Category Archives: Features

HIV damages the Brain, but treatment halts progression

From Poz Magazine

Not long after an individual contracts HIV, the virus penetrates the brain and begins to cause progressive damage to the volume of the organ as well as cortical thickness. Antiretroviral (ARV) treatment apparently halts this progression and is able to dial back some of the damage.

Publishing their findings in Clinical Infectious Diseases, researchers studied 65 people who entered the study soon after they contracted HIV, in a period known as primary HIV infection. These participants, 30 of whom started ARV treatment during the study, received multiple MRIs of their brains over time.

The researchers compared the brain scans of the participants with scans of 16 people with long-term, or chronic, HIV infection as well as 19 HIV-negative individuals.

The study authors found that before participants began ARV treatment, a longer time spent with untreated HIV was associated with loss in volume in various parts of the brain, including the thalamus, caudate and cerebellum. More time living with untreated HIV was also linked with cortical thinning in the frontal and temporal lobes and the cingulate cortex.

After individuals started ARVs, the progression of such brain damage stopped, and there were some small increases in cortical thickness measures.

“We knew HIV could cause neurological damage, but we did not know it happened so early in the infection,” Serena Spudich, MD, MA, a professor of neurology at Yale and a co–senior author of the paper, said in a press release. “The findings emphasize the importance of identifying infected people early and treating them so we can halt its progression.”

To read a press release about the study, click here.

To read the study abstract, click here.

HIV-infected people are living for years, but age-related diseases set in early

From the Washington Post

David Hardy has been treating HIV-infected patients since the early 1980s, when the epidemic began. In those days, people newly diagnosed with AIDS lived for only about six months. Hardy, an infectious-disease specialist and internist, was ecstatic when powerful new drug combinations came into widespread use in 1996, enabling HIV-infected people to measure their lives in decades rather than months. But in recent years, his euphoria has turned bittersweet.

“Most people assume that the medicines have worked and that everything has gone back to normal, and that’s not really true,” says Hardy, who directs research for Whitman-Walker Health in Washington and who still sees patients weekly. “While we have suppressed HIV very well, we’ve now discovered that the medicines only treat part of the problem.”

Many HIV-infected people, now in their 50s and 60s, who have lived for years with HIV under control, are developing aging-related conditions — heart, liver and kidney disease, certain cancers and frailty, for example — at a rate significantly higher than uninfected people of the same age. “These are things that people develop all the time as they get old, but they are occurring at an earlier age in HIV-positive people,” Hardy says.

Read the full article.

Lower prevalence of HIV testing among sexually active older adults

From MD Magazine online

According to the Centers for Disease Control and Prevention (CDC), older adults are increasingly affected by HIV infections, as they constitute 17% of new diagnoses, 45% of adult persons living with HIV (PLWH) in the US, and 39% of HIV-related deaths in the US.

Although the prevalence of HIV infection among old adults is increasing worldwide, a recent study in the US suggests that only about a quarter of older adults have been tested for HIV. As a result of less aggressive testing in this patient population, older adults tend to be diagnosed with HIV at a later stage in the disease.

Emeka Oraka, MPH, a senior health research analyst at ICF International in Atlanta, GA, recently led an investigation into the prevalence of HIV testing among older adults and the characteristics of patients being tested. For this study, Oraka and colleagues utilized the General Social Survey (GSS), a biennial survey conducted among the civilian, noninstitutionalized population in the US that collects data on demographics, sexual behaviors and HIV-related behaviors.

Read the full article.

Diabetes rates are rising fast among people with HIV

From Poz Magazine

People with HIV are increasingly developing prediabetes and diabetes, Infectious Disease Advisor reports. While living longer thanks to antiretroviral (ARV) treatment may play a role in this population’s development of such aging-related conditions, the toxicities of ARVs may also raise their risk.

Publishing their findings in Epidemiology, researchers conducted a meta-analysis of 44 studies published between 2000 and 2017 that included estimates of the annual rate of diagnosis, or incidence, of prediabetes and diabetes among individuals who had been exposed to ARV treatment.

Overall, the annual diagnosis rate was 125 cases of prediabetes and 13.7 cases of diabetes per cumulative 1,000 years of follow-up. These two estimates were based on 396,496 and 1,532 cumulative years of follow-up, respectively.

The researchers found that, over time, the annual diagnosis rate for these conditions increased quickly.

Major risk factors for developing either condition included aging, having family history of diabetes, being Black or Latino, being overweight or obese, having central obesity (weight around the abdomen, or a “beer gut”), having lipodystrophy or lipoatrophy (abnormal distribution of fat on the body and face, which is associated with some of the earliest ARVs), having metabolic syndrome (a collection of symptoms, including abnormal cholesterol, triglycerides and blood sugar, central obesity, and high blood pressure), having a higher initial fasting glucose test result and taking certain ARV regimens.

On the bright side, it is possible that given the lower toxicity of today’s preferred ARV regimens, the incidence of prediabetes and diabetes may ultimately decline.

The researchers stressed that more research is necessary to “better capture the interplay” between the two health conditions and ARV treatment.

To read the Infectious Disease Advisor article, click here.

To read the study abstract, click here.

HIV care continuum: Effects of depression, alcohol use on early retention in ART

From Infectiousdiseaseadvisor.com

Both alcohol use and depression are associated with increased disengagement from antiretroviral therapy for patients with HIV in South Africa, according to the results of a recent study published in PLoS ONE.

In this prospective cohort study, 136 people living with HIV in South Africa who were initiating antiretroviral therapy were enrolled. Anxiety and depression were measured with the Hospital Anxiety and Depression Scale, and alcohol use disorder was evaluated with the CAGE questionnaire. Researchers also measured internalized stigma and quality of life in participants. The associations between mental health variables and 6-month retention in care and viral suppression were evaluated.

Read the full article here.

The WHO public health approach to HIV treatment and care: looking back and looking ahead

From the Lancet

In 2006, WHO set forth its vision for a public health approach to delivering antiretroviral therapy. This approach has been broadly adopted in resource-poor settings and has provided the foundation for scaling up treatment to over 19·5 million people. There is a global commitment to end the AIDS epidemic as a public health threat by 2030 and, to support this goal, there are opportunities to adapt the public health approach to meet the ensuing challenges. These challenges include the need to improve identification of people with HIV infection through expanded approaches to testing; further simplify and improve treatment and laboratory monitoring; adapt the public health approach to concentrated epidemics; and link HIV testing, treatment, and care to HIV prevention. Implementation of these key public health principles will bring countries closer to the goals of controlling the HIV epidemic and providing universal health coverage.

Read the full paper here.

 

HRSA awards $2.36 billion in grants to help Americans access HIV/AIDS care and medications

From HIV.gov

The Health Resources and Services Administration (HRSA) announced [yesterday] approximately $2.36 billion in Ryan White HIV/AIDS Program grants awarded to cities, counties, states, and local community-based organizations in fiscal year (FY) 2017. This funding supports a comprehensive system of HIV primary medical care, medication, and essential support services to more than half a million people living with HIV in the United States.

“The Ryan White HIV/AIDS Program plays a critical role in the United States’ public health response to HIV,” said HRSA Administrator George Sigounas, MS, Ph.D. “These grants will ensure that the most vulnerable Americans living with HIV/AIDS will have access to the necessary care and treatment needed to improve their health quality and medical outcomes.”

HRSA oversees the Ryan White HIV/AIDS Program, which is a patient-centered system that provides care and treatment services to low income people living with HIV to improve health outcomes and reduce HIV transmission among hard to reach populations. The program serves more than 50 percent of people living with diagnosed HIV infection in the United States.

Read the full article.