This Week in HIV Research: Not-So-Routine Testing

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Welcome to our latest tour of recently published HIV-related research. This week, we learn more about:

  • How far we still have to go in fully embracing Centers for Disease Control and Prevention recommendations for routine HIV testing among high-risk Americans.
  • The relationship between mental health, engagement in HIV care, and viral load -- which is not as clear cut as you may think.
  • Evolving perceptions of health care discrimination experienced by people living with HIV.
  • How zoledronic acid may be a better intervention for bone mass improvement among people taking tenofovir disoproxil fumarate (TDF) than switching off the TDF.

Come with us as we take a closer look at 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 and Follow Myles on Twitter: @MylesatTheBody.

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Among Recently Diagnosed People, Missed Chances for HIV Testing

A significant number of high-risk Americans who were newly diagnosed with HIV had not been tested for the virus during visits with a health care provider the prior year, even though the Centers for Disease Control and Prevention recommends that high-risk individuals receive annual HIV testing, a study published in Journal of the American Medical Association found.

The study focused on men who have sex with men (MSM) and people who inject drugs (PWID) in 19 U.S. cities with a high HIV burden. A 2014 survey of MSM in those cities identified 2,002 as living with HIV -- 151 (7.5%) of whom were unaware of their status. Of those 151 MSM, 67 said they had not received HIV testing within the past year -- and 35 further said that they had visited a clinician during that span without being offered a test.

Among PWID, surveys conducted in 2012 and 2015 identified 1,589 as HIV positive; 184 (11.6%) unaware of their status; 141 who had not received HIV testing in the past year; and 64 who had visited a clinician during that span without being offered an HIV test.

These findings were echoed by a study recently published in Mortality and Morbidity Weekly Report, which showed that people with a recent risk of seroconversion were tested for HIV less often than annually, and that between 32% and 40% had never been tested at all within the multi-year span of the study. That said, the MMWR report found that HIV testing was relatively common overall among MSM, with 71% having been tested at some point, compared to 40% of all respondents.

The authors of this second study recommended electronical medical record prompts to increase routine HIV screening during medical visits.

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Depressive Symptoms Associated With Detectable HIV Viral Load, Not Missed Visits

Reduced engagement in HIV care may be associated more with people’s mental health conditions before starting antiretroviral treatment than with their recent depressive symptoms, a study published in Clinical Infectious Diseases found. By comparison, having a detectable HIV viral load was linked to recent depressive symptoms, the study noted.

At baseline, 35% of 1,057 study participants had a mental health diagnosis and 30% showed depressive symptoms. For those with recent depressive symptoms, the risk ratio (RR) was 1.28 for a detectable viral load over time and 1.20 for a missed clinic appointment, both compared to no depression.

However, when missed appointments were adjusted for pre-existing mental health issues, RR was 1.00 -- i.e., no greater risk associated with depression. Higher viral loads among people living with HIV and depression thus appeared to be associated not with missed clinic visits, but with lower treatment adherence or the effect of depression on viral replication, study authors noted. For more detailed information, see our article exploring this study in more detail.

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Perceived HIV Discrimination Declines Overall, but With Notable Exceptions

HIV-positive people's perceptions of discrimination in health care settings based on their serostatus dropped from 24% in 1996 to 15% in 2011-2013, a study published in AIDS showed.

Researchers compared data from two similar surveys conducted at timepoints in 1996 and 2011-2013, yielding a total of 2,859 respondents, most of whom were men. More participants were white (1,398) than African American (955) or Latino (415).

The reduction in perceived discrimination during the study period may be related to the introduction of U.S. recommendations for including HIV prevention in routine medical care and public acceptance of social issues experienced by some groups affected by the virus, study authors hypothesized.

However, no reduction was evident among people age 50 or older, those with CD4 cell counts ≥ 500 cells/mm3, or people who identified their ethnicity as "other" (a category that included Asian Americans and Native Americans).

While the lower overall discrimination rates are encouraging, there is room for improvement, study authors said. They called for better communication training for health care providers and staff and an improved understanding of the settings where discrimination occurs.

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Zoledronic Acid Beats TDF Switching for Bone Mass Improvement, Study Says

Intravenous zoledronic acid (ZOL) is more effective at increasing bone density than switching away from a tenofovir disoproxil fumarate (TDF)-based antiretroviral regimen, a small study published in AIDS found.

ZOL was administered annually for two years. Eighty-seven people virally suppressed on TDF with low bone mineral density (BMD) were randomized to continue TDF and receive ZOL or to switch from TDF to another antiretroviral drug. Of the 85 participants included in the analysis, 82 were men and 66 were white. All three participating women were in the ZOL arm.

At 48 months, median BMD at the spine had increased by 7.4% in the ZOL group, compared to 2.9% in the TDF switch arm. Study follow-up is continuing up to 36 months, although no further ZOL will be administered.

Tenofovir alafenamide, an alternative to TDF associated with less bone loss, was not yet available at the start of this study, authors noted.

While ZOL may be a good option for people with osteoporosis, absolute fracture risk -- which increases with age -- will need to be considered when deciding on a strategy against bone loss, study authors concluded.