The latest news from the XVI Conference on Retroviruses and Opportunistic Infections, Montreal, Canada, 2009.

News from CROI 2009

• Male partner clinic attendance and HIV testing associated with better outcomes for infants born to HIV-positive mothers
  When the male partner of a pregnant woman attends antenatal clinic visits with her and gets tested for HIV, there appears to be a reduced risk of HIV transmission to their infant and increased survival in the child according to a Kenyan study presented at IAS 2009 in Cape Town this week.
• Africans and African Americans progress to AIDS more slowly: strong association with hepatitis B
  Two posters, one from Europe and one from the USA, presented at the recent Conference on Retroviruses and Opportunistic Infections (CROI) in Montreal, found that people of African descent with HIV have slower CD4 declines and progress more slowly to AIDS compared with people of European descent.
• Continuous antiretroviral therapy improves survival in HIV/hepatitis C co-infected patients with liver cirrhosis
  Antiretroviral therapy - but not treatment for chronic hepatitis C virus (HCV) infection - was associated with significantly improved survival in HIV/HCV co-infected individuals with liver cirrhosis, researchers reported on February 10^th at the Sixteenth Conference on Retroviruses and Opportunistic Infections (CROI) in Montreal, Canada.
• Low HDL cholesterol linked to cardiovascular disease in people with HIV
  Lower levels of beneficial high-density lipoprotein (HDL) cholesterol - but not of harmful low-density lipoprotein (LDL) - were associated with cardiovascular disease in the SMART treatment interruption study, researchers reported on February 11^th at the Sixteenth Conference on Retroviruses and Opportunistic Infections (CROI) in Montreal, Canada.
• Treatment intensification does not eliminate HIV in reservoir sites
  HIV continues to be released in small amounts from "reservoir" sites in the body despite suppressive antiretroviral therapy, and adding more drugs has not succeeded in eradicating the virus, researchers reported at the Sixteenth Conference on Retroviruses and Opportunistic Infections in Montreal last month.
• High hepatitis C viral load increases risk of death in HIV/HCV co-infected patients
  A high level of hepatitis C virus (HCV) in the blood is associated with an increased risk of death in HIV/HCV co-infected individuals, according to data presented on February 10^th at the Sixteenth Conference on Retroviruses and Opportunistic Infections in Montreal, Canada.
• Treatment switches on basis of CD4 declines often unnecessary, Uganda research shows
  Switching people to second-line antiretroviral treatment on the basis of CD4 declines, without information from viral load tests, could result in a large numbers of unnecessary switches to more expensive second-line regimens in resource-limited settings, a study in Uganda has found.
• Disadvantage of late treatment start in Africa may persist for years, studies find
  Starting antiretroviral therapy earlier, before the development of symptoms, is the most likely way to reduce the high death rates after treatment initiation seen in people with HIV in resource-limited settings, two large cohort analyses show. The studies also show that the major disadvantage of starting treatment late – an increased risk of death – may persist for some years, burdening already overstretched health systems with illness that could be avoided by earlier treatment.
• Hormonal contraception does not affect HIV progression in large international cohort
  Previous analyses, including a cohort study in Kenya and secondary results from a randomised controlled trial in Zambia, have suggested that hormonal contraception may accelerate HIV disease progression in women not yet on antiretroviral treatment (ART). However, an analysis of a cohort of over 4500 women across multiple sites in Africa and elsewhere found no evidence that hormonal contraception affects mortality or disease progression. Elizabeth Stringer, of the University of Alabama at Birmingham, reported the findings to the Sixteenth Conference on Retroviruses and Opportunistic Infections last week on behalf of a research team from Zambia and the US.
• Hepatitis C in HIV-positive gay men: Amsterdam, Paris, New York and UK compared
  Several posters at the Sixteenth Conference on Retroviruses and Opportunistic Infections in Montreal examined the rise in sexually transmitted hepatitis C in gay men with HIV, each highlighting different aspects of this new epidemic. Risk behaviour was compared between New York and the UK; researchers documented an apparently separate and long-lasting epidemic of HCV genotype 4 in France (in all other cities, genotype 1 predominated); New York investigators documented rapid progression of liver fibrosis in their patients, and also treatment success rates.
• Tenofovir provides good hepatitis B virus suppression in HIV/HBV co-infected patients
  Most HIV/hepatitis B co-infected people who include tenofovir (Viread, also in the Truvada and Atripla coformulation pills) in their antiretroviral regimen achieve sustained suppression of hepatitis B virus (HBV), according to a presentation last week at the Sixteenth Conference on Retroviruses and Opportunistic Infections in Montreal.
• High failure rate for people with low CD4 nadirs in Kaletra monotherapy study
  An unexpectedly high failure rate was seen in patients taking boosted lopinavir (lopinavir/ritonavir: Kaletra) as their only HIV drug, according to a Swiss study presented at the Sixteenth Conference on Retroviruses and Opportunistic Infections last week.
• Breastfeeding in HIV-positive mothers in Botswana did not affect mortality
  A controlled, randomised, prospective trial of 1200 HIV-positive mothers in Botswana found no differences in mortality between those who breastfed and those who formula fed. A trend toward faster declines in CD4 cell count began to emerge several years after cessation of breastfeeding, but this was not statistically significant and its significance is unknown.
• HIV testing in Kenya on the rise, but four out of five Kenyans with HIV still unaware of their status
  HIV prevalence in Kenyan adults has remained relatively steady since 2003, at around 7%, according to a major national study presented to the Sixteenth Conference on Retroviruses and Opportunistic Infections (CROI) on Wednesday. However, fewer than one in five HIV-positive adults were aware of their HIV status, and over half had never been tested for HIV at all.
• Men becoming visible: more light shed on men who have sex with men in Africa and India
  The majority of men who have sex with men (MSM) in three different African countries and in Tamil Nadu State in India also have sex with women, according to two presentations and a poster at the 16th Conference on Retroviruses and Opportunistic Infections (CROI) in Montreal.
• HIV infection has similar impact on hardening of arteries as smoking, diabetes
  HIV infection independently increases the severity of atherosclerosis as much as traditional cardiovascular risk factors such as smoking and diabetes, researchers reported on Wednesday at the Sixteenth Conference on Retroviruses and Opportunistic Infections in Montreal.
• Double-dose lopinavir/ritonavir provides insufficient lopinavir exposure in children on rifampicin-based TB treatment
  Doubling the dose of lopinavir/ritonavir (Kaletra) in children with HIV on rifampicin-based TB treatment fails to provide adequate lopinavir concentrations, according to a drug interaction study presented this week at the Sixteenth Conference on Retroviruses and Opportunistic Infections in Montreal.
• Rosiglitazone improves fat loss and insulin resistance in people with lipoatrophy
  The diabetes drug rosiglitazone (Avandia) improved limb lipoatrophy in HIV-positive people taking antiretroviral therapy, researchers reported on Wednesday at the Sixteenth Conference on Retroviruses and Opportunistic Infections in Montreal. However, the researchers did not study the drug's effect on facial fat loss.
• More treatment failure in people on TB treatment who start once daily nevirapine-based ART than efavirenz-based ART
  People on TB treatment who started a once-daily antiretroviral therapy (ART) regimen of nevirapine/ddI/3TC were significantly more likely to fail ART than those who started on a once-daily regimen of efavirenz/ddI/3TC, according to a randomised prospective study from Chennai, India. In fact, the nevirapine arm performed so poorly that the study’s Data Safety and Monitoring Board (DSMB) ended accrual to that study arm and closed the study ahead of schedule.
• ART use in mothers with low CD4 cell counts reduces breastfeeding transmission fivefold: Malawi
  The use of antiretroviral therapy (ART) by breastfeeding mothers greatly reduced the risk of HIV transmission to their infants after a 14-week course of infant HIV prophylaxis was stopped, according to a study performed in Malawi and presented to the Sixteenth Conference on Retroviruses and Opportunistic Infections (CROI) on Tuesday. However, ART use did not significantly reduce transmission risk in mothers with CD4 cell counts above 250 cells/mm³.
• Ugandan studies identify benefits of home-based HIV counselling and testing approaches
  Findings from two Ugandan studies suggest that home-based HIV counselling and testing may augment traditional HIV counselling and testing services in important ways in some settings, both by increasing acceptance and uptake of HIV testing, but also by impacting attitudes toward HIV at a population level. The results of both studies were presented to the Sixteenth Conference on Retroviruses and Opportunistic Infections (CROI) on Wednesday by Sundeep Gupta of the Centres for Disease Control, Uganda, on behalf of the investigating teams.
• Abacavir may increase blood coagulation risk
  Two studies have shown contrasting findings on the relationship between the nucleoside reverse transcriptase inhibitor (NRTI) drug abacavir (Ziagen; also in Kivexa (Epzicom) and Trizivir. Ever since a relationship was found between current abacavir use and cardiovascular heart disease in 2008, with abacavir raising the risk of heart attack by 90%, a search has been on to find the reason for this apparent association.
• Diabetes, high blood pressure and smoking raise risk of death for all people with HIV
  A number of modifiable or preventable medical conditions can nearly double the risk of death in people with HIV, a large cohort study has found, and can double the risk of death due to specific causes. Colette Smith of University College Medical School, London, presented the latest analysis of the D:A:D study to the Sixteenth Conference on Retroviruses and Opportunistic Infections in Montreal on Wednesday.
• Corticosteroid therapy improves outcomes in people with TB-IRIS in trial
  A four-week course of the anti-inflammatory corticosteroid, prednisone, improves outcomes when given to people who develop tuberculosis (TB)-immune reconstitution inflammatory syndrome (TB-IRIS) after starting antiretroviral therapy (ART) - without causing an excess of steroid side-effects or other infections, according to a randomised placebo-controlled trial conducted in Cape Town, and presented on Monday at the Sixteenth Conference on Retroviruses and Opportunistic Infections in Montreal.
• Hospitalisation and disability are higher amongst HIV patients with hepatitis C coinfection
  HIV-positive individuals co-infected with hepatitis C virus are hospitalised longer, visit emergency departments more often and spend more days disabled than people with HIV alone, according to new data presented on Tuesday at the Sixteenth Conference on Retroviruses and Opportunistic Infections in Montreal, Canada.
• Half of HIV/HCV co-infected early responders are cured with 72-week treatment
  HIV/HCV co-infected individuals who achieve a complete early response to interferon-based therapy for chronic hepatitis C have a 51% chance of achieving a sustained virological response using an extended 72-week course of treatment, researchers reported on Tuesday at the Sixteenth Conference on Retroviruses and Opportunistic Infections in Montreal, Canada.
• Maternal resistance to nevirapine following single dose reduced by AZT/ddI or one month's ART
  Two Thai studies have provided further evidence that short courses of more than one antiretroviral drug after delivery almost eliminate the risk of nevirapine resistance in mothers when it is used to prevent mother-to-child transmission, thus preserving nevirapine as an option for maternal treatment when eventually needed.
• Kaletra superior to nevirapine-based ART for women already exposed to single-dose nevirapine
  An antiretroviral regimen based on the boosted protease inhibitor lopinavir/ritonavir (Kaletra, or Aluvia) was significantly more effective than a nevirapine-containing regimen in mothers previously exposed to single-dose nevirapine, according to results from the randomised OCTANE study presented on Tuesday at the Sixteenth Conference on Retroviruses and Opportunistic Infections in Montreal.
• Ugandan study supports the use of fluconazole to prevent cryptococcal meningitis
  Oral fluconazole prophylaxis safely prevents invasive cryptococcal disease in people with advanced HIV, according to a randomised, double-blind, placebo-controlled trial conducted in over 1500 participants in rural Uganda, and presented on Monday at the Sixteenth Conference on Retrovirus and Opportunistic Infections (CROI) in Montreal. Prophylaxis was effective in people who were waiting to receive antiretroviral therapy (ART) and in those who had recently started ART, but who had not yet had a significant improvement in their immune status. It also significantly reduced the incidence of other serious fungal infections like oesophageal candidiasis.
• Nearly half of new infant HIV infections in Botswana may result from mothers infected during pregnancy or after delivery
  In discussions of mother-to-child transmission of HIV, the assumption is often made that the mothers themselves were already HIV-positive at or before the time of becoming pregnant. This assumption was challenged at a Tuesday morning session on mother and child health issues at the Sixteenth Conference on Retroviruses and Opportunistic Infections in Montreal. Presenter Lydia Lu of the Centers for Disease Control, on behalf of a US/Botswana research team, estimated that over 40% of infants who acquired HIV via mother-to-child transmission (MTCT) in 2007 may have been born to mothers who became HIV-infected during pregnancy or in their first post-partum year, when they were likely to be breastfeeding.
• Switching from Kaletra to raltegravir improves lipid profiles at the risk of viral rebound
  People whose viral load is well controlled on a lopinavir/ritonavir (Kaletra) regimen may see significantly improved cholesterol and triglyceride levels if they switch to raltegravir (Isentress), but at the risk of losing viral suppression, delegates to the Sixteenth Conference on Retroviruses and Opportunistic Infections heard on Monday.
• Interleukin-2 shows no benefit in two large clinical trials
  The Sixteenth Conference on Retroviruses and Opportunistic Infections heard today that two large, seven-year-long, international trials of the immune-stimulating drug interleukin-2 (IL-2, Proleukin) in people with HIV had produced a negative result. Both trials found that there was no clinical benefit in using the injectable therapy and that it produced significant serious side-effects. Exactly why these trials, which involved 5800 participants and cost $85 million, made no difference in terms of deaths or AIDS diagnoses, despite producing CD4 cell increases in participants, is still unknown and may lead to other discoveries about the immune system.
• Certain protease inhibitors and abacavir linked to heart attacks in two large cohort studies
  The latest follow-up data from two large cohort studies, presented on Monday at the Sixteenth Conference on Retroviruses and Opportunistic Infections in Montreal, adds further evidence that specific protease inhibitors (PIs) and nucleos(t)ide reverse transcriptase inhibitors (N(t)RTIs) are associated with a higher risk of cardiovascular problems in people with HIV.
• Two novel ‘enhancer’ drugs boost protease inhibitors as much as ritonavir
  Two novel pharmacokinetic-enhancing agents - GS 9350 and SPI-425 - appear to work as well as ritonavir (Norvir) for boosting protease-inhibitor levels, but with fewer side-effects, according to presentations on Monday at the Sixteenth Conference on Retroviruses and Opportunistic Infections in Montreal.
• Antiretroviral treatment lowers rates of HIV transmission in heterosexual couples in Africa
  Antiretroviral treatment is associated with a lower risk of heterosexual HIV transmission in African serodiscordant couples, according to findings from Uganda, Rwanda and Zambia, presented on Monday at the Sixteenth Conference on Retroviruses and Opportunistic Infections.
• HIV sporadically detectable in semen of men with undetectable plasma viral loads
  At the Sixteenth Conference on Retroviruses and Opportunistic Infections in Montreal on Monday morning, two back-to-back oral presentations affirmed that HIV is indeed often detectable in semen despite undetectable viral loads in blood plasma. The two studies found measurable HIV RNA ("viral shedding") in 3% to 14% of seminal fluid samples taken from study participants with undetectable plasma viral loads.
• Seminal HIV: cell-free virus, not infected cells, leads to transmission between men
  At the Sixteenth Conference on Retroviruses and Opportunistic Infections in Montreal on Monday morning, David Butler of the University of California San Diego presented data on four cases of male-to-male sexual transmission, showing that cell-free virus in semen – not proviral DNA in infected cells – was the means of transmission in all four cases.
• PrEP could work even if taken several days in advance
  A study using tenofovir and FTC (Truvada) to prevent rectal SHIV infection in monkeys – so-called pre-exposure prophylaxis (PrEP) - has shown that it is as effective for the medication to be given up to three days before exposure as it is one day before. Even giving Truvada a full week before exposure resulted in a considerable reduction in the risk of infection.
• Microbicide reduces HIV infections by 30% in first success for field
  Campaigners were celebrating the results of a trial of a microbicide to prevent HIV that has produced a positive result, the first one to do so. The results of the HPTN 035 were announced at the Sixteenth Conference on Retroviruses and Opportunistic Infections in Montreal today.
• Test can predict non-Hodgkin's lymphoma in people with HIV
  The risk of non-Hodgkin’s lymphoma developing in people with HIV within two to five years can be predicted with a high degree of accuracy using an assay already used to monitor for the development of multiple myeloma, according to findings presented on Monday at the Sixteenth Conference on Retroviruses and Opportunistic Infections in Montreal, Canada.

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