This Week in HIV Research: The Fast-Acting Power of Integrase
When we look back on the past decade in HIV, primary highlights often tend to focus on the groundbreaking prevention effects of pre-exposure prophylaxis (PrEP) and the stigma-busting empowerment of our understanding that an undetectable viral load renders HIV sexually untransmittable (U=U). It’s easy to overlook the dramatic impact of another innovation of the 2010s, the integrase inhibitor—a development that has made HIV treatment simpler, safer, and more effective than it’s ever been.
Our top story this week notes one other benefit of integrase-based antiretroviral therapy: It works really fast, which fits hand-in-glove with PrEP and U=U as a potential curb on onward HIV transmission. Of course, that’s just one of the four recently published HIV-related studies we’re summarizing for you this week. Our full slate:
- Integrase-based treatment suppresses primary HIV infection roughly five times as rapidly as protease inhibitor-based treatment.
- PrEP ad campaigns, if executed well, can yield significant benefits for education and advocacy.
- It may be wise to screen PrEP users for non-HIV sexually transmitted infections (STIs) quarterly rather than every half year.
- Ryan White funding remains a critical pillar of HIV care and services in rural parts of the U.S.
Continue onward for additional details on each of this week’s selected manuscripts. To beat HIV, you have to follow the science!
Integrase Treatment Speeds Viral Suppression During Primary HIV Infection
During primary HIV infection, people taking an integrase inhibitor-based regimen achieved viral suppression sooner than those on protease inhibitor-based treatment, researchers reported in AIDS.
They compared viral load, CD4 count, and CD4/CD8 ratio among 712 participants, 299 of whom took INSTIs, who started antiretroviral therapy during primary infection between 2013 and 2017 in France. After four weeks of treatment, 32% in the INSTI arm had an undetectable viral load, compared to 6% in the PI arm. That trend continued at 12 weeks (72% on INSTI vs. 31% on PI) and 24 weeks (92% vs. 78%), but by week 48 the two arms had essentially converged (96% vs. 94%).
CD4 counts and CD4/CD8 ratios followed similar trajectories, with greater initial CD4 count gains in the INSTI arm, but similar CD4 cell counts on either regimen after 48 weeks.
Being virally suppressed early on not only reduces inflammation and prevents neurological damage, but also prevents transmission of the virus to sexual partners, study authors noted. “On the basis of this study and available literature, we recommend the use of INSTI-based [antiretroviral therapy] for treatment initiation during PHI, as it leads to faster viral suppression and immune restoration,” they concluded.
PrEP Ad Campaign Improved Awareness, Lessened Stigma in Chicago
PrEP4Love, a social marketing campaign employed in the U.S. to address PrEP stigma, appears to have been successful at improving public opinion about PrEP in a major U.S. city, researchers concluded in Journal of Acquired Immune Deficiency Syndromes.
The PrEP4Love advertising campaign was launched in 2016 as an effort to put a sex-positive spin on PrEP advocacy and education in Chicago, Illinois. Ads were displayed throughout the city’s transit system in 2016.
The current study surveyed 700 young men who have sex with men (MSM) and transgender women who were participants in a longitudinal HIV risk cohort based in Chicago. The surveys took place between June 2017 and April 2018, well after PrEP4Love ads were displayed in the city’s transit system in 2016.
Seventy-six percent of participants reported having seen the ads. Those who saw them were more likely to be out to their providers (odds ratio = 1.95), have taken PrEP during the previous six months (OR = 1.87), and believe that their friends and the general public approve of this HIV prevention method compared to those who had not seen the ads.
The researchers allowed that the encouraging results of the study could be due to perceptual bias, since people who view PrEP positively and/or know someone taking the medication may have been more likely to notice the ads. As a result, they called for additional explorations into the successes and failures of campaigns such as PrEP4Love: “Continued implementation research in messaging and prevention advocacy is integral to establishing evidence-based approaches for this promising form of intervention,” they wrote.
Screen People on PrEP for STIs Every Three Months, Researchers Recommend
In addition to HIV, people taking PrEP should be tested for other STIs every three months, a study published in AIDS suggested. That’s a more aggressive recommendation than current U.S. guidelines, which recommend STI screening every three to six months for people receiving biomedical HIV prevention.
Researchers evaluated 557 MSM and transgender women receiving PrEP at STI clinics in three U.S. cities. All participants were screened quarterly for gonorrhea, chlamydia, and syphilis; 51% were diagnosed with one of these STIs during follow-up.
If participants had been tested only semiannually or when they showed symptoms, 34% of gonorrhea cases, 40% of chlamydia cases, and 20% of syphilis cases would not have been detected until up to three months later than they were on the quarterly screening schedule, the researchers found.
Syphilis testing could easily be combined with HIV tests, and self-collected swabs during these health care visits could help screen for other STIs, study authors suggested. “Quarterly STI screening among MSM on PrEP could prevent a substantial number of partners from being exposed to asymptomatic STIs and decrease transmission,” they concluded.
Ryan White-Funded Providers Fill Critical HIV Care Needs in Rural U.S.
The Ryan White HIV/AIDS Program (RWHAP) is a small but critical component of HIV care and services in rural U.S. communities, according to a study published in PLoS One.
In 2017, only 132 of the 2,113 providers funded through that program were located in rural areas, the study found. Yet compared to non-rural providers, the array of services offered by these rural Ryan White HIV/AIDS Program providers was more comprehensive:
- 45% of rural providers were funded for ≥ 5 services, compared to 34% of non-rural providers.
- Oral health care was offered by 45% of rural providers vs. 28% of non-rural providers.
- Emergency financial assistance was offered by 26% of rural providers vs. 18% of non-rural providers.
- Food banks or meals were offered by 24% of rural providers vs. 15% of non-rural providers.
While only 2.3% of Ryan White clients get their care solely from rural providers, this minority tends to be older and more likely to live at incomes below the federal poverty level, the study found. Transportation is often an issue among rural Ryan White patients, with almost 40% of rural providers receiving RWHAP funding for medical transportation.
Study authors also noted that inclusion of mental health and substance use services by rural HIV providers helps to address the intersection of three epidemics: opioid use, HIV, and hepatitis C.