September 15, 2017
This week, a study finds that reducing U.S. foreign aid for HIV-fighting efforts is a really bad idea no matter which way you cut it. We also examine meta-analysis data regarding pregnancy and the "old" tenofovir; newly published findings regarding cancer risk among people with HIV; and data regarding the potential viability of a neighborhood-specific approach to reduce HIV disparities in the U.S.
To beat HIV, you have to follow the science!
Almost any strategy to handle expected cutbacks in U.S. foreign aid for HIV services will cause significant harm, researchers concluded in an analysis published in Annals of Internal Medicine.
The international group of study authors estimated the five- and 10-year outcomes of five different scenarios, both individually and in combination, compared to current standards used to combat HIV in South Africa and Ivory Coast. They found that even the most efficient scenario for absorbing 10 to 20% HIV budget cuts would save only US $600 to $900 for each year of life lost, due to scaled-back HIV testing and care.
Scenarios examined included reducing HIV testing efforts, starting antiretroviral therapy at lower CD4+ cell counts (or not at all), lowering spending on retention in care, eliminating viral load monitoring, and not providing second-line treatment. Among these, the least harmful strategies were: 1) reducing spending on HIV testing and retention in care; and 2) either starting treatment later than currently recommended or not starting it at all. However, any cuts to foreign aid for HIV "will produce modest savings to donors at the expense of ... massive loss of life among recipient nations," study authors concluded.
Most pregnancy problems or adverse outcomes among infants did not differ significantly between HIV-positive women who were taking tenofovir disoproxil fumarate (TDF, Viread) compared to those on other antiretroviral therapies, a review of 17 studies that was published in Journal of Acquired Immune Deficiency Syndrome found.
Preterm delivery or still birth were less likely in pregnant women who were taking TDF than in women who were on other antiretroviral regimens. However, one clinical trial (PROMISE) bucked the trend: It appeared to show a greater mortality risk during the first two weeks of life if the mother had taken TDF during pregnancy compared to mothers who took non-TDF antiretrovirals -- but not compared to women who took zidovudine (AZT, Retrovir) and a single dose of nevirapine (Viramune) during labor. Most of the newborns who died in the PROMISE study had been born very prematurely (i.e., at less than 34 weeks gestation).
Study authors noted that longer-term data on bone density and growth for infants born to women who took TDF during pregnancy is needed to assess the safety of this antiretroviral during pregnancy.
People living with HIV (PLWH) are more likely to have AIDS-defining or HIV-related cancers, as well as lung cancer, than those who do not live with the virus, a registry-linkage study published in The Lancet HIV showed.
Researchers compared data from HIV and cancer registries in nine U.S. states between 1996 and 2012, yielding information on almost 450,000 PLWH. Standardized incidence ratios for AIDS-defining and HIV-related cancers, as well as lung cancer, declined over that period, which likely reflects the impact of antiretroviral treatment after 1996, study authors noted.
Smoking was found to be more common among PLWH than among the general population, but the higher lung cancer risk for PLWH may also be related to HIV-associated chronic pulmonary inflammation and repeated lung infections, the study authors hypothesized. Overall cancer risk remained elevated among PLWH, pointing to the need for monitoring potential cancer symptoms, even in people whose viral load is undetectable.
As PLWH age, the cancer burden among this population may increase, study authors concluded.
In an ecological study published in Journal of Acquired Immune Deficiency Syndrome, researchers called for HIV prevention and care measures that address unique social and economic factors in a specific location, in hopes that such an approach might reduce geographic disparities in HIV outcomes.
The study of Philadelphia, Pennsylvania, found that rates of late HIV diagnosis and linkage to care once diagnosed are geographically clustered in the city, and that these clusters are associated with varying levels of participation in neighborhood social organizations. Clusters of the two HIV outcomes studied did not overlap, suggesting that HIV interventions need to be tailored at the neighborhood level. For example, the southwest of the city scored high in both late HIV diagnosis and linkage to care, suggesting that HIV prevention efforts there should emphasize testing. The area was also characterized by high social participation, which in theory might be leveraged for such efforts.
Consistent with other studies, clusters with higher median incomes had better HIV outcomes. However, higher income inequality in these areas was not correlated with worse HIV diagnosis and care. Study authors speculated that this may be due to relatively few high-income residents raising the census tract's median income, or could be due to other sociocontextual factors.
|This Week in HIV Research: Increased Muscle Area After Starting Treatment Likely Due to Fat Accumulation|
|Cancer Causes 10% of Deaths Among People With HIV in U.S., Canada|
|PREP in Pregnancy Does Not Increase Poor Birth Outcomes|
No comments have been made.
The content on this page is free of advertiser influence and was produced by our editorial team. See our content and advertising policies.