This Week in HIV Research: Missed Opportunities to Close the Gap

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Our latest exploration of recently published HIV-related research turned up these clinically noteworthy new findings:

  • Emergency care clinicians in the U.S. may be inadvertently passing up key opportunities to prescribe PrEP to at-risk people.
  • Effective antiretroviral therapy appears to bring an additional long-term benefit: lower risk of cancer.
  • Many sexual health clinics could be doing more to identify people with HIV who are out of care and reconnect them.
  • A proof-of-concept trial suggests neurocognitive benefits of low-dose hydrocortisone therapy for women living with HIV.

Come along with us as we take a closer look at each of these intriguing studies. 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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Missed Opportunities for Prescribing PrEP in South Carolina

Emergency care may be a missed opportunity for identifying people who could benefit from pre-exposure prophylaxis (PrEP), a study published in Clinical Infectious Diseases found.

Data from South Carolina showed that 66% of 885 people diagnosed with HIV from 2013 through 2016 visited a health care facility a mean of 6.9 times before their diagnosis, and 28.5% of those with health care visits had been diagnosed with a sexually transmitted disease (STD). Sixty-one percent of these visits were handled by emergency care clinicians; just 10 percent were handled by primary care clinicians. While visit-level data on PrEP prescriptions was not available, few people in the state have filled such prescriptions.

"This strongly suggests that nearly all of the persons identified in this analysis, were not provided PrEP at health care visits prior to the date of their HIV diagnosis," study authors concluded. They noted that provider training on this biomedical HIV prevention method has focused on infectious disease and primary care physicians, but that emergency medicine providers also want to be trained. HIV testing should be offered at all health care visits and those testing negative should be screened for PrEP, especially when they have been diagnosed with a bacterial STD, study authors recommended.


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Long-Term Viral Suppression Reduces Cancer Risk

Cancer risk is significantly reduced among people living with HIV (PLWH) whose virus has been suppressed long-term but is still higher than in people not living with the virus, a large study published in Annals of Internal Medicine showed.

Researchers analyzed 16-year data on 147,153 US veterans (mostly men), 42,441 of whom are PLWH. Among PLWH, overall cancer incidence was lowest for participants whose HIV RNA level had remained below 500 copies/mL for more than two years (risk ratio [RR] 1.52), intermediate for those with suppressed viral loads for less than two years (RR 1.99), and highest among PLWH whose viral load was ≥ 500 copies/mL (RR 2.35), all compared to participants not living with HIV.

A similar development was observed for AIDS-defining cancers and to a lesser extent for non-AIDS-defining cancers that are caused by viruses, but the pattern did not hold for other cancers.

The relatively high viral load threshold was necessary because of less-sensitive HIV tests in the early years of the study period, researchers noted. They called for future research at lower thresholds and for longer periods of viral suppression.


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Sexual Health Clinic Visits Can More Effectively Provide Linkage to HIV Care

Visits to sexual health clinics are often a missed opportunity for linking PLWH to care, an analysis of New York City data published in Journal of Acquired Immune Deficiency Syndrome found.

Researchers matched clinic data on 1,649 PLWH and 1,195 people whose HIV status was unknown with information in the New York HIV Registry. Five percent of the unknown status sample was living with HIV, according to registry data, but had not disclosed this to the clinic. Sixty percent of that group was not in HIV care at the time of the clinic visit.

Study authors proposed a technological solution similar to the Louisiana Public Health Information Exchange to facilitate real-time information in order to link eligible patients to care before they leave the clinic. "To improve patient care, such innovative technology could be expanded beyond a focus on out-of-care patients and include HIV serostatus for all patients and current HIV care status for all those previously diagnosed with HIV," they added.


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Hydrocortisone May Enhance Cognitive Performance in Women Living With HIV

In women living with HIV (WLWH), a single low dose of hydrocortisone (LDH) appears to enhance cognitive performance even after cortisol levels return to normal, a small trial published in AIDS showed.

Thirty-six WLWH were randomized to LDH or placebo, and a month later were switched to the opposite treatment. At both visits, participants were tested on various cognitive measures 30 minutes and four hours, respectively, after receiving the study pill.

In participants who had received LDH, verbal learning and delayed memory were improved at both time points, while visuospatial abilities and behavioral inhibition were only enhanced at the 30-minute mark. A similar, separate study among men had found learning improvements only after 30 minutes.

Larger studies verifying these findings and their clinical significance in HIV are ongoing. The four-hour results suggest improvements are maintained beyond the time during which cortisol levels are elevated, study authors said.

The researchers also noted that study participants reported above-average levels of stress and trauma. The benefits of LDH -- which has also been studied in people with post-traumatic stress disorder -- may be related to these psychological characteristics, rather than HIV, the researchers explained.