This week, a study finds that continuous HIV treatment adherence, without a 90-day gap, has increased from 2001-2010, and is now longer than adherence to medications for some other chronic diseases. Another study finds that programs specifically to help people living with HIV quit smoking are needed. And continuing to take antiretroviral therapy after giving birth despite having a high CD4 count helps prevent future mild-to-moderate, HIV-related illnesses. To beat HIV, you have to follow the science!
People Living With HIV Take Meds for Longer Than Do Other Chronically Ill People
The median amount of time for which people adhered to antiretrovirals without a 90-day gap increased significantly between 2001 and 2010, an analysis of Medicaid data published in AIDS found.
Researchers evaluated data on prescriptions filled for HIV medications, as well as for drugs to treat certain other chronic conditions, such as heart disease, high cholesterol and diabetes. During the period of 2001-2003, the median time to non-persistence (having a 90-day gap in treatment) was 23.9 months for HIV-positive individuals taking antiretrovirals. From 2004-2006, the median time to non-persistence increased to 35.4 months. For 2007-2010, the study authors note that no median was reached because more than half of study participants were still adherent to treatment, suggesting that fewer people reached non-persistence than the previous two study periods.
HIV-negative controls, on the other hand, had lower median time to non-persistence for drugs for other chronic conditions. For those taking angiotensin-converting enzyme inhibitors (ACE) or angiotensin receptor blockers (ARB), the median time to non-persistence was 25.6 months for 2001-2003, 25.5 months for 2004-2006, and 21.6 months for 2007-2010. For those taking statins and metformin, the median time to non-persistence was 19.5 months for 2001-2003, 20.4 months for 2004-2006, and 20.7 months for 2007-2010.
Persistence was also greater among people with HIV whose antiretroviral regimens were less toxic and included fewer pills. However, the data showed large disparities among genders, races, and states of residence. "There is lots of room for further improvement," lead researcher Bora Youn noted in the study press release.
Related: This Week in HIV Research: Spotlight on HIV Cure Research
The Importance of Tobacco Cessation Programs Specifically for People Living With HIV
More people living with HIV use tobacco products than do in the general population, an analysis of data from 28 middle- and low-income countries published in The Lancet Global Health found.
Researchers included smokeless tobacco, such as snuff or chewing tobacco. In many countries, these forms of tobacco are more commonly used by women. Overall, about 27% of men and 3.6% of women living with HIV used tobacco, compared to 28% of men not living with HIV. However, these rates varied widely among countries. For example, 9.7% of Ethiopian men living with HIV smoked, while the comparable rate in The Gambia was 54.8%.
Standard smoking cessation interventions do not appear to be effective among people with HIV, lead study author Noreen Mdege, M.P.H., Ph.D., noted in the study press release. Her team's next step therefore is to examine the specific factors that contribute to higher rates of tobacco use among people with HIV in order to develop anti-tobacco interventions tailored specifically to them.
Antiretroviral Therapy Postpartum Despite High CD4 Counts Still Beneficial
Continuing antiretroviral therapy after giving birth, even when the mother's CD4 cell counts are high, cut the rate of World Health Organization (WHO) stage 2 or 3 events in half, a clinical trial published in PLOS One showed.
Such events are mild to moderate HIV-related illnesses, such as herpes zoster or oral candidiasis. More than 1,600 women across the world with CD4 cell counts of at least 400 cells were randomized to take antiretroviral medication -- preferably lopinavir/ritonavir (Kaletra) plus tenofovir/emtricitabine (Truvada) -- or to stop treatment within about six weeks of giving birth.
In addition to the beneficial effects of continued therapy, the data "also highlight the challenges of adherence to [treatment] over the long term," lead author Judith S. Currier, M.D., M.P.H., noted in the study press release. More than a fifth of women in the treatment arm experienced virologic failure, and most of their virus was not resistant to the antiretrovirals, suggesting adherence problems. This is "an issue we must find ways to address," Currier concluded.
Methadone Treatment Most Effective HIV Prevention Method for People Who Inject Drugs
Opioid agonist therapy (OAT) is the most cost-effective intervention to prevent people who inject drugs (PWID) from acquiring HIV, a modeling study published in PLOS Medicine found.
The intervention could become even more effective, if it were more widely available across the U.S., study authors noted. They evaluated four HIV prevention strategies: OAT, needle exchange programs, HIV testing and treatment, and oral pre-exposure prophylaxis (PrEP). Among these, only PrEP was found not to be cost-effective at current prices for the medication.
Study authors estimate that a combination of the other three methods could prevent more than 40,000 seroconversions over a period of 20 years, if half of PWID were enrolled in such programs. Researchers cautioned that despite these findings, PrEP "should not be denied on the basis of injection drug use," since cost-effectiveness is only one consideration in deciding on a specific intervention.
The greatest health benefit is reaped by stopping injection drug use itself and not merely preventing HIV, noted Cora Bernard, the lead study author, in a related press release. "This is why we found OAT to be the highest-value investment," she concluded.