This Week in HIV Research: HIV Is Not an Obstacle

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Hardly a week goes by without a new study highlighting the extent to which HIV status has been rendered inconsequential thanks to the success of modern antiretroviral therapy. We review a couple of such studies in this week's tour of recently published HIV-related research -- as well as a study that reminds us of the extent to which stigma remains supremely prevalent in our society despite those scientific successes.

On tap this week:

  • The effect -- or lack thereof -- of acute syphilis on virologic control.
  • The value -- or lack thereof -- of switching off efavirenz (Sustiva, Stocrin, component of Atripla) to improve neuropsychological performance.
  • The relationship -- or lack thereof -- between structural LGBTQ stigma and HIV criminalization in individual U.S. states.
  • The safety -- period -- of lung cancer resection surgery in people with HIV.

Come along as we peer more closely at 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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Acute Syphilis Doesn't Impair Successful Antiretroviral Therapy Among MSM

Acute syphilis is not associated with an increased risk of virologic failure among HIV-positive men who have sex with men (MSM), a Canadian study published in AIDS showed. The findings support the use of antiretroviral therapy during acute syphilis infection.

The study's 2,632 participants had been virally suppressed (VL < 50 copies/mL) on antiretroviral therapy for at least six months at baseline. Overall, viral failure incidence was 3.5 per 100 person-years. The unadjusted rate ratio of viral failure to acute syphilis was 1.5; that fell to 1.2 when adjusted for age, education, region, income, and drug use.

The researchers also explored the potential effect of substance use on the study findings. Despite the lack of a relationship between acute syphilis and virologic failure, the authors noted that data did appear to indicate that such drug use may be a positive confounder. In the study, drug use accounted for 25% of the effect of syphilis on viral failure (defined as a viral load spike of ≥ 1,000 copies/mL or a viral load of ≥ 200 copies/mL for a month).

Study authors cautioned that only men attending HIV clinics in Ontario province were included, and those recently diagnosed were underrepresented in the study population compared to all people living with HIV in the study location. They concluded that antiretroviral therapy may still reduce the risk of transmitting HIV sexually, even if the man has acute syphilis. Future studies should take drug use into account when reporting associations between syphilis and viral load, they recommended.

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Stopping Efavirenz Does Not Improve Neuropsychological Functioning or Depression

Efavirenz has been associated with neuropsychological side effects, such as abnormal dreams, insomnia, and impaired concentration. Yet discontinuing the drug does not appear to improve neuropsychological performance or depression in men, a study published in AIDS showed.

Researchers compared data on 1,989 men who have sex with men, 314 of whom had taken efavirenz for a median of 2.87 years at baseline. Participants were followed for a median of three years. During the study period, 270 men switched off efavirenz, while 44 remained on the drug.

Trends in performance on neurocognitive tests or depression scores did not differ significantly over time among the three groups: never on efavirenz, switched off it, still on it. While various cognitive domains such as attention, memory, and learning were included in the study, no data on sleep quality were available, nor were efavirenz plasma levels.

"Our study indicates that it may not be absolutely necessary to switch EFV-based regimen [sic] to other regimens due to neuropsychological concerns, especially in people with mild or no baseline neuropsychological symptoms," study authors concluded.

Mixed Early Findings on Structural LGBTQ Stigma and HIV Criminalization in U.S. States

The amount of structural stigma that exists against sexual and gender minorities within a given U.S. state is related to greater enforcement of HIV criminalization laws within that state, a data analysis published in AIDS found.

Researchers compared state-level measures of stigma, the existence and severity (i.e., felony) of HIV criminalization laws, and arrests based on such laws in the U.S. Stigma was calculated using proportions of same-sex households and gay-straight alliances in high schools, as well as laws and statutes about sexual orientation (e.g., workplace nondiscrimination and legal adoption by same-sex couples).

States with high levels of structural stigma had higher rates of arrests based on HIV criminalization laws. However, the researchers also found that such states were no more (or less) likely to have HIV criminalization laws in the first place than states with low levels of stigma.

Researchers noted that their results are preliminary data to generate hypotheses that need to be further explored. Future studies should focus on temporal relationships between enforcement, stigma and HIV incidence through individual-level data, they recommended.

Lung Cancer Resection Surgery Safe in People Living With HIV

HIV status is not related to outcomes after surgical resection for early-stage lung cancer, a study published in AIDS found.

Back in 1997-2002, post-surgery complications were more common in people with low CD4 cell counts than in those not living with the virus. With the widespread use of effective HIV treatment, surgery outcomes, including survival, are now on a par between people living with and without HIV. The current study supports that trend.

Researchers analyzed data on 8,371 people, 137 of whom were living with HIV, who underwent lung cancer surgery between 2000 and 2016 within the U.S. Veterans Affairs system, which provides health care for people who served in the U.S. military. No statistical difference was found between people living with HIV and HIV-negative people in terms of mortality rate, risk of major complications, or risk of common complications. Study authors did note, however, that people living with HIV in the study tended to be younger, were more likely to be people of color, and were less likely to have chronic obstructive pulmonary disease.

In a 2018 interview, the study's lead author, Keith M. Sigel, M.D., Ph.D., M.P.H., encouraged health care providers to refer their patients for lung surgery: "Make that referral -- don't let the HIV stand in your way."