April 7, 2017
This week, a study finds that starting antiretroviral therapy immediately after diagnosis lowered the risk of severe bacterial infections. Another study finds that providers in the San Francisco area are willing to prescribe pre-exposure prophylaxis (PrEP), but with more training. And researchers are examining how fibroblasts, which are cells in the genital and intestinal mucosa, may be carrying HIV to CD4 cells in the mucosa. To beat HIV, you have to follow the science!
Starting antiretroviral therapy on diagnosis independent of CD4+ cell count reduces the risk of severe bacterial infections, an analysis of data from the START trial published in The Lancet HIV found.
Immediate treatment has been shown to provide a variety of benefits and is recommended by the World Health Organization, among others. This study adds another advantage to that list. The START trial enrolled 4,685 people living with HIV who had CD4+ cell counts above 500 cells/μL, and placed them in two arms: those who begin taking antiretrovirals immediately, and thosewho wait until their CD4+ cell count drops below 350 cells/μL. Severe bacterial infections occurred in 120 trial participants in both arms, with more than 70% of cases in the deferred treatment arm.
Over time the statistical risk of contracting one of these infections was 61% lower in the immediate treatment arm. This outcome is a result of higher CD4+ cell counts, but not higher neutrophil counts, among people on treaetment, researchers explained.
Medical providers in the San Francisco area are very willing to prescribe PrEP, but would like more training on that HIV prevention method, according to an analysis of survey data published in Journal of Acquired Immune Deficiency Syndrome.
Almost 100 primary care physicians and HIV specialists responded to a survey about their attitudes toward and experience with PrEP. Clinicians who had experience caring for people living with HIV were more willing to prescribe PrEP than those without such experience (adjusted odds ratio 4.76, 95% confidence interval [CI]: 1.43 to 15.76, P = 0.01).
Most respondents wanted more training; this was especially true of those concerned about drug resistance or medication side effects. Results show that more widespread prescription of PrEP could be achieved by providing support to physicians who already care for people living with HIV, study authors suggested. The training offered should focus on clinical issues and should be provided both online and in person, they added.
Researchers may have found the clue to a new HIV prevention strategy, PLOS Pathogen reports. They discovered that fibroblasts, cells that are quite numerous in the mucous lining (mucosa) of the genital and intestinal tracts, carry the virus to the CD4+ cells in that lining.
Normally the mucosa is lined with epithelial cells that suppress infection by secreting antiviral proteins. However, if that layer of cells is breached either by physical damage or because of certain sexually transmitted diseases, the fibroblasts can spring into action. In addition to acting as a transport system, fibroblasts also make CD4+ cells more susceptible to HIV.
The exact mechanism by which this happens will be the subject of further investigations. Meanwhile, knowing that fibroblasts facilitate HIV infection "will enable us to find better ways to limit HIV transmission rates," Warner Greene, M.D., Ph.D., one of the study authors said in a related press release.
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