Top Stories on June 13, 2017
The Power of Positive Thinking Could Help Lower Viral Load

The power of positive thinking might extend well beyond emotional well-being to include physical benefits such as lower viral load in people with HIV, according to new research.

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This Week in HIV Research: Continuous Treatment Adherence Increases

This week, a study finds that continuous HIV treatment adherence, without a 90-day gap, has increased from 2001-2010, and is now longer than adherence to medications for some other chronic diseases.

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New Hepatitis C Infections Nearly Tripled Over Five Years

Over just five years, the number of new hepatitis C virus infections reported to CDC has nearly tripled, reaching a 15-year high, according to new data.

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Increased Prevalence of Diabetes in HIV-Positive People

Diabetes occurs at an increased frequency in people with HIV and may develop at earlier stages than it does in the general population.

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What’s Up With PrEP and STIs?

HIV Patients 65 Years or Older Face Higher Rates of Serious Non-HIV Illnesses

Poppers and Cancer Risk in HIV-Negative and HIV-Positive Gay Men

In Case You Missed It:

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Top Stories on June 6, 2017
In the Vanguard of HIV Vaccine Research

An interview with Dan Barouch, M.D., Ph.D., on the key challenges in vaccine development, potentially curing HIV and why we should be excited about antibodies.

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This Week in HIV Research: Spotlight on HIV Cure Research, and TAF vs. TDF in Triple-Drug Regimens

This week, we look at a special issue of The Journal of Infectious Diseases that highlighted HIV cure research.

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Can’t HIV Serodiscordant Couples Now Just Have Children the Regular Way?

Do mixed-status couples still need “sperm washing” to get pregnant if one is on suppressive ART and the other is taking PrEP?

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Transforming the HIV Workforce

“After 25 years of social justice hiring and management work, the first question I ask any HIV organization looking to transform its workforce and work culture is: Why?” writes Jaime M. Grant.

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Next-Generation PrEP Trials: The Age of “Active Controls”

Emphysema Tied to Cough and Slower Walking With HIV but Not Without HIV

Designing Prevention Programs With Latino Community Input Improves Public Health

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Top Stories on May 30, 2017
Depression Not Tied to Mortality Risk in Current Treatment Era

Experiencing symptoms of depression had no impact on risk of all-cause mortality in a 2005-2014 U.S. study of people with HIV.

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How Can Providers Deal With Concerns About Risk Compensation in PrEP Users?

Some health care providers may have concerns that some PrEP users may increase their sexual risk-taking behavior because they feel less susceptible to HIV while taking PrEP.

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Main Barriers to Taking Meds Among Adults, Adolescents and Children

Simply forgetting to take antiretroviral pills, being away from home and a change in the daily routine headed the list of reasons for inconsistent antiretroviral pill taking in a 125-study analysis.

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Grip Strength Falls Faster in Older Men With HIV Than Without HIV

Grip strength fell faster after age 50 in men with HIV than in a similar group of HIV-negative men, according to a 7-year analysis in the U.S.

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Access Means More Than Co-Pays: PrEP Success for Transgender Women

HIV and Hepatitis C Not the Most Serious Infectious Threats to People Who Inject Drugs

Some Issues Related to Sexual Dysfunction in Men
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News from aidsmap

Belgium, Portugal and Brazil will provide PrEP through their health services; Morocco announces a PrEP study

In the last two weeks, several countries have announced that they will soon launch pre-exposure prophylaxis (PrEP) programmes. On 19 May, Belgium announced that it would start rolling out PrEP provision and had set aside €1 million to pay for it. had learned this will be introduced gradually from 1 June. Two hundred Belgian men who have sex with men are already enrolled in a PrEP demonstration project, Be-PrEP-ared.


High prevalence of tobacco use among HIV-positive individuals in low- and middle-income countries

There is a high prevalence of tobacco use among HIV-positive adults in low- and middle-income countries (LMICs), investigators report in The Lancet Global Health. Overall, 27% of HIV-positive men and 4% of HIV-positive women reported tobacco use, significantly higher than the rates seen in the general population. The authors call for targeted policy and interventions to promote tobacco cessation among HIV-positive individuals in LMICs.


Taking PrEP has a profound impact on gay men’s sexual health and wellbeing

Men who have sex with men (MSM) in Seattle who had recently begun to take pre-exposure prophylaxis (PrEP) described profound impacts on their sexual health and wellbeing that go beyond PrEP’s primary function of preventing HIV infection, according to a qualitative study recently published in the International Journal of Sexual Health.


Swiss Grindr survey finds 50% want to use PrEP in the next six months

A survey of Swiss gay men and men who have sex with men recruited through the Grindr networking app has found that while only 4.3% had taken HIV pre-exposure prophylaxis (PrEP), 50% would consider taking it within the next six months and 79% would either take it some time in the future or want to learn more about it.


Point-of-care CD4 counts improve linkage to HIV care in Kenya

Carrying out a point-of-care CD4 count immediately after a person was diagnosed with HIV by home-based testing doubled the rate of linkage to HIV care, a randomised study in Kenya has shown. The results were published on 31 May in The Lancet HIV.


MSM, especially if HIV-positive, have an increased risk of meningococcal disease, according to US research

Men who have sex with men (MSM) have an increased risk of meningococcal disease, investigators from the United States report in the online edition of Clinical Infectious Diseases. The number of cases was small, but overall incidence of meningococcal disease was four times higher among MSM compared to non-MSM, with the risk especially high for HIV-positive MSM.


Six-question risk score can identify HIV-positive gay men needing testing for acute hepatitis C

Six questions can identify HIV-positive gay men who are at elevated risk of having acute (recent) hepatitis C infection and who would benefit from further testing, according to a paper published in Eurosurveillance. The risk score was based on data from a Dutch cohort and has been validated with separate datasets from Belgium, the Netherlands and England.


Young women in Zimbabwe in sexual relationships with older men have an especially high risk of infection with HIV

Young women in Zimbabwe have an especially high risk of infection with HIV if they have a sexual partner who is ten or more years older, investigators report in the online edition of AIDS. Such inter-generational relationships increased the risk of contracting HIV by approximately 75%.


HIV treatment targets for people who inject drugs will be missed without focus on rights, privacy and prisons

Reaching ambitious HIV treatment targets for people who use drugs requires efforts to protect privacy, to promote access to opioid substitution treatment and to keep people out of prison, the 25th International Harm Reduction Conference (HR17) in Montréal, Canada, heard in May.


High frequency of recurrent high-grade pre-cancerous anal lesions in HIV-positive MSM

A high proportion of HIV-positive men who have sex with men (MSM) successfully treated for high-grade pre-cancerous anal lesions experience a recurrence of disease within 18 months, investigators from Barcelona report in the online edition of AIDS.


Agreements with cash incentives boost patient adherence to HIV therapy and rates of viral suppression

People who enter into a contract with their HIV healthcare provider to receive cash incentives in return for high levels of antiretroviral therapy (ART) adherence are more likely to achieve sustained viral suppression compared to people in a control arm, investigators from the United States report in the online edition of AIDS.


Editors’ picks from other sources

‘Miracle’ hepatitis C drugs costing £30k per patient ‘may have no clinical effect’

from The Guardian

Review concludes drugs hailed as cure for potentially fatal liver disease may clear virus from blood, but there is no evidence they prevent harm or save lives.

PrEP stymied in Europe: What’s the hold up?

from AVAC

Europe is the birthplace of the smallpox vaccine and the Renaissance, among other treasures. So why can’t this continent that has brought forth such cornerstones of public health and flourishing civilisation deliver oral PrEP – a mere pill a day to prevent HIV, which already exists and is being successfully implemented in several countries, including Brazil, Kenya, South Africa and the US?

America’s hidden HIV epidemic

from New York Times

Why do America’s black gay and bisexual men have a higher HIV rate than any country in the world?

Expert: Long-awaited CDC HIV report on conception options for serodiscordant couples is disappointing and confusing

from The Body Pro

We’re in the middle of a revolution in our efforts to fight HIV. However, you wouldn’t know it from a new Centers for Disease Control and Prevention (CDC) report that advises providers about conception when one partner is living with HIV.

South Africa: Has South Africa’s new HIV plan been captured?

from AllAfrica

The new strategy is the first in a decade that does not advocate for the decriminalisation of sex work.

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News from HR17

Canadian Minister of Health opens International Harm Reduction Conference amid controversy over overdose deaths

The 25th International Harm Reduction Conference (HR17) in Montréal, Canada, kicked off with a dramatic opening session, featuring Jane Philpott, Canadian Minister of Health, along with a group of angry protesters chanting ‘They talk, we die’.


Heroin combined with fentanyl is driving overdose crisis in US

New sources of heroin and increasing adulteration with fentanyl and other stronger analogues are contributing to a growing epidemic of opioid overdose deaths in several regions of the US, researchers reported at the conference.


Injecting drug use increases worldwide, but no increases in needle and syringe programmes

Despite reports of expanding rates of injecting drug use in a new list of countries around the world, no new countries have established needle and syringe programmes in the last three years.


Indonesian buyers club helps people obtain generic hepatitis C treatment

A community-led buyers club in Indonesia has helped more than 100 people get generic direct-acting antiviral (DAA) drugs to treat hepatitis C and is seeing a high cure rate, according to a presentation at the conference.


Pet care can connect people to health and harm reduction services

Providing free veterinary care can be a good way to bring homeless and marginally housed people into contact with health care, harm reduction and other services, according to a presentation at the conference.


Use of psychedelic drugs may reduce the risk of suicide in female sex workers

Women sex workers who used psychedelic drugs such as LSD were less likely to think about or attempt suicide, while some other drugs increased the risk, according to study results presented at the conference.


People who use drugs may use cannabis and drug cocktails as a form of harm reduction

People who use drugs have come up with innovative strategies that help them reduce harm, including using marijuana to decrease crack use and mixing heroin with methamphetamine to moderate the effects of meth or prolong the duration of heroin’s effects, according to presentations at the conference.


Hepatitis C virus reinfection is uncommon after being cured with DAAs

Most people on opiate substitution therapy were successfully treated for hepatitis C with an interferon-free regimen of grazoprevir/elbasvir (Zepatier), and only a small number became reinfected during three years of follow-up, researchers reported at the conference.


Overamping is a common problem among people who use stimulants

Overdosing on stimulants such as methamphetamine – known as ‘overamping’ – is an under-recognised problem in a harm reduction community that more often focuses on opioid overdose, according to a presentation at the conference.


Combining drug addiction treatment and perinatal HIV prevention leads to good outcomes in Kenya

An integrated programme offering medication-assisted drug addiction treatment and services aimed at preventing mother-to-child HIV transmission led to improved outcomes for opioid-dependent HIV-positive mothers and their babies, according to a presentation at the conference.


Hydromorphone works as well as heroin-assisted drug addiction treatment

Hydromorphone was as effective as pharmaceutical heroin for opioid addiction treatment, but it was associated with fewer serious side-effects, according to results from the SALOME trial presented at the conference.


Drug checking reveals high levels of fentanyl contamination in Vancouver street drugs

A pilot project to check the purity of drugs at Vancouver’s Insite safe injection facility found that around 80% of tested samples contained fentanyl, and people who learned their drugs were contaminated were more likely to reduce their drug doses and less likely to overdose, researchers reported at the conference.


AA amyloidosis is an unrecognised problem among people who inject drugs

AA amyloidosis, a condition resulting from skin and soft tissue infections that can lead to kidney failure, may be more common than previously recognised among people who inject drugs, according to a presentation at the conference.


Other recent news headlines

People with HIV have impaired respiratory health, even when viral load is undetectable

HIV-positive people have impaired respiratory health, even when they have viral suppression with antiretroviral therapy (ART), investigators from London report in HIV Medicine. Respiratory health was compared between HIV-positive and HIV-negative outpatients. Individuals with HIV had poorer respiratory health and were more likely to report breathlessness than HIV-negative participants, findings which remained unchanged when analysis focused on ART-treated HIV-positive people with an undetectable viral load.


Many physicians are wary of providing HIV PrEP for young people

Only about a third of family practice and paediatric providers said they would be likely to prescribe HIV pre-exposure prophylaxis (PrEP) to adolescent patients, underlining the need to educate providers outside the HIV and sexually transmitted disease fields, according to a report at the 2017 Pediatric Academic Societies Meeting in San Francisco.


Editors’ picks from other sources

PrEP 17 – The coming of age of PrEP

from Prepster

PrEP17 explores the stories of over a dozen PrEP activists, current and former PrEP users, clinicians, and policy-makers. The 36 minute documentary film, commissioned by PrEPster, shines a light on how PrEP has become available to thousands of people, despite the failures of the health system.

120 Beats per Minute review – passionate and defiant account of 80s AIDS activism

from The Guardian

Cannes Film Festival: Robin Campillo commemorates the legacy of direct-action group ACT UP with a movie that is tragic, urgent and full of cinematic life.

Cuts to AIDS treatment programmes could cost a million lives

from New York Times

At least one million people will die in sub-Saharan Africa and elsewhere, researchers and advocates have said, if funding cuts proposed by the Trump administration to global public health programmes are enacted.

Trump’s restrictions for abortion funding overseas could hinder HIV prevention

from NPR

The newly-released details of the Trump administration’s version of the “Mexico City policy” are raising many questions about its impact not only on abortion but also on preventing HIV and infectious diseases like malaria.

Twilight of a difficult man: Larry Kramer and the birth of AIDS activism

from New York Times

Larry Kramer – writer, advocate, “loudmouth” – helped define AIDS activism and gay life. He ruffled some feathers along the way.

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Life expectancy now near-normal in people with CD4 counts over 350 a year after starting therapy

A large study of 88,504 people with HIV on antiretroviral therapy (ART), published in The Lancet journal and reported widely in the news, has found substantial improvements in life expectancy in people with HIV who started ART after 2008, even in their first year of therapy. People who started ART between 2008 and 2010 and who had achieved CD4 counts over 350 cells/mm3 by the end of their first year of therapy had life expectancies approaching normal.


Protease inhibitor drug suppresses HIV in semen more slowly than drugs from other classes

Protease inhibitors may not be the best class of drug for people newly diagnosed with HIV to start treatment with, if they wish to quickly reduce their risk of passing HIV on to others, a Spanish study has found.


MDR-TB numbers could keep growing despite improved treatment

Up to one-in-three tuberculosis cases in Russia could be multidrug resistant by 2040, and one-in-eight in India, unless more is done to stop the person-to-person spread of drug-resistant TB and suboptimal treatment, a modelling study published in The Lancet Infectious Diseases predicts.


Switching from efavirenz to lopinavir/ritonavir has no meaningful impact on neurological function, says UK study

Switching from efavirenz does not significantly improve the neurological function of patients taking virologically suppressive antiretroviral therapy, investigators from the UK report in HIV Medicine.


Undocumented migrants more likely to be lost to follow-up and have poor virological outcomes after starting ART, Milan study confirms

Undocumented migrants living with HIV have especially poor rates of retention in care and virological suppression after starting antiretroviral therapy (ART), investigators from Italy report in the online edition of the Journal of Acquired Immune Deficiency Syndromes. The single-centre study compared outcomes according to migration and residency status among people starting HIV therapy in Milan between 2001 and 2013. Undocumented migrants were more likely to be lost to follow-up and both documented and undocumented migrants were less likely to attain virological suppression compared to Italian citizens.


Besifovir and tenofovir exalidex look promising as new hepatitis B drugs

Two investigational nucleotide analogue antivirals were shown to be active against hepatitis B virus (HBV) with minimal potential for kidney and bone toxicity, researchers reported at the International Liver Congress last month in Amsterdam. Besifovir is in phase 3 clinical trials, while tenofovir exalidex is in early development.


Naloxone is a heath intervention that can’t be effectively provided without the knowledge and social connections of people who inject drugs

Programmes to provide naloxone, a drug that reverses the effects of opiate overdose, are successful because they harness the social contexts of drug use and train drug users to be ‘indigenous public health workers’ capable of intervening in an overdose, according to a qualitative study published in the May issue of Social Science & Medicine.


Fear of stigma is prompting young South Africans to seek early HIV treatment

Young South Africans are strongly motivated to seek HIV testing and treatment by a desire to maintain a healthy physical appearance and to appear normal to other people, so as to avoid the stigma attached to HIV infection in their communities and peer groups, a qualitative study in South Africa has found.


Increased screening for syphilis boosts detection of early latent infections among Australian gay men

Increased syphilis testing among gay men increased detection of early latent infections and was accompanied by a fall in the proportion of cases involving secondary syphilis, investigators report in the online edition of Clinical Infectious Diseases.


Editors’ picks from other sources

A path toward ending AIDS in the US by 2025

from Eurekalert Medicine & Health

Using prevention surveillance data to model rates of HIV incidence, prevalence and mortality, investigators at Brigham and Women’s Hospital and Johns Hopkins Bloomberg School of Public Health set targets, specifically a decrease in new infections to 21,000 by 2020 and to 12,000 by 2025, that would mark a transition toward ending the HIV/AIDS epidemic.

The continuum of HIV care: What does it mean and how is Europe doing?

from Eurekalert Inf Dis

From diagnosis of HIV to successful viral suppression: this new ECDC report summarises key findings concerning the Continuum of HIV Care in Europe based on data reported by countries in Europe and Central Asia. In the 37 countries reporting data, an estimated 1.2 million people are living with HIV, 898,000 of whom (75%) have been diagnosed; 88% of these are estimated to be virally suppressed.

New HRI report warns of HIV and hepatitis C ‘powder keg’ in the European Union ahead of the 25th Harm Reduction International Conference (HR17)

from HIV / AIDS News From Medical News Today

UK based NGO Harm Reduction International (HRI) warns that if the roll back of funding harm reduction services such as needle and syringe programmes and methadone provision in the European Union remained unchecked, renewed spikes in HIV and hepatitis C (HCV) infections amongst people who use drugs were inevitable.

Kenya launches self-test kits and PrEP


The Government of Kenya has reinforced its commitment to end AIDS by 2030 by launching two innovative technologies: self-testing for HIV and PrEP.

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Body Pro – In HIV News: Treating PTSD in Long-Term Survivors and more

Post-Traumatic Stress Disorder and Long-Term Survivors: There Are Solutions

Many long-term survivors of HIV remain locked in painful and disabling emotional states. But with awareness and treatment, PTSD need not create even more casualties among lives shaped by traumatic events. Read More

This Week in HIV Research: Non-AIDS Cancers More Common as People With HIV Age

This week, a study finds that as people living with HIV continue to age, the prevalence of non-AIDS-defining cancers will go up.

Read More →

Getting Real on Smoking and HIV Prevention

Lilianna Angel Reyes writes about what works and doesn’t work for helping people to quit smoking, while drawing lessons from the HIV prevention world.

Read More →

Scientists Develop Technique That Makes Cells Resistant to HIV

Scientists at The Scripps Research Institute (TSRI) have discovered a way of creating HIV- resistant cells by using antibodies to block HIV directly on the cell surface.

Read More →

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aidsmap news: News from the International Liver Congress

News from the 2017 International Liver Congress

EASL releases updated hepatitis B guidelines at International Liver Congress

The European Association for the Study of the Liver (EASL) presented revised clinical practice guidelines for the management of hepatitis B virus infection – the first update since 2012 – during a special session at its International Liver Congress last month in Amsterdam. For the first time, the guidelines include tenofovir alafenamide and present evidence about when and how to stop antiviral therapy.


Triple combination cures most hepatitis C patients with prior DAA treatment failure

Almost all people with genotype 1 hepatitis C who were previously unsuccessfully treated with a course of interferon-free direct-acting antiviral therapy achieved sustained response when retreated with a three-drug combination being developed by Merck, researchers reported at the International Liver Congress.


Switching to TAF for hepatitis B improves kidney function and bone loss

People with hepatitis B who switched from the old tenofovir disoproxil fumarate (TDF) to the new tenofovir alafenamide (TAF) saw improvements in kidney function biomarkers and recovery of bone loss, researchers reported at the International Liver Congress.


Generic hepatitis C drugs continue to produce high cure rates

Treatment with generic versions of direct-acting antiviral drugs continues to produce similar cure rates to those reported in clinical trials, Dr James Freeman reported at the International Liver Congress.


AbbVie combination cures 95% of genotype 3 hepatitis C

AbbVie’s pangenotypic direct-acting antiviral combination of two drugs cured 95% of people with early-stage genotype 3 hepatitis C virus, the hardest genotype to treat, according to results of the ENDURANCE-3 trial presented at the International Liver Congress.


New AbbVie hepatitis C combination cures 99% of people with cirrhosis

A new pangenotypic direct-acting antiviral combination developed by AbbVie is highly effective in curing hepatitis C in people with cirrhosis, achieving a 99% cure rate after 12 weeks of treatment with minimal side-effects, Xavier Forns reported on behalf of the EXPEDITION-1 study investigators at the International Liver Congress.


Direct-acting antivirals for hepatitis C not linked to higher liver cancer risk in most studies

People with hepatitis C who take treatment with direct-acting antivirals do not appear to have a higher risk of developing liver cancer compared to those treated with interferon, and the seemingly higher rates seen in some studies are attributable to risk factors such as older age and more advanced liver disease, according to a set of studies presented at the International Liver Congress.


European HCV treatment access survey shows big variations in eligibility

England, Malta, Slovakia, Hungary and Croatia have the tightest restrictions on who can receive direct-acting antiviral treatment for hepatitis C, while France, Ireland, Portugal, Germany, Poland and the Netherlands are the least restrictive, research presented at the International Liver Congress shows.


Curing hepatitis C reduces cardiovascular risk

Curing hepatitis C reduces the risk of cardiovascular events in people with compensated cirrhosis, a large French study presented at the International Liver Congress shows.


More news from the BHIVA conference

Switching from Atripla to generic-containing regimens can produce large cost savings

Switching from branded Atripla to regimens that include at least one generic drug formulation can achieve big cost savings without compromising virological efficacy, according to research from Brighton presented to the recent conference of the British HIV Association in Liverpool.


Study shows that HIV-positive nursing mothers in London can struggle to obtain and afford formula milk

Many HIV-positive nursing mothers in London are struggling to meet the financial costs of formula feed, according to research presented to the recent conference of the British HIV Association. The study showed that a quarter of women did not receive any provision for formula feed and that almost three-quarters had a weekly spend of £10 or more on formula. More than half of women reported that they or their family went hungry in order to buy formula milk.


British HIV Association (BHIVA) conference

The 23rd Annual Conference of the British HIV Association (BHIVA) took place in Liverpool, UK, from 4-7 April 2017. Visit our conference webpages for more news.


Other recent news headlines

Avoiding false positives: rapid HIV tests vary in their accuracy, so need to be used in combination

An evaluation of eight rapid diagnostic tests widely used in a variety of African countries by Médecins Sans Frontières (MSF) shows that the tests vary in their performance, with false positive results being a concern. Samples from some geographical locations were more likely to have false positive results than others, suggesting that tests need to be locally validated, researchers report in the Journal of the International AIDS Society.


Early ART highly acceptable and achieves excellent rates of viral suppression among young South African women

Early antiretroviral therapy (ART) is highly acceptable to the majority of young women with HIV in South Africa, according to research published in AIDS and Behavior.


A quarter of people taking antiretroviral therapy in Kenya have exhausted current treatment options

Affordable third-line antiretrovirals are urgently needed in resource-limited settings, according to research conducted in Kenya and published in the online edition of AIDS. The study showed that a quarter of patients had exhausted current treatment options and only 18% had virus that was fully susceptible to the three main classes of anti-HIV drugs.


Monitoring of progress towards 90-90-90 blighted by poor quality reporting

Only six countries, representing just 2% of the global HIV burden, have high quality data reporting on the HIV care continuum and progress towards the UNAIDS 90-90-90 target, investigators report in PLOS Medicine. The study also showed that only nine countries in sub-Saharan Africa have surveillance data for viral suppression. Globally, an estimated 48% of all HIV-positive individuals are now on antiretroviral therapy, with 40% of all people with HIV virally suppressed.


Hepatitis C treatment can be provided successfully at syringe programme sites

Administering direct-acting antiviral therapy for people who inject drugs at a syringe exchange site led to high sustained response rates in a pilot study in New York City, researchers reported at the recent Conference on Retroviruses and Opportunistic Infections (CROI) in Seattle. Expanding treatment for this population could reduce hepatitis C virus transmission and ultimately help eliminate hepatitis C as a public health threat.


Editors’ picks from other sources

Fentanyl, the drug deadlier than heroin, has reached the UK

from Vice

Everything you need to know about the drug that has already caused a spate of fatal overdoses.

The CEO of HIV

from New York Times

Michael Weinstein’s AIDS Healthcare Foundation treats an enormous number of patients – and makes an enormous amount of money. Is that why so many activists distrust him?

Thai HIV advocates drop the PrEP ball

from AVAC

It is astonishing that strong, albeit subtle, resistance for PrEP [pre-exposure prophylaxis] scale-up in Thailand comes from a few influential leaders of HIV NGOs [non-governmental organisations]. Small in number, these NGOs are vocal and influential. Their opinions are esteemed by government officials and fellow NGOs. The resistance is not stated in public. Most of the objections to PrEP I have heard from these individuals during backroom talks or various office meetings or private discussions. Concerns, doubts, or cautions against PrEP that are said in public were vague and ambivalent.

The future of investment in PEPFAR: Understanding PEPFAR’s multiple economic, health, and diplomatic impacts

from Health Affairs

At a time when the future of the program is in doubt due to possibly severe budget cuts to the US State Department (where PEPFAR [President’s Emergency Plan for AIDS Relief] is based) proposed by the new administration, we thought it would be an opportune moment to highlight some of the key studies we have published exploring PEPFAR’s role in fighting the HIV and AIDS epidemic.

Open letter to Gilead Sciences about PrEP by EATG and the PrEP in Europe Initiative

from EATG / PrEP in Europe

Please read and share this letter signed by the European AIDS Treatment Group (EATG) and the PrEP in Europe Initiative (PEI), a partnership of European prevention and policy NGOs. It requests Gilead Sciences to surrender their patent of Truvada or otherwise make it possible for Truvada or generic equivalents of it to be offered at greatly reduced prices to all European health care systems so that it can be used as HIV pre-exposure prophylaxis (PrEP).

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NAM AIDS Map – April 26, 2017

26 April 2017

HIV-positive mothers going hungry in order to pay for formula milk

Many HIV-positive nursing mothers in London are struggling to meet the financial costs of formula milk, according to a recent study.

Current UK guidelines recommend that HIV-positive nursing mothers should exclusively formula feed, as breastfeeding is a possible route of mother-to-child HIV transmission (although the risk is low for women taking treatment with an undetectable viral load).

But while medical interventions to prevent mother-to-child transmission (such as antiretroviral drugs) are provided free of charge by the NHS, it does not generally provide formula milk to women living with HIV. There are local schemes provided by some NHS trusts and local authorities, but they are not available in all areas or to all mothers.

Many of the women the researchers interviewed had very few financial resources. Purchasing formula milk was often a severe financial strain – most spent over £10 a week on formula milk.

One woman told interviewers:

“We bought less food to make sure we could afford milk. I will be happy when my baby is [weaned] so there is less financial strain. Formula feeding is very expensive, I found it a struggle to afford. I felt sad not being able to breastfeed especially as culturally I am expected to.”

Over half said that they or their family went hungry so they could afford formula milk. Half reported feeling unsupported and two women told investigators they had resorted to breastfeeding because they did not have enough money to afford formula.

Another woman said:

“My benefits were cut at the time. I found it really difficult to afford formula milk. I would rather walk the streets asking for change than resort to breastfeeding, which I did have to do sometimes. I went to my hospital crying because I was really struggling to afford formula milk.”

The National AIDS Trust (NAT) says that formula milk should be provided to mothers living with HIV to cover the first year of an infant’s life. They point out that this would be a low-cost intervention (less than £500) compared to the lifetime treatment cost for an infant should they contract HIV. It might need to be provided to 1300 mothers a year – the total cost would probably still be less than the lifetime HIV treatment cost for one child.

For more information on infant feeding, read NAM’s booklet ‘HIV & women’.

Switching to generic HIV drugs cuts costs without compromising effectiveness

The financial pressures faced by HIV clinics in the NHS was a major theme of the recent British HIV Association conference. Doctors discussed how they can keep costs down without compromising the quality of care. One of the most important ways they can do so is to switch some patients from branded, expensive drugs to generic, lower-cost alternatives. Many HIV drugs which only used to be available as branded, patented drugs are now available as generic medicines.

After a drug’s patent expires, other companies can produce their own version of the same drug, called generic drugs. They contain the same active ingredient as the branded products and have the same safety and quality requirements as the original product. They are much cheaper.

Pharmacists and clinicians in Brighton described how they encouraged people taking Atripla to switch to alternative regimens containing generic medicines. Atripla combines efavirenz, emtricitabine and tenofovir in a single pill taken once daily. Two alternative regimens were proposed:

  • Generic efavirenz, generic lamivudine (a very similar drug to emtricitabine) and branded tenofovir. (Three pills, once daily.)
  • Generic efavirenz, branded emtricitabine and branded tenofovir. (Two pills, once daily.)

Of 428 people taking Atripla, 268 were referred to a pharmacist to discuss making a switch. Of these, just under half (119 people) agreed to switch, most often to the first alternative regimen. This resulted in an annual cost saving of £159,000.

All the study participants who switched maintained an undetectable viral load. Only one person discontinued their new regimen because of pill burden.

Wanting to remain on a single-pill regimen was the main reason why people declined to switch. Many people felt it was more discreet.

However, switching to generics was not without its challenges. High levels of demand for generics from clinics across the country led to supply shortages and delays. As a result, patients sometimes received different brands of medication, with pills of differing appearance. This could cause confusion about which pills needed to be taken.

For more information on generic medicines, read NAM’s booklet ‘Taking your HIV treatment’.

Getting access to hepatitis C treatment

Access to hepatitis C treatment varies considerably across Europe, with England being one of the countries with tight restrictions on who can receive modern hepatitis C drugs, a new analysis shows. As a result, increasing numbers of people are being forced to import their own generic versions of the drugs – a strategy that is proving to provide effective treatment.

Researchers looked at national policies to check which patients were eligible to receive treatment with direct-acting antiviral combinations recommended in European hepatitis C treatment guidelines.

Numerous countries only provided treatment to people who already had significant liver damage (F3 fibrosis or F4 cirrhosis) – Slovakia, Croatia, Italy, the Czech Republic, Greece, Latvia and Romania.

England, Scotland, Wales and Northern Ireland each have their own decision-making process for health spending. In Scotland, everyone with F2 fibrosis or above can get treatment.

England and Northern Ireland have different restrictions for different genotypes of hepatitis C. Treatment is available for everyone with genotypes 1 or 4. But modern drugs are not available for people with genotypes 2 or 3 who have F3 fibrosis or less, except in cases where people cannot tolerate interferon injections. Moreover, only one drug combination is currently reimbursed.

No country refuses treatment because people have HIV and hepatitis C co-infection. But many central European countries don’t provide treatment to people who continue to drink alcohol or use drugs.

Faced with restrictive health service policies, individuals around the world have turned to the FixHepC buyer’s club in order to purchase their own hepatitis C medications. Whereas the NHS is legally obliged to purchase the branded, patent-protected versions of the medications which may cost £35,000 for a 12-week course, FixHepC helps people import generic versions of the medications, which cost far less – around £1000 a course.

They are manufactured by reputable companies in India, primarily for sale in Asian and African countries where the patents do not apply. It is legal for individuals to import small quantities of these generic medications into the UK and other countries, for their personal use only. Treatment still needs to be managed and monitored by a doctor specialised in hepatitis.

A conference heard results from 448 people who taken treatment in this way. Most were living in Australia, New Zealand, the United States and European countries, but there was also a large cluster of patients in Nigeria. Four-in-ten had previously tried treatment (generally with the older, interferon-based treatments) and three-in-ten had cirrhosis.

The sustained virologic response rate four weeks after treatment (SVR4) was 94% and twelve weeks after (SVR12) was 90%. This is similar to the results in clinical trials, using branded medications. Results were good for all genotypes, except for some treatment failures in people with genotype 3.

If you are thinking of getting your hepatitis C treated in this way, it’s very important to identify a reputable supplier for the medication and to be monitored by a doctor specialised in hepatitis. For more details, visit

Editors’ picks from other sources

Complexity of health system is ‘holding back progress’ in HIV care

from The King’s Fund

While HIV care in England is among the best in the world, the Health and Social Care Act 2012 has created a complex and fragmented system for HIV care. Responsibility for delivering services is spread between NHS England, local NHS organisations and councils, which has made it harder for areas to make co-ordinated changes across HIV services.

Open letter to Gilead Sciences about PrEP by EATG and the PrEP in Europe Initiative

from EATG / PrEP in Europe

Please read and share this letter signed by the European AIDS Treatment Group and the PrEP in Europe Initiative (PEI), a partnership of European prevention and policy NGOs. It requests Gilead Sciences to surrender their patent of Truvada or otherwise make it possible for Truvada or generic equivalents of it to be offered at greatly reduced prices to all European health care systems so that it can be used as HIV pre-exposure prophylaxis (PrEP).

The real sex lives of gay men – GMFA’s biggest survey

from GMFA

GMFA has just conducted its biggest-ever sex survey for the 150th edition of its resource FS. Ian Howley, Chief Executive of GMFA, said: “With over 3,000 responses it gives a fascinating snapshot of the kind of sex that gay and bisexual men in the UK are having, what they enjoy and what they are doing, or not doing, to maintain their sexual health.”

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The Body PRO – April 25, 2017
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