'Remarkable' Improvements - UK HIV Patients

posted: 02/08/2010

People taking HIV treatments were broadly doing much better between 2000-2007, and things will continue to improve until at least 2012, says a report in HIV Medicine. The researchers say that the improvements seen between 2000 and 2007 are “remarkable”.
 

Since 2000 death rates have continued to fall in real terms, and the number of people with a low CD4 cell count (below 200) has also halved and there has been a big rise in the proportion of people with an undetectable viral load. Although the proportion of people with triple-class treatment failure has risen, nonetheless over half the people with triple HIV drug class treatment failure still had an undetectable viral load.
 

Five out of six people on HIV treatment have undetectable viral load
“The success of ART [antiretroviral therapy] has improved markedly over the period 2000-2007, with five in every six ART-treated patients having a viral load below 50 copies/ml. Nine in 10 of all patients now have a CD4 count above the particularly high risk level of 200 cells/mm3”, comment the investigators.
 

Watching for improvements
The study was a reality check, to see if the key outcomes for HIV-positive people using HIV clinics in the UK were being maintained, or even improved. They checked four key markers of the success of HIV treatments between 2000-2007: deaths, low CD4 cell count, multi-class drug resistance, and detectable viral load. They also designed a computer model to project how these things may change, for better or worse, between 2007 and 2012.
 

To do the study they used data in the UK Collaborative HIV Cohort (UK-CHIC), as well as the Health Protection Agency’s Survey of Prevalent HIV Infections Diagnosed (SOPHID) study. The number of people in the UK-CHIC rose by over 50%, from 9041 in 2000 to 14,812 in 2007.
 

By 2012 there will be 74,000 people using HIV clinics in UK
When these were combined with data from the HPA, it is now expected that the total number of patients receiving HIV care in the UK will increase to 74,000 by 2012, of whom 73% would be taking treatments.
 

Different types of HIV drugs
By 2007, 81% of people having treatment have taken an NNRTI, 56% a protease inhibitor, and 39% had experience of all three of the original classes of anti-HIV drugs.
 

Doing better - Fewer people have low CD4 counts, and more have undetectable viral load
There was a substantial fall in the proportion of people with a CD4 cell count below 200 (19% in 2000, 8% in 2007). A CD4 below 200 makes opportunistic HIV illnesses more likely. The fall in low CD4 counts was matched by a rise in the percentage of people on treatment who have an undetectable viral load - undetectable means below 50 (62% in 2000, 83% in 2007). An undetectable viral load means the treatment is working well at keeping HIV under control, and means people are much less likely to pass on HIV.
 

Deaths stable
The observed annual number of deaths amongst people with HIV remained stable between 2000-2007, and the computer model suggested that there would be no substantial increase through to 2012. Death rates plummeted after effective combination treatments began in the mid 1990s. The investigators comment, “there is no apparent increasing trend in the numbers of deaths, despite the increasing number of people infected with HIV, indicating a decrease in the death rate.”
 

More have used the three main HIV drug types
The number and proportion of people who have now taken the three main classes of HIV drugs has risen from 14% in 2000 to 19% in 2007. Based on data from the UK-CHIC, they estimate that the proportion of patients with extensive triple class treatment failure increased from 1% in 2000 to 4% in 2007.
 

However, better HIV treatment and new drugs are more than keeping pace with this. The proportion of people who had extensive treatment failure leading to a detectable viral load fell from 80% in 2000 to 48% in 2007.
“This decrease is projected to continue as more patients start newer drugs, including those from the newly available classes such as integrase inhibitors and perhaps CCR5 antagonists”, write the researchers.
 

Less transmission of drug-resistant HIV
Such a fall in the number of treatment-experienced patients with a detectable viral load is likely to have public health benefits. The investigators comment, “our results have positive implications for future transmission of resistant virus, with the proportion of new infections with resistant virus predicted to remain low.”
 

Outlook brighter even for people with extensive treatment experience
The researchers believe that the improvements in outcomes between 2000 and 2007 are “remarkable”.

They conclude that newly licensed drugs and future developments in HIV treatment and care will mean that further improvements in outcomes are likely for people who have been extensively treated.
 

Source

Reference : Bansi L et al. Trends over calendar time in antiretroviral treatment success and failure in HIV clinic populations. HIV Medicine 11: 432-38, 2010.

Dental Problems Update

posted: 07/10/2008

Feedback from the dental consultation event held at George House Trust on 1 October 2008.

As many of you will be aware there have been a lot of complaints about how people living with HIV are treated by dentists.

We recently hosted a consultation event for people living with HIV to find out more about people's experience of dentists.

Some good news came out of the event as a number of people contacted George House Trust and said that they had disclosed their HIV status to their dentist and were very happy with the treatment that they had received.  Other people had examples of good practice such as surgeries making it easier for people to disclose.

21 people came along to the dentistry meeting with a good mix of people using all the different George House Trust services.

half the attenders have no dentist

Of the people attending half did not have a dentist. Mostly this was because people had tried unsuccessfully to find a dentist. There was also confusion over charging and private dentistry so some people were worried about being unable to afford treatment.

Different treatment

There were cases of different treatment of people living with HIV. Often people living with HIV seem to be asked to have double appointments for routine work, be asked to come in at the end of the day or be taken off a list for being a few minutes late. Some people were concerned that they had been over charged and that their dentist appeared to be working on piece work and not giving a good service.

We were pleased to have representatives of the PCT at the meeting, Val Bayliss Brideaux from the Engagement Team and Mark Carroll from the Patient and Liaison service (PALS).

What will happen next

• We will continue to speak to the PCTs across the region raising the issues any concerns regarding people with HIV accessing dentists
• PALs tell us that there is capacity among NHS dentists so we will continue to support people accessing dentists
• We will feed in specific complaints about treatment. We will do this in consultation with the person making the complaint to make sure they are happy with the way a complaint is taken forward
• We need your help! Please continue to give us feedback (good and bad) about dentists as we want to publicise the good practice as well as highlight the bad.

Please email any examples of good or bad practice to Lynda Shentall Director of Services

Thanks to those who came for the event, thanks to the PCT for helping with the costs on the day.