August 26, 2016
This week, a study finds that mild neurocognitive symptoms are common during acute HIV infection, but disappear within a month of starting antiretroviral treatment. Another study reports that estimates for the number of people living with HIV in the U.S. may be too high. To beat HIV, you have to follow the science!
Mild cognitive findings are widespread in acute HIV infection, but resolve themselves within a month of starting antiretroviral therapy, according to a study published in Neurology.
The 139 participants were part of a U.S. military-sponsored early capture cohort in Thailand that is studying the effects of the virus during very early infection as part of research into a cure for HIV. More than half (53%) of the recently HIV-infected study volunteers experienced one or more cognitive findings within 12 weeks of being diagnosed with HIV. The median duration of HIV infection before diagnosis was 19 days. Half of these neurocognitive problems existed at HIV diagnosis, with higher viral load associated with a higher likelihood of experiencing neurocognitive issues.
Most neurocognitive findings (90%) resolved themselves during the first month on antiretroviral therapy and only one such finding was classified as severe. This underscores the recommendation for frequent HIV testing and immediate start of treatment upon diagnosis, according to lead study author Joanna Hellmuth, M.D., M.H.S., quoted in the press release on the research.
The number of people living with HIV in the United States may be overestated, a comparison of estimating methods published in the Journal of Acquired Immune Deficiency Syndromes found.
The U.S. Centers for Disease Control and Prevention (CDC) estimate that there were about 1.2 million people living with HIV in the U.S. at year-end 2011. That number is derived from a process based on HIV cases reported to the CDC by local jurisdictions. This study compared case-based figures to numbers derived from HIV laboratory reports for New York City. The case data were more than a quarter higher than the laboratory data.
Using the new figures and estimates based on patients in HIV care in 19 other jurisdictions, as well as other local data from these areas, study authors estimate that there are 819,200 people living with HIV, 86% of whom know that they are infected, and that 72% of all people living with HIV are in care, 67% are on anti-retroviral therapy, and 55% are virally suppressed. However, the authors emphasize that "[t]his study is not an attempt to precisely quantify" people living with HIV in the U.S., "but rather to examine the extent to which the current estimates change when derived from evidence available at the state and local levels."
Men who have sex with men (MSM) and live in the interior of British Columbia, Canada, are significantly less likely to have ever been tested for HIV than their "big city" counterparts, a small study recently reported in AIDS Care shows.
In the study, 153 MSM who lived at least 400 kilometers (248 miles) away from a large urban center (≥ 500,000 inhabitants), in a town or village with 120,000 or fewer inhabitants, completed an anonymous online questionnaire. Analysis of the questionnaire revealed that 24% of respondents had never been tested for HIV, compared to 14-17% of MSM in large cities. This lack of testing was explained, in part, by the fact that 35% of study participants had not disclosed their sexual preference to their health care provider.
The reluctance to discuss same-sex attraction with one's doctor was partly driven by internalized homophobia, according to the study. Spending more leisure time with other MSM was not associated with a greater likelihood of being tested for HIV, but almost half of respondents (43%) reported spending little such time during the prior three months.
Barbara Jungwirth is a freelance writer and translator based in New York.
Follow Barbara on Twitter: @reliabletran.
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