This week, a study in Europe finds that over 50% of individuals living with HIV who were at risk for cardiovascular disease were able to actively lower that risk by using interventions such as quitting smoking. Another study finds that for those on pre-exposure prophylaxis (PrEP), declining renal function varies based on age, adherence and baseline kidney functioning. And broadly neutralizing antibodies that are minimally mutated may provide better pathway to an HIV vaccine, a study suggests. To beat HIV, you have to follow the science!
Cardiovascular Risk Reduction Works in People Living With HIV
Over half of people living with HIV in Europe who were at risk for cardiovascular disease were able to modify that risk, a study published in AIDS found.
At baseline, about 20% of the 8,762 people in the EuroSIDA cohort had a moderate to high risk of developing a cardiovascular disease, and each year another 7% fell into that category. More than half of study participants with high blood pressure (BP) lowered their BP, almost a third of smokers quit that habit, and a quarter of overweight people reduced their body mass index to < 25. However, fewer than one-fifth of those who needed lipid-lowering treatment managed to reduce their cholesterol levels.
Participants with undetectable viral load (80% of the cohort) were more likely to stop smoking, but less likely to lower their lipid levels. Among people living with HIV, older men in Eastern Europe were more likely to be at risk for cardiovascular disease than people in other demographic and geographic categories.
Not Everyone on PrEP Needs the Same Renal Monitoring Frequency
Decline in renal function differed substantially by age, adherence and baseline kidney functioning in a cohort of people taking tenofovir disoproxil fumarate plus emtricitabine (Truvada) daily to prevent the acquisition of HIV, a study published in The Lancet HIV found.
This sub-study of the iPrEX OLE (open-label extension) trial used hair samples to estimate drug concentrations, and thus adherence to the study drug. It showed that almost a third of participants did not take it at all. Higher drug concentrations in the hair samples -- consistent with taking four to seven doses per week -- were associated with a significant decline in creatinine clearance (a measure of kidney function).
Such a decline was also more likely in participants who were older than 40 years. These results show that the necessary frequency of renal function monitoring in people who take tenofovir disoproxil fumarate may differ by age, kidney function at baseline, and adherence to the medication regimen, study authors concluded.
Minimally Mutated bNAbs May Be Better HIV Vaccine Leads
Minimally mutated broadly neutralizing antibodies (bNAbs) may be more realistic leads for developing an HIV vaccine than existing bNAbs, a study published in PLOS Pathogens showed.
While existing bNAbs neutralize a variety of HIV strains and subtypes, they work in relatively few people living with HIV, contain rare features such as extensive changes to their structure, and are sometimes polyreactive -- i.e., they can bind to a variety of antigens. This feature makes use of existing bNAbs in specific vaccines difficult. By contrast, the minimally mutated VRC01-class bNAbs produced in this study are not polyreactive, but still include the same feature sets as conventional HIV bNAbs.
Researchers also determined the most important mutations in these bNAbs for designing an HIV vaccine and proposed a way to elicit these mutations by determining the specific epitope structure necessary for each mutation. Based on that data, they developed a working concept for a logical progression of selective mutations. Such a "reductionist approach to vaccine design ... has promise for designing vaccines against HIV and many other pathogens," study authors concluded.