This Week in HIV Research: Monday, Wednesday, Treatment Days

Taking efavirenz/emtricitabine/tenofovir disoproxil fumarate (Atripla) three times a week instead of daily maintained undetectable viral loads and reduced subclinical toxicities in a small proof-of-concept study published in AIDS.

All 61 participants had been virologically suppressed on daily doses of the medication before entering the study. Half continued that regimen and the other half took the drug only on Mondays, Wednesdays and Fridays. After 24 weeks, there were no virologic failures and ultrasensitive plasma testing showed no difference in HIV viral load between the arms.

Bone mineral density, proteinuria and sleep quality were better in the 3-day arm than in the daily group. However, cholesterol values were worse in the fewer pills arm. Study authors hypothesized that this result reflected the cholesterol-lowering effect of tenofovir: three instead of seven pills means less tenofovir, and hence less reduction of cholesterol.

The study has a 3-year extension phase, which is ongoing and includes all original participants. Two years in, no treatment failures have occurred.

Monitoring of chronic opioid use among people living with HIV does not conform to guidelines, a small study published in Clinical Infectious Diseases found.

Researchers interviewed 166 participants who attended one of two urban HIV clinics in the U.S. and were prescribed opioids at least three times, 21 days or more apart, during the prior six months. Ninety percent acknowledged the addictive potential of the medication and 43% scored high on a measure of potential opioid misuse known as COMM. Thirty percent reported signing an opioid treatment agreement, and 12% received pill counts. The urine of 66% of participants was tested for drugs at least once during their treatment, although it was unclear whether test results were followed up.

Guidelines recommend the concurrent use of three monitoring measures together -- an opioid treatment agreement, pill counts, and urine testing -- but this occurred in only 4.8% of participants. Those who were subject to one or more drug monitoring measure said they were highly satisfied with the monitoring.

According to safe prescribing practices, naloxone, an emergency medication to treat an opioid overdose, should be prescribed along with the opioid. Ten percent of participants reported receiving such a secondary prescription.

Study authors called for implementing guidelines on monitoring practices, as well as increasing naloxone distribution.

Starting antiretroviral treatment immediately on HIV diagnosis does not improve performance on neurocognitive tests among people with CD4 cell counts > 500 cells/μl, a study published in AIDS showed.

Researchers repeatedly tested neurocognition in 592 participants over a mean of 3.4 years. During the first year of the study, neuro scores rose in both the immediate and deferred treatment arms. They attributed the observed first-year improvement to a practice effect due to the repeat testing. Study authors noted that this effect had not been taken into account in prior studies that did not include a control group.

Participants in the current study were relatively young, urban and educated, and lacked rapid immune progression. These characteristics may protect them against neurocognitive decline as a result of HIV and thus explain why treatment had no effect on neurocognitive performance, study authors reasoned. A longer observation period may also be needed to capture differences in test results, they cautioned -- plus, early treatment offers other benefits.

These findings were published shortly after a study we highlighted in last week's recap, in which HIV treatment initiation was found to curb brain volume loss during primary infection.

Duration of influenza virus shedding was independent of serostatus, but longer in people with low CD4 cell counts compared to higher counts, a study published in The Journal of Infectious Diseases showed.

Researchers followed 65 people living with HIV and 176 people not living with the virus, all of whom had confirmed influenza and had sought care at one of two South African clinics. The study was conducted over multiple influenza seasons covering different virus types.

Among participants living with HIV, people with CD4 cell counts ≤ 200 cells/μl shed influenza virus for a median of 13 days compared to 10 days among those with higher CD4 cell counts. The longer duration increases the likelihood that they pass the virus on or develop resistance against flu medications.

"In addition to influenza-specific prevention and treatment strategies it is vital that severely immunocompromised HIV-infected individuals are given appropriate [antiretroviral treatment] to prevent a potential increased risk of influenza transmission and resistant mutations," study authors concluded.