September 16, 2016
This week, a study finds that despite effective antiretroviral therapy, people living with HIV are still likely to die eight years earlier than their HIV-negative counterparts. Another study suggests that in order to develop an HIV cure, we need biomarkers for quantifying the HIV reservoir in the central nervous system. To beat HIV, you have to follow the science!
Despite advances in HIV treatment, people living with HIV who are taking antiretrovirals are still likely to die eight years earlier than those without the virus, a California study published in Journal of Acquired Immune Deficiency Syndromes discovered.
That gap in life expectancy is substantially lower than early in the epidemic, when 20-year-olds living with HIV in 1996-1997 could expect to live another 19.1 years, while others in that age group could look forward to 63.4 more years. By 2011, the difference in mortality rates between those with and without the virus had narrowed to 11.8 years, which was further reduced about four years for people who started HIV treatment at CD4 counts of at least 500.
Living a healthy lifestyle with HIV, but not hepatitis, cut the difference in life expectancy to 5.7 years. Study authors caution that their data stem from health insurance records and that the results may therefore not apply to people living with HIV who lack such insurance.
Appropriate biomarkers for quantifying the reservoir of HIV in the central nervous system (CNS) must be developed if HIV eradication is to be achieved, a review of available evidence published in Current Opinion in HIV and AIDS suggests.
HIV establishes a reservoir of infected cells in the CNS of a person who seroconverts. However, the body's mechanisms for protecting the brain also keep many antiretroviral medications from reaching that reservoir. This also applies to the latency-reversing agents (LRAs) used in one of the strategies for developing an HIV cure, "shock and kill." In addition, brain cells do not replenish to the same extent as T cells elsewhere in the body.
Killing infected brain cells may therefore cause neurological damage. To overcome these challenges, biomarkers that allow for monitoring the effect of treatment on the CNS reservoir as well as LRAs that also work in the brain are needed, study authors concluded.
Women on integrase inhibitor-based antiretroviral regimens are somewhat more likely to achieve viral suppression than those whose therapy is based on a protease inhibitor (PI), a clinical trial published in The Lancet found.
The integrase inhibitor combination was also better tolerated, with five women discontinuing the study due to adverse events compared to 19 in the PI arm. The study, dubbed WAVES, enrolled 575 treatment-naive women in 11 countries who were randomized to one of two arms: elvitegravir (Vitekta) and cobicistat (Tybost) for the integrase inhibitor group, and ritonavir-boosted atazanavir (Reyataz) for the PI group, both combined with emtrictabine (FTC/Emtriva) and tenofovir disproxil fumarate (TDF, Viread).
After 48 weeks, 87% of women in the integrase inhibitor group had achieved viral loads of less than 50 copies/mL, while 81% in the PI arm had done so. In addition, three study participants in the PI arm developed virological failure with resistance, but none did in the integrase inhibitor arm. These results support recommendations for initial treatment with an integrase inhibitor, study authors concluded.
Barbara Jungwirth is a freelance writer and translator based in New York.
Follow Barbara on Twitter: @reliabletran.
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