This Week in HIV Research: Fentanyl Smooths the Path for HIV

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We've got an effervescent potpourri of HIV-related research findings to share with you this week! In our latest review of newly published science of potential clinical note, we:

  • Learn more about what's driving the ongoing HIV outbreak in northeastern Massachusetts. (Hint: It rhymes with "sentinel." Also it's in the headline.)
  • Gain insight into significant race-gender disparities in HIV prevalence among sex workers in Baltimore.
  • Get a stark reminder of just how far we have to go -- but also how much potential there is -- in improving pre-exposure prophylaxis (PrEP) awareness and access among black women in the southern U.S.
  • Find out about the promise of a naltrexone implant as a possible replacement for oral drugs in the management of opioid dependence.

Let's sniff out some details from each of these interesting reports. 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.

Opioid Use Closely Associated With HIV Outbreak in Massachusetts

Newly published data offer insight into some of the underlying drivers of a recent surge in HIV diagnoses in northeastern Massachusetts -- and a rapidly increasing number of opioid overdose deaths in the same span.

Reporting in Morbidity and Mortality Weekly Report, researchers traced seroconversions among 129 people who acquired HIV between 2015 and 2018 and either lived in or were linked to Lawrence and Lowell, two towns in northeast Massachusetts. Eighty-eight percent of those surveyed reported injection drug use, and 60% of seroconversions occurred in two of the four clusters that had five or more HIV acquisitions each.

Interviews with 34 participants revealed that fentanyl had replaced heroin in this marketplace, resulting in more frequent injections and possibly increasing HIV transmissions, study authors hypothesized. Respondents also noted that homelessness and incarceration impaired HIV treatment adherence, and said that the limited opening hours of syringe service programs in the two communities were a challenge.

Additional public health staff has been sent to the area and is providing partner notification and linkage to care, while partner organizations are providing services to address the instability resulting from homelessness and incarceration in an attempt to improve treatment adherence, the report noted.

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HIV Prevalence Much Higher Among Transwomen Than Ciswomen Sex Workers in Baltimore

HIV prevalence was eight times higher among trans- compared to cisgender female sex workers in a Baltimore study published in Journal of Acquired Immune Deficiency Syndrome.

Structural vulnerabilities, including experiences of childhood abuse and client violence, were common among all 324 women, 62 of whom were transgender. However, there were racial disparities among this sample of street-based sex workers: 66% of cis women where white compared to none of the trans women, while 76% of trans women were African American compared to 23% of cis women. Latinas accounted for 11% and 24% of cis- and transgender participants, respectively.

"Given the different racial demographics by gender identity in this study, our findings could suggest how experiences of race and racism may intersect with transphobia to compound HIV risk beyond traditional risk factors," the study authors wrote.

Other differences included injection drug use, which was more common among cis than trans women, and early entry into sex work, which was more common among trans than cis participants. Most trans participants knew their serostatus and those living with HIV were more likely to use condoms than HIV negative trans participants.

HIV testing and PrEP for trans women sex workers could decrease the levels of HIV in that community, study authors concluded.

Few African-American Women in the U.S. South Are Aware of PrEP

The good news: 88% of African-American women in the southern U.S. who were eligible for PrEP were willing to consider this HIV prevention method once it had been described to them, a study published in Journal of Acquired Immune Deficiency Syndrome found.

The bad news: Only 11% of the women said they had known about PrEP before entering the study.

Researchers analyzed data on 225 HIV-negative women, 32% of whom were eligible for PrEP. They applied criteria from the U.S. Centers for Disease Control and Prevention, but noted that these guidelines are based mainly on the characteristics of male partners, such as the partner having sex with men or living with HIV. (If men do not disclose these factors, women may not know that they are at risk for acquiring HIV.)

Study authors suggested that PrEP screening could become more accurate if providers also ask women about a their level of education, history of sexual violence, and whether she considers herself at risk of seroconversion. "Careful history-taking by providers and enhanced education targeted to women at most risk can expand HIV prevention opportunities for U.S. women," they concluded.

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Naltrexone Implant May Replace Methadone for Some People With HIV

In people living with HIV who are dependent on opioids, long-acting naltrexone implants were associated with lower viral loads compared to oral naltrexone, a small Russian study published in The Lancet showed.

Naltrexone is an opioid antagonist used to keep people from relapsing once they are opioid-free. The implant is only approved in Russia, where opioid agonists commonly used in the U.S., such as methadone, are prohibited. Two of the study authors are involved in efforts to bring the implant to the U.S.

Researchers randomized 200 people starting antiretroviral therapy and seeking addiction treatment in and around St. Petersburg, Russia, 1:1 to receive either a naltrexone implant and oral placebo or a placebo implant and oral naltrexone. All participants had baseline viral loads above 1,000 copies/mL. By week 48, 66 participants in the implant group and 50 in the oral group had viral loads below 400 copies/mL.

These viral suppression rates are similar to rates among people on agonist maintenance therapy, study authors noted. They proposed that naltrexone implants could become an alternative for those who cannot or do not want to access opioid agonist therapy.