January 12, 2018
In our latest jaunt through HIV journals, we spot a new attempt to focus and prioritize HIV testing through the use of a symptom-based scoring system. We also see whether a person's sex plays a role in HIV's effect on psychomotor function, and learn about the degree to which vitamin D supplementation can affect lipid levels in people starting HIV treatment (spoiler: not much).
To beat HIV, you have to follow the science!
A scoring system developed in the U.S. can predict with good accuracy whether someone is in the acute phase of HIV infection, researchers reported in Clinical Infectious Diseases. The system is based on a range of symptoms experienced during the two weeks before a person receives an HIV test.
The San Diego Symptom Score for assessing the likelihood of acute HIV infection (AHI) was developed from data on 998 people who were tested for HIV at a San Diego site. Respondents -- 113 of whom had AHI -- reported whether they had experienced any of 11 symptoms during the prior two weeks. Three symptoms -- fever, myalgia and the loss of at least 2.5 kg body weight -- were found to predict AHI.
A scoring system based on those findings was then tested using the study participants. It found that the system was 72% sensitive and 96% specific for predicting AHI among participants who scored 11 or higher. Among men who have sex with men, the scoring system performed better than traditional AHI assessments based on behavioral risk factors. This could be because stigma may prevent people from disclosing certain behaviors, but not from describing symptoms, study authors hypothesized.
The researchers cautioned that results need to be validated among different demographic groups before the score can be used more widely.
Psychomotor function is worse in young women who have been living with HIV since early childhood than in women not living with HIV, a study published in AIDS found. The study also found that young women with HIV may lose more overall psychomotor function than young men.
Researchers tested 250 male and female Romanians who had acquired HIV during or soon after birth, as well as 72 age-matched compatriots not living with HIV, for neurocognition, as well as psychological and medical factors. The average age of participants was 23 years.
Both men and women living with HIV scored worse on most cognitive tests than did people in the comparison group. Participants living with HIV had not been on antiretroviral treatment at the start of their lives, which may have affected neurocognitive development, study authors hypothesized.
On psychomotor tests, women not living with HIV outperformed their male counterparts. However, in the HIV group, women did no better than the men, despite having less advanced HIV disease on average. Study authors posited that this difference may be related to hormonal factors. They called for longitudinal studies as this group of young people matures.
Adding vitamin D supplements when starting antiretroviral therapy does not improve lipid profiles within 48 weeks, a randomized clinical trial published in Open Forum Infectious Diseases showed.
All 165 treatment-naive participants in this U.S. study took efavirenz/emtricitabine/tenofovir (Atripla); 79 of them also took a high-dose vitamin D/calcium supplement, while the remainder took a placebo supplement. Vitamin D levels did increase in the supplement arm, but this did not affect lipid parameters, insulin resistance, body composition or the prevalence of metabolic syndrome.
"These data did not affirm the hypothesis that vitamin D plays a crucial role in lipid metabolism or insulin sensitivity," study authors concluded. However, they cautioned that participants had no prior metabolic issues and only one antiretroviral regimen was evaluated. They called for further studies to assess supplementation for people who take different antiretrovirals or have pre-existing conditions, such as diabetes.
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