Smoking Cessation & Caner Risk in HIV Patients
Previous studies suggest that the impact of smoking is much greater in patients with HIV than in the general population. However, research on the long-term outcomes of HIV patients who quit smoking is lacking. For a study, investigators reviewed outcomes among nearly 40,000 HIV-infected active smokers, ex-smokers, and non-smokers. Among ex-smokers, the risk for most cancers at 1 year after quitting was about the same as what was observed among non-smokers. However, lung cancer risk was 11 times higher at 1 year after quitting and eight times higher after 5 years. The authors note that the findings are contrary to those of similar studies, which have shown a consistent decline in lung cancer incidence with increasing time since smoking cessation among HIV-negative people.
HCV Treatment as Prevention?
In prior research, researchers found that initiating a policy for unrestricted reimbursement for new, direct-acting agents against chronic hepatitis C virus (HCV) resulted in 76% of HIV-positive people in the Netherlands being cured in 14 months. However, little is known about the impact of such a policy on new cases of HCV among men who have sex with men. In a new analysis, investigators compared the incidence of acute HCV in the year before initiating this type of policy with HCV rates at 1 year after the policy was set forth. During the year before initiation, the acute HCV incidence rate was 11.2 per 1,000 person-years follow-up. During the year after initiation, the incidence rate dropped to 5.5 per 1,000 person-years follow-up. The study authors noted that although their findings may be the result of changes in behavior, HCV was the only sexually transmitted disease that declined during the study period.
Post-Exposure Prophylaxis Reduces STIs
Rates of sexually transmitted infections (STIs)—particularly syphilis and drug-resistant gonorrhea— have been rising among men who have sex with men (MSM) for more than 6 years, increasing susceptibility to HIV among this patient population. For a study, MSM were randomized to receive STI prophylaxis or no such prophylaxis. Men in the prophylaxis group were instructed to take two 100-mg doxycycline pills during the 72 hours after condom-less sexual intercourse. At a median of 8.7 months follow up, men in the prophylaxis group had a 47% lower rate of STIs. Risk reductions for gonorrhea, chlamydia, and syphilis were 17%, 70%, and 73%, respectively. Overall, 71% of men in the study were asymptomatic.
Disease Progression in Untreated HIV-2
Anecdotal evidence suggests that most patients infected with HIV-2 do not experience severe pathogenic consequences throughout the disease course. However, conclusive survival data are lacking from cohorts with long-term follow-up. For a study, researchers followed 312 people infected with HIV-1 or HIV-2 after enrollment in a cohort with 23 years of follow-up. The median times to AIDS and mortality were 14.3 years and 15.6 years, respectively, for HIV-2 infected patients, whereas these times were 6.2 years and 8.2 years, respectively, for HIV-1 infected individuals.
Patients Lack Confidence in PrEP
Pre-exposure prophylaxis (PrEP) can help reduce risks for new HIV infections. However, a better understanding of PrEP users’ perspectives is needed to help clinicians optimize uptake of this treatment and anticipate barriers to implementing it. To address this research gap, investigators analyzed serodiscordant couples’ understandings of and feelings about PrEP. Couples generally understood that antiretroviral therapy (ART) helps prevent HIV transmission to uninfected partners, but some doubted that ART alone could protect them from acquiring the virus. Others lacked confidence in PrEP and expressed concerns about the effectiveness of ART for prevention in the absence of other methods of protection. There were also misunderstandings about how viral suppression and sustained ART use reduces infectiousness and HIV risk. Many patients preferred using multiple methods of protection simultaneously.
HIV Screening & Costs in Heterosexuals
The cost-effectiveness of HIV screening for men who have sex with men and injection drug users has been well documented, but few studies have explored the cost-effectiveness of HIV screening and frequency among heterosexuals, particularly those who have historically been considered at high risk of HIV. For a study, researchers examined HIV screening at various frequencies for the mutually exclusive general heterosexual and high-risk heterosexual populations. With the general heterosexual population screened every 20 years, screening high-risk heterosexuals as frequently as annually was cost-effective compared with screening every 3 years. Screening high-risk heterosexuals annually compared with every 20 years reduced projected cumulative HIV incidence for the total population by 5%.
NEWS FROM CROI 2017
MORE FROM CROI 2017