November 17, 2017
Credit: vchal for iStock via Thinkstock
This week, we take a brief look back at a few notable studies published earlier this year Among those findings are sobering data regarding poor linkage to care among HIV-diagnosed women in the U.S., a reminder about HIV incidence inequalities among the Latinx population, encouraging findings regarding the efficacy of hepatitis C treatment among people with HIV, and a call to remember frequent testing for sexually transmitted infections among at-risk people with HIV.
To beat HIV, you have to follow the science!
A majority of the 4,749 U.S. women who received an HIV diagnosis via a Centers for Disease Control and Prevention (CDC)-funded program in 2015 had previously learned that they lived with the virus, CDC reported in Morbidity and Mortality Weekly Report.
Of the 2,951 women with a repeat diagnosis, almost 90% were not receiving HIV care at the time of the current test, the study found. A little more than half of these women were promptly linked to care (within three months).
More than 70% of those who were re-diagnosed were African American, the study noted.
Linking women to HIV care and identifying those who have already been tested but are not in care, especially in the African-American community, are important areas of focus in order to lower HIV rates among women in the U.S., study authors concluded.
Latinx people in the U.S. are diagnosed with HIV three times as often as whites, but serious gaps remain in their continuum of care, a data analysis published in Morbidity and Mortality Weekly Report showed.
Among Latinx people, about three-quarters diagnosed with HIV were linked to care within one month, but fewer than 60% of those diagnosed remained in care, and about the same percentage were virally suppressed, the study found. The corresponding numbers for whites were almost 80% linked to care, close to 60% retained in care, and 65% virally suppressed.
Linkage to care varied among age groups, genders and routes of HIV acquisition.
Study authors suggested that more targeted strategies are needed to link people who inject drugs to HIV care, as they were the least likely group in the study to start HIV care promptly. They cautioned that the data cover only 38 U.S. jurisdictions and results may not be applicable to all Latinx people in the U.S.: Some of the states missing from the analysis, such as Florida and Arizona, have large Latinx populations.
Direct-acting antivirals (DAAs) effectively cured hepatitis C (HCV) in more than 90% of HIV/HCV co-infected people in an urban clinic despite real-world challenges, researchers reported in Open Forum Infectious Diseases.
The retrospective cohort study analyzed data from 172 coinfected patients, most of whom were African-American men. Median CD4 count was just below 500 cells/µL, and the vast majority had HCV genotype 1. Participants took a DAA -- mostly ledipasvir/sofosbuvir (Harvoni) -- for three months and had their virologic response evaluated 12 weeks after ending treatment.
The sustained virologic response rate at 12 weeks was 93%, at least as good as clinical trial outcomes. However, in a contrast with findings from clinical trials, medication access was an issue in this study. Nonetheless, all participants were able to receive the drugs, in part through pharmaceutical companies' patient assistance programs. Study authors attributed this success to the multidisciplinary hepatitis C model used at the clinic at which the study was conducted.
The study also found that drug-drug interactions with other medications, another common issue, required dosage or medication changes for 40% of participants.
People living with HIV who report sexual behaviors that may put them at risk of sexually transmitted infections (STIs) should be screened for STIs every three months, the authors of a study published in Clinical Infectious Diseases recommend.
The prospective cohort study of 174 participants (mostly men who have sex with men) in Zurich, Switzerland, found that two-thirds of the 79 STIs detected were asymptomatic. Engaging in insertive anal intercourse or reporting sex without a condom, as well as exhibiting STI symptoms, predicted an STI diagnosis. Incident STI was also associated with non-injectable drug use.
The study's 33% period prevalence rate for STIs was significantly higher than that of other Western European trials, study authors noted. They attributed the difference to higher rates of risky sexual behavior during primary infection compared to chronic infection, and risk compensation behavior among people who are virally suppressed and therefore cannot pass on HIV.
Regular STI screenings should include rectum, pharynx and urethra, and anyone showing signs of STIs should be promptly tested, the authors recommended.
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