HIV WEEKLY – 6TH JANUARY 2010
Posted by: admin | Posted on: January 13th, 2010 | 0 Comments
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.
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.
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
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
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
