April 21, 2017
This week, a study finds that people living with HIV have a higher mortality rate than the general population, often because of AIDS-defining illnesses, highlighting the importance of earlier HIV diagnoses. Another study looks at the challenges of treatment for teenagers who have lived with HIV for most of their lives. And researchers recommend giving pre-exposure prophylaxis (PrEP) to all infants who are breastfed by mothers living with HIV. To beat HIV, you have to follow the science!
Despite the availability of highly active antiretroviral therapy, people living with HIV are still at a higher risk of dying than the general population, an analysis of data in the United Kingdom that was published in The Lancet Public Health showed.
Six percent of the almost 89,000 people diagnosed with HIV in England and Wales between 1997 and 2012 had passed away by the end of that period, a rate of 118 per 10,000 person years. This represents six times the mortality rate in the general population for the same gender and age.
Most of the deaths among people living with HIV were due to AIDS-defining illnesses; three-quarters of those who died were diagnosed late (CD4+ count < 350 cells/mm3 within three months of diagnosis) and a third of those in care never received antiretroviral therapy. Risk of death was highest during the first year after diagnosis.
"These findings highlight the importance of prompt diagnosis and linkage to care as major public health interventions to reduce premature mortality," study authors concluded.
In the United Kingdom and Ireland, most adolescents who acquired HIV early in life transition to adult HIV care with suppressed viral loads and relatively high CD4+ counts, an analysis of data from the Collaborative Pediatric HIV Study that was published in Clinical Infectious Diseases found.
Among the 644 youths who moved to adult care between 1996 and 2014, the median viral load was 444 cells/ml at time of transfer. A quarter were not on treatment, including 69 who had never taken antiretrovirals -- 15% of them had low viral loads and may be "elite controllers" whose body is capable of suppressing HIV without medication.
More than 80% of the almost 300 youths for whom such information was available were resistant to at least one class of antiretrovirals, and more than half were resistant to two classes. An accompanying comment noted that providers may be reluctant to switch treatment regimens in this age group because of adherence issues and the fear of "running out of options."
PrEP should be given to all infants born to women who live with HIV as long as the infant is breastfed, researchers recommended in an analysis published in the British Medical Journal.
They note that most women breastfeed for much longer than six weeks, the PrEP duration currently recommended by the World Health Organization for babies born to women living with HIV, aidsmap reported. Almost 4% of infants who acquired HIV from their mothers in sub-Saharan Africa were older than six weeks, the publication noted. In addition, some women seroconvert while breastfeeding, so their babies would not have received the WHO-recommended initial PrEP.
The researchers are involved in the ANRS 12174 trial of PrEP for infants, which reduced mother-to-child transmission of HIV to 0.5% a year, even when the mother was not on antiretroviral treatment. The trial used lamivudine (Epivir), which could be a cost-effective way to provide longer-term PrEP for infants, aidsmap noted.
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