This Week in HIV Research: Mitigating an ICE-y Reception

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U.S. Immigration and Customs Enforcement (Public domain), via Wikimedia Commons

As the summer continues to heat up in much of the Northern Hemisphere, the fires of HIV research keep on burning. Here are a few stories we recently spotted heating up the journal scene:

  • The anti-immigration push that's grabbed so many headlines in the U.S. this year may have ramifications for Latinx people with HIV -- but health care providers can help improve the situation.
  • Even when plasma is devoid of HIV, a person’s rectal tissue may not be, a small study notes.
  • Hepatitis C (HCV) treatment initiation is a boon for HIV/HCV-coinfected patients regardless of their fibrosis stage, a Canadian study finds.
  • Human papillomavirus (HPV) vaccination significantly reduces HPV persistence among women living with HIV, research suggests.

As the old saying goes: If you can't stand the heat, keep on reading this article. And, of course, 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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Harsher Immigration Enforcement Poses Additional Risks to People Living With HIV

Clinicians can help mitigate some of the uncertainty experienced by immigrants to the U.S. during the current wave of deportations, the authors of a viewpoint article published in The Lancet HIV noted.

The group of 11 notable American clinicians, researchers, and advocates, described the challenges faced by Latinx people living with HIV who are facing involuntary removal from the U.S. These include fear of disclosing even to health care personnel, lack of treatment in detention facilities, and difficulty getting care or accessing medical records after deportation. Additional stressors, such as being separated from children and other family members, may take priority over HIV treatment, they warned.

The authors recommended that health care providers:

  • Create safe spaces to discuss immigration concerns.
  • Partner with legal organizations to address these concerns.
  • Establish ways for patients to communicate with their US clinic, if they are deported.
  • Use AIDS Education and Training Center resources to facilitate linkage to care.
  • Inform patients of their right to medical care while detained.
  • Discuss possible unintended consequences of disclosure.
  • Partner with human rights organizations to monitor HIV discrimination in detention facilities.

International systems for handling tuberculosis under such circumstances may provide a model for HIV, but must be carefully adapted to avoid unintended consequences, given the stigma attached to HIV, they wrote.


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Rectal HIV RNA Sometimes Found in Virally Suppressed People

HIV RNA may persist in rectal tissue even after a person achieves viral suppression in plasma, a small study published in AIDS showed.

Viral loads in blood and rectal tissue were measured in 12 participants, six of whom are women, before they started antiretroviral therapy, and were measured again 2, 6 and 12 weeks into treatment. All volunteers started on a three-drug antiretroviral regimen that contained dolutegravir.

Every participant had an undetectable plasma viral load by week 6. However, only 27.3% (3 people) had an undetectable level of the virus in their rectum at any point during the study.

Baseline viral loads in both plasma and rectal tissue were lower in those who achieved rectal viral suppression than in the other participants. However, viral suppression in rectal tissue was independent of dolutegravir levels.

All three of the people with a suppressed rectal viral load in this study were women. This study was too small to determine why this might be so, but larger studies are planned that should elucidate potential sex differences in tissue viral load, study authors said.


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HCV Treatment Urged for Nearly All Coinfected People, Regardless of Fibrosis Stage

Successful hepatitis C (HCV) treatment with interferon-free therapy reduces proviral HIV DNA, as well as markers of immune activation and microbial translocation, a Spanish study published in The Journal of Infectious Diseases found. However, while HIV biomarkers improved, CD4 cell count and the ratio of CD4 to CD8 cells did not increase.

Researchers assessed various biomarkers in 97 HIV/HCV co-infected people before they started HCV treatment, then repeated the assessment three times: one month into therapy, immediately after the end of treatment, and one month later. CD4 count and CD4:CD8 ratio were additionally measured 6 months after HCV treatment initiation.

All participants maintained undetectable levels of HIV and achieved sustained virologic response to HCV.

At baseline, median CD4 cell count was 719 cells/μL. Study authors hypothesized that the paucity of participants with very low CD4 cell counts may be related to the observed lack of CD4 cell count improvement.

The observed improvement in biomarkers supports HCV treatment for everyone coinfected with HIV/HCV even when there is little fibrosis, except in cases of decompensated cirrhosis, study authors concluded.


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Women With HIV Should Get Quadrivalent HPV Vaccine, Study Suggests

The quadrivalent human papilloma virus (HPV) vaccine provided protection to women living with HIV (WLWH), even though vaccine failure rates were higher than among women not living with HIV, a Canadian study published in Clinical Infectious Diseases showed.

Three doses of the HPV vaccine were administered to 279 women living with HIV. These women were then followed for a median of two years. Because of ethical considerations, there was no placebo control group. Instead, vaccine failure rates were compared to those in the published literature.

Persistent HPV infection involving the four viral subtypes covered by the vaccine was 2.3/100 person-years among the study population, which was similar to the rate among women not living with HIV who had not been vaccinated. More importantly, among unvaccinated WLWH, the rate of persistent HPV infection was 6.0/100 person-years.

Study authors recommended that WLWH should be offered the HPV vaccine but should have additional regular cervical screenings. Study participants continue to be followed, and longer-term results will be published in the future.