New research was presented at AIDS 2018, the 22nd International AIDS Conference, from July 23-37 in Amsterdam, The Netherlands. The features below highlight some of the studies that emerged from the conference.
Cancer in Teens With Perinatally Acquired HIV
While research indicates that adults living with HIV have an increased risk of malignancy when compared with counterparts without the infection, data are lacking on the levels of this risk among teenage young adults (TYA) living with perinatally acquired HIV (PaHIV). For a study, researchers assessed mortality, cancer presentation, immunology, and virology among TYAPaHIV compared with age-matched participants in the general population. TYAPaHIV had an overall mortality rate 9.4 times that of the age-matched general population. The incidence rate of malignancy was 3.0 per 1,000 person-years in TYAPaHIV, with an incidence rate ratio of 12.9 when compared with the age-matched general population. Excess in malignancy by TYAPaHIV was driven mostly by lymphomas.
Frailty & HIV
Studies have shown frailty to be associated with morbidity and mortality in the general geriatric population. However, less is known about the impact of frailty on mortality, incident comorbidity risk, and factors associated with frailty progress among people living with HIV (PLWH). Study investigators analyzed this data among PLWH and matched cohorts without HIV. Rates of frailty were 8.5% among HIV-positive participants and 3.4% among HIV-negative participants. All-cause mortality rates were 5.2 and 3.8 per 1,000 person-years of follow-up for HIV-positive and HIV-negative participants, respectively. Those who were frail had a shorter time to death, with frailty found to be independently associated with mortality after adjusting for HIV status, age, and number or pre-existing comorbidities. Frail participants also had higher odd of developing at least one comorbidity after adjusting for HIV status, age, gender, ethnicity, education, and number of pre-existing comorbidities. No interaction was found between frailty and HIV-status on mortality or incident comorbidity risk.
Suppressed HIV Not Transmitted in Serodiscordant Gay Couples
The 2015 PARTNER study found no transmission of HIV during more than 53,000 condom-less sex acts in gay and heterosexual serodiscordant gay couples in which the HIV-positive partner had a suppressed viral load. However, there were few men who have sex with men (MSM) in the study and follow-up times for MSM in the study were short. As a follow-up study, researchers assessed the protective effect of suppressive treatment to see if it would hold up for HIV-negative gay men who had receptive anal sex with HIV-positive partners without a condom. During 1,600 couple-years of follow-up, the men had condom-less sex 77,000 times, with no linked HIV transmissions.
Donor Cuts Threaten Global HIV Progress
Data are limited on whether the downward trend in development assistance for HIV threatens global progress against the disease. To address this and other research questions, study investigators estimated HIV expenditures by source and function in 188 countries from 2000 to 2015. The team found that of $48 billion spent on HIV in 2015, about 62% came from domestic spending by governments and about 30% from development assistance. In countries with high HIV prevalence, nearly 80% came from development assistance. With a report from the Kaiser Family Foundation and UNAIDS finding that eight of 14 donor governments reduced their spending on global HIV efforts in 2017 and increases in spending from 2016 to 2017 largely due to United States support that is not expected to last, the study authors state that nearly two decades of progress against the disease will be in jeopardy.
User-Initiated PrEP Switches
Daily pre-exposure prophylaxis (dPrEP) or event-driven PrEP (edPrEP) can be offered at the choice of the user to meet individual HIV prevention needs for at-risk people. As needs may vary over time, a study was conducted to assess user-initiated switches and factors associated with them during the first 2 years of follow-up among HIV-negative men who have sex with men (MSM) and transgender people (TGP). At baseline, 73% chose dPrEP. In total, 28% of participants switched regimens 154 times, with 35% switching more than once. Among switches, 51% were from dPrEP to edPrEP, and 49% from edPrEP to dPrEP. The cumulative proportion of participants who switched 2 years after PrEP start was 30%. Older age was associated with switching from for both regimens. Among those who started edPrEP, a higher number of sex acts with casual partners was associated with a higher switch hazard.
Treating Opioid Use Disorder in HIV/HCV Co-infection
Studies suggest that untreated opioid use disorder (OUD) impacts the care of HIV/hepatitis C virus (HCV) co-infected people who inject drugs (PWID). Other research indicates that some in this population are engaged in HIV care, adherent to HIV therapy, and increasingly offered HCV treatment. While integrating medication of OUD into the care of this population may improve outcomes, the clinical impact and costs of doing so are unknown. To do so, the cost-effectiveness of integrating OUD medications into onsite HIV/HCV treatment for this population was compared with the status quo (referral to offsite OUD care) for a study. Status quo therapy resulted in life expectancy of 10.85 years and 3.61 quality-adjusted life-years (QALYs) at a cost of $4364,400. Integrated care extended life expectancy by 0.35, provided an additional 0.23 QALYs, and, when compared with status quo care, had an incremental cost-effectiveness ratio of $59,000 per QALY. Integrated care resulted in fewer reinfections and deaths and decreased the burden of liver-related mortality.