March 18, 2017
This week, a study finds that nanoformulated antiretrovirals are well-tolerated and effective at doses lower than current formulations, which could translate into cost savings. Another study finds that the majority of older individuals with HIV in the UK live below the poverty line and feel at least moderate loneliness. And the combination of respondent-driven sampling and anonymous HIV testing during the same session may better reach heterosexuals with multiple HIV risks, another study finds. To beat HIV, you have to follow the science!
Solid drug nanoparticle (SDN) formulations of lopinavir (LPV, Kaletra) and efavirenz (Sustiva, Stocrin) were well-tolerated and effective at lower drug concentrations, a small trial presented at the 2017 Conference on Retroviruses and Opportunistic Infections showed.
Nine volunteers not living with HIV took one of the new formulations at a different dose. Computer models then predicted the drugs' pharmacokinetic profiles in 1000 people. The results were compared to historical data on the medications' conventional formulations.
Sufficiently active drug levels in the blood were achieved with a 50% lower dose of both drugs. This means cost reductions, which is especially important in low-income countries, presenter Andrew Owen, Ph.D. F.S.B., of the University of Liverpool noted. The World Health Organization recommends efavirenz as an initial regimen in such settings, a related press release observed.
Nanoparticles are also soluble in water rather than organic solvents, which is important for pediatric use. A potential disadvantage of SDN formulations is the longer persistence of some drug level in the body compared to current versions of lopinavir and efavirenz.
Primary care providers often seem unsure about the effect of HIV on aging and other comorbidities, noted a survey by the Terrence Higgins Trust in the United Kingdom that was published in The Lancet.
The organization asked 246 people living with HIV who were at least 50 years old about their health, finances and emotional well-being. While better HIV training for primary care providers may be helpful, it is unlikely to address the systemic issues that these providers face, Philippa Matthews of the Royal College of General Practitioners said in the Lancet article. "Many of our consultations are as a direct effect of the poverty and social isolation covered in the report," she added.
More than half of survey respondents live below the poverty line and over 80% expressed at least moderate loneliness. Studies have shown higher rates of depression and fatigue among this group compared to the general population. This fact needs to be considered when providing medical care or social services, Clive Blowes of the Terrence Higgins Trust noted.
Respondent-driven sampling (RDS) and anonymous HIV testing during the same session best reach heterosexuals with multiple risk factors for seroconverting, a study conducted among people of color in New York City found. The study was published in Journal of Acquired Immune Deficiency Syndromes.
For the peer-recruitment arms, people were approached in public spaces, recruited for the study, and asked to enlist their peers as well. Some compensation was offered for participation in interviews and intervention sessions, as well as for getting additional volunteers. Participants in the comparison arm were recruited by staff in specific venues.
In one RDS arm, training for peer recruitment and HIV counseling/testing were performed at the same time, while in the other arm the two steps happened in separate sessions. More people in the single-session RDS arm had recently used drugs and fewer had been tested for HIV during the prior year than in the other two arms, showing that strategy reached people at even higher risk of undiagnosed HIV than did the other approaches.
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