Health | Dr Shay
Living With HIV And Its Treatment This month, Dr Shay Keating talks about effective HIV treatment, and answers the question: ‘if my virus is undetectable in the blood, can I pass the virus on?’ This year, 2014, marks the 30th anniversary of the discovery of the human immunodeficiency Virus (HIV) the infectious cause of what was known as the Acquired Immunodeficiency Syndrome or AIDS. In these thirty years, so much has been discovered about this virus, how it causes loss of immune function, how it is detected in the blood, how its blood levels are measured, and most importantly, how it is treated. We know that HIV attacks a cell in the immune system termed the ‘T-helper’ cell. With time and without appropriate clinical or pharmaceutical intervention, for the majority, the virus depletes the T-helper population, and immunodeficiency develops. The way we can monitor the health of the immune system is to do a laboratory test called the CD4 count, which gives us a good measure of the body’s immunity. In the late 1990s, the first antiHIV or anti-retroviral (ARV) then called AZT was licensed. Since then, over the last 2 decades, ARTs have become more tolerable to the patient, both from a toxicity or side effect point of view, and also from the number of pills taken daily, the pill burden. We now have co-formulated 60 EILE Magazine
medication, one tablet containing three or even four drugs, that can be taken once a day. This has revolutionised the medical care of HIV disease. Effectively, what we have now is a cohort of HIVpositive individuals, whose HIV disease is controlled on a simple one-pill-a-day regime. Who is offered treatment and when? With the exception of resourcepoor settings, anti HIV medicines are available where clinically indicated. In Europe, the clinical consensus is that when the CD4 count is greater than 350, the body’s immune function is healthy, and ART is not always indicated. There are a few exceptions. If a woman is HIV-positive and for herself, does not need to be on ARTs, if she becomes pregnant it is recommended that she start ART at the start of her second trimester, around week 12-14 of pregnancy. This is to prevent her unborn baby becoming infected. If a HIV-positive person’s partner, with whom they are having sex, is negative, in spite of the fact that he/she might have a high CD4 count, the positive partner might opt to go on medication to minimise transmission to the negative partner. Other scenarios that might
warrant ART prescription, in the face of a healthy immune system, might be where one is unwell from a HIV point of view, with a high amount of virus in the blood (viral load), where one is also infected with another virus, such as hepatitis B or C, or when one has other HIV-related illness, particularly a neurological one. Once on appropriate medications, clinicians like to see a drop in the viral load, ideally to undetectable levels, by at least 6 months. The question often asked of HIV specialists is,’ if my virus is undetectable in the blood, can I pass the virus on?’ In January 2008, the ‘Swiss Statement’ was issued by the Swiss federal Commission on AIDS related Issues, an expert group of doctors and HIV researchers. They advised that if someone is on ART for a minimum amount of time, and has an undetectable amount of virus in the blood for at least 6 months, they are not infectious, even sexually. They added a caveat however, stating that this only held true if neither sexual partner had another, even undiagnosed, sexually transmitted disease. In this scenario, the genital fluids may be more infectious, and this may
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