New UK HIV guidelines - new questions to ponder

think.upThu 10/07/08 15:00

Hello folks

Those who get the NAM emails will know that the new UK guidelines on treating HIV have been issued, and with them a lot more interesting and new information.

Here's a quick summary for those who don't get the email.
The new recommendation to start treatment at CD4=350 comes as no surprise, as the process of examining and discussing data was never secretive.
Kivexa was going to lose its equal status with Truvada as a preferred first treatment, but they are now equally recommended, with conditions and qualifications surrounding the prescription of Kivexa. Kivexa contains abacavir, which may be linked to an increased risk of heart disease and is considered less effective against a very high viral load. A couple of years ago there were also panics about people developing severe allergy to abacavir if they stopped and then re-started, so they now recommmend testing for allergy too.

Now that doctors consider it hopeful that someone with HIV may live a more-or-less normal lifespan (albeit with complications), new issues arising from living long-term with HIV are appearing, and I'm wondering about sensible responses to these.

LIVER DISEASE: obviously if someone with Hep B or Hep C has HIV then obviously they're likely to test as having a fatty liver. However, over a third of HIV+ people on treatment who have neither of these diseases still has a fatty liver.
As well as scarring and hardening of the liver, this can lead to problems like hardening arteries, inability to process sugars properly and the consequences of high cholesterol. There were associations with NRTI drugs (*swallows nervously*), with weight around the waist, and men were more prone than women.

In other words, even if we have no complications with HIV, we really need to think about ways to encourage the best possible liver and arterial health in our own bodies.

Apart from a raw food diet and masses of garlic, I'd be interested to hear people's thoughts - not only for prevention (ie avoiding fry-ups) but for ways of actively improving liver health.

BLOOD CLOTS: any evidence formerly believed to suggest that HIV treatment can lead to blood clots appears now to have been disproved.
However, people with HIV are still TEN TIMES more likely than average to have a DVT or pulmonary embolism. Within the group surveyed, were men, the mean age was 39 and 84% of the men were black. They took 160 HIV+ people who had experienced a blood clot and matched each of them with four HIV+ control patients who had not.
In the study, they found that the following factors were more common in the group than amongst those in the control group:
Black race; Age over 36 years; CD4 cell count below 500 cells/mm3; Haemoglobin below 12g/dl; Hospitalisation within the previous three months; Hospitalisation with lymphoma; Use of central venous catheter in the previous three months; and Use of mechanical ventilation within the previous three months.

Once they had calculated out these factors, the following factors remained "significantly related to venous blood clots" for everyone with HIV: Age (every one year increase); Hospitalisation in the previous three months; Central venous catheter in the previous three months; CD4 cell count below 500 cells/mm3

(A CD4 count below 500 is, let's remember, within the normal range and by no means low.) Without understanding the impact of an African upbringing, childhood conditions and nutrition and genetic predispositions it's hard to know whether any given one of us is truly in high risk or a medium risk group. What seems clear in the conclusions is that, if we've been HIV+ and on treatment for a good number of years, our risk of clots is definitely higher than average, and quite likely by a significant factor.

UNEMPLOYMENT: High unemployment, especially amongst those diagnosed before effective treatment existed, was not surprising to me until I read that these levels exist despite a prevalence of higher education:
In common with earlier studies, the investigators found that the majority of patients from all the communities had some form of higher education.

Despite this level of education, only 47% of individuals were employed. The investigators found that there was little difference between levels of employment between white and ethnic minority gay men [58% vs. 54%], but gay men were significantly more likely to be employed than black African heterosexual men [45%] and women [35%].
For those interested, here's a link to the summary of the report:
http://www.aidsmap.com/en/news/540BA09C-B63E-43AB-9EB3-CCB8F13CCDCF.asp

So, we need to keep thin blood, low-fat livers and properly metabolised sugars. And being gay makes us more likely to be employed (or maybe, to seek employment? *slaps wrist*)

Thoughts and responses would be welcome...

buddhaboiThu 10/07/08 15:47

How about milk thistle to improve liver functioning? Is the liver problems due to the medication used? if thats the case Milk thistle is right up ur street.

think.upThu 10/07/08 17:29

I've used milk thistle in the past, before the HIV days, because I have a hereditary liver problem called Gilberts Syndrome.

However, the problem related to HIV is not specifically a sluggish or underperforming liver, it's the accumulation of lipids in and around the liver. Not sure whether milk thistle has any effect on this tendency.