September 23, 2016
This week, a study finds that body mass index is associated with type-2 diabetes risk after 12 months of treatment. Another study seeks to streamline testing for HIV-associated neurocognitive disorders (HAND). And adding ribavirin to hepatitis C salvage therapy (in which patients may have failed initial treatment) can cure hepatitis C, another study reports. To beat HIV, you have to follow the science!
Body mass index (BMI) was not a risk factor for having type-2 diabetes before starting antiretroviral therapy, but was associated with diabetes risk after 12 months on treatment, a study in Nigeria published in Clinical Infectious Diseases found.
At baseline, 2.3% of study participants were diagnosed with type-2 diabetes at enrollment, and an additional 5.3% of the 2,452 participants followed for a year developed the condition while taking HIV medications. Most (70.5%) of those with type-2 diabetes at baseline were over 40 years old. One year later, however, fewer than half (39.2%) of those with new-onset T2DM were in that age group.
A BMI above 25 kg/m2 was found among about a third (36.1%) of those with baseline type-2 diabetes, and was associated with a greater likelihood of developing diabetes while on antiretrovirals, independent of the particular medication regimen. Study authors theorize that the weight loss sometimes accompanying untreated diabetes and the fact that 41% of study participants with type-2 diabetes at baseline did not know that they were diabetic may explain the lack of relationship between BMI and type-2 diabetes at study enrollment.
A newly developed set of computerized tests for cognitive functioning could streamline screening for HIV-associated neurocognitive disorders in HIV clinics, according to a study reported in Clinical Infectious Diseases.
A total of 326 Australian participants, more than three quarters of whom are living with HIV, completed the new battery of tests, while a subset also underwent a standard neuropsychological (NP) assessment. The new CogState set of tests correctly identified those with symptomatic HAND who needed further neurological assessment just as well as did the standard NP evaluation.
This may be helpful in HIV clinics because the computerized screening can be administered by nonspecialists trained by neuropsychologists while the standard NP testing must be performed by a specialist.
Study participants were mainly white men who have sex with men, were well educated and fluent in English. Computerized testing of cognitive functioning may not work as well for other demographics, study authors noted, although they believe that the test can be adapted for other cultural settings.
People who are infected with both HIV and hepatitis C (HCV) and whose HCV was not suppressed by an initial regimen of ledipasvir/sofosbuvir (Harvoni) for 12 weeks can be successfully retreated with the same drug plus ribavirin, a small study published in Clinical Infectious Diseases shows.
Most (89%) of the nine patients in the ION-4 clinical trial whose HCV relapsed and who took a second, 24-week round of ledipasvir/sofosbuvir plus ribavirin achieved sustained HCV repression 12 weeks after the end of that retreatment. This result held even for the majority of those whose virus showed resistance-associated variants (RAVs) that reduce its susceptibility to ledipasvir.
While the longer duration of the second set of medication helped in the treatment success, prior studies had shown that it would not have been enough to obtain this result without the addition of ribavirin. The study is a proof of concept for a salvage therapy using an NS5A-inhibitor treatment regimen, the authors concluded.
A mathematical model shows that regular home HIV testing and counseling (HTC) on a province-wide scale combined with starting antiretroviral therapy could reduce HIV incidence by up to 51.6% over a decade, compared to a 33.8% reduction with current practices, The Lancet reports.
The modeling study evaluated HTC every 5 years across KwaZulu-Natal, a South African province with a current 28% adult HIV prevalence, with antiretroviral therapy initiated at various levels of HIV. Starting treatment for those with CD4 counts of ≤ 350 would achieve a 40.6% drop in HIV incidence, the model predicts.
A more cost-effective approach would be to initiate treatment also in those with HIV viral loads of >10,000 copies/mL, independent of CD4 count, according to the model. Such an approach would lower HIV incidence by 51.6% over 10 years at an incremental cost-effectiveness ratio of US$2,960 per infection averted.
Next on the agenda is an assessment of how "community-based HIV testing and linkage strategies can be scaled up and integrated into existing health care programmes," study authors concluded.
Barbara Jungwirth is a freelance writer and translator based in New York.
Follow Barbara on Twitter: @reliabletran.
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