By Rachel Pugh
People with HIV now have near-normal life expectancy thanks to a number of key successes in treatment, but that has thrown up a new challenge of how to manage this population and their age-related comorbidities.
Professor Chloe Orkin, Chair of the British HIV Association and Consultant Physician at the Royal London Hospital, United Kingdom, explored the current trends in HIV treatment at the Royal College of Physicians’ 2018 annual conference. Encouraging clinical vigilance, she said: “As the population of individuals with HIV is ageing, we are seeing more of the usual comorbidities, such as diabetes and hypertension, but in the HIV population we are also seeing bone fractures and liver disease.”
The particular problem with this group, she explained, is that HIV has an inflammatory effect on the immune system. Although this is improved by anti-retroviral drugs, the effect is not complete.
She highlighted some key successes in treatment of people living with HIV. In 2016 in London, the UNAIDS 90-90-90 target1 was achieved for the first time. England came close to meeting that target, with 88% of those living with HIV being diagnosed, 96% of those on HIV treatment and 97% of them having an undetectable viral load2.
She said: “This is an incredibly positive advance and an important concept for medical professionals and the public to understand. However, only 80% with HIV are diagnosed and we need to get better at that.”
Pre-exposure prophylaxis (PrEP), involving a drug or a combination of drugs which can prevent HIV infection, is now available as part of a trial in England and on prescription from NHS Scotland, which she says is contributing to the positive picture.
Instances of HIV diagnosis are going down, especially in 5 clinics in London which maintain high levels of testing, ensuring earlier HIV diagnosis. PrEP is also making a positive contribution.
Improvements have also been made in antiviral medication, notably the dramatic reduction in the sheer number of tablets patients require and the consequent decrease in side effects.
However, Professor Orkin pointed out that with 103,000 people living with HIV in the United Kingdom, many of whom were diagnosed in the 90s, lifestyle issues are becoming acute alongside management of comorbidities. Smoking is an issue with 50-70% of HIV patients, low levels of alcohol are harmful in this group and mental health problems are also higher than in the general population.