This Week in HIV Research: Additional Nuance on Pregnancy and Antiretrovirals

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Major landmark studies with fundamental, field-changing ramifications tend to grab the most headlines. But one of the things we love about This Week in HIV Research is that we can often cede the stage to studies that further our ability to provide effective HIV care and services in comparatively small but nonetheless important ways. For instance, our highlighted research this week suggests that:

  • There's no harm in switching HIV treatment regimens during the first trimester of pregnancy out of concern for drug safety.
  • Fears are unfounded that pre-existing drug resistance is the primary driver of elevated viral load during pregnancy in South Africa.
  • Successful hepatitis C treatment using direct-acting antivirals renders HIV status irrelevant to future liver complication risk.
  • Hepatic steatosis is a concern among young people who have been living with HIV since infancy.

Let's take a moment to learn a bit more about each of these recently published 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 and TheBodyPRO. Follow Myles on Twitter: @MylesatTheBody.

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Switching Meds in Early Pregnancy Does Not Impair Treatment Outcome

Switching antiretroviral medications during the first three months of pregnancy because of concerns about drug side effects in the fetus does not cause poorer treatment outcomes, a French study published in the Journal of Acquired Immune Deficiency Syndromes found.

Researchers analyzed data spanning from 2005 to 2015 that included 1,797 women who were on HIV treatment at conception and virally suppressed during the first 14 weeks of pregnancy. Twenty-two participants changed regimens because they couldn't tolerate their previous drugs, and 23% of the remaining 1,775 women switched because of concerns for the safety of the fetus.

Viral rebound occurred in 15.6% of all participants, and in 19.3% of those who switched treatment for safety concerns -- a difference that fell well below the threshold for statistical significance.

Study authors noted that markers of social or personal vulnerability were associated with treatment changes later during pregnancy, which they said highlights the need for multidisciplinary care that considers the desire for biological children when selecting an HIV regimen. Much of the concern about certain drugs during pregnancy stems from a lack of safety data rather than a definitive risk to the fetus, they added, calling for more research on the effects of HIV drugs during pregnancy.

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Viral Load Spikes During Pregnancy: Adherence or Prior Resistance?

Spikes in viral load after initial viral suppression during pregnancy are mostly due to suboptimal treatment adherence rather than resistance mutations acquired before conception, a South African case-control study published in Clinical Infectious Diseases showed.

All 167 participants initially achieved viral suppression during pregnancy, but viral load subsequently rose in 80 of the women, while 87 controls remained suppressed. All were followed for up to one year after giving birth.

Among the 80 women who experienced an eventual viral load increase, pre-treatment drug resistance mutations had been found in just 10%. Among the women who remained suppressed, 5% had such mutations.

By contrast, recent HIV medication usage was detected in only 19% of cases in which a woman's viral load was elevated, compared to 94% of women who remained virologically suppressed. The method of detection used in the study was only capable of detecting medications taken within two to four days before a study visit; thus, long-term adherence was unknown.

Among women who experienced an elevated viral load, the most common drug resistance mutations discovered were for non-nucleoside reverse transcriptase inhibitors -- particularly the K103N and V106M mutations, which show the limitation of efavirenz (Sustiva, Stocrin) as first-line therapy, study authors wrote. They suggested dolutegravir (Tivicay, DTG) as a better alternative for the study population.

HIV Status Does Not Affect Liver Complication Risk Following Successful HCV Treatment

People with advanced liver fibrosis and hepatitis C (HCV) who were successfully treated with direct-acting antivirals (DAAs) are no more likely to suffer liver complications if they are living with HIV than if they are not, a Spanish study published in Journal of Infectious Diseases showed. Rather, more severe liver disease, as well as intravenous drug use as the avenue through which HCV was acquired, were better predictors of liver complications.

Researchers followed 717 people, 507 (71%) of whom were coinfected with HIV, for a median of 21 months. All participants had achieved sustained viral response (SVR) to HCV after being treated with DAAs. The likelihood of remaining free of liver complications after two years was 96% for HCV monoinfected participants and 98% for those coinfected with HIV.

While most liver complications manifest soon after SVR, longer follow-up might find liver damage not evident in this study, authors acknowledged. Results show that HCV management should not differ between mono- and co-infected people, they concluded.

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Fatty Liver More Common Among Young People Living With HIV Since Infancy

In a small study published in AIDS, 33% of young people living with HIV since early childhood were found to have hepatic steatosis, compared to 10% of matched controls.

Hepatic steatosis, also called fatty liver disease, can lead to liver fibrosis and ultimately cirrhosis. In a 2012 study, the average age of people with fatty liver was 53 years, compared to 47 years for those without the condition. The mean age of the 66 participants in the current study (46 living with HIV, 20 controls) was 28 years.

While metabolic parameters -- in particular, waist circumference -- were the most important predictors of this liver problem, metabolic issues were found to be more common in general among those living with HIV. Study authors noted that some antiretrovirals affect these parameters, although lifestyle changes can modify them. "While this finding should be replicated in larger cohorts, modifiable metabolic disturbances may be important targets to optimize liver health in this population," they concluded.