Inscape LGBT

HIV and cardiovascular disease

Cardiovascular diseases such as heart attack and stroke are an important cause of illness in people with HIV. There has been a lot of debate about the reasons for this. One possible explanation is the increases in blood fats that are a possible side-effect of some anti-HIV drugs. But it’s also thought that HIV itself can cause damage that can lead to cardiovascular problems.

Now a new study has shown that having HIV for just a couple of years can cause subtle changes to the health of arteries and veins that can increase the risk of cardiovascular disease.

Italian researchers compared the vascular health of 38 people with HIV and 41 HIV-negative people of the same age and sex. The two groups were also well matched for traditional risk factors of cardiovascular disease, such as having high levels of blood fats or diabetes, or behaviours such as smoking.

To see if HIV itself was causing vascular damage, only HIV-positive people who’d never taken anti-HIV drugs were included in the study. And these people had only been infected with HIV for an average of two years.
Results showed that the HIV-positive study participants were more likely to have damage to their arteries and blood vessels than the HIV-negative people who formed the control group.

The researchers also found that the people with HIV most likely to have such damage had a higher viral load and lower CD4 cell count.

The findings of this research add even more weight to the recommendation that HIV treatment should be started when your CD4 cell count is around 350. Starting treatment at this time reduces the risk of both HIV-related illnesses and other diseases as well, notably heart disease.

MRSA

The infection MRSA (methicillin-resistant Staphylococcus aureus) is rarely out of the news. Mostly this concerns the spread of the infection in hospitals.

However, people are also acquiring this infection outside of hospitals and it can lead to skin and soft-tissue infections.

Researchers are eager to find out how people are acquiring MRSA. Because the infection is present on the skin, close physical contact has been suggested as one possible source.

Increased rates of MRSA have been seen amongst gay men in the USA, many of whom have been HIV-positive.

Researchers in the US city of Boston wanted to see how common MRSA infection was amongst patients using primary care. They also wanted to see if the location of MRSA infection was important in the later development of skin infections. Seventy percent of the people in the study were gay men and a third were HIV-positive.

They found that 4% of study participants had MRSA. In most of these people, the infection was found in the nasal passages, but a significant proportion had it detected using swabs taken from the area just outside the anus.

Having MRSA, particularly in the region around the anus, increased the risk of developing skin or soft-tissue infections.

The researchers also found that there were some other important factors that predicted the development of skin infections. These included having sex between men, having anal sex, and the use of recreational drugs, particularly methamphetamine.

They believe this strongly indicates that MRSA is being passed on through skin-to-skin contact.

Although often talked of as a ‘superbug’, MRSA can, in most cases, be successfully treated with antibiotics.

There’s little evidence of MRSA being transmitted between gay men in the UK. Simple, good hygiene practices such as washing thoroughly with soap and hot water after intimate physical contact can help reduce the risk of acquiring the infection.

Hepatitis C co-infection

Hepatitis C and cardiovascular disease

Many people with HIV are also infected with hepatitis C virus. This is often described as co-infection. Liver disease caused by hepatitis C is an important cause of illness and death in co-infected people.

Now researchers have also found that infection with hepatitis C can also increase the risk of cardiovascular disease. As was discussed earlier in this bulletin, it’s already thought that HIV can also increase the risk of illnesses such as heart disease and stroke.

American researchers conducted a very large study involving 82,000 people with hepatitis C and 90,000 people without the infection.
Even though the people with hepatitis C were less likely to have traditional risk factors for cardiovascular disease, such as high blood fats, they were 27% more likely than people without the infection to develop cardiovascular disease.

One of the groups especially encouraged to start HIV treatment when their CD4 cell count is around 350 are those co-infected with hepatitis C. This is because HIV treatment can help slow the rate of liver damage. But in the context of this study, it’s also important to note that starting HIV treatment at higher CD4 cell counts, rather than waiting until your CD4 count has dropped further, reduces the risk of cardiovascular disease.

New drugs for hepatitis C treatment

There are treatments available for hepatitis C, but they don’t work for everyone and can cause unpleasant side-effects. New anti-hepatitis C drugs are being developed, some of which are doing very well in clinical trials.

One drug currently being investigated is telaprevir. Results of a recently published study showed that the addition of telaprevir to standard hepatitis C treatment (pegylated interferon and weight-dosed ribavirin) increased the chances of this treatment working.

The study is especially important because it involved people with hepatitis C genotype-1, which is the hardest of the hepatitis C strains to treat.

It’s important to note that people with HIV weren’t included in this study, so it’s not yet known how well it will work in co-infected people.
There are concerns that there could be interactions between anti-HIV drugs and the anti-hepatitis C drugs currently being developed. This is being investigated by doctors and researchers who specialise in this field. It is hoped that there will soon be trials looking at the safety and effectiveness of new anti-hepatitis C drugs in people with HIV.

Sourced from NAM