Category Archives: Research

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.

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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.

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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 rate among gay and bi men between the age of 25 to 34 rose 45% between 2008 and 2015

During that time, the rate dropped 15 percent nationally and rose 25 percent among Latino men who have sex with men.

From Poz Magazine online

While the national annual HIV infection rate dropped by an estimated 15 percent between 2008 and 2015, a few key subgroups saw a rise in yearly new HIV infections, also known as HIV incidence. During this period, HIV incidence among 25- to 34-year-old men who have sex with men (MSM) increased by an estimated 45 percent while the rate increased 25 percent among Latino MSM.

These figures come from the Centers for Disease Control and Prevention’s (CDC) new, in-depth analysis of epidemic trends in the United States. Published in the Annals of Internal Medicine, the report is a more precise and granular version of reports on epidemic trends that CDC officials presented at the 2017 Conference on Retroviruses and Opportunistic Infections (CROI) in Seattle a year ago.

At that time, the agency estimated that HIV incidence declined 18 percent between 2008 and 2014. This new estimate, therefore, represents a disappointing reduction in that hopeful figure.

Prior to 2008, HIV incidence was essentially stable in the United States for the two decades since the beginning of the modern era of combination antiretroviral (ARV) treatment.

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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.”

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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.

Fostemsavir controls viral load in half of people with highly drug-resistant HIV

From aidsmap.com

Fostemsavir, a new experimental attachment inhibitor, suppressed viral load in over half of participants with extensive drug resistance when added to a background regimen selected by resistance testing, Max Lataillade of ViiV Healthcare reported at the 16th European AIDS Conference in Milan on Friday.

The findings come from the phase 3 BRIGHTE study carried out in the United States, France and Brazil.

Fostemsavir (formerly BMS-663068) is a new experimental HIV attachment inhibitor which binds to the HIV gp120 protein, preventing HIV attachment to CD4 cells. Other inhibitors of HIV entry, enfuvirtide and maraviroc, have limited roles in HIV treatment. Enfuvirtide is an HIV fusion inhibitor, an injectable agent that is prescribed only for patients with no other treatment options. Maraviroc is a CCR5 antagonist; it prevents HIV from using the CCR5 receptor on the surface of CD4 cells to gain entry to the cell. It is used in treatment-experienced patients.

Fostemsavir is being developed by ViiV Healthcare as an agent for use in treatment-experienced patients with resistance to several classes of antiretroviral drug. The drug was acquired from Bristol-Myers Squibb along with several other experimental antiretroviral drugs in 2016.

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