THEGAYUK

Tag: HIV

Read the latest news and analysis of HIV in the UK and abroad. Browse THEGAYUK’s entire archive on news about HIV.

  • COMMENT | The Dangerous Relationship Between Obesity and HIV

    The Dangerous Relationship Between Obesity and HIV

    According to recent data from the SUN (Study to Understand the Natural History of HIV and AIDS in the Era of Effective Therapy), which includes 494 patients, approximately 61% were either overweight or obese. Obesity was associated with insulin resistance, elevated cholesterol, increased inflammation and atherosclerosis.

    A reduction of dietary intake of 500 calories per day for 8 weeks resulted in a 6% decrease in body weight. What was remarkable in this study was the dramatic decline in systemic inflammation observed in the study participants. Indeed, two reputable markers of inflammation, tumour necrosis factor (TNF) and C-reactive protein, were reduced by almost 50% in only 8 weeks of calorie reduction.

    Inflammatory diseases such as diabetes, cardiovascular disease (CVD), kidney problems, osteoporosis, cogitative impairment and fragility, are becoming increasingly common in people living with HIV. As the prevalence of obesity and HIV-associated co-morbidities continues to rise, and concerns for the spiralling economic and social costs escalate, innovative management strategies beyond primary care are urgently needed. Many traditional lifestyle interventions can be implemented with the assistance of professionals, including:

    • Maintain a maximal viral suppression with antiretroviral therapy
    • Reduce or stop smoking
    • Lose at least 5-10% of body weight (if overweight)
    • Exercise
    • Consume more fruits and vegetables
    • Reduce alcohol intake

    One reason why people who are infected with HIV have high levels of inflammation is that HIV destroys the structure of the intestine (gut), causing bad bacteria to strive, and changes the dynamics of the gut microbiota.

    Toxins produced by bad bacteria cross the wall of the intestine and into the blood stream to instigate and fuel inflammation, and cause age-associated diseases. Similarly, alterations of the gut microbiota and mucosal barrier have been identified as a novel CVD risk factor and are associated with metabolic diseases such as obesity and type 2 diabetes.

    Incredibly, probiotic treatment using Bifidobacterium animalis ssp. lactis 420 has shown great promise in reducing body weight and liver inflammation in animal models.

    The increasing prevalence of obesity and type 2 diabetes demonstrates the difficulties of conventional treatments and interventions to curb these diseases. Efforts to identify new therapeutic strategies to modulate gut microbiota are now a high priority for public health and, to date, probiotics and/or prebiotics seem to be the most effective tools.

    Diet, especially high intake of fermentable fibres and plant polyphenols, appears to regulate microbial activities within the gut, supporting regulatory guidelines that encourage increased consumption of whole-plant foods (fruit, vegetables and whole-grain cereals) and providing the scientific rationale for the design of efficacious prebiotics.

    Polyphenol-rich cranberry extract has been proven to protect mice from diet-induced obesity and insulin resistance, although the effect might have been mediated by the regulation of intestinal inflammation. Recent human studies with carefully selected probiotic strains have shown that ingestion of viable micro-organisms with the ability to hydrolyse bile salts could lower blood cholesterol, a recognised risk factor in obesity-related CVD.

    1. Overton ET. Metabolic complications of HIV infection and its therapies. Top Antivir Med 2014,22:651-654.
    2. Palmer CS. Inflammation speeds up the aging process in people infected with HIV, 2014, http://www.naturalimmunity.com.au/hiv.html#B.
    3. Palmer CS, Crowe SM. How does monocyte metabolism impact inflammation and aging during chronic HIV infection? AIDS Res Hum Retroviruses 2014,30:335-336.
    4. Stenman LK, Waget A, Garret C, Klopp P, Burcelin R, Lahtinen S. Potential probiotic Bifidobacterium animalis ssp. lactis 420 prevents weight gain and glucose intolerance in diet-induced obese mice. Benef Microbes 2014,5:437-445.

    Dr Clovis Palmer is a graduate of the University of Sydney, Australia, and holds a PhD in plant biochemistry and molecular genetics. He conducted postdoctoral studies in immunology, liver disease and obesity at the University of New South Wales, Australia.

    Dr Palmer is a reviewer for several top ranked international journals including Hepatology, AIDS and Antioxidants and Redox Signalling. He is the chief scientific editor for Natural Immunity-Health, Australia (www.naturalimmunity.com.au).

     

    Opinions expressed in this article may not reflect those of THEGAYUK, its management or editorial teams. If you’d like to comment or write a comment, opinion or blog piece, please click here.

  • HIV Exhibit Opens At The Museum Of Liverpool

    On Friday 10 October, a new multi-media display Now + then: Three Decades of HIV in Merseyside will open at the Museum of Liverpool. The display forms part of the 2014 Homotopia festival.

    Now + then uncovers how local people and communities have responded to the challenges of HIV from the 1980s to the present day. The display will include a new powerful short film, interviews, photography and objects, all exploring people’s own remarkable stories and experiences.

    Located in The People’s Republic gallery, the display highlights an important chapter in Merseyside’s history of activism. Merseyside’s communities were among the first nationally to respond to the 1980s crisis of ‘AIDS’. Liverpool’s pioneering drug harm reduction and needle exchange schemes became internationally renowned as the Mersey Model.

    Kay Jones, Curator of Community History at National Museums Liverpool said: “It has been incredibly rewarding to work closely with Sahir House to help reveal this untold part of our history. We hope that the display will educate and raise awareness of HIV, which could affect anyone in our local community”.

    Andrew has been living with HIV for 30 years and lost many people to late stage HIV, previously known as ‘AIDS’. He said: “Back in the 80s if you didn’t see someone for a few weeks you would assume the worst. I remember funerals happening every week. Although much has changed since then, the film included in the display shows the impact that an HIV diagnosis can have on a person’s life whether it was 30 years ago, 30 months or 30 days.”

    Now + then was created by Sahir House – Merseyside and North Cheshire’s HIV charity – in collaboration with Soft Octopus Design Studio and Thinking Film, as part of the Museum of Liverpool’s partnership programme Our City, Our Stories. The display is the culmination of a wider two-year project, funded by the Heritage Lottery.

    The idea for the project came from service users and volunteers at Sahir House who felt it was important to record people’s own stories about HIV and Merseyside before they were lost forever.

    In 2012 the Museum of Liverpool hosted a community meeting to develop ideas for the project. Following this Sahir House successfully bid for £76,000 from the Heritage Lottery Fund. Since the first community meeting, the Museum of Liverpool has provided a base for Now + then public events.

    Early supporters of the project were Liverpool Archives and the North West Sound Archive, as the oral testimonies and archive materials collected during the project will form two new nationally significant archive collections.

  • £90,000 Raised To Support People Living With HIV

    A host of celebrities including, Nigella Lawson, Jim Broadbent, Jemima Khan and Harry Enfield, were among dinner party guests who took part in HIV and sexual health charity Terrence Higgins Trust’s ‘The Supper Club’ fundraiser last night.

    The THT event, which is in its 14th year raised more than £90,000 to support people living with and affected by HIV. On the night guests attended 50 dinner parties at some of London’s most iconic restaurants, including Roast, Wilton’s, Polpo, Aqua Shard, and Scott’s, which all donated a meal in support of the charity.

    Afterwards guests where whisked away to a star studded after party at the Underglobe where they enjoyed entertainment by British singer-song writer Chloe Howl, Britain’s Got Talent Semi-Finalist La Voix and boylesque troop Briefs. Guests were also treated to cocktails by 6 O’Clock Gin and took part in ‘The Supper Club’ silent auction, which boasted an array of bespoke foodie prizes, including a chocolate making master class with acclaimed chocolatier Paul A Young, dinner at home catered by Michelin-starred chef Angela Hartnett, and the chance to create a bespoke brownie flavour with Bad Brownie.
    Sonya Trivedy, Director of Fundraising at Terrence Higgins Trust, said: “Thank you to everyone who has once again made ‘The Supper Club’ such a huge success and another night to remember. Each year our supporters came out in full force to help us raise awareness for the work that we do – and this year was no different. We are really lucky to have support from such exceptional people, who once again have helped us raise a phenomenal amount for people living with and affected by HIV in the UK ”

  • Gay Men Buck Downward HIV Infection Trend

    New figures from Public Health England (PHE) show that gay men are bucking the downward trend for new HIV infections.

    Yesterday PHE released its 2013 HIV statistics, showing new HIV diagnoses amongst gay men have slightly increased, whilst new diagnoses overall are declining.

    Shockingly the new statistics show that, in the past ten year new diagnoses amongst gay and bisexual men aged 15-24 have almost doubled, as well as new diagnoses amongst the over 50s have almost doubled. This worry for the over 50 was mentioned by Doctor Christian Jessen in his interview with TheGayUK in 2012.

    The latest PHE figures come after a recent campaign by a coalition of LGBT organisations which called on political leaders to improve sex and relationships education in schools. These figures highlight the urgent need to make LGBT-inclusive Sex and Relationship Education (SRE) statutory in all schools.

    Yusef Azad, director of policy and campaigns at (NAT) National AIDS Trust, said: ‘The Public Health England statistics for 2013 show a continuing high rate of new MSM HIV diagnoses in the UK – about nine gay and bisexual men are being told they have HIV every day. This reflects undiminished and significant levels of HIV transmission in our society amongst gay men.’

    LESS GAY MEN DIAGNOSED LATE
    However more positively, less gay men are being diagnosed late (within four years of infection). Yusef Azad, director of policy and campaigns at (NAT) National AIDS Trust, said: ‘There continues to be an encouraging decline in the proportion of gay men diagnosed with HIV late – from 43% in 2004 to 31% in 2013. Being diagnosed late, which usually means you have had HIV for at least four years, can have a serious impact on your health, potentially leading to a shorter life expectancy, worse health outcomes and in some cases death soon after diagnosis.’

    ONE IN TWENTY
    According to the Terrence Higgins Trust (THT) around 100,000 people in the UK were living with HIV in 2013, which means 1 in 665. In gay and bisexual men THT estimates this figure jumps to one in twenty. It could even be as high as one in twelve in highly populated cities such as London.

    Dates for the National HIV Testing Week were announced last month. The week will run from the 22nd to the 30th of November.

    If you’re worried about sexual health visit our online sexual health microsite for some easy tips and to ask our experts questions on sexual health.

  • STIs, HIV and AIDS To Be Discussed In Secondary Education

    This will help make it clear to schools that every pupil must leave secondary school equipped with knowledge about STIs and specifically about HIV and AIDS.

    However, the Sex Education Forum warns that learning about STIs must not be left to the final years of secondary school, and will only be effective if it builds on earlier learning about how our bodies work, and crucially about relationships. Having sex and relationships education (SRE) in every year of school helps children build up the understanding needed for good sexual health, and ensures that children learn about stigma and challenging prejudice as well as the biological aspects of the transmission, prevention and treatment of STIs including HIV.

    The Sex Education Forum is the national authority on sex and relationships education (SRE).

    The Chair of the Sex Education Forum, Jane Lees said, ‘The curriculum for Key Stage 4 science proposed earlier this year had no reference to sexual health, HIV or AIDS. It is very encouraging that calls from the Sex Education Forum and others have been heeded and the Department for Education has made this important change. Our survey with young people showed that 1 in 4 had not learnt anything about this topic at school. There is an urgent need to remedy this situation and this move by the Department for Education will help. We will continue to campaign for action to make the broader subject of SRE statutory in all schools’.

    Last week, Human rights activist Peter Tatchell called for LGBTI-inclusive sex & relationship education to be statutory in all schools. Saying that sex and relationship education SRE should be made compulsory in all schools.
    One in three gay men diagnosed with HIV in 2012 were in their teens or early twenties, yet 85% of gay and bisexual men receive no information about same-sex relationships in school.

    If you’ve got sexual health questions visit our no excuse project http://www.noexcuse.thegayuk.com or you can call the London Lesbian And Gay Switchboard on 0300 330 0630.

  • Is HIV medication making you suicidal?

    HIV drug increases risk of suicidal ideation.

    A recent study shows an association between Efavirenz (a common anti-HIV drug) and increased risk for suicidal ideation or attempted or completed suicide. The study conducted by Mollan KR et al., and published in Ann Intern Med. 2014 confirmed the neuropsychiatric effects of Efavirenz. With increased life expectancy of people living with HIV infection – and the opportunity to study the long term effects of drugs – the emergence of drug-induced co-morbidities is concerning.

    This underscores the need for the development of longer-acting drugs or treatment modalities that limit the constant (daily) use of antiretroviral therapy. Emerging data also beg the question as to the longer-term benefits of immediate treatment of a young individual with normal CD4 T cell count and low viral load.

    Indeed, early treatment reduces inflammation and impacts the size of the viral reservoir – yet the clinical benefits are questionable.

    One argument for early treatment is epidemiological-based: “to protect the community”. But we probably can dismiss this one because with fashionable PrEP picking up steam we might all be chewing PrEP candies in the near future.

    I think more needs to be done to delay the use of antiretroviral drugs wherever possible, and more reliable measures of inflammation are needed so that we are not only guiding treatment based on CD4 cell counts and viral load but also take into account the levels of inflammation a person has. After all, inflammation (which generally is associated with CD4 T cell count) has been shown to be the best predictor of HIV disease progression and mortality.

    Dr Clovis Palmer is a graduate of the University of Sydney, Australia, and holds a PhD in plant biochemistry and molecular genetics. He conducted postdoctoral studies in immunology, liver disease and obesity at the University of New South Wales, Australia.

    Dr Palmer is a reviewer for several top-ranked international journals including Hepatology, AIDS and Antioxidants and Redox Signalling. He is the chief scientific editor for Natural Immunity-Health, Australia (www.naturalimmunity.com.au).

     

    Opinions expressed in this article may not reflect those of THEGAYUK, its management or editorial teams. If you’d like to comment or write a comment, opinion or blog piece, please click here.

  • OPINION | “Always Wear A Condom” Isn’t Enough

    It’s some thirty years since the AIDS pandemic began to decimate the gay community. Anyone who survived that time, or, like me, watched on in fear, will never forget the very simple message disseminated at the time: Always Wear A Condom.

    How is it then, with such a simple rule to follow, HIV acquisition rates, especially among young gay men, are rising, not falling? Something’s not quite connecting and this was something I wanted to address in This Book Is Gay, the first guide to sex and relationships for young, modern LGBT people.

    It’s my job, I believe, to not sugar-coat or pretty-up sex for young adults. I don’t think that’s helping. So here’s the truth no-one dares utter: Sex feels better without a condom. A contact describes sex with a condom as ‘like wearing a raincoat in the shower’ and he has a point. The new question becomes ‘is sex so much better without a condom, it’s worth gambling your health?’ Of course the answer is NO, but we can’t rule out this most basic of reasons why some gay and bi men choose to eschew condoms.

    That’s not the whole story. The post-pandemic generation was sufficiently scared into condom-compliance regardless of how much better sex might feel. I’d argue poor education is chiefly to blame, and is certainly the impetus behind This Book Is Gay. By this, I mean both school-based sex education and general health messages. Now that there are effective treatments for managing HIV perhaps emphasis has slipped as a public health issue.

    I interviewed a young man who wished to remain anonymous as part of my research. A pupil at a Catholic school, he received very little sex education at all and didn’t feel able to talk to his parents about sex. As such, with little media awareness, he truly believed AIDS was something that affected women in Africa. He tested HIV positive through unprotected sex aged nineteen.

    I don’t know if pornography is to blame, but it certainly doesn’t help. Post AIDS, nearly all gay porn depicted condom use (even if the condom does magically appear, hands-free, seconds before penetration). However, with a little time, bareback fetishism crept into pornography and you don’t have to look far at all to view condom-free porn. And let’s not even get into ‘bug chasing’ – that’s a whole other issue.

    The problem with porn is that it isn’t sex education. If sex education isn’t robust, young people will turn to the internet for advice, and porn provides only fantasy.

    So what can we do to reduce infection rates? I think while we must continue with the Always Wear A Condom mantra – as this is by far the most effective way to halt the spread of any STI and prevention is better than no-actual-cure – we need a second layer of education. Namely: Get Tested A Lot.

    Knowledge is power, and, HIV carriers are at their most infectious when they don’t know they’re carrying the virus. Once a patient is receiving medication, the viral load (the amount of HIV in their system) can be reduced to ‘undetectable’ levels. Basically, they are lot less infectious. If everyone knew their HIV status every time they had sex, I think we could reduce infection rates greatly.

    Guidelines suggest that sexually active gay and bi men (a high risk demographic) should be tested approximately every six months. I would suggest this should be a minimum. A finger-prick HIV test takes five minutes, you can do them yourself at home or at a sexual health clinic. It’s pain-free and the results are instant. When writing This Book Is Gay, the only reason I heard to not get tested was from a man who was simply terrified of the result.

    The next step is likely to be PrEP – Pre-Exposure Prophylaxis. High-risk groups in the US are now being given a truncated version of HIV treatment to prevent converting to HIV positive. It’s not a vaccine, however, and it’s only effective if taken routinely. Trials are still underway in this country, but it seems likely to be made available on a voluntary basis soon.

    It’s my hope that This Book Is Gay will help drag HIV into the 21st Century. Young people must be made aware of HIV, the risks, and taught the lessons we learned in the nineties but also how to approach HIV without fear and stigma, but knowledge and protection. As HIV campaigner Kristian Johns so eloquently said: ‘HIV is no longer a death sentence, but it’s one hell of a life sentence.’

     

    Opinions expressed in this article may not reflect those of THEGAYUK, its management or editorial teams. If you’d like to comment or write a comment, opinion or blog piece, please click here.

  • Life Assurance Policies Up 140% For People Living With HIV

    A new report out today shows that those men and women living with HIV are taking out more life assurance as new policies soar by 140%.

    However, the report also highlights that the average amount for which people are insuring themselves has decreased year-on-year to just £114,607.

    In 2013 the amount that people were insuring themselves for £134,667 and £134,130 in 2012, showing a decrease of just over £20,000 a survey showed.

    Chris Morgan, Marketing Manager of Unusual Risks, Mortgage & Insurance Services says,

    ‘It has come as a complete surprise that the average sum Assured of an HIV Life Assurance Policy has decreased over the last year to £114,607. However, at the same time over the last twelve months we have also seen a rapid increase in the number of people taking up HIV Life Assurance products.

    ‘We believe the volume of people taking HIV Life Assurance has increased by around 140% over the last two years, which seems to have had an effect on the average sum-assured being taken by policy holders. We are of course delighted to see that more people with HIV are protecting their homes, mortgages, families and children’.

    In last year’s HIV Life Assurance Survey it was established that 70% of Life Insurance providers now offer cover to people with HIV. However, the terms and premiums they offer vary wildly between different insurance companies. Those looking for HIV Life Assurance are urged to seek specialist advice before applying for insurance.

  • OPINION | World Health Organisation Moves To Medicate All Homosexual Men

    For the first time in history, the World Health Organisation (WHO) has suggested that all men who have sex with men should take antiretroviral medication. Warning that if no action is taken, there would be a serious risk of an HIV infection rates exploding around the world.

    The WHO is the directing and coordinating authority for health within the United Nations. As such, they are responsible for leading global health matters, shaping the research agenda and setting the standards in health trends.

    Gottfriend Hirnschall, the head of WHO’s HIV department, says that infection rates of HIV among homosexual men are on the rise again, 33 years after the epidemic hit. Further, than this, he believes that the infection doesn’t hold as much fear to a younger generation with access to drugs that enable users to live with AIDS.

    The guidelines have been published after a period of a significant drop in HIV transmission rates between 2001 and 2012.

    Antiretroviral medication is the most common used method of managing HIV/AIDS, treatment being a combination of two drugs, in one pill, taken daily for the rest of the individual’s life. There are several issues with the use of such medication, the main one being an intolerance to the drug, which can have serious side effects such as gastrointestinal tract intolerance, hypersensitivity and central nervous system adverse effects. With such severe side effects, it must be questioned why the WHO would subject them on healthy individuals unnecessarily.

    The suggested approach is known as pre-exposure prophylaxis (PrEP), meaning that even those who are not infected would be required to take the medication. With the hope that it could cut the number of new diagnoses by up to 20%.

    The WHO believe that medicating ALL homosexual men will provide an additional method of preventing infection. Along with condom use and regular testing. But activists have suggested that introducing government mandated antiretroviral would discourage the use of condoms, currently the best method to prevent the transmission of sexually transmitted infections. Resulting in an increase of other sexually transmitted infections such as gonorrhoea, chlamydia and hepatitis in the gay community.

    PrEP treatment averages at roughly £10,000 a year, per individual. This is an extremely expensive medication, especially considering that the majority of those who will be forced to take the medication will not be infected. Unfortunately, by increasing the number of people taking the drugs, with the same supply, the cost of the drug would rise. This is one of the main complaints about the proposal, as it encourages the use of a costly medicine for a preventable disease.

    The second danger of introducing this medication would be running the risk of the HIV virus evolving immunity to current drugs. Recently there has been much concern about the overuse of antibiotics and how they have become less effective as viruses evolve immunity. HIV is already a deadly disease that has been a cause of death across the globe. If it were to further evolve, current treatment would become ineffective and we would be faced with the same crises that were present in the 70s and 80s.

    Those that are most at risk of infection are gay and bisexual men, who are up to 19 times more likely to be infected with the virus than the general population, according to WHO studies. But for transgendered women, injecting drug users and female sex workers, the risk of infection can be up to 50 times higher than the general public.

    So why are the homosexual community the only ones being targeted by the WHO? By targeting the homosexual community specifically, the WHO are contributing to the stigma that HIV is a “gay disease”.

    That, in turn, creates the impression that gay sex is wrong. using HIV as a way to discriminate against homosexuals.

    In a world where homosexuality is a capital crime in five countries and punishable by imprisonment in over 70 more, the issue of stigma, discrimination and violence are still a real threat to the homosexual community. The WHO has made it clear that it does not class homosexuality as a disease, but the recent guidelines would result in homosexuals being medicated as if it were one.

    The sad truth is, that almost every other high-risk group are seeing a decrease in HIV infection rate but the homosexual community is seeing an increase since 2012. New HIV cases are being seen, mostly, in young people. This can easily be explained by the fact that gay sexual education is far more unique and complex than what is being taught or more importantly what is not being taught in schools.

    Let’s not forget that compulsory sex education is not required by UK law and back in January an amendment to introduce compulsory sex education, including information about same-sex relationships, sexual violence, consent and safe sex, was rejected by the House of Lords.

    A far cheaper alternative would be mandating by law that all young people should be taught about every form of contraception, safe sex methods and importance of regular testing. With a comprehensive sexual education, the dangers of HIV/AIDs and other STIs will be made known to the next generation. Equally as importantly, taught in such a manner, the stigma attached to HIV as the “gay” disease would hopefully be removed. Education is clearly preferable over medication.

     

    Opinions expressed in this article may not reflect those of THEGAYUK, it’s management or editorial teams. If you’d like to comment or write a comment, opinion or blog piece, please click here.

  • HIV death rates halved since 1999

    HIV-positive adults in high-income countries face a substantially reduced risk of death from AIDS-related causes, cardiovascular disease, and liver disease compared with a decade ago, according to a large international study published in The Lancet.

    The study which involved nearly 50 000 HIV-positive adults receiving care and antiretroviral therapy (ART) at more than 200 clinics across Europe, USA, and Australia found that overall death rates have almost halved since 1999.

    The development in the mid-1990s of antiretroviral treatment for the management of HIV infections is one of medicine’s greatest success stories. For individuals who can access and adhere to treatment at early stages of the infection, the risk of developing an AIDS-defining complication is vanishingly small. Treatment, however, does not fully restore health. Treated adults have a higher than expected risk of developing many non-AIDS complications including cardiovascular disease and cancer. The excess risk has been attributed to antiretroviral drug toxicity, traditional risk factors, immune dysfunction, or chronic inflammation. With the advent of effective antiretroviral treatment, the life expectancy for people with HIV is now approaching that seen in the general population. Consequently, the relative importance of other traditionally non-AIDS-related morbidities has increased. The team behind the study investigated trends over time in all-cause mortality and for specific causes of death in people with HIV from 1999 to 2011.

    The team behind the study noted that their findings suggest that death rates in HIV-positive individuals with access to care and antiretroviral therapy have decreased since 1999-2000. They can detect no indication of an increase in risk of death from any specific cause as a potential result of long-term adverse effects of ART, and the risk of death from other causes – ie, those other than AIDs-related disease, cardiovascular disease, liver disease, and non-AIDS cancers – is low.

    Rates of death from non-AIDS-related cancers have remained stable over time, and these types of cancers are now the most common cause of non-AIDS deaths in people with HIV. The finding of a stable rate of death from non-AIDS cancer in the study is of concern when compared with the experience in the general population, in which death rates have decreased over the same time period.

    However a potential limitation to the study is that the investigators could only report on the outcomes of HIV-infected individuals who were followed up regularly in clinic, and thus excluded a large population of HIV-infected individuals who remain untreated because they are unaware of their infected status or not engaged in care.

    Steven Deeks and Peter Hunt from the University of California in San Francisco, USA, say, ‘The benefits of ART are unquestioned, and their beneficial effect on the HIV epidemic continues to grow. Still, clear limitations exist because many patients are not accessing treatment, and some problems persist even in those on ART, including a higher than expected risk of non-AIDS cancers and other morbidities. Finally, it needs to be emphasised that we are still early in the ART era. In the absence of a cure, most patients will need to continue on ART for decades. Continued monitoring for unexpected consequences of treatment will be needed indefinitely.’

    To read the article, see below:
    http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)60604-8/abstract

  • Theory: What causes the loss of CD4 T cells in people infected with HIV?

    A Theory for HIV infection: What causes the loss of CD4 T cells in people infected with HIV?

    HIV infection causes dysfunction and destruction of CD4 T cells that, without antiretroviral therapy (ART: a cocktail of drugs that interrupts the HIV life cycle), result in AIDS and eventual death within 7 to 10 years).
    Scientists believe that most CD4 T cells die, not because of direct infection by HIV of these cells, but through a process called inflammation, by which immune cells secrete toxic molecules to get rid of the virus.

    However, the logic behind how inflammation causes cell death has been a mystery for decades.

    But now, research conducted by scientists at the Burnet Institute in Melbourne, Australia, and published in the premiere HIV/AIDS Journal, AIDS in 2014, shows for the first time that HIV infection not only disturbs the functions of CD4 T cells but affects how these cells use energy (1). The team, led by chief investigator Dr Clovis Palmer, proposed a new model of how CD4 T cells are destroyed in people infected with HIV.

    In healthy persons, immune cells such as CD4 T cells take up low levels of glucose through a protein known as Glucose transporter 1 (Glut1). By a series of steps the glucose is broken down to produce pockets of energy called adenosine triphosphate (ATP) to maintain the general wellbeing of the cells

    The Burnet team showed that the Glucose transporter (Glut1) level is increased on CD4 T cells in people infected with HIV, and that this causes more glucose to enter the cells. This is a survival mechanism because the CD4 T cells need more energy to divide and manufacture antiviral and inflammatory molecules to fight the infection. This is what is called CD4 T cell activation or immune activation.
    In this activated state, instead of breaking down glucose to form energy pockets (ATP), glucose is broken down into a substance called lactic acid through a process called aerobic glycolysis. Glycolysis is only moderately efficient in energy production and, as a result, the CD4 T cells die of exhaustion. The researchers called this process ‘metabolic exhaustion’

    Dr Palmer believes that this finding could lead to new drugs that delay the start of anti-retroviral therapy and will strengthen the immune systems of HIV-positive people.

    Healthy adults have between 600 to 1,200 CD4 T cells in their blood but up to 30 percent of HIV infected adults have a CD4 cell count consistently less than 350, well below the normal range despite being on ART and having undetectable viral load. The team showed that glycolysis remains elevated in CD4 T cells from these persons and that this could explain why they are unable to reconstitute their normal CD4 T cell levels. These low levels of CD4 T cells put HIV-positive people on ART at higher risk of cardiovascular disease, liver disease, kidney failure and other life-threatening diseases.

    The results from this study suggest that CD4 T cells in HIV infected people cannot replenish themselves because they exhaust their energy reserves through their high metabolic activity. What’s exciting about this is a very real scenario where, by returning metabolic activity to normal, these cells could be re-energised to fight the infection by themselves.

    Dr Clovis Palmer heads the immunometabolism group at the world renowned Burnet Institute of Medical Research in Melbourne, Australia. Dr Palmer is a reviewer for several top-ranked international journals including Hepatology, AIDS and Antioxidants and Redox Signalling. He is the chief scientific editor for Natural Immunity-Health, Australia (www.naturalimmunity.com.au).

    by Doctor Clovis Palmer

     

    Opinions expressed in this article may not reflect those of THEGAYUK, its management or editorial teams. If you’d like to comment or write a comment, opinion or blog piece, please click here.