This Week in HIV Research: A Long-Acting Popularity Contest

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This may be the last edition of This Week in HIV Research we'll publish in 2018, but we're still going strong as we hit the home stretch. This week's slate of four recently published HIV-related studies features these findings:

  • Think the most popular form of long-acting HIV treatment is the one with least-frequent dosage? Think again.
  • Telehealth may be a valuable tool in improving HIV pre-exposure prophylaxis (PrEP) uptake among young men of color who have sex with men.
  • PrEP awareness and usage remain extremely low among cisgender women in Rhode Island.
  • When it comes to assessing the neurocognitive benefits of switching off of efavirenz (Sustiva, Stocrin), the form of measurement really matters.

Join us for one final dive into these weekly study recaps before we ring in the new year. And when you're done, be sure to read our analysis of the top 10 HIV clinical developments of 2018 by David Alain Wohl, M.D. To beat HIV, you have to follow the science!

Barbara Jungwirth is a freelance writer and translator based in New York. Follow Barbara on Twitter: @reliabletran.

Myles Helfand is the executive editor and general manager of TheBody and TheBodyPRO. Follow Myles on Twitter: @MylesatTheBody.

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Among Long-Acting HIV Treatment Options, Survey Says: Weekly Pills

Among novel HIV drug delivery systems, one pill a week was significantly more appealing to survey participants than injectables or implants, a study published in Open Forum Infectious Diseases found.

The survey included 263 adults who were currently on HIV treatment and visited an infectious diseases clinic at Duke University or the University of South Carolina. Sixty-six percent of respondents reported being "very interested" in switching from their current daily regimen to a weekly pill; 39% said the same about switching to two injections every other month; and 18% expressed great interest in switching to two implants every six months. On the flip side, only 14% said they were "not at all interested" in the weekly pill, compared to 38% who said the same about injections and 58% who ruled out implants.

These preferences may change once risks, side effects, cost and other characteristics of these as-yet hypothetical delivery systems are better known, study authors cautioned. Interest in the various delivery methods also differed by age, education, current regimen (single versus multiple tablets), and experience with long-term side effects.

"Understanding preference heterogeneity for these novel treatment modalities may help to inform their development, predict uptake, and inform educational efforts to better engage patients in shared antiretroviral decision-making," the authors concluded.

Telehealth Program Gets Young MSM of Color on PrEP

A telehealth-based service called PrEPTECH successfully started young men who have sex with men (YMSM) on PrEP, a small pilot study in the San Francisco Bay Area published in Journal of Acquired Immune Deficiency Syndrome showed.

PrEPTECH involved doctor's visits by telephone, and home delivery of PrEP medication and sexually transmitted infection testing kits, plus two in-person laboratory visits. Eighty-four percent of the 25 participants were men of color, mainly Asian/Pacific Islander and Latino. Twenty-one men completed the 180-day study; 16 of them said they wanted to continue PrEP. Eleven of these 16 were transitioned to a long-term PrEP provider; one was still in the process of transitioning at the end of the study period; and the other four moved out of the area or were lost to follow-up.

PrEPTECH could help overcome barriers to PrEP, such as cost, the need for provider visits, or fear of stigma, study authors claimed. However, it requires people to be aware of PrEP in the first place, they noted. They called for larger studies involving more African-American and Latino men to corroborate their findings.

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Few Cisgender Women of Color Know About PrEP

Cisgender women of color are less aware of PrEP than their white counterparts, a study published in Journal of Acquired Immune Deficiency Syndrome found.

Researchers surveyed 1,431 HIV-negative cisgender women who attended a sexually transmitted disease clinic in Rhode Island between 2013 and 2016. Six women reporting having used PrEP at some point, and one woman reported using it at the time of the survey. Only 20.7% of white, 13.8% of African-American, and 11.0% of Latina participants reported that they knew about this HIV prevention method, compared to 60.3% of men who have sex with men (MSM) who were not using injection drugs.

Five percent of the 84 women who met Centers for Disease Control and Prevention (CDC) indications for PrEP were African American, even though in 2016, 47% of new HIV diagnoses among women in the state were among African American cisgender women. The reason for this demographic discrepancy may be that CDC indications are based on the characteristics of women's male sexual partners, which may not be disclosed in this community because of stigma, study authors hypothesized.

The authors called for more research into better identifying cisgender women who would benefit from PrEP, as well as efforts to increase PrEP awareness among cisgender women of color.

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Switching Off of Efavirenz: Objective vs. Subjective Cognitive Improvement

The extent to which switching from one efavirenz-containing HIV medication to another option results in neurocognitive improvements may vary significantly depending on the type of measurements used, a small study published in Journal of Acquired Immune Deficiency Syndrome showed.

The final study results included data on 48 men who were virologically suppressed on efavirenz/emtricitabine/tenofovir disoproxil fumarate (Atripla) and had no neurocognitive symptoms at baseline. They were randomized 2:1 to either switch to emtricitabine/rilpivirine/tenofovir disoproxil fumarate (Eviplera) or remain on their current regimen. All participants completed extensive neuropsychological assessments (NPA) at baseline and week 12 (study end).

By week 12, NPA scores had improved similarly for both study groups overall, although participants who switched off of efavirenz scored objectively better within two specific cognitive function domains: attention and speed of information processing. That said, only five of the 34 participants (15%) who switched medications experienced an overall objective score improvement that was significantly greater than those who did not switch.

By contrast, 25 of the participants (74%) in the switch group reported subjective improvements in cognitive function, leading them to elect to remain on an efavirenz-free regimen mostly because of perceived benefits in their daily life, even though emtricitabine/rilpivirine/tenofovir disoproxil fumarate has dietary restrictions and efavirenz/emtricitabine/tenofovir disoproxil fumarate does not.

Based on their results, the study authors cautioned that it may be difficult to predict which cognitively asymptomatic patients might benefit from a switch off of efavirenz, due to the potential gap between objective and subjective measurements of the effects of such a change.