This Week in HIV Research: Matters of the Heart

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The global HIV research community has spent a ton of time, effort, and cash over the years to address a central concern: To what extent does a person's HIV status affect their long-term risk for heart disease, and how do other factors come into play? We've already seen the results of several major studies on this topic -- and this week, our lead story is about a massive meta-analysis that pulls them together.

But that's just one of the intriguing explorations of recently published research we've got on tap this week. Our four picks cover:

  • Myocardial infarction risk among people with HIV.
  • Dolutegravir vs. efavirenz : Brazil edition.
  • A new tool to estimate the time interval in which a person acquired HIV.
  • An "HIV Index" that may help identify people at imminent risk for disengagement from care.

Let's take a closer look at this new research. To beat HIV, you have to follow the science!

Microscopic image of heart tissue 72 hours after acute myocardial infarction.

Heart Attack Risk Doubled for People With HIV

People living with HIV have twice the risk of acute myocardial infarction than their HIV-negative counterparts, a meta-analysis of 16 studies published in Journal of Acquired Immune Deficiency Syndrome found. The vast meta-analysis includes data on more than 1.6 million individuals who were followed for a median of six and a half years.

Modifiable risk factors, such as hypertension, smoking, and dyslipidemia, significantly contributed to this result. Greater prevalence of hypertension was associated with a 20% higher risk of infarction, and higher hyperlipidemia and smoking rates were each related to a 9% greater risk.

Comparing groups living with HIV with matched groups not living with the virus still yielded excess myocardial infarction risk among the seroconverters. Thus, HIV-related factors, including antiretroviral therapy, may also play a role in the greater burden of heart disease among those living with the virus, the authors wrote.

Study authors recommended aggressive management of traditional heart disease risk factors in people living with HIV, warning: "Unless [cardiovascular disease] risk is effectively managed in the HIV population, the gains in life expectancy conferred by antiretroviral therapies may be lost."

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12-Month Viral Suppression Rates Better on Dolutegravir Than Efavirenz

In antiretroviral therapy-naive Brazilians, tenofovir/lamivudine/dolutegravir resulted in higher rates of viral suppression after a year than did tenofovir/lamivudine/efavirenz, a large retrospective cohort study published in AIDS showed.

Data on 107,647 people who initiated HIV treatment between 2014-2017 within Brazil's national health care system were analyzed. Seventy-two percent started on the efavirenz-based regimen, 11% began with dolutegravir, and the remainder initiated various other regimens. (The study noted that women more frequently took protease inhibitor-based regimens than men; the study period overlapped with a block of time during which such treatment was recommended for pregnant women.)

In 2017, Brazil began to recommend dolutegravir as preferred first-line therapy. Results of this study confirm that decision, study authors concluded. After 12 months on antiretroviral therapy, 91% of participants in the dolutegravir group were virally suppressed, compared to 84% in the efavirenz group, and fewer than 80% of those on protease inhibitor treatment. This difference persisted after adjusting for adherence based on pharmacy refill data.

The study did not include people treated in the private health care system, nor did it account for the underlying reasons why people were prescribed specific regimens.

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New Method More Accurately Estimates Time Since Seroconversion

Compared to more common methods, a "two-step" model can more accurately estimate the window of time within which an HIV-positive person seroconverted, researchers reported in AIDS. Knowing the likely interval during which a person acquired HIV may be helpful for efforts such as determining which of their partners to notify.

Data was used from 31 people in a repeat blood donor program who seroconverted and whose plasma had been previously tested. Methods for estimating seroconversion were:

  • Fiebig stages.
  • Fourth gen testing.
  • A viral ramp-up model.
  • A detailed clinical testing history.

The latter two methods, which are relatively new, both individually and in combination (i.e., the "two-step" method), were found to be more accurate than the former two methods, which are common but older.

Based on the results of the study, authors developed an online tool to facilitate calculation of a person's seroconversion interval.  However, "[p]erformance differences favoring the new methods were generally small but statistically significant," they cautioned. "Whether or not such differences are meaningful in practice will depend on the clinical or research question being asked."

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"HIV Index" May Help Curb Disengagement From Care

A new tool could help clinicians to measure disengagement from care before HIV treatment adherence suffers, researchers reported in Journal of Acquired Immune Deficiency Syndrome.

The researchers developed their "HIV Index" with patient and provider input. It is self-administered and returns a single value based on 10 survey questions. Higher index scores indicate better engagement in care. The 10 items ask about patients' relationships with their provider, their impression of the clinic, perception of their role in their care, and their follow-through and medication refill habits.

The index was validated with 3,296 patients of HIV clinics at research universities. However, the study population differed in some respects from those at greatest risk of dropping out of care, study authors noted: It was more urban, only included people with at least 12 months of clinic attendance, and excluded those who appeared intoxicated at their appointment or were acutely ill at the time. Furthermore, adherence data relied on self-reporting.

Study authors consider their HIV Index to be only a first step, and wrote that they plan to evaluate it with people disproportionately impacted by HIV or those with comorbidities.