This Week in HIV Research: Cracking the Contraception Conundrum

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In the vast, ever-evolving world of HIV research, study results can yield any number of ends. Some break entirely new ground; others answer important (or not-so-important) questions; still others follow up on earlier research to either support or refute those prior findings.

Regardless of their purpose, one of the common threads we seek in the studies we select for this series is that they further our conversation about important issues in HIV. This week, the research we've chosen adds these new sentences to a few ongoing conversations in the field:

  • We probably don't need to be concerned about a direct impact of long-acting contraceptives on a woman's susceptibility to HIV.
  • We sorely need to pay substantial attention to implementing cardiovascular health interventions for people with HIV.
  • We're falling well short in our efforts to ensure HIV testing among people living in some of the hardest-hit areas of the U.S.
  • We can probably consider E/C/F/TAF as a viable option for HIV post-exposure prophylaxis (PEP).

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Seroconversion Risk Similar Among Three Long-Acting Contraceptives

HIV risk did not differ substantially among women using one of three long-acting contraceptive methods, researchers reported in The Lancet. The findings appear to alleviate concerns raised by some earlier studies about a potential association between heightened HIV risk and the use of some hormonal contraceptives. But they also highlight a need for greater communication and education for women in resource-poor regions of the world regarding HIV prevention and family planning.

The researchers randomly assigned 7,829 women seeking contraception in sub-Saharan Africa to receive an injection of depot medroxyprogesterone acetate every three months, a copper intrauterine device, or a levonorgestrel implant. Despite HIV prevention counseling, seroconversion rates were similarly high among the three arms (per 100 woman-years: 4.19, 3.94, and 3.31, respectively). The trial was not powered to detect an increase in seroconversions below 30%, nor did it evaluate all pregnancy prevention methods in use, such as oral contraceptives.

"Our results strongly emphasize the need for more aggressive HIV and STI prevention and management efforts for African women, including PrEP and HIV prevention integrated with contraceptive services," study authors concluded.

In a related commentary, Lisa Miyako Noguchi, Ph.D., of Johns Hopkins University, and Princess Nothemba Simelela, M.D., of the World Health Organization urged, "Decision makers need to listen to the voices of women and girls -- who continue to suffer and die not solely as a result of their unconscionable lack of access to high-quality contraceptive and HIV-related care but also to primary care, cancer prevention, mental health, safe abortion, violence prevention, and maternal health services."

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Large Health Care Claims Database Reiterates Need for Cardiovascular Health Interventions in People Living With HIV

Prior research has solidly established a heightened risk for cardiovascular disease among people living with HIV. A large new dataset, this time in the U.S., adds substantial heft to the growing body of findings on this topic and reiterates the need for cardiovascular health interventions among people living with HIV.

The study, published in Journal of the American Heart Association, analyzed health care claims for 19,798 HIV seropositive and 59,302 age- and sex-matched HIV seronegative people. Hazard ratios (HR) for heart failure (3.2), stroke (2.7), and any heart-related hospitalization (1.7) were significantly higher among those living with HIV compared to HIV-negative controls. The risk for myocardial infarction (HR = 1.3) and atrial fibrillation (HR = 1.2) was slightly elevated in the HIV group, while serostatus made little difference in peripheral artery disease (HR = 1.1).

The diverse set of participants from a large insurance database and the variety of cardiovascular endpoints measured differentiate this analysis from other studies on the subject, study authors noted. However, they acknowledged that their methodology excluded people with different or no health insurance, was subject to potential misclassification when claims were filed, and could not control for other risk factors that may be more prevalent among those living with HIV.

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HIV Testing in High-Prevalence U.S. Areas Is Suboptimal

HIV testing rates in the 57 geographic areas on which the U.S. "Ending the HIV Epidemic" initiative focuses were suboptimal during 2016 and 2017, researchers reported in Morbidity and Mortality Weekly Report (MMWR).

The initiative was announced in February 2019 and will focus on areas in the U.S. with high HIV prevalence -- 50 counties and local areas, plus seven states with high rates of rural HIV diagnoses. The MMWR study, which was based on self-report in a national telephone survey, found that 39% of adults in the U.S. had ever been tested for HIV, and 29% of those at risk for seroconversion were tested during the previous year. The percentage of those ever tested in the 50 local focus jurisdictions (47%) was above the national average, but that in the seven focus states (36%) was below average.

Among people deemed to be at risk for HIV, annual testing rates within the initiative's target areas were low: 34% in the local jurisdictions and 26% in the focus states said they had been tested in the previous year. "The observed variability in both ever and past-year testing by jurisdiction highlights the need for screening strategies that are tailored to local needs," study authors concluded.

TheBody, TheBodyPro's sister site for the HIV community, is examining the "Ending the HIV Epidemic" plan in detail through its Eyes on the End series.

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E/C/F/TAF May Be Suitable for PEP

A single-tablet regimen of elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide (E/C/F/TAF, Genvoya) showed similar results for post-exposure prophylaxis (PEP) as other such single-tablet regimens, a small French study published in Clinical Infectious Diseases showed. The trial was funded by Gilead, the manufacturer of E/C/F/TAF, which is approved for treating, but not for preventing, HIV.

As in similar PEP trials, loss to follow-up was high, with 78 of 95 initial participants completing the 28-day study regimen, and 64 people attending their follow-up visit 120 days after initial exposure to HIV. Eighty-seven participants had been exposed to the virus through sexual contact and eight through their occupation. No seroconversions were observed at days 28 or 120.

Participants reported similar quality of life as the general population. Mild adverse events -- mostly weakness, abdominal pain, diarrhea, and headache -- were common (68% and 59% of participants at days 14 and 28, respectively) but did not cause interruption of the course of medication. Results show that the study drug could be used for PEP, study authors concluded.