This Week in HIV Research: Health in Unity

Men who have sex with men (MSM) in serodiscordant relationships could benefit from dyad-level interventions to improve HIV medication adherence among both partners, a study published in Journal of Acquired Immune Deficiency Syndromes suggested.

The study analyzed data from Project Stronger Together, a randomized controlled trial of serodiscordant male couples in three U.S. metropolitan areas. One-hundred twenty HIV-negative partners were assessed every six months for a total of 24 months. At baseline, 42% of participants were on PrEP and 63% of partners living with HIV were virally suppressed.

PrEP use was found to be twice as common among participants whose partners had an undetectable HIV viral load compared to participants whose partners were viremic. By contrast, a partner’s level of self-reported HIV treatment adherence did not appear to affect a person’s decision to take PrEP—nor did whether the HIV-positive partner was currently taking HIV medications at all.

A person can encourage their partner’s healthy behavior; such concern, in turn, can strengthen the relationship, which in turn can increase both partners’ motivation to stay healthy by taking HIV medications for prevention or treatment, study authors theorized. Dyad-level interventions may help to start such a virtuous cycle. “We do want to emphasize the important [sic] of having collective goals because dyadic benefits of mutual pill-taking do exist,” study authors wrote.

All that said, in the era of U=U, mutually monogamous couples may not need PrEP if the HIV-positive partner has an undetectable viral load while on HIV treatment, the authors noted.

Study limitations included self-reported data, lack of information on insurance status, exclusively urban study sites, and the possibility that those volunteering for this study may be more health conscious than the general public.

A peer network approach using social media may help to increase PrEP uptake among young Black men, according to data from the PrEPChicago trial published in Journal of Acquired Immune Deficiency Syndromes.

Four hundred twenty-three participants were randomized to either an intervention or control arm. The intervention consisted of opinion leader workshops and telephone booster sessions. Each participant had an average of 1,822 contacts on Facebook; social contacts who were referred to a PrEP assessment were more likely to be linked to a participant in the intervention arm than in the control arm (adjusted odds ratio: 1.50).

Referrals were most likely within three days of a workshop, but the effect remained strong for three months. While the booster sessions did not increase referrals, they may have helped to maintain long-term engagement, study authors noted.

The authors also offered that additional referrals for PrEP assessment may have occurred outside the social media platform, and Facebook friends may have referred their own contacts to PrEP screenings. However, such onward diffusion was not measured.

The findings show that a single, in-person session may be a low-cost, scalable intervention to increase PrEP uptake, study authors concluded, calling for further research into the use of such interventions to help end the HIV epidemic.

The presence of hepatitis C antibodies remains quite common among men who have sex with men, a U.S. study published in Clinical Infectious Diseases found.

Data for this study came from the HPTN 078 trial (on the role of integrated case management in achieving viral suppression), which included 1,287 participants screened between March 2016 and December 2017 who had HCV antibody results available.

Overall, 19% of the screened participants were positive for HCV antibodies, indicating an infection with that virus at some point in the past. It is unclear how many of these were spontaneously cleared and how many required medications. The difference in prevalence between people living with HIV (PLWH),who comprised 70% of the study population, and HIV-negative participants was not statistically significant: 20% among PLWH versus 17% among HIV-negative people).

Hepatitis C is mainly spread by needle sharing, although sexual transmission is also possible. Lacking data on injection drug use, researchers used receipt of substance use counseling as a proxy. Thirty-six percent of participants who had received such counseling had hep C antibodies, compared to 15% of those who didn’t get counseling. Unstable housing was also associated with a greater likelihood of previous HCV infection.

Study authors recommended that hepatitis C screening be co-located with substance use treatment and be offered through organizations that serve people experiencing homelessness. They also suggested that guidelines be updated to recommend regular screening for HIV-negative MSM not on PrEP who report HCV risk factors.

Doxycycline prophylaxis against mycoplasma genitalium, a sexually transmitted bacterial infection that causes non-gonococcal urethritis, is not effective in MSM, data from the French ANRS IPERGAY study published in Clinical Infectious Diseases showed.

Two-hundred-ten participants were tested for MG at three sites (urine, anal, and throat swabs) at baseline and six months later. Overall prevalence was around 10% at each timepoint; it differed little between those receiving post-exposure prophylaxis with doxycycline and those without such PEP.

Analyzing the bacterium itself, 68% of specimen were resistant to azithromycin, 9% to fluoroquinolones, and 13% had a mutation associated with tetracycline resistance. Such high rates of resistance against common antibiotics could make this STI difficult to treat in the future, study authors warned.

The 2016 French guidelines preferred a five-day course of azithromycin for uncomplicated mycoplasma genitalium. They were revised in 2019 to suggest no treatment at all in asymptomatic patients to preserve treatment options for those who need them. The study authors stated that these findings continue to support that no-treat recommendation.

Before prescribing antibiotics to symptomatic patients, resistance testing should be performed, study authors suggested.