News from IAS 2017

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.

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Why curing HIV may be like curing cancer – and may be as difficult

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.

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What marks out HIV controllers from others?

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.

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Can we achieve a complete HIV cure in more patients?

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.

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VRC01 antibody can delay but not prevent viral rebound after interruption of early treatment

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.

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Long-acting NRTI shows promise for HIV treatment and PrEP

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.

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Stillbirth more frequent in women with HIV in UK and Ireland than in general population

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.

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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.

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First protease inhibitor combination pill maintains viral suppression

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.

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Adolescents with HIV do better in more prosperous African countries, even with treatment

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.

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France’s next PrEP study aims to assess the wider impact of PrEP on the HIV epidemic

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.

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Dutch study finds out whether gay men prefer daily or on-demand PrEP

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.

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Long-acting cabotegravir injection shows promise for HIV prevention

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.

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Doravirine combination pill looks good for initial HIV treatment

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.

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Acute kidney injury ‘uncommon’ but unpredictable on tenofovir and ritonavir

Doctors need to monitor patients regularly for kidney function if they are taking tenofovir disoproxil, especially if combined with ritonavir, the conference heard.

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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.

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Medical male circumcision for HIV has benefits for women too

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.

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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. 

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Ipergay trial: PrEP still protected people who had less sex and used it less often

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.

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Another HIV vaccine efficacy trial will start this year

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.

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Glecaprevir/pibrentasvir is effective for people with HIV/HCV co-infection

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.

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90-90-90 progress in southern Africa: HIV testing gap needs to be closed in young people and men

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.

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Can self-testing engage 'hard-to-reach' men with HIV testing?

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.

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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.

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New guidance says start HIV treatment within 7 days of diagnosis – but is everyone ready?

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.

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New integrase inhibitor bictegravir works well for first-line HIV treatment

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.

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Hepatitis C treatment is effective and feasible in Africa

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.

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High uptake of HIV self-testing by female sex workers in African countries

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.

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South African child has controlled HIV off treatment for 8.5 years

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.

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Programme to provide free self-tests helps gay men to test for HIV more often

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.

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Less frequent clinic visits for HIV care: fine tuning needed

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.

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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.

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Swaziland: new infections halved in five years as HIV treatment scales up

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.

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Long-acting cabotegravir + rilpivirine injection shows good results at 96 weeks

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.

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London gonorrhoea rates fall, and HIV rates falling in Australia as more join PrEP demo

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.

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World on track to reach the 90-90-90 targets for HIV treatment by 2020

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.

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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.

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Other recent news headlines

PrEP demand in England is rapidly accelerating – and most will want to join the trial

A survey of people currently using pre-exposure prophylaxis (PrEP) has found that PrEP use has rapidly accelerated in the last year, with more than half of those surveyed starting since the beginning of 2017. The short survey was conducted by PrEP advocacy sites iwantPrEPnow and PrEPster, with assistance from Public Health England.

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European and US regulators approve AbbVie's new combo for all hepatitis C genotypes

The European Commission and the US Food and Drug Administration (FDA) last week approved AbbVie's new combination pill for people with hepatitis C virus (HCV) genotypes 1 through 6, to be marketed as Maviret in the European Union and as Mavyret in the United States.

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Few people with HIV starting raltegravir and dolutegravir change therapy because of side-effects

Only a few people starting an integrase inhibitor discontinue the treatment during the first year of therapy due to drug-related toxicities, investigators from Switzerland report in an advance online publication in the journal AIDS. The prospective study monitored over 4000 HIV-positive people who started treatment with raltegravir or dolutegravir between 2006 and 2015. Side-effects leading to the discontinuation of therapy occurred in 5% of people and less than 2% of individuals switched from an integrase inhibitor because of neuropsychiatric toxicity.

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US regulator approves Gilead's Vosevi combo pill for hepatitis C retreatment

On 18 July the US Food and Drug Administration (FDA) approved Gilead Sciences' Vosevi, a new once-daily combination pill containing sofosbuvir, velpatasvir, and voxilaprevir. Vosevi was approved as "salvage therapy" for people with all hepatitis C virus (HCV) genotypes who were not previously cured with prior direct-acting antiviral (DAA) therapy.

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Many people living with HIV at high risk of cardiovascular disease are not on statins

Only half of HIV-positive patients at a Chicago clinic eligible for statin therapy according to the latest US guidelines are receiving this treatment, investigators report in the online edition of the Journal of Acquired Immune Deficiency Syndromes. The researchers say their findings raise concerns about suboptimal cardiovascular disease (CVD) prevention among people living with HIV.

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People treated with atazanavir had lower risk of stroke and heart attack

People who started HIV treatment with a drug combination containing atazanavir (Reyataz) were significantly less likely to suffer a heart attack or stroke than people starting treatment with other regimens, a large study of US military veterans has found.

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Gay men using HIV self-tests promptly seek confirmatory testing and linkage to care, New York data suggests

Data from the partner services programme in New York City suggests that gay men who have previously used an HIV self-test tend to seek confirmatory testing without delay, according to an article published online ahead of print in Sexually Transmitted Diseases. The study also highlights socio-demographic differences between those using self-tests and other people with new HIV diagnoses, suggesting that the price of the kit discourages its use by those with lower incomes.

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Proton pump inhibitors may blunt CD4 cell gains, cause immune activation, in people with HIV

Proton pump inhibitors should be used with caution in people with HIV, US researchers say, after finding that people who received long-term treatment for gastric reflux with the drugs failed to gain CD4 cells and experienced more immune activation. The findings are published in advance online in Clinical Infectious Diseases.

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Non-alcoholic fatty liver disease common in people living with HIV – metabolic disorders are key risk factors

Over a third of people with HIV have non-alcoholic fatty liver disease (NAFLD) in the absence of hepatitis B or C, according to the results of a meta-analysis and systematic review published in AIDS. Metabolic disorders including high body mass index (BMI), diabetes and elevated lipids were key risk factors. The study also revealed high prevalences of non-alcoholic steatohepatitis (NASH) and liver fibrosis, possible outcomes of NAFLD, with metabolic disorders once again shown as the most important factors.

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High uptake of home-based HIV testing in Zambia, but repeat visits needed to get close to universal coverage

Preliminary results from PopART, a large-scale study of a universal test and treat approach to slowing the spread of HIV in southern Africa, show that a door-to-door HIV testing programme is feasible, acceptable and effective. Testing was most likely to be accepted by women, younger people, those with symptoms and those who had not recently tested. Following repeat visits to households, knowledge of HIV status increased from around 50% of residents to around 90%.

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Frailty is associated with loss of bone mineral density in middle-aged HIV-positive men and women

Frailty is associated with loss of bone mineral density (BMD) in HIV-positive people, investigators from France report in AIDS. They found that people living with HIV who were frail were more likely to show signs of bone loss in the spine and femur among women, and femoral osteoporosis in men. 

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Editors' picks from other sources

NHS England announces world’s largest single PrEP implementation trial to prevent HIV infection

from NHS England

NHS England has announced the start of a pioneering implementation trial to provide HIV prevention drugs to people at high risk of HIV infection. From September, pre-exposure prophylaxis (PrEP) will now be provided by the NHS through the initial three-year trial to an estimated 10,000 people, in what will be the largest single study of its type in the world.

HIV treatment: Strategies to reach the next 10 million patients

from Devex

Campaigners know that reaching the next 10 million people with treatment will be harder in some ways. These patients are among the most difficult to reach: people living in conflict areas, stigmatised and criminalised populations – like men who have sex with men and sex workers – and young people, leery at the thought of taking HIV medication every day for the rest of their lives.

HIV: MSF concerned by high numbers of AIDS deaths in sub-Saharan Africa

from Médecins Sans Frontières (MSF) International

Global attention is needed to prevent and treat AIDS in the antiretroviral era, with 50% of hospital admissions in MSF hospitals already on treatment and showing signs of clinical failure.

WHO urges action against HIV drug resistance threat

from World Health Organization

WHO alerts countries to the increasing trend of resistance to HIV drugs detailed in a report based on national surveys conducted in several countries. The Organization warns that this growing threat could undermine global progress in treating and preventing HIV infection if early and effective action is not taken.

The 2017 Pipeline Report

from Treatment Action Group

Treatment Action Group (TAG) announces the launch of its annual research and development landscape analysis: The Pipeline Report: Drugs, Diagnostics, Vaccines, Preventive Technologies, Research Toward a Cure, and Immune-Based and Gene Therapies in Development.