please contact NAM

tel: +44 (0)20 7840 0050
fax: +44 (0)20 7735 5351
email: info@nam.org.uk
web: www.aidsmap.comTo unsubscribe from this email, please visit www.aidsmap.com/page/1492854/

Reasons suggested for this include the effects of HIV itself, side-effects of anti-HIV drugs and the fact that people with HIV also have high levels of the traditional risk factors for CVD, such as smoking and high blood pressure.

Now some research in the US has confirmed that some of these traditional risk factors are the main cause of the thickening of the carotid artery, a key early sign of CVD.

Researchers found that age, blood pressure, HDL cholesterol levels and being of African American or Hispanic origin were all associated with thickening of the artery.

There was no association between HIV disease progression and arterial thickening, nor between most classes of anti-HIV drugs and increased carotid artery thickness. In fact, one drug – tenofovir (Viread) – was found to be associated with lower arterial thickness.

Your lifestyle can have a big impact on your risk of heart disease and there’s a lot you can do to reduce the risk. It makes good sense not to smoke, to eat a healthy diet and to get some exercise. Help is available for all these things, so ask your HIV clinic or GP.

HIV treatment
A newer anti-HIV drug, maraviroc (Celsentri), is potentially a useful treatment for people who are diagnosed late (with a CD4 count of under 200) with HIV, researchers in Austria have found.

People whose CD4 count is under 200 when they are diagnosed are at greater risk of developing a number of serious illnesses.

Maraviroc has been used for some time to treat people who have been on other sorts of anti-HIV drugs. It works by preventing HIV from interacting with CCR5 and therefore infecting other cells and replicating. It is now available as a first-line treatment and the researchers wanted to see how well it could work in people diagnosed with a low CD4 count.

Almost all types of HIV use ‘co-receptors’ called CXCR4 or CCR5 to allow HIV to attach to other cells. CCR5 inhibitors block infection by viruses that use CCR5. In later stages of HIV disease the virus mainly uses CXCR4, so a CCR5 inhibitor wouldn’t work against these viruses.

However, this study found that a high proportion of patients with low CD4 counts and advanced HIV disease would respond to a CCR5 inhibitor.

The study suggests that maraviroc could be a useful drug to include in a treatment combination for people diagnosed late – it shouldn’t be assumed that this drug won’t work in patients with low CD4 counts without doing a test, called a tropism test, first.

HIV, treatment and risk behaviour
Sexual risk behaviour by injecting drug users doesn’t increase once they have started HIV treatment, a study from Canada has found.

HIV treatment can both dramatically increase people’s life expectancy and reduce the chances that they will pass on the virus through sexual transmission.

But there have been some concerns that injecting drug users may have difficulty taking their treatment properly (‘adherence’), and also that people might take more risks in their sexual behaviour once they are on treatment – perhaps having more sex, more unprotected sex or a higher number of partners.

This study showed no evidence that starting HIV treatment increased any of these risk factors. The researchers recommended that different ways of encouraging and enabling injecting drug users to start HIV treatment should be put in place.

When used properly and consistently, condoms can prevent HIV and many other sexually transmitted infections.

HIV and bone health
Bone loss is an issue that affects people more as they age, and the number of older people with HIV is increasing, especially as effective HIV treatment means people are living longer.

HIV, and some HIV treatments, have also been associated with lower bone mineral density, which may possibly lead to an increased risk of fracture.

And people with HIV have high levels of other risk factors for bone loss, such as low testosterone levels, low body weight, smoking, heavy drinking and poor nutrition.

Recent research has looked at bone loss in older men, who were either HIV-positive or at high risk of becoming so because of injecting drug use or high-risk sexual behaviour.

It was found that the HIV-positive men had lower bone density then those without HIV, and that they were more likely to develop osteopenia, the precursor to osteoporosis.

Having had an AIDS diagnosis or having used heroin was also associated with greater bone loss.

There is a lot you can do to protect the health of your bones. Eating a balanced diet, with plenty of calcium and vitamin D (and taking supplements if necessary), not smoking, and taking weight-bearing exercise, will all help to reduce bone loss. Ask your clinic or GP if you’d like more information on any of these.
Jobs at NAM

We’re currently recruiting for a key role at NAM, based in London.

Visit the jobs page of our website for more information and to download an application form.

HIV Treatment Update – please tell us what you think!
HIV Treatment Update is NAM’s regular printed newsletter, bringing you analysis and discussion of the latest HIV news and developments.

We’re currently asking HTU readers what you think of the publication. You can complete the printed survey included in the July edition, or let us have your views by filling it in online here.

We really want to hear from you, so if you haven’t already, please fill in a survey today.

Good luck Craig!
Craig starts his mammoth cycle ride from London to Vienna (2200 miles!) on Friday, raising funds for NAM.

“NAM is a vital resource in the fight against HIV and AIDS for affected communities and those working to support them. Needless to say, a very worthy cause and one I’m proud to be supporting.”

You can sponsor Craig and also keep an eye on his progress at www.justgiving.com/vienna.

Or if you would like to find out more about raising money for NAM, visit our fundraising webpages or contact us at info@nam.org.uk or 020 7840 0050.

EHRC Inquiry into Disability Harassment
The Equality and Human Rights Commission is holding a formal inquiry into disability harassment.

If you’ve been bullied or harrassed because of your HIV status, or know of it happening to others, you might like to give evidence and help stop it happening.

The deadline is Friday 10 September. You can find out more and submit your evidence here.

For more details, please contact NAM

tel: +44 (0)20 7840 0050
fax: +44 (0)20 7735 5351
email: info@nam.org.uk
web: www.aidsmap.comTo unsubscribe from this email, please visit www.aidsmap.com/page/1492854/

Aspirin is already widely used to reduce the risk of illnesses such as heart disease and stroke in HIV-negative patients. The treatment is simple and involves taking a single tablet every day. The drug thins the blood and prevents the formation of clots that are a feature of some cardiovascular conditions.

Cardiovascular disease is now a major cause of illness in people with HIV. The number of patients with HIV at risk of such diseases is expected to increase even more as more people with HIV live into older age.

Updated guidance on the use of aspirin to prevent cardiovascular disease was recently published in the US. It supports the use of aspirin for men aged between 45 and 79 and women between the ages of 55 and 79 who have other risk factors for cardiovascular disease.

Spanish researchers looked at the records of 120 HIV-positive patients to see how it could be applied to patients with HIV. They calculated that, using the new US guidance, 31% of all patients (and 40% of men) would be candidates for aspirin therapy.

However, only two people were currently taking this treatment.

The researchers believe that many people with HIV who have risk factors for cardiovascular disease would benefit from treatment with aspirin.

But although aspirin is a very widely used drug, it can have other effects. If you are thinking about using aspirin, you should talk to a member of your healthcare team first.

Symptoms can predict an increase in viral load
Both physical and psychological symptoms can predict viral load increases in people taking HIV treatment.

Symptoms such as worry, sadness and diarrhoea were especially associated with rebounds in viral load to detectable levels.

Earlier research had shown that depression is associated with HIV disease progression in people who are not taking treatment.

Researchers in London wanted to see if symptoms could show which patients who were taking HIV treatment and who had an undetectable viral load had an increased risk of a rebound in their viral load.

In 2005, 188 patients who were taking HIV treatment and who had an undetectable viral load completed a questionnaire asking if they had experienced a range of physical and psychological symptoms.

Many of the patients reported experiencing symptoms. Some of the more common ones were tiredness (25%), worry (25%), and problems sleeping (21%).

The researchers then monitored their patients for an average of two years to see if there was any association between symptoms and changes in viral load. They found that both physical and psychological symptoms were associated with an increased risk of viral load increasing to detectable levels.

Even after taking into account reported adherence, the researchers found that anxiety and depression predicted a sustained rebound in viral load.

The researchers believe that their findings could have implications for the type of care offered patients taking treatment.

They suggest that an assessment “of virologic failure risk that is based solely on laboratory results, treatment history and adherence may be missing an important dimension – information from the patient’s perspective”.

Hepatitis C co-infection and CD4 cell count
CD4 cell count increases in HIV-positive patients taking antiretroviral therapy are smaller if they have a detectable hepatitis C viral load.

Many people with HIV are co-infected with hepatitis C. The liver disease caused by hepatitis C is a major cause of illness and death in these co-infected patients.

It’s known that HIV can hasten hepatitis C disease progression. However, there’s contradictory information about the impact of hepatitis C on HIV disease progression.

Canadian researchers were concerned that some of the research looking at the association between hepatitis C and the pace of HIV disease may have been flawed. This is because people were defined as having hepatitis C if they had antibodies to the disease.

Some people spontaneously clear hepatitis C, but they still have antibodies to the infection. This means that earlier research was likely to have included patients in the hepatitis C group who were actually free of the infection but still had antibodies.

To try and overcome this issue, the researchers compared changes in CD4 cell counts in two groups of HIV-positive patients. One group of patients had cleared infection with hepatitis C; the other group had developed long-term hepatitis C infection, with ongoing replication of the virus.

Changes in CD4 cell count were monitored before and after these two groups started taking HIV treatment.

There was some evidence that the rate of CD4 cell count loss was faster amongst the patients with ongoing hepatitis C replication. These patients lost an average of 84 CD4 cells per year, compared to a loss of 44 cells for patients who had cleared their hepatitis C infection.

After the patients started treatment, increases in CD4 cell count were significantly lower for patients with chronic hepatitis C infection. What’s more, these patients continued to have reduced increases in their CD4 cell count over time.

The researchers believe that successful treatment for hepatitis C would have dual benefits for co-infected patients. It would reduce their risk of liver disease, and also improve their HIV-related prognosis.

HIV and the criminal law
In many countries people with HIV have been prosecuted because they didn’t tell their sexual partner they had the virus.

In England, a person with HIV can only be prosecuted if they don’t disclose their HIV status to their sexual partner and transmission occurs. However, in some countries you can be charged for just having sex without disclosing your HIV status, even if there is no transmission.

The recent International AIDS Conference in Vienna was told about some of the tactics that have been used to stop prosecutions in Europe and the US.

For example, in the Netherlands constitutional arguments were used to stop prosecutions.

In England, the defence was able to show the limitations of the scientific evidence that the prosecution was relying on to secure convictions.

In Switzerland, the Geneva Court of Justice ruled that a person was not guilty of unlawfully exposing a sexual partner to HIV because the accused had an undetectable viral load and was fully adherent to treatment. In these circumstances, the objective risk of transmission was judged to be so low that it was hypothetical. In this decision, the court was aided by the Swiss Federal AIDS Commission’s statement on transmission risks and by expert testimony from one of its authors. This tactic is relevant in exposure (rather than transmission) cases.

NAM has recently published a new resource HIV and the criminal law. It is currently available in full online and a print version is in production.

A satellite meeting, ‘Criminalisation of HIV exposure and transmission: global extent, impact and the way forward’, was held in Vienna and you can view a video of the meeting on our website.
aidsmap 2.0

We’ve recently launched a new version of our website aidsmap.com. Come and have a look around and let us know what you think!

You can read more about the redevelopment on our blog.

HIV Treatment Update – please tell us what you think!
HIV Treatment Update is NAM’s regular printed newsletter, bringing you analysis and discussion of the latest HIV news and developments.

We’re currently asking HTU readers what you think of the publication. You can complete the printed survey included in the July edition, or let us have your views by filling it in online here.

We really want to hear from you, so if you haven’t already, please fill in a survey today.

Living with HIV? Help shape the global response
GNP+, the Global Network of People Living with HIV, is carrying out an online survey. Through this, they hope to include the voices of as many people living with HIV as possible throughout the world.

The survey takes 15 minutes and is confidential and anonymous. It is available in English, French, Spanish and Russian, and is open until 31 August 2010.

You can also find it on the GNP+ website, where you can find out more about GNP+ and its work.

Meet Craig
Craig is cycling from London to Vienna (2200 miles in 21 days!) to raise money for NAM. We think he’s amazing.

“NAM is a vital resource in the fight against HIV and AIDS for affected communities and those working to support them. Needless to say, a very worthy cause and one I’m proud to be supporting.”

You can sponsor Craig and also keep an eye on his progress at www.justgiving.com/vienna.

Or if you would like to find out more about raising money for NAM, visit our fundraising webpages or contact us at info@nam.org.uk or 020 7840 0050.

Gay and bisexual men’s sex survey
There’s still time to take part in EMIS – the European gay and bisexual men’s sex survey which incorporates the UK’s Gay Men’s Sex Survey also known as Vital Statistics. Run by Sigma Research, the survey is available to complete in 25 languages, until 31st August 2010.

For more details, please contact NAM

• HIV and illness
• CD4 cell count and lymphoma risk
• Alcohol and HIV disease progression

HIV and illness

The life expectancy of people with HIV has improved dramatically in recent years.

Treatment with anti-HIV drugs means that many people with HIV can expect to live a long and healthy life, with a prognosis that is near normal.

Taking HIV treatment means that not only is it highly unlikely someone will become ill because of HIV, but it also reduces the risk of some other serious illnesses such as heart, kidney and liver disease.

HIV itself is thought to cause inflammation and other disturbances to the body’s systems that can lead to these illnesses. Therefore, it’s recommended that people should start taking HIV treatment when their CD4 cell count is around 350, and people with other risk factors for heart, kidney and liver problems are especially encouraged to start treatment at this time.

But US research has now shown that many patients taking HIV treatment are still much more likely to have blood abnormalities indicating inflammation, an increased risk of blood clots, or kidney problems than people in the general population.

The researchers say that more studies are needed to find out why this is the case.

Routine HIV care should involve regular tests to monitor the health of your heart and other organs. The early identification of problems means that appropriate treatment can be provided.

For more information on tests used to monitor your health, you may find our booklet CD4, viral load and other tests helpful. It is available to download as a PDF from our website, or can be ordered from our online bookshop.

CD4 cell count and lymphoma risk

Taking HIV treatment has been shown to reduce the risk of developing AIDS-related and non-AIDS-related cancers.

One AIDS-related cancer is non-Hodgkin’s lymphoma.

Rates of this cancer have dropped dramatically since effective HIV treatment became available.

However, the cancer is still more likely to occur in people with HIV than in the general population. What’s more, researchers have found that patients with HIV who develop this cancer are about 40% more likely to die from it than HIV-negative individuals with the malignancy.

More encouragingly, the researchers found that HIV-positive patients with non-Hodgkin’s lymphoma whose CD4 cell count was above 200 were no more likely to die because of it than HIV-negative patients with the cancer.

The researchers therefore stress that protecting the immune system reduces the risk of death from this cancer. They believe their findings support starting HIV treatment before the virus has done too much damage to the immune system.

Alcohol and HIV disease progression

General advice about healthy living applies to people with HIV. A good diet, exercise, and not smoking are all important parts of a healthy lifestyle.

Many people enjoy drinking alcohol, and it is generally considered that low levels of alcohol consumption do not have any impact on the risk of HIV disease progression.

In the UK the NHS recommends that men should not drink more than 3 to 4 units a day, on a regular basis. For women the recommendation is lower – no more than 2 to 3 units a day. A unit of alcohol is equivalent to a third of a pint of beer, lager or cider, half a standard glass (175ml) of wine, or a 25ml measure of spirits.

But American researchers have found that HIV-positive individuals who have just two alcoholic drinks a day have faster disease progression than those who have lower levels of alcohol consumption.

Their research involved 231 HIV-positive drug users. Their alcohol consumption and CD4 cell counts were monitored over a 30-month period.

Individuals who drank two or more alcoholic beverages a day were about three times more likely to experience a drop in their CD4 cell count to below 200 than those who didn’t drink at all, or who consumed smaller amounts.

The researchers think this is because alcohol has an adverse effect on the immune system.

They also found that patients taking HIV treatment who consumed two or more alcoholic drinks a day were more likely to have a detectable viral load. They believe this was because drinkers had poorer adherence.

But the findings need to be treated with some caution. The study contradicts a lot of earlier research that found that moderate drinking has no impact on disease progression.

In addition, the study was conducted in a population of drug users, so it’s far from certain if its findings can be applied to be people with HIV generally.

Regardless of the findings of this study, it’s good to know that a lot of support is available if you are concerned about your use of alcohol or drugs. Your healthcare team at your HIV clinic are a good place to start.

The June issue of HIV Treatment Update (HTU) will include a feature article on alcohol. If you are personally affected by HIV you can subscribe to HTU free of charge through our online bookshop.

HIV Treatment Update – free to people with HIV

HIV Treatment Update is NAM’s regular printed newsletter, bringing you analysis and discussion of the latest HIV news and developments.

Recent editions have included features on insurance, employment rights, HIV-related bone loss, self-insemination, clinical trials, life expectancy, crystal meth, treatment guidelines and exercise, as well as regular updates on news and conferences around the world. An archive is available on our website.

HIV Treatment Update is available free to people living with HIV, or subscriptions can be bought. Visit our online bookshop for more information, or contact us at info@nam.org.uk or 020 7840 0050.

‘Finding out’
by Mr Turbulence

“For every one that is affected by this illness, I’d say to you, ‘your life doesn’t have to be defined by HIV, rather by what you make of it’!”

Read Mr Turbulence’s story on our mini website namlife.org.

Translated resources

New translations of our HIV information resources are now available on aidsmap.com.

You can download popular resources like the basics and our patient information booklets in ten languages: French, Spanish, Portuguese, Russian, German, Polish, Italian, Dutch, Romanian and Turkish.

Translations of our news coverage is also available in Spanish, Portuguese and Romanian.

For more details, please contact NAM

tel: +44 (0)20 7840 0050
fax: +44 (0)20 7735 5351
email: info@nam.org.uk

• Late diagnosis
• HIV-positive adolescents and pregnancy
• HIV and TB

Late diagnosis

It’s recommended that you should start taking HIV treatment when your CD4 cell count is around 350.

Starting HIV treatment at this time – rather than waiting until later – reduces your risk of becoming ill because of HIV. It also reduces your risk of developing some other serious illnesses as well – for example heart, kidney and liver disease, and some cancers.

But many people with HIV are diagnosed when their CD4 cell count is already low. Late diagnosis of HIV is the main reason underlying much of the HIV-related illness and death still seen in the UK today.

Now US researchers have found that, at the time of diagnosis, over half of all patients in the US have a CD4 cell count below the recommended threshold for starting HIV treatment.

Black people were especially likely to have low CD4 cell counts at the time of diagnosis.

But even if your CD4 cell count is below 350 at the time of your diagnosis, it’s good to know that HIV treatment can still be very effective.

HIV-positive adolescents and pregnancy

Thanks to improvements in treatment and care, many children who were infected with HIV at birth are now adolescents or young adults.

British researchers have found a high rate of unplanned pregnancies in this group of patients.

A quarter of the pregnancies were terminated. In 39% of cases, HIV status had not been disclosed to their sexual partners.

HYPNet, the HIV in Young People Network, and the Children’s HIV Association (CHIVA) have published draft guidance about the provision of pregnancy and sexual health support for HIV-positive adolescents.

It covers topics such as:

• preventing the transmission of HIV and other sexually transmitted infections;
• contraception;
• symptoms and treatment of sexually transmitted infections;
• vaccinations;
• HIV disclosure;
• post-exposure prophylaxis (PEP);
• conception options and fertility issues;
• pregnancy and avoiding mother-to-child transmission;
• options if there is an unplanned pregnancy;
• sexual exploitation and sexual violence;
• sexual difficulties;
• psychological support for negotiating safe sex,
• self-assertion, bullying and other issues.

The draft is on HYPNet’s website and out to consultation until 28^th May 2010. HYPNet and CHIVA would welcome comments.

HIV and TB

Preventing TB

Worldwide, tuberculosis (TB) is the biggest single cause of death amongst people with HIV, and in the UK it’s one of the most common AIDS-defining illnesses.

A vaccine against TB has been available since the mid-20th century, but it doesn’t always work. Research is currently underway to find a more effective vaccine against the infection.

Some people are infected with a form of TB that isn’t currently causing illness, but could do so in the future. This is called latent TB, and nine months of treatment with the anti-TB drug isoniazid can clear the infection in many cases. However, this can cause side-effects, and many people find this treatment difficult to take properly.

Now researchers are testing an experimental vaccine that works against TB (a therapeutic vaccine) that could reduce the duration of isoniazid therapy to just one month.

The study is being conducted in South Africa and the results are expected at the end of this year.

Recognising TB

Research from New York City shows that some progress has been made combating the TB epidemic.

TB emerged as a major public health problem in the city in the early 1990s. Most of the patients with the infection were HIV-positive.

The introduction of effective HIV treatment in 1996 was accompanied by a fall in the proportion of TB patients who were also HIV-positive. By 2005, only 22% of those with TB also had HIV.

The risk of HIV-positive patients dying fell considerably once powerful HIV treatment became available.

The proportion of drug-resistant TB cases also fell.

There were also changes in the demographics of TB patients. The percentage of patients diagnosed with the infection who were born outside the US increased. In the UK, many patients with TB are migrants from countries with a high prevalence of TB.

For more information on HIV and TB, including treatment for each condition, you may find our information booklet HIV & TB useful. It is available to download as a PDF from our website, or copies can be ordered from our online bookshop .

Translated resources

New translations of our HIV information resources are now available on aidsmap.com.

You can download popular resources like the basics and our patient information booklets in ten languages: French, Spanish, Portuguese, Russian, German, Polish, Italian, Dutch, Romanian and Turkish.

Translations of our news coverage is also available in Spanish, Portuguese and Romanian.

“I feel like me again”, by Matthew

“I found out in November last year that I was HIV-positive. It was a total shock. I was visiting family for dinner and was literally walking through the front door when the phone rang.

I think I already knew what she was trying to tell me, albeit that she didn’t want to tell me on the phone…”

Read Matthew’s story on our mini website namlife.org.

HIV Treatment Update – free to people with HIV

HIV Treatment Update is NAM’s regular newsletter, bringing you the latest HIV news and developments.

Recent editions have included features on insurance, clinical trials, life expectancy, crystal meth, HIV services after the election, smoking, exercise and treatment guidelines, as well as regular updates on news and conferences around the world. An archive is available on our website.

HIV Treatment Update is available free to people living with HIV, or subscriptions can be bought.

A cloud of volcanic ash has caused serious problems for people trying to travel to or within large areas of Europe for several days now. Some people may be experiencing problems because they are not at home and running out of supplies of antiretroviral drugs.

You can find more detailed advice on how to get hold of anti-HIV drugs here, or search for an HIV clinic for help and advice on finding emergency drug supplies here.

HIV treatment as prevention

One of the hottest topics in HIV at the moment is the use of treatment as prevention.

Taking HIV treatment reduces the amount of virus, not only in the blood, but also in sexual fluids. The levels of viral load in blood and genital secretions are related.

Very few HIV transmissions are thought to originate in people who are on HIV treatment and whose blood viral load is undetectable.

Most of the research looking at the link between treatment, viral load and infectiousness has so far been conducted in heterosexual people.

In 2008, a group of senior Swiss HIV doctors used this research as the basis for a statement, which said that – in certain circumstances – people taking HIV treatment should not be considered infectious to their sexual partners.

These conditions are:

• The HIV-positive partner has been on stable HIV treatment, with an undetectable viral load, for at least six months.
• They have good adherence to treatment, with no missed, late or incorrectly taken doses.
• They have no other sexually transmitted infections.

But Swiss doctors are now arguing that “early and continuous” HIV treatment could have a “profound” effect on the spread of HIV in gay men.

The doctors studied the virus in a group of gay men recently infected with HIV to see if it could be placed within clusters of HIV transmissions.

All the men took HIV treatment soon after their infection with HIV, but stopped after a year or so.

The researchers traced six transmission clusters, involving 28 men.

None of the men who transmitted HIV to a sexual partner had an undetectable viral load.

Most of the men those who passed on HIV were in the “chronic” phase of HIV infection, having had HIV for at least one year.

This surprised the researchers. Viral load is highest soon after a person is first infected with HIV, and some researchers have argued that as many as half of all new HIV infections originate in people who have only recently been infected themselves.

In the Swiss research, the viral load in people transmitting the virus ranged from as low as 300 to over 1 million copies/ml.

The researchers think that their findings could have major implications, suggesting that gay men should take early and continuous HIV treatment as a way of reducing transmissions.

However, Swiss HIV doctors have previously pointed out that treatment is not a replacement for safer sex.

The use of treatment as prevention is a highly controversial and rapidly evolving subject. Further developments will be reported in HIV Weekly.

HIV and TB

New international TB treatment guidelines

Tuberculosis (TB) is the single biggest cause of serious illness and death in people with HIV.

Treatment with combinations of antibiotics can cure TB in people with HIV, and there are guidelines about how these should be used.

The World Health Organization has just issued a new set of guidelines that include important changes on the earlier edition.

The new guidelines recommend that treatment should include the key anti-TB drug rifampicin (one of the drug group called rifamycins) for the duration of treatment.

They also say that treatment should be provided daily.

Antiretroviral treatment is endorsed for all HIV-positive patients with active TB.

Coinciding with the release of the guidelines was the publication of a paper which reviewed the studies looking at TB treatment for people with HIV.

This paper found that rifamycin treatment for eight months had the best results. The researchers also found evidence supporting the new recommendation that treatment should be taken daily, and that TB was more likely to be cured if a person took HIV treatment as well.

You can find out more about TB treatment in NAM’s information booklet, HIV and TB.

Preventing TB: a new vaccine being tested in people with HIV

A clinical trial has started, looking at the safety and effectiveness of a possible TB vaccine in people with HIV.

Although a vaccine for TB already exists, it doesn’t always work.

The candidate vaccine, which is called AERAS-402/Crucell Ad35, is being studied in HIV-positive patients in South Africa.

Treatment with the anti-TB drug isoniazid is recommended by the World Health Organization for people who have latent TB (TB that isn’t causing them to be ill at present).

But despite this recommendation, many of those with latent TB do not receive this treatment.

One reason is that some doctors fear it could lead to the development of drug-resistant TB.

However, researchers in South Africa have found that these fears may be unfounded.

They looked at the sensitivity of TB to the antibiotics used to treat people who developed active TB.

Their results showed that rates of isoniazid resistance were no higher amongst people who took preventive therapy with this drug, compared to those who did not.

Most of the people in the study were also HIV-positive.

HIV Treatment Update – free to people with HIV

HIV Treatment Update is NAM’s regular newsletter, bringing you the latest HIV news and developments.

Recent editions have included features on insurance, clinical trials, life expectancy, crystal meth, HIV services after the election, smoking, exercise and treatment guidelines, as well as regular updates on news and conferences around the world. An archive is available on our website.

HIV Treatment Update is available free to people living with HIV, or subscriptions can be bought. Visit our online bookshop for more information, or contact us at info@nam.org.uk or 020 7840 0050.

Looking for information on HIV transmission?

Clear and comprehensive information on HIV transmission can be hard to find.

Visit the HIV transmission section of our website for detailed information on subjects including co-factors that affect transmission, viral load and risk of transmission and protective measures.

We also produce a book covering these topics, HIV Transmission & Testing, which is available to buy from our online bookshop.

Women and HIV:
Inner strengths

A study is investigating the inner strengths women use in coping with HIV. If you are an HIV-positive woman in the UK, you can help by visiting the research team’s website and filling in an online questionnaire. You do not have to give your name.

HIV and TB

It’s World TB Day today.
Worldwide, tuberculosis (TB) is the biggest single cause of illness and death amongst people with HIV. Its impact is especially severe in poorer countries that have been hardest hit by HIV. But TB is also one of the most common AIDS-defining illnesses diagnosed in the UK.
TB is treated with a combination of antibiotics. This treatment can cure TB. However, some strains of TB have become resistant to the drugs used to treat them, and these resistant strains may need more intensive therapy. New figures show that rates of drug-resistant TB are now at record levels, and many HIV-positive TB patients in South Africa have resistant strains.
Resistant TB is also a problem here in the UK. Recent research showed that a third of all TB cases in prisoners involve a strain of the infection that has resistance to at least one anti-TB drug.
As with HIV treatment, therapy for TB works best if you take your treatment properly. That means completing the full six to nine months of treatment, and taking all the doses correctly.
You can find out more about TB, HIV and treatment in NAM’s information booklet, HIV & TB . The booklet Adherence & resistance tells you more about taking your HIV treatment.

Body weight and HIV
How body-weight issues differ for HIV-positive patients in richer and poorer countries has been shown by two recent studies.
A study conducted in the US showed that obese patients have poorer gains in CD4 cell counts after starting HIV treatment than those of normal weight, or patients who are overweight.
By contrast, a study conducted in Zambia showed that low body weight is a real concern for people with HIV, and that patients who gained weight after starting HIV treatment had the best outcomes.
Wasting and a low body weight are linked to an increased risk of illness and death for people with HIV.
Muscle and modest amounts of fat provide reserves that help the body fight off, and recover from, infections.
But being obese (significantly over your ideal weight) has been linked to a number of serious health conditions. Some of these, for example diabetes, cardiovascular disease and kidney dysfunction, are now major causes of illness in people with HIV.
Rates of obesity are increasing in many western countries, most notably the US. Researchers from the US military wanted to see what impact obesity had on immune function in people taking HIV treatment.
They monitored the weight and CD4 cell count of over 1000 patients.
Their results showed that obese patients gained significantly fewer CD4 cells after starting HIV treatment than people who were of normal weight or who were moderately overweight.
About 1% of patients in the US study were underweight. Just like the people taking part in the study in Zambia, these patients did less well after starting HIV treatment than those with a healthy body weight.
Diet and exercise can help you achieve and maintain a healthy body weight.
There’s information about these subjects in the NAM booklet, Nutrition, and on namlife.org , a site especially for people with HIV.

Drug interactions

Like most medications, anti-HIV drugs can interact with other treatments.
This is because many anti-HIV drugs are processed by the body in the same ways as other medicines.
As a result, levels of drugs can be increased, meaning that there’s a greater risk of having some side-effects. Or levels of drugs can be lowered. This can mean that there isn’t enough of a drug in the blood to work properly.
Researchers have found that levels of the important drugs used to prevent malaria called atovaquone/proguanil (Malarone) are reduced by up to 75% in people taking the anti-HIV drugs efavirenz (Sustiva, also in Atripla), Kaletra (lopinavir/ritonavir) and boosted atazanavir (Reyataz).
The researchers are uncertain how important this finding is. There’s never been a recorded case of atovaquone/proguanil treatment failure in people who are also being treated with anti-HIV drugs.
But they recommend that people taking HIV treatment should make sure that they take all their doses of atovaquone/proguanil and ensure that they do this with their main meal of the day.
It’s usually possible to do something about interactions and the study underlines that it’s important to tell your HIV doctor or pharmacist about any other medicines or drugs that you are taking when you are prescribed a new drug.
This includes those prescribed by another healthcare professional, over-the-counter treatment (such as cold and flu remedies), herbal and alternative remedies, and recreational drugs.
You can find out more about interactions in the NAM booklets Adherence & resistance and Anti-HIV drugs, or on namlife.org.
HIV Treatments Directory

New: the HIV Treatments Directory (28th edition)
A complete reference guide to HIV treatment and medical aspects of HIV, with A to Z listings and an intuitive layout. Comprehensive information, and details of published research covering topics including:
 starting and changing treatment
 A to Z of antiretroviral drugs
 women’s health issues
 drug resistance
 drug interactions and pharmacokinetics
 HIV and genetics
 side-effects
 the immune system and HIV
 prevention of mother-to-child transmission
Plus a full-colour drug chart and CD-ROM.
To order your copy, please visit NAM’s online bookshop. Alternatively, call 020 7840 0050 or email info@nam.org.uk.
Recently diagnosed and living in London?

HIV Weekly, 24 March 2010

HIV and TB

It’s World TB Day today.
Worldwide, tuberculosis (TB) is the biggest single cause of illness and death amongst people with HIV. Its impact is especially severe in poorer countries that have been hardest hit by HIV. But TB is also one of the most common AIDS-defining illnesses diagnosed in the UK.
TB is treated with a combination of antibiotics. This treatment can cure TB. However, some strains of TB have become resistant to the drugs used to treat them, and these resistant strains may need more intensive therapy. New figures show that rates of drug-resistant TB are now at record levels, and many HIV-positive TB patients in South Africa have resistant strains.
Resistant TB is also a problem here in the UK. Recent research showed that a third of all TB cases in prisoners involve a strain of the infection that has resistance to at least one anti-TB drug.
As with HIV treatment, therapy for TB works best if you take your treatment properly. That means completing the full six to nine months of treatment, and taking all the doses correctly.
You can find out more about TB, HIV and treatment in NAM’s information booklet, HIV & TB . The booklet Adherence & resistance tells you more about taking your HIV treatment.

Body weight and HIV
How body-weight issues differ for HIV-positive patients in richer and poorer countries has been shown by two recent studies.
A study conducted in the US showed that obese patients have poorer gains in CD4 cell counts after starting HIV treatment than those of normal weight, or patients who are overweight.
By contrast, a study conducted in Zambia showed that low body weight is a real concern for people with HIV, and that patients who gained weight after starting HIV treatment had the best outcomes.
Wasting and a low body weight are linked to an increased risk of illness and death for people with HIV.
Muscle and modest amounts of fat provide reserves that help the body fight off, and recover from, infections.
But being obese (significantly over your ideal weight) has been linked to a number of serious health conditions. Some of these, for example diabetes, cardiovascular disease and kidney dysfunction, are now major causes of illness in people with HIV.
Rates of obesity are increasing in many western countries, most notably the US. Researchers from the US military wanted to see what impact obesity had on immune function in people taking HIV treatment.
They monitored the weight and CD4 cell count of over 1000 patients.
Their results showed that obese patients gained significantly fewer CD4 cells after starting HIV treatment than people who were of normal weight or who were moderately overweight.
About 1% of patients in the US study were underweight. Just like the people taking part in the study in Zambia, these patients did less well after starting HIV treatment than those with a healthy body weight.
Diet and exercise can help you achieve and maintain a healthy body weight.
There’s information about these subjects in the NAM booklet, Nutrition, and on namlife.org , a site especially for people with HIV.

Drug interactions

Like most medications, anti-HIV drugs can interact with other treatments.
This is because many anti-HIV drugs are processed by the body in the same ways as other medicines.
As a result, levels of drugs can be increased, meaning that there’s a greater risk of having some side-effects. Or levels of drugs can be lowered. This can mean that there isn’t enough of a drug in the blood to work properly.
Researchers have found that levels of the important drugs used to prevent malaria called atovaquone/proguanil (Malarone) are reduced by up to 75% in people taking the anti-HIV drugs efavirenz (Sustiva, also in Atripla), Kaletra (lopinavir/ritonavir) and boosted atazanavir (Reyataz).
The researchers are uncertain how important this finding is. There’s never been a recorded case of atovaquone/proguanil treatment failure in people who are also being treated with anti-HIV drugs.
But they recommend that people taking HIV treatment should make sure that they take all their doses of atovaquone/proguanil and ensure that they do this with their main meal of the day.
It’s usually possible to do something about interactions and the study underlines that it’s important to tell your HIV doctor or pharmacist about any other medicines or drugs that you are taking when you are prescribed a new drug.
This includes those prescribed by another healthcare professional, over-the-counter treatment (such as cold and flu remedies), herbal and alternative remedies, and recreational drugs.
You can find out more about interactions in the NAM booklets Adherence & resistance and Anti-HIV drugs, or on namlife.org.
HIV Treatments Directory

New: the HIV Treatments Directory (28th edition)
A complete reference guide to HIV treatment and medical aspects of HIV, with A to Z listings and an intuitive layout. Comprehensive information, and details of published research covering topics including:
 starting and changing treatment
 A to Z of antiretroviral drugs
 women’s health issues
 drug resistance
 drug interactions and pharmacokinetics
 HIV and genetics
 side-effects
 the immune system and HIV
 prevention of mother-to-child transmission
Plus a full-colour drug chart and CD-ROM.
To order your copy, please visit NAM’s online bookshop. Alternatively, call 020 7840 0050 or email info@nam.org.uk.
Recently diagnosed and living in London?

Positive East in Stepney Green (London, E1) runs a ‘recently diagnosed’ course several times a year. The next one begins on Saturday, 10 April and then continues on Wednesday evenings from 14 April until 2 June.
The course is free and designed mainly for people who have received a diagnosis of HIV at some time within the last twelve months. However, you are also welcome if you have known about your positive status for longer but only now are able to start dealing with it.
For more information about this course, please telephone Jim at Positive East on 020 7791 2855 or email workshops@positiveeast.org.uk
About NAM
NAM is an award-winning, community-based organisation. We deliver reliable and accurate HIV information to HIV-positive people and to the professionals who treat, support and care for them.
We believe information helps people to make decisions about, and be in control of, their lives, health and treatment options. NAM is a UK registered charity number 1011220.
Find out more about NAM on our website: aidsmap.com.

For more details, please contact NAM

tel: +44 (0)20 7840 0050
fax: +44 (0)20 7735 5351
email: info@nam.org.uk
web: www.aidsmap.com