December 8, 2016
This week, a study in Africa finds that targeted training for health care workers greatly improves the number of patients who start treatment. Another study finds that few injection drug users transmit HIV during acute infection. And testing infants who have been exposed to HIV at birth and again at six weeks gives them the best chance for survival, a study suggests. To beat HIV, you have to follow the science!
An intervention targeted at health care workers, combined with point-of-care CD4 count facilities, can significantly improve the number of people who start antiretroviral therapy when they meet eligibility criteria for treatment, a study published in The Lancet HIV showed.
In parts of Africa, 30% of those eligible to initiate antiretroviral therapy do not do so in a timely fashion. This study enrolled 20 clinics in Uganda, following a total of 15,000 treatment-naive people living with HIV. Of these, 12,042 met criteria for starting antiretroviral medications during the study period. In the intervention group, 80% initiated treatment within two weeks of being eligible. In the control group, that percentage was 38%.
The intervention trained and coached health care workers, provided a CD4 cell count testing platform, and revised the approach to patient counseling. Clinics were also told about the rate at which people in their care began to take HIV medications and how that rate compared to other facilities in the study. Because of the real-world nature of this study, authors consider the approach "well positioned for use at scale."
Few people who inject drugs (PWID) transmit HIV while acutely infected with the virus, according to a model of the HIV epidemic in New York City that was published in AIDS.
Over a period of nearly 20 years, fewer than 10% of HIV transmissions from PWID occurred during the early, acute stage of HIV infection (AHI), the simulation showed. It was based on the development of the HIV epidemic between 1996 and 2012, and assumed that AHI lasted for the first 3 months after virus acquisition. Study authors cautioned that they only investigated the mature epidemic stage. Even so, one in 20 HIV acquisitions among PWID are likely driven by acute infection.
Studies elsewhere have detected greater infectiousness, and hence a higher risk of HIV transmission, during AHI. This means that the "elimination of structural barriers to early detection and treatment of PWID" is important for reducing the rate of new HIV cases in this population, the authors added.
Infants exposed to HIV have the best chance for long-term survival if they are tested for the virus at birth and again at six weeks of age, a simulation of HIV testing strategies in South Africa published in The Journal of Infectious Diseases showed.
The four variations studied were: testing only after HIV symptoms appear, testing only at either birth or six weeks old, and testing both at birth and six weeks. Without routine testing of infants exposed to HIV, life expectancy dropped to 21 years for those living with HIV, compared to 61 years for the entire cohort.
Routine testing strategies increased life expectancy to between 24 and 26.5 years, with testing at birth and six weeks producing the longest survival. The second test can also be performed at 10 weeks of age for a similar outcome, especially if the infant is taking antiretrovirals to prevent mother-to-child transmission of the virus. However, that outcome is only achieved if babies who test negative at birth are brought to the clinic for the second test, study authors caution.
Warren Tong is the senior science editor for TheBody.com and TheBodyPRO.com. Follow Warren on Twitter: @WarrenAtTheBody.
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