This Week in HIV Research: Internalized Stigma Decreases Adherence in Women of Color, and Annual CD4 Tests Sufficient For HIV/HCV Coinfection
This week, a study finds that for women of color living with HIV, internalized stigma significantly contributes to sub-optimal adherence. Another study reports that for those living with HIV/HCV coinfection, CD4 testing once a year may be sufficient enough. And a study comparing maraviroc versus tenofovir/emtricitabine for initial HIV treatment was terminated early because maraviroc was found to have less efficacy. To beat HIV, you have to follow the science!
Internalized HIV-related stigma contributes significantly to a lack of HIV treatment adherence in some women of color, according to a study published in the Journal of Acquired Immune Deficiency Syndromes. Questionnaire responses by 1,168 participants in the Women's Interagency HIV Study were analyzed to determine the relationship between internalized stigma and suboptimal adherence to HIV medication regimens.
There was a significant association among women of color between stigma and not taking antiretrovirals as prescribed (adjusted odds ratio[AOR] = 0.69), but not among white women (AOR = 2.15). This association was mediated by depressive symptoms, loneliness and a perceived lack of social support, leading to a chain reaction: internalized stigma, and then belief in less social support and/or feeling of loneliness, more depressive symptoms, and finally lower adherence.
These results show that "improvements in adherence may require multifaceted interventions addressing both mental health and interpersonal factors, especially for minority women," the study authors concluded.
CD4 counts need to be monitored only once a year in people living with HIV whose CD4 count is greater than 300, and in those living with HIV and hepatitis C (HCV) whose CD4 count is greater than 350, according to a Spanish study published in Clinical Infectious Diseases.
While current guidelines recommend less frequent CD4 tests for HIV-positive persons who are on antiretroviral treatment and whose viral loads are undetectable, they do not apply to those living with HIV/HCV coinfection.
This study of 4,625 HIV mono-infected and 1,804 HCV coinfected persons found that those with initial CD4 counts above 300 or 350, respectively, were highly likely (almost 90% or higher probability) to maintain stable CD4 counts of greater than or equal to 200, for a decade.
Less frequent CD4 count monitoring could save as much as $10.2 million per year in the U.S. alone, study authors note. However, viral load should still be tested every three to six months, they caution.
A recent study comparing once-daily maraviroc (Selzentry, Celsentri) to once-daily tenofovir/emtricitabine (Truvada) in treatment-naive HIV-positive patients was stopped early because maraviroc proved to be less efficacious than tenofovir/emtricitabine, according to a study published in AIDS.
By week 48, 77.3% of study participants in the maraviroc arm had achieved viral loads below 50 copies/mL compared to 86.8% in the tenofovir/emtricitabine arm. Both drugs were combined with once-daily darunavir (Prezista) boosted with ritonavir (Norvir).
The multi-center phase-3 study -- dubbed MODERN -- included 797 participants with viral loads greater than or equal to 1,000 copies/mL at study enrollment. At that time participants were tested for resistance to the study drugs. While the primary end point was the proportion of participants in each arm who achieved viral loads below 50 copies/mL at week 48, the study had originally been planned for 96 weeks.
Other studies had found lower rates of bone loss in maraviroc-containing regimens compared to tenofovir-based treatment. According to the International Osteoporosis Foundation, an estimated 80% of those suffering from bone loss in the U.S. are women. However, participants in MODERN were overwhelmingly male (more than 90%) and white (over 80%).