September 2, 2016
This week, a study suggests that current cardiovascular assessment scores may miss the underlying heart disease risk for many men living with HIV. Another study finds that three specific microRNAs may be biomarkers for HIV-associated neurocognitive disorder. To beat HIV, you have to follow the science!
Generally used scores for assessing the risk of cardiovascular disease may underestimate that risk for men living with HIV, a study reported in AIDS found.
The study analyzed data from a computed tomography (CT) scan sub-study of the Multicenter AIDS Cohort Study, generating cardiovascular risk scores for almost 1,000 men who have sex with men (MSM) in the U.S.
Three scores were produced for each participant: Two were methods used for the general population (Framingham risk score [FRS] and American Heart Association's PCE] and one was developed specifically for people with HIV (D:A:D score). These were then correlated with the degree of coronary artery plaque found in the CT scans.
FRS and PCE scores better matched the existence of plaque among participants who are not living with HIV than among those who are. As a result, current recommendations for statin therapy based on PCE scores will miss most men under age 50 living with HIV and are at risk for CVD, the study authors said.
Three specific host-encoded microRNAs (miRNA) may be biomarkers for HIV-associated neurocognitive disorder (HAND), a clinical trial of 71 people receiving care at an HIV clinic in Alberta, Canada, found. The study was reported in AIDS.
Almost half of the participants were diagnosed with HAND. In general, miRNAs regulate gene expression, and the three miRNAs identified in this study target genes that are associated with neural development and inflammation, among other functions.
The plasma of all participants was examined for the presence of various miRNAs and findings were correlated with a neurocognitive diagnosis using several different methodologies.
All methods identified the same three miRNAs in the plasma of those with the neurocognitive problems. In addition to their potential use in diagnosing HAND among people living with HIV, the study results may also help to elucidate the molecular mechanisms by which the disorder develops, the authors said. However, "studies in larger and different HAND cohorts are required to substantiate these findings," they cautioned.
Treating people living with HIV with two rather than three antiretrovirals can be effective, but increases the risk of resistance mutations in the virus, a retrospective meta-analysis of 21 studies that was published in The Lancet HIV found.
Initial regimens with two antiretrovirals, but without maraviroc (Selzentry), worked better than therapies that included maraviroc. Dual-drug antiretroviral therapy may avoid some of the toxic side-effects of long-term antiretroviral therapy, allow for a greater pool of HIV drugs to which people may switch if their current medications no longer work, and be cheaper, study authors noted.
The risk ratio (RR) of therapy failure in dual-drug versus triple-drug regimens was 1.14 for both first-line and switch studies, but fell to 1.05 in initial therapy trials that did not use maraviroc. Among patients whose viral load at study start was more than 100,000 copies/mL, the RR rose to 1.24. Ongoing clinical trials are assessing dual-therapy strategies using newer drugs to which the virus is less likely to develop resistance.
Barbara Jungwirth is a freelance writer and translator based in New York.
Follow Barbara on Twitter: @reliabletran.
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