Most people with HIV remain sexually active after their diagnosis.

But sexual problems are widespread.

A lot is known about sexual dysfunction in HIV-positive men, and now researchers have found that women with HIV are more likely to report sexual problems than their HIV-negative peers.

Support and help is available if you encounter problems with sex, so it’s worth mentioning it to a member of your healthcare team.

Smoking and lung cancer

Smoking is the only risk factor for lung cancer in HIV-positive women, US researchers have reported.

Rates of HIV-related cancers have fallen since effective HIV treatment became available.

But doctors have noted an increase in the rates of some other cancers, including lung cancer.

This cancer is still quite rare in people with HIV. However, researchers want to find out if those with HIV are at increased risk of developing it, and what its risk factors are.

They therefore looked at rates of lung cancer in women with or at risk of HIV. They then compared these rates to those seen in the general female US population.

Their analysis showed that rates of lung cancer did not differ between the HIV-positive and HIV-negative women in their study population.

However, the cancer rate for the women in the study was three times that seen in US women generally.

The women in the study were more likely to smoke than US women generally.

All the women who developed lung cancer were cigarette smokers, and the researchers found that smoking was the only risk factor for lung cancer.

A low CD4 cell count and increasing age were both associated with an increased risk of cancer for the women with HIV.

People with HIV should be given help to stop smoking, say the researchers.

You can find out more about smoking on namlife.org, NAM’s website for people with HIV.

Help to stop smoking will be available from your HIV clinic and GP.

The current issue of NAM’s HIV Treatment Update includes a feature article on smoking. HIV Treatment Update is available free to people living with HIV. Visit our online bookshop for more information.

Increases in viral load

Viral load increases in people taking HIV treatment are often preceded by physical or psychological symptoms, British researchers have found.

Modern HIV treatment is very effective and is able to suppress viral load to undetectable levels in most patients.

You’ll get the most benefit from your HIV treatment if you take it as prescribed. Missing doses can lead to viral load increasing, and in some cases the development of drug-resistant strains of HIV.

Researchers wanted to see if patients’ perceptions of their own health could be related to changes in viral load.

They therefore monitored 188 patients taking HIV treatment for the first time for an average of two years.

Viral load increased to detectable levels in about 20% of patients. The researchers found that the risk of this was significantly associated with physical and psychological symptoms.

The researchers speculate that such symptoms could indicate that patients are experiencing distress, which in turn could lead to poor adherence to HIV treatment.

If your HIV treatment is causing side-effects, then you should mention this to your HIV doctor. It’s good to know that it’s nearly always possible to do something about side-effects.

Similarly, if you are unhappy or depressed, it’s good to know that a lot of mental health support is available to people with HIV.

Sexual wellbeing

Many women with HIV have experienced some form of sexual dysfunction, US researchers have found.

The researchers asked approximately 1300 HIV-positive women and 500 HIV-negative women about their sexual function and satisfaction.

They found that women with HIV were less likely to report that they were satisfied with sex.

HIV was also found to be significantly associated with poorer sexual function.

Poor health, indicated by CD4 cell count, seemed be associated with lower levels of sexual functioning in women with HIV.

The researchers suggest that sexual wellbeing should be monitored in routine HIV care.

In the UK, the HIV support organisation Positively Women is also there to help. Their helpline is operated by women who are living with HIV, and can provide a good source of support and referral to other services. They can be contacted on 020 7713 0222.

Beliefs about infectiousness

A US study has found that HIV-positive people who believed that having an undetectable viral load meant they were less infectious were more likely to be diagnosed with a sexually transmitted infection.

The impact of HIV treatment on infectiousness is a hotly debated topic.

HIV treatment reduces viral load in both the blood and sexual fluids. Very few infections are thought to be passed on from people taking HIV treatment who have a low, or undetectable, viral load.

There is real hope that increasing the number of people taking HIV treatment will help to control the pace of the epidemic.

But untreated sexually transmitted infections can increase viral load in genital secretions. And wider increases in HIV risk behaviours could offset the reductions in new infections that are achieved by increasing the number of people taking HIV treatment.

Now US researchers have found that those who believed that people with an undetectable viral load were not infectious were about 33% more likely to be diagnosed with a sexually transmitted infection.

However, those diagnosed with a sexually transmitted infection were just as likely to use a condom as those without such a diagnosis.

HIV Treatments Directory

New from NAM for 2010: 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 antiretroviral drug chart and a fully searchable CD-ROM.

To order your copy, please visit NAM’s online bookshop. Alternatively, call 020 7840 0050 or email info@nam.org.uk.

Anti-HIV drugs

A new edition of NAM’s information booklet, Anti-HIV Drugs, is now available, covering information on each of the drugs currently licensed in the UK.

This comprehensive booklet is now available on aidsmap.com. The booklets in this series are available free to people living with HIV in the UK, or can be ordered through the aidsmap online bookshop for £1. Alternatively they can be read online, or downloaded as PDFs.

If you work in a clinic or support group in the UK, you can order these booklets for free for your clients and patients. Get in touch with Rose for details on 020 7840 0060 or by emailing rose@nam.org.uk.

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.

You can also request to have a questionnaire pack mailed to you or you can contact the lead researcher for more information.

This study is being conducted through Canterbury Christ Church University and has NHS ethical approval.

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

To unsubscribe from this email, please visit www.aidsmap.com/en/main/emailupdate.asp

In this issue

• HIV and ageing
• Cardiovascular disease
• Saquinavir/ritonavir and heart rhythm
• Bone disease
• Brain impairment
• Kidney disease
• Long sentence in Scottish case

HIV and ageing

Much of the news in this edition of HIV Weekly is concerned with the diseases of ageing.

Rates of HIV-related illnesses have fallen dramatically since effective HIV treatment became available. Because of this, many doctors are now optimistic that many people with HIV will live a near-normal life span.

But there’s concern that HIV itself, and possibly some of the drugs used to treat it, can cause bone, cardiovascular, kidney and liver disease. These are illnesses that are often associated with ageing.

There’s much that can be done to reduce the risk and impact of many of these illnesses.

This includes:

• Regular clinic check-ups to monitor for early warning signs.
• Starting HIV treatment if your CD4 cell count is around 350, or earlier if you have risk factors for any of the diseases of ageing.
• Taking a combination of anti-HIV drugs that takes into account your medical history.
• Doing your best to lead a healthy life by not smoking, eating a good diet, and exercising.

Cardiovascular disease

HIV treatment that reduces viral load to undetectable levels can cut the risk of hardening of the arteries, a study has shown.

An important factor associated with diseases such as heart attack and stroke is the hardening of the arteries (atherosclerosis). The arteries generally harden as people age, but more rapid hardening has been seen in people with HIV.

But now US researchers have found that HIV treatment may help slow the progression of atherosclerosis.

They found that the arteries of people taking HIV treatment whose viral load was constantly below 400 hardened at a slower rate than patients whose viral load was higher.

Older age and being over-weight – both traditional risk factors for cardiovascular disease – were associated with more rapid hardening of the arteries.

Saquinavir/ritonavir and heart rhythm

Medicine regulatory authorities in the US have issued a warning that the boosted protease inhibitor, saquinavir (Invirase) with ritonavir (Norvir), can cause disturbances in the rhythm of the heart.

They are cautioning that patients with heart rhythm problems, or who are taking other drugs that can cause an irregular heartbeat, should not use saquinavir/ritonavir.

If you are taking saquinavir/ritonavir and are concerned about this side-effect, it’s recommended that you to speak to your HIV doctor about your concerns.

You should not stop taking this drug without talking to your doctor first.

Bone disease

Both HIV itself and some of the drugs used to treat it – especially tenofovir (Viread, also in Truvada and Atripla) – have been associated with bone loss.

Bone loss often happens as people age and this can increase the risk of fractures.

Now two separate US studies have produced apparently contradictory results about the risk of fracture for people with HIV.

Most patients (79%) in the HOPS study were male, and researchers found that fractures were much more common amongst these HIV-positive patients than in the general US population.

Increasing age was identified as one of the factors associated with fracture. But so too were HIV-related characteristics, including a lowest-ever CD4 cell count below 200. Therefore, starting HIV treatment at the recommended level of 350 could potentially cut the long-term risk of bone problems and fracture.

However, separate research involving younger HIV-positive and HIV-negative women found that, although those with HIV had lower bone mineral density, this did not translate into an increased risk of fracture.

Brain impairment

Many people find the thought of HIV-associated brain impairment very frightening.

HIV-related dementia is now very rare, but some research suggests that milder forms of cognitive impairment are more common in people with HIV than in the general, age-matched population.

Now US researchers have found that patients whose lowest-ever CD4 cell count was below 50 have an increased risk of subsequently developing cognitive impairment.

Rates of cognitive impairment were lowest in patients who started HIV treatment when their CD4 cell count was 350 and above.

You can read more about HIV-related brain impairment in Issue 186 of HIV Treatment Update, available on our website.

Kidney disease

Untreated HIV can increase the risk of serious kidney problems, and one of the groups of people encouraged to start HIV treatment when their CD4 cell count is around 350 are those who have kidney disease or have other risk factors for it.

But some anti-HIV drugs have also been associated with kidney problems, most especially tenofovir (Viread, also in Truvada and Atripla), a drug that is widely used by people starting HIV treatment for the first time.

About 1 to 2% of people taking tenofovir develop kidney problems. Most research suggests that once treatment with the drug is stopped, kidney function quickly returns to normal.

In a newly published study, Australian researchers used a highly sensitive test, called estimated glomerular filtration rate, to measure kidney function and found that this doesn’t always happen.

This test showed that, in about 40% of patients, kidney function was still impaired over a year after treatment with tenofovir was stopped.

They found that patients who had a gradual decline in kidney function when taking tenofovir had the greatest risk of developing longer-term kidney damage.

The researchers recommend that patients taking tenofovir who develop kidney problems should quickly be changed to an alternative treatment.

Long sentence in Scottish case

A man has been sentenced to ten years in prison after infecting one female sexual partner with HIV, and for having unprotected sex without disclosure with three other women, none of whom contracted the virus.

The man was convicted of the Scottish offence of reckless and culpable behaviour.

HIV organisations have expressed alarm that the case has set a legal precedent in Scotland and that unprotected sex without disclosure, even if no HIV transmission occurs, can now be prosecuted.

In this BBC report, they point out faults in the logic of such a development.

About a quarter of all people with HIV are undiagnosed and therefore unable to disclose. Epidemiological evidence suggests that the source of many new HIV infections is people who are unaware that they have HIV, and that many of these individuals have only just been infected with HIV themselves.

The case has also been associated with some highly stigmatising press coverage.

In England and Wales, a prosecution can only be brought if a person knows that they have HIV, they do not disclose their status before having unprotected sex, and HIV transmission occurs.

If you have concerns about HIV transmission and the criminal law , a good place to seek support is THT Direct on 0845 12 21 200.

National AIDS Trust (NAT) has a trained group of HIV-positive volunteers called Press Gang who respond to inaccurate coverage of HIV in the media. For information about joining Press Gang, visit the NAT website.

Self-management courses

Are you HIV-positive? Would you like to improve your skills in managing your health and care? If so, and you live in South London, Terrence Higgins Trust is running several groups that can help, between now and June 2010. For more information on the Positive Self-Management Programme (PSMP) and the Newly Diagnosed Group (NDG), please email groupworklondon@tht.org.uk or call 020 7812 1773 to book a place.

HIV & Children

A new edition of NAM’s information booklet, HIV & Children, is now available. HIV & Children provides information about HIV treatment and care for HIV-positive children.

This comprehensive booklet is now available on aidsmap.com. Written for a UK audience, the booklets in this series are available free to people living with HIV in the UK, or can be ordered through the aidsmap online bookshop for £1. Alternatively they can be read online, or downloaded as PDFs.

If you work in a clinic or support group in the UK, you can order these booklets for free for your clients and patients. Get in touch with Rose for details on 020 7840 0060 or by emailing rose@nam.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

• HIV treatment
• New ritonavir tablet approved
• 3TC and FTC not as equal as previously thought
• Mother-to-child HIV transmission
• Treatment for lipodystrophy looks safe and effective

HIV treatment

Before approval, every anti-HIV drug goes through a series of clinical trials to make sure that it’s safe and effective.

Clinical trials have shown that the HIV treatment combinations used today have a very powerful anti-HIV effect.

New research has provided reassurance that combinations found effective in clinical trials are equally effective among people who start these treatments during their routine care.

American researchers found that equal proportions of patients starting treatment as part of a trial and during everyday care had an undetectable viral load after a year.

Gains in CD4 cell count were also similar.

But many people receiving routine HIV care failed to attend clinic appointments. The researchers think that social problems and difficulty accessing health care may have contributed to this.

It’s very important that you go to your HIV clinic for regular check-ups. If you are entitled to free NHS care, then all the treatment and care you receive from the clinic will be free.

You can also choose which clinic you go to. For help finding an HIV clinic in the UK, you can contact the Terrence Higgins Trust helpline, THT Direct, on 0845 12 21 200. You can also look for clinics near you by visiting the organisations section of our website, aidsmap.com.

back to top ^

New ritonavir tablet approved

All the protease inhibitors recommended for use in HIV treatment have their anti-HIV effect boosted by a small dose of a second protease inhibitor called ritonavir (Norvir).

A new formulation of ritonavir has been approved for use in Europe. Unlike the older formulation of this drug, these 100mg pills don’t need to be kept in the fridge.

This heat-stable formulation is already used in the combination pill Kaletra (lopinavir/ritonavir).

The approval of the new formulation of ritonavir in Europe is an important step in making it available in other regions of the world, where a heat-stable version of the drug is especially needed.

3TC and FTC not as equal as previously thought

Most people starting HIV treatment do so with a combination that includes either 3TC (lamivudine, Epivir) or FTC (emtricitabine, Emtriva).

This drug is normally taken in a combination pill. In the case of 3TC, this is called Kivexa, and the drug is combined with abacavir.

FTC is available combined with tenofovir in a pill called Truvada.

It is also in a pill called Atripla where it is combined with tenofovir and efavirenz (Sustiva). This drug provides triple-drug HIV treatment in one pill, taken once a day.

But some people take a combination that includes 3TC and tenofovir. This combination isn’t very widely used because it involves taking two separate pills.

Researchers have found that people who take this combination, and experience an increase in their viral load, are more likely to develop resistance if treatment fails to control viral load than those who take FTC and tenofovir.

All the people in the study were taking triple-drug HIV treatment and had had an undetectable viral load for at least six months. But their viral load then increased.

Tests showed that people taking 3TC and tenofovir were more likely to develop resistance, which meant that 3TC (and probably FTC) would no longer work well against their HIV.

The researchers also found that it could lead to resistance to an important new drug in the non-nucleoside reverse transcriptase inhibitor (NNRTI) class called etravirine (Intelence).

The researchers believe that their findings have implications for HIV care. They warn, “budget restrictions and the perception of a fundamental equivalence between 3TC and FTC may…lead to this possibly suboptimal prescription.”

Mother-to-child HIV transmission

HIV treatment during pregnancy, an appropriately managed delivery, and not breastfeeding can reduce the risk of mother-to-child HIV transmission to very low levels.

Thanks to these interventions, the rate of mother-to-child transmission in the UK and similar countries is very low – about 1%.

However, a very small number of transmissions do still occur when the mother has a low viral load – under 500 copies/ml.

French researchers have found some reasons why this might happen.

Their study involved women who took HIV treatment during pregnancy and had a low viral load (below 500) at the time of delivery. Nineteen of these women passed on HIV to their infants and 60 did not.

The researchers found that women who transmitted HIV to their infants had higher viral loads throughout pregnancy than the women who did not pass on HIV.

None of the women who transmitted HIV had a viral load below 500 for the entire duration of their pregnancy. However, 40% of women whose infants were HIV-negative had a viral load below this level throughout their pregnancy.

During the 30th week of pregnancy, 42% of mothers who passed on HIV to their infants had a viral load above 10,000 compared to only 11% of those who did not.

In addition, women who transmitted HIV were more likely to report adherence problems during pregnancy than those who did not.

To further reduce the risk of mother-to-child transmission, the researchers emphasise the importance of controlling viral load throughout pregnancy and of good adherence to HIV treatment.

Treatment for lipodystrophy looks safe and effective

Some older anti-HIV drugs cause a collection of side-effects called lipodystrophy.

Often this involves the accumulation of hard, visceral fat around the abdomen.

Not only can this be distressing, but the accumulation of visceral fat has been associated with an increased risk of cardiovascular disease. Increased levels of such diseases have been seen in people with HIV.

A year-long study has shown that a drug called tesamorelin is a safe and effective treatment for visceral fat accumulation.

The study was a placebo-controlled trial.

Overall, visceral fat levels fell by 17.5% in people taking tesamorelin compared to only 1% in people taking the placebo.

Body shape also improved in people taking tesamorelin.

In addition, cholesterol levels fell in patients treated with tesamorelin.

The drug is awaiting formal approval in the US, and its trade name will be Egrifta.

News from CROI 2010

The 17th Conference on Retroviruses and Opportunistic Infections takes place in San Francisco this month.

NAM will be reporting from each day of this major scientific conference and you will receive email bulletins summarising key news.

You can incorporate aidsmap news from the conference into your own website or newsreader using our news feeds, or encourage colleagues and friends to sign up to receive the bulletins, free of charge.

The bulletin will also be translated into French, Spanish, Portuguese, Russian and Romanian.

HIV & Children

A new edition of NAM’s information booklet, HIV & Children, is now available. HIV & Children provides information about HIV treatment and care for HIV-positive children.

This comprehensive booklet is now available on aidsmap.com. Written for a UK audience, the booklets in this series are available free to people living with HIV in the UK, or can be ordered through the aidsmap online bookshop for £1. Alternatively they can be read online, or downloaded as PDFs.

If you work in a clinic or support group in the UK, you can order these booklets for free for your clients and patients. Get in touch with Rose for details on 020 7840 0060 or by emailing rose@nam.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

To unsubscribe from this email, please visit www.aidsmap.com/en/main/emailupdate.asp

HIV Weekly, 13 January 2010

Taking antiretroviral treatment can mean that people with HIV are able to live a long and healthy life. Doctors are now hopeful that with the right treatment and care, a person with HIV will be able to live a near-normal lifespan.

But higher rates of illness and death are still seen in people with HIV compared to the general population. A lot of research is underway to find the reasons for this.

Some of the research reported in this edition of HIV Weekly shows the damage that untreated HIV can do. Starting HIV treatment before your CD4 cell count falls to around 350 reduces the risk of HIV-related illnesses and other serious diseases as well, such as those of the heart, liver and kidneys.

Risk factors for thrombocytopenia

Thrombocytopenia is a shortage of platelets in the blood. Platelets help the blood clot, and thrombocytopenia can have serious consequences and lead to major bleeds.

The condition can develop as a result of HIV infection. As many as 45% of people with very low CD4 cell counts and serious HIV-related illnesses developed thrombocytopenia.

Researchers in the US wanted to see how common thrombocytopenia was since effective HIV treatment became available.

Their research involved 2300 patients who were monitored between 2004-05. A total of 3% developed the condition.

The researchers then compared the characteristics of patients who developed thrombocytopenia to HIV-positive patients who didn’t.

A detectable viral load, co-infection with hepatitis C virus, and liver cirrhosis were all associated with thrombocytopenia.

Major bleeding events were more common in patients with thrombocytopenia, and they also had a higher overall mortality rate.

HIV itself increased the risk of thrombocytopenia, the researchers emphasise. This adds to the evidence showing the damage that untreated HIV can cause.

A side-effect of pegylated interferon, which is used to treat hepatitis C, can be a fall in platelets. Co-infected patients should have their platelet count carefully monitored to make sure the drug is safe to use.

A second study looked at the risk of thrombocytopenia during breaks from HIV treatment.

Interrupting HIV treatment is not recommended. A big international study showed that patients who took treatment breaks were more likely to develop both HIV-related and serious non-HIV-related illnesses.

Now French researchers have found that interrupting HIV treatment may also involve a substantial risk of thrombocytopenia.

They found that 25% of patients taking a treatment break developed the condition compared to 10% of those who did not.

Thrombocytopenia developed very quickly after treatment was interrupted – within an average of only nine weeks.

Once again, the study showed that a detectable HIV viral load increased the risk of thrombocytopenia, as did a CD4 cell count below 200.

Rare heart condition associated with low CD4 cell count

Pulmonary arterial hypertension is a very serious heart condition. It is occurs when the small pulmonary arteries become blocked. This can lead to heart failure and death.

Before HIV treatment became available, the condition was seen more often in patients with HIV than in the general population.

Now French researchers have examined its risk factors in the modern HIV treatment era.

They monitored cases of pulmonary arterial hypertension that were referred to a specialist clinic between 2000 and 2008.

Overall, 7% of patients had HIV as the only risk factor for the condition.

Most (62%) of those diagnosed with pulmonary arterial hypertension were taking HIV treatment. Viral load was undetectable in half the patients and 79% had a CD4 cell count above 200.

HIV treatment was not an effective therapy for the condition. However, it did improve some aspects.

About two-thirds of patients were still alive five years after their diagnosis with pulmonary arterial hypertension.

A low CD4 cell count was an important factor linked to poorer survival.

Cardiovascular disease risks common in young US women with HIV

Cardiovascular diseases such as heart attack and stroke are an important cause of illness and death in people with HIV.

There’s been a lot of debate about the reasons for this. But research suggests that a number of factors may be important. These include traditional risks factors, the damage that untreated HIV can cause, and possibly the side-effects of some anti-HIV drugs.

It’s recommended that HIV treatment should be started before a person’s CD4 cell count falls to around 350. This has been shown to help reduce the risk of heart disease. Regular check-ups at an HIV clinic can mean that changes in blood fats and sugars can be detected and prompt treatment provided.

HIV clinics can also offer advice on lifestyle factors that can help reduce the risk of cardiovascular diseases: for example diet, stopping smoking and exercise.

New US research shows why it’s so important to take the cardiovascular health of people with HIV seriously. It showed that about a third of young HIV-positive women had traditional risk factors that are associated with an increased risk of heart disease.

The women in the study were aged between 14 and 24 years.

These include obesity, smoking, a poor diet, not exercising, drug use, and a family history of cardiovascular illnesses or diabetes.

Compared to HIV-negative women of a similar age, those with HIV also had higher levels of some blood fats.

In addition, blood tests showed many women with HIV had inflammation that is associated with an increased risk of cardiovascular disease.

Herbal medicines widely used by people with HIV

Specialist HIV care and appropriate HIV treatment can mean that people with HIV can lead a long and healthy life.

It’s also important that people with HIV look after their general health.

Herbal and complementary therapies are quite widely used by people with HIV. They are not an alternative to HIV treatment, but some people use them to help reduce symptoms or improve their general wellbeing.

However, some herbal and alternative treatments can interact with some drugs used to treat HIV.

For that reason, it’s important that people with HIV tell their specialist HIV doctor and pharmacist about all other medicines and drugs they are taking. This includes those prescribed by another healthcare professional, bought from a chemist, recreational drugs – and herbal and alternative remedies.

New research conducted in London shows that many HIV-positive patients from southern Africa are using herbal remedies, but aren’t telling their doctor.

The research showed that people feared their doctor would frown upon the use of herbal remedies, or even rebuke individuals for using them.

Others said that they feared asking busy doctors questions, or did not understand the answers they were provided with.

You can read more about complementary therapies on our mini-site namlife.org. There is also information on getting the most from the relationship between you and your doctor . Some people find it helps to talk to someone else at their clinic about their concerns, like a health adviser or a nurse. Some people find it helpful to talk to someone at an HIV organisation.

HIV & Children

A new edition of NAM’s information booklet, HIV & Children, is now available. HIV & Children provides information about HIV treatment and care for HIV-positive children.

This comprehensive booklet is now available on aidsmap.com. Written for a UK audience, the booklets in this series are available free to people living with HIV in the UK, or can be ordered through the aidsmap online bookshop for £1. Alternatively they can be read online, or downloaded as PDFs.

If you work in a clinic or support group in the UK, you can order these booklets for free for your clients and patients. Get in touch with Rose for details on 020 7840 0060 or by emailing rose@nam.org.uk.

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 friendship and health, milestones in the search for a cure, contraceptive choices for women with HIV, hepatitis C treatment, dental care and stigma, 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.

Women and HIV:
Inner strengths

A new 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.

You can also request to have a questionnaire pack mailed to you or you can contact the lead researcher for more information.

This study is being conducted through Canterbury Christ Church University and has NHS ethical approval.

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

Welcome to the first HIV Weekly of 2010. This is the time of year when many people plan to make changes to their lives. For example by tackling money worries, stopping smoking, eating a healthier diet, or by exercising.

Coincidentally, some of the news published over the Christmas and New Year period underlines the importance of good general health for people with HIV.

There’s a lot of help available to you from your HIV clinic and HIV support agencies if you are thinking of making changes to your life.

Or why not start your year by making sure you know about the resources we have available to you if you are living with HIV, or if you are a professional working in the HIV sector?

HIV and cardiovascular health

Cardiovascular diseases such as heart attack and stroke are now an important cause of illness and death in people with HIV.

There’s a lot of debate about the reasons for this, but recently published research suggests that HIV may be a significant cause.

Duration of infection with HIV increases risk of hardening of the arteries

An important early warning sign of cardiovascular disease is hardening of the coronary arteries. This restricts the flow of blood to the heart. Deposits of plaque can form in the arteries, and these can break off, block an artery and cause a heart attack.

Hardening of the coronary arteries doesn’t always cause any symptoms.

A type of CT (computed tomography) scan can be used to monitor whether someone is developing this condition. If hardening of the arteries is detected, especially if blood flow is being restricted, then treatment can be provided.

Using these scans American researchers have found that approximately 60% of HIV-positive men have some hardening of their arteries. This percentage was much higher than the 34% prevalence detected in HIV-negative men of a similar age (average, mid-40s).

The researchers also found that hardening of the coronary arteries was more severe in the men with HIV.

Indeed, the coronary arteries of 7% of men with HIV were so hardened that the flow of blood was restricted.

The only factor significantly associated with hardening of the coronary arteries was longer duration of HIV infection.

There’s now quite a lot of research showing that HIV itself increases the risk of cardiovascular diseases.

For that reason, HIV treatment is recommended for everyone when their CD4 cell count is around 350. Treatment at this time is especially recommended for those with existing risk factors for heart disease.

It’s possible to help control the health risks that arise from hardening of the arteries near the heart. Importantly, lifestyle changes such as stopping smoking, eating a diet rich in fruit and vegetables and without too much fat, and regular exercise can all have a big impact.

HIV treatment reduces risk of death from all causes

Rates of HIV-related illnesses and deaths plummeted once effective, combination HIV treatment became available in 1996.

Many doctors are now optimistic that people with HIV will be able to live a nearly normal lifespan – with the right treatment and care.

But the overall risk of early death is still higher in people with HIV compared to the general population.

Now researchers have found that taking HIV treatment can lead to dramatic reductions in the risk of death from all causes.

The very large study involved over 62,000 patients from Europe and the US. They started HIV treatment between 1996 and 1998 and were then monitored for five years.

Mortality rates were compared between those who started HIV treatment and those who did not.

Taking combination HIV treatment reduced the risk of death from any cause by 52%.

Treatment was especially beneficial for patients with a low CD4 cell count. But a reduced risk of death was also seen if treatment was started when an individual had a CD4 cell count around 350 – the current threshold for starting therapy.

Those who started HIV treatment at CD4 cell counts around 500 had the lowest overall risk of death. New US treatment guidelines now recommend HIV treatment with CD4 cell counts up to this level.

Quality of life has an impact on length of life for those taking HIV treatment

Taking HIV treatment can have a big impact on the health and life-expectancy of people with HIV. But not everyone with HIV does equally well on HIV treatment.

Now Dutch researchers have found that a person’s quality of life is also important to their outcomes. Patients who reported lower health-related quality of life had a worse life-expectancy.

The research involved 560 people who started HIV treatment in the Netherlands between 1998 and 2000. They completed questionnaires about their health-related quality of life in a number of important areas. These included experiences of pain, physical functioning and perceptions of personal health.

Patients were monitored until the spring of 2008.

Those with the worst health-related quality of life had the highest mortality rate (20%). This compared to just 4% among those with the best quality of life.

HIV-related conditions were the most important causes of death, but 20% were attributed to cardiovascular diseases and non-HIV-related cancers.

Pain and a reduction in the ability to perform daily tasks could be important early warning signs of illness, the researchers suggest.

They recommend that doctors should take into account a patient’s health-related quality of life when deciding when to start HIV treatment.

More effective HIV treatment means less resistance

The number of patients developing resistance to anti-HIV drugs has fallen dramatically, Canadian researchers have found.

Resistance can develop if levels of anti-HIV drugs in the blood are too low to effectively fight the virus. This can happen if the drugs aren’t being processed properly, if they have a weak anti-HIV effect, or if a person doesn’t take their treatment properly.

Resistance was a major problem when combination HIV treatment became available. The drugs available at this time were not especially powerful, HIV could easily develop resistance to them, and they were often difficult to take (up to three times a day) and in many cases caused unpleasant side-effects.

Since then, better, more powerful, safer and easier-to-take drugs have become available.

The Canadian research showed the implications of these improvements in HIV treatment and care.

New cases of resistance fell from a peak of 571 in 1996 to only 71 in 2008.

This reduction in new resistance happened despite a massive increase in the number of people taking HIV treatment.

US travel ban now lifted

It’s now possible for people with HIV to travel or migrate to the US without any special restrictions placed upon them.

HIV-positive UK passport holders will now be able to enter the US by filling out a green “visa waiver” form.

South Korea has also removed its entry ban for people with HIV.

These moves have been widely welcomed. But some countries still restrict or ban entry for people with HIV. A list of countries and entry restrictions can be found here.

“I call for global freedom of movement for people living with HIV in 2010″, said the director of UNAIDS, Michel Sidibé.

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 friendship and health, milestones in the search for a cure, contraceptive choices for women with HIV, hepatitis C treatment, dental care and stigma, 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.

Translated resources

Some of the HIV information we produce is now available in other languages – visit aidsmap.com to download popular resources like the basics and patient booklets, and to read our news coverage in other languages. Languages currently available are Spanish, French, Portuguese, Russian and Romanian.

Having a relationship with an HIV-negative partner

Based on your feedback, we have added a new section to our mini-site, namlife.org. Called Having a relationship with an HIV-negative partner, it explores some of the common themes and issues experienced by people with HIV.

namlife.org is full of facts and personal stories shared by readers about aspects of living with HIV.

If you are in a relationship with someone who doesn’t have HIV (or have been in the past), and think your story could help make a difference to someone else, then please visit the Share your story webpage.

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