March 18, 2016
This week, a study finds that the racial gap in retention in care gradually develops over time. Another study finds that scaling up treatment for people who use drugs does not increase drug resistance in that community. Plus, increasing retention in care could cut the number of new infections in half by the year 2025, according to new estimates. To beat HIV, you have to follow the science!
While African Americans and whites are retained in HIV care at roughly the same rate during the first year of treatment, the gap between ethnicities widens considerably over time, a recent longitudinal chart review found.
"The absence of a racial disparity in retention at 12 months, but emergence of a disparity over time suggests a need for specific interventions that address barriers to care as they arise," the study authors concluded.
The study also confirmed that retention in care is important for achieving viral suppression: 82% of participants who had stayed in care for the entire 36 months were virally suppressed at the end of that period, while only 25% of those who had not remained in HIV care achieved viral suppression.
Scaling up antiretroviral therapy among groups who are less likely to adhere to treatment regimens, such as people who use illicit drugs, does not increase the level of drug resistance in that community, a recent study in Vancouver, British Columbia, found.
Researchers analyzed data on 819 people living with HIV who also used illicit drugs other than cannabis during a treatment as prevention (TasP) initiative in that community. Previous studies in similar populations had found lower likelihoods of viral suppression and significant barriers to effective HIV care.
By contrast, the proportion of participants in this study with an undetectable viral load (less than 50 copies/mL) more than doubled, from 28% to 63%, during the study period (2006-2014). While the number of people on antiretroviral treatment increased during that time, HIV drug resistance declined. "Our findings support continued efforts to scale up [antiretroviral therapy] coverage among HIV-positive [people who use illicit drugs]," the researchers believe.
The number of new HIV infections in the U.S. could be more than halved by 2025, if 90% of people diagnosed with HIV were in care for their infection, a mathematical model reported in The Lancet shows.
The modeling study projects 524,000 new HIV infections within 10 years, if current rates of engagement in care continue. However, 52% of these infections could be averted, if the U.S. National HIV/AIDS Strategy's (NHAS) target of 90% retention in care was met.
By contrast, achieving two other NHAS targets -- 90% of people living with HIV knowing their serostatus, and 85% of them linked to care within one month of diagnosis -- would only marginally reduce HIV incidence, by 2.0% and 3.9%, respectively, the study predicts. The model suggests that an additional U.S. $105 billion would have to be spent in order to achieve that reduction in new HIV infections, along with all NHAS care targets.
"[Antiretroviral therapy] drug prices are the most influential drivers of cost in meeting the goals of improving HIV care engagement," the researchers concluded.
Barbara Jungwirth is a freelance writer and translator based in New York.
Follow Barbara on Twitter: @reliabletran.
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