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This Week In HIV Research

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This Week in HIV Research: Reasons for Skipping Meds; Tenofovir Monotherapy PrEP Failures; and Increasing HIV Test Acceptance

January 22, 2016

This week, we read a study highlighting the most common reasons individuals skip their HIV medications in Tanzania, Uganda and Zambia. We also read about two cases of pre-exposure prophylaxis (PrEP) failure using tenofovir (TDF, Viread) monotherapy. And we see how opt-out testing significantly increases the number of people who accept HIV tests. To beat HIV, you have to follow the science!


Treatment

Reasons for Missing Antiretroviral Therapy: Results from a Multi-Country Study in Tanzania, Uganda and Zambia

About 29% of individuals living with HIV in Tanzania, Uganda and Zambia skip antiretroviral therapy for at least one of 16 common reasons, according to a study published in PLOS One. The study followed 4,425 patients, 68% female, with a median age of 40 years old.

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Among those who reported ever missing a dose, the most common reason was simply forgetting (53%). Other reasons for missing a dose were treatment-related hunger or not having enough food (30%), and symptoms such as feeling sick or uncomfortable (12%). Participants reported a median number of four symptoms, with women being more likely to experience symptoms. The researchers found that every additional symptom increased the risk of incomplete adherence by 12%.

Less common reasons for skipping treatment included not having transportation to the pharmacy (11%) and being away from home (3%).

With over half of missed doses being attributed to forgetting, the researchers suggested implementing a text message-based reminder system to help boost adherence.

"The integration of food supplementation into HIV care programs has been shown to improve adherence, and to have clinical and immunological benefits," the authors noted in response to treatment-related hunger or not having enough food accounting for a third of missed doses.

Notably, 50.3% of participants were on a regimen containing zidovudine (AZT, Retrovir), and 18.2% were on a regimen containing stavudine (d4T, Zerit).


HIV Prevention

Two Cases of PrEP Failure on Solo Tenofovir Raise Significant Questions

Taking tenofovir (TDF, Viread) monotherapy as PrEP failed to prevent two cases of HIV transmission, according to a study published in the journal Infectious Diseases and Therapy.

The study details two men who have sex with men (MSM) in Thailand who were diagnosed with acute HIV while receiving tenofovir monotherapy for hepatitis B, despite both having therapeutic levels of drug during HIV acquisition.

As noted in a report by Aidsmap, the study raises many questions:

  • Whether the levels of tenofovir required to prevent infection need to be higher than those used for treatment.
  • Whether hepatitis B coinfection may have made HIV infection more likely.
  • Whether the men would have been infected if they had been taking tenofovir/emtricitabine (Truvada).
  • And if not, what are the exact contributions to prevention of the two drugs?

In November 2015, the World Health Organization recommended oral PrEP containing tenofovir disoproxil fumarate (TDF) for individuals at high risk of HIV. However, as the study authors note, "As PrEP is becoming more widely available and uptake increasing, this is a timely reminder that [tenofovir] monotherapy PrEP in MSM has limited efficacy data and that HIV acquisition can occur in the presence of [tenofovir] drug levels within the therapeutic range required to treat HIV."


HIV Testing

How to Increase HIV Testing: Opt-In vs. Active Choice vs. Opt-Out Testing

With an estimated 20% of individuals living with HIV unaware of their status, how providers offer an HIV test affects whether or not patients get tested, according to a study published in The British Medical Journal.

The study included 4,800 patients who had visited the emergency department of an urban teaching hospital and regional trauma center between June 2011 and June 2013.

The participants were randomized into three testing groups:

  • Opt-in testing: informing patients that an HIV test was available should they want one.
  • Active choice testing: directly asking patients if they wanted an HIV test.
  • Opt-out testing: informing patients that they would be tested for HIV unless they specifically declined.

Only 38% of the opt-in testing group accepted an HIV test, compared to 51.3% of the active choice testing group. Meanwhile, 65.9% of the opt-out group accepted an HIV test.

The researchers noted that the distinction between opt-in and active choice testing was subtle (e.g. "You can let me know if you'd like a test," vs. "Would you like a test?"), but ultimately important since the resulting difference in test acceptance was clinically significant.

Since 2006, the U.S. Centers for Disease Control and Prevention (CDC) has recommended opt-out testing for patients in all health care settings

Warren Tong is the senior science editor for TheBody.com and TheBodyPRO.com.

Follow Warren on Twitter: @WarrenAtTheBody.


Copyright © 2016 Remedy Health Media, LLC. All rights reserved.




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