AIDSMAP UPDATE FROM CROI CONFERENCE – FEBRUARY 20, 2017

News from CROI 2017

Unique case of PrEP failure without drug resistance reported from Amsterdam

HIV pre-exposure prophylaxis (PrEP) appears to be nearly 100% effective if taken consistently so that there are high drug levels in the body at the time of exposure to HIV. However, the Conference on Retroviruses and Opportunistic Infections (CROI) held in Seattle, US, heard about a case where someone in a PrEP demonstration study caught a strain of HIV with no drug resistance, despite documented high drug levels.

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Will there be a new wave of HIV in people who inject drugs in the US?

Ever since there was an outbreak of HIV among white, largely rural heroin users in Indiana in 2015, there have been concerns that the conditions exist in some parts of the US for more outbreaks among heterosexual people who inject drugs.

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New NNRTI doravirine shows good efficacy in phase 3 study

Doravirine, an investigational next-generation non-nucleoside reverse transcriptase inhibitor (NNRTI) from Merck, reduced HIV viral load as well as boosted darunavir in a phase 3 clinical trial of people starting antiretroviral therapy for the first time, but it had a better lipid profile, according to a late-breaking presentation at the conference.

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Time spent by people in HIV care in US with a transmissible viral load has fallen by three-quarters since 2000

A study by the US Centers for the Disease Control (CDC) presented at the conference found that the proportion of people who are in care but not virally suppressed has fallen from 40% to 10% in the last 15 years.

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One in five ‘heterosexual’ men in the UK caught their HIV from another man

A genetic analysis of a large database of people with HIV in the UK in care shows that 18% of men with HIV who claim to be exclusively heterosexual in fact belong to clusters of linked infections that consist only of men.

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When science, community and political will come together, we can end the epidemic, says New York commissioner

New York City’s strategy to end the AIDS epidemic is firmly rooted in science, was developed in conjunction with community activists, and has support from top-level political leaders, Demetre Daskalakis told the conference.

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Spanish vaccine induces viral control off ART in nearly 40% of recipients

A so-called ‘HIV Conserv’ vaccine has, for the first time, produced significant prolonged viral control in a large minority of recipients once they were taken off antiretroviral therapy (ART). So far, one participant has stayed off ART for seven months without having to resume it. Presenting at the conference, Beatriz Mothe said that viral control in recipients of the vaccine occurred more frequently than spontaneous control of HIV seen in previous studies of treatment interruption.

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New hepatitis C infections among HIV-positive gay men drop by half after direct-acting antiviral roll-out in Netherlands

A little more than a year after the Netherlands instituted a policy allowing unrestricted access to direct-acting antivirals for the treatment of hepatitis C, researchers have already seen a dramatic decline in acute hepatitis C virus (HCV) infections among one at-risk population, HIV-positive men who have sex with men.

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Three-drug regimen beats XDR-TB in first trial

A regimen of three oral drugs given for six months was enough to clear extensively drug-resistant tuberculosis (XDR-TB) in 29 of the first 31 people to have completed the treatment course, Dr Francesca Conradie of Sizwe Tropical Disease Hospital, Johannesburg, told the conference. If the results are replicated in a larger population, the findings could revolutionise the prospects for treating not just XDR-TB, but also the more severe cases of MDR-TB (multidrug-resistant tuberculosis).

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Stopping smoking cuts the risk of some cancers quickly in people with HIV

Smoking probably contributes far more to the risk of cardiovascular disease in people with HIV than antiretroviral drug choice, viral load or any factor linked to the virus, but stopping smoking leads to a rapid reduction in the risk of some cancers, according to results from a cluster of studies presented at the conference.

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How should HIV self-testing services be provided?

Chairing a session on HIV self-testing at the conference, Joanne Stekler said that much is already known about the subject – that self-testing is acceptable to a broad range of people, has good uptake with people who have never tested before and can identify new cases, but that the longer window period means that self-testing is a less sensitive method for populations with a high incidence of HIV.

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New HIV infections fall in the US, but demographic and geographic disparities persist

The number of annual new HIV infections in the US fell by 18% overall since 2008, offering evidence that prevention and treatment efforts are having an impact, according to data from the US Centers for Disease Control and Prevention (CDC) released to coincide with presentations at the conference. A closer look at the data, however, shows some notable differences across demographic groups and geographic regions.

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Isoniazid preventive treatment reduces the risk of death by 37% in people living with HIV

A six-month course of isoniazid preventive treatment (IPT) at the beginning of the Temprano trial in Ivory Coast reduced the risk of death by 37% over a mean follow-up period of 4.5 years, Anani Badje reported at the conference.

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Treatment or watchful waiting for cervical abnormalities in women with HIV?

Close monitoring of earlier-stage cervical abnormalities (CIN-2) may be preferable to treatment for many women with HIV, a US study suggests. The findings, presented at the conference, show that CIN-2 regressed in over three-quarters of women taking antiretroviral therapy (ART), without the need for treatment. A higher CD4 count was associated with a lower likelihood that the lesion would progress.

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Tenofovir/emtricitabine/efavirenz less likely to cause adverse birth outcomes than other regimens, Botswana study finds

Infants exposed to an antiretroviral regimen of tenofovir, emtricitabine and efavirenz (Atripla) from conception experienced fewer adverse birth outcomes compared to other three-drug regimens, according to a study of births in Botswana between 2014 and 2016, presented at the conference.

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Experimental STI prophylaxis in PrEP users produces big drops in syphilis and chlamydia infections but not in gonorrhoea

Use of the antibiotic doxycycline as on-demand post-exposure prophylaxis by men who have sex with men taking part in the Ipergay HIV pre-exposure prophylaxis (PrEP) trial produced a 70% drop in chlamydia infections and a 73% drop in syphilis, but no reduction in gonorrhoea. The results were presented at the conference.

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Changes in viral suppression over time reveal disparities in HIV care in the United States

Sustained viral suppression over the course of a year may be a better measure than the most recent viral load test result when it comes to understanding access to and engagement in HIV care, according to a study by US Centers for Disease Control and Prevention (CDC) researchers presented at the conference.

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Dual antiretroviral regimen maintains durable HIV suppression after switch

People who switched from standard antiretroviral therapy (ART) to a two-drug regimen of dolutegravir (Tivicay) plus rilpivirine (Edurant) were able to maintain an undetectable viral load for 48 weeks in a pair of late-stage clinical trials, according to a late-breaking report presented at the conference.

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Infants treated within days of birth can clear HIV reservoir rapidly

Viral load and viral DNA fall rapidly in infants who begin antiretroviral therapy (ART) within days of birth, two South African studies have found, showing the potential for clearing the reservoir of HIV-infected cells – but infants with such a dramatic response to treatment may be a minority. The findings were presented at the conference.

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Treatment-as-prevention study sees substantial levels of transmitted drug resistance in participants, but no impact on treatment 

A study of the prevalence of transmitted drug resistance in participants in the ANRS 12249 trial of treatment as prevention, which reported its main results at the International AIDS Conference in Durban last year, has found that a substantial minority of participants in the trial had HIV with resistance mutations against the virus.

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Point-of-care test improves infant HIV diagnosis rate, treatment starts and retention in care

Using a point-of-care test to diagnose HIV in infants significantly improved retention in care, speeded up antiretroviral therapy (ART) initiation and increased the proportion of infants who started treatment, a large randomised study in Mozambique has found. The results were presented at the conference.

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Integrase inhibitor bictegravir matches dolutegravir for first-line HIV treatment

Bictegravir, an investigational integrase inhibitor from Gilead Sciences, was highly potent, well tolerated and worked as well as dolutegravir (Tivicay) in a phase 2 clinical trial, according to study results presented on Tuesday at the conference and published in The Lancet HIV.

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A benign circle: how a combination of factors has reduced HIV infections in one of the hardest-hit parts of Africa

HIV incidence has started to tumble in one of the best-studied groups of people in Africa, the conference heard. The annual infection rate has fallen 40% in the last four years, the conference was told. A combination of factors, including wider availability of antiretroviral therapy, increased male circumcision, and later age of sexual debut in young people, all appear to be contributing to this decline.

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Other aidsmap news

Men from Latin America and central Europe now outnumber sub-Saharan Africans in HIV diagnoses in European migrants

The latest figures from the European Centre for Disease Control (ECDC), presented at the recent HIV in Europe HepHIV2017 meeting in Malta, show that while in the last ten years in Europe the proportion of people with HIV who are not from the country where they are diagnosed has hardly changed, the makeup of the migrant population has. Although sub-Saharan Africans still form the largest regional population, diagnoses (in countries that document ethnicity adequately) in migrants from Latin America and the Caribbean, and intra-European migrants from central and eastern Europe, now comfortably outnumber new diagnoses in sub-Saharan Africans.

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Across western Europe, migrants from all parts of the world start HIV treatment later

An analysis of over 150,000 people living with HIV in eleven western European countries shows that people born abroad are more likely to start HIV treatment with a lower CD4 cell count, especially men coming from African or Caribbean countries.

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Living with diagnosed HIV infection for a long time is associated with poor quality of life

Longer time living with diagnosed HIV infection is strongly associated with depression, anxiety and poor quality of life, according to UK research published in HIV Medicine. Older age in itself was not associated with symptoms of distress or poor mental health but did have an association with lower physical functioning.

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Sustained reductions in sexual risk behaviour following couples’ HIV testing 

A programme of couples’ HIV testing and counselling in Zambia appears to result in durable reductions in sex without a condom in couples where one person has HIV and the other does not, according to an article published online ahead of print in Sexually Transmitted Infections.

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Delays in linkage to care after HIV diagnosis pose the biggest barrier to treatment access

Following individuals through the cascade of care, from HIV diagnosis to treatment and undetectable viral load, rather than taking snapshots of performance, has led researchers on a major South African study to pinpoint linkage to care after testing HIV positive as the biggest weakness of treatment programmes seeking to achieve the UNAIDS 90-90-90 targets, an article in the journal The Lancet HIV reports.

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Women significantly more likely than men to have suboptimal adherence to HIV therapy

Women are more likely than men to have poor adherence to combination antiretroviral therapy (cART), according to Canadian research published in HIV Medicine. Adherence was monitored in a cohort of over 4000 people in British Columbia over 14 years. After controlling for injecting drug use and ethnicity, 57% of women and 77% of men attained optimum 95% adherence.

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Legalisation of sex work associated with lower prevalence of HIV in sex workers

Countries that have legalised some aspects of sex work have fewer sex workers living with HIV than countries that criminalise all aspects of sex work, according to an ecological analysis of 27 European countries published online ahead of print in The Lancet HIV.

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Editors’ picks from other sources

Vaccine trial: Community trust is key

 from Fred Hutch

Dr Linda-Gail Bekker knows from more than 20 years in the field that researchers have to work hand in hand with the communities most affected if they want to halt an epidemic. And the townships are ground zero for HIV/AIDS in Cape Town.

Pharma industry shuns Trump push for radical shift at FDA

from Reuters

President Donald Trump’s vow to roll back government regulations at least 75% is causing anxiety for some pharmaceutical executives that a less robust Food and Drug Administration (FDA) would make it harder to secure insurance coverage for pricey new medicines.

Obamacare significantly expanded insurance for people with HIV 

from Reuters

The first national analysis of the impact of the Affordable Care Act on people with HIV showed significant increases in health insurance coverage among people living with the virus that causes AIDS, according to a report released on Tuesday.

New ACON campaign shows there’s now more to safe sex than just condoms

from Gay News Network

Whilst condoms are mainstay of preventing HIV infections, ACON is sending a message that with options such as PrEP (pre-exposure prophylaxis) becoming more commonplace and UVL (undetectable viral load) a common catchphrase, there are other approaches to preventing transmission that don’t always involve a condom.

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