Inscape LGBT

Swine flu and underlying health conditions

There is no indication that being HIV-positive increases the risk of death from swine flu, according to a French study looking at all swine flu deaths that occurred before mid-July.

The principal underlying conditions associated with death are obesity and diabetes. Respiratory and heart disease were also factors in some deaths.

But the overall death rate from swine flu is low and HIV was not named as a specific risk factor.
People with HIV are not thought to be at increased risk of contracting swine flu, nor of having complications unless they have a CD4 cell count of less than 200.

People with HIV will be one of the priority groups to receive the swine flu vaccination when it becomes available in the autumn.

If you have flu-like symptoms and are concerned, you can call the National Pandemic Flu Service on 0800 1 513 100 or use their website to assess your symptoms. Alternatively you could contact your doctor for further advice.

If you do have a low CD4 cell count, then you should contact your clinic if your flu symptoms won’t go away or get worse despite taking anti-flu treatment. Your doctor will be able to monitor your health and see if your symptoms are being caused by other illnesses.

HIV and transmission

Viral load and infectiousness

In January 2008, senior Swiss HIV doctors and researchers issued a controversial statement saying that people taking HIV treatment who had an undetectable viral load (below 40 copies/ml) in their blood were uninfectious to sexual partners provided:
 Their viral load had been undetectable for at least six months.
 They took their HIV treatment properly.
 They did not have a sexually transmitted infection.

One of the objections to this statement was the reliability of maintaining an undetectable viral load. Now the findings of a Swiss study inform this view further. It reports that people who are taking HIV treatment and have had their viral load suppressed to undetectable levels can be confident it will stay undetectable between viral load tests.

Some people had short-lived, small increases, but a small number of people had a rebound in their viral load to a potentially infectious level without a clear explanation. Viral load was more likely to stay undetectable in people who started treatment with a potent triple-drug combination, and adherence had an effect on the maintenance of an undetectable viral load.

‘Serosorting’ and ‘strategic positioning’

Unprotected sex is the term used to describe anal or vaginal sex if a condom is not used.

HIV and sexually transmitted infections (STIs) can be passed on by unprotected sex. Gay and other men who have sex with men in the US are disproportionately affected by HIV and other sexually transmitted infections. Many men reduce their HIV risk behaviour after their diagnosis with HIV, but others continue to have unprotected sex and this may involve a risk of HIV transmission to others, or exposure to sexually transmitted infections.

A meta-analysis study in the US has shown that over 40% of gay and other men who have sex with men and are HIV-positive have unprotected anal intercourse. But there seemed to be evidence that those men were trying to limit the risk of passing on HIV to their partners by using strategies such as ‘serosorting’ (only having sex with other men with HIV) or ‘strategic positioning’ (being the receptive partner in unprotected sex).

The investigators say that the numbers of HIV-positive men having unprotected sex is of concern, but evidence shows that some of these men are making efforts to reduce the risk of transmission; they suggest that targeted prevention campaigns should prioritise informing people about the safety and risks of strategies such as serosorting and strategic positioning.

HIV and women

Starting treatment and genital ulcer disease

Genital ulcers are common in women with HIV, and a Kenyan study has shown that they often flare up when a woman starts HIV treatment.

The risk of this happening is increased if the woman has a low CD4 count and a history of genital ulcers. Sexually transmitted infections, especially the herpes simplex virus-2, are often the cause of the ulcers.
These ulcers can cause inflammation and damage to the mucous membranes in the genital area and may increase HIV viral load present there, causing a greater risk of HIV transmission to partners.

The investigators suggested that women with a history of genital ulcers should be given additional advice about avoiding HIV transmission during their first couple of months of treatment.

HIV and hepatitis co-infection and arterial disease

There is now considerable evidence that people with HIV have an increased risk of hardening of the arteries and cardiovascular disease, but there is little information on whether co-infection with hepatitis C has any effect on this risk.

Researchers from the Women’s Interagency HIV study have looked at this situation and found that co-infection does not increase the risk of hardening of the arteries for HIV-positive women.

In the study, the women with hepatitis C had a higher rate of risk factors for cardiovascular disease, being older, more likely to smoke and more likely to have high blood pressure or diabetes. They were also likely to have lower CD4 cell counts and to have a higher viral load and less likely to be on HIV treatment.

When the investigators took these factors into account, they found that women with both HIV and hepatitis C were not more likely to have thicker arteries, although they did have a modestly increased risk of carotid plaques, another marker of early arterial disease.

HIV transmission and breastfeeding

A mother can pass on HIV to her baby through breastfeeding, and therefore HIV-positive mothers should not breastfeed in settings, such as the UK, where safe alternatives are available.

A study in China has shown a high risk of HIV transmission from mother to child when a woman becomes infected herself after the baby has been born and then continues to breastfeed.

The infection rate (36% of babies born to women in the study were HIV-positive) was much higher than in babies of women whose HIV was diagnosed early in pregnancy.

Much less is known about the risk of transmission when the mother is diagnosed late in her pregnancy or after delivery. This study suggests that infection rates were much higher than in women with chronic HIV infection, perhaps because the women more recently infected had higher viral loads and were therefore more infectious.

Transmission rates were much higher in babies of women who had mastitis or other breast problems causing cracked nipples.

The researchers suggest that women who test negative for HIV in early pregnancy should have repeat tests later in the pregnancy, during delivery and at check ups for their babies’ health.