Aging and HIV
Italian Study Finds Potential Drug Interactions Are Common Among Older Persons Living with HIV
In a recent study of nearly 750 older (age 50+) persons being treated for HIV, Italian researchers found that more than half were at risk for experiencing an interaction between their antiretroviral drugs (ARVs) for HIV and the medications they were taking for other health conditions. Of this total, about 6% were taking contraindicated medications and an additional 47% were taking drugs requiring dose adjustment or careful monitoring. Patients with especially high risks of potential drug-drug interactions (PDDIs) included those who were taking a total of five or more medications, and those taking calcium channel blockers, antacids, hypnotics/sedatives, antipsychotics, anticoagulants, or medications to treat osteoporosis or benign prostatic hypertrophy. The researchers also found that persons taking protease inhibitor-based HIV treatment regimens had a higher risk of PDDIs than those taking HIV regimens based on non-nucleoside reverse transcriptase inhibitors or integrase inhibitors. They concluded that, “Older patients with HIV are highly exposed to PDDIs between ARVs and comedications. The knowledge of their complete medication regimens and the screening for PDDIs and PIMs [potentially inappropriate medications] is therefore crucial to prevent drug-related adverse outcomes in this population.”
MACS: HIV+ Middle-Aged and Elderly Men at Increased Risk for Frailty
The prevalence of frailty is approximately twice as high among middle-aged and elderly men living with HIV than among uninfected men of similar age, according to researchers from the Multicenter AIDS Cohort Study (MACS). As in uninfected men, the risk factors for frailty among men living with HIV included large waist size (abdominal obesity), loss of skeletal muscle mass, and osteoporosis. Frailty – especially among older persons – is associated with negative health outcomes, including a reduced capacity for self-care and for completing everyday tasks, as well as reduced resilience in the settings of stress, injury, or comorbid health conditions. “Underlying mechanisms that link central adiposity, sarcopenia, and frailty [among middle-aged and elderly men living with HIV infection] are likely due, in part, to chronic levels of underlying inflammation and immune activation,” the MACS researchers note. Further, “the high degree of overlap in central adiposity, sarcopenia, and femoral osteoporosis supports the probable existence of a common mechanistic pathway for these conditions; interventions with beneficial effects on all three outcomes may have the greatest potential to prevent, delay, or improve frailty.” For further information, please see a detailed summary of the study from NATAP.
HIV Vaccine Development
HIV Vaccine Elicits Antibodies in Animals that Neutralize Dozens of HIV Strains
An experimental HIV vaccine regimen based on the structure of a vulnerable site on the virus has been shown to elicit antibodies in mice, guinea pigs, and monkeys that neutralize dozens of HIV strains from around the world, according to the National Institute of Allergy and Infectious Diseases (NIAID). The experimental vaccine is based on an epitope called the HIV fusion peptide, which was identified by NIAID scientists in 2016. This peptide is part of the spike on the surface of HIV that the virus uses to enter human cells. According to NIAID scientists, the fusion peptide epitope is particularly promising for vaccine use because its structure is the same across most strains of HIV, and because the immune system clearly “sees” it and makes a strong immune response to it. “NIH scientists have used their detailed knowledge of the structure of HIV to find an unusual site of vulnerability on the virus and design a novel and potentially powerful vaccine,” notes NIAID Director Anthony Fauci. “This elegant study is a potentially important step forward in the ongoing quest to develop a safe and effective HIV vaccine.”
NIAID researchers are now working to improve the vaccine, including making it more potent and able to achieve more consistent outcomes with fewer injections. They also are isolating other broadly neutralizing antibodies generated by the vaccine in monkeys, and they will evaluate these antibodies for their ability to protect the animals from a virus similar to HIV that is found in monkeys. The NIAID scientists will use their findings to optimize the vaccine and then manufacture a version of it suitable for safety testing in human volunteers in a clinical trial, which may begin in the second half of 2019.
CDC Issues Health Advisory on Ongoing Hepatitis A Outbreaks
On June 11, the U.S. Centers for Disease Control and Prevention (CDC) issued a health advisory on recent outbreaks of hepatitis A virus (HAV) infection among persons who use drugs and among persons experiencing homelessness. “From January 2017 to April 2018, CDC has received more than 2,500 reports of hepatitis A infections associated with person-to-person transmission from multiple states,” according to the advisory. “Of the more than 1,900 reports for which risk factors are known, more than 1,300 (68%) of the infected persons report drug use (injection and non-injection), homelessness, or both. During this time, responses conducted in various states resulted in increased vaccine demand and usage, resulting in constrained supplies of vaccine. As available vaccine supply has increased and progress has been made towards controlling ongoing outbreaks in some jurisdictions, vaccine is more readily available. However, both CDC and vaccine manufacturers continue to closely monitor ongoing demand for adult hepatitis A vaccine in the United States.” The advisory includes a series of recommendations on HAV vaccination, diagnosis, testing, and reporting for both health departments and health care providers.
Media and Health Communication
PBS NewsHour Series Focuses on Challenges in Ending the Global HIV Epidemic
During the week of June 11-15, PBS NewsHour launched a new five-part broadcast and digital series, “The End of AIDS: Far from Over,” examines major challenges that remain in the fight to end the global HIV epidemic. The new series, which was developed in partnership with Science magazine, is a follow-up to the Emmy Award winning 2016 series “The End of AIDS,” which examined aggressive efforts to end the epidemic in Atlanta, New York, San Francisco, Kenya, Rwanda, and South Africa. According to PBS, the Far from Over series spotlights “the political forces, social stigma, economic currents, and other factors that continue to frustrate efforts to contain the virus.” The broadcast segments, which are available on an associated website, provide an in-depth look at the HIV epidemic in:
- Russia, where the epidemic is growing at a rate of 10% per year – one of the few places in the world where the epidemic continues to get dramatically worse;
- Nigeria, a country that is home to nearly one-quarter of all babies born with HIV worldwide because the country has failed to implement measures that have nearly eliminated mother-to-child transmission of HIV in many nations; and
- Florida, a state that accounts of 10% of all HIV cases in the United States. Miami has the most new HIV infections of any U.S. city, and Fort Lauderdale ranks number two.
NLM Study Tracks Trends in the Use of HIV Terminology Over Time
The National Library of Medicine (NLM) recently published a report describing changes in HIV-related terminology during the 25-year period from 1989 to 2014. For their analysis, the NLM authors used data visualization and text mining software to evaluate HIV-related language used in more than 80,000 abstracts presented at International AIDS Conferences (IAC) between 1989 and 2014. They found that the addition, disappearance, and changing use of HIV-related terms reflect advances in HIV research and medical practice, as well as efforts to destigmatize the disease and affected population groups. For example:
- The term “AIDS epidemic” was dominantly used from 1989 to 1991 and then declined in use. In contrast, use of the term “HIV epidemic” increased through the end of the study period (2014).
- Beginning in the mid-1990s, the term “treatment experienced” appeared with increasing frequency in the IAC abstracts.
- The use of terms identifying persons as “carriers or victims” of HIV rarely appeared after 2008.
- Use of the terms “HIV positive” and “HIV infected” peaked in the early-1990s and then declined in use.
- The terms “men who have sex with men” and “MSM” were rarely used until 1994; subsequently, use of these terms increased through 2014.
- The term “sex worker” steadily increased in frequency throughout the years studied, in contrast to the term “prostitute,” which decreased over time.
The report authors also make a series of recommendations for clearer and less stigmatizing language. In particular, they recommend:
- Use consistent, biomedically accurate language to describe HIV. For example, use “HIV” and not “HIV/AIDS,” which equates the disease with its terminal stage.
- When describing people living with HIV, put the person before the disease (e.g., use “person with HIV” and not “HIV-infected person”).
- Avoid language that stigmatizes people at increased risk of HIV infection. For example, use “drug user” not “drug abuser” and “sex worker” not “prostitute.”
- Consider group and personal preferences when communicating with and about people affected by HIV. For example, follow the example of the individual or group when using terms such as “gay” or “men who have sex with men.”
- Avoid language that assigns blame. For example, use “the treatment failed” not “the individual failed treatment.”
#DoingItMyWay Campaign Encourages HIV Testing
CDC’s Act Against AIDS initiative has launched the #DoingItMyWay campaign to encourage people to share via social media the ways in which they get tested for HIV. On the #DoingItMyWay web page, CDC asks visitors what motivates them to make HIV testing part of their health routine and shares selected posts from Facebook, Twitter, and Instagram from people who tell when, where, and how they “do it” [get tested for HIV].
More Digital Marketing Tips from HIV.gov
In recent weeks, the HIV.gov blog has published several new posts focusing on digital marketing as part of its ongoing series to help agencies and organizations increase their understanding of health literacy and make better use of digital tools when communicating about HIV-related topics. These posts include:
Reports and Fact Sheets from CDC
Behavioral and Clinical Characteristics of Persons with Diagnosed HIV Infection: Medical Monitoring Project, United States 2015 Cycle (June 2015–May 2016) – As the title implies, this 37-page CDC surveillance report summarizes the clinical and behavioral characteristics of adults with diagnosed HIV infection in the U.S. and Puerto Rico. For the 3,654 MMP participant sample, the report provides detailed data on sociodemographic characteristics, clinical characteristics (disease stage, CD4 count, and viral suppression rates), use of health care services, self-report of antiretroviral therapy and adherence, depression and substance use, sexual behavior, gynecologic and reproductive health, intimate partner and sexual violence, met and unmet needs for ancillary services, and HIV and sexually transmitted disease prevention activities. Breakdowns of clinical characteristics by race/ethnicity and age are also provided.
Increasing PrEP for Women: CDC Town Hall Discussion Series – This illustrated brief provides basic information from three 2017 CDC web-based town hall events in which clinicians, community advocates, and representatives from health departments, researchers, and federal agencies discussed challenges and opportunities for helping increase access to post-exposure prophylaxis (PrEP) amount at-risk women.
Women and HIV Pre-exposure Prophylaxis (PrEP) – This one-page fact sheet provides more detailed information from the above town hall discussions, with a summary of: 1) key findings on the barriers among both health providers and at-risk women that have limited women’s access to PrEP; and 2) suggested activities to improve awareness and knowledge of PrEP and develop best practices for identifying women who might benefit from PrEP.