This Week in HIV Research: For Many U.S. MSM, Tenuous Connections to Care
This week, we highlight research showing just how far the U.S. still has to go in keeping HIV-positive people within some high-risk communities connected to care after they're diagnosed. We also look at stroke risk among HIV-positive women and a successful health care re-engagement effort in Africa.
To beat HIV, you have to follow the science!
Many MSM Diagnosed Late, HIV Care Outcomes Worse for African Americans
Almost one in five men who have sex with men (MSM) who were diagnosed with HIV in 2015 already had met the clinical definition of AIDS at diagnosis, the Centers for Disease Control (CDC) reported in its Morbidity and Mortality Weekly Report.
Close to three-quarters of newly diagnosed MSM in 2015 were linked to HIV care within one month of diagnosis, the study found -- about the same percentage as all MSM living with HIV (MSMLWH) who received care by the end of 2014. However, more than 40% of those initially in care do not remain, the report said. Fewer than two-thirds of MSMLWH were virally suppressed, and that percentage fell to 52% for African Americans, despite fewer men in that group being diagnosed at advanced stages of HIV. The CDC also estimated that more than half of young MSMLWH remain undiagnosed.
Study authors called HIV testing "a gateway" to HIV care or pre-exposure prophylaxis, depending on the test result, and called for "targeted HIV testing" for young and African-American MSM in particular.
Ischemic Stroke Risk in Women Higher Among Those Living With HIV
Women living with HIV (WLWH) were almost twice as likely to suffer an ischemic stroke than were women who do not live with HIV, an observational cohort study published in AIDS showed.
The higher stroke risk remained after adjusting for general and sex-specific risk factors, such as hypertension or estrogen use, although the likelihood of stroke declined from nearly 2.5-fold before adjustment to a hazard ratio of 1.89 after adjusting for all factors. Among WLWH, long-term antiretroviral treatment lowered the risk of ischemic stroke.
Data were based on more than 1,200 WLWH and almost 10 times as many women not living with HIV in Boston, Massachusetts. The full duration of the study spanned from 1996 to 2011; on average, the participants were about 40 years old when they entered the study and were followed for 7 years.
Several stroke risk factors, such as smoking, were more common among WLWH than among the control group. Even so, the results "suggest that novel, HIV-related factors that remain unaccounted for may be relevant to ischemic stroke risk among WLWH," study authors concluded.
Early Outreach After Missed Clinic Appointment Effective in Re-Engaging People in HIV Care
People living with HIV who received a counseling visit within eight days of a missed clinic appointment were twice as likely to return to care than those who did not receive such a visit, an observational study in Kenya that was published in Journal of Acquired Immune Deficiency Syndrome found.
Trained staff traced those who did not show up for their clinic visit and counseled them to return for HIV care. Return to care increased even for visits later than the first week, but the longer the gap between the missed appointment and the outreach effort, the less likely the person was to return. Study authors noted that people also re-engaged with care on their own and suggested an optimization approach to determine the most effective timeframe for outreach.
Other studies have identified a fear of mistreatment by clinic staff because of the missed appointment as a reason for not returning. Counseling visits may mitigate that fear, researchers hypothesized.