The Conference on Retroviruses and Opportunistic Infections, or CROI, held its 2010 annual conference from February 16 to 19 in San Francisco. The features below highlight some of the news emerging from the meeting. For more information on these items and other research that was presented, go to http://retroconference.org/2010.
Hormonal Contraception in Women With HIV
The Particulars: There has been a significant unmet need for contraception among HIV-positive women. Reports from the World Health Organization currently conclude that most forms of contraception are safe for HIV-positive women. Use of hormonal contraception has doubled over the past decade, but had still reached only 19.2% in 2005-2006.
Data Breakdown: A population-based study of 625 women in Uganda who had more than 10 years of follow-up and yearly information on contraceptive use was conducted. Hormonal contraception was associated with a median of 4.45 years longer until AIDS or death compared with no contraception. However, hormonal contraception appeared to offer no more benefit with regard to risk of AIDS and death than other forms of contraception.
Take Home Pearls: Hormonal contraception appears to carry no harm for women with HIV. Users of the pill and other forms of hormonal contraception appear to be protected against progression to AIDS or death.
Increasing the Identification of HIV
The Particulars: Identifying patients with HIV earlier, when they have higher CD4 counts, is important because these individuals are more likely to respond to therapy. Washington, DC has one of the highest rates of HIV in the United States, with an estimated prevalence of 3%.
Data Breakdown: Washington, DC’s Department of Health launched an initiative in 2006 with a three-pronged strategy, which involved providing rapid HIV testing, using social marketing to empower patients to ask for HIV testing in medical settings, and providing immediate linkage to care with confirmatory testing. Researchers noted a 3.7-fold increase in the number of publicly funded HIV tests from 2006 to 2008. New HIV/AIDS case reports increased by 17%, and the proportion of patients entering into care within 3 months of diagnosis also increased. Patients were also identified earlier in the course of their disease, and their HIV infections were not as severe at the time of diagnosis.
Take Home Pearls: A program using rapid HIV testing, social marketing tools, and provision of linkage to care appears to result in increased identification of HIV/AIDS cases, more rapid entry into the healthcare system, and earlier diagnoses of HIV/AIDS. Such large-scale targeted programs can be important in identifying HIV patients early in the course of their disease.
Reducing HIV Transmission Rates
The Particulars: In sub-Saharan countries in Africa, HIV affects about 10% of couples, of which about 60% are HIV discordant between the partners. The drop-off in serum and genital viral loads that accompanies antiretroviral treatment has long been suspected to counteract transmissibility of HIV. To date, limited data are available.
Data Breakdown: A study of 3,408 heterosexual couples in which only one partner was confirmed to have HIV infection was conducted in several African countries. Researchers sought to determine the effect of incidentally starting standard antiretroviral treatment during the trial. The study team observed a 92% reduction in risk of transmission among antiretroviral-treated patients, dropping the incidence of in-couple transmission from 2.23% to 0.39%.
Take Home Pearls: Antiretroviral treatment appears to be highly effective at reducing risk of HIV transmission to uninfected partners. There appears to be a significant treatment benefit for patients initiating antiretroviral therapy when CD4 counts drop below 200 cells/mm3 as well as benefits to their partners.
A Connection Between H1N1 and HIV?
The Particulars: The interaction of the pandemic H1N1 flu with HIV has not been well evaluated. There has been concern among physicians that HIV infection may make H1N1 pandemic flu more dangerous.
Data Breakdown: An analysis of 623 people with confirmed H1N1 flu, including 56 who were HIV-positive, was conducted. HIV-positive patients were mainly male, older, and smokers, suggesting that the flu was not attacking any particular segment of HIV-infected people. HIV-positive patients were less likely to have pneumonia and respiratory failure (9% and 9%, respectively, vs 25% and 21%, respectively). Rates of complications after H1N1 flu diagnosis were similar (12% vs 11%). No HIV-positive flu patients died, although 2% of the others in the cohort died. Among the HIV-positive patients, median CD4 counts and HIV viral loads did not differ before and after the flu.
Take Home Pearls: HIV infection does not appear to make the H1N1 pandemic flu more dangerous. Identifying H1N1 pandemic flu did not appear to worsen the progression of HIV.
Neurologic Impairment in HIV
The Particulars: Recent studies have shown that there appears to be a very early attack against the brain by HIV. Neurological aspects of HIV infection are an area that clinicians often do not pay attention to early in the management of HIV. Events during acute and early HIV-infection stages may set the stage for neurological disease during chronic infection.
Data Breakdown: A study was conducted to assess the impact of neurologic impairment among HIV patients. At baseline, 24 of the 37 participants evaluated a median of 3.5 months after initial HIV infection had evidence of impairment on one or more composite neuropsychological test scores, registering greater than one standard deviation below the mean. One in five patients with acute early HIV infection was diagnosed with neurological impairments. The study found that 16 of the patients had one test indicating impaired functioning, six had impairment observed in two tests, and two patients were impaired on three tests.
Take Home Pearls: Within a few months of infection with HIV, a large percentage of patients appear to exhibit neurological impairments. Whether this impairment reflects premorbid factors or an effect of HIV in the nervous system requires further study with well-matched, uninfected control subjects.
Readings & Resources (click to view)
For more information on CROI 2010, as well as further data on the studies presented in this feature story, go to http://retroconference.org/2010/.