This Week in HIV Research: Matters of the Mind

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Welcome to this week's examination of recently published research of relevance to HIV care and services. Our selection of intriguing studies this time around brings us incremental, but important, new insights into:

  • The role of anticholinergics in cognitive performance among women with HIV.
  • The effect of physical activity on cognitive decline in women vs. men.
  • The potential benefits of tapping into peer networks to distribute HIV self-tests.
  • The harsh realities regarding what HIV care providers know -- or don't know -- about the Affordable Care Act.

Read further for additional data points regarding 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.com and TheBodyPRO.com. Follow Myles on Twitter: @MylesatTheBody.


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Anticholinergic Drugs May Add to HIV's Cognitive Burden

Women living with HIV may be at greater risk of cognitive problems when they take anticholinergic medications, a cross-sectional study published in Journal of Acquired Immune Deficiency Syndrome found.

Researchers examined the effects of certain non-antiretroviral medications known to cause neurocognitive problems -- anticholinergics (which affect muscle movement), opiates, and anticonvulsants and anxiolytics (anti-anxiety drugs) -- on 1,558 women, 1,037 of whom are living with HIV. Participants living with HIV were found to take more such medications on average than the control group.

Cognitive performance did not differ by serostatus across the board. However, women living with HIV (WLHIV) who took anticholinergics had more difficulty with the cognitive tests than did women who are not living with the virus. Researchers attributed this finding to these medications' side effects compounding HIV's neurotoxic effects.

While some of the other non-antiretroviral drugs investigated also affected WLHIV more than the control group, these differences disappeared when uncontrolled HIV was taken into account.

Providers should consider these findings before prescribing anticholinergic drugs to women living with HIV, study authors concluded.


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Physical Activity Protects Against Cognitive Decline in Women, but Not in Men

In older people living with HIV, physical activity protected against cognitive impairment in women, but not in men, a cross-sectional analysis published in The Journal of Infectious Diseases showed.

Data on 195 women and 793 men participating in the ACTG A5322 study were analyzed. The mean age was 52, and participants' HIV was well controlled. On average, women had a higher body mass index and greater total cholesterol than men.

Women who were physically active (43% of women) were less likely to suffer cognitive decline than those who were more sedentary. The same did not hold true for men (55% of whom were physically active). Similarly, higher levels of high-density lipoprotein cholesterol appeared to protect women, but not men, from cognitive decline.

There are several plausible biological explanations for these findings, study authors noted. However, due to the study's design, no causal connections can be drawn, they cautioned. Authors called for further studies about the effect of interventions to promote greater physical activity on cognitive impairment among women living with HIV.


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Peer Distribution of HIV Test Kits More Successful Than County Program

Distributing HIV self-testing kits through a peer network to men of color who have sex with men yielded higher testing and diagnosis rates than a targeted county-based HIV testing program, a small study published in Journal of Acquired Immune Deficiency Syndrome found. The study took place in Alameda County, California.

All of the peer recruiters who attempted to distribute self-test kits were men who have sex with men (MSM) or transwomen. There was some initial resistance to testing due to participants' privacy concerns, as well as from transwomen and MSM who identified as heterosexual, but these obstacles were mostly overcome, the researchers stated. Peers living with HIV were more successful than peers not living with the virus at recruiting MSM who ended up testing positive.

Seven of the 114 people who self-tested (6.14%) during the study were seropositive, compared to 18 of 1,205 (1.49%) in the county program. Among the 69% of people who self-tested and also completed a questionnaire provided by the peer recruiter, sexual activities that risk seroconversion were found to be less common than among people who received testing in the county program.

This result may reflect multiple responses from frequent testers in the county program, study authors reasoned. Using peer networks to distribute HIV self-test kits is a promising strategy for reaching and diagnosing African-American and Latino MSM, they concluded.


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Many U.S. HIV Providers Lack Understanding of Local Health Coverage

Almost 40% of 253 HIV medical providers did not correctly answer four basic questions about the Affordable Care Act (ACA), a survey published in Clinical Infectious Diseases showed.

Researchers had distributed 1,203 surveys, 21% of which were returned. Among respondents, 73% knew whether they were practicing in a state that had expanded Medicaid. Those in Medicaid-expansion states more strongly agreed with the proposition that ACA would improve their patients' HIV outcomes than did those in non-expansion states (3.78 versus 3.37 on a 1-5 scale, from "strongly disagree" to "strongly agree").

HIV care providers in states that did not expand Medicaid were more likely to provide correct answers on the ACA than those in states that did expand Medicaid (adjusted odds ratio 2.07). Study authors hypothesized that HIV care providers in non-expansion states may have read up more on the law because they continued to care for uninsured or underinsured patients, whereas states that expanded Medicaid were more likely to see an influx of HIV-positive patients into primary care providers rather than HIV care providers.

The authors warned that health policy has changed since the survey was conducted, potentially affecting the relevance of the data. Nonetheless, they advocated for improving providers' knowledge of these issues through interaction with HIV case managers, a corresponding module in the National HIV Curriculum, or training via the Ryan White HIV/AIDS Program.