Top 5 stories on HIV, ageing and co-morbidities from CROI 2022

Professor Joel Palefsky, presenting the results of the anal screening trial, at CROI 2022. CROI 2022.
Professor Joel Palefsky, presenting the results of the anal screening trial, at CROI 2022. CROI 2022.

An enormous quantity of important and fascinating HIV research is presented each year at the Conference on Retroviruses and Opportunistic Infections (CROI). We have published 30 news articles from this year’s conference. As it is hard for anyone to keep up, here is a round-up of the latest research on COVID-19 and other health issues facing people living with HIV.

Anal screening for precancerous lesions and treating them early lowers the risk of progression to anal cancer in people living with HIV by 57%, a major clinical trial has shown. Until now, the benefits of treating precancerous lesions were uncertain, but these definitive findings should lead to a change in medical guidelines for people living with HIV. Rates of anal cancer are higher in people with HIV than other groups.

Booster doses of the Pfizer or Moderna COVID-19 vaccines revive antibody levels in people with HIV, including in people who have a low CD4 count, Italian researchers told the conference. A US study also showed that booster vaccine doses helped people with immune dysfunction avoid breakthrough infection, being hospitalised with COVID-19, and death.

Glossary

frailty

Describes a general decline in physical health and a loss of reserves, most often seen in older people. Frailty leads to a person being less robust and less able to bounce back after an adverse event. A person with frailty may move more slowly, have lost some of their physical strength, have less energy and be less mentally agile. 

lesions

Small scrapes, sores or tears in tissue. Lesions in the vagina or rectum can be cellular entry points for HIV.

boosting agent

Booster drugs are used to ‘boost’ the effects of protease inhibitors and some other antiretrovirals. Adding a small dose of a booster drug to an antiretroviral makes the liver break down the primary drug more slowly, which means that it stays in the body for longer times or at higher levels. Without the boosting agent, the prescribed dose of the primary drug would be ineffective.

integrase inhibitors (INI, INSTI)

A class of antiretroviral drugs. Integrase strand transfer inhibitors (INSTIs) block integrase, which is an HIV enzyme that the virus uses to insert its genetic material into a cell that it has infected. Blocking integrase prevents HIV from replicating.

cure

To eliminate a disease or a condition in an individual, or to fully restore health. A cure for HIV infection is one of the ultimate long-term goals of research today. It refers to a strategy or strategies that would eliminate HIV from a person’s body, or permanently control the virus and render it unable to cause disease. A ‘sterilising’ cure would completely eliminate the virus. A ‘functional’ cure would suppress HIV viral load, keeping it below the level of detection without the use of ART. The virus would not be eliminated from the body but would be effectively controlled and prevented from causing any illness. 

A US study found a declining rate of heart attack in HIV-negative people, but not those living with HIV. Factors specific to HIV, such as a longer duration of HIV infection and the use of antiretrovirals that are linked to weight gain and raised cholesterol, might be part of the explanation, the researchers speculated.

The number of people who have HIV-associated neurocognitive disorder (HAND) has decreased over the last decade, a study in Italy shows. Lower rates of HAND were seen in people taking dual therapies and integrase inhibitor-based regimens, suggesting a potential beneficial role of modern antiretrovirals. Rates were also lower in people who were younger, more educated and had a higher CD4 count.

A widely prescribed group of medications are associated with falls and frailty in people with HIV, doctors warn. In a UK study, 27% of HIV-positive people over the age of 50 were taking anticholinergic drugs, including codeine, citalopram, loperamide and amitriptyline. Those using them were more likely to have recurrent falls and to be defined as frail.

Click on the links to find out more.

You can also read our selections of the top five stories from African countries, and on HIV prevention, HIV treatment and HIV cure and vaccine from CROI 2022.