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Conference Highlights: IDWeek 2017

Conference Highlights: IDWeek 2017
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New research was presented at IDWeek 2017, the combined annual meeting of the Infectious Diseases Society of America, Society for Healthcare Epidemiology of America, HIV Medicine Association, and Pediatric Infectious Diseases Society, from October 4 to 8 in San Diego. The features below highlight some of the studies that emerged from the conference.
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Comorbidities Screening in HIV Patients

For a study, researchers analyzed medical records of HIV patients to determine screening frequencies for potential comorbid conditions and clinical factors associated with screening the previous 12 months. Only 18% of patients were screened for hepatitis B, 26% for hepatitis C, 37% for diabetes, 38% for gonorrhea, 41% for chlamydia, 42% for tuberculosis, and 46% for syphilis. Patients with three or more medical visits with CD4 count or viral load tests during the previous year were significantly more likely to be screened for sexually transmitted infections (STIs) and hepatitis C. When compared with African-American patients, Hispanic patients were more likely to be screened for hepatitis C, and Caucasian patients were less likely to be screened for diabetes. Self-reported sexual risk behaviors and injection drug use were not associated with screening for STIs or hepatitis C, respectively.

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Continuous Virologic Suppression & Non-AIDS Diagnoses

The distribution of non-AIDS diagnoses (NAD) among early diagnosed and treatment patients with HIV who had equal access to care was examined for a study that sought to evaluate the effect of continuous virologic suppression (CS) on NAD. Among the 15.2% of patients with NAD, the most common were cardiovascular disease (4.4%) and acute renal failure (2.8%), followed by chronic kidney disease (2.0%), anal cancer (1.0%), cirrhosis (0.8%), and prostate cancer (0.6%). Older age at antiretroviral therapy initiation and female gender were associated with NAD, whereas higher CD4 cell count was protective. Although not statistically significant, hazard ratios for NAD trended toward demonstrating a benefit for CS.

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Herpes Zoster Incidence in Patients With HIV

Current herpes zoster incidence data are needed to guide vaccine strategies, but are lacking, among patients with HIV. An examination of data on nearly 3,000 patients in the US Military HIV Natural History Study found that 8% were diagnosed with herpes zoster. At herpes zoster diagnosis, patients had an average age of 38.6 years, CD4 count of 461 cells/uL, and viral load of 1,900 copies/mL. Incidence rates for herpes zoster in the study population declined from 3.24 cases per 100 person years of follow-up in 1996 to 0.9 cases per 100 person years of follow-up in 2011-2016. Longer time from HIV diagnosis to antiretroviral therapy (ART) initiation was associated with herpes zoster, whereas ART use, higher CD4 count, recent year of HIV diagnosis, and older age were protective.

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Water Intake & Repeat UTIs

While increasing water intake to flush bacteria from—and diminish concentrations of in—the bladder has been recommended for years for patients experiencing repeat urinary tract infections (UTIs), few, if any, prospective trials have backed this recommendation. Premenopausal women who had experienced at least three UTIs and self-reported daily fluid intake below 1.5 liters were instructed to increase fluid intake by 1.5 liters per day or continue usual intake for a 1-year study. Average daily intakes were 2.8 liters for the intervention group and 1.2 liters for the control group. At 1 year, the intervention group had 48% fewer UTIs. Times until the first recurrent episode of acute uncomplicated cystitis and between episodes were 148 and 143 days, respectively for the intervention group, compared with 93 and 85 days for the control group. The intervention group also required 47% fewer courses of antibiotics.

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Characterizing New HIV Infections in Older Adults

Evidence suggests that HIV prevention efforts mostly target younger people, leaving the characterization of HIV transmission in older adults less well known. For a study, HIV transmission characteristics of patients aged 45 and older were compared with those of patients aged 13 to 44. Among HIV-infected patients, acute HIV infection was diagnosed in approximately 13% of both older and younger participants. Among HIV-infected patients who participated in partner notification, older participants were less likely to report meeting a sex partner online (11.3% vs 26.9%) and less likely to name two or more sex partners (31.5% vs 46.8%).

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HIV Risk Behavior, Partnership Type, & PrEP Adherence in MSM

Due to a lack of data, study investigators examined the effect of recent HIV risk behavior and partnership type on pre-exposure prophylaxis (PrEP) adherence among HIV-at-risk men who have sex with men (MSM). No significant changes in HIV risk category from baseline to week 48 were seen among the 313 MSM. However, the proportion of those with no or one HIV-negative partnerships increased from 1% to 9% during this period. Moderate- and high-risk groups had higher tenofovir-diphosphate (TFV-DP) levels at week 48 than did the low-risk group. Participants with no or one HIV-negative partner also had significantly lower TFV-DP levels than those with one HIV-positive partner or multiple partners.

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