www.thebodypro.com Open in urlscan Pro
65.9.66.105  Public Scan

Form analysis
3 forms found in the DOM

/search

<form action="/search" class="header-search"><button class="unstylize" role="button"><i class="fas fa-search"></i></button><input type="text" name="q" placeholder="Search for health topics, stories &amp; more"
    class="unstylize"><a href="#" class="close">×</a></form>

/newsletter

<form class="form-subscribe" action="/newsletter"><label>
    <div>SUBSCRIBE TO OUR NEWSLETTER</div>
    <section><input type="email" name="email" placeholder="Email Address"><button class="btn btn-tertiary">Sign Up</button></section>
  </label></form>

/newsletter

<form class="form-subscribe" action="/newsletter"><label>
    <div>SUBSCRIBE TO OUR NEWSLETTER</div>
    <section><input type="email" name="email" placeholder="Email Address"><button class="btn btn-tertiary">Sign Up</button></section>
  </label></form>

Text Content

Öffnet in einem neuen Fenster Öffnet eine externe Website Öffnet eine externe
Website in einem neuen Fenster
Auf dieser Website werden Daten wie Cookies gespeichert, um wichtige Funktionen
der Website sowie Marketing, Personalisierung und Analyse zu ermöglichen. Sie
können Ihre Einstellungen jederzeit ändern oder die Standardeinstellungen
übernehmen. Datenspeicherungsrichtlinie
   
 * Marketing
   
   
 * Personalisierung
   
   
 * Analyse
   

Speichern Alle akzeptieren



<!---->Schließen Sie die Cookie-Einstellungen<!---->

×
HIV Clinical Care
Basic Science & PathogenesisProviding Quality HIV CareHIV Treatment
StrategiesFDA-Approved HIV MedicationsAdverse Events & ComorbiditiesCare &
Services Outside the U.S.
HIV Services & Quality of Life
Mental HealthDiscrimination & LawMeeting the Costs of CareCase Management &
Social WorkPolicy & AdvocacyCare & Services Outside the U.S.
HIV Transmission & Testing
EpidemiologyEducation & Risk ManagementPrevention MethodsHIV Testing
Research & Conferences
This Week in HIV ResearchCROI 2022ANAC 2021IDWeek 2021IAS 2021All Conference
CoverageNewsroom
Subscribe
All CategoriesVisit TheBody (Our HIV Community Resource)
SUBSCRIBE TO OUR NEWSLETTER
Sign Up

FOLLOW US

AboutContactWrite For Us


THIS WEEK IN HIV RESEARCH

https://www.thebodypro.com/slideshow/week-hiv-research-ifs-ands-buts

--------------------------------------------------------------------------------

Providing Quality HIV CareNews


THIS WEEK IN HIV RESEARCH: IFS, ANDS, AND BUTS

Barbara Jungwirth
Myles HelfandExecutive Editor
March 24, 2022
VIEW AS: LIST | SLIDES
1 of 5 NEXT

iStock/FotografiaBasica

There are precious few “sure things” in HIV medicine. The sheer scale and
duration of the global HIV epidemic, along with the incredible variability of
human biology and the adaptability of HIV itself, mean that as confident as we
rightly are in many aspects of our science, there will be rare exceptions: Every
now and then, for instance, antiretroviral therapy will inexplicably fail, or a
person will test positive for HIV despite being on PrEP.

It is a few of these “buts” that we’ll take a few moments to highlight in our
latest tour of recently published HIV research. Our intent isn’t to raise a
disproportionate amount of alarm or leave you feeling discouraged; it’s more
meant to acknowledge the reality that for all we rely on data to guide our
decisions, day-to-day clinical care can sometimes navigate in areas where the
exception has suddenly become the reality.

Our areas of focus this week:

 * Amidst our recent excitement over the latest HIV remission case, a new case
   report reminds us that stem-cell transplants as an HIV cure method are
   anything but a sure thing.
 * A long-term Swedish study found that low levels of CD4 recovery among virally
   suppressed people may be a risk indicator for both AIDS-related and non-AIDS
   cancers.
 * Progressive multifocal leukoencephalopathy (PML) is not just a relic of the
   old AIDS era—in fact, it can rarely occur in virally suppressed people, a
   small French study found.
 * A new model may be able to help clinicians assess who among their patients
   living with HIV (PLWH) who have liver impairment are most likely to progress
   to end-stage disease.

Let’s get into some of the details. To beat HIV, you have to follow the science!

Show More




iStock/Vadym Terelyuk


HIV REBOUND CASE HIGHLIGHTS UNCERTAINTIES IN BONE MARROW TRANSPLANTATION

Latent, replication-competent HIV can persist and reestablish HIV infection even
after a successful allogenic bone marrow transplant, researchers reported in
Journal of Acquired Immune Deficiency Syndromes. The findings underscore the
risks of the procedure even as recent news of a third person potentially cured
of HIV has raised hopes for the eventual scalability of similar methods.

The first two people cured of HIV received bone marrow transplants from donors
with a genetic mutation that protects against HIV infection. The current study
details the case of one participant in a 10-person trial of bone marrow
transplants in PLWH with hematological malignancies.

Testing four weeks after the transplant revealed that more than 99% of the host
cells in the participant’s blood had been replaced, and HIV viral load was
undetectable at 84 days post-transplant. However, the participant began to miss
study visits, and eventually was hospitalized with severe acute retroviral
syndrome and meningoencephalitis. (The researchers ultimately determined that
the participant had decided on their own to stop taking ART.) Phylogenetic
analysis revealed that the rebound virus matched the pre-transplant virus.

This case shows the clinical risk of interrupting ART after an allogenic bone
marrow transplant, the study authors stated. They hypothesized that the rebound
may be due to an HIV reservoir in central nervous system cells or because the
donor’s HIV-naive CD8 T cells did not respond to the virus. One solution to the
latter problem may be to infuse engineered HIV-specific T cells that secrete
broadly neutralizing antibodies, they suggested. A current trial is studying
such cells derived from donors.

“This unique case suggests that recipient cells persist early after alloBMT
[allogenic bone marrow transplant] and that a single predominant viral
population latent in resting memory CD4+ T cells can reestablish infection,”
study authors concluded.

Show More




iStock/Design Cells


POOR CD4 RECOVERY DESPITE VIRAL SUPPRESSION ASSOCIATED WITH HIGHER CANCER RISK

Low CD4 cell count recovery after starting ART is associated with a greater risk
of developing both AIDS-related and non-AIDS cancers, a Swedish population-based
study published in AIDS found.

Researchers matched the country’s general population register with HIV and
cancer registries spanning from 1988 to 2017. The rate of AIDS-related cancers
dropped significantly over the study period, but remained elevated among PLWH
compared to HIV-negative people.

Overall, 44% of all cancers in PLWH were AIDS-related compared to 9% in
HIV-negative participants. During the study period, the proportion of non-AIDS
cancers among PLWH increased, likely due to the aging of this population, the
authors stated.

Among PLWH, the risk of both AIDS-related and non-AIDS cancers was higher in
people whose CD4 cell counts rose < 100 cells/µL after starting ART, even if
they were virally suppressed. This was especially true of lung and breast
cancer. Unsurprisingly, an unsuppressed viral load and/or CD4 cell count < 200
cells/µL increased the likelihood of developing AIDS-related cancers.

WLWH were less likely to develop AIDS-related cancers than MLWH, mostly because
Kaposi’s sarcoma rates were higher in men – a sex disparity that has also been
seen among HIV-negative people.

In a high-income country with universal health care such as Sweden, low CD4 cell
counts among the study population point to late HIV diagnoses and hence late
treatment initiation, the study authors argued. “Early HIV detection and early
adherent ART remain essential for cancer prevention,” they wrote. They also
suggested that PLWH be screened for lung cancer earlier and at a lower smoking
threshold than the general population.

Show More




Moussa81 via iStock


PML CAN SOMETIMES OCCUR AMONG VIRALLY SUPPRESSED PLWH

Some PLWH with well-controlled HIV may still develop progressive multifocal
leukoencephalopathy, a comorbidity traditionally associated with advanced HIV
infection, a small French study published in AIDS showed.

Seventy-four percent of 571 PLWH diagnosed with PML between 2000 and 2019 had an
uncontrolled viral load, the study found. However, 10 participants had a CD4
count > 200 cells/µL and an undetectable viral load at the time of PML
diagnosis. Only one of the 10 had an established risk factor for
leukoencephalopathy (rituximab after chemotherapy).

Nine of the 10 individuals had a nadir CD4 cell count below 200 cells/µL, and
four had previously been diagnosed with AIDS. While their CD4 cell counts had
recovered to 300 or higher by the time PML was diagnosed, CD4/CD8 cell ratios
were low (ranging from 0.4 to 0.5) in all 10 people, the researchers found.

The 10 individuals’ viral loads had been suppressed for a median of 41 months
before their PML diagnosis. Six were coinfected with hepatitis C (four of them
chronically) at the time of their PML diagnosis, and four had cancer
(AIDS-related cancers in three of the four cases). HHV-8 was found in three
participants. The study authors suggested that these facts point to the
possibility of altered natural killer cell activity—i.e., ART may not have fully
restored the individuals’ NK cell phenotypes.

After five years of follow-up, seven of the 10 individuals had died (after a
median 11.7 months following their PML diagnosis); five of the seven deaths were
attributed to PML.

Study limitations included the lack of further immunological studies in most
participants, the small number of cases, and the fact that this was a
retrospective study.

“This study highlights that factors other than a low CD4+ cell count and a high
HIV viral load may be associated with the occurrence of PML,” study authors
wrote. They called for further research into the causes of PML among PLWH with
well-controlled HIV.

Show More




PALMIHELP via iStock


NEW MODEL MAY HELP PREDICT ESLD RISK IN PLWH

A model to predict the risk of end-stage liver disease (ESLD) in PLWH could help
clinicians decide which patients warrant prioritization of their hepatic
complications, researchers reported in Journal of Acquired Immune Deficiency
Syndromes.

Their model was trained on data spanning from 2000 to 2016 from 13,787 PLWH in
the U.S. and Canada (82% of whom were men and 54% of whom were Black), among
whom there were 390 ESLD events; it was then validated on a separate set of
3,173 PLWH in the U.S. and Canada (90% men, 14% Black), among whom there were
112 ESDL events. All participants had two Fibrosis-4 indices above 1.45 at
baseline, which suggested they had liver disease but not end-stage disease. The
model was based on a combination of 12 factors, including age, sex,
race/ethnicity, hepatitis B and C status, liver function, and lipid metabolism
laboratory markers.

The model predicted an event rate within the validation group of 2.5% over five
years; the actual observed rate was 3.5%. The C statistic was 0.81, which
generally indicates a relatively strong model.

HIV-related biomarkers were not found to be predictive of ESLD, possibly because
most of the cohort was virally suppressed on ART, the authors suggested.

The model is based on standard laboratory values and could be auto-populated
from the electronic health record to aid clinicians, the study authors noted.
However, they pointed out several limitations to their study, including that the
data predated the advent of direct acting antiviral treatment for HCV and was
collected when HBV/HIV coinfection was mainly treated with tenofovir; that all
participants were in HIV care in North America and had pre-existing liver
disease; and that while sex and race/ethnicity were input factors, few women
were included, and the demographic characteristics of the training and testing
data sets differed markedly.

Show More








BARBARA JUNGWIRTH

@BJUNGWIRTHNY

Barbara Jungwirth is an experienced freelance journalist, writer, and translator
who has been reporting on HIV for TheBody and TheBodyPro since 2002.

MYLES HELFAND

@MYLESATTHEBODY

Myles Helfand is the executive editor and general manager of TheBody/TheBodyPro.



RECOMMENDED FOR YOU

News

THIS WEEK IN HIV RESEARCH: WHAT DOESN’T KILL US

By Barbara Jungwirth and Myles Helfand

AboutContactWrite For Us

FOLLOW US

SUBSCRIBE TO OUR NEWSLETTER
Sign Up

© 2022 Remedy Health Media, LLC ALL RIGHTS RESERVED

Remedy Health Media SitesPrivacy PolicyTerms of UseCookie PreferencesDo Not Sell
My InfoSecurity PolicyAdvertising PolicyAdvertise With Us