John is a gay man in their 50s and has worked at MESMAC since 1996 and been involved with HIV since his university days in the 80s. John shares with us how we’ve come a long way since the late 1980’s when HIV was first identified.
The pandemic has given us a once in a life time chance to have a real impact on HIV transmission
Back in the 80’s we couldn’t interrupt HIV replication and could only treat the infections and diseases that took hold as the immune system was damaged by HIV. In the mid-1990s, combination therapy arrived using three different types of medication, which together was able to disrupt the multiplication of HIV and boost the damaged immune system.
“Initially, many of the medicines had severe side effects, which meant that treatment was started as late as possible.”
People waited until their CD4 count dropped to 200. The CD4 cells are a type of white blood cell that defend the body against certain infections and are damaged by HIV infection. By the 2000’s a new raft of medicines became available and treatment began to start sooner, when the CD4 cells dropped to 350.
Over the coming years treatment options improved and world-wide research informed us that starting treatment sooner would keep someone’s immune system stronger for longer. They would be less susceptible to new infections and diseases with a stronger, fitter immune system. The evidence showed that keeping the immune system as strong as possible was better than letting it drop and trying to bring it back to healthy levels. Recently the guidance has changed from “wait to start treatment” to “start as soon as possible”.
These days best practice says that treatment should be started within 90 days of being diagnosed with HIV. In London, many clinics begin treatment within 48 hours.
The treatment for HIV aims to disrupt HIV replication and boost the immune system back to normal levels. The viral load is a marker that is used to assess how effective the treatment is. Viral load gives an indication of how many HIV there are per millimetre of blood. Someone newly infected with HIV can have a viral load in the tens of thousands. The aim of the treatment is to bring the viral load down to levels that can’t be detected in the blood sample. This means that there are fewer than 30-50 HIV per millimetre of blood. This is called an undetectable viral load. We now know it takes usually 3-12 months to bring the viral load down to undetectable levels once treatment has begun.
Today in the UK, 97% of people who know they have HIV, have started treatment. 98% of those on treatment for HIV have an undetectable viral load. This is brilliant for those infected with HIV and it also means that they can’t pass on HIV.
U=U. Undetectable viral load equals Untransmittable HIV;
There is just not enough HIV to infect someone else.
The challenges for the future include supporting people who are on treatment to keep taking. For treatment to work, it needs to be taken every day – consistently. In the UK, an estimated 92% of people who are infected with HIV, know that they have HIV.
“8% of people who have HIV don’t yet know”
Either because they’ve never tested before or the last time they tested it was negative and they’ve got HIV since then. If we’re sexually active it’s good to test annually; if we’re having a number of different partners, then it’s better to test every three months.
During lockdown access to clinics, if you don’t have symptoms, is limited. MESMAC & SHINE offer a rapid HIV test where you get the result in 15 minutes. You can also get a DIY STI kit sent out. You take the samples yourself and post it back (envelope & postage included). You should get results in 1-2weeks.
Call to book an appointment on 0191 233 1333. We’re all working from home during lockdown, so leave a message and we’ll get back to you or check our website for sexual health clinics and postal HIV tests from THT & SH24, www.mesmacnewcastle.com .
If you are not always good at negotiating condom use then PrEP may be of use. PrEP is a tablet that can be taken before sex with someone with HIV. PrEP blocks HIV from infecting the CD4 white blood cells. It therefore stops HIV from establishing itself. The rest of the immune system can then identify HIV as a virus and get rid of it. PrEP has been available on a clinical trial through sexual health clinics.
It should soon be widely available once lockdown is eased. You can buy it now from NHS clinic 56 Dean Street from £17.50/month or “I want PrEP now” website from £30/month. It can either be taken all the time; one tablet daily, or a short course just when you anticipate meeting up with someone. For a cis man or trans woman, take two tablets 2 – 24 hours before you hope to have sex with someone, then one for the next two days or until 2 days after the last sex. PrEP works really well against HIV but doesn’t stop other STIs; for that it’s worth using condoms – they work well. A cis woman or trans man needs to take a tablet a day for a week before they anticipate having sex, then daily thereafter until 2 days after the last sex.
If you’re worried you’ve been in contact with HIV; PEP is for after sex – medication to help stop HIV infection from taking hold. It can be started within 72 hours but it works best if started within 24 hours. PEP is a combination of three kinds of medicine that are used to treat HIV and it needs to be taken for 28 days. PEP is still available from Sexual Health Clinics, or from A & E if it’s an evening or weekend. The sooner it’s started, the better it works. Check our website for clinic details.
My role these days is all about prevention, helping people to avoid getting HIV and helping promote the U=U message. It is good to be able to tell people about what tests are available and the choices they have. If we work together we can stop HIV transmission in the UK!