New research was presented at AIDS 2022, the 24th International AIDS Conference, from July 29-August 2. The features below highlight some of the studies presented during the conference.

ART-Related Recovery Predicts Mortality in Patients Starting Treatment Late

Data indicate that one-half of patients with HIV in Western countries are diagnosed late, which has a negative effect on life expectancy and the incidence of comorbidities. Researchers, however, do not fully understand determinants of long-term mortality or the impact of beginning an integrase inhibitor (INSTI)-based antiretroviral therapy (ART) regimen. To assess this, Juliana Reyes–Urueña, MD, PhD, MPH, MSc, and colleagues examined treatment-naïve adult patients who initiated ART between 2005 and 2020 and survived for the first 2 years, estimating mortality rates (MR) upon immune recovery 2 years after starting ART and related prognostic factors. They also examined risk factors for incomplete immune recovery at 2 years (defined as CD4 counts ≤500 cells/µL). Among 2,719 participants, more than one-half (53%) were late presenters, among whom only 44% reached CD4 counts of greater than 500 cells/µL at 2 years. In total, 113 patients (4.2%) died (crude all-cause MR, 7.3/1,000 person-years; 95% CI, 6.0-8.7). Late presenters experienced greater MR than nonlate presenters, except for those reaching CD4 counts of more than 500 cells/µL at 2 years, regardless of nadir CD4 counts. On multivariate analysis, risk factor for death included a CD4 recovery of less than 500 cells/µL, a viral load of more than 200 copies/mL at 2 years, and injection drug use. Starting an INSTI-based regimen (N=979) was associated with a trend toward reduced mortality compared with other regimens and with favorable immune recovery (CD4 counts >500 cells/µL; aOR, 0.70).

HIV Exposure Impacts Long-Term Health of HIV-Negative Children

Previous research has shown an increased risk for morbidity and mortality in early life among children exposed to HIV but uninfected with the virus (cHEU). However, the need for follow-up care following the confirmation of HIV negative status is unknown. Jeanne Brochon, MD, and colleagues examined long-term risk for hospitalization and chronic disease incidence among cHEU compared with HIV-unexposed and uninfected (cHUU) controls in a longitudinal cohort study. Investigators followed 726 cHEU and 2,178 cHUU for a median of 11.1 years. They observed a significantly greater risk for hospitalization among cHEU compared with cHUU (P<0.001), a finding that retained significance after adjustment for gestational age (P=0.001) and in a sensitivity analysis excluding extended (>5 days) hospitalization at birth (HR, 1.21). In their lifetime, cHEU had a significantly greater risk for neuropsychiatric disorders (33.3% vs 26.1%; P<0.001) and congenital anomalies (5.5% vs 3.5%; P=0.016). Dr. Brochon and colleagues observed no difference in risk for chronic cardiovascular, respiratory, or neoplastic diseases. The findings indicate “that cHEU would benefit from enhanced pediatric care, including early neurodevelopmental assessment,” according to the researchers.

Novel Immune Signature May Improve CVD Risk Management in HIV

Evidence demonstrates that cardiovascular disease (CVD) is a common comorbidity among people with HIV on antiretroviral therapy (ART). Petronela Ancuta, PhD, and colleagues examined immunological patterns associated with subclinical coronary artery atherosclerosis in relation to changes in gut-associated lymphoid tissues among
people with HIV on ART and HIV-negative participants. They measured total plaque volume (TPV) and low attenuated plaque volume (LAPV), as well as markers of microbial translocation, lipid profiles, and coagulation. Dr. Ancuta and colleagues also characterized the frequency and expression of chemokine receptors implicated in atherosclerotic plaque infiltration in Th17, Tregs, classical/intermediate/non-classical monocyte, and myeloid/plasmacytoid dendritic cells. Reduced HDL and high levels of triglycerides and most markers of microbial translocation differentiated people with HIV from HIV-negative individuals. Individuals with HIV also had greater rates of Tregs and reduced Th17/Treg ratios. Stratifying people with HIV according to the presence or absence of subclinical coronary atherosclerotic plaque (TPV+vs TPV-) showed decreased Th17 frequencies and Th17/Treg ratios in TPV+ individuals versus TPVindividuals. Following adjustments for age, smoking and LDL or statins, smoking and triglycerides, only the frequency of CCR9+HLADRlow and CCR9-HLADRhigh monocytes remained significantly associated with coronary plaque; the Th17/ Tregs ratio retained its significant association solely when adjusted for age, smoking, and LDL. The findings reveal “a new immunological signature associated with presence of coronary plaque” that could improve management of CVD risk among people with HIV on ART, according to Dr. Ancuta and colleagues.

Vertical Transmission During Pandemic Highest in 5 Years

Using an ongoing perinatal surveillance cohort of births among women with HIV, researchers aimed to determine the impact of the COVID-19 pandemic on access to treatment and perinatal transmission. Joel Singer, PhD, and colleagues examined updated information from 22 pediatric and HIV centers that report data every January on demographics, antiretroviral therapy (ART) during pregnancy, and perinatal transmission. The analysis, which included 2020 births, showed that the number of HIV-exposed infants per year rose over time, with 250 infants born in 2020. HIV acquisition among mothers occurred through heterosexual contact (63%), injection drug use (13%), and perinatal exposure (4.4%). The proportion and number of pregnant women receiving suboptimal therapy from May-December 2020 was 7.7%, compared with 6.6% from 2015-2019; corresponding vertical transmission rates were 3.2% versus 1.3%. Among mothers who acquired HIV through injection drug use, the suboptimal treatment rate was 26.1% during the pandemic, compared with 13.6% before. The findings indicate “disturbing problems in accessing care for addictions, prenatal care, and HIV-specific care in the first waves of the pandemic,” according to Dr. Singer and colleagues, and the need for greater attention to at-risk populations as the pandemic continues.

People With HIV Interested in Long-Acting Injectable Antiretrovirals

While the advent of long-acting injectable antiretroviral (iARV) treatment for HIV has been shown to be welcomed by healthcare professionals, the perceptions of this therapeutic advance among people living with HIV is less clear. To address this, Cynthia Lacoux and colleagues sought to determine the factors associated with interest in iARV among people with HIV. They disseminated a 16-question survey from July-October 2021. Among 581 respondents (79% men; median age, 52), 47% were very interested in iARV. Factors related to a high level of interest included daily intake of non-ARV treatments (aOR=1.9), cohabiting with persons unaware of the respondent’s HIV status (aOR=2.3), confidence in iARV efficacy (aOR=2.8), anticipated improvements in QOL (aOR=6.4), and willingness to continue iARV despite possible side effects (aOR=4.4). The ease of current, non-injectable ARV (aOR=0.6) was associated with a low level of interest in iARV.