This Week in HIV Research: This Is Your Brain on Stigma

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Even studies that yield unsurprising overarching results can sometimes contain individual findings that are unusual or thought-provoking. So it is with some of our featured studies in this week's exploration of recently published HIV-related research. This week, we learn that:

  • HIV-related stigma may have a direct impact not only on anxiety levels, but also cognitive performance.
  • Trauma history and social factors may help explain higher HIV rates among young black men who have sex with men (MSM) despite other risk-reducing behaviors.
  • Receiving fewer than 12 weeks of HIV treatment in pregnancy may correlate with a greater risk of falling out of the care continuum afterward.
  • Raltegravir (Isentress) passes muster as a pediatric treatment option, but with an important caveat.

Join us for a closer look at each of these studies -- and a few of their intriguing data points. 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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HIV Stigma Affects Cognitive Performance in Older White Men

Experience of HIV-related stigma is related to lower performance on cognitive tests in older white men living with HIV, a Canadian study published in Journal of Acquired Immune Deficiency Syndrome showed.

Data from 512 participants (mean age: 54 years; mean time living with HIV: 17 years) in the parent Positive Brain Health Now cohort were used to build a structural equation model. The study did not include women or people of color in an attempt to isolate HIV stigma from other forms of stigma, study authors said.

The model found that stigma related to HIV directly affected cognitive test performance, as well as anxiety. Stigma's effect on cognition, as well as mood, in turn affected physical function and social role mobility, among other real-world consequences. However, causality for social effects could run either way, study authors cautioned: The experience of stigma may keep people from trying to engage in social activities, or people may feel stigmatized because they are excluded from such activities.

"This study underscores the need for interventions that reduce social stigma and support resilience against its toxic effects on brain health," senior study author Lesley Fellows, M.D., concluded in a related press release.

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Past Trauma, "Denser" Networks Linked to Higher HIV Rates Among Young Black MSM

Denser social networks and greater rates of past trauma may contribute to higher HIV rates among young African-American MSM compared to their white peers, a data analysis published in Journal of Acquired Immune Deficiency Syndrome suggests. Overall HIV prevalence among 1,015 young MSM in Chicago, Illinois, was 16.5%, but among African Americans it was 32%; among Latinos, 12.5%; and among whites, 2%.

"Density" in this study refers to a measurement of the degree to which all possible relationships within a network are, in fact, observed -- i.e., the denser a network, the more sexual relationships that take place within that network. While African Americans reported fewer sexual partners and more frequent HIV testing, their network was denser than that of the other groups, the study found. Furthermore, levels of past trauma, stigma, victimization, and childhood sexual abuse were highest among African Americans.

Results show that HIV prevention efforts among young African American men are having an effect, but further research to develop interventions focused on the social determinants of HIV is needed, study authors concluded.

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Less Prenatal Antiretroviral Therapy Associated With Lower Postpartum Retention in Care

Women who received < 12 weeks of antiretroviral therapy during pregnancy were less likely to remain in HIV care 24 months postpartum, a study published in AIDS found. In addition, younger women were less likely to remain in care or be virologically suppressed two years after giving birth.

The study included 141 women who gave birth and received HIV care at a single North Carolina site, 28% of whom were diagnosed with HIV during pregnancy. Overall, 70% of women were retained in HIV care 12 months after birth; that proportion dropped to 48% by the 24-month mark.

Among women with < 12 weeks of antiretroviral therapy, adjusted odds ratios (AOR) for retention in care were 0.24 and 0.27 at 12 and 24 months postpartum, respectively. For age ≥ 30 years, the numbers were 2.44 at 12 months and 2.41 at 24 months.

While the study site offers comprehensive HIV and obstetric care, structural barriers to care exist, study authors noted. They called for greater attention to pre- and post-partum HIV care access, as well as the development of interventions to retain women in HIV care after they give birth.


Raltegravir Safe Long-Term in Children, but Caution Advised in Treatment-Experienced Youth

Raltegravir is safe in the long run for children 4 weeks and up, but should be used with caution in older, extensively treatment-experienced children and adolescents, a study published in The Lancet concluded.

The open-label phase 1/2 trial was conducted among 153 children aged 4 weeks to 18 years in the U.S., Africa, and South America. Participants were enrolled between 2007-2012 and followed for 240 weeks. The study drug (as adult tablets, chewable tablets, or oral granules) was added to each participant's optimized background regimen.

At the end point, 77% of those using chewable tablets (age 2-12 years) and 87% of those on oral granules (< 2 years old) were virally suppressed, compared to 44% of those on adult tablets (participants weighing >25 kg). That older group also seemed less adherent to therapy, with the virus still sensitive to raltegravir in only 61% of virologic failures. The study drug's long-term safety profile was favorable, and only one participant discontinued due to a drug-related adverse event (skin rash).