News from CROI 2018

New HIV infections halved after scale-up of HIV treatment and circumcision in Uganda's hardest-hit district

The rate of new HIV infections has halved since 2011 in a Ugandan community following large increases in male circumcision, antiretroviral treatment and viral suppression, Joseph Kagaayi of the Rakai Health Sciences Program told the 25th Conference on Retroviruses and Opportunistic Infections (CROI 2018) in Boston, USA.


Powerful new PrEP and treatment drug should be effective as a small weekly pill

MK-8591 or EFdA is a novel and exceptionally long-lasting and potent HIV drug, being developed by Merck. It is a nucleoside reverse transcriptase translocation inhibitor (NRTTI). Its potency and longevity are due to the fact that it acts at two stages of the HIV lifecycle: as well as blocking HIV from making a DNA copy of its genes that can be inserted into a human cell, it also blocks integrated HIV DNA inside cells from being turned back into viruses.


High uptake of HIV self-testing by men who have sex with men and transgender women in Burma

HIV self-testing is feasible and acceptable for men who have sex with men and transgender women, engaging more people than usual testing services, according to the results of a randomised trial in Burma presented to the conference.


Another likely case of PrEP 'breakthrough' infection reported

A presentation at the conference describes what appears to be another case of infection with HIV in someone consistently taking pre-exposure prophylaxis (PrEP). However, a lack of monitoring and a failure to give the subject an HIV test around the time he experienced what may have been HIV seroconversion symptoms means that it is difficult to be 100% certain that this is a case of PrEP failure.


How much 'PrEP-resistant' HIV is out there?

A study presented at the conference aims to quantify how many people with HIV there might be in the community who both have a detectable HIV viral load and also have significant resistance to tenofovir and emtricitabine, the two drugs currently used in pre-exposure prophylaxis (PrEP).


Ibalizumab, active against highly resistant HIV, now approved in US

Ibalizumab, a long-acting monoclonal antibody that prevents HIV from entering cells, is active against virus strains that have developed resistance to multiple other antiretrovirals, according to a poster presentation at the conference.


Statin users have lower rates of many types of cancer

Both HIV-positive and HIV-negative people who use statins to manage cardiovascular disease risk also have a lower risk of cancer, according to research presented at the conference.


The vaginal ring: more HOPE to the DREAM? Higher adherence and better effectiveness seen in open-label ring studies

Two open-label, parallel studies of vaginal rings used to prevent HIV in women released interim results at the conference. Although, as open-label studies, there was no placebo arm and so no direct comparison with no intervention, the researchers estimated that in both studies there were 54% fewer HIV infections than there would have been on a placebo.


Efavirenz may undermine effectiveness of the vaginal ring contraceptive

The antiretroviral drug efavirenz significantly reduces the levels of both hormones in the vaginal ring contraceptive in women with HIV, Kimberly Scarsi of University of Nebraska Medical Center reported at the conference.


Average time from HIV diagnosis to treatment fell to six days in 2016 in San Francisco

The average time from HIV diagnosis to treatment initiation in San Francisco shrank from 35 days to six days between 2013 and 2016 as the city implemented its RAPID programme to speed up treatment starts, Oliver Bacon of San Francisco Department of Public Health reported at the conference.


Transgender women in Los Angeles are more likely to be in high HIV incidence clusters than any other group

A phylogenetic study of HIV infections in Los Angeles has found that transgender women (TGW) are more likely than any other risk group to be in a genetically connected cluster of cases, which is a marker of high HIV risk. But they are less likely than gay men and other men who have sex with men (MSM), who also tend to be in transmission clusters, to be diagnosed.


PrEP use growing in US, but not reaching all those in need

The number of people taking HIV pre-exposure prophylaxis (PrEP) in the United States is steadily increasing, exceeding 77,000 in 2016, according to figures released by AIDSVu in conjunction with the conference.


Biktarvy combo maintains viral suppression after switching therapy

People who switched to a single-tablet regimen containing the integrase inhibitor bictegravir were as likely to maintain an undetectable viral load as those who stayed on their current suppressive regimen containing dolutegravir, according to a presentation at the conference.


Same-day treatment start improves retention in care and viral suppression in Lesotho

Starting treatment at home, on the day of diagnosis, proved acceptable in rural Lesotho and resulted in improved linkage to care and viral suppression compared with routine care, Niklaus Labhardt of the Swiss Public Health Institute reported at the conference.


Twice-daily dolutegravir is safe and effective when used alongside TB treatment

Twice-daily dosing of dolutegravir when combined with the tuberculosis (TB) drug rifampicin is safe and effective and will allow dolutegravir to be used alongside TB treatment as part of first-line antiretroviral therapy (ART), according to results of the INSPIRING study presented at the conference.


Antiretroviral drug levels in hair strongly predict viral suppression

Antiretroviral drug levels in a sample of hair were the strongest predictor of response to HIV treatment, and this method also holds promise for monitoring adherence to pre-exposure prophylaxis (PrEP), according to research presented at the conference.


One-month TB prevention regimen just as effective as 9-month regimen

A one-month course of the antibiotic rifapentine combined with isoniazid was just as effective as a nine-month course of isoniazid in preventing the development of tuberculosis (TB) in people with HIV in a large international study presented at the conference.


US genotyping survey finds rapid HIV infection rate in young and Latino gay men

A US study of HIV gene sequences in networks with a particularly high HIV infection rate has found the highest rates in groups containing more young gay men, which is not unexpected, but also in more Latino than black men, which may signal a shift in the demographics of those most at risk of HIV.


New TB screening methods cut deaths in people with HIV

Screening for tuberculosis (TB) and intensified follow-up of TB cases in people starting antiretroviral therapy and urine-based screening of inpatients with HIV both have the potential to significantly reduce deaths and improve rates of TB treatment in people with HIV, according to results of two large studies presented at the conference.


Study finds that women are much more vulnerable to HIV infection during pregnancy and in the months after giving birth

A study presented at the conference found that women in two prevention studies were nearly three times more likely to become infected with HIV while they were pregnant, and four times as likely in the six months after giving birth, compared with the risk of HIV infection at other times.


Experimental antibody plus TLR7 agonist maintains viral suppression in monkeys

Treatment with a broadly neutralising antibody plus an immune-stimulating drug led to long-term viral remission after interrupting antiretroviral therapy in a monkey study, according to data presented at the conference.


Other aidsmap news

US studies underline importance of primary care physicians for people with HIV

People with HIV who have other medical conditions such as high blood pressure or high lipids appear to do better if they have a primary care physician as well as an HIV physician, according to a study of people receiving care through UCLA Center for Clinical AIDS Research and Education, researchers report in The Journal of Infectious Diseases.


Intimate partner violence a major contributor to HIV epidemic among MSM in China, shows study

HIV prevention programmes targeted at men who have sex with men (MSM) should include intimate partner violence (IPV) screening and interventions, research published in Nature Scientific Reports shows. Investigators from China found that recent experience of IPV was associated with a fourfold increase in the risk of infection with HIV. Moreover, experiencing IPV was a more important risk factor for infection with HIV than several other factors traditionally associated with high HIV risk, with 38% of the risk attributed to IPV.


Chronic depression leads to poorer engagement with key stages of HIV care continuum, say US researchers

Increased time spent living with depression is associated with poorer engagement with the HIV care continuum, investigators from the United States report in JAMA Psychiatry. Chronic depression was associated with missing appointments, a detectable viral load and an increased mortality risk.


HIV prevention: It’s time to stop accepting the status quo, PrEP Summit concludes

The biggest barrier to HIV pre-exposure prophylaxis (PrEP) becoming more available and more widely used is not cost so much as widespread acceptance of the status quo in HIV prevention, the first-ever European PrEP Summit, held in Amsterdam in February, heard.


Smoking threatens health gains from hepatitis C treatment, US researchers warn

People with hepatitis C in the United States are at least three times more likely to smoke than the general population but little is being done to help them stop smoking, and US researchers say it is folly to spend huge sums on hepatitis C treatment without trying to help patients stop smoking.


Lymphoma treatment outcomes just as good for people with HIV

People with HIV treated for aggressive forms of non-Hodgkin lymphoma or Burkitt lymphoma appear no more likely to suffer a relapse after treatment than HIV-negative people treated for the same conditions, according to findings of an analysis of the German HIV Lymphoma Cohort published in Haematologica, the journal of the European Hematology Association.


Severe fibrosis improves in most people after hepatitis C cure but persists in a quarter

Hepatitis C virus (HCV)-related liver fibrosis improves significantly in the majority of people with pre-treatment advanced fibrosis or cirrhosis after treatment resulting in a sustained virological response, Swedish investigators report in the Journal of Viral Hepatitis.


HPV16 highly prevalent among HIV-positive MSM in France and strongly associated with high-grade pre-cancerous anal lesions

HIV-positive gay men in France have a very high prevalence of anal infection with strains of human papillomavirus (HPV) associated with a high risk of anal cancer, investigators report in The Journal of Infectious Diseases. HPV16 was the most commonly detected high-risk HPV (HR-HPV) strain.


PrEP does not raise lipids or alter body fat, safety study finds

Using pre-exposure prophylaxis (PrEP) does not raise lipid levels or have any substantial effect on body fat, investigators from the iPrEX trial report in the journal Clinical Infectious Diseases.


Zambia: HIV deaths on treatment underestimated

People with HIV in Zambia were at least ten times more likely to die in the first two years after starting antiretroviral treatment than European patients, according to findings of a study which traced people lost from HIV care in Zambia.


Darunavir/ritonavir most durable boosted protease inhibitor in European patients, especially those switching treatment for any reason

Darunavir/ritonavir (DRV/r) is the most durable boosted protease inhibitor for antiretroviral therapy (ART)-experienced people, investigators from the EuroSIDA cohort report in HIV Medicine. People switching treatment to a DRV/r-containing regimen had a significantly lower risk of virological failure and/or treatment discontinuation compared to people changing to combinations including either atazanavir/ritonavir (ATZ/r) or lopinavir/ritonavir (LPV/r).


High prevalence of hypertension among HIV-positive people in the US with 'missed opportunities' for its diagnosis and control

There is a high prevalence of hypertension among HIV-positive people in the United States and many of these individuals are not receiving hypertensive therapy, investigators report in Open Forum Infectious Diseases. Overall, 42% of people were classified as hypertensive and 13% of these people were undiagnosed with a further 26% with uncontrolled high blood pressure despite therapy.


Communication skills training for healthcare workers improves HIV treatment adherence

People with HIV in Tanzania were more likely to report problems with non-adherence to antiretroviral treatment after their healthcare providers underwent training in patient-centred communication skills and how to discuss adherence with patients, findings from a cohort study published in HIV Medicine show.


US regulators approve new HIV combo pill containing bictegravir

The US Food and Drug Administration (FDA) has approved Biktarvy, Gilead Sciences' new single tablet antiretroviral regimen containing the HIV integrase inhibitor bictegravir, which was highly effective and well tolerated in clinical trials.


Generic drugs for HIV treatment may save money, but barriers to prescription make savings elusive

The potential savings from prescribing generic antiretrovirals predicted by economic models may be overstated and numerous barriers need to be overcome to bring down the cost of HIV treatment in higher-income countries, according to the findings of several recently published analyses.


Reproductive health of HIV-positive women in Switzerland being neglected, says study

HIV-positive women in Switzerland are mainly relying on male condoms for contraception, investigators report in HIV Medicine. Two-thirds of reproductive age women reported using contraception, with three-quarters of these individuals putting their trust in male condoms. Unwanted pregnancies were not uncommon among women using contraception.


Editors' picks from other sources

Really Rapid Review – CROI 2018, Boston

from New England Journal of Medicine Journal Watch

Dr Paul Sax reviews the clinical highlights of CROI 2018.

Dolutegravir and rifapentine study stopped due to serious toxicities

from Medical Brief

A study examining pharmacokinetic interactions between the first-line HIV drug dolutegravir and a once-weekly tuberculosis regimen was terminated early after National Institutes of Health (NIH) researchers found that the combined use of the treatments led to “unexpected and serious toxicities” in healthy participants.

In the era of daily PrEP, feds may stop research funding gels, rings, and douches for HIV prevention

from The Body

It's precisely because of the overwhelming success in recent years of oral PrEP that the future of the anal douche and other sorts of topically applied anti-HIV agents, such as gels and dissolvable films, all loosely termed "microbicides," is suddenly up in the air, if not outright doomed.

More people living with HIV and cancer should get appropriate cancer treatment, according to new guidelines

from National Comprehensive Cancer Network (NCCN)

New NCCN guidelines for cancer in people living with HIV seek to reduce unnecessary, deadly cancer care gaps. “The disparity in cancer care is large and significant. For most cancers, people living with HIV are two to three times more likely to receive no cancer treatment compared to uninfected people,” said Gita Suneja, MD, Duke Cancer Institute.

How social conservatism fuelled Russia's HIV epidemic

from Politico

Putin turned to the Orthodox Church to help consolidate his rule. And the Church cracked down on sensible approaches to sexually transmitted diseases. Now, Russia has a crisis on its hands.

Who knows about U=U? Awareness that undetectable individuals do not transmit HIV increasing, says new study

from BETA blog

Recent research, conducted in Vancouver, British Columbia with HIV-positive and HIV-negative men who have sex with men, found that awareness of treatment as prevention is increasing, but still unevenly distributed with HIV-negative men and men with lower social capital less likely to be aware or accepting of treatment as prevention information.

Mexico City to host IAS 2019

from International AIDS Society

The International AIDS Society (IAS) has announced that Mexico City, Mexico, will host the 10th IAS Conference on HIV Science (IAS 2019). IAS 2019 will take place at the Centro Citibanamex from 21-24 July 2019.

How Avram Finkelstein changed the way we think about AIDS – with one pink triangle

from Forward

In the 1980s the American Jewish artist and writer Avram Finkelstein was a co-creator of the iconic AIDS crisis protest poster which features a pink triangle with the words “Silence=Death.”

For the Trump Administration, anti-LGBT stances inform HIV policy

from AIDS United

During their 13 months in power, the Trump administration has made it abundantly clear that they have no desire to protect the rights of the LGBT community and, if anything, are actively looking to undermine them.