January 19, 2018
In this week's brief tour of recently published research, we get a new glimpse into the huge successes of Vancouver's years-long effort to reduce harm and increase HIV-related services among injection drug users. We also learn about the relative safety of stem-cell transplantation in people with HIV, the ability of certain biomarkers to predict future serious AIDS- and non-AIDS events, and the factors that increase the likelihood of partner notification among young people living with HIV.
To beat HIV, you have to follow the science!
Mortality among people living with HIV who inject drugs has declined significantly since a "seek-and-treat" program was scaled up in Vancouver, Canada, a prospective cohort study published in The Journal of Infectious Diseases showed.
In 2010, Vancouver scaled up its STOP HIV/AIDS Program campaign with a Seek and Treat pilot program that aimed to identify people at high risk for acquiring HIV and pursue a multifaceted approach of outreach, testing, care and treatment.
In the cohort study, researchers estimated HIV-related, overdose, nonaccidental and all-cause deaths among 961 people attending a local Vancouver HIV clinic who reported injection drug use. Two periods, 2010-2014 and 2004-2009, were compared with the base period, 1996-2003. In the 2010-2014 period, the adjusted rate ratio (ARR) for deaths was consistently lower for both men and women compared to the base period. For example, the HIV-related mortality ARR for women, which was 0.65 in the 2004-2009 period compared to the base period, dropped to 0.15 in the 2010-2014 period compared to the base period. For men, using the same comparison, the HIV-related mortality ARR dropped from 0.77 to 0.12.
Other independent predictors of death among men included intensive use of prescription opioids and white ancestry. That latter finding was unexpected, study authors noted; they called for additional research into the gap in care for this population.
People living with HIV do not experience a greater rate of serious complications after hematopoietic stem cell transplants (HSCTs) than people not living with the virus, a data analysis published in Clinical Infectious Diseases found. HSCTs, which are used to treat a number of cancers and other immune conditions, have been pursued for years as a potential route to an HIV cure. The only confirmed cure of HIV infection to date was the result of an HSCT performed in 2006.
This study found that frequency of most in-hospital complications of the procedure did not differ by HIV status among 39,517 people (108 of whom were living with HIV) who underwent HSCT between 1998 and 2012. These results held for both allogeneic and autologous cell transplants. However, after receiving an allogeneic stem cell transplant, incidence of non-tuberculous mycobacteria and cytomegalovirus were much more common among the HIV-positive people in the study than among those not living with the virus.
Study authors cautioned that they were unable to assess complications that might have arisen after a patient was discharged from the hospital. Similarly, no HIV-specific information, such as viral load, was available, nor was there data on specific conditioning regimens prior to the transplants. Because of the limited data, the results should be used only to generate a hypothesis, study authors cautioned, but concluded: "Allogeneic and autologous HSCT can be safely performed in HIV (+) patients."
Inflammation and coagulation biomarkers were independently associated with AIDS, serious non-AIDS events or death, an analysis of data from the START trial that was published in Open Forum Infectious Diseases found.
Blood samples from 4,299 participants in the Strategic Timing of Antiretroviral Treatment (often referred to as START) trial were analyzed for biomarkers of inflammation, coagulation and vascular injury at baseline and eight months later. Higher baseline levels of interleukin-6, a marker for systemic inflammation, or D-dimer, a marker for coagulation activity, were associated with greater risk of developing AIDS or serious non-AIDS events, as well as death. This was true across baseline CD4 counts or viral loads. In the immediate treatment arm, these markers were significantly reduced at month eight compared to the deferred treatment arm, as well as in absolute numbers.
Longer-term follow-up will be necessary to determine whether viral suppression evens out biomarker levels over the long run independent of when treatment was started, study authors said. They also called for additional research into interventions that might reduce these biomarkers even further in people living with HIV.
If more than one staff member talks to a young person who is living with HIV about partner services, partner notification is more likely to be successful, a study published in Journal of Acquired Immune Deficiency Syndrome suggested. But more often than not, the study found, only a single staff member does so.
A computerized interview completed by 924 people between the ages of 13 and 24 who are living with HIV revealed that at least one person in a health care setting spoke to 99% of participants about letting their partners know that they might be at risk for acquiring the virus. However, 52.4% of respondents indicated that only one person in a health care setting had spoken of partner notification, and only 18.3% had themselves received such a notification about their own exposure. More than half (364) of the 705 people who answered the question notified all of their partners themselves; another third (235) let some of their partners know about their seroconversion.
Researchers identified three factors that contributed to successful partner notifications: at least two people broached the topic; the participant had been notified of exposure risk; and the young person had at least some higher education. Study authors called for updated guidelines that specify conversations about partner notification by both the HIV tester and the care provider.
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