This Week in HIV Research: A New Frontier in Organ Transplantation
As the seasons begin to noticeably turn throughout much of the world, the gears of our communal HIV research machine keep inexorably grinding. Among the recently published studies with the potential to impact HIV care, this week we see:
- A first in liver transplantation: an HIV-positive donor and an HIV-negative recipient.
- New data showing the degradation of the continuum of care for formerly incarcerated people in the U.S.
- Signs that reduced bone mineral density is a complication that extends to men with HIV under the age of 50, despite viral suppression (and regardless of tenofovir disoproxil fumarate use).
- Discouraging findings regarding the (lack of) anti-inflammatory effects of an antiplatelet agent for people with HIV.
Let's take a deeper look at each of these studies together. 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.
First Successful Liver Transplant From Donor Living With HIV to HIV-Negative Recipient
The world's first known liver transplant from a person living with HIV (PLWH) to an HIV-negative person was successful, but the HIV status of the recipient remains uncertain, a South African medical team reported in AIDS.
A mother living with HIV donated part of her liver to her young child who was in urgent need of a transplant. The child was HIV-negative before the transplant, but in preparation for the surgical procedure, was put on antiretroviral therapy. Highly sensitive repeated testing for HIV found that the child did seroconvert, but HIV antibodies have since declined to undetectable levels, and no HIV-1 RNA or cell-associated HIV-1 DNA have been detected in the child.
One year after the procedure, both mother and child are doing well, but both remain on antiretrovirals, so the child's HIV status remains unclear.
While this outcome is encouraging, general conclusions should not be drawn hastily, Jürgen Rockstroh of University Hospital Bonn, Germany, and Francisco Gonzàlez-Scarano of the University of Texas cautioned in a commentary published in the same issue of AIDS. More information is needed regarding the recipient's HIV status in this case, and other cases, before deciding that PLWH can safely donate organs to HIV-negative people, they concluded.
Few People Leaving Jail or Prison Retained in Long-Term HIV Care
Fewer than half of PLWH in Connecticut who were incarcerated and later released were still in HIV care three years after their release, a longitudinal study published in PLOS Medicine found.
One year after release, 67.2% of formerly incarcerated people had been retained in care, but that proportion dropped to 42.5% for the entire three-year period.
Researchers linked statewide databases to analyze information on 1,094 PLWH, each of whom was followed for three years after release. Although a return to jail or prison necessarily meant a return to HIV care, viral suppression rates were worse among that group than among those who remained in the community (72% versus 81%). Health insurance, HIV treatment in jail or prison, case management, and early linkage to care upon release were associated with better treatment outcomes.
Study authors called for policy changes, such as avoiding suspension of health insurance enrollment; having probation/parole promote health care engagement, including psychiatric care; and pre- and post-release substance use treatment, concluding: "Such changes in policy will likely positively influence HIV treatment outcomes while diminishing the negative consequences of mass incarceration, especially for racial/ethnic minorities in the U.S."
Reduced Bone Mineral Density Common in Younger Men Living With HIV
Reduced bone mineral density (BMD) was observed among a relatively large proportion of men under age 50 whose HIV was well treated, researchers reported in AIDS.
BMD was reduced in 48.3% of 230 participants, with 32.6% of those with low BMD diagnosed with osteopenia and 15.7% with osteoporosis. Osteopenia is a less severe bone loss than osteoporosis and is common in older people. Osteopenia risk was higher among participants who had been on antiretroviral treatment for less than three years. Low BMD was also associated with other factors generally seen in women past menopause and older HIV-negative men, such as low serum oestradiol levels.
Exposure to tenofovir disoproxil fumarate, which has kidney- and bone-related side effects, did not change the risk for low-level bone loss.
Results suggest the study participants were experiencing complications related to premature aging from HIV, study authors noted. They proposed BMD assessments for people living with HIV who are younger than 50 years old.
Vorapaxar Does Not Reduce Inflammation in People Living With HIV
The antiplatelet agent vorapaxar (Zontivity) did not reduce inflammation or hypercoagulation in PLWH whose viral loads were undetectable, a small placebo-controlled study published in The Lancet found.
The study drug is used to prevent cardiovascular disease in the general population. In this study, vorapaxar's effect was assessed by its impact on D-dimer concentrations, a marker for blood clotting ability. Sixty-five people living with HIV on stable therapy and with D-dimer concentrations above 200ng/mL were randomized to study drug or placebo.
After 8 to 12 weeks, D-dimer concentrations did not differ significantly between the two arms. A larger trial of the drug in PLWH is therefore not warranted, study authors concluded.
In a related comment, Philip E. Tarr and Alexandra Calmy, both from major Swiss hospitals, questioned the need for anti-inflammatory drugs in PLWH during the modern treatment era. They advocated instead for starting HIV treatment early, promoting a healthy lifestyle, and counseling smoking cessation to reduce non-AIDS comorbidities in PLWH.