April 17, 2017
This week, a study finds that for individuals living with HIV, experiencing symptoms of depression does not increase mortality risk. Another study finds that common sexual practices among pregnant women and new mothers in Kenya may decrease the effectiveness of some HIV prevention methods. And pre-exposure prophylaxis (PrEP) is a good option for HIV prevention among individuals who use injection drugs. To beat HIV, you have to follow the science!
Reporting depressive symptoms at some point does not increase the likelihood of death among people living with HIV, a study published in AIDS showed.
Almost 11,000 people living with HIV, about a third of whom had reported one or more measures of depression, were followed for an average of 3.1 years between 2005 and 2014. All study participants were in HIV care for at least part of the study period. All-cause mortality did not differ among participants with or without depressive symptoms once results were adjusted for time-varying confounding and unobserved patient-reported outcome assessments.
Previous studies among people living with HIV had associated depression with higher mortality rates. However, these studies had not addressed confounding factors that change over time. Newer antiretroviral treatment that is less susceptible to imperfect adherence, as well as greater awareness of depression among people living with HIV, may explain the discrepancy in findings, the authors of this study speculated. They also acknowledged that their study included relatively few women (who are statistically more likely to suffer from depression).
Common vaginal practices among pregnant women and new mothers in Kenya may render some HIV prevention methods less effective, a study published in Journal of Acquired Immune Deficiency Syndrome found.
Researchers administered questionnaires to 1,252 women who did not live with HIV and were pregnant, then followed up after the women gave birth. More than half of study participants reported having sex during the prior month, and the vast majority of them did not use condoms. A third of participants did not know their partner's HIV status and almost a sixth of the married women lived in polygamous unions.
Reported sexual activity declined markedly during the later stages of pregnancy. Some male partners may therefore seek sex elsewhere, study authors theorize. These results "underscore the need for ... promotion of condom use in women during [pregnancy and postpartum]," they note. Vaginal washing after intercourse was reported by 60% of the women -- a practice that could render microbicide gels less effective.
People who inject drugs are likely to choose PrEP, according to the open-label extension of the Bangkok Tenofovir Study, which was published in The Lancet HIV.
More than half of the 2,306 surviving participants in the original study returned for the extension trial and over 60% of those returning began PrEP. Participants with a perceived higher risk of HIV infection -- heroin injection or a recent stay in prison -- were more likely to return for a follow-up visit than those without such characteristics. Former prisoners were also more likely to take their medication daily at least 90% of the time, as were those who inject the anti-anxiety medication midazolam, compared to the rest of the study population.
Study authors note that the availability of tenofovir disproxil fumarate in prison clinics promoted adherence among that group. They also theorize that overall lower adherence rates in the extension trial compared to the original study may be due to lower rates of reported needle sharing in the open-label trial than at the beginning of the original trial. Participants who do not share needles may not take PrEP daily because of their lower risk of seroconversion.
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