This Week in HIV Research: How Antiretrovirals May Affect Birth

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With each edition of our Week in HIV Research series, we aim to briefly shine a spotlight on studies with potential clinical importance that may nonetheless fall by the wayside amidst the constant stream of published and presented research on HIV. This week is no different, as we turn our eye toward noteworthy recent findings focusing in particular on women and people who inject drugs. On the docket this time:

  • One of the most detailed explorations yet around the effect of HIV treatment on preterm delivery or low-birthweight babies.
  • A microcosm of the obstacles faced by providers seeking to increase pre-exposure prophylaxis (PrEP) usage among U.S. women.
  • A highly successful, and relatively simple, set of interventions changing the lives of HIV-positive people who inject drugs.
  • Supplemental data adding to our understanding of chronic kidney disease among people taking "old" tenofovir.

Let's take a closer look at each of these findings, shall we? 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.


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Some Antiretroviral Regimens Associated With Preterm Birth or Low Birthweight

Although antiretroviral therapy as a whole is safe for pregnant women, specific regimens are associated with more frequent occurrences of premature or low-birthweight babies, a meta-analysis of 13 studies published in Journal of Acquired Immune Deficiency Syndrome found. Specifically, lopinavir plus zidovudine and lamivudine was associated with pre-term births, and several regimens were associated with low birth weight -- although efavirenz plus tenofovir disoproxil fumarate/emtricitabine appeared to protect against it.

All 13 studies examined in the meta-analysis involved women in low- and middle-income countries. However, study authors cautioned that most studies were conducted when HIV treatment was only begun at lower CD4 cell counts (<350 cells/μL), suggesting that those on treatment already had more severe HIV disease, which may have influenced the rate of adverse birth outcomes in that group.

The challenge is to find a treatment regimen that simultaneously protects against mother-to-child transmission of the virus, promotes the mother's health, and protects against low birthweight or premature delivery of the infant, researchers stated. The insights in this analysis might help define such regimens, they concluded.


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PrEP Stigma High, Awareness Low Among Connecticut Women

Fewer than a quarter (23%) of women attending Planned Parenthood clinics in Connecticut were aware of pre-exposure prophylaxis (PrEP) five years after the approval of this HIV prevention method in the U.S., a study published in Journal of Acquired Immune Deficiency Syndrome showed.

Prior to the study, the state had launched PrEP awareness campaigns, including some targeted at women. PrEP stigma was as prevalent among women who had previously known about biomedical HIV prevention as it was among those who were newly introduced to this prevention method. Participants who believed stereotypes about those using PrEP or thought others would disapprove if they took PrEP also felt less comfortable discussing this prevention method with their health care provider than women who did not believe in these stigmas.

Study authors suggested that PrEP messaging must not only provide information, but also counter stigma. One way to do this, they noted, is to incorporate discussion about PrEP into routine health care. To that end, providers need to be trained on handling sexual health conversations with their patients, they added.


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Programs Lower Mortality, Increased Antiretroviral Use in People Who Inject Drugs

Psychosocial counseling and support navigating the health care system halved mortality (53% reduction) and almost doubled antiretroviral treatment) uptake among people who inject drugs (PWID) and live with HIV, a study published in The Lancet reported.

The trial was conducted among 502 PWID who live with HIV and 806 of their injection partners in Indonesia, Ukraine and Vietnam -- all countries where injection drug use is driving the HIV epidemic, according to a U.S. National Institutes of Health press release. Participants were randomized 1:3 to the intervention or the respective country's standard of care.

After one year, seven injection partners in the comparator arm had acquired HIV, but none had in the intervention group. This low incidence rate makes a future randomized controlled trial infeasible, study authors said. However, because of the intervention's effect on mortality, antiretroviral use and viral suppression (probability ratio 1.7 in favor of intervention), all study participants were offered counseling and navigation support during a second year of follow-up, the press release noted.


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Development of Chronic Kidney Disease Independent of TDF Exposure

Development of chronic kidney disease (CKD) was associated with older age and lower kidney function at baseline, but not with exposure to tenofovir disoproxil fumarate (TDF) in an Australian retrospective cohort study published in AIDS.

Estimated glomerular filtration rates (eGFRs) over time of 748 people living with HIV who attended a Melbourne clinic were analyzed. Participants were mostly middle-aged (median age 46 years), treatment-experienced (92.6%), and male (90.9%).

Over the course of six years, new CKD developed in 5% of participants. Those with low baseline eGFR rates were more likely to develop CKD, even in the absence of proteinuria. However, relatively few people had urinalysis data, study authors cautioned.

Based on the finding that TDF exposure (63.2% of participants for a median of 2.6 years) did not change the CKD risk, using tenofovir alafenamide instead of TDF likely will not stop those with borderline eGFR results from progressing to CKD, authors noted. They advocated for using the D:A:D and Scherzer risk scores to help clinicians identify patients at greater risk of CKD.