September 30, 2016
This week, a study finds that adding a statin for people taking lopinavir/ritonavir (Kaletra) helped control cholesterol levels better than switching to atazanavir/ritonavir (Reyataz). Another study finds that the risk of developing virologic failure is greater for those who have a single detectable viral load versus those who stay undetectable. To beat HIV, you have to follow the science!
Cholesterol levels in people taking lopinavir/ritonavir were better controlled when they also took atorvastatin (Lipitor) than when they instead switched to atazanavir/ritonavir, a clinical trial published in Clinical Infectious Diseases found.
Elevated cholesterol levels, which are often associated with taking a protease inhibitor, put people at risk for cardiovascular disease. All 50 study participants were virally suppressed, but suffered from hypercholesterolemia. They were randomized to either add the statin to their existing treatment regimen or to change the antiretroviral.
Everyone's viral loads remained below 50 copies/mL, but by week 48, total cholesterol of those in the atorvastatin arm had dropped by 51.8 mg/dL on average from baseline, compared to a 19.1 mg/dL average drop in people in the atazanavir arm. The study was conducted in Thailand.
Based on these findings, study authors recommend that "[i]n resource-limited settings, lipid-lowering agents such as atorvastatin should be considered for inclusion in the national AIDS program."
The risk of developing virologic failure (VF) for those with a single detectable viral load between 50 and 200 copies/mL is twice to four times that of those who had an undetectable viral load at baseline, a retrospective analysis of data from the Austrian HIV Cohort found.
VF was defined as a viral load of at least 200 copies/mL, and an undetectable viral load was below 20 copies/mL. Study participants with one detectable viral load measurement of ≤ 50 copies/mL were 2.19 times more likely to see their viral load rise to ≥ 200 copies/mL than those with an undetectable viral load, and participants with a viral load spike of 51-199 copies/mL were 4.21 times more likely to experience VF.
People living with HIV who had previously interrupted their antiretroviral treatment were more than twice as likely to develop VF than those without such an interruption. "These results provide implications for patient management by emphasizing closer monitoring and adherence counseling," study authors concluded.
The mixture of HIV prevention strategies that would achieve the best results through 2050 should emphasize more male circumcisions and early antiretroviral treatment for a greater number of those living with HIV, plus intravaginal rings for sex workers and a vaccine for teenagers, a mathematical model of HIV prevention in South Africa recommends.
The model assumes that intravaginal rings will become available by 2017 and a vaccine by 2024. The study, which was published in The Lancet, predicts that at the low end of the plan, US$44 billion spent over the next 34 years could prevent 1.9 million HIV infections, while spending an additional US$26 billion for the high-end scenario could avoid another 4.7 million infections.
The development of long-acting antiretrovirals and broadly neutralizing antibodies was also considered, but "the single most crucial intervention is the development of a vaccine," study authors conclude. This is especially true for the medium scenario with a budget of US$50 billion over the study period.
Barbara Jungwirth is a freelance writer and translator based in New York.
Follow Barbara on Twitter: @reliabletran.
Copyright © 2016 Remedy Health Media, LLC. All rights reserved.
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