This Week in HIV Research: Just a Text Away
As plenty of parents of millennials have long since learned, if you want to effectively contact your child, you don’t call, you don’t send an email, you don’t post on their Facebook page—you text them. Our featured study this week suggests much the same is true when it comes to improving retention in HIV care.
The slate of HIV-related published findings we investigate this week include new data suggesting that:
- We should forget about those email reminders telling patients their next appointment is soon; texting may be the care-retention mother lode.
- HIV exposure at birth may warrant close health monitoring well beyond childhood, due to emerging long-term obesity and breathing concerns.
- HIV may work synergistically with cardiovascular risk to impair cognitive function.
- Direct-acting antiretrovirals are highly effective in people coinfected with HIV and hepatitis C—but treatment initiation delays are common.
So hey, put down that smartphone for a second—well, unless you’re reading this on one—and let’s spend some quality time learning a little more about each of these studies. To beat HIV, you have to follow the science!
HIV Care Retention Improved by Texts, Stigma Support—But Not Email
Text message reminders of upcoming clinic appointments and help with handling stigma proved to be the most effective clinic measures for retaining patients in care, a U.S. study published in Clinical Infectious Diseases found.
The retrospective cohort study followed 21,046 PLWH at seven clinic sites for a total of 103,348 person-years. Overall, 67% of participants were retained in care, compared to a U.S. average of 49%. Study sites were “centers of excellence,” which may have better resources than a general HIV clinic and may therefore be better equipped to keep people in care, study authors explained.
Text messages appeared to have the greatest impact, potentially increasing retention by 21% within clinics that did not currently offer them, the researchers determined. (However, only two study sites actually sent such texts at the time of the study.) Stigma support services, which were offered at four study sites, would increase retention in care by 9% in sites where such services were not currently offered, the authors calculated. Email reminders, on the other hand, lowered retention—possibly because texting access is more widespread than email access.
These services covered a wide range of practices, and providing additional clinic-patient contact points may have contributed to the result, study authors noted. They nonetheless recommended that HIV clinics implement text reminders and stigma support to improve retention.
Health of HIV-Exposed Children Should Be Monitored Into Adulthood, Findings Suggest
People born to women living with HIV (WLWH) in the U.S. may be predisposed to obesity and reactive airway disease (RAD, which causes asthma-like symptoms) even if they never become perinatally infected, a small study at Massachusetts General Hospital that was reported in Journal of Acquired Immune Deficiency Syndromes found.
The study matched 50 adolescents and young adults born to WLWH with 141 young people who were born to HIV-negative mothers. Obesity and RAD were significantly more common among those exposed to HIV in utero than the control group (42% vs. 22% for obesity, 40% vs. 23% for RAD).
Ongoing inflammation and other effects of HIV on the mother’s body might explain the observed results, but RAD is multifactorial, study authors noted. While controls were matched on ZIP code as a proxy for socioeconomic status, no data on individual household income or infant feeding practices were available, they acknowledged.
“These results underscore the need for all children of mothers with HIV—even those who are HIV-negative—to be screened and continually monitored over their lifetimes by clinicians attuned to their health risks,” Lindsay Fourman, M.D., the study’s lead author, commented in a press release.
HIV May Accelerate Impact of Cardiovascular Risk Factors on Cognitive Function
Baseline cardiovascular risk scores significantly predicted the likelihood of cognitive function impairment four years later in a prospective observational cohort of 988 people living with HIV (PLWH). The results appear similar to those found in dementia studies of the general population, but the effects on cognition occurred earlier in PLWH.
The study found that two of the factors included in the CV risk score, diabetes mellitus and high-density lipoproteins, were independently associated with lower cognitive function. Thus, the effect of CV risk factors appears to be cumulative, study authors suggested.
Twenty percent of the cohort consisted of women, and the study found that the association between cardiovascular disease (CVD) risk and cognitive impairment was especially pronounced in women compared to men. The Atherosclerotic Cardiovascular Disease (ASCVD) risk score predicted cognitive function difficulties at a standard deviation of -2.17 for women and -0.78 for men. This sex difference, which is also observed in general population studies, may be related to the lower initial CV risk in women or differences in vascular physiology, although the specific mechanism is unknown.
The mean age of study participants was 52 years. Most of them were long-term virally suppressed—a fact that may prevent the results from being generalizable to all PLWH in the U.S., study authors cautioned.
“Our findings raise key questions regarding the mechanisms underpinning the observed associations between CV risk and cognition, including whether a critical window exists during which lowering CV risk may preserve cognitive health and prevent cognitive decline in PLWH,” they concluded.
Modern Hepatitis C Treatment Equally Effective in Coinfected vs. Monoinfected People, Delays Notwithstanding
An analysis of data on 312 people who took direct acting antivirals (DAAs) for the treatment of hepatitis C (43% of whom were coinfected with HIV) showed similar sustained virologic response rates in PLWH and monoinfected participants—that is, once the researchers corrected for the greater number of monoinfected participants lost to follow-up. The study was published in PLOS One.
Coinfection was associated with a longer time before starting DAAs. Other factors for delay were Medicaid insurance, the need to switch or discontinue non-DAA medications, and comorbid psychiatric or substance use issues. “Among these, having Medicaid insurance caused the most significant delay with a nine-fold increase in the time to treatment initiation,” study authors explained.
Treatment delays due to antiretroviral changes should become less common as fewer HIV/hepatitis C-coinfected people are prescribed HIV antiretroviral regimens containing tenofovir disoproxil fumarate (TDF) and more receive regimens containing tenofovir alafenamide (TAF) instead, due to treatment changes necessitated by interactions between TDF and some hepatitis C medications.
Study authors also recommended the following to reduce time to HCV treatment start:
- Provide resources to address social determinants of health.
- Help with insurance approvals for HCV medications.
- Manage drug interactions, preferably with the help of a clinical pharmacist.
- Establish clear communication between all providers, as well as between provider and patient.
- Develop methods for keeping people in care.