This Week in HIV Research: Heavier Health Burdens Begin Before Diagnosis
In our perusal of the HIV journal universe this week, another slate of four studies piqued our interest. This eclectic collection offered new data to suggest:
- People who are eventually diagnosed with HIV are more likely to have developed a non-AIDS comorbidity prior to their diagnosis than people who remain HIV negative.
- Even when a country offers universal health care, socioeconomic status can impair access to HIV treatment.
- The benefits of food supplementation may be uncertain in Africans with advanced HIV disease.
- Universal hepatitis C treatment access has yielded excellent results in the Netherlands -- but with enough caveats that there's concern about long-term success and broader viability of the approach.
Come read through some of the details with us. 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.com and TheBodyPRO.com. Follow Myles on Twitter: @MylesatTheBody.
Even Before Diagnosis, Non-AIDS Comorbidities Are More Common in People With HIV
People living with HIV (PLWH) had higher rates of non-AIDS comorbidities before being diagnosed with the virus than the general population, a Danish study published in Clinical Infectious Diseases found.
Researchers matched 2,322 PLWH with five general-population controls each, for a total of 14,028 participants for whom up to 20 years of health data were analyzed. People who inject drugs were excluded from the study.
Ten years before HIV diagnosis, comorbidity prevalence was 5.5% in PLWH compared to 4.8% in the control group. Liver disease, in particular, was more common among those subsequently diagnosed with HIV, at an odds ratio of 1.94 compared to controls.
In the PLWH group, the rate of comorbidities increased around the time of HIV diagnosis. Study authors reasoned that this may be due to people being diagnosed with a comorbidity when they were tested for HIV or, conversely, having an HIV test when they sought care for the comorbidity.
Overall, the study authors suggested that higher rates of cigarette smoking and alcohol use among PLWH prior to HIV diagnosis are likely to blame for these findings, and recommended that interventions start at HIV diagnosis.
Lack of Paid Employment Associated With Delay in Starting Antiretrovirals, Despite Universal Health Care
Even with universal health care, people who are unemployed or on social assistance are less likely to start antiretroviral therapy early than those who are gainfully employed, a Canadian study published in Journal of the International AIDS Society showed.
For this study, early treatment was defined as starting antiretrovirals within six months of being diagnosed with primary HIV. The study cohort consisted of 348 people diagnosed with HIV within 180 days of seroconversion at five community and university medical centers in Montreal between 1996 and 2015.
Those with paid employment were 2.43 times more likely to begin treatment early than people without such employment. Other factors increasing the likelihood of early treatment were lower CD4 counts and being treated at a university clinic compared to a community clinic.
"This paper shows we need to take socio-economic factors into consideration when it comes to better controlling the HIV epidemic in Canada," concluded Jean-Pierre Routy, M.D., the paper's lead author, according to an associated press release.
Debate Over Food Supplementation for People With Advanced HIV
Lipid-based nutritional supplements do not reduce mortality or increase CD4 count in severely immunocompromised people in sub-Saharan Africa, a clinical trial published in The Lancet found.
In the study, 1,805 people starting antiretroviral therapy at CD4 cell counts below 100 cells/μL were randomized to receive peanut-based ready-to-use supplements or no additional food. Severely malnourished participants in either group were given ready-to-use therapeutic supplements. After 24 weeks, mortality rates did not differ between the two arms (10.9% in the supplement group, 10.3% in the control), nor did CD4 cell counts or rates of viral suppression. Over the 48-week study period, those in the supplement arm gained significantly more weight and body mass than the control arm, but that gain was not sustained thereafter.
As a result of the findings, the study authors elected not to recommend nutritional supplements for everyone with advanced HIV. However, a related commentary argued that even though supplements do not appear to lower mortality or raise CD4 counts, they still might raise lean body mass and thus increase work capacity and improve quality of life. The commentary's authors recommended nutritional supplementation for those starting antiretrovirals, but also called for additional research to determine the best timing of such extra food.
Unrestricted HCV Treatment Yields High Uptake, Large Decline in HCV Incidence
In late 2015, the Netherlands began to provide direct-acting antiretrovirals, the newest class of medications for hepatitis C (HCV), free of charge to everyone with HCV. Fifteen months later, 76% of HCV infections among people living with HIV (PLWH) had been cured, a study published in Clinical Infectious Diseases showed. However, those cured are still at risk of reinfection, and not everyone infected with HCV has been so diagnosed, study authors cautioned.
Between 2014 and 2016 -- bracketing that DAA introduction -- HCV incidence declined by 51%, another study found. However, the initial drop did not continue into 2017, partly due to reinfections from surrounding countries with more restrictive policies on DAA treatment, the authors of that study noted.
"Behavioral interventions and additional strategies for tackling the high reinfection rate, however, need to be developed," Jürgen Kurt Rockstroh, M.D., concluded in a related commentary. He expressed hope for a reduction in DAA prices, which he believes will allow everyone to be treated with the new medications and thereby pave the way for eradicating HCV from specific patient groups.