Co-morbidities – other health issues affecting people with HIV – continue to be an important focus of research in the HIV field. Here are some of the top stories on co-morbidities research presented at the Conference on Retroviruses and Opportunistic Infections (CROI 2024).
A study in the US compared nurse-led care including home blood pressure monitoring with standard care and found blood pressure and non-HDL cholesterol were lower in the nurse-led care group after a year. A study in Kenya and Uganda compared management through home visits by community health workers and telehealth consultation with clinicians, with management in a clinic. After a year, 86% of people having home visits had their blood pressure under control, compared with 44% in the group attending a clinic. And in Haiti, a study in people with pre-hypertension compared immediate treatment with deferring treatment until blood pressure was considered high. People in the immediate treatment group were 59% more likely to achieve blood pressure control after 12 months compared to the deferred treatment group.
The people presenting the studies stressed the importance of integrating blood pressure management into HIV care rather than referring on to specialists.
In 2023, the REPRIEVE study of pitavastatin for prevention of cardiovascular disease showed that statins reduced the risk of major cardiovascular events such as heart attack and stroke by a similar extent in men and women (approximately 35%). An overview of insights from the study into the differences in cardiovascular risk between men and women with HIV was presented at CROI 2024.
In the general population, women have a lower estimated cardiovascular risk than men. However, when the incidence of major cardiovascular events was compared in REPRIEVE, using four groups of baseline cardiovascular risk, women had the same rate of cardiovascular events as men. One of the study’s investigators told the conference that counselling about heart disease risk and statin use for women with HIV should highlight 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.
The IMPAACT 2010 study reported that the widely used antiretroviral dolutegravir did not increase the risk of high blood pressure during pregnancy. The large study was comparing antiretroviral regimens started during pregnancy: dolutegravir- and efavirenz-containing regimens, and also two formulations of tenofovir combined with dolutegravir and emtricitabine. Blood pressure was measured every four weeks during pregnancy, at delivery and five times during the following year. There was no association between antiretroviral regimen and the risk of developing high blood pressure. Weight was the critical factor: for every 5kg increase in weight, the risk of developing high blood pressure increased by 16 to 22%.
Men with HIV were more likely to be diagnosed late with prostate cancer and less likely to undergo testing that may warn of an increased prostate cancer risk, according to a study presented at CROI 2024. Researchers matched data from 751 men with HIV diagnosed with prostate cancer between 2001 and 2018 with 2778 men without HIV who had been diagnosed with prostate cancer during the same period. Men with HIV had significantly higher prostate-specific antigen (PSA) levels at diagnosis and a significantly higher proportion had metastatic cancer at diagnosis (indicating late diagnosis).
Semaglutide reduced liver fat build-up and metabolic dysfunction-associated steatotic liver disease (MASLD) in people with HIV in a phase IIb trial. The trial evaluated the effects of semaglutide, best known as a weight-loss medication, on liver fat content in 51 people with HIV. The study enrolled adults on suppressive antiretroviral therapy with a large waist circumference, insulin resistance or pre-diabetes, and MASLD (defined as at least 5% liver fat content by MRI imaging). Participants self-administered subcutaneous injections of semaglutide once weekly for 24 weeks. The mean absolute decline in liver fat was 4.2% while the mean relative decline was 31.3%. Presenting the results, Dr Jordan Lake warned that semaglutide may not be effective against advanced disease, rather it could be a way of treating or prevent early disease.