This Week in HIV Research: What’s in Your Head

While modern antiretroviral therapy has dramatically improved the medical management of HIV, living with the virus still involves managing burdens that a significant portion of PLWH need assistance in navigating, a Dutch study published in The Lancet HIV found.

Researchers combined an online survey of 438 men who have sex with men (MSM) with 18 in-depth interviews. Thirty-one percent of survey respondents said they considered the overall experience of living with HIV to be a “high burden” with negative consequences on their lives, while 46% identified HIV as a “medium burden” with neutral consequences, and the remaining 23% said living with HIV was no burden at all. Only 12% of respondents said their quality of life had become worse since their HIV diagnosis.

That said, there were clearly areas in which a substantial number of survey respondents reported challenging experiences as people living with HIV. The most troublesome issue was disclosure, which respondents indicated often translated into difficulties initiating sex and establishing relationships. Some viewed it as a no-win situation: Telling others might invite stigma and rejection, but not telling them meant the burden of carrying a big secret.

Acknowledging the need to go beyond medical issues in defining success in the country’s fight against HIV, the Netherlands has added another step to its HIV treatment cascade goals: By 2030, 90% of Dutch PLWH who are virally suppressed should have a good quality of life.

“These results highlight the importance of continuing stigma reduction programs and adapting psychosocial guidance and counselling to the present realities of living with HIV as a chronic illness,” study authors concluded.

PLWH with asymptomatic neurocognitive impairments are more likely to progress to HIV-associated neurocognitive disorder than neuropsychologically normal PLWH, a Canadian observational cohort study published in AIDS showed.

Overall, 24% of 720 study participants progressed to HAND. The 317 participants who showed asymptomatic impairments at baseline were more likely to progress (adjusted hazard ratio: 1.88). Other risk factors for worsening neurocognitive problems were depression, cigarette smoking, and being a woman.

The authors hypothesized that the findings regarding women may be partly explained by differences in demographic characteristics (e.g., educational level), but acknowledged that biological factors, such as menopause, may also play a role.

The association between neurocognitive issues and depression has been previously established; this research largely replicated earlier studies conducted in the U.S., although the current study took place in a country with universal health care access and in which local AIDS organizations are able to offer an array of supportive services.

The link between HAND and cigarettes, however, is less clear. In this study, participants who currently smoked were 2.5 times more likely to progress to HAND compared to former or never smokers. Findings have been contradictory in other studies.

“Despite better access to treatment and supportive services, participants with [asymptomatic neurocognitive impairment] had higher risk of progression to symptomatic HAND suggesting that, in addition to early initiation of [antiretroviral treatment], managing comorbidities and other factors (e.g., mental health, smoking) may be important in lowering risk for development of HAND,” study authors concluded.

A campaign that provides relatively small financial incentives with the provision of HIV prevention information appears to successfully increase HIV testing rates and prevention knowledge among Latinx MSM and transgender women, a “quasi-experimental pilot study” published in Journal of Acquired Immune Deficiency Syndromes found.

The study was conducted at Bienestar, an HIV clinic in Los Angeles County that serves primarily Latinx clients. HIV-negative participants (n=218) were split into two groups, one of which only received informational text messages about HIV prevention (this group was called Information Only), and the other of which received the same messages but also had periodic opportunities to win prizes (such as $50 Target gift cards) for correctly answering quizzes or being tested for HIV quarterly (this group was called Information Plus).

Both interventions increased HIV testing rates: Whereas Bienestar clients not involved in the study were tested at a 13% rate, the quarterly HIV testing rate was 22% in the Information Only group and 25% in the Information Plus group. Although the study was not powered to identify which of the two intervention arms was actually superior, the authors nonetheless found that the Information Plus group appeared to yield a “clinically important” level of additional benefit. Demonstrated HIV risk knowledge also appeared to improve within the Information Plus group but not the Information Only group, the authors stated.

“Our findings suggest that simple text messages combined with small incentives based on [behavioral economics] insights may have the potential to positively impact critical prevention behaviors such as HIV testing, warranting a fully-powered investigation to determine the intervention’s full effect,” the study authors wrote.

If every person who received a test for SARS-CoV-2, the virus that causes COVID-19, also received a rapid HIV test at the same time, up to 17% of future HIV seroconversions could ultimately be averted, according to a model of six U.S. cities that was published in Clinical Infectious Diseases.

Researchers compared different scenarios involving a range of COVID-19 impacts on HIV-related health services, personal risk behaviors (for both HIV and COVID-19), and access to linked HIV and SARS-CoV-2 testing. Their modeling sought to calculate the impact of each scenario on HIV incidence from 2020 through 2025. The model used Atlanta, Georgia; Baltimore, Maryland; Los Angeles, California; Miami, Florida; Seattle, Washington; and New York City.

The study authors calculated that, depending on the level of disruption in HIV-related services and the extent to which people reduced their risk behaviors, the introduction of opt-out testing for HIV linked to SARS-CoV-2 testing could avert anywhere from 1.6% of new HIV infections in those six cities (assuming that 10% of the adult population received linked testing) up to 17.2% (assuming that 90% of the adult population received linked testing).

To minimize interaction with health care staff, a self-administered oral swab could test for HIV, the researchers noted. They added that while fingerstick HIV testing would require more interaction, it could also allow for screening of hepatitis C and other viruses, as well.

The modeling study was intended to assess not only the efficacy of linked testing, but also the cost. Although the price tag was significant (up-front costs alone ranged from $21 million at the 10% linked-testing level to $221 million at the 90% level), the authors argued that the short-term investment would be offset by long-term savings in health care costs due to fewer people living with HIV.

Beyond cost, potential roadblocks to implementation of a linked-testing approach included insufficient lab capacity to process both tests, insufficient staff for HIV testing, and the possibility of fewer people volunteering to be tested for SARS-CoV-2 if they knew that HIV testing would also be offered. On the other hand, “Incorporating HIV testing and linkage to care within SARS-CoV-2 viral and serological testing, when done responsibly and with input from the most affected communities, could be a promising approach to addressing these overlapping racial/ethnic health disparities in the United States,” the study authors wrote.