This Week in HIV Research: Where Are the Cervical Cancer Screens?

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Headlining our latest glimpse at recently published HIV research are a couple of studies that highlight the frustrating gap that so often seems to exist between reality and best practices or intentions. This week, we see:

  • Poor rates of cervical cancer screening among HIV-positive women of color.
  • A lot of interest, but little action, when it comes to organ donation among people with HIV.
  • Encouraging signs for an online depression intervention aimed at people with HIV.
  • No significant differences by sex in hair-derived drug concentrations of tenofovir disoproxil fumarate/emtricitabine (Truvada).

Learn more about the specific findings of each of these studies in the coming paragraphs. 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.com and TheBodyPRO.com. Follow Myles on Twitter: @MylesatTheBody.


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Low Cervical Cancer Screening Rates Among Women of Color With HIV

Fewer than half of the women living with HIV who attended an urban safety net clinic in the U.S. South received cervical cancer screenings at the recommended intervals, a study published in AIDS found.

Researchers analyzed data on 1,490 women, 830 of whom had not had a cervical cancer screening during the 15 months before study entry. Participants were mostly African American (71.7%) and Latinx (15%), and few (4%) had commercial health insurance.

Three cases of cervical cancer and 21 cases of high-grade cervical dysplasia were diagnosed among the 447 women who had not been screened before study entry but had a Pap smear during the 15 months thereafter. However, 383 those women not screened before were not screened after study entry, either. Similarly, 40% of women with an abnormal Pap result did not receive the recommended follow-up colposcopy.

"Intervention efforts to increase cervical cancer screening and follow-up are needed," study authors concluded.


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Organ Donation Among Americans With HIV: More Interest Than Action

Many people living with HIV (PLWH) are willing to donate their organs, but there's a wide gap between willingness and registering to donate, a small survey published in Journal of Acquired Immune Deficiency Syndrome showed.

The study included survey data from 114 respondents at an HIV clinic in Baltimore, Maryland. The vast majority (91.2%) were African American. Of all respondents, about 79.8% said they were OK with their organs being used after their death, and 62.3% were willing to be living organ donors. However, only 24.6% knew that current legislation permits PLWH to donate organs for use in other PLWH.

Just over one in five of the survey respondents (21.1%) was a registered organ donor, and only 17.8% had discussed the issue with their next-of-kin. One concern might be that such discussions could inadvertently disclose a person's HIV status. However, 93.0% of respondents said they had told their family members about their serostatus.

Study authors noted that targeted interventions might encourage PLWH to talk to their family not just about HIV, but also about organ donation. In addition, they recommended educating all PLWH about organ transplants, including the passage of the 2013 HOPE Act, the process for registering as a donor and the need to inform next-of-kin about such a decision.


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Online Intervention for Depression Successful in People With HIV

In the Netherlands, a self-guided online intervention decreased depressive symptoms in people living with HIV (PLWH) significantly more than an attention-only wait list, a study published in The Lancet found.

Researchers randomized 188 PLWH with mild to moderate depressive symptoms to the intervention arm (97 people) or the control arm (91 people). At start, mean scores on a standard depression assessment tool, Patient Health Questionnaire-9 (PHQ-9), were 11.74 in the intervention and 11.11 in the control group. PHQ-9 scores of >4 indicate mild depression, and the scale tops out at 20. Eight weeks after baseline, PHQ-9 scores were 6.73 in the intervention arm and 8.60 in the control group. Three months later, scores in the two arms were 6.62 and 8.06, respectively.

In a related commentary, Eirini Karyotaki, Ph.D., of Vrije Universiteit Amsterdam, offered that online interventions, especially if implemented in a massive, open manner, could provide mental health care for PLWH with depression in resource-limited settings, where such care might otherwise not be available.


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Truvada Hair Concentrations Don't Differ by Sex

Hair concentrations of tenofovir disoproxil fumarate/emtricitabine (Truvada) do not differ between men and women, a small study that was published in AIDS found.

Truvada concentrations were assessed in 23 women and 24 men not living with HIV. Participants were randomized to take 33%, 67% or 100% of the medication's standard dose daily for 12 weeks during directly observed therapy (DOT). Hair samples were taken after 4, 8 and 12 weeks of daily medication, as well as 3 and 6 weeks after the end of DOT, yielding a total of 264 samples.

Across all samples, the estimated fold-difference in drug levels of women compared to men was 0.92 (95% confidence interval 0.75-1.13, p = 0.43). Age, weight and race/ethnicity barely changed that number.

"As PrEP [pre-exposure prophylaxis] programs expand worldwide and pharmacokinetic metrics are increasingly used to monitor PrEP use, these findings provide guidance for assessing adherence via hair concentrations among women and men on PrEP," study authors concluded.