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HIV research update: Early May 2016


 

References

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

Viral load measurements can be used to predict if an HIV-infected patient will be suppressed by 6-months after starting combination antiretroviral therapy, according to a study in the journal AIDS. The investigators said graphical presentations of this information could help clinicians decide the optimum time to switch treatment regimen during the first months of cART.

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A study in The Lancet HIV shows the first application of an automated phylogenetic system monitoring a clinical database to detect a recent HIV outbreak and support the ensuing public health response. The authors said that by making secondary use of routinely collected HIV genotypes, such an approach is cost-effective, attains near real-time monitoring of new cases, and can be implemented in all settings in which HIV genotyping is the standard of care.

According to a study in Epidemiology & Infection, statistical models of risk for skin and soft tissue infection (SSTIs) in HIV patients may yield biased results if they do not account for how HIV viral load may be a marker of adherence to trimethoprim-sulfamethoxazole (TMP-SMX) prophylaxis. TMP-SMX is prescribed to many severely immunocompromised HIV patients and is potentially protective against SSTIs.

The treatment failure misclassification rate in HIV-infected Kenyan children was 21% for the 2006 World Health Organization treatment guidelines and 46% for the 2010/2013 guidelines, according to a recent analysis. Investigators said the findings support current WHO recommendations for routine viral load monitoring but not necessarily the proposed CD4 thresholds.

Doravirine, a new non-nucleoside reverse transcriptase inhibitor in phase III clinical trials, is susceptible to a number of well-known NNRTI resistance mutations, reports a study in JAIDS. The authors said an understanding of the mutational susceptibilities and binding interactions of NNRTIs with reverse transcriptase could be used to develop pairs of compounds with nonoverlapping mutational susceptibilities.

The pharmacokinetics of the antiretroviral drug abacavir, prescribed at 600 mg once daily, in pregnant HIV-infected women are equivalent to those post partum, according to a study in the journal AIDS. No dose adjustments are required during pregnancy and similar antiviral activity is expected, researchers said.

A recent study describes the processes by which the SMILE Program, with Connect-to-Protect community coalitions – which are affiliated with the Adolescent Trials Network for HIV/AIDS Interventions – addressed structural barriers that prevented HIV testing, linkage, and engagement in HIV health care among young people.

Serial HIV viral load measures are a valid source for estimating antiretroviral initiation, a study published in JAIDS confirmed. The investigators said a definition that includes a >=1-log viral load decline or a change from detectable to undetectable viral load performed best.

The acceptability of the HPV vaccine was high among HIV-negative men who have sex with men in Ireland, based on no cost vaccine and on stated vaccine efficacy (78%). Higher cost was negatively associated with vaccine acceptability, researchers reported.

Most HIV-infected people discontinuing therapy release a diverse population of virus, and this released virus has entry features of virus selected for replication in CD4+ T cells rather than myeloid cells, according to a report in the Journal of Infectious Diseases.

The majority of new HIV-infected patients in a Ugandan study who screened positive for suspected TB did not have a sputum order, and those who did were more likely to have more advanced HIV disease and symptoms. The authors said improved evaluation of provider behavior in the management of TB screen positive patients could improve active TB case detection rates.

Researchers writing in JAIDS said etravirine 200 mg twice daily, as part of individualized combination antiretroviral therapy, may be a treatment option for HIV-1-infected pregnant women.

Offering single-visit antiretroviral therapy initiation to adult patients in South Africa increased uptake of ART by 36% and viral suppression by 26%, a study in PLOS Medicine revealed. The authors said this intervention should be considered for adoption in the public sector in Africa.

Elevated levels of invariant natural killer T (iNKT) cell and natural killer (NK) cell activation are associated with viremia and disease progression markers in both HIV-1 and HIV-2 infections, according to a study in AIDS.

A study of 22 German HIV clinics demonstrated the noninferiority of ritonavir-boosted darunavir (DRV/r) therapy to standard of care, and said DRV/r should be included as a standard component of recommended regimens in postexposure prophylaxis guidelines.

A study in a large pediatric HIV care setting in Botswana found that children “lost to follow-up” (LTFU) were more likely than were controls to have advanced disease and greater immunosuppression, and to not be receiving antiretroviral therapy. Socioeconomic and psychosocial factors were listed as characteristic of children LTFU but not of controls.

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