The Conference on Retroviruses and Opportunistic Infections (CROI 2024) was held in Denver, US, in March. Here is a roundup of some of the HIV treatment and prevention research focused on women that was presented at the conference.
New insights from a large study raised the profile of the risk of cardiovascular disease for women. Results from the REPRIEVE study have been influential, as they showed that the use of a statin reduced the risk of heart attacks, strokes and other cardiovascular events when given to people with HIV who are at low to moderate risk for cardiovascular disease. Risk was lowered by around 35%.
But the study also revealed an unexpected level of cardiovascular risk in women with HIV, especially in high-income countries. In the general population, women have a lower estimated cardiovascular risk than men. But in the REPRIEVE study, women had the same rate of cardiovascular events as men.
One of the study’s investigators told the conference that the findings should change how women with HIV are counselled about cardiovascular risk and statin therapy, highlighting the similar levels of risk for men and women with HIV. Advice also needs to make women aware of how the symptoms of heart disease differ in women and men. Shortness of breath, nausea, vomiting and back or jaw pain are more common symptoms of heart disease and pending heart attack in women.
In people with HIV who have not previously taken antiretroviral therapy, weight gain after starting treatment with an integrase inhibitor tends to be greater than with other classes of HIV medication. In people who are already taking antiretroviral therapy, the effect on weight of switching to an integrase inhibitor is less clear. Menopause is accompanied by changes in body fat distribution and weight gain and the impact on weight of changing antiretroviral therapy around the time of the menopause is unknown.
This retrospective study looked at 424 women with HIV who switched to an integrase inhibitor, 733 who did not, and included a control group of 994 women who do not have HIV. It found that whereas switching to an integrase inhibitor did not seem to accelerate weight gain before the menopause, it did speed up weight gain as women with HIV reached the menopause.
Modest increases in blood pressure during pregnancy are common, but in its most severe form, high blood pressure in pregnancy can be dangerous. Reassuring findings from a large study showed that the integrase inhibitor dolutegravir was not linked with increased blood pressure during pregnancy.
The findings were based on an analysis of results from the large IMPAACT 2010 study, which compared treatment combinations based on dolutegravir and efavirenz. As part of the study, participants had their blood pressure measured every four weeks during pregnancy, at delivery and five times in the following year. The analysis found no association between antiretroviral regimen and the risk of developing high blood pressure.
Turning to research on PrEP (regular medication to prevent HIV), a large study involving young women in six countries in Africa reported high uptake of oral PrEP and good adherence. The study is working with women with an average age 24 in Eswatini, Kenya, Malawi, South Africa, Uganda and Zambia.
Follow-up time for each individual was quite short, at six months, but over that time uptake and persistence with PrEP was good, with 92% of participants completing all four study visits and 90% receiving every refill of PrEP.
Urine tests to look for the PrEP drug tenofovir were used with some participants and these indicated recent adherence of around 70%. This level of adherence is better than that seen in most previous studies of PrEP with women in African countries. But despite high levels of PrEP use, HIV annual incidence remained quite high at 1.38% – or one infection in every 72 participants a year.
In a symposium at the conference, Dr Jenell Stewart of the Hennepin Healthcare Research Institute in Minneapolis argued that there is accumulating evidence that event-driven PrEP could work just as well for women as daily PrEP and that it should be included as an option for everyone in PrEP guidelines. Event-driven PrEP means taking PrEP only around the time of a possible exposure to HIV, rather than every day. Most guidelines support event-driven PrEP as an option for gay and bisexual men and trans women, but not for cisgender women. Stewart argued that event-driven PrEP for cisgender women should be reconsidered and researched further.