This Week in HIV Research: Check Your Frailty

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Thanks for joining us as we examine the latest in peer-reviewed journal studies exploring HIV-related clinical science. In this week's highlighted set of recently published studies with potential clinical relevance for HIV care providers, we find:

  • An association between frailty and chronic disease development among people with HIV over age 50.
  • Affirmation of Atripla's long-term efficacy in parts of the world that still rely on it -- but with some caveats.
  • Signs that overly restrictive eligibility criteria for hepatitis C treatment yield more lives lost in the long run.
  • A signal that nicotine is metabolized faster than normal among people living with HIV.

Come on in as we peer a little more deeply into each of these findings. 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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Study Supports Routine Frailty Assessment in HIV-Positive People Over 50

There is an association between frailty and the eventual development of a range of chronic conditions among virally suppressed people over age 50, researchers reported in Clinical Infectious Diseases.

Six percent of 1,016 study participants (median age 51; 195 participants were women) were considered frail at baseline. Frailty assessment included measurements of grip strength and gait speed, as well as self-reported exhaustion, weight loss, and limitations on vigorous physical activity. Baseline frailty was associated with a higher risk of cardiovascular disease, diabetes, and bone disease a median of 21 to 23 months later. An increase in the frailty score over 48 weeks was also linked to a greater risk of death.

Researchers noted, however, that not all components of the score were related to all outcomes. For example, slow gait was associated with diabetes, but not with bone problems. The study authors also stated that, although the findings associated frailty with some chronic diseases, they did not offer proof of a causal relationship.

Routine annual frailty assessments for people living with HIV who are more than 50 years old could help predict the risk of age-related chronic diseases, study authors concluded. Interventions, such as structured exercise programs, could then be used to mitigate some of that risk.

Atripla Effective for Long-Term Viral Suppression Overall, But Not in Some Subgroups

First-line efavirenz + tenofovir disoproxil fumarate + emtricitabine/lamivudine (Atripla) remains effective overall in maintaining long-term viral suppression, a European study published in AIDS found.

While the World Health Organization now prefers first-line therapy based on dolutegravir instead of Atripla, dolutegravir-based treatment is not accessible everywhere at a low cost, study authors noted. By contrast, a generic version of Atripla is available around the world, and many patients remain on the regimen after being originally prescribed it in the 2000s and 2010s.

For this paper, data was analyzed from 19,527 participants in the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) and UK Collaborative HIV Cohort (UK CHIC) studies. Patients were followed for a median of 3.7 years after first being virally suppressed on Atripla. Rates of virologic failure and treatment interruption declined over the first three years, to less than 3.5/100 person-years for those who remained on the study regimen. Treatment interruption rates were also low.

However, results differed for some subgroups: Atripla was less successful among African-Americans, young people (< 35 years old), and those who reported acquiring HIV through injection drug use or heterosexual intercourse.

"The substantial differences in rates of [viral failure] and treatment interruption according to demographic and clinical characteristics may be useful for targeted monitoring and adherence interventions," the study authors concluded.

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Restricting DAAs to the Severely Ill Costs Lives, Researchers Say

Among people coinfected with HIV and hepatitis C, applying common eligibility criteria for direct-acting antivirals -- such as requiring that patients have advanced liver fibrosis or a fully suppressed HIV viral load -- results in a lower decline in mortality than treating a similar proportion of people selected at random, a statistical analysis published in Clinical Infectious Diseases showed.

Over 10 years, the difference in mortality risk among 3,056 study participants was -3.7% for treatment versus no treatment, according to the study authors. If only those with suppressed HIV and severe liver fibrosis were treated, 51% of participants would receive DAAs and the difference in risk would be -1.1%. Using these drugs in a random 51% of participants yielded a risk difference of -1.9%.

Restricting the access to DAAs of those with severe fibrosis or cirrhosis means the intervention may come too late in the process and the drug's benefit may be limited by the effects of the fibrosis. "These findings suggest that setting treatment access policies with only short-term cost-containment in mind can cause patients unnecessary harm, and lives may have been saved if careful consideration had been used to set DAA treatment policies," study authors concluded.

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Faster Nicotine Metabolism Found Among People Living With HIV

People living with HIV metabolize nicotine faster than those who do not live with the virus, a study published in AIDS found. This fact may partly explain the lower smoking cessation rates among those living with HIV, study authors noted.

Researchers calculated the nicotine metabolite ratio (NMR) of 131 people living with HIV who smoke cigarettes and 199 smokers in the general population. The two groups were matched on sex, race, body mass index, and smoking rate, all of which influence NMR. The mean ratio was 0.47 in the HIV group and 0.34 among the controls.

NMR is calculated using the activity of a particular enzyme, CYP2A6. That enzyme may be induced by HIV itself; it is also known to be affected by efavirenz and possibly other antiretrovirals. Study authors called for further research into these mechanisms, concluding: "Understanding the mechanisms that contribute to faster nicotine metabolism among PLWH is necessary to understand tobacco's role in undermining clinical outcomes in HIV, and identifying novel therapeutic interventions."