February 3, 2017
This week, a study finds that interventions to improve adherence often stop working over time and that long-term solutions are needed. Another study finds that if 40% of people who needed pre-exposure prophylaxis (PrEP) started taking it, at least a third of new HIV infections could be prevented. And women who begin HIV treatment before becoming pregnant are more likely to give birth to premature babies, another study finds. To beat HIV, you have to follow the science!
Interventions to improve adherence to antiretroviral therapy are only moderately effective and their impact dissipates over time, an analysis of 85 clinical trials across the world that was published in The Lancet HIV showed.
The most effective intervention was text messaging, at an odds ratio (OR) of 1.48 globally and 1.49 in low- and middle-income countries (LMIC). Study authors note that some interventions that were evaluated, such as cognitive behavior therapy, are better suited to high-resource settings, while others can easily be implemented in low-resource scenarios. Regardless of the specific measure taken, the effect waned over time once the intervention ended.
Since antiretroviral therapy must be taken for life, "long-term interventions are clearly needed" to support treatment adherence and prevent the development of drug resistance, the authors conclude. Recent World Health Organization recommendations have incorporated some of the findings from this analysis and now include a variety of interventions, as well as nutritional and financial support for specific adherence challenges.
A third of new HIV infections among men who have sex with men (MSM) could be prevented if the U.S. Centers for Disease Control and Prevention (CDC) guidelines on PrEP for that population were implemented, according to a modeling study reported in The Journal of Infectious Diseases.
The guidelines call for PrEP to be offered to MSM who during the prior six months had condomless anal intercourse in a monogamous relationship where the partner's HIV status was unknown, had such intercourse outside a monogamous relationship, or had anal intercourse in a serodiscordant monogamous relationship. The model evaluated the impact of PrEP for each of these indications individually and for various combinations of behaviors.
The highest number of HIV infections was averted when PrEP was prescribed for all three behaviors, but only if 40% of those meeting the criteria in fact took medication for HIV prevention and 62% of those starting PrEP continued to use it consistently. Achieving these levels of PrEP initiation and adherence will require "addressing gaps in access to HIV testing and other clinical settings in which PrEP assessment and prescription occur," study authors note.
Women who began to take antiretroviral therapy prior to becoming pregnant were significantly more likely to deliver premature or low-birthweight babies than those who began treatment after conception, a meta-analysis of 11 studies published in The Lancet HIV found.
The association between the initiation of antiretroviral therapy and pregnancy outcome was more pronounced in low- and middle-income countries, which have higher rates of preterm deliveries overall, than in high-income countries. Study authors caution that these results may reflect demographic differences. For example, in one study women who were taking antiretrovirals prior to conception were more likely to have had problems with previous pregnancies than those who didn't begin treatment until after conception.
Despite the findings, "[t]he benefits of [antiretroviral therapy] for prevention of mother-to-child transmission of HIV and for maternal health clearly outweigh any risks identified so far," the authors emphasize. They call for more research to establish the effect of specific treatment regimens on pregnancy outcomes and better monitoring of such outcomes.
Warren Tong is the senior science editor for TheBody.com and TheBodyPRO.com. Follow Warren on Twitter: @WarrenAtTheBody.
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