Achieving the 90-90-90 target news

Ending AIDS by 2030 a distant prospect, global HIV incidence, prevalence, treatment coverage and mortality figures suggest

Remarkable progress has been made towards curbing the global HIV epidemic, but there is little chance of achieving the UNAIDS goal of “ending AIDS” by 2030, according to data published in The Lancet. Investigators found that global HIV incidence peaked in 1997 and fell steadily until 2005. However, for the past ten years there have been only modest annual falls in the rate of new infections. Of the 195 countries included in the study, 102 experienced an increase in the annual number of new HIV infections between 2005 and 2015. 

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San Francisco reports new low in HIV infections and faster treatment, but disparities remain

On 1 September the San Francisco Department of Public Health released its HIV Epidemiology Annual Report 2015, showing that the number of newly diagnosed HIV infections has continued to fall and people with HIV are being linked to care and achieving viral suppression more quickly. But some notable disparities remain, with African-American men and women, in particular, not benefitting as much as the city's population as a whole.

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How can clinical services engage men who have sex with men in Africa?

Men who have sex with men living in African countries have an extremely high burden of HIV, Stefan Baral of Johns Hopkins University reminded delegates at the 21st International AIDS Conference (AIDS 2016) in Durban, South Africa. Across the region, the average prevalence of HIV in men who have sex with men (MSM) is estimated to be 18%. Studies suggest annual rates of new infections of 6% in South Africa, 7% in Malawi and 16% in Senegal.

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Most people taking second-line ART in sub-Saharan Africa achieve viral suppression but there's a need for third-line treatment options

Approximately 85% of people switched to protease inhibitor-based second-line antiretroviral therapy (ART) in sub-Saharan Africa achieve and maintain an undetectable viral load with their new regimen, according to research in the online edition of Clinical Infectious Diseases.

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People shifting from paediatric to adult HIV care have a high risk of ART failure

HIV-positive adolescents and young adults are especially likely to experience the virological failure of their antiretroviral treatment when they move from paediatric to adult HIV care, according to Dutch research published in the online edition of Clinical Infectious Diseases. The risk of virological failure was increased over fourfold at the time of care transition, 18 to 19 years of age. Risk factors associated with viral breakthrough were low educational attainment, poor knowledge of HIV and lack of independence regarding HIV treatment adherence.

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Package of prophylaxis against infections reduces the risk of death for people starting HIV treatment very late

A package of enhanced prophylaxis against infections significantly reduced the risk of death in adults and children with advanced HIV disease after starting antiretroviral treatment in a randomised study, Professor James Hakim of the University of Zimbabwe told AIDS 2016.

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Progress towards 90-90-90: news highlights from other sources

HIV infections in San Francisco hit low, but drive misses African Americans

from SFGate

New HIV infections dropped to historic lows in San Francisco last year as the city amped up an aggressive campaign to essentially end the AIDS epidemic by 2020, but those efforts are not reaching everyone in equal measure, according to an annual report set to be released on Thursday.

South Africa: ARVs now easier to get

from TIMES Live

From today anyone who is HIV positive can access ARVs from a state facility – good news for about 4 million people living with the virus but not on medication. Until now only HIV-positive people with CD4 counts lower than 500 (the measure of immune system strength) qualified for treatment under the Department of Health's treatment guidelines.

Zimbabwe: all HIV+ patients to get ARVs

from AllAfrica

All people who tested positive to HIV from Manicaland and Matabeleland South provinces in June will immediately be placed on antiretroviral therapy regardless of their CD4 count as the country seeks to operationalise the latest World Health Organization guidelines on treatment and care of HIV.

Tanzania: ARVs now for any CD4 count

from AllAfrica

People living with HIV will, from October, start antiretroviral treatment after testing, the government has announced. This comes after the World Health Organization (WHO) has given new directives last year that anyone who tests HIV-positive must immediately be put on the lifelong medications regardless of their CD4 count.

HIV effort let down by test shortages, says WHO

from BBC Health

A shortage of HIV testing could undermine global efforts to diagnose and treat people with the infection, warn experts from the World Health Organization.

The end of the end of AIDS

from World Bank (blog)

The Durban 2016 AIDS Conference marks the end of "ending the HIV epidemic" as a feasible goal with the tools we have. We need new and better tools. Talk of ending AIDS has led to a widespread perception in the broader health and development community that this crisis is over. It isn't.

Rhetoric meets reality: ending HIV and AIDS

from Open Democracy

Ending AIDS by 2030 is redundant rhetoric. It is meaningless without investment in community participation.

Other recent news headlines

Improvements in HIV treatment and care have had no impact on rates of endstage liver disease among HIV-positive people with viral hepatitis

Incidence of endstage liver disease (ESLD) among HIV-positive people with viral hepatitis changed little between 1996 and 2010, despite major improvements in HIV treatment and care, investigators from Canada and the United States report in the online edition of Clinical Infectious Diseases

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Vaginal ring for HIV prevention effective and acceptable

An updated adherence analysis from the ASPIRE study indicates that consistent users of a vaginal ring containing dapivirine experienced 65% fewer infections, the 21st International AIDS Conference (AIDS 2016) in Durban, South Africa heard. Some additional analyses suggested a higher level of effectiveness. Moreover, African women who took part in the study told researchers that they liked the product, found it easy to use and preferred it to possible alternatives such as tablets or vaginal gels.

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Study looks at use of PrEP during pregnancy and breastfeeding

Women in San Francisco and New York City frequently chose to use Truvada for pre-exposure prophylaxis (PrEP) when it was offered as an additional tool for preventing HIV infection during the pre-conception period, pregnancy and breastfeeding, according to study findings presented at AIDS 2016 and published in the 19 July online edition of the American Journal of Obstetrics and Gynecology.

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Realism needed about the benefits and risks of taking part in HIV cure studies

A significant proportion of people living with HIV would be willing to take part in a study towards a cure for HIV, research presented at AIDS 2016 shows. However, some potential participants may not fully understand that taking part in an early-phase study is highly unlikely to afford any personal clinical benefit, but might have the potential to cause harm.

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Depression increases risk of heart attack for adults with HIV

Major depression is associated with an increased risk of heart attack for middle-aged HIV-positive people, investigators from the United States report in JAMA Cardiology. Overall, presence of a major depressive disorder (MDD) increased the risk of heart attack – acute myocardial infarction (AMI) – by almost a third. Use of antidepressants weakened the association between depression and heart attack risk, and there was no evidence that milder forms of depression – dysthymic disorders – were associated with an elevated risk of heart attack.

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Elevated lipids associated with cognitive decline in middle-aged HIV-positive men doing well on ART

Elevated cholesterol and a gene associated with Alzheimer’s risk in the general population are both risk factors for cognitive decline in middle-aged HIV-positive people with a suppressed viral load, according to US research published in the online edition of Clinical Infectious Diseases.

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US PrEP study achieves high levels of engagement and adherence among black men who have sex with men

What was described at AIDS 2016 as “the first PrEP trial devised and run by four black gay men” has shown that high levels of PrEP (pre-exposure prophylaxis) use, retention and adherence can be achieved in a demonstration project if its recruitment and support structures are tailored to the needs of black men who have sex with men. 

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Many people in the US with chronic hepatitis B not being properly monitored

Many people with chronic hepatitis B virus infection have infrequent medical monitoring, according to US research published in the online edition of Clinical Infectious Diseases. Analysis of the records of over 2000 people with the chronic infection followed for an average of six years showed that a quarter did not have an annual assessment of a key marker of liver function, only a third had yearly measurement of hepatitis B virus (HBV) DNA, and that 11% of people with cirrhosis had never had a liver ultrasound. Only 32% were prescribed HBV therapy and 44% of those with cirrhosis were not under treatment.

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Neglect of infectious diseases in prisons highlighted at AIDS 2016

“Prisoners are among the most neglected of the key populations; they bear higher burdens of HIV, viral hepatitis and tuberculosis than in the communities from which they come,” said Professor Chris Beyrer of Johns Hopkins University and outgoing President of the International AIDS Society. He was speaking during a symposium dedicated to a special issue of The Lancet, published to coincide with AIDS 2016, containing a comprehensive series of reviews on HIV and related infections in prisoners.

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HIV not a risk factor for fibrosis progression in people with hepatitis C

HIV co-infection is not associated with accelerated progression of liver fibrosis in people with hepatitis C virus (HCV) infection, according to US research published in the online edition of the Journal of Infectious Diseases. Factors linked with fibrosis progression were low fibrosis stage at baseline and flares in alanine aminotransferase (ALT) levels.

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New WHO algorithm to prevent TB deaths in very ill people with HIV

The World Health Organization (WHO) has released a new diagnostic algorithm in order to reduce the likelihood of ‘seriously ill’ people with HIV dying of undiagnosed and untreated tuberculosis (TB).

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German medicines watchdog rejects ‘new tenofovir’ pill

The German health technology assessment agency IQWiG has announced that it finds no advantage in Descovy, a combination pill containing a new version of the HIV drug tenofovir, over its alternative, Truvada, which is the most widely-used HIV medicine. A press release says that it will not be recommending the provision of Descovy free to patients by the German federal health service as part of antiretroviral therapy (ART) .

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Poor kidney function associated with increased cardiovascular risk for people with HIV

Renal impairment is associated with an increased risk of cardiovascular disease (CVD) in HIV-positive individuals, according to data from a large observational cohort study published in the online edition of the Journal of Infectious Diseases.

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Most contraceptives not linked to HIV infection, but Depo-Provera may raise risk

Birth control pills and some types of injectable and implanted contraceptives were not associated with an increased risk of HIV acquisition in an updated meta-analysis that included several recent studies, researchers reported in the 5 August online edition of AIDS. However, evidence continues to suggest that use of depot medroxyprogesterone acetate (DMPA or Depo-Provera) raises the likelihood of HIV infection. The World Health Organization plans to meet soon to assess whether guidance needs to change in the light of the new findings.

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Ongoing hepatitis B virus replication associated with higher mortality for people with HIV

People with HIV and hepatitis B virus (HBV) co-infection have more than double the risk of death if they have ongoing high-level HBV replication, indicating a need for prompt treatment, according to an analysis from the Temprano trial presented at an HIV and viral hepatitis co-infection session at AIDS 2016.

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Editors' picks from other sources

Free testing and treatment for all South Africans with HIV

from i-News

South Africa is set to provide universal testing and free treatment to all people with HIV, in a major public health effort in the country worst affected by the virus that causes AIDS. Under the new guidelines, all patients will be offered free treatment, regardless of the condition of their immune system.

Global fund welcomes US pledge of up to $4.3 billion

from Global Fund to Fight AIDS, TB and Malaria

The Global Fund to Fight AIDS, Tuberculosis and Malaria warmly welcomed an announcement by the United States Government to contribute up to US$4.3 billion to the Global Fund, a demonstration of outstanding commitment to global health. "We are committing to match one dollar for every two dollars in pledges made by other donors through September 30th, 2017," said US National Security Advisor Susan E. Rice in a statement.

European Commission grants marketing authorisation for Gilead’s once-daily Truvada for reducing the risk of sexually acquired HIV-1

from Gilead press release

Gilead Sciences, Inc. today announced that the European Commission has granted marketing authorisation for once-daily Truvada (emtricitabine 200 mg/tenofovir disoproxil 245 mg; FTC/TDF) in combination with safer-sex practices to reduce the risk of sexually acquired HIV-1 infection among uninfected adults at high risk, a strategy known as pre-exposure prophylaxis, or PrEP.

HIV prevention drug Truvada won't be subsidised in Australia

from Sydney Morning Herald

Truvada, an expensive breakthrough drug that prevents people from getting HIV won't be funded by taxpayers in Australia this year, the nation's drug funding panel has ruled. A Department of Health spokeswoman said the Pharmaceutical Benefits Advisory Committee (PBAC) understood "this is an important new prevention medication for HIV", but decided the price set by the drug's sponsor, Gilead Sciences, was too high and a proposal to limit subsidy to a small subset of the "at risk" group was not feasible. "In its deliberations the PBAC indicated a substantial price reduction would be needed to make Truvada available for PrEP for the whole 'at risk' population, but noted that Truvada for PrEP could represent value for money in the broader population at a substantially lower price," the spokeswoman said.

Glaxo bets it can shake up HIV treatment

from Wall Street Journal

GlaxoSmithKline PLC is pinning the future of its HIV business on an audacious bet. They hope their latest HIV pill is powerful enough to suppress the virus with the help of just one other drug.