HIV Treatment
When to start treatment
It is recommended that you should start HIV treatment when your CD4 cell count is around 350 or if you are ill because of HIV.
Compared to waiting until your CD4 cell count is lower, starting treatment when it is around 350 reduces your risk of becoming ill because of HIV and also of developing illnesses like heart, kidney and liver disease.
Doctors have also found another advantage of starting HIV treatment promptly – it reduces your risk of developing resistance to anti-HIV drugs.
The research involved over 700 patients taking HIV treatment in the US. All experienced a fall in their viral load after starting HIV treatment. They found that viral load stayed undetectable for longer in patients who started treatment with a CD4 cell count above 350.
Furthermore, the research also showed that people who didn’t start taking anti-HIV drugs until their CD4 cell count was below 350 were more likely to develop resistance to their anti-HIV drugs if their viral load increased.
The researchers believe that these findings should provide reassurance that starting HIV treatment earlier does not increase the risk of resistance.
HIV and cancer
The number of cases of the AIDS-defining cancers Kaposi’s sarcoma and non-Hodgkin’s lymphoma have fallen dramatically since effective HIV treatment became available.
However, increased rates of some other cancers have also been seen in people with HIV. Many of these are linked to infections. For example some strains of the common infection human papilloma virus (HPV) have been linked to the development of anal and cervical cancer.
Nelfinavir (Viracept) is one of the older protease inhibitors. Laboratory research suggests that it may have anti-cancer properties and it is being investigated as an anti-cancer drug in HIV-negative people.
In 2007, the drug was recalled after it was found that batches of it had accidentally become contaminated with excess levels of a substance linked to cancer. But it was shown that this did not involve any risks for patients taking the drug.
Now researchers have found that nelfinavir doesn’t seem to have any anti-cancer benefits in people with HIV. Rates of cancers, both HIV-related and non-HIV-related, were identical in people taking nelfinavir and other protease inhibitors.
Nevertheless, the research provides further reassurance that treatment with nelfinavir does not involve an increased risk of cancer.
Cervical cancer screening
Many HIV-positive women have cervical infection with human papilloma virus (HPV). Some strains of this virus can increase the risk of developing cervical cancer. This is an AIDS-defining cancer.
It’s possible to prevent and treat cervical cancer. But it’s important to spot it early. All women with HIV should have annual cervical screening as part of their HIV care.
Research from America has shown that this often isn’t happening. Almost a quarter of women reported that they had not undergone cervical screening in the previous year.
Worryingly, women who had a low CD4 cell count, and therefore may be at greater risk of developing cervical cancer were one of the groups less likely to report having had an annual screen.
The May 2009 edition of HIV Treatment Update featured an article on cervical cancer and screening. HIV Treatment Update is available free to people affected by HIV in the UK, or subscriptions can be bought. Please contact us on 020 7840 0050 or email info@nam.org.uk for more details. Subscriptions can also be arranged via our website.
Superinfection
It’s possible to be infected with a second strain of HIV. This is called superinfection (and sometimes reinfection).
A lot of research has been conducted into the risk of superinfection. This has shown that it is most likely to happen in the first three years or so after a person is infected with HIV.
The risk of superinfection is thought to be low for people who’ve had HIV for a long time and who are taking HIV treatment.
Researchers have reported two cases of superinfection in HIV-positive gay men. They were superinfected by their long-term partner.
Although these men were taking anti-HIV drugs, they had a detectable viral load. The researchers think that this may have allowed superinfection to occur.
Sexual health
Good sexual health is important for everyone, but is especially so for people with HIV.
Sexually transmitted infections can cause unpleasant symptoms and if left untreated can make you unwell. They can also increase the risk of you passing on HIV to a sexual partner.
About five years ago, cases of a rare sexually transmitted infection called lymphogranuloma venereum (LGV) were diagnosed in some HIV-positive gay men in the Netherlands.
Cases were soon seen in the UK and other European countries, and it has since spread to the US.
LGV can cause very unpleasant symptoms. Most of the cases seen so far have involved rectal symptoms such as pain and bleeding. It can also make you feel generally unwell. It can cause other symptoms, for example very swollen glands in the groin.
The infection is a strain of chlamydia and can be cured by taking the antibiotic doxycycline for 21 days.
It appears to have spread through networks of men. Most of the men diagnosed with LGV have been HIV-positive. Many of the men diagnosed with LGV also seem to have been infected with other sexually transmitted infections at the same time such as syphilis or hepatitis C.
Because so many of the cases have involved rectal infection, it’s thought that it is being spread by fisting and unprotected sex.
Researchers have concluded that there are now so many cases of LGV that it’s probably “here to stay”. Using condoms for penetrative sex and latex gloves for fisting are an effective way of preventing the transmission of LGV, HIV and other sexually transmitted infections.
Sourced from hivweekly@nam.org.uk
