This Week in HIV Research: How Should We Measure Success?

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As the leaves fall from the trees in much of the U.S., we've got some particularly juicy fruits to harvest in this week's collection of recently published HIV research. Here's what we've plucked for you this time around:

  • New York City health officials make the case for a new measurement of HIV treatment success: 90-day virologic control.
  • Pre-exposure prophylaxis (PrEP) has been strongly associated with a 25% drop in HIV incidence in one Australian state.
  • Data tie moderate exercise to significant health benefits among older people with HIV.
  • A study finds CD4 recovery occurs among roughly seven of 10 people with long-term viral suppression on antiretroviral therapy.

Let's take a closer look at each of these fresh picks. 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.

Speed of Viral Suppression Should Be Key Indicator, NYC HIV Officials Say

The U.S. National HIV/AIDS Strategy (NHAS) should include an additional metric, the percentage of people whose viral load drops below 200 copies/mL within three months of starting treatment, officials within the Division of Disease Control in the New York City Department of Health and Mental Hygiene proposed in The Journal of Infectious Diseases.

The officials, including New York City Deputy Commissioner for Disease Control Demetre C. Daskalakis, M.D., M.P.H., argue that such an outcome indicator would help health agencies and the U.S. Centers for Disease Control and Prevention monitor HIV care progress for those newly diagnosed. Data from New York City’s HIV surveillance registry, for example, shows that this measurement rose from 9% in 2007 to 37% in 2016, although progress was uneven among racial and ethnic groups.

The new indicator measures a health system’s effectiveness, Julia C. Dombrowski and Jared M. Baeten of the University of Washington, noted in a related commentary. While the status of NHAS -- and thus the utility of including a new metric --- is unclear under the current U.S. presidential administration, the proposed measurement could help drive improvements in the systems of care for the newly diagnosed, they argued.

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Sharp Drop in New HIV Diagnoses After Rapid PrEP Rollout

In New South Wales (NSW), Australia, new HIV diagnoses among men who have sex with men (MSM) declined by 25% after rapid rollout of free pre-exposure prophylaxis (PrEP), a study published in The Lancet showed.

Initially, researchers provided 3,700 participants at high risk of seroconversion with free daily oral tenofovir disoproxil fumarate/emtricitabine (Truvada). MSM continued to enroll, for a total of 7,621 participants by the end of follow-up (12 months after completion of initial enrollment) -- an estimated 19.6% of MSM not living with HIV in the state.

During the 12 months before study start, 295 MSM were diagnosed with HIV; in the 12 months after the study was initiated, that number was 221. Recent seroconversions among those diagnosed dropped by 31.5% overall. A 23.5% increase in recent HIV diagnoses among people born outside of high-income English-speaking countries or Asia was offset by greater declines among other groups (e.g., 48.7% among those born in Australia).

"Rollout should be prioritized as a crucial component of HIV prevention in epidemics predominantly affecting men who have sex with men," Andrew Grulich, M.B.B.S., M.Sc., Ph.D., of the University of New South Wales-Sydney concluded in a related press release.

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Exercise Greatly Improves Physical Functioning in Older Adults With HIV

Even moderate exercise greatly improves physical functioning among older people living with HIV (PLWH), a small study published in AIDS found.

Researchers enrolled 69 sedentary adults aged 50 years or more, 32 of whom were living with HIV. After 12 weeks of moderate-intensity workouts three times a week, participants were randomized to continue that regimen or switch to a high-intensity workout on the same schedule.

At baseline, physical functioning was significantly poorer among PLWH than among controls. Both exercise regimens improved physical measures, such as climbing stairs and walking 400 meters, more in the HIV arm than in the control arm. PLWH on the high-intensity regimen also gained significantly more strength than PLWH who exercised moderately, but no such difference was found among the controls.

Results show that PLWH can move to high-intensity workouts, study authors concluded. They also recommended that older PLWH perform moderate endurance exercises for 150 minutes/week, or half that long if they are training at high intensity, and regularly perform resistance exercises.

Most People Experience CD4 Recovery After Starting HIV Treatment

After six years of undetectable viral loads, CD4 cell counts were likely to recover in 69.7% of those who started antiretroviral therapy between 2006 and 2014, a French data analysis published in AIDS showed.

Researchers analyzed data on 6,050 people -- all of whom initiated HIV treatment with a CD4 count below 500 cells/mm3 -- using a competing-risk approach that separately considered viral loads returning above detectable levels, loss to follow-up, and death. Higher CD4 cell counts when starting antiretrovirals predicted a greater likelihood of CD4 levels returning to normal after virologic control.

Perhaps counterintuitively, higher baseline viral load was also associated with a better chance of a recovering CD4 cell count. Study authors explained that this was likely due to the body redistributing memory CD4 cells from lymphoid tissue after starting HIV treatment.

Results show the importance of early diagnosis and treatment initiation, when CD4 cell counts are still high, study authors concluded.