July 20, 2011
In TheBody.com's HIV/AIDS Treatment & Research Update, we take a down-to-earth look at recent, noteworthy HIV-related study results -- especially those that have to do with HIV treatment and health issues among people living with HIV.
A bucket load of HIV treatment- and health-related research is making headlines this week. That's mostly thanks to a major HIV/AIDS research conference in Rome that just wrapped up: the 6th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2011). The meeting, which occurs just once every two years, often features important new study findings.
Here's a sampling of highlights from the conference. Be sure to check out our index of conference coverage for a more complete list!
The biggest story at IAS 2011 -- at least, the story that grabbed the most headlines in the mainstream media -- was the hubbub over pre-exposure prophylaxis, or PrEP. PrEP is a potential HIV prevention strategy in which an HIV-negative person takes HIV medications (usually just once-daily Truvada [tenofovir/FTC] or Viread [Tenofovir]) every day in hopes it will reduce the risk of getting HIV from an infected partner.
So far, those hopes are coming true. Last week, news broke about two studies that showed PrEP could reduce HIV risk by half or more in HIV-negative, heterosexual men and women who had sex with HIV-positive partners. More detailed findings from those studies were presented at IAS 2011. They follow similar findings released last year on PrEP use among men who have sex with men -- and they seem to counter a study earlier this year that suggested PrEP did not work for heterosexual women.
The new study results have sparked an explosion of questions about PrEP, namely over whether (and how) taking HIV medications should become a recommended part of an HIV-negative person's daily diet. But as several HIV/AIDS activists have pointed out, there's another big question to ask here:
Instead of worrying about how to give HIV medications to HIV negative people, why aren't we trying harder to ensure that people who already have HIV receive the medications they need?
Just a couple of months ago, we saw results from a landmark study known as HPTN 052. The study found that HIV-positive people who were on effective HIV treatment reduced their risk of passing HIV to partners by at least 96 percent, and maybe more. Further results from the same study, newly presented at IAS 2011, add more good news: If HIVers start treatment with a relatively high CD4 count -- over 550 -- their odds of developing a serious illness appear to drop by 40 percent.
Most of the people who volunteered for HPTN 052 live in Africa and Asia, so those of us who live in wealthier nations need to be cautious about drawing too many direct conclusions. (The main "serious illness" reported in the study was tuberculosis, which is not a major concern in most Western countries. In addition, while rates of serious illness dropped among those starting treatment early, rates of death did not, although people in the study were only followed for an average of less than two years.) But it is only the latest of an increasingly long string of studies that suggest starting HIV treatment -- and starting it pretty quickly -- is much better for everyone involved than not starting treatment.
And yet, five years after the U.S. Centers for Disease Control and Prevention recommended routine HIV testing for all in the hopes it would increase the number of people who learn their status and get treatment, HIV testing is anything but routine in much of the U.S. Meanwhile, virtually every week for the past year, we've had to pencil a new number in the record books for Longest-Ever Waiting List for U.S. AIDS Drug Assistance Programs. (Right now, more than 8,600 people with HIV in the U.S. are standing by to receive medications through the programs, even though it may be their only way to get access to treatment they otherwise can't afford. An unknown number of additional people have been dropped from the programs entirely due to changes that some states have made in eligibility rules.)
The evidence increasingly shows that the best way to make people with HIV healthier, while simultaneously ensuring that HIV doesn't pass from one person to another, is to help as many HIVers as possible get on effective HIV treatment. When will much of the world catch up with the evidence?
For more info and analysis:
Ah, nothing like a decade-old pop reference to make HIV research seem relevant and hip.
Over the past couple of years, it's become increasingly clear that people with HIV are at a greater risk than HIV-negative people of developing bone disease (or of having a bone break) as they age. It's also clear that low bone mineral density is very common among HIVers. The question is: Why?
As studies examining this question continue to pile up, the answer so far remains: We don't really know. Is it HIV itself? Is it HIV treatment? Is it some other mysterious combination of causes that just happens to be more likely to occur in people with HIV?
A new study presented at IAS 2011 may provide a small step forward in getting answers to these questions. The study, an examination of medical records of more than 56,000 HIV-positive U.S. military veterans, found that bone fractures are more than twice as common in the HAART era (i.e., since 1996, the year combination HIV treatment became available) than in the pre-HAART era. It also found that two HIV meds in particular, Viread (one of the meds in the combo drugs Atripla and Truvada) and Kaletra (lopinavir/ritonavir), are tied to a higher risk of bone fracture. Viread appeared to increase the risk of fracture by about 12 percent per year, and Kaletra increased the risk by about 9 percent per year. (Keep in mind, however, that an HIVer's risk of breaking a bone in the study was well below 1 percent in any given year, so even if you increase that by 12 percent a year, it'll still be extremely low.)
However, despite the findings on Viread and Kaletra, the study did not find that HIV treatment in general increased a person's risk of breaking a bone. It also found that, no matter what bone risks an HIV med might cause, they paled in comparison to traditional risk factors for bone problems, including smoking cigarettes, being Caucasian, being underweight, having hepatitis C and simply getting older.
That's a lot like what we now know about cardiovascular disease. People with HIV are more likely to develop heart problems, and some HIV meds have been pinpointed as possible contributors. There are also some signs that HIV itself may play a role. But far and away, more traditional heart risk factors appear to have the biggest impact: smoking, high cholesterol, blood pressure, family history of heart problems, age and so forth. A very similar story appears to now be emerging with bone problems. (In fact, another study presented at IAS 2011 found that hardening in the coronary artery -- a key measure of heart risk -- also appears to be associated with low bone density in the hip.)
For more (and related) information:
For much more from this conference, browse our index of articles. The index includes links to the following (among many others):