News in brief

This article originally appeared in HIV Treatment Update, a newsletter published by NAM between 1992 and 2013.

Summaries of news from the last quarter. For full news reports and references to the original sources, visit www.aidsmap.com/news

Self-testing acceptable to at least three-quarters of people seeking a test

A meta-analysis of 21 studies of self-testing for HIV has found that self-testing was acceptable to between 74 and 100% of participants. Only seven of the 21 studies concerned completely unsupervised self-testing (in the others, a healthcare worker observed), and acceptability was 87 and 84% respectively in the two unsupervised studies that measured acceptability. No more than 5% of self-testers made mistakes in the testing process. False-negative results were almost non-existent, though one study had 7% false-positive results. In developed countries, US$20 was the average price deemed acceptable for an over-the-counter HIV test kit.

For the full news report see: www.aidsmap.com/page/2621239

New integrase inhibitors more potent and longer-lasting

The new integrase inhibitor dolutegravir is more effective and more tolerable than the first licensed integrase inhibitor, raltegravir (Isentress), a study presented at the Conference on Retroviruses and Opportunistic Infections (CROI) in March found. Seventy-nine per cent of people with highly drug-resistant HIV taking one 50mg dolutegravir pill a day achieved a viral load under 50 copies/ml compared with 70% taking the licensed raltegravir dose (400mg twice a day). The difference was greater in people who started with a viral load over 100,000 copies/ml (70 versus 53% under 50 copies/ml). Meanwhile, a study in monkeys of a third-generation integrase inhibitor, GSK744, indicates that it may be possible to give it as an injection as infrequently as once every three months. Dolutegravir is likely to receive marketing approval in Europe during the the second half of 2013.

Glossary

integrase

HIV enzyme that the virus uses to insert its genetic material into a cell that it has infected.

self-testing

In HIV testing, when the person testing collects their own sample and performs the whole test themselves, including reading and interpreting the result. 

integrase inhibitors (INI, INSTI)

A class of antiretroviral drugs. Integrase strand transfer inhibitors (INSTIs) block integrase (see ‘integrase’). Blocking integrase prevents HIV from replicating.

unprotected anal intercourse (UAI)

In relation to sex, a term previously used to describe sex without condoms. However, we now know that protection from HIV can be achieved by taking PrEP or the HIV-positive partner having an undetectable viral load, without condoms being required. The term has fallen out of favour due to its ambiguity.

middle income countries

The World Bank classifies countries according to their income: low, lower-middle, upper-middle and high. There are around 50 lower-middle income countries (mostly in Africa and Asia) and around 60 upper-middle income countries (in Africa, Eastern Europe, Asia, Latin America and the Caribbean).

For the full news report see: www.aidsmap.com/page/2595521

Condoms '70% effective' in anal sex

An analysis of the effectiveness of condoms in preventing HIV transmission in anal sex between men has concluded that 100% condom use as a strategy (i.e. men reported using condoms every time, but not necessarily without accidents) stops about 70% of possible HIV infections. This is only the second-ever attempt to quantify condom effectiveness in anal sex, but the first study to do so, back in 1989, came out with exactly the same figure. This is about 10% less than the effectiveness of 100% condom use as a strategy in vaginal sex, which may be due to the greater likelihood of transmitting HIV via anal sex, or could be due to a higher likelihood of condom failure in anal sex. The study also found that, although two-thirds of gay men reported using condoms 100% of the time during a six-month period, only 16% maintained that over three years or more.

For the full news report see: www.aidsmap.com/page/2595521

French patients stop drugs but remain undetectable

Up to 15% of people with HIV who are given antiretroviral therapy within ten weeks of being infected could later stop taking antiretroviral therapy (ART) and maintain an undetectable viral load, French researchers suggest. Their prediction is based on a study of 14 people who all started ART that early, stayed on ART for at least a year (on average, three years), and then discontinued it for various reasons, but who did not experience their HIV viral load ‘rebounding’. Six had occasional low-level ‘blips’ of HIV but the other eight have never had another detectable viral load result in an average time of 7.5 years off ART (a minimum of four years). The researchers combed French medical records and found 70 similar cases, leading them to conclude that up to 15% of people who start ART early could come off the drugs later and experience a similar ‘remission’ of HIV.

For the full news report see: www.aidsmap.com/page/2602347

English sexual health framework says the right things but may have little power

Twelve years after the English Department of Health’s first strategy on sexual health was published, a second Framework for Sexual Health Improvement in England has been issued. Setting out the government’s “ambitions for improving sexual health”, this document’s language is revealing, as it was issued just before local authorities took over the commissioning of sexual health services on 1 April; the Department of Health has no power to mandate public health priorities for them. The Framework acknowledges the roles that HIV treatment and HIV testing in non-specialist settings have in reducing transmission; discusses primary HIV infection and pre-exposure prophylaxis (PrEP); highlights the sexual health needs of young people and people over 50; and considers the impact of drugs and alcohol on sexual health. But whereas local authorities will be required to commission clinical services for sexually transmitted infections (STIs) and contraception, the Framework draws less attention to HIV prevention and sexual health promotion. Local authorities will commission these sorts of services if they wish but the Framework does not say that they should. Casualties have already been seen since 1 April, most notably projects commissioned by the former Pan-London HIV Prevention Programme such as those run by gay men’s HIV prevention charity GMFA, which recently announced the withdrawal of many of its services following the loss of all of its statutory funding from London.

For the full news report see: www.aidsmap.com/page/2606010

Life expectancy for people with HIV in South Africa begins to approach normal

As more people start antiretroviral therapy (ART) in South Africa, life expectancy among people with HIV has begun to rise, a survey finds. Although studies done in developed countries, including England, have found that life expectancy in some groups of people with HIV is approaching normal, and local studies in south Africa also find this, little is known yet about the national impact of ART in low- and middle-income countries. The South African survey, which documented mortality in people with HIV between 2001 and 2010, found that there is still a way to go. Whereas HIV-negative South Africans can, at the age of 20, expect to live till 65 if they are men and 73 if they are women, men with HIV have an average life expectancy of 48 and women of 57, a 26 and 22% shortfall respectively. However, life expectancy in people starting HIV therapy after 2006 with a CD4 count over 200 only had a shortfall of about 15%. This is expected to improve further as the country has recently raised the CD4 cell count threshold for starting treatment to 350.

For the full news report see: www.aidsmap.com/page/2630355

Little change in gay men’s condom use between 2001 and 2008

an analysis of data from two English gay men’s sex surveys in 2001 and 2008 shows little change in the overall proportion of gay men having unprotected anal intercourse (UAI) during this time, though it does find a higher rate of gay men with HIV having UAI and a fall in the proportion of HIV-negative men with a large number of partners. The study also found that the proportion of men who had ever had an HIV test increased by 50% over this period and that the proportion who said they knew they had HIV almost tripled.

For the full news report see: www.aidsmap.com/page/2625697

Researchers stop the only current HIV vaccine efficacy trial

In a blow to HIV vaccine development, the US National Institute of Allergy and Infectious Diseases (NIAID) announced on 25 April that it was discontinuing the HVTN 505 HIV vaccine trial. This trial started in July 2009 and involved 2504 volunteers. Since the successful conclusion of the RV144 vaccine trial in September 2009, HVTN 505 has been the only ongoing HIV vaccine trial large enough to be a true test of vaccine efficacy. The trial‘s data and safety monitoring board (DSMB) found that the vaccine regimen was neither preventing HIV infection nor reducing viral load among vaccine recipients who acquired HIV. There were actually more HIV infections in volunteers receiving vaccine than placebo, but this difference was not statistically significant and may be due to chance. Nonetheless, as HIV prevention advocates AVAC comment, “even disappointing results like those of 505 are critical to refine future vaccine strategies. AIDS vaccine research is still in its most promising period in decades with breakthroughs in a number of approaches different from that studied in 505.” Trials of the vaccine that produced the promising result in the RV144 trial, which used a different kind of vaccine to HVTN505, are ongoing.

For the full news report see: www.aidsmap.com/page/2640732

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

Three types of HIV cure

If you’ve been following the news lately, you may be starting to wonder why anybody ever thought curing HIV was so challenging. On March 3 we heard the news that a child appeared to have been cured. Hard on the heels of that report came the news that 14 individuals in France had been functionally cured. So what do these cases mean? How are they similar, and how do they differ? And importantly for HIV research, where do we go from here?

For the full news report, visit the amfAR website: http://bit.ly/11jTJ1i

Option B+: Understanding perspectives and experiences of women living with HIV

Option B+ is a prevention of vertical transmission approach for expectant mothers living with HIV in which women are immediately offered treatment for life regardless of their CD4 count. This approach offers advantages such as protection of partner(s) and (unborn) child, as well as benefits to the woman's health, but also carries with it risks.

For the full news report, visit the GNP+ website: http://bit.ly/15htHAR

National AIDS Trust calls on London Councils to tackle drug use amongst gay men

The UK’s National AIDS Trust (NAT) has called for urgent action from London Councils to tackle a recent rise in the use of drugs amongst the London gay community.

For the full news report, visit the Pink News website: http://bit.ly/XSH1tl