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News in brief

Gus Cairns
Published: 03 February 2012

As well as our news reporting, the news pages on our website include selected stories from other sources. Here we highlight stories from the last quarter – visit www.aidsmap.com/news for the full news reports and references to the original sources.

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Extra vitamin D “no help”

There is little evidence that giving people with HIV vitamin D supplements helps strengthen their bones or avoid fractures, a systematic review of studies has found.

It is well-established that people with HIV tend to have lower bone mineral density – a condition that can lead to osteoporosis and fractures – and also that their levels of vitamin D, which helps build bones, are lower than average.

Because of this, it has been thought that giving vitamin D supplements might help ward off bone problems. This research found no evidence that supplementation helped, however. It concluded that people with HIV tended to have other risk factors for low vitamin D, such as black ethnicity, high blood pressure, lower levels of exercise, and being overweight.

The reviewers found that people with HIV experience an approximately 5% reduction in their bone mineral density when they start therapy, but the cause is unknown and it may have no clinical consequences. They also found that the drug efavirenz (Sustiva – also in Atripla) was associated with low vitamin D levels.

For the full news report, see: www.aidsmap.com/page/2207048.

Monkey vaccine most robust yet

An experimental vaccine tested in monkeys has provided the highest level of protection yet seen and may form the basis of new human HIV vaccine candidates.

The most effective formulation of the vaccine produced an 80% reduction in the risk of infection from SIV, the monkey equivalent of HIV, after one exposure. When animals were infected, their resultant viral load was 100-fold lower than in non-vaccinated infected animals and three infected animals developed an undetectable viral load.

The most effective form of the vaccine contained four fragments of SIV genetic material contained in two different vectors – the shells of harmless viruses that help ‘smuggle’ the vaccine inside cells. Vaccines that worked in animals have failed in humans before because they only worked against a narrow range of viruses; so this time the researchers deliberately used a form of SIV with a different genetic make-up to the fragments in the vaccine, and also one known for its ability to resist neutralisation by antibodies.

The vaccine prevented four out of five infections in monkeys given one exposure to SIV. Half the unvaccinated monkeys were infected with SIV after one exposure, whereas it took three exposures to SIV before half of the vaccinated monkeys were infected.

The researchers now plan to take a vaccine based on one of the most effective designs into early human studies.

For the full news report, see: www.aidsmap.com/page/2205713.

Early-infection test fails to detect HIV

A rapid ‘fourth-generation’ test used in some UK clinics works fine as an HIV antibody test, but fails to detect very early HIV infection, before the body has made anti-HIV antibodies.

Laboratory testing can detect a viral protein called p24 that appears soon after HIV infection (as well as detecting antibodies), thus shortening the length of time immediately after infection with HIV when people do not test HIV positive. Most people start to test HIV positive for antibodies after about a month and adding in p24 detection can halve the time to diagnosis, to 12 to 14 days after infection.

The Determine HIV1/2 Ag/Ab test is the first to offer the combination of antibody and p24 in a rapid test, meaning results can be given at point of testing.

Two studies from Malawi and the UK, however, found that the Determine test failed to detect acute HIV infection (infection that has occurred less than a month ago) in a third of samples in London and three-quarters of patients in Malawi (where laboratory conditions may be more difficult). Worse, in the Malawi study it also ‘detected’ the p24 protein in 14 out of 838 people who were in fact HIV negative, a false-positive rate of one in every 60 tests.

The researchers in London comment that if people have suspected acute HIV infection, a combination of lab tests should be used and health providers should explain to patients that HIV is still hard to test for within the first month of infection.

For the full news report, see: www.aidsmap.com/page/2204685.

UK BME gay men do just as well on treatment

In the UK, gay men from various non-white ethnic backgrounds are just as likely to respond to HIV treatment as white gay men, a study has shown. It found that 85% of gay men achieved an undetectable viral load within a year of starting treatment regardless of ethnicity, that the average time both white and non-white men took to reach a viral load under 50 copies/ml was four months, and that CD4 increases were almost the same.

This contrasts with the situation in the US, where a study last year found that only 70% of black patients who took antiretroviral drugs had an undetectable viral load, compared with 83% of white patients.

The UK study did find, however, that black and minority ethnic (BME) gay men were accessing treatment later than white gay men and that their CD4 cell counts at the time they started treatment were lower.

For the full news report, see: www.aidsmap.com/page/2201034.

PEP guidelines take account of viral load

New UK guidelines for post-exposure prophylaxis (PEP) now take account of the viral load of the ‘source partner’ of the person seeking PEP, if they are known to have HIV.

The new guidelines now only recommend that PEP is given to individuals whose partner is HIV positive but has an undetectable viral load if the person seeking PEP was the receptive partner in unprotected anal sex. In all other cases where the HIV-positive partner is known to have an undetectable viral load, clinicians following the guidelines will explain that PEP is unnecessary. This includes all unprotected vaginal sex (whether the HIV-positive partner is male or female) and cases where the person seeking PEP has been the insertive partner in anal sex.

In a case where the source partner’s HIV status is unknown, PEP is still recommended in cases of unprotected receptive anal sex, but only if the person is a gay man or a migrant from Africa. Clinicians are told they should ‘consider’ PEP in cases of insertive anal sex, vaginal sex or the sharing of injection equipment if there has been an additional factor that could raise the risk of HIV transmission, such as particularly high local HIV prevalence, a sexually transmitted infection in either partner, sexual assault, acute HIV infection in the source partner and – in vaginal sex – the woman menstruating or the man being uncircumcised.

Where the source partner has HIV and has a detectable viral load, PEP is recommended in the case of anal or vaginal sex or the sharing of injection equipment and should be ‘considered’ in case of receptive fellatio with ejaculation (giving a blow job to an HIV-positive man) and semen getting into the eye.

The guidelines make it clear that contact with a needle or syringe discarded in a public place, and human bites, are not regarded as risky enough for PEP to be indicated.

For the full news report, see: www.aidsmap.com/page/2186929.

News picks from other sources

As well as writing our news reports, our team of editors regularly select news from other sources for the news pages of our website. Here is a small selection of recent examples. For more of these, visit www.aidsmap.com/news

Is Ireland failing its heroin addicts?

The number of heroin users in Ireland is the highest in the EU while deaths of people on methadone programmes are increasing. For the full news report, see the Irish Times website: http://bit.ly/ABTjct   

We Could End AIDS, But Will We?

There are two things standing in the way: political will and the money to do it. For the full news report, see the Open Society Foundation website: http://bit.ly/zKqqiL

Europe approves Gilead's HIV combo Eviplera

The European Commission has granted marketing authorisation for Gilead Sciences' combination drug Eviplera. For the full news report, see the Pharma Times website: http://bit.ly/yyMHEe

This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.