Spotlight on… HIV and AIDS

Hannah Blake interviews Dr Michael Brady

Terrence Higgins Trust

For our latest “spotlight on”, we speak with Dr Michael Brady from the Terrence Higgins Trust about the symptoms and treatments available for HIV and AIDS.

By the end of 2010, an estimated 34 million people were living with HIV worldwide – up 17% from the year 2001, only nine years previously.

This month, in our regular “spotlight on” piece, we look into the disease area of HIV and AIDS, speaking with Medical Director of the Terrence Higgins Trust, Dr Michael Brady. Michael explains to us the difference between HIV and AIDS, as well as the symptoms and treatments available.

In October 2012, the UK government announced it was going to offer everyone living with HIV access to free treatment – we ask Michael his thoughts on this massive step forward. We also find out what other changes he wishes the government would implement and how pharma can better support HIV and AIDS patients.

Interview summary

HB: What are HIV and AIDS?

MB: HIV stands for human immunodeficiency virus. It’s a virus that’s spread through body fluids and infects the human immune system. It causes illness and disease by slowly destroying CD4 cells, which are a key part of the immune system and help us to fight off diseases.

When the disease is advanced and the HIV infection has been there for a number of years, the immune system can become so weak that people get ill with diseases, infections and cancers that they wouldn’t normally get if they had a healthy immune system. And that’s what’s called AIDS.

AIDS stands for acquired immunodeficiency syndrome, and it’s a disease, or a mixture of diseases, which people only get when they’re infected with HIV, and only get when their immune system is damaged to such an extent that these diseases occur.

HIV is the virus and AIDS is the disease that it can cause if it’s not identified early enough and treated.

HB: Who is most at risk from HIV and AIDS?

MB: In the UK, the two main groups at risk are men who have sex with men and people who have come from parts of the world where HIV is more common, and that’s predominantly sub-Saharan Africa.

HB: What are the initial symptoms to look out for?

MB: It’s important to know that most people who have HIV don’t have any symptoms, which is why we really encourage people to test, particularly those who are at more risk.

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“There are approximately 24% of people living with HIV in the UK who don’t know they have it…”

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Around two or three weeks after catching the virus, most people get what’s called a seroconversion illness, which is a non-specific group of symptoms. It’s really quite like having the flu with aches and pains, fevers, sore throat, swollen lymph glands, or a rash on the body. This will be the first sign that someone has become infected with HIV.

After this seroconversion illness, the symptoms settle down and most people will then remain well without any symptoms for a number of years. On average it could be six, seven or eight years of feeling completely fine, but in that time the virus is slowly damaging the immune system. As the immune system weakens and the CD4 count drops, people may start to get some non-specific symptoms like weight loss, rashes, fevers, swollen glands, or infections such as chest infections, skin conditions, genital warts, or herpes, or things which are perhaps a little bit more severe, unusual, harder to treat, or lasting for longer than normal.

Further down the line, if HIV remains undiagnosed and people aren’t able to access treatment the disease will further advance to the development of AIDS-related diseases or infections.

HB: What treatments for HIV and AIDS are available?

MB: There are now excellent treatments for HIV, which is another reasons why we really encourage people to test and to test regularly, because if you are HIV positive you can access highly effective treatments and expect a long and healthy life. There are around 24 or 25 different drugs which we use to treat HIV. They work in slightly different ways, but generally they all work to inhibit the virus at different stages of its lifecycle to stop it from reproducing and replicating.

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“…the recent announcements by the government to allow everyone living with HIV access to free treatment is a great step forward…”

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We use a combination of drugs to treat HIV, so most people would be on at least three drugs at any one time. One of the biggest advancements in HIV treatments over the last few years has been to reduce the number of tablets that people need to take. It is now possible to have two, three or four drugs combined in one tablet and it’s really common for people to take only one or two tablets once a day. Treatments are now much easier to take, and are certainly a lot simpler and much less unpleasant than they were a few years ago.

HB: In what ways do you believe the pharma industry could better support HIV and AIDS patients?

MB: I think it’s important to note, and fair to say, that the pharma industry already does quite a lot of work supporting people living with HIV and AIDS. They support community projects and patient groups and provide educational resources and support around living with HIV. Whilst there’s a lot of work that they already do, I think the pharma industry has an important role to continue to play in offering advice, support and information around HIV and resources to support people taking HIV therapies, and advice about side effects or managing toxicities.

I think there’s also a role for pharma in the context of broader policy and service provision around HIV. I’ve certainly worked with pharma companies to develop strategies to encourage people to test for HIV and in the development of new models of clinical service provision for people living with HIV.

HB: How will the government’s recent announcement of free access to HIV treatment affect patients in the UK?

MB: I think the recent announcements by the government to allow everyone living with HIV access to free treatment is a great step forward and they should be applauded for that. It’s certainly something that the Terrence Higgins Trust has been campaigning for, for a long time.

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“…the pharma industry already does quite a lot of work supporting people living with HIV and AIDS.”

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Before this happened, people were deterred from testing for HIV, and they were thinking “well what’s the point in testing if I’m not going to be able to get any treatment?” or perhaps anxious that being diagnosed HIV positive would affect their immigration status. If people don’t test then their health will deteriorate because they don’t have access to treatment. There is also a public health risk that they could pass the virus on to someone else. I think universal and free access to HIV therapy may be one of the things that will help improve our rates of late diagnosis, improve the rates of undiagnosed HIV, and affect the health both of individuals and the general population.

If people don’t come and get tested then they will get ill eventually, so in a way we might feel we were saving some money, by not treating everybody, but that cost comes back at some point later when they get admitted to A&amp,E or ITU with a severe illness further on down the line. So I think it’s a good thing, and long overdue.

HB: What other changes would you like to see the government implement?

MB: I think there are a number of other things the government could, and should, do which would have a big impact on the HIV epidemic.

It is essential that we improve our HIV testing rates in the UK so firstly, I think they should change the legislation to allow home testing for HIV as it’s currently illegal to do your own HIV test at home. There are lots of reasons why people don’t test for HIV and I think anything that can be done to increase the access to or acceptability of HIV testing would be a good thing and make a big difference.

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“There still is a lot of stigma and discrimination against people living with HIV, and World AIDS Day can perhaps go some way to reduce that.”

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Secondly, it’s really important that the government continues to support and fund sustained and appropriate national HIV prevention programmes. I think over the years, as a country, we’ve not been great at HIV prevention messages and campaigns. People who are sexually active now perhaps don’t have all the information that they need around their own personal risks of HIV and how to keep themselves safe and HIV negative, so I think well-funded and effective national HIV prevention programmes are important.

Thirdly, our sex and relationship education in school needs to be better. I think we’re a bit rubbish as a country at properly teaching children and young people about sex in general, including contraception, sexually transmitted infections, and also about HIV. So I think the government needs to do something that makes our sex and relationships education more robust, more standardised and ensure that every young person has access to the same level of quality sexual health education.

HB: The 1st of December 2012 is World AIDS Day. Why is this campaign so important and what do you expect to achieve from this awareness day?

MB: I think World AIDS Day is as important as it has ever been. It’s important to keep the profile of HIV high. We still have a lot to do in terms of increasing HIV testing and diagnosis. There are approximately 24% of people living with HIV in the UK who don’t know they have it, and approximately 50% of people who get diagnosed late. So raising awareness is important, encouraging testing is important and decreasing stigma is important.

Whilst HIV is increasingly seen and managed as a long-term condition rather than a terminal illness – it’s not the same as other long-term conditions. There still is a lot of stigma and discrimination against people living with HIV, and World AIDS Day can perhaps go some way to reduce that. By keeping it in the public eye and keeping it in the focus of the policymakers, it enables us to hopefully continue to secure funding for health promotion and HIV prevention programmes. I think what we’d like to achieve from the day is a mixture of all of this: keeping the profile of HIV high, making sure that the public, the policymakers and those at risk of HIV understand what the current state of play is, and to hopefully encourage some individual behaviour changes, both in terms of testing and in terms of safe sex.

HB: Finally, how do you see the future for HIV and AIDS patients?

MB: I think in general, the future for people living with HIV looks good. Already we’re 30 years into the epidemic, and it is a completely different disease. The widespread use of effective HIV therapy has really shifted it from being a terminal illness to being a manageable long-term condition. We now expect people living with HIV to have a life expectancy that’s really not much different from that of people who are HIV negative – we expect people to live with their HIV and not to die from it.

While in general the future looks good, there are a few things that we need to put into place to ensure continued progress against the disease. We need to keep the message of HIV prevention going, to ensure that we reduce the number of new infections and that we reduce the proportion of people with HIV who don’t know that they’ve got it, and therefore aren’t able to access treatment, and aren’t able to make the changes that can stop them from passing the virus on to someone else

In the UK, we’re pretty good at getting people into treatment and care once we know they are positive. What we’re not so good at is HIV testing and that is the single most important thing we need to focus on. As a society, we’ve still got more to do around the stigma and the discrimination against HIV. But if we can work on those two things, I think the future will be good.

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About the interviewee:

Dr Michael Brady is a Consultant in Sexual Health and HIV at King’s College Hospital, London and is the Medical Director of the Terrence Higgins Trust. He works in an area of London with the highest local prevalence of HIV in the UK and with a local population that has generally poor sexual health. His areas of interest include HIV transmission, testing and prevention, primary HIV infection and the development of novel service models for HIV treatment and care.

Terrence Higgins Trust and Streaming Well have also launched a video series designed to educate young people on the basics of HIV in the UK.

How can we raise further awareness of HIV?