Among people living with the virus, the perception of how HIV cure trials does not jibe with actual practice in such studies, aidsmap reports.
Jillian Lau, MBBS, of Monash University in Melbourne, and colleagues conducted a survey about cure research among 442 people with HIV and published their findings in AIDS Research and Retroviruses.
The majority of the participants lived in middle- and high-income nations, 22% were women, 64% were gay and 39% were older than 50 years old. Ninety-five percent were on antiretrovirals (ARVs), of whom 83% said they had an undetectable viral load.
In cure studies, people with HIV may be taken off their ARVs for a period of time, during which they are very closely monitored. When their viral load rises, they resume treatment. This is known as an analytical treatment interruption (ATI) and is considered relatively safe.
About one third of the survey’s respondents said they would prefer monthly CD4 tests during an ATI, whereas in practice such monitoring is conducted weekly.
Thirty-five percent of the respondents said that during an ATI they would prefer to maintain an undetectable viral load at all times. However, during ATIs, viral loads are expected to rise eventually. Twenty-seven percent said they would accept having their viral load increase up to 1,000.
The new study also surveyed health care providers, 18% of whom said they were not comfortable with their patients developing a detectable viral load during a cure study and would prefer they start back on ARVs as soon as they crossed this threshold. One third of the clinicians said they were not concerned whether their patients developed a detectable viral load in such a study so long as they did not develop signs of illness.
Both the people with HIV and the health care providers said they would prefer that CD4 counts remain above 350 during cure research. Both groups were also “very concerned” about HIV transmission occurring during an ATI, as has been documented in rare cases.
Additionally, the HIV-positive individuals expressed concern that their health would decline during a cure study, that they would be at risk for opportunistic infections and that their virus would develop drug resistance.
“Our work demonstrates that [people living with HIV’s] expectations of ATI in cure-focused clinical trials do not align with current practices, with [people living with HIV] less accepting of [having a detectable viral load] during ATI and preferring less frequent monitoring,“ the study authors concluded. ”Clear education messages and careful consent processes need to be developed in relationship to ATIs in HIV cure research.”
To read the aidsmap article, click here.
To read the study abstract, click here.