This Week in HIV Research: How Discrimination Feeds Cigarette Use
This week, our perusal of recently published HIV-related research reveals new, intriguing developments in these areas:
- A potential link among people living with HIV between tobacco use and feeling targeted by discrimination.
- The use of naltrexone to enhance viral suppression among HIV-positive people who are released from prison.
- The risks of asymptomatic myocardial impairment during acute HIV infection.
- The relationship between HIV viral suppression and the efficacy of the yellow fever vaccine.
Read on for the salient details. 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.
Tobacco Use May Be Related to HIV-Related Discrimination
People living with HIV (PLWH) may use tobacco to cope with discrimination related to their serostatus, a study published in Journal of Acquired Immune Deficiency Syndrome showed.
In the U.S., PLWH smoke at almost double the rate of the general population, but are much less likely to quit the habit, according to a recent study. Researchers assessed 202 PLWH in Birmingham, Alabama, for experiences of discrimination and avoidance coping mechanisms, and correlated that data with participants' self-reported tobacco use.
In the study, tobacco use was significantly associated with experiences of HIV-related prejudice, but not with other forms of discrimination. However, study authors cautioned that various forms of discrimination, such as those experienced by a sexual minority person of color living with HIV, may not be easily separated. They called for further study, but also recommended that smoking cessation interventions consider the coping aspect of this behavior, which may not be susceptible to pharmacological approaches.
Naltrexone Helps Ex-Inmates Recently Released Keep HIV Viral Load Down
In a clinical trial examining opioid-use disorder among PLWH, extended-release naltrexone (XR-NTX) was associated with significantly higher rates of viral suppression six months after release from a correctional facility.
Ninety-three participants leaving Connecticut prisons or jails were randomized 2:1 to receive monthly XR-NTX or placebo injections starting just before they returned to their communities and continuing for six months thereafter. The study findings were published in the Journal of Acquired Immune Deficiency Syndrome.
The proportion of participants with HIV viral loads < 50 copies/mL rose in the naltrexone arm from 37.9% at release to 60.6% half a year later but dropped from 55.6% to 40.7% in the placebo group during the same period. Even though 83.5% also lived with hepatitis C, there were no serious hepatic events.
These findings inform guidelines on treating people who are transitioning from the correctional system, study authors concluded, adding: "When XR-NTX is initiated just before release and maintained thereafter, it results in both improved individual and public health benefits."
Acute HIV Associated With Asymptomatic Myocardial Impairment
Acute HIV infection may cause myocardial impairment without cardiac symptoms, a small study published in The Journal of Infectious Diseases showed. The viral replication and inflammation caused by acute HIV lead to inflammatory cardiomyopathy, which is reversible, but the resulting myocardial damage may not be, the study authors warn.
Researchers used a specific peptide, NT-proBNP, and protein, troponin T, as markers of myocardial function and damage, respectively. They enrolled 49 people with acute HIV at a hospital in Vienna, Austria, in the study. At baseline, NT-proBNP levels were elevated in 32.7% of participants, and troponin T levels in 22.4%. Both biomarkers dropped significantly after participants' viral loads had been suppressed on antiretroviral therapy.
However, it is unclear whether the damage to the heart muscle tissue indicated by the initially high troponin T levels is permanent. In the general population, elevated troponin T is associated with higher rates of cardiac events. To what extent this also applies to PLWH needs to be investigated, said the researchers, who also called for further studies on this topic.
Yellow Fever Vaccination Protects Better When HIV Is Suppressed
In PLWH, long-term protection rates after a yellow fever vaccination depend on whether their HIV was suppressed when the vaccine was administered, a study published in Clinical Infectious Diseases found.
The yellow-fever vaccine uses live virus, and the effectiveness of the vaccine depends on the body's ability to generate viral antibodies. Blood samples from 247 study participants were included in the study, and those samples from people whose viral load was suppressed when they were vaccinated had sufficient levels of yellow fever antibodies 10 years later, similar to the general population. However, when participants with detectable viral loads at the time of vaccination were included in the analysis, only 75% had sufficient antibodies.
The Centers for Disease Control and Protection advises against yellow fever vaccination for PLWH with symptomatic HIV, but the shot is required for entry into some countries. Study authors recommended that PLWH receive a booster shot 10 years after initial vaccination, and that people who were vaccinated while their HIV was still replicating receive that booster shot as soon as their HIV is suppressed.