This Week in HIV Research: Do We Need New Statin Guidelines?

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Thanks for tuning in to our latest review of peer-reviewed journals for HIV-related research with potential clinical implications. Our slate of study summaries this week includes newly published findings that suggest:

  • Guidelines for cholesterol management appear to underestimate the potential value of statin use among people with HIV.
  • In the Affordable Care Act era, viral suppression is usually maintained when people transition from Ryan White CARE Act coverage to Medicaid or Obamacare plans.
  • Hepatitis C seroconversion appears to suppress CD4 count for a couple of years in people living with HIV.
  • Hepatitis C reinfection is more common among HIV-positive men who have sex with men than among HIV-positive people who inject drugs.

Let's examine each of these findings in a little more detail. 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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Cholesterol Guidelines Fall Short for People Living With HIV

Among people with a high risk of cardiovascular disease, established sets of guidelines for cholesterol management appear to recommend statins for HIV-positive people much less often than for HIV-negative people, researchers reported in Open Forum Infectious Diseases.

The study utilized data on 1,394 people living with HIV, 71 of whom had a CVD event, and 6,141 matched controls (among whom there were 197 CVD events). The more recent American College of Cardiology/American Heart Association (ACA/AHA) guidelines recommended statins for more people living with HIV who went on to have a CVD event (59%) than did the older National Cholesterol Education Program Adult Treatment Program III (ATPIII) guidelines (35%). The corresponding figures for HIV-negative controls were 72% and 43%, respectively.

Despite the higher statin recommendation rates seen with the ACA/AHA guidelines, the researchers found that many high-risk patients were missed: Data indicated that 40% of HIV-positive patients (compared to 29% of HIV-negative controls) who went on to experience a CVD event would not have met ACT/AHA guideline criteria. Further, a tendency to underprescribe statins was also observed in the study: Statins were prescribed to 22% of participants living with HIV who met guideline criteria, compared to 34% of controls.

Results show that even recently updated cholesterol guidelines do not adequately take into account the unique CVD risk factors associated with HIV, study authors said. "Our findings underscore an urgent need for ongoing research on CVD risk stratification and prevention strategies in HIV," they concluded.

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Viral Suppression Unharmed by Transition From Ryan White to ACA

Moving from Ryan White HIV/AIDS Program-funded health care to Medicaid or private health insurance after implementation of the Affordable Care Act in 2014 barely affected viral suppression rates, researchers reported in Clinical Infectious Diseases.

The authors used data from four clinical sites in the U.S., two of which were located in states that chose to expand Medicaid. The vast majority of the study's 1,942 participants lived in non-expansion states, where only 15% moved to Medicaid and 7% to private insurance (compared to 55% and 15%, respectively, in expansion states).

In 2013, the study found that 74% of those who remained uninsured after ACA implementation were consistently virally suppressed. That rate rose to 75% in 2015. The corresponding figures for participants who moved to Medicaid were 64% in 2013 and 67% in 2015. Among those who transitioned to private insurance, 83% were virally suppressed in 2013 and 79% in 2015.

Participants who enrolled in health insurance may have continued to receive Ryan White-funded assistance with copayments and other issues, study authors noted. "The comprehensive system of HIV care and treatment the [Ryan White program] provides to uncovered [people living with HIV] is effective support for maintaining viral suppression," they concluded.

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CD4 Count Temporarily Drops After HCV Seroconversion

CD4 cell counts temporarily drop in men living with HIV after they acquire hepatitis C (HCV), even when they are on antiretroviral treatment, a study published in AIDS found.

Researchers matched 361 men who have sex with men and who were co-infected with HIV and HCV -- 147 of whom were taking antiretrovirals -- with 9,338 matched controls who live with HIV only (3,954 on treatment). For the first two to three years after HCV seroconversion, CD4 cell counts were lower in coinfected participants than in the controls. These counts rebounded at later time points.

Among those on antiretrovirals, HIV viral load trajectories were similar irrespective of HCV status, but these trajectories differed between treatment-naive coinfected participants and controls. Time between HIV acquisition and HCV infection did not affect viral load or CD4 count curves.

Health care providers should consider testing for HCV if CD4 cell counts drop while their patient is on antiretroviral therapy, study authors recommended.

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HCV Reinfection Rates May Be Higher Among MSM Than Drug Users

Among participants living with HIV, hepatitis C (HCV) reinfection rates were significantly higher among men who have sex with men than among people who inject drugs, a study published in AIDS showed.

Data came from health care centers in Madrid, Spain. All 2,359 participants were coinfected with HIV and HCV, treated with direct-acting antiviral drugs and had shown a sustained viral response to HCV therapy 12 weeks after the end of treatment. Of the participants, 62% identified injection drug use as the likely mode of HIV acquisition, 7% identified male-to-male sex, and 31% reported different or unknown routes of HIV acquisition.

Overall, 0.72% of participants tested positive for HCV a median of 14.86 weeks after being cured of their prior hepatitis C infection. The HCV reinfection rate was 7% among MSM and 0.34% among injection drug users. All 12 MSM who were re-infected reported engaging in anal intercourse with multiple partners and other sexual practices that carry a high risk for hepatitis C seroconversion.

Study authors called for a focus on that high-risk group: targeted HCV screenings after cure, rapid treatment of any subsequent HCV infection, and harm reduction interventions to address risky behaviors.