This Week in HIV Research: In the Care Continuum, Self-Worth Matters
In this week's brief tour of recently published studies, we get a reminder about just how deeply mental health can affect an HIV-positive person's clinical care. We also look at encouraging new data on the odds of significant CD4 decline in the face of viral suppression; the intertwined complexities of cardiovascular and renal complications; and the extent to which cardiovascular care itself appears to decline among care providers treating people with HIV.
To beat HIV, you have to follow the science!
Internalized Stigma Associated With Missing More HIV Care Visits
People living with HIV who have internalized the stigma associated with the virus are more likely to miss care appointments than their peers with a more positive view of living with HIV, an exploratory analysis published in Journal of Acquired Immune Deficiency Syndrome found.
The study assessed negative feelings about living with HIV and depressive symptoms among 196 people who attended a clinic in Alabama. Researchers correlated these results with clinic data about visits and medication adherence. The degree to which people believed negative views about HIV correlated with lower clinic attendance. Missing medical appointments in turn mediated lower treatment adherence. These correlations were even more pronounced among African Americans compared to whites. Researchers called for further studies into the contribution of racism to this outcome.
Among men -- but not women -- with internalized stigma, depressive symptoms were associated with lower clinic attendance. Study authors hypothesized that men experience greater depressive symptoms, leading to more missed appointments.
Regular CD4 Cell Counts May Not Be Needed for Some People Who Are Virally Suppressed
People living with HIV who have a CD4 count of 350 cells/μL and remain virally suppressed are at "negligible" risk of their CD4 count dropping below 200 cells/μL, a prospective cohort study in Italy published in Journal of Acquired Immune Deficiency Syndrome showed.
Both U.S. and European guidelines recommend prophylaxis to prevent opportunistic infections when CD4 counts fall below that 200 cells/μL threshold. The study shows that, among more than 6,000 participants followed for a median of 3.75 years, not a single person who achieved a CD4 count of at least 350 cells/mL and maintained viral suppression experienced a confirmed CD4 count decline below 200 cells/mL. Researchers estimated that even in the worst case, there would be only one to two CD4 cell counts that fell below 200 for each 1000 person-years of follow-up.
Thus, regular CD4 count monitoring may not be required among this population, study authors concluded; instead, "optional monitoring" should be considered, provided viral load testing continued to be readily available. Dispensing with unnecessary CD4 counts would not only save money, but might also remove a source of anxiety for people living with HIV, they suggested.
Cardiovascular and Kidney Disease Risks Should Be Assessed Together, Researchers Recommend
People living with HIV (PLWH) who are at high risk of both cardiovascular disease (CVD) and chronic kidney disease (CKD) are more likely to experience either a cardiovascular or a kidney event than PLWH who are at high risk for only one of the two diseases, a data analysis published in PLOS Medicine found.
The study involved more than 27,000 participants from the larger D:A:D cohort. Those at high risk for CVD were much more likely to develop a CKD event than were people at low risk for CVD. The reverse association, CKD risk predicting a CVD event, also held, but was less pronounced.
Study authors noted that almost a quarter of participants at high risk for both diseases also had diabetes, calling for better diabetes prevention and treatment efforts in this population.
Disparities in Cardiovascular Care May Impact Heart Disease Rates in People Living With HIV
Higher rates of cardiovascular events in PLWH may be partly explained by lower prescription rates for statins and aspirin in at-risk PLWH compared to the general population, the authors of a study published in Journal of the American Heart Association concluded.
The researchers analyzed data from more than 1,600 doctor visits by PLWH and over 220,000 visits by people not living with the virus. When patients met guideline criteria for aspirin or statins, physicians prescribed these medications during 5.1% of appointments with PLWH and 13.8% of general population visits.
The percentage of visits during which counseling on diet, exercise or smoking was provided declined for everyone during the 7-year study period. While differences between the groups were less pronounced in this respect, fewer visits by PLWH included behavioral interventions than did general population appointments, a related press release noted.
Study authors called for guideline and policy changes to address these cardiovascular care disparities.