This Week in HIV Research: Looking Forward, Looking Back
In our final installment of 2017, we intermingle forward-looking research with some retrospective analysis. We join researchers in Tennessee for an exercise in HIV outbreak prediction; scan some intriguing data in HIV/hepatitis C-coinfected women that suggests a drink a day may not worsen the liver; learn more about the effects of lopinavir (once a pillar of antiretroviral therapy) on preterm delivery; and look at how one of our greatest historical successes of the fight against HIV, the U.S.'s dramatic reduction in mother-to-child HIV transmission, has played out into the current decade.
For additional summaries of noteworthy recent studies, be sure to flip through our recap of late-2017 conference highlights, as well as our annual exploration of the top 10 HIV clinical developments of the year. To beat HIV, you have to follow the science!
Combining Data Sets May Better Identify Local HIV Outbreak Risks
Integrating data from "siloed" sets improves predictions for local HIV or hepatitis C virus (HCV) outbreak risks, an analysis in Tennessee published in Clinical Infectious Diseases showed.
Researchers calculated a "vulnerability index" for HIV and HCV in each of the 95 counties in the state. They expanded risk criteria previously used by the Centers for Disease Control and Prevention (CDC) in 2012-2013 by collaborating with four separate state agencies to combine otherwise isolated data sets. This analysis identified additional counties not highlighted by the CDC and re-ranked several locations. For example, the county identified as highest risk in this study had been ranked No. 41 by the CDC method.
The most vulnerable counties were characterized by a low per-capita income, a lack of mental health and addiction treatment services, high opioid prescriptions rates, high unemployment rates, and few people with health insurance.
Unexpectedly, counties with many deaths from opioids ranked lower in the index, despite the association between opioid use and HIV or HCV outbreaks. Study authors hypothesized that in these locations, people at highest risk for contracting HCV died before acquiring the virus. They recommended that more recent data be analyzed for similar trends and that results be provided to local health departments for public health planning purposes.
Coinfection: Moderate Alcohol Use May Not Accelerate Liver Fibrosis
Having one alcoholic drink a day does not worsen liver fibrosis in women living with HIV and hepatitis C (HCV), a study published in Clinical Infectious Diseases found.
Data on 686 HIV/HCV-coinfected participants in the Women's Interagency HIV Study for a median of 10 years was analyzed. At study start, 46% reported no alcohol use at all, 20% heavy or very heavy use (eight or more drinks/week), and the remainder light to moderate drinking (fewer than seven drinks/week).
Reported alcohol use changed over the course of the study, with 23% remaining abstinent during the entire period. This group's fibrosis measurements formed the baseline.
Hepatic fibrosis did not differ substantially between abstinent participants and those with light to moderate consumption. More than two drinks/day accelerated hepatic fibrosis by 0.25 Fibrosis-4 Index for Liver Fibrosis (FIB-4) units per year.
A related commentary cautioned, however, that more research is needed into the effect of moderate alcohol intake on treatment adherence, as well as on other liver complications, before "safe" levels of alcohol use can be established.
Kaletra-Based Treatment at Conception Associated With Higher Risk of Preterm Delivery
Women on ritonavir-boosted lopinavir (Kaletra)-based HIV treatment when they became pregnant are more likely to deliver their baby before 37 weeks of gestation (preterm) than women on non-nucleoside reverse transcriptase inhibitor-based regimens, an analysis of British data from 2007 to 2015 published in AIDS showed.
Women who took other protease inhibitor-based regimens when they conceived and had a CD4 cell count of ≤350 cells/mm3 were also at higher risk of having their baby too soon.
Most of the women in the 6,073 pregnancies analyzed were originally from sub-Saharan Africa; 50.9% were on antiretroviral treatment at the time of conception and the rest began treatment at a median of 19.1 weeks of gestation.
There was no clear association between lopinavir and early labor in women who started treatment after becoming pregnant.
Researchers hypothesized that, given prescribing patterns in the early years of the study, women taking lopinavir before conception had worse HIV-related health -- and were therefore at higher risk of preterm delivery -- than those who started treatment only during pregnancy.
Rate of Infants Born With HIV Has Declined Dramatically in the U.S.
The incidence of perinatally acquired HIV declined by 96% between 1992 and 2013, a study published in Journal of Acquired Immune Deficiency Syndrome found.
Researchers combined CDC estimates on HIV among newborns with census data on total live births from 1978 to 2013. Since data were limited in the beginning of the epidemic, estimates through 1993 were "back calculated" from the number of children who had been diagnosed with AIDS. In addition, data were interpolated for years in which the CDC did not publish an estimate.
Based on these calculations, HIV incidence peaked in 1992 at 43.1 per 100,000 births, dropped 76% by 1996, and has been steadily declining to the 2013 low of 1.8 per 100,000 births -- which is approaching the CDC goal of less than 1 per 100,000 live births. Study authors believed that this rate has continued to fall since then.
The researchers credited several factors for this decline, including prophylactic zidovudine (Retrovir) treatment of pregnant women since 1994; the advent of triple-drug antiretroviral therapy after 1996; and the start of scheduled cesarean deliveries for women with poorly-controlled viral loads.