Category Archives: HIV care

NIH study: combination antibody treatment for HIV

From Medicalxpress.com

A clinical trial testing infusions of combination antibodies in people living with HIV has begun at the National Institutes of Health. The early-phase clinical trial will evaluate whether periodic infusions of two highly potent, HIV-specific, broadly neutralizing antibodies (bNAbs)—3BNC117 and 10-1074—are safe in people living with HIV. The study also will gather preliminary data on how effectively the bNAb infusions, delivered together every two to four weeks, suppress HIV following discontinuation of antiretroviral therapy (ART).

Read the full article.

Today’s HIV meds are not linked to high blood pressure

From Poz Magazine online

The antiretrovirals (ARVs) in common usage today are not associated with an increased risk of high blood pressure, aidsmap reports.

Publishing their findings in HIV Medicine, researchers from the D:A:D study, a large, ongoing multi-cohort observational study of people with HIV, updated their 2005 paper in which they were unable to identify a clear link between ARVs and high blood pressure.

For this new analysis, the researchers analyzed data on 33,278 HIV-positive study participants who were in medical care for the virus in Europe, Australia and the United States between 1999 and 2013. They looked for a relationship between hypertension diagnoses and 18 ARVs as well as various other risk factors.

A high blood pressure diagnosis was defined as developing blood pressure of 140 over 90, receiving a blood pressure medication or both.

Three out of four of the participants were male, and 44 percent of the participants overall were men who likely contracted the virus through sex with another man. The median age upon entry into the study was 38 years old. About half of the study members were white and one in five had received an AIDS diagnosis. The median CD4 count was 429. Almost 40 percent had a fully suppressed viral load and 68 percent had received ARVs.

As for cardiovascular risk factors, 60 percent had a history of smoking, 16 percent had a body mass index (BMI) over 26 (between 25 and 29.5 indicates overweight), 18 percent had lipodystrophy (the irregular distribution of body fat associated with some of the earliest ARVs) 4 percent were on medication to lower their blood lipids and 2 percent had diabetes.

During a cumulative 223,000 years of follow-up, 7,636 members of the study (23 percent) developed high blood pressure, for a rate of 3.42 diagnoses per 100 cumulative years of follow-up.

When the researchers analyzed the data without adjusting for any non-ARV factors associated with high blood pressure, they found that all the HIV medications were linked to the condition except for Norvir (ritonavir)-boosted Prezista (darunavir) and Emtriva (emtricitabine).

Then the study authors adjusted for demographic risk factors for high blood pressure and found that the only ARVs still linked to the condition were Ziagen (abacavir), Viramune (nevirapine), Norvir and Norvir-boosted Crixivan (indinavir).

Finally, after the investigators adjusted the data to account for differences in metabolic risk factors, Ziagen and Norvir were no longer associated with high blood pressure. Each five years of exposure to Norvir-boosted Crixivan was associated with a 12 percent increase in the risk of high blood pressure, and Viramune was associated with an 8 percent increase per five years of exposure.

The most prominent risk factors for high blood pressure included being male, being older, being Black, engaging in injection drug use and having an AIDS diagnosis, diabetes, high blood lipids, lipodystrophy, obesity and impaired kidney function.

To read the aidsmap article, click here.

To read the study abstract, click here.

Neurological manifestations of HIV

Dr Faktorovich, Department of Neurology, Icahn School of Medicine, Mt Sinai, New York, NY

From Neurologytimes.com

Human immunodeficiency virus (HIV) is responsible for a wide spectrum of neurological manifestations, with etiologies ranging from inflammatory, infectious, neoplastic. and more. The development of antiretroviral therapy (ART) has dramatically increased life expectancy, however neurological complications remain a significant cause of long-term disability. Understanding and recognizing these conditions is crucial in effectively managing HIV.

Dr Svetlana Faktorovich, Department of Neurology, Icahn School of Medicine, explains the various forms of neurological manifestations of HIV in this Neurologytimes.com article.

How Truvada helped propel the evolution of LGBT health

From The Advocate online

In light of the progress we’ve made over the past decades, it’s tempting to think that we are only steps away from a cure and that our previous advances will protect younger LGBTQ people for generations. While it’s empowering to feel confident in our current position, it is essential that we remember that all of this is fragile. According to a recent statistic from the Centers for Disease Control and Prevention, HIV and AIDS remain persistent problems globally. We’ve come a long way in preventing and treating HIV, but there is still much more to accomplish. Annual HIV infections and diagnoses are declining in the U.S., but progress has been uneven, and annual infections and diagnoses have increased among some groups. The declines can thankfully be attributed to targeted HIV prevention efforts, such as Truvada.

Read the full article.

By 2030, top cancers among people with HIV expected to be prostate and lung

From POZ Magazine online

By 2030, the most common cancers among people with HIV are projected to be prostate and lung cancer.

Publishing their findings in the Annals of Internal Medicine, researchers analyzed data from the National Cancer Institute’s HIV/AIDS Cancer Match study, modeling cancer diagnosis rates during 2000 to 2012 to make projections about how rates will change from 2013 to 2030.

The U.S. HIV population is steadily aging, thanks to effective antiretroviral treatment. In 2006, an estimated 27 percent of the population was age 50 or older, a proportion that increased to 45 percent in 2014. Between 2010 and 2030, the proportion of the population age 65 and older is expected to increase from 8.5 percent to 21.4 percent, while the proportion that is age 45 to 64 is expected to increase from 39.4 percent to 47.7 percent.

Between 2000 and 2012, the 463,300 HIV-positive adults in the HIV/AIDS Cancer Match Study were diagnosed with 23,907 cancers. During this period, the annual diagnosis rates (known as incidence) declined for Kaposi sarcoma (KS), non–Hodgkin lymphoma (NHL), cervical cancer, anal cancer (among men who have sex with men), lung cancer, Hodgkin lymphoma and other cancers among all age types. Colon cancer incidence decreased among those age 65 and older. Meanwhile, prostate cancer incidence increased among men ages 35 to 64.

Overall, cancer incidence among the U.S. HIV population is expected to decline through the next decade.

Among three AIDS-defining cancers, the estimated numbers of diagnoses seen in the U.S. HIV population in 2010 and projected to occur in 2020 and 2030, respectively, according to the study authors’ analysis were: 8,150, 7,490 and 6,690 diagnoses of NHL; 1,490, 750 and 450 diagnoses of KS; and 120, 50 and 30 diagnoses of cervical cancer.

As for non-AIDS-defining cancers, the respective numbers of diagnoses seen in 2010 and projected to occur in 2020 and 2030 were: 5,420, 6,150 and 5,980 diagnoses of lung cancer; 830, 910 and 1,030 diagnoses of prostate cancer; 750, 1,340, 1,590 diagnoses of anal cancer; 360, 460 and 480 diagnoses of liver cancer; 300, 200 and 120 diagnoses of Hodgkin lymphoma; 250, 320 and 340 diagnoses of oral cavity/pharyngeal cancer; 220, 260 and 260 diagnoses of breast cancer; 220, 230 and 200 diagnoses of colon cancer; and 1,910, 1,880 and 1,510 diagnoses of other types of cancers.

The study authors concluded that their findings stress the importance of expanding access to HIV treatment and cancer prevention, screening and treatment.

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

To read the study abstract, click here.

HIV patients with depression face serious risks

From Reuters Health

The proportion of time patients with HIV spend depressed is directly related to their likelihood of missing doctor appointments, how well their infection is suppressed and their risk of death from any cause, according to a multi-site U. S. study.

In a large analysis of records for nearly 6,000 patients receiving HIV primary care across the country, the researchers found that for patients depressed during the entire study period, the risk of death was double that of patients with no depression.

Even shorter periods of time spent with depression were tied to increases in viral load, missed appointments and increased mortality, researchers report in JAMA Psychiatry.

“If we can shorten an HIV patient’s exposure to depression by picking it up early and treating it well using evidence based protocols, we can make a difference in their outcomes,” said lead author Brian W. Pence, an associate professor of epidemiology at the Gillings School of Global Public Health at the University of North Carolina, Chapel Hill.

This is the first time that the impact of cumulative depression has been studied across the whole HIV care continuum, Pence told Reuters Health in a telephone interview.

The results suggest that even short-term, mild depression can have“meaningful negative outcomes on HIV treatment and survival,” Pence and colleagues write.

An estimated 1.1 million people in the U. S. were living with HIV at the end of 2015, according to the latest statistics from the Centers for Disease Control and Prevention. Between 20 percent and 40 percent of people living with HIV also have depression, Pence noted.

“We need to find better ways to integrate mental health care into chronic disease care . . . There’s good evidence that primary care providers and non-specialists can be as effective as psychiatrists using assertive dosing schedules.”

Read the full article.

Free continuing education for clinicians caring for people with HIV

CDC’s MMWR and Medscape are proud to introduce a new FREE continuing education (CE) activity that describes diagnosis delay among persons infected with HIV: Vital Signs: Human Immunodeficiency Virus Testing and Diagnosis Delays — United States.

This activity is intended for infectious disease clinicians, family medicine specialists, internists, nurses, pharmacists, public health officials, and other clinicians caring for patients with or at risk for HIV infection.

Upon completion of this activity, participants will be able to:

  1. Describe diagnosis delay among persons infected with HIV, based on an analysis of data from the Centers for Disease Control and Prevention’s National HIV Surveillance System, and missed opportunities for HIV testing, based on CDC’s National HIV Behavioral Surveillance.
  2. Identify the proportions of persons in various high-risk populations who tested for HIV in the past 12 months.
  3. Determine the clinical and public health implications of these findings regarding HIV testing, missed opportunities for testing, and diagnosis delay among persons infected with HIV.

To access this FREE MMWR / Medscape CE activity visit https://www.cdc.gov/mmwr/cme/medscape_cme.html. If you are not a registered user on Medscape, please register for free or login without a password and get unlimited access to all continuing education activities and other Medscape features.