This Week in HIV Research: Our High Tally of Glucose Disorders

Men living with HIV whose viral load has been suppressed for many years nonetheless develop glucose disorders at an extremely high rate, a longitudinal Australian study reported in AIDS showed.

Starting in 1997 and continuing for a mean of 11.8 years, researchers followed 104 men who have sex with men who attended a Sydney, Australia, HIV clinic. None had diabetes at baseline, but 12.5% developed that disease over the course of follow-up. Another 32.3% developed prediabetes, for a total glucose disorder incidence rate of 45.8%.

Even small gains in abdominal fat significantly increased the risk of glucose disorders. Furthermore, oral glucose tolerance tests (OGTT) detected many more cases of impaired glucose tolerance than did the standard fasting glucose measurement. Study authors therefore recommended that OGTT be used to assess the glucose status of people living with HIV. Weight management strategies should then be offered to those at risk of diabetes, they added.

TheBodyPRO has also published a more detailed article exploring the study and its implications for HIV care in the U.S.

High-risk HPV types were more prevalent and cleared more slowly in the anus than in the cervix of women living with HIV, a study published in AIDS showed.

From 2004 to 2006, researchers collected anal and cervical swabs annually from 167 women living with HIV in four U.S. cities. Participants with multiple types of HPV in their anus and/or cervix cleared that virus more slowly than women with just one type, the study found.

The finding suggests that HPV vaccination might be effective even when it does not cover all types, because it reduces the number of HPV types that remain to be cleared, study authors wrote. The nonavalent HPV vaccine, which protects against nine virus types, works against most HPV types found in anal or cervical tissue samples that showed abnormalities. Study authors recommended vaccinating women living with HIV with the nonavalent vaccine.

A similar study of anal HPV types among men who have sex with men (MSM) also recommended vaccinating MSM against HPV.

Among U.S. veterans prescribed pre-exposure prophylaxis (PrEP), median adherence rates during the first year of their prescription was above the threshold needed to ensure efficacy, but rates differed substantially by demographic characteristics, a study published in Journal of Acquired Immune Deficiency Syndrome showed. In addition, 44% of those prescribed tenofovir disoproxil fumarate/emtricitabine (Truvada) for PrEP stopped taking it within a year, the study found.

Results were based on prescription and refill data for 1,086 people attending U.S. Veterans Health Administration clinics between 2012 and 2016. Older white men were most likely to have Truvada refilled regularly. Odds ratios for high PrEP adherence were found to be 1.97 in favor of older age (50-64 years old versus <35 years old), 2.12 in favor of people of white race versus African Americans, and 3.39 in favor of males versus females. However, the gender difference was based on relatively few women (3.7% of participants) included in the cohort.

These demographic variations are similar to those observed in studies on treatment adherence and undetectable viral loads, study authors noted. "It will be important to monitor PrEP adherence, as uptake expands from highly motivated early adopters to larger populations," they concluded.

Financial incentives increased the number of children and adolescents who came to a clinic in Harare, Zimbabwe, for HIV testing, a randomized trial published in The Lancet found.

Field workers enrolled 1,688 households with children between 8 and 17 years of age in this sub-study of an HIV prevalence survey. Each household was assigned to either receive US$2, be entered in a lottery for a one-in-eight chance of winning US$5 or US$10, or get no incentive; eligibility was based on whether at least one child in the household was tested at the clinic within four weeks of enrollment.

The fixed payment yielded the greatest proportion of households tested (48% of that arm), followed by the lottery (40%), and trailed by no incentive (20%). Testing was only available during business hours, which might have affected the low uptake in the no payment arm, study authors hypothesized.

Participants' monthly household income is about US$100, a related comment noted. Payments offered thus represent 2%-10% of monthly incomes. Such incentive programs might set up expectations that could lead people to refuse an HIV test if they do not receive compensation, the comment authors warned. Nonetheless, relatively small incentives may save medical costs in the long run by identifying and treating hard-to-reach populations early on, they conceded.

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.