This edition of HATIP collects together some of the most important news stories from the Sixth International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention, which took place in Rome, July 17-21.These stories and others were published at http://www.aidsmap.com/ias2011
NAM was official provider of online scientific coverage for the conference. We would like to thank the International AIDS Society for their help in facilitating this news coverage. You can browse and search for conference abstracts and slides at the conference website here.
TREATMENT AS PREVENTION
- Results of the HPTN 052 study showed that when compared to delaying treatment until the CD4 cell count falls to 250 cells/mm3, antiretroviral treatment started at a CD4 count between 350 and 550 cells/mm3 reduced the risk of HIV transmission to an uninfected partner by at least 96%.
- The only transmission that occurred from a person on treatment probably occurred in the first few weeks on treatment, before viral load was fully suppressed.
- The study also found that early treatment reduced the risk of serious illness or death by 40%. However this reduction in risk was largely explained by a reduction in the risk of extrapulmonary TB. Earlier treatment had no significant impact on the risk of death, pulmonary TB, serious illness (WHO stage 4 disease) or severe bacterial infection.
- The study recruited couples in Africa, India and Brazil. There was no difference in the effect of treatment on transmission between regions.
- Reducing new HIV infections by treating more people will require improvements in performance at every stage from HIV testing, retention in care prior to treatment, initiation of treatment, retention in care once on treatment and adherence to treatment.
- WHO plans to look at all its guidelines over the next year in order to produce one simplified set of guidance to replace all current guidelines.
Community organisations want to see an immediate review of counselling and medical services for serodiscordant couples and pregnant women, and say that every person with HIV should decide for themselves when and how to start treatment, without coercion.
PRE-EXPOSURE PROPHYLAXIS
- Three studies presented at the conference showed that pre-exposure prophylaxis using the antiretroviral drugs tenofovir or Truvada (tenofovir / emtricitabine) reduced the risk of acquiring HIV very substantially.
- The Partners study showed that pre-exposure prophylaxis with Truvada or tenofovir protected both men and women in serodiscordant couples. PrEP reduced the risk of HIV infection by 62% - 73%.
- The TDF2 study showed that PrEP reduced the risk of HIV infection by 63%.
- The IPrEX study showed that Truvada reduced the risk of infection by 42% in men who have sex with men.
- In the TDF2 and IPrEX studies, better adherence was associated with greater reductions in the risk of infection.
- Implementing these findings in a cost-effective way will require careful targeting of an intervention to the right groups. For example PrEP may be suitable for some couples, but a microbicide containing tenofovir might be better for others.
OPERATIONAL RESEARCH
- New point of care CD4 cell counting tests were described at the meeting. The cost-effectiveness of these technologies will be highly dependent on the volume of patients being tested, and the cost of materials.
- The Gene Xpert TB test being rolled out in South Africa is detecting much higher rates of TB and of MDR TB than the existing method of diagnosis.
- It is estimated that Gene Xpert will result in 39% more people on TB treatment in South Africa by 2013, and could cut the time to starting TB treatment by over 50 days, to around 5 days.
- There is controversy over whether Gene Xpert should be used in all people with HIV, regardless of whether they have symptoms of TB, as a screening tool.
Trials of task-shifting antiretroviral initiation and management to nurses highlighted the tension between rapid devolution of care to the primary health level and the need to fully train staff as this process goes forward.
- The STRETCH trial in South Africa showed that task shifting of ART initiation and management to nurses showed that a nurse-led service delivered ART just as effectively as a physician-led service. However the trial was unable to show that a nurse-led service resulted in a reduction in deaths among people waiting for treatment, or a speeding up of treatment initation for those waiting.
- Nurses are successfully providing circumcision services in several countries but a shortage of nurses will limit the scale-up of circumcision. Bringing retired or unemployed nurses back into service might be one way of expanding the workforce.