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Latest MS research update - Could HIV drugs be a new treatment for MS? - 11 Aug 2014

The MS Trust runs a weekly search for interesting and relevant research articles relating to multiple sclerosis using Medline, a specialised search engine for medical journals. The original abstracts to each of the articles can be accessed via the links provided.

For further information on any topic please contact the information team at info@mstrust.org.uk.


This week's highlighted research...

Could HIV drugs be a new treatment for MS?

Research by topic areas...

Assessment tools
Other
Paediatric MS
Prognosis
Psychological aspects
Self-management


Could HIV drugs be a new treatment for MS?

Summary

The cause of MS is not well understood. Previous research has shown a link between certain viruses and MS, suggesting infection can act as a trigger which sets off a train of events in some people that develops into MS over a period of time.

Two previous studies suggested that infection with HIV (human immunodeficiency virus) had an effect on the risk of developing MS, but those studies were on a small number of people. This study examined a much larger number of people to investigate the relationship between HIV and MS further.

The researchers used 12 years of English NHS hospital admission information to identify 21,207 people with HIV and a further 5.3 million people who acted as the control group. These were then followed up through the hospital information to see if any of them were diagnosed with MS later in their medical records.

The researchers found that overall people with HIV were 62% less likely to get MS than people without HIV.

As the study is based on observations it does not answer the question of what causes the risk to be lower. The authors suggest two theories which could explain the lower risk of MS in people with HIV. First, the suppression of the immune system caused by HIV may stop the body attacking itself and the development of MS. Alternatively the drugs used to treat HIV may suppress other viruses in the body, including those that have been suggested as having a possible role in causing MS.

They conclude that further studies are needed to determine the reasons why the risk is lower and they have already started one study that is investigating the effect of the anti-retroviral treatment raltegravir in people with relapsing remitting MS.


Background

The cause of MS is not well understood. Previous research has shown a link between certain viruses and MS, suggesting infection can act as a trigger which sets off a train of events in some people that develops into MS over a period of time. Most treatments for MS work by interacting with different parts of the immune system to calm down the inflammation that causes MS relapses.

HIV (human immunodeficiency virus) is a virus that attacks the immune system, reducing the ability to fight infections and disease. It is treated using antiretroviral drugs which work by slowing down the spread of the virus in the body.

Both MS and HIV are well documented conditions, however there is only one reported case of a person with MS and HIV treated with HIV antiretroviral drugs. Their MS symptoms disappeared completely for 12 years while they were taking the antiretroviral drugs. This case led to a study in Denmark which investigated risk of developing MS in people with HIV. Their results showed that people with HIV appeared to be less likely to develop MS, but the difference was not significant and the study included a relatively small number of people. To build on the results of the Danish study, this study examined a much larger number of people to investigate the relationship between HIV and MS further.


How this study was carried out

For this study the researchers used the information from the Hospital Episode Statistics (HES). This is a data set that contains information on all admissions, outpatient appointments and A&E attendances at NHS hospitals in England. The information was anonymised so the researchers could not identify individual people from the data.

The HES was used to identify all people with HIV who were discharged from NHS hospitals between 1999 and 2011. A control group was also identified from the HES data, this group consisted of people who had required hospital treatment for a minor medical or surgical condition or injury. Anyone who already had a diagnosis of MS in either group was excluded and both groups were followed up through the hospital records to see if any of them were diagnosed with MS later in their medical records.

The study tracked 21,207 people with HIV and 5.3 million people in the control group. On average they followed people in the group with HIV for 6.7 years and people in the control group for 7.6 years.

The researchers analysed the data to account of age, sex, year of fist hospital admission, region of residence and socioeconomic background.


What was found

The researchers found that overall people with HIV were 62% less likely to get MS than people without HIV.

The study also found that HIV appeared to provide an increased level of protection as more years passed by between diagnosis of HIV and a subsequent MS diagnosis. HIV positive people were 75% less likely to be diagnosed with MS after one year since their HIV diagnosis and they were 85% less likely to get MS after five years.


What does it mean?

The study shows that HIV infection appears to be associated with a significantly decreased risk of developing MS. As the study is based on observations it does not answer the question of what causes the risk to be lower. The authors suggest two theories which could explain the lower risk of MS in people with HIV. First, the suppression of the immune system caused by HIV may stop the body attacking itself and the development of MS. Alternatively the drugs used to treat HIV may suppress other viruses in the body, including those that have been suggested as having a possible role in causing MS.

The authors conclude that further studies are needed to investigate this finding and determine the reason why HIV infection is protective. This includes using antiretroviral drugs, which are usually used to treat HIV, in people with different types of MS. There is already a small pilot study underway that is investigating the effect of the anti-retroviral treatment raltegravir in people with relapsing remitting MS.


Gold J, Goldacre R, Maruszak H, et al.
HIV and lower risk of multiple sclerosis: beginning to unravel a mystery using a record-linked database study.
J Neurol Neurosurg Psychiatry. 2014 Aug 4. pii: jnnp-2014-307932 [Epub ahead of print]
abstract
Read the full text of this paper

More about the causes of MS

Almost 150 years after the condition was first recognised, the cause of MS remains a mystery. The theory that is widely held is that MS is an autoimmune disease - where the immune system, which should only target invading germs, turns on the body's own tissues. In the case of MS, the immune system attacks myelin, the fatty protein that covers nerves in the central nervous system.

The reason why the body reacts in this way is unknown but it is thought that the genetic make up of some people means that MS can be triggered by an environmental factor, possibly an infectious agent or agents.

Research to see if MS was directly caused by an infectious agent failed to find any positive results, however subsequent research, has worked on the theory that, rather than being an immediate cause, an infection acts as a trigger which sets off a train of events in some people that develops into MS over a period of time.

A number of viruses have been investigated, including chicken pox, measles, mumps, canine distemper and a number of herpes viruses. Recent research has been looking at the Epstein Barr virus (EBV), a common virus that causes glandular fever in some people. However, if there is a particular virus or combination of viruses, they still have to be identified.

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Assessment tools

Kalron A, Greenberg-Avrahami M, Achiron A.
Validity and test-retest reliability of a measure of hand sensibility and manual dexterity in people with multiple sclerosis: the ReSense test.
Disabil Rehabil. 2014 Aug 6:1-7. [Epub ahead of print]
abstract

Monticone M, Ambrosini E, Fiorentini R, et al.
Reliability of spatial-temporal gait parameters during dual-task interference in people with multiple sclerosis. A cross-sectional study.
Gait Posture. 2014 Jul 7. [Epub ahead of print]
abstract

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Other

Maida S, Dalla Costa G, Rodegher M, et al.
Overcoming recruitment challenges in patients with multiple sclerosis: results from an Italian survey.
Clin Trials. 2014 Aug 3. [Epub ahead of print]
abstract

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Paediatric MS

Suppiej A, Cainelli E.
Cognitive dysfunction in pediatric multiple sclerosis.
Neuropsychiatr Dis Treat. 2014;10:1385-92.
abstract

Read the full text of this paper

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Prognosis

Koch MW, Greenfield J, Javizian O, et al.
The natural history of early versus late disability accumulation in primary progressive MS.
J Neurol Neurosurg Psychiatry. 2014 Aug 4. [Epub ahead of print]
abstract

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Psychological aspects

Magalhães R, Alves J, Thomas RE, et al.
Are cognitive interventions for multiple sclerosis effective and feasible?
Restor Neurol Neurosci. 2014 Aug 5. [Epub ahead of print]
abstract

Brenner P, Alexanderson K, Björkenstam C, et al.
Psychiatric diagnoses, medication and risk for disability pension in multiple sclerosis patients; a population-based register study.
PLoS One. 2014;9(8):e104165.
abstract

Read the full text of this paper

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Self-management

Colombo C, Mosconi P, Confalonieri P, et al.
Web search behavior and information needs of people with multiple sclerosis: focus group study and analysis of online postings.
Interact J Med Res. 2014 Jul 24;3(3):e12.
abstract

Read the full text of this paper