June 16, 2017
This week, a study finds that stable housing can impact CD4 counts and viral load suppression rates in people living with HIV. Another study finds that treatment initiation is often delayed because of assistance program eligibility and provider inexperience. And a study links interleukin-8 levels to viral load in semen. Finally, a nanoparticle version of lopinavir shows good pharmacokinetics in a rat study. To beat HIV, you have to follow the science!
After entering a supportive housing program for formerly homeless people with HIV, the percentage of participants who had undetectable viral loads increased from 66% to 79%, a statistically significant improvement (P < .05), according to data from the Shelter Plus Care program in Cincinnati, Ohio. The results were published in AIDS Care.
Researchers analyzed data on 86 program participants. At the start of the study, 28% of participants had a healthy CD4 count (greater than 500). That percentage increased to 45% at the end of the study, which was also statistically significant (P < .01). Those who did not have health insurance before entering supportive housing, who had been previously in jail or prison, or who stayed only briefly in the program were less likely to achieve viral suppression than participants without these characteristics. However, other health, mental health, or substance use issues did not influence these outcomes.
"Without stable housing, it's hard to achieve these good health outcomes," noted lead study author Elizabeth Bowen in an associated press release.
In 2013, almost 30% of HIV care providers did not start patients on antiretroviral therapy independent of CD4 count, a study published in the Journal of Acquired Immune Deficiency Syndrome estimated.
Researchers based this conclusion on surveys returned by 1,234 medical practitioners who care for people living with HIV. Medical providers who saw 20 or fewer patients living with HIV or worked at facilities that did not receive Ryan White HIV/AIDS Program (RWHAP) funds were more likely to defer treatment. Study authors noted that various programs link medical providers with experienced HIV specialists, and recommended that such support be expanded to practitioners at non-RWHAP facilities.
Patients who refuse to go on treatment and providers' concern about their patients' ability to adhere to the medication regimen were the most common reasons cited for not prescribing antiretrovirals. Providers also waited before starting patients on HIV treatment when patient assistance programs did not provide sufficient medications, sometimes because of CD4 count thresholds for program eligibility.
Proinflammatory cytokines, especially interleukin-8 (IL-8), appear to be the common pathway for increased viral load in semen, a small study published in Open Forum Infectious Diseases showed.
Researchers analyzed blood and semen samples from 30 men who have sex with men, are living with HIV, and have never taken antiretroviral medications. Thirteen of the participants were observed longitudinally for up to one year. Since current guidelines recommend most people start antiretroviral therapy upon diagnosis, relatively few men were eligible for this trial. A large variation in shedding patterns for HIV and cytomegalovirus was seen both within the group and in individuals over time.
Among the variables studied, only levels of IL-8 in the semen and blood viral loads were consistently associated with semen viral loads. Factors such as T-cell influx, reactivation of the herpes virus, as well as the person's microbiome appear to be mediated through these IL-8 levels, study authors concluded. Understanding these mechanisms may lead to new HIV prevention techniques, they noted.
Nanoparticle versions of lopinavir (Kaletra) showed favorable pharmacokinetic profiles in rats, a study published in Nature Communications reports.
The liquid version of ritonavir-boosted lopinavir, which is currently recommended by the World Health Organization for young children living with HIV, contains a high percentage of ethanol in order to dissolve the drugs. This liquid formulation also has a limited shelf life and requires refrigeration. By contrast, the solid drug nanoparticles (SDN) of lopinavir that were produced in this study can be re-dissolved in water and do not need to be kept cold.
SDN technology has already been applied successfully for other medications. This study also developed methods for accelerating the screening of potential nanoparticles, which may speed up development of other nanomedicine-based therapies.
Study authors caution that the results of this animal model may not be directly applicable to humans. However, Andrew Owen, one of the lead authors, is optimistic, stating, "Our approach has the potential to overcome challenges with current antiretroviral therapy, which include administration of high doses needed to achieve efficacious concentrations in the body, and the urgent need for better formulations for children living with HIV," according to a press release about the study.
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