Treatment, Care and Access

Leading through guidance
How can we harmonize the 
differences between HIV treatment 
guidelines in wealthy and 
resource-limited countries?

IAS Newsletter, July 2009

By the end of 2008, HIV treatment guidelines in wealthy countries were harmonized in their recommendation to begin antiretroviral therapy no later than when an individual’s CD4 count reaches 350, with consideration to start earlier under many certain circumstances, such as pregnancy,  hepatitis co-infection and underlying risks for cardiovascular diseases, or in individuals in a sero-discordant relationship. As evidence accrues from clinical trials suggesting that earlier treatment initiation may further reduce the risk of non-AIDS cancers and heart, liver or kidney disease, and with a number of more potent, less toxic, and easier-to-take-and-tolerate antiretrovirals available, the pendulum is swinging towards treating earlier and earlier.Yet, the World Health Organization (WHO) treatment guidelines for low- and middle-income countries on when to start therapy have remained relatively unchanged since 2006.

Back to the future
Edwin J Bernard looks back over five years as editor of HIV Treatment Update

HIV Treatment Update, Jan/Feb 2009

backtofutureBack in October 2003, when I edited my first edition of AIDS Treatment Update (as it was known then), interest rates were 3.5% (they are currently 1% and falling) and the average house price was just over £135,000 (currently £203,500 and also falling).

Although the number of drugs available and those prescribed have changed dramatically over these five years, some things have not changed at all. 

Back when I began as editor, the greatest concern for someone about to start treatment was how to avoid side-effects, notably lipodystrophy, and in particular facial fat loss (lipoatrophy). Today, it seems, many people with HIV still concerned about side-effects.

[Read full article (as PDF, 280 KB)]

Giving anal cancer the finger
What every HIV-positive person should know about this increasingly common – and preventable – disease

HIV Treatment Update, July 2008

In May, the largest analysis ever undertaken of cancer incidence trends among HIV-positive individuals in the United States  found that nine non-AIDS-defining cancers are more likely to be seen in HIV-positive individuals than in the general population. Notably, the study found that between 2000 and 2003 (the most recent time period analysed), anal cancer was almost 60 times more common in HIV-positive individuals than in the general population.

HIV and aging

HIV Treatment Update, March 2008

One of the tangible benefits of successfully treated HIV infection is the expectation of a longer – and healthier – life. A recent article in the New York Times, entitled ‘AIDS patients face downside of living longer’ suggested otherwise. The article paints a bleak picture of prematurely aging long-term survivors, and suggests that this may be the future for all HIV-positive individuals. But how real are the risks of premature aging for someone on effective treatment today? Is it correct to call an increased risk of heart disease, cancer, bone disease and other illnesses traditionally associated with aging ‘premature aging’? And is it true that these health conditions are an inevitable result of living with HIV, and that we are powerless to do anything about it?  And what about the benefits of aging? If you are aging with HIV, doesn’t that mean that you are still alive? And doesn’t the wisdom that comes with aging with HIV mean anything?

Better practice
Why GPs need to be integrated into HIV-positive care

AIDS Treatment Update, July 2006

Some GPs have never been exposed to diagnosed HIV-positive patients because in the past, HIV clinics have made it easy for us to use them as a one-stop-shop, negating our need for a GP. This has led to a vicious circle that needs to be broken because some GPs continue to miss undiagnosed HIV, since they're not HIV-aware. Besides, sooner or later, we will all require anHIV-knowledgeable GP, because GPs will need to prescribe medicines that your HIV clinic can no longer afford - like lipid-lowering and anti-diabetes drugs, and antidepressants.

New Life
A very personal perspective of life before and after New-Fill

AIDS Treatment Update, January 2004

I don't recall the exact moment when I realised that my face looked different. It was some time in 1999; 16 years after I became infected with HIV, 11 years after my HIV diagnosis, six years since I first began antiretrovirals, and three years into dual therapy with 3TC and d4T.

© 2008 - 2011 Edwin J Bernard