This Week in HIV Research: New Explorations of Antiretroviral Adherence

"Treatment of mood disorders may be important for promoting sustained viral suppression," the authors of a study among 5,904 participants in Washington, D.C., concluded in Journal of Acquired Immune Deficiency Syndromes.

Data came from the electronic medical records of an observational cohort of PLWH (more than 80% African American, and 70% cisgender men). Overall, 45% of participants were diagnosed with at least one psychiatric disorder at some point during the study. Participants who had been diagnosed with depressive or bipolar disorders spent more time with viral loads ≥ 200 copies/mL than those without mood disorders. That association was even stronger when the psychiatric condition was not treated with prescription medications, suggesting that pharmacological treatment of depressive or bipolar disorders improved a person's ability to maintain viral suppression.

The percentages of people who received a pharmacologic prescription for their psychiatric disorder varied within the study, from a high of 64% among people with disorders related to anxiety, stress, or trauma to a low of 50% among people diagnosed with a mood disorder. However, researchers cautioned that data were not available regarding mental health prescriptions a participant may have received elsewhere, or cases in which psychotherapy without medications was successful.

Curiously, participants who were diagnosed with an anxiety disorder spent less overall time with a viral load at or above 200 compared to participants without an anxiety disorder. Psychopharmacological medications heightened that association, suggesting that in some cases, untreated but manageable anxiety led to a greater attention to antiretroviral adherence, according to the study authors.

"Taken together, these findings reinforce that the appropriate diagnosis, treatment, and monitoring of psychiatric disorders, particularly for depressive and bipolar disorders, are critical for promoting sustained viral suppression among PLWH with comorbid psychiatric disorders," study authors concluded.

The more days a woman living with HIV spends with depression, the greater their risk of experiencing a range of factors that can result in treatment failure, a study reported in Journal of Acquired Immune Deficiency Syndromes showed.

The research involved 1,491 women from the Women's Interagency HIV Study followed between 2013 and 2017 at nine U.S. sites. Findings indicated that time with depression was associated with increased risk of missing an appointment, taking HIV medications less than 95% of the time, and experiencing virologic failure. The association between length of depressive episodes and viral suppression was entirely mediated by treatment adherence. Study authors concluded:

• Being fully depressed for as little as a quarter of the time adversely affects treatment engagement.
• Even though modern antiretrovirals do not require absolute adherence, they must be taken at least 95% of the time to maintain viral suppression.
• Depression care may need to be implemented in HIV treatment settings to close a gap in mental health care and improve adherence.
• A prior history of depression importantly predicts antiretroviral success, even in the absence of current depressive symptoms.

Given that other psychiatric conditions often co-occur with depression, the observed outcomes may have been affected by these other conditions, study authors cautioned. They called for evaluating approaches that might reduce the length and severity of depression in order to improve HIV care outcomes.

In women living with HIV, food insecurity is associated with lower concentrations of antiretrovirals in hair -- an established measure of adherence -- a study reported in Clinical Infectious Diseases showed.

Data came from 677 participants in the Women's HIV Interagency Study who contributed 1,944 person visits. At baseline, 59% of participants were virally suppressed and 45% reported not having consistent access to nutritious food as measured by the US Household Food Security Survey Module. "Each 3-point increase in food insecurity was associated with a 0.94-fold lower [antiretroviral] concentration in hair," researchers observed.

While many newer HIV drugs do not have food restrictions, some are still better absorbed when taken with a meal. Lack of food thus may impair drug absorption, study authors hypothesized. Although self-reported treatment adherence did not affect the result, actual adherence may vary from what women told researchers, they cautioned.

Prior research in resource-limited settings has shown improved antiretroviral adherence when people receive food assistance. "Our findings suggest that such interventions may also be relevant in the US," study authors concluded. They called for HIV treatment services to address food insecurity among their clients to improve antiretroviral levels.

A newly developed point-of-care adherence test for tenofovir is 97% specific and 99% sensitive, researchers reported in AIDS.

The new test works similarly to modern pregnancy tests, using urine and a control line to deliver rapid results. It can detect both tenofovir disoproxil fumarate (TDF) and tenofovir alafenamide (TAF) but has been calibrated only for TDF.

The assay was validated against 300 samples from HIV-negative volunteers, which were also tested with the current gold standard for determining adherence to tenofovir, liquid chromatography/tandem-mass-spectrometry.

Using the test, providers can determine quickly and inexpensively whether someone took the prescribed doses of tenofovir -- either for prevention or treatment -- within the last one to seven days, according to the study authors. This allows providers to discuss potential barriers to adherence during that appointment, they wrote.

While biomedical determination of adherence is more reliable than self-reporting, the "white coat effect" -- when someone takes prescribed medication only a few days before a medical appointment -- cannot be excluded, they cautioned.

Study authors called for additional studies on implementing this test in diverse populations. Work on TAF cutoff quantities in urine, as well as on pursuing regulatory approval, is ongoing, the authors noted.