News from aidsmap

HIV incidence is falling in English gay men, say Public Health England

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.


To better target HIV prevention, identify people whose social contacts have high viral loads

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.


Despite reassuring data, we can’t yet say U=U for breastfeeding

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.


Gay men’s stories of monogamy and non-monogamy: change, flexibility and tensions

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.


European Cure Review concentrates on HIV therapeutic vaccines

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.”


Who is taking an HIV test in England and where?

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.


Screen all HIV-positive MSM for pre-cancerous anal cell changes, say Dutch investigators

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 improves outcomes in liver cancer study

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.


Editors' picks from other sources

'I don't feel like I'm a threat anymore.' New HIV guidelines are changing lives.

from Washington Post

Last year, Chris Kimmenez and his wife asked their doctors a simple question. Could Chris, who has been HIV positive since 1989 but keeps the virus in check through medication, transmit it sexually to Paula?

Who is Peter Sands?

from The Lancet

Peter Sands, the new Executive Director to lead the Global Fund to Fight AIDS, Tuberculosis, and Malaria is an economist and banker. He was CEO of Standard Chartered, an international bank headquartered in London, from 2006 to 2015. But Sands is rather more interesting than his employment history suggests.

No end in sight for TB

from Health-e

South Africa is one of seven countries responsible for the majority of the world’s tuberculosis (TB) burden, according to the 2017 Global TB Report published last month. The goal, set by the World Health Assembly, to effectively end TB by 2035 will not be met unless the country meets its own targets.

UNAIDS announces nearly 21 million people living with HIV now on treatment

from UNAIDS press release

In the year 2000, just 685,000 people living with HIV had access to antiretroviral therapy. By June 2017, around 20.9 million people had access to the life-saving medicines. Such a dramatic scale-up could not have happened without the courage and determination of people living with HIV demanding and claiming their rights, backed up by steady, strong leadership and financial commitment.

Harm reduction beyond numbers

from Drug Reporter

How cultural attitudes, the political environment, and donor expectations shape harm reduction – and how they can divert it from its original mission as a movement.

Top 10 HIV clinical developments of 2017

from The Body Pro

By David Alain Wohl, M.D., professor of medicine in the Division of Infectious Diseases at the University of North Carolina.

A reduction in new HIV diagnoses is no reason to reduce effort

from The King's Fund

The drop in new diagnoses among gay and bisexual men must be seen as an indicator of the reductions that are possible, rather than meaning that the job is done or that a downwards trajectory in new diagnoses will continue in the future. Importantly, so far these reductions have only been seen in one population group.