New research was presented at AIDS 2012, the 19th International AIDS Conference, from July 22-27 in Washington, DC. The features below highlight just some of the studies that emerged from the conference.
Multiple Benefits With Early HIV Treatment
The Particulars: Research has indicated that early treatment of HIV helps prevent various adverse outcomes. A landmark trial (HPTN 052) recently found that effective early treatment of HIV appears to help prevent transmission among heterosexuals.
Data Breakdown: Two analyses of HPTN 052 were conducted. The first reviewed HIV patients who underwent immediate therapy when compared with those whose treatment began after CD4 counts fell below 250 cells/mm3. Immediate therapy was associated with longer time to an AIDS-defining event and to tuberculosis. The second analysis, conducted in similar patients, found that early HIV treatment was cost-effective, and in some cases, perhaps less expensive than delaying therapy.
Take Home Pearls: Early treatment of HIV appears to reduce the risk of AIDS-defining events and tuberculosis. Early treatment also appears to be cost-effective.
HIV/HCV Co-Infection & Outcomes
The Particulars: HIV has been shown in previous studies to accelerate hepatitis C virus (HCV) progression. Whether antiretroviral therapy (ART) slows this progression has not been explored in clinical trials.
Data Breakdown: In a study, the outcomes of patients with HIV/HCV co-infection—all of whom were on ART—were compared with those of patients with HCV only. Co-infected patients had a 6.3% rate of hepatic decompensation, compared with 5.0% for those with HCV only. Hepatocellular carcinoma developed in 1.2% of co-infected patients, compared with 0.9% of HCV patients. The mortality rate was 32.9% for co-infected patients, compared with 15.4% for HCV-only patients.
Take Home Pearls: Patients co-infected with HIV and HCV appear to have a higher risk of hepatic decompensation, even when on ART, than patients with HCV alone. When compared with people who have only HCV, those with HIV/HCV co-infection appear to have higher mortality rates.
HIV & Cervical Cancer Risk
The Particulars: Cervical cancer screening guidelines for women aged 30 and older recently included the recommendation to increase the interval between Pap tests from 3 years to 5 years. It is unknown if a 5-year interval could be used in women with HIV who are cytologically normal and oncogenically HPV-negative.
Data Breakdown: Researchers conducted a study comparing the 5-year cumulative incidence of cervical cancer among HIV-positive women with HIV-negative women. At 5 years, the incidence of squamous epithelial intraepithelial lesions that are high grade or greater (HSIL+) and of carcinoma in situ (CIN) was similar in both groups of women. No oncogenic HPV was detected in 88% of HIVinfected women, compared with a 91% rate for women uninfected with HIV.
Take Home Pearl: The 5-year cumulative incidence of HSIL+ and CIN appears to be similar in women with HIV and women without HIV when their Pap tests are cytologically normal.
Effects of Depression on HIV Treatment
The Particulars: HIV and depression are significant illnesses in their own right. The effects of depression on patients with HIV are not well studied, particularly regarding how depression affects adherence to antiretroviral treatment.
Data Breakdown: Two cohort studies investigating insured HIV patients found that symptoms of depression were significantly associated with a lack of retention in care. Depression was also associated with increased risk of failure of viral suppression. Men with depression were more likely than depressed women to remain in care and significantly less likely to experience failure to achieve viral suppression.
Take Home Pearl: Symptoms of depression appear to be associated with viral suppression failure and poor retention in care among patients with HIV.
A Look at Adolescent HIV Risk
The Particulars: Many efforts have been undertaken to encourage teens to reduce their risk of being infected with HIV through safer sex over the past 2 decades. The effects of these efforts are not well known.
Data Breakdown: CDC investigators explored the progress of HIV risk reduction efforts between 1991 and 2011. While more teens in 2011 were practicing safe sex than in 1991, most of the progress in this area occurred before 2001. Condom use increased until 2003 but declined through 2011. Rates for ever having sexual intercourse were 54.1% in 1991, 45.6% in 2001, and 47.4% in 2011. Rates for having had sex with four or more partners were 18.7%, 14.2%, and 15.3%, respectively.
Take Home Pearls: Although teens have reduced risky behaviors associated with HIV over the past 2 decades, progress appears to have stalled since 2001. Education on HIV prevention may help address these risky behaviors.