March 3, 2017
This week, we're looking at four more studies from CROI 2017. The first finds that starting treatment earlier helped prevent severe weight gain in African Americans with HIV. The second study finds many pharmacists would be willing to prescribe pre-exposure prophylaxis (PrEP) if they received training.
Our third study finds that syphilis rates are rising, particularly among African-American men who have sex with men. And finally, long-term exposure to some of the older antiretroviral drugs or tenofovoir is associated with bone and kidney problems. To beat HIV, you have to follow the science!
For our complete conference coverage, visit our CROI 2017 home page.
African Americans with low CD4 cell counts and high viral loads at the start of antiretroviral treatment who took raltegravir (Isentress) were more likely to experience severe weight gain after starting HIV treatment than did those without these characteristics, an analysis of data from an AIDS Clinical Trials Group study of three initial antiretroviral regimens found.
The same factors also predicted a large increase in body mass index (BMI). About three-quarters of the 1,809 study participants were men and more than 40% were African American. The changes in weight were observed during the first 96 weeks after the start of HIV therapy.
Early treatment after seroconversion -- before CD4 levels have plunged and viral loads have climbed -- may prevent excessive weight gain, study authors concluded. They noted that initiating treatment with a protease inhibitor instead of raltegravir may also prevent the added weight. Researchers also called for further investigation into the apparent link between race and weight/BMI increases after starting treatment.
Many pharmacists would be willing to provide PrEP if they received appropriate training, a survey in Iowa and Nebraska found.
Fewer than half of the 140 professionals surveyed were familiar with PrEP. Older pharmacists who had been dispensing medications longer were less likely to know about this HIV prevention method. If they were trained on oral HIV prevention, more than half of those surveyed would provide PrEP in the context of a collaborative practice agreement with a local physician.
Concerns raised included the additional time needed for counseling and assessment, insufficient compensation for that time, and medical issues related to taking antiretrovirals for HIV prevention (adherence, loss to follow-up, development of drug resistance). If issues of time and money were addressed, pharmacy-provided PrEP could become another avenue for delivering HIV prevention to people at risk of seroconverting who are not reached by other models, study authors concluded.
Syphilis rates are on the rise, especially among young African-American men who have sex with men (MSM) and live with HIV, an analysis of data from the HIV Outpatient Study showed.
A steady increase in the number of new syphilis infections was observed over the entire 16-year period analyzed (1999-2015), but that trend sped up during the last five years (2011-2015). Almost 800 cases of this sexually transmitted infection (STI) were diagnosed among 641 of the 6,888 participants during the study period. The overall incidence rate was 1.8 per 100 person-years (95% Confidence Interval 1.7-2.0). Higher syphilis rates in later years parallel more frequent testing for that STI among MSM.
Study authors conceded that the observed incidence rates may be partly explained by that improved screening. Yet, the data "reflect ongoing sexual risk," pointing to the need for "ongoing syphilis testing and comprehensive sexual risk reduction interventions" among that group, the researchers concluded.
Long-Term Exposure to Early Antiretrovirals or Tenofovir Related to Bone and Kidney Problems
Cumulative exposure to ddI (Videx) and d4T (Stavudine) is associated with lower bone density and dysfunctional bone formation, a study of people who have been living with HIV since birth or early childhood showed.
Furthermore, taking tenofovir disproxil fumarate (Truvada, TDF) increased the likelihood of subclinical renal dysfunction markers. Both bone and kidney measurements tended to improve over time, however. The study included 65 people living with HIV and 21 people who are not living with HIV. More than 80 percent of those living with HIV had been infected perinatally.
Study participants in the HIV arm had been taking antiretrovirals for a median of 15.8 years (range: 12.4-19.5 years), with a median of 3-4 years on ddI, d4T or TDF. The longer someone had been taking ddI or d4T, the worse their body mineral density measurements were. Longer exposure to TDF was associated with a greater anion gap, but not with differences in bone-related measurements.
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