This Week in HIV Research: Self-Testing Passes a Big Test

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This week, we've got a bevy of intriguing, care-impacting study findings from the world of HIV to share. Our selected research this time around is likely to:

  • Alleviate fears that HIV self-testing is inherently less reliable than professional HIV testing.
  • Advise the most effective influenza vaccine strategies for people with HIV.
  • Inform how age can affect flu vaccine efficacy among HIV-positive people.
  • Affirm yet another value to early HIV treatment initiation: CD4:CD8 ratio normalization.

Follow along as we learn more about each of these clinically important 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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HIV Self-Testing Is Reliable, But Test Kits Could Be Improved

People can reliably test their own serostatus using rapid HIV tests, but there is room for improvement of the test kits, a metareview of studies published in The Lancet HIV found.

Among 25 studies, 85.4% to 100% of self-test results matched those obtained by a health care professional. While blood-based testing was more sensitive than oral-fluid testing, more errors occurred during specimen collection for the blood test.

Study authors recommended several measures to reduce errors in both specimen collection and interpretation of results: easier sample collection, simpler instructions, better labeling -- including information on test limitations -- and instructional videos for low-literacy users. In particular, labeling should note the invalidity of results in people already taking antiretroviral medications (including for pre-exposure prophylaxis) who may use at-home HIV tests to reconfirm their serostatus. Instructions should also be translated into local languages and adapted for specific cultural contexts, and include detailed, well-designed images, researchers added.

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Best-Performing Influenza Vaccine Strategies for People Living With HIV

Among 11 influenza vaccine strategies, the adjuvant 7.5 μg booster and 60 μg single vaccine variations provide the best outcomes for people living with HIV, a meta-analysis of 13 randomized controlled trials that was published in Science Direct found.

Both "winning" strategies performed better than the rest against the H1N1 influenza strain, but only the 60 μg single vaccine was more effective than the others against influenza strain B. All strategies worked equally well against the H3N2 strain. Vaccine performance was evaluated based on seroconversion (of the influenza virus, not HIV), seroprotection and outcome measurement timepoints. "These findings have important implications for national and international guidelines for influenza vaccination in HIV-positive people and may inform future research evaluating novel vaccination strategies," study authors concluded.

Study population sizes varied but remained below 307 participants in any one trial. None of the studies investigated more than three different strategies, and not all trials targeted all influenza strains.

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Flu Vaccine Response Lags in Younger People Living With HIV

Influenza vaccine response is lower in people living with HIV (PLWH) than in those not living with the virus, and that difference is even more pronounced among people under the age of 40, a study published in AIDS found.

Researchers tested flu antibodies in 315 participants, 151 of whom were PLWH with undetectable viral loads, before and after influenza vaccination. Among most participants, antibody titers were already in the seroprotective range before vaccination -- likely due to previous bouts of flu and/or influenza vaccinations, researchers speculated. Antibodies -- especially to the H1N1 and B influenza strains -- increased for everyone after the vaccine was administered. However, more participants in the HIV arm did not respond to the vaccine than in the non-HIV arm. When stratified by age (under 40, 60 or older, or 40-59 years old), antibodies against the B strain were lower in PLWH compared to similarly-aged people who do not live with HIV.

"High-potency influenza vaccination recommended for healthy aging could be considered for HIV+ adults of all ages," study authors concluded.

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CD4:CD8 Ratio Returns to Normal Faster With Earlier Antiretroviral Start

Yet another reason to start antiretroviral treatment early: In people beginning treatment at CD4 cell counts < 200 cells/mm3, predicted CD4:CD8 cell count ratios remained below normal levels even 15 years later, a cohort study published in AIDS showed. However, among those who began treatment at CD4 cell counts above 200 cells/mm3, the ratio returned to normal levels during that time.

Researchers used data on 39,979 participants in the ART Cohort Collaboration who had started treatment after 1997. Median follow-up was 53 months, and all participants lived in North America or Europe. In those with baseline CD4 cell counts of < 50 cells/mm3, changes in the CD4:CD8 cell count ratio were driven only by higher CD4 cell counts over time, while in those with higher baseline CD4 cell counts, CD4 cells increased and CD8 cells decreased. The higher someone's baseline CD4 count was, the less time it took for them to achieve a normal (> 1) CD4:CD8 cell count ratio after starting antiretrovirals.