While several recent reports have shown that new HIV diagnoses have been falling in UK gay men, what really matters is the actual number of new HIV infections, regardless of whether people are diagnosed or not. This is HIV incidence and Public Health England (PHE) said earlier this month that, according to their current estimates, incidence among gay and bisexual men in England has been falling since 2012. In previous years, PHE has always believed that incidence was stable.
HIV-positive children in resource-limited settings can achieve good virological outcomes without routine viral load or CD4 cell count monitoring
HIV-positive children can achieve good virological outcomes without routine monitoring of CD4 cell count or viral load, investigators report in PLOS Medicine. The research was conducted in Uganda and Zimbabwe and involved children starting antiretroviral therapy (ART). None had viral load monitoring over four years of follow-up. Viral load testing at the end of the study showed that three-quarters of children had viral suppression, and rates did not differ between children who had regular CD4 cell counts and those who had clinical monitoring only.
Undetectable viral load at time of immunisation enhances yellow fever vaccine protection for people with HIV
Viral suppression at the time of immunisation is the most important determinant of long-term response to yellow fever vaccination among people with HIV, Swiss investigators report in Clinical Infectious Diseases. Every person with an undetectable viral load at the time of first yellow fever vaccination continued to have a protective response ten years after vaccination, they found.
Rather than relying on assessment of an individual’s sexual behaviour or of ‘community viral load’, targeting of pre-exposure prophylaxis (PrEP) and other prevention interventions could in part be based on the proportion of a person’s social contacts who have unsuppressed HIV. There is a correlation between young gay men having HIV and their ‘network viral load’, according to a study published online ahead of print in the Journal of Acquired Immune Deficiency Syndromes.
While effective HIV treatment greatly reduces the risk of onward transmission during breastfeeding, it does not appear that the risk is zero, a leading paediatrician told the British HIV Association (BHIVA) conference in London. Although formula feeding is the safest option in high-income countries, some women will choose to breastfeed and healthcare professionals should support them to do so as safely as possible.
Risk of chronic kidney disease and cardiovascular disease in people with HIV should be assessed together
People with HIV should have their risk of cardiovascular disease (CVD) and chronic kidney disease (CKD) assessed together, results from the D:A:D study published in PLOS Medicine show. Investigators found that individuals with a high predicted risk for both CVD and CKD had a much greater risk of developing both CVD and CKD events, compared to people with a high predicted risk for CVD or CKD alone and people assessed as low risk for either morbidity.
Schistosomiasis increases risk of infection with HIV, especially for women and is also associated with a higher HIV viral load
Infection with schistosome parasitic worms has an important role in HIV transmission, especially for women, and may accelerate HIV disease progression, according to research published in PLOS Neglected Tropical Diseases. Women with schistosomiasis had a threefold increased risk in becoming infected with HIV, compared to women who did not carry the worms. Moreover, HIV viral load after infection was higher among schistosome-infected individuals, increasing both their potential infectiousness to sex partners and the risk of HIV disease progression.
Although some gay men idealise monogamy, particularly in the early stages of a relationship, couples often become non-monogamous over time, Australian researchers report in an article published online ahead of print in Culture, Health and Sexuality.
A cure for HIV would almost inevitably have to involve a vaccine to improve the body’s natural ability to control HIV, a seminar on European HIV cure research heard recently. The STEPS seminar, held by the European AIDS Treatment Group (EATG) ahead of the 16th European AIDS Conference (EACS) in Milan last month, also heard that, in the words of Giulio Maria Corbelli, EATG member and European Community Advisory Board chair, “Cure research reminds us of the importance of patient involvement from the very earliest phases of the development of treatment and prevention.”
The range of settings in which people test for HIV has expanded significantly in recent years in England, according to a new Public Health England report on HIV testing services. It includes new estimates of the numbers of people who test and re-test for HIV, suggesting that relatively few people at elevated risk of HIV take a test as often as recommended.
Younger age and shorter duration of viral suppression are risk factors for the development of high-grade pre-cancerous anal lesions in HIV-positive men who have sex with men (MSM), investigators from the Netherlands report in AIDS.
Nivolumab (Opdivo), a PD-1 checkpoint inhibitor that helps the immune system fight cancer, was associated with a decrease in tumour size or disease stabilisation in people with hepatocellular carcinoma (HCC) in the CheckMate 040 study, according to a report at the 2017 AASLD Liver Meeting last month in Washington, DC.
No change in cognitive function or brain structure in people taking effective HIV treatment for 2 years
People with HIV taking antiretroviral treatment who had undetectable viral load did not suffer any loss of cognitive function or brain volume during a two-year period when compared with their HIV-negative peers, but did have lower cognitive function and brain volume at the start of the study, suggesting that changes occur before effective treatment starts, according to the findings of a study published in the journal JAMA Neurology.