International study of gay couples reports no transmissions from an HIV-positive partner on treatment
A study of 343 gay couples, where one partner had HIV and the other did not, has not found a single case of HIV transmission in 16,889 acts of condomless anal sex, the 9th International AIDS Society Conference on HIV Science (IAS 2017) in Paris, France, was told.
For the last few years, a specialist symposium on HIV cure research has preceded the IAS Conferences and this one was no exception, with a 1.5-day forum at Paris’s Curie Institute on the weekend the conference opened.
What if we are asking the wrong, question, though? What if trying to destroy or at least expose and inactivate every cell containing HIV is not the way forward and instead the answer is to teach the body to simply either ignore HIV, or develop an immune response that controls it? One of the most widely-reported stories of the conference was the discovery of a South African child who had been born and started treatment early but who had now been off antiretroviral therapy (ART) for 8.5 years without development of a viral load.
What all the different approaches discussed in the previous report have in common is to put HIV infection into persistent remission, but they do not completely remove HIV from the body. But in what is still the one case of a person cured of HIV, that is what was achieved; researchers have not managed to find any trace of HIV in the body of Timothy Ray Brown (who attended a symposium presenting the main data from the Cure and Cancer Forum) nearly a decade after he was cured.
A broadly neutralising antibody modestly delayed the resurgence of viral replication following interruption of antiretroviral therapy (ART) started during very early infection, but all study participants ultimately experienced viral rebound, according to results presented at the conference.
A single oral dose of MK-8591, a long-acting antiretroviral in a novel drug class, suppressed HIV for seven days in an early clinical trial, and the drug also appears to protect monkeys from rectal infection with an HIV-like virus, researchers reported at the conference.
The stillbirth rate among women living with HIV in the UK and Ireland from 2007 to 2015 was more than twice that of the general population, Graziella Favarato, presenting on behalf of the National Study of HIV in Pregnancy and Childhood (NSHPC), told participants at the conference.
US HIV funding decisions on PEPFAR in 2017 will have critical effect on ability to reach 90-90-90 goals
A withdrawal of United States funding for HIV treatment and prevention in sub-Saharan Africa could lead to 20 million additional HIV infections and 2 million additional AIDS deaths between now and 2032, according to modelling of the impact of US funding carried out by Imperial College, London, and presented at the conference.
The first once-daily single-tablet regimen containing a protease inhibitor maintained viral suppression in almost everyone who switched after achieving undetectable HIV RNA on a multi-pill regimen, according to a report at the conference.
Adolescents who acquired HIV perinatally were less likely to die, grew faster and had better immune restoration on treatment if they lived in upper-middle income countries in sub-Saharan Africa, a comparative study presented at the conference reported.
France is launching a new study which will enrol 3000 new pre-exposure prophylaxis (PrEP) users over the next three years, Jean-Michel Molina told the conference. Whereas previous studies, including Molina’s own IPERGAY study, proved the benefit of PrEP to the individual taking it, the new study has set an ambitious target in relation to the public health benefit of PrEP. The aim is to show that having an extra 3000 people take PrEP will result in a marked fall in HIV diagnoses among men who have sex with men in the Paris region.
In Europe, whether through national programmes or in trials, people are more often than not being given the choice of taking pre-exposure prophylaxis (PrEP) daily or intermittently (“event-driven” or “on-demand” PrEP). The French national rollout programme offers this choice as does the one recently set up by Scotland. The large implementation study hopefully soon to start in England will offer this choice too.
A long-acting injectable formulation of cabotegravir given every 8 weeks produces high enough drug levels in both men and women to offer protection against HIV, according to results from the HPTN 077 study presented at the conference. But another injectable prevention candidate, long-acting rilpivirine, has been abandoned.
A single-tablet regimen containing the next-generation non-nucleoside reverse transcriptase inhibitor (NNRTI) doravirine reduced HIV viral load as much as an efavirenz-based co-formulation, but it had a more favourable side-effect profile, according to results from the DRIVE-AHEAD study presentation at the conference.
Doctors need to monitor patients regularly for kidney function if they are taking tenofovir disoproxil, especially if combined with ritonavir, the conference heard.
Countries and donors should aim for new $90-$90-$90 target on HIV, hepatitis, TB drug prices, study shows
HIV, hepatitis B and C and tuberculosis (TB) can each be treated for less than $90 a year where generic drugs can be made available, Dzintars Gotham of Imperial College, London, reported at the conference.
South African women whose most recent sexual partner was circumcised are less likely to have HIV, suggesting that the voluntary medical male circumcision programmes have benefits for women too, according to a study presented to the conference.
Demonstration projects explore the feasibility of PrEP for adolescents and young women in South Africa
One of the first studies to explore the acceptability, safety and use of pre-exposure prophylaxis (PrEP) in adolescents in an African context has found that PrEP was safe and tolerable, although PrEP usage and adherence did tail off during the 12 months of the programme.
A substudy of the French Ipergay trial of ‘on-demand’ pre-exposure prophylaxis (PrEP) has found that PrEP was just as effective for participants who had sex less often than average, and so took PrEP less often, as long as they did take it when it was needed.
A year ago, one of the biggest pieces of prevention news at the Durban International AIDS Conference was the announcement that a large HIV vaccine efficacy study would start in South Africa. HVTN 702, now running, is only the eighth human vaccine efficacy trial ever run in the history of the HIV epidemic and the first since 2009.
AbbVie's new pangenotypic regimen combining glecaprevir and pibrentasvir cured almost all HIV-positive people with hepatitis C co-infection in the EXPEDITION-2 study, according to a presentation at the conference.
Three African countries with high burdens of HIV infection are achieving very high levels of HIV treatment initiation and viral suppression but need to make better progress on HIV testing in order to achieve the 90-90-90 targets, according to results from large studies presented at the conference.
Adding HIV self-testing as an additional option to a door-to-door programme offering HIV testing in Zambia boosted the uptake of HIV testing among men, younger adults and those who had previously refused HIV testing, Helen Ayles of the London School of Hygiene and Tropical Medicine told the conference. It appears that HIV self-testing may have a particular impact on testing rates in men and could contribute to meeting the 90-90-90 targets in men.
Integrase inhibitors not causing higher rates of adverse birth outcomes, Botswana and French studies show
Dolutegravir-based antiretroviral therapy (ART) started in pregnancy is as safe as efavirenz-based ART, according to a study of birth outcomes at eight maternity wards throughout Botswana accounting for close to half of all nationwide deliveries, Rebecca Zash of Beth Israel Deaconess Medical Center told participants at the conference.
Everyone diagnosed with HIV should be offered the option to start treatment within seven days of diagnosis and everyone who feels ready should have the option to start treatment on the day of diagnosis, the World Health Organization (WHO) has recommended.
A single-tablet regimen containing the experimental integrase inhibitor bictegravir was as effective as two widely used approved regimens for first-line therapy in a pair of phase 3 clinical trials, according to presentations at the conference.
Treatment for hepatitis C in sub-Saharan Africa can produce cure rates as high as those seen in industrialised countries, with high adherence and minimal side-effects, according to a presentation at the conference.
A year ago there was virtually no evidence on the acceptability and feasibility of HIV self-testing in female sex workers, but a series of presentations from Zimbabwe, Zambia, Uganda and Kenya at the conference suggest that self-testing has potential in improving the uptake of testing among sex workers in Africa.
A nine-year-old South African child who was diagnosed with HIV infection at one month of age and received HIV treatment for 40 weeks during infancy has suppressed the virus without anti-HIV drugs for eight and a half years, scientists reported at the conference.
Providing free HIV self-testing kits to gay and bisexual men is an effective way to increase the frequency with which men test for HIV and the number of new HIV diagnoses, Robin MacGowan of the US Centers for Disease Control and Prevention (CDC) told the conference.
Shifts to less frequent clinic visits and medication pick-ups to free up healthcare resources and make life easier for people living with HIV are being implemented successfully in some African countries, but still need fine tuning, several studies presented at the conference show.
Improved treatment for cryptococcal meningitis in HIV could save thousands of lives – if generic drug becomes available
Urgent action is needed to improve access to the antifungal drug flucytosine, say investigators, following the presentation of the results of a trial showing that treatment containing flucytosine is superior to any other form of treatment in reducing the risk of death from cryptococcal meningitis in people with very advanced HIV disease.
New HIV infections have halved in Swaziland since 2011 at the same time as the proportion of people on antiretroviral treatment with fully suppressed viral load has doubled, the conference heard. It is the first direct evidence that expanding HIV treatment results in fewer HIV infections in a country with a major epidemic, researchers said.
Two long-acting injectable antiretrovirals, cabotegravir and rilpivirine, administered once every 4 or 8 weeks maintained viral suppression in about 90% of people who started therapy with an undetectable viral load, according to the latest results from the LATTE-2 trial, presented at the conference.
Gonorrhoea diagnoses among gay men attending the largest STI clinic in the UK at 56 Dean Street in London’s Soho have declined by 24% in the last year, the clinic’s Professor Sheena McCormack, principal investigator of the PROUD PrEP study, told the conference.
The world is on track to reach global targets for reducing AIDS deaths and HIV treatment access by 2020, but some regions of the world risk falling further behind due to lack of political commitment, UNAIDS announced in the run-up to the conference.
WHO recommends package of tests, treatment and prevention for 'urgent need' people with HIV with low CD4 counts
A new package of measures to ensure rapid initiation of antiretroviral treatment and diagnosis of opportunistic infections has been recommended by the World Health Organization (WHO) to reduce the still high rates of death in people diagnosed with HIV at a very advanced stage of disease.