July 1, 2016
This week, a study finds that an intravaginal ring containing tenofovir/emtricitabine (Truvada) is highly effective at preventing the simian form of HIV among monkeys. Another study finds that individuals with a history of AIDS are more likely to die at the hospital after admission for a heart attack or stroke than either those without HIV or HIV-positive individuals without a history of AIDS. To beat HIV, you have to follow the science!
A pod intravaginal ring (IVR) containing tenofovir disoproxil fumarate and emtricitabine proved 100% effective in preventing the simian version of HIV, reports a study of macaque monkeys published in PLOS One. It is unclear whether these results can be replicated in humans.
Six female monkeys received pod IVRs every two weeks, while nine other monkeys did not. All animals were then vaginally exposed to SHIV, the monkey version of HIV, once a week for up to four months. By the end of the study period, none of the macaques with the ring had contracted SHIV, while all in the control group tested positive for SHIV.
The pod design of this IVR allows for controlled release rates and, because of its modular nature, can easily include a third antiretroviral, according to the study. The device is currently in a pre-phase 1 clinical trial.
While the drug combination used in the ring is the same as the one approved for pre-exposure prophylaxis (PrEP) of HIV, trials of oral PrEP among women have shown relatively low adherence rates, which significantly reduce the efficacy of the medication. An IVR could solve that problem, study authors said.
The study was published online in PLOS One.
Those with a history of AIDS are much more likely to die while still in the hospital following admission for a heart attack (acute myocardial infarction, AMI) or a stroke than patients without HIV, according to a recent study. No such likelihood was observed for people living with HIV who do not have a history of AIDS.
The study analyzed 18,369,785 hospitalizations for AMI or stroke. People living with HIV who were hospitalized for stroke or AMI were significantly younger than those not living with HIV (median age around 51 years versus 68-70 years).
The odds ratio (OR) for dying in the hospital was 2.59 (stroke) to 3.03 (AMI) for people with an AIDS history compared with those not living with HIV, while that ratio was 0.80 (AMI) to 1.14 (stroke) for people living with HIV without an AIDS history.
The results imply that "preserving immune function may improve cardiovascular outcomes in HIV-infected persons," according to study authors.
The study was published online in The Journal of Infectious Diseases.
HIV testing can be successfully promoted by providing multiple HIV home testing kits to women for distribution to their male sexual partners, according to a Kenyan study following 280 women who were pregnant, had recently given birth or were sex workers.
This secondary distribution of HIV tests via clinics that the women attended resulted in 45 men testing positive for HIV, mainly sex worker clients. Serostatus awareness also impacted sexual practices: Participants reported condom use during all sexual intercourse after a positive test result. However, condoms were used during fewer than half of intercourse events after a negative test result.
Furthermore, four study participants, including two sex workers, reported intimate partner violence because they had handed out an HIV self-test. Still, provision of HIV self-tests for further distribution is "a promising strategy for increasing HIV testing among populations that are traditionally hard to reach," the study authors concluded.
The study was published online in The Lancet HIV.
Using raltegravir (Isentress) instead of nucleoside reverse transcriptase inhibitors (NRTIs) in second-line antiretroviral therapy is a viable option, according to a study involving 515 participants in nine low- and middle-income countries in Africa, Asia and South America.
The World Health Organization recommends a boosted protease inhibitor plus NRTIs for those who experience virologic failure (viral load greater than 400 copies/mL) on their initial treatment regimen. However, resistance testing is often not available in resource-limited settings, leading to the prescription of NRTIs against which a patient may have already developed resistance. In addition, NRTIs have known toxicities. Researchers are therefore looking for alternatives to these drugs.
The weighted difference in the cumulative probability of virologic failure between the two study arms (lopinavir/ritonavir [Kaletra] plus raltegravir versus lopinavir/ritonavir plus two to three NRTIs) was -3.4%. This indicates that the raltegravir regimen was "non-inferior, but not superior" to the NRTI regimen, according to study authors.
The study was published online in The Lancet HIV.
Barbara Jungwirth is a freelance writer and translator based in New York.
Follow Barbara on Twitter: @reliabletran.
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