This Week in HIV Research: The Clinical Impacts of HIV Stigma

Among women living with HIV, greater internalized HIV stigma was associated with lower treatment adherence two years later, a longitudinal study published in AIDS found.

Internalized stigma was found to increase depressive symptoms, which in turn decreased adherence. Prior research had not found such a significant relationship between stigma and adherence, but these studies had not focused specifically on internalized stigma, study authors contended. This prior research showed that perceived stigma is not internalized to the same extent by everyone, the authors wrote.

Their current study analyzed data on 914 women who had internalized stigma assessed at baseline and self-reported adherence assessed both at baseline and again roughly two years later. Eighteen months into the study, depression symptoms were assessed in 862 participants. The adjusted odds ratio for optimal adherence was 0.61 in those with internalized HIV stigma compared to no stigma.

Study authors called for further research into the long-term effectiveness of programs that deal with depression and internalized stigma among women living with HIV. In a related commentary, Linda J. Koenig and Ann O’Leary of the U.S. Centers for Disease Control and Prevention called for a focus on treating depression in this population.

Why do some people living with HIV internalize stigma that they experience in the community and others do not?

A group of researchers from across the U.S. explored three factors that influence someone's response to life's stresses: fear of being viewed negatively in a social context, being afraid of losing one's partner in a time of need, and being involved with people while affecting outcomes and learning from experience. Higher scores on the first two -- fear of negative social evaluation and attachment-related anxiety -- increased the likelihood that stigma would be internalized, while the last one -- dispositional resilience -- lowered that probability, they reported in the Journal of Acquired Immune Deficiency Syndromes. Results are based on an analysis of data from two separate studies among 656 total people; the larger study (453 participants) included only women.

While community-level campaigns can reduce external stigma, it takes time for such changes to take effect, study authors suggested. Meanwhile, individual-level interventions, such as cognitive strategies or other psychological methods, could increase people's resilience and lower their anxiety, thereby reducing the effect of internalized stigma on health outcomes, they wrote.

A tenofovir-containing gel initially developed for HIV prevention may be effective in preventing herpes simplex virus type 2 (HSV-2), a secondary analysis of VOICE study data published in the Journal of Infectious Diseases found. Having HSV-2 increases the risk of HIV seroconversion, as well as transmission of HIV by people coinfected with HIV and HSV.

The VOICE study tested daily tenofovir in oral or vaginal gel form for HIV prevention in sub-Saharan African women. While overall efficacy was low in that study, the gel did reduce HIV seroconversion risk among those who applied the product daily. In the current analysis, study authors found that among 532 participants at risk for HSV-2, a 40% reduction was seen in HSV-2 acquisition among those adherent to the gel (as determined by study drug levels in blood plasma) compared to non-adherent participants.

In 2015, the FACTS 001 study of the same gel had shown low efficacy for HIV prevention, likely due to limited adherence to the study regimen, which called for application pre- and post-intercourse. Authors of the HSV analysis noted the promise of new delivery systems, such as vaginal rings. One such ring -- containing a different drug, dapivirine -- is [bout to be tested in sub-Saharan Africa and compared to oral HIV prevention with tenofovir.

HIV escape into cerebrospinal fluid (CSF) may take place in virally suppressed people living with HIV, but it is not a common occurrence and does not appear to cause neurocognitive harm, a study published in AIDS showed.

Fifty-five (4.4%) of 1,264 participants with plasma viral loads of < 50 copies/ml who were on stable antiretroviral therapy had the virus in their spinal fluid. The odds of CSF viral escape were greater among those on ritonavir (Norvir)-boosted protease inhibitors (odds ratio [OR] = 2.0) or unboosted atazanavir (Reyataz, OR = 5.1) compared to NNRTI-based regimens. While previous studies suggested that this association may be related to lower effectiveness of some antiretrovirals in the central nervous system (CNS), participants on PI-based regimens may have had other risk factors, study authors noted.

HIV in the cerebrospinal fluid was also associated with markers of CNS inflammation, although not with worse neurocognitive performance. The lack of association between inflammation and neurocognitive performance could be due to transient rather than persistent escapes or to the low number of participants with any viral escape, they explained.

Authors called for longitudinal research into the relationship of CSF viral escapes, CNS inflammation, and long-term CNS outcomes.