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HIV research update: Late April 2016


 

References

A great volume of HIV and AIDS research enters the medical literature every month. It’s difficult to keep track of everything, so here’s a quick look at some notable news items and journal articles published over the past few weeks.

CD4 cell count monitoring can be safely performed annually in HIV-monoinfected patients with CD4 cell counts greater than 300 cells/mcL and HIV/hepatitis C virus–coinfected patients with counts greater than 350 cells/mcL, according to a study in Clinical Infectious Diseases.

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A three-pill trial of generic antiretroviral therapy is more likely to lead to post-trial treatment changes and to provide more value than a two-pill trial if policy decisions are based on cost-effectiveness, reports a study in HIV Clinical Trials. The authors said value of information analysis can identify trials likely to confer the greatest impact and value for HIV care.

Researchers reported the first case of Alzheimer’s disease (AD) diagnosed in an HIV-positive individual, in a case study published in the journal Alzheimer’s & Dementia. The authors say progressive dementia in older HIV-positive individuals may be due to HIV-associated neurocognitive disorder (HAND), AD, or both, and that amyloid PET imaging may be of value in distinguishing HAND from AD pathologies.

Despite expanded treatment, attrition along the continuum of HIV care is slowing prevention progress in South Africa, according to a study in JAIDS. Investigators said improved detection is critically needed, particularly among men.

A commentary in Lancet Infectious Diseases concluded that plasma concentrations of efavirenz are difficult to predict in HIV-infected children because of immaturity of and genetic variation in metabolic enzymes, and that efavirenz exerts a lysergide (LSD)-like effect on brain serotonergic pathways and affects CNS metabolic pathways. The authors say these uncertainties underline the imminent need for better monitoring of mental health and neurocognitive development in children given and exposed to efavirenz.

A study in the journal AIDS found that HIV infection was independently associated with higher FIB-4 scores, indicating more advanced liver fibrosis, though the difference in FIB-4 score between HIV-infected and uninfected was small. Researchers said higher levels of immune activation were associated with liver fibrosis in HIV-infected, even in the absence of hepatitis B or C virus infection, but not in HIV-uninfected individuals.

The results of a case study of a patient who developed a peripheral facial palsy and a trigeminal neuralgia during an acute HIV infection strongly suggested the HIV primary infection as the etiology of these neuropathies, according to researchers, who assessed laboratory and microbiological findings, including the HIV viral load in cerebrospinal fluid.

A study in the International Journal of Infectious Diseases found that concurrent sexual partnerships may increase the HIV infection risk for black South African women, and in particular, for younger women.

A study of prolonged breastfeeding in Zambia found that the practice increased the risk of human cytomegalovirus (HCMV) infection in infants generally, but children of HIV-positive women were at increased risk of infection. Women who were HIV-positive secreted higher HCMV levels, and for longer duration, than HIV-negative women.

Both chronic and recent HIV infection lead to an average aging advancement of 4.9 years, increasing expected mortality risk by 19%, according to a study in Molecular Cell. In addition, the authors say that decreased human leukocyte antigen methylation is predictive of lower CD4 / CD8 T cell ratio, linking molecular aging, epigenetic regulation, and disease progression.

Lipid-based nutrient supplements given during the first 4 months of antiretroviral therapy improve the quality of life of people living with HIV, according to a study published in Tropical Medicine & International Health.

Because HIV-related immunosuppression and ongoing viral replication may contribute to an increased hypertension risk, a new study recommends aggressive cardiovascular disease risk factor management, early HIV diagnosis, linkage to care, antiretroviral therapy initiation, and durable viral suppression as important components of a comprehensive primary cardiovascular disease prevention strategy in HIV-infected persons.

A study in the Journal of Infectious Diseases reports that for HIV-infected persons in care during 2000-2010 in the U.S. and Canada, rates of first opportunistic infection were relatively low and generally declined over time.

Single viral load measurements overestimated the percent of HIV patients with stable suppressed viral load by 16% (relative difference), according to a study in JAIDS. The authors said targeted clinical interventions are needed to increase the percent of patients with stable suppression.

An Italian population-based study of 5,285 people with AIDS documented extremely elevated risks of death for non-AIDS defining cancers among this population. The authors say the findings stress the need for preventive interventions for both virus-related and non virus-related cancers among HIV-infected individuals.

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