Issues in HIV in the era of Highly Active Antiretroviral Therapy

The topics presented reflect the changing and diverse nature of HIV in the era of HAART. \nChanging characteristics at the Royal Free Hospital (RFH) \nBetween 1992 & 2000 the proportion HIV cases that are in heterosexuals and in black Africans (women in particular) has increased. There has been evidence of improving survival after HAART (in terms of increasing age and CD4 counts and decreasing viral loads over time). However, the CD4 count at diagnosis has fallen and the proportion of patients presenting with AIDS at HIV diagnosis remains high. \nGender and response to HAART \nThe possible influence of gender on response to HAART was examined in the RFH and EuroSIDA cohorts. Virological outcomes were similar in males and females although the results suggest a possible disadvantage for women in terms of virological rebound and failure. Immunological and clinical outcomes were, however, similar. The clinical relevance of a potential virological gender difference is uncertain, particularly if this does not translate into a clinical difference. \nCervical abnormality and HIV \nThe prevalence of cervical abnormality in women attending for a first cervical screen at the RFH is 60%. Those with a higher baseline CD4 count were less likely, and those who were smokers more likely, to have an abnormality. Fifty-five percent of women starting HAART had cervical abnormalities and this had risen to 62% at the time of a follow-up visit six months later. Those with the largest increases in CD4 count on treatment were those most likely to experience regression of a lesion. \nBone Mineral Density (BMD) and HIV \nIn a cross sectional study the prevalence of reduced BMD was found to be greater in those who had ever been exposed to PIs than other individuals. The value of serum markers of bone turnover as screening tools to detect abnormal BMD was assessed. Neither marker was effective for screening for reduced BMD but the methods used may provide a useful model for future work.