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.


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.


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.


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.


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.


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.


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.


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.


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).


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.


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.


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.


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.


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.


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.


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.


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.


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.


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.


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.


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.


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.


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.


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.


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.


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.


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.


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.


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.


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.


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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Friday 17 February 2017


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, the Conference on Retroviruses and Opportunistic Infections (CROI 2017) in Seattle heard yesterday.

Although a number of vaccine studies in monkeys have produced long-term viral suppression, this is the first human study to produce such an effect.

HIV Conserv vaccines contain selected antigens (immune-stimulating sequences of proteins or genes) from HIV that are highly conserved, hence the name. ‘Highly conserved’ means that they are the parts of HIV the virus can least afford to change, and which vary little from one virus to another.

The vaccine thus consists of sections of proteins from different strains of HIV stitched together that generate an immune response to HIV that the virus finds it hard to ‘escape’ from. It cannot afford to generate mutations that get round the body’s immune responses because to do so would weaken it.

What this means is that the vaccine ‘pushes’ the body’s anti-HIV CD8 T-cell response in the direction of becoming more potent and less wasteful, because the body does not generate responses that the virus can easily evade.

In the BCN02 study reported at the conference, 15 people received the vaccine at weeks zero and nine. They also received three doses of romidepsin, a drug which stimulates latently infected cells to produce HIV. It was hoped these bursts of virus production would strengthen the immune responses produced by the vaccine.

ART was stopped at week 17 in a so-called Monitored Antiretroviral Pause (MAP). ART was resumed if there was viral rebound. So far, 13 people have interrupted treatment.

Eight people experienced a rapid rebound in viral load, but five people have controlled HIV at very low levels for periods between 6 weeks and 28 weeks.

“This study is exciting because it is the first to demonstrate post-treatment control – that is, the virus is present but doesn’t rebound after stopping antiretroviral therapy,” said Sharon Lewin, Director of The Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Australia. “However we also need to be cautious – there was no control group and we don’t know which part of the intervention was important.”

Unique case of PrEP failure without drug resistance

Elske Hoornenborg and Godelieve de Bree at CROI 2017. Photo by Gus Cairns,

A man taking part in a pre-exposure prophylaxis (PrEP) demonstration project in Amsterdam has acquired HIV despite good adherence to PrEP and high drug levels. In unique contrast to the handful of previous case reports of PrEP failure, this case cannot be explained by starting PrEP during acute infection or by exposure to drug-resistant HIV.

Among the tens of thousands of cases of PrEP preventing HIV, there have been a few reports of people who acquired HIV. The most fully documented case was reported at last year’s CROI.

The new case concerns a man who tested HIV negative at months one, three and six after starting PrEP. Dried blood spot testing (which is a good guide to adherence in the past month) suggested excellent adherence.

Approximately eight months after starting PrEP, the trial participant came to the clinic complaining of fever, difficulty in urination and urethral inflammation. He tested HIV positive that day. Resistance testing showed that he had no drug resistance mutations at all, not even minority ones.

The clinicians involved say that this is the first case of infection with wild type HIV-1 in a person with documented intracellular levels of tenofovir diphosphate that would be considered to be protective. It is the first evidence that suggests that on rare occasions PrEP may not work against non-drug resistant HIV.

Some aspects of the case are intriguing. The man had an atypical pattern of seroconversion, potentially due to an aberrant immune response under PrEP. When he first tested positive to HIV antibodies, tests could not detect p24 antigen, cellular RNA or integrated DNA in blood cells or rectal tissues.

The man had a great deal of condomless sex, which could mean repeated exposure to HIV and mucosal damage. He had condomless sex, on average, 16 days per month with 3.7 partners on each of those days.

The researchers have a number of hypotheses about potential mechanisms for this extremely rare case of infection despite PrEP, but stress that any explanation at this time is speculative.

Hepatitis C ‘treatment as prevention’ cuts new infections by half

Victor Virlogeux and Bart Rijnders at CROI 2017. Photo by Liz Highleyman,

One year after the Netherlands instituted a policy allowing unrestricted access to direct-acting antivirals (DAAs) for the treatment of hepatitis C virus (HCV), there is already a dramatic decline in acute HCV infections in HIV-positive men who have sex with men.

The new DAAs make hepatitis C treatment faster, easier and much more effective. Promptly treating everyone with hepatitis C infection, especially those at greatest risk of passing the infection on, could cut transmission. But in many countries access to the new drugs has been limited due to their high cost.

From November 2015, all people with HIV and hepatitis C co-infection in the Netherlands could be prescribed DAAs, regardless of liver fibrosis stage. Uptake was swift, especially in people without severe liver disease who would previously have been denied treatment.

The study looked at 2422 participants in the Dutch ATHENA cohort of HIV-positive people who had hepatitis C co-infection.

As of January 2017, 82% had started treatment and 70% were either cured or still on therapy. Among people treated with DAAs, the sustained virologic response rate was very high, at 98%.

About three-quarters (76%) of gay men had been cured or were still on treatment, compared to 45% of other groups, including women and people who had formerly injected drugs. Gay men had been targeted for treatment in an effort to interrupt transmission networks and men were eager to be cured as soon as possible for this reason.

Within another cohort of HIV-positive men who have sex with men, there were 93 identified acute hepatitis C infections in 2014, but 49 infections in 2016. The annual incidence rate was 1.1% in 2014 and 0.5% in 2016, a highly significant 51% reduction.

This drop in hepatitis C incidence occurred at the same time as a substantial increase in syphilis infections and evidence of more sexualised drug use, suggesting that the drop in hepatitis infections is not attributable to changes in sexual risk behaviour.

France is another country offering unrestricted access to DAAs, although uptake is lower. A mathematical model presented to the conference looked at the potential impact of different levels of treatment coverage in France.

As of January 2016, around 7200 people living with HIV had active hepatitis C co-infection and were receiving care. Assuming hepatitis C treatment coverage is maintained at its current level of 30% per year, the model predicted that overall hepatitis C prevalence would drop from 5.1% to 1.1% in 2026, equivalent to around 2000 people. Increasing coverage to 70% would bring the number under 1000.

The decreases would be seen in most subgroups, including lower risk men who have sex with men. But given their higher rates of acute infection and reinfection, higher levels of treatment coverage would be needed for higher risk men who have sex with men. Behavioural interventions; regular screening, including in previously treated people; and reaching undiagnosed individuals for engagement in care would also be required to eradicate hepatitis C in this population.

American researchers called attention to the contrast between these European examples of falling incidence and the other countries where access to treatment is still heavily restricted and incidence is rising.

Smoking, cancer and heart attacks

Leah Shepherd at CROI 2017. Photo by Liz Highleyman,

Stopping smoking has profound benefits for people living with HIV, the conference heard. Just one year after quitting, the incidence of a range of smoking-related cancers falls significantly, although the risk of lung cancer persists. Moreover, smoking probably contributes far more to the risk of cardiovascular disease in people with HIV than viral load, antiretroviral drug choice or any factor linked to HIV.

Smoking is more common in people living with HIV than in the general population. Around 17% of the general population in the United States smoke, compared to 40% of people living with HIV. Comparative figures for the United Kingdom are 19% and 29% respectively, with people with HIV especially likely to be heavy smokers.

An analysis from the large D:A:D cohort included data on change in smoking behaviour with participants followed for a median of nine years. During this time, 1980 cancers were diagnosed among 35,424 participants, including 242 lung cancers and 487 other cancers recognised as smoking-related (such as head and neck, oesophageal, stomach, pancreatic, kidney and urinary, ovarian and liver cancer).

The incidence of smoking-related cancers – excluding lung cancer – fell substantially a year after quitting and thereafter it was comparable to the incidence in people who had never smoked.

On the other hand, the incidence of lung cancer remained at least eight times higher in ex-smokers five years after giving up when compared to people who had never smoked. This finding is in contrast to studies in HIV-negative people, where a decline in the risk of lung cancer begins to become evident five years after quitting.

A second study analysed the contribution of various risk factors to heart attacks in people in the NA-ACCORD collection of North American cohorts. During a median of three and a half years, 347 heart attacks occurred in 29,515 people.

  • If everyone stopped smoking, 38% of all heart attacks would be avoided.
  • If everyone had normal cholesterol, 43% of heart attacks would be avoided.
  • If everyone had normal blood pressure, 41% of heart attacks would be avoided.

In comparison, changing risk factors associated with HIV – a low CD4 cell count, a lack of viral suppression, an AIDS diagnosis, or hepatitis C co-infection – would have a much smaller effect on the total number of heart attacks.

The studies suggest the need for a much greater emphasis on smoking cessation in people with HIV, as well as a greater emphasis on the management of cholesterol and high blood pressure. This will require greater input from primary care physicians and non-HIV health care services.

Good results for three-drug regimen against XDR-TB

Nix-TB patient in waiting area at Brooklyn Chest Hospital in Cape Town. Credit: John-Michael Maas for TB Alliance.

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, CROI heard this week. If the results are replicated in a larger study, the findings could revolutionise the prospects for treating XDR-TB and severe cases of multidrug-resistant tuberculosis (MDR-TB).

XDR-TB is a growing problem in countries with a high burden of MDR-TB, such as South Africa. Current treatment for XDR-TB requires a six-drug regimen, including a six-month phase of treatment that includes injectable drugs, and a further 12-18 months of treatment with five drugs. Some of the drugs used have serious side-effects, and the cure rate is shockingly low: just 11% of South Africans are cured five years after beginning treatment, whereas 73% die.

The NIX-TB study is testing a three-drug regimen consisting of bedaquiline (Sirturo, the first new TB drug to be approved in 40 years), linezolid (a cheap antibiotic), and pretomanid (PA-824), an experimental TB drug being developed by TB Alliance.

Early results from the first participants were presented at CROI. Thirty-one people in South Africa have completed treatment and 6 months of post-treatment follow-up. The study’s primary endpoint is the incidence of bacteriologic failure, relapse, or clinical failure at this stage. This was only reached by two individuals – one person has been reinfected with drug-susceptible TB and one person appears to have suffered a relapse of XDR-TB.

A separate study used genetic analysis to show that migration and travel plays a big part in the spread of XDR-TB in South Africa’s most severely affected province, KwaZulu-Natal. It had been thought that the transmission of XDR-TB is concentrated in households, but the analysis found the median geographical distance between pairs of genetically-linked XDR-TB infections was 111km. Four in five people in genetically linked pairs lived in different districts of the province.

How should HIV self-testing services be provided?

Pitchaya Indravudh at CROI 2017. Photo credit: Robb Cohen Photography & Video.

The best way to implement HIV self-testing, the most appropriate form of self-testing services and the best ways to ensure linkage to care remain open questions, but the conference heard research from Malawi and the United States that addresses these issues.

In order to inform service design in Malawi, discrete choice experiments were used to determine the strength of user preferences for different aspects of service delivery. Provision of self-test kits by lay volunteers in people’s homes was preferred. Even a price as low as US$0.10 would deter people from testing. Participants expected more than a leaflet for post-test support and would like to be able to link to follow-on care at home.

There were problems with comprehension of the pictorial instructions provided with the self-test kits, but the researchers found that an in-person demonstration prior to testing was acceptable and allowed people to test accurately.

In New York City, the free distribution of self-testing kits to gay men using dating apps and websites was a feasible and acceptable way to reach a diverse range of participants, including many who had not tested recently. However, relatively few new cases of HIV were identified.

One US pilot study is trialling a test kit fitted with sensors that detect when the kit is opened. A telephone counsellor can then call the person to offer support and linkage to care.

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News from aidsmap

Tenofovir alafenamide approved for hepatitis B in Europe

The European Commission has granted marketing authorisation for tenofovir alafenamide, to be sold under the brand name Vemlidy, for the treatment of chronic hepatitis B virus (HBV) infection, according to an announcement from Gilead Sciences.


Regular small incentives can improve adherence to ART

The provision of regular low-value economic incentives can improve adherence to antiretroviral therapy (ART), according to research conducted in Uganda and published in the online edition of AIDS. People were eligible for prizes worth approximately $1.50 if they attended their clinic appointments or took at least 90% of the ART doses as evaluated using electronic monitoring.


What are the key steps to effective delivery of PrEP care?

Providing pre-exposure prophylaxis (PrEP) to people who need it entails at least nine key steps, which can be conceived of as a PrEP continuum of care, according to an article published online ahead of print by Amy Nunn and colleagues in AIDS. This continuum can help define benchmarks by which progress in implementing PrEP in different programmes can be compared.


Many older people living with HIV in the UK worried about poverty, loneliness and social care

People over the age of 50 now represent one third of all people living with HIV, but the social care, healthcare and welfare systems aren’t ready for this growing cohort, according to research published by the Terrence Higgins Trust. They describe the situation as a ‘social care timebomb’.


Vitamin D deficiency reduces statin potency, increases risk of muscle pain in people with HIV

People living with HIV who take statins are less likely to experience cholesterol reductions and more likely to develop painful muscle damage as a side-effect if they have vitamin D deficiency, studies published this month in two journals show.


People taking ART in the UK have an accurate understanding of their viral load

The vast majority of people taking antiretroviral therapy (ART) in the UK have an accurate knowledge of their current viral load (VL) level, investigators report in HIV Medicine. Overall, 96% of people who told researchers their viral load was undetectable had a clinic-recorded viral load below 50 copies/ml, with 99% having a viral load below 1000 copies/ml.


Implants and injectables: PrEP in the future

Last month’s announcement that the Bill and Melinda Gates Foundation will give up to $140 million to a Boston drug device manufacturer to develop an implantable mini-pump to deliver drugs for pre-exposure prophylaxis (PrEP) against HIV infection has focused attention on the future of PrEP. Is the future all about implants, or will it offer multiple options for people who want to use PrEP?


Risk of pregnancy loss among smokers much higher for women with HIV

Smoking “dramatically” increases the risk of pregnancy loss – miscarriage or stillbirth – in HIV-positive women, US investigators report in the online edition of AIDS. Researchers from the large Women’s Interagency HIV Study (WIHS) examined the impact of smoking on pregnancy loss in HIV-positive and HIV-negative women over a 20-year period. The effect of smoking on pregnancy loss differed dramatically by HIV status, increasing the absolute risk by 19% in HIV-positive women compared to 10% in HIV-positive women.


Risk score accurately predicts which pregnant and postpartum women would benefit most from PrEP

A risk score based on routine assessments carried out during antenatal care in resource-limited settings can accurately predict which pregnant and breastfeeding women have an especially high risk of infection with HIV and would therefore benefit from pre-exposure prophylaxis (PrEP), investigators report in the online edition of Clinical Infectious Diseases.


Editors’ picks from other sources

Person-to-person contact may cause most drug-resistant TB cases

from Reuters

The worst form of drug-resistant tuberculosis isn’t just arising from inadequate treatment, it’s mostly being spread from person to person, according to a new study of hundreds of cases in South Africa.

Tragedy would unfold if Trump cancels Bush’s AIDS programme

 from The Atlantic

A questionnaire from the president-elect’s transition team asked whether the extraordinarily successful PEPFAR had become a “massive, international entitlement program,” and whether it was worth the investment.

PrEP: a dream deferred

 from Poz

PrEP is largely failing to help those who need an HIV prevention game changer most desperately, namely black men who have sex with men, in particular those younger than 25.

The US Government should buy Gilead for $156 billion to save money on hepatitis C 

 from Forbes

The US Government could cure most Americans suffering from hepatitis C infections if it simply bought drug maker Gilead Sciences on the stock market rather than purchasing its products in the drug market.

Why addicts take drugs in ‘fix rooms’

 from BBC

Britain could soon see its first “fix room” for drug users – a safe space where addicts can take illegal narcotics under medical supervision. But who uses such places and how do they work?

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CROI 2017: Wednesday 15 February 2017

Wednesday 15 February 2017


Two-drug regimen maintains HIV suppression for 48 weeks after switch

Josep Llibre at CROI 2017. Photo by Liz Highleyman,

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 up to 48 weeks, according to a late-breaking report at the 2017 Conference on Retroviruses and Opportunistic Infections (CROI) yesterday in Seattle.

“This is the first time we can prove [a two-drug regimen] is non-inferior in a once-daily regimen with no booster, no protease inhibitor and no NRTIs [nucleoside reverse transcriptase inhibitors],” Dr Josep Llibre of University Hospital Germans Trias Barcelona told the conference.

There has been increasing interest in treatment simplification strategies in recent months, especially following last summer’s report of good results for dolutegravir plus lamivudine (Epivir) in a small study of people taking treatment for the first time. ViiV Healthcare’s dolutegravir is a potent integrase inhibitor with a high barrier to resistance, making it a good candidate for simplified therapy.

SWORD-1 and SWORD-2 are identical randomised phase 3 trials recruiting from clinics around the world. Together the studies included 1024 people with HIV who had been on three-drug ART with undetectable viral load for at least a year. Individuals with a history of virological failure, drug resistance or chronic hepatitis B co-infection were excluded.

At baseline the average CD4 cell count was approximately 600 cells/mm3. Their regimens contained integrase inhibitors (20%), NNRTIs (non-nucleoside reverse-transcriptase inhibitors) (54%) and protease inhibitors (26%), as well as two NRTIs.

Participants in these open-label studies were randomly assigned either to switch to the dual regimen (dolutegravir plus rilpivirine) or to stay on their current regimen. The primary endpoint was continued undetectable viral load at 48 weeks, which was achieved by 95% of participants in each arm of the studies.

Virological failure was rare (< 1% in the dual therapy arm and 1% in the unchanged regimen arm). Treatment was generally safe and well tolerated.

The SWORD studies are continuing through to 148 weeks. Also, a new trial will assess a fixed-dose co-formulation of dolutegravir plus rilpivirine. This study will enrol some people with pre-existing drug resistance, to better reflect a ‘real world’ population.

New integrase inhibitor bictegravir matches dolutegravir for first-line HIV treatment

Paul Sax at CROI 2017. Photo by Liz Highleyman,

Bictegravir, an investigational integrase inhibitor, was highly potent, well tolerated and worked as well as dolutegravir (Tivicay) as part of a three-drug regimen in a phase 2 clinical trial presented to CROI yesterday.

Integrase strand transfer inhibitors – such as dolutegravir – are an increasingly important part of first-line treatment and are recommended in European and US HIV treatment guidelines. Bictegravir (formerly GS-9883) belongs to the same drug class and is manufactured by Gilead Sciences. It can be taken once-daily and does not require a booster such as cobicistat.

The phase 2 study recruited 98 individuals who had not taken antiretroviral therapy (ART) before. They generally had asymptomatic HIV infection with a median CD4 cell count of approximately 450 cells/mmand a median viral load of about 4.4 log10 copies/ml.

The 98 participants in this double-blind study were randomly assigned to receive 75mg bictegravir or 50mg dolutegravir, plus 25mg tenofovir alafenamide and 200mg emtricitabine, taken once daily with or without food for 48 weeks.

The primary endpoint was the proportion of people with HIV RNA below 50 copies/ml at 24 weeks, which was achieved for 97% of participants in the bictegravir arm and 94% in the dolutegravir arm. At 48 weeks, an undetectable viral load was maintained for 97% and 91% in the two arms, respectively. Given the small number of participants, these differences were not statistically significant.

No significant drug resistance was detected in either arm. Both regimens were generally safe and well tolerated. As there are concerns about the potential for bictegravir to have a negative impact on kidney function, attention was paid to this. Estimated glomerular filtration rate declines were -7.0 ml/min in the bictegravir arm and -11.3 ml/min in the dolutegravir arm at week 48. There were no discontinuations due to kidney-related adverse events.

These results were promising enough to proceed with four phase 3 trials using a single-tablet regimen of bictegravir, tenofovir alafenamide and emtricitabine. Optimising the formulation allowed for a lower 50mg bictegravir dose in the co-formulation.

Combination HIV prevention drives incidence down in Rakai, Uganda

Mary Grabowski at CROI 2017. Photo by Liz Highleyman,

The annual rate of new HIV infections (incidence) has fallen dramatically in one of the best-studied groups of people in Africa, the Rakai cohort in southern Uganda. 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.

Data were collected between 1999 and 2016 in 12 surveys from 30 communities in the Rakai Community Cohort. Almost 34,000 people took part in at least one survey.

Rakai is a rural area that has been hard hit by HIV, with around 13% of people living with HIV.

HIV incidence was a steady 1.17% a year over most of the study period, from 2000 to 2010. But after that it started to fall. By 2012 it was 0.8% a year and by 2016 it was 0.66% a year, a 42% decline.

The researchers pointed to three key factors that may explain the reduction:

  • Use of antiretroviral therapy by people living with HIV increased from 12% in 2006 to 69% in 2016. An undetectable viral load was achieved by 42% of people with HIV in 2009 and 75% in 2016.
  • The proportion of men who were medically circumcised rose from 15% in 1999 to 59% in 2016.
  • Young people started having sex later – the proportion of 15-19 year olds who reported not having had sex rose from 30% in 1999 to 55% in 2016.

Incidence fell further in men (by 54%) than in women (by 32%), probably reflecting the benefits men get both from medical male circumcision and from the relatively high rates of treatment coverage in their female partners.

This is the first time a population-level decline in incidence in the Rakai cohort has been seen. The results provide empirical evidence that combination HIV prevention can have a substantial population-level impact, the researchers say.

Infants treated within days of birth may rapidly clear HIV reservoir

Louise Kuhn at CROI 2017. Photo by Liz Highleyman,

Viral load and viral DNA fall rapidly in infants who begin antiretroviral therapy (ART) within days of birth, two South African studies have found. This shows the potential for clearing the reservoir of HIV-infected cells, but it seems that only a minority of infants may have such a dramatic response to treatment.

Clearing the reservoir of HIV-infected cells is considered to be essential for developing an eventual cure for HIV infection. The reservoir of immune system cells containing HIV DNA is established very soon after infection, so to give the best chance of reducing or clearing HIV DNA in infants, it may be necessary to identify and treat infants within days of birth.

One group of researchers reported on five infants who were treated with ART within eight days of birth. In three infants, HIV RNA declined to less than 100 copies/ml within around three months; in the two remaining infants, HIV RNA fell below 100 copies/ml after six months.

HIV DNA fell very rapidly in the first two weeks of treatment, before entering a more gradual decline throughout the first year of life. HIV DNA was cleared much more quickly than in adults or in infants who began treatment two months after birth.

A second study reported 75 infants, including 30 who started ART within the first two days of life. HIV RNA (viral load) was tested at weeks 1, 2, 4, 8, 12, 16, 20, 24, 32, 40 and 48.

In three infants, HIV RNA ceased to be detectable by qualitative PCR (which would mean an HIV-negative result if this had been used as a diagnostic test). But there was huge variation in viral load responses. Although one-third of infants did achieve undetectable viral load, this took anywhere from 90 to 330 days, and in the remaining infants viral load either rebounded after initial suppression or never fell below the limit of detection.

Point-of-care test for early infant diagnosis improves outcomes

Ilesh Jani at CROI 2017. Photo by Liz Highleyman,

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 presented to CROI yesterday found.

HIV diagnosis in infants requires different testing procedures and assays to adults. There are numerous logistical barriers to providing laboratory-based tests for HIV DNA to infants in settings with a high burden of HIV.

Many of these barriers can be overcome if the test is carried out at the health facility while the mother and infant wait, so that treatment can be offered immediately after the result is known. Two point-of-care tests for early infant diagnosis have been approved recently by the World Health Organization. The use of one of them, the Alere HIV-1/2 Detect system, was assessed in a study conducted in Mozambique.

The study randomised 16 health facilities to provide standard-of-care testing or to implement point-of-care testing. Almost 4000 infants were born to women with HIV during the study.

Of the point-of-care results, 99.5% were provided to the infant’s caregiver, compared to 65% of the standard-of-care test results. In the standard-of-care arm, it took a median of 125 days for caregivers to receive the results.

Whereas 90% of infants who tested positive on a point-of-care test had started treatment within two months of diagnosis, only 13% of those tested by the standard method did so. In the point-of-care arm, 62% of infants were still on ART three months after initiation, compared to 43% in the standard-of-care arm.

UNITAID, the international drug and diagnostics purchase fund, is investing US$63 million in point-of-care early infant diagnosis and HIV viral load testing in nine countries in sub-Saharan Africa, in order to test at least 215,000 infants.

Changes in viral suppression over time a better indicator than a single measure

Nicole Crepaz at CROI 2017. Photo by Liz Highleyman,

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 a study by the US Centers for Disease Control and Prevention (CDC). The researchers analysed data from the National HIV Surveillance System for 2014, which includes around 70% of all people aged 13 and over diagnosed with HIV in the US.

They found that 57% had an undetectable viral load on their last test in 2014. But only 48% had an undetectable viral load on all their viral load tests done during the year. Therefore relying on a single viral load test could over-estimate durable viral suppression by 20%.

The CDC also reported that 8% of tested individuals never had an undetectable viral load during 2014. A further 32% of diagnosed individuals did not get tested for viral load during the year, probably indicating that they were not engaged with healthcare and were unlikely to be virally suppressed.

The results revealed some notable demographic disparities. Women, younger people, African Americans and people who inject drugs were less likely to have durable viral suppression.

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Top Stories on January 10, 2017
Top Stories on January 10, 2017

A new provider training centralizes the lived experiences of black gay and bisexual men, and transgender people. Heather Boerner takes an in-depth look.

This Week in HIV Research: Vitamin D May Protect Against HIV; and Protease Inhibitor Monotherapy

This week, a study examines how two precursor forms of vitamin D may help protect against HIV infection.

Paul Sax, M.D., Top Stories in HIV Medicine for 2016

From cure research to developments in prevention and vaccines, Paul Sax, M.D., identifies what he considers the five most most important HIV-related stories of last year.

NIH Launches First Large Trial of a Long-Acting Injectable Drug for HIV Prevention

The study will examine whether a long-acting form of the investigational anti-HIV drug cabotegravir injected once every 8 weeks can safely protect men and transgender women from HIV infection.

Young Gay Men of Color Accept PrEP, but Struggle With Adherence

At the PrEP Summit, I Saw the Hope and Challenges of HIV Prevention Today

Patient Navigators for Hepatitis C Patients Found Useful in New York City
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Policy makers’ inaction is leading people to take PrEP ‘in the wild’


Policy makers’ inaction is leading people to take PrEP ‘in the wild’

Jerome Galea presenting at HIVR4P. Photo by Roger Pebody /
Roger Pebody
Published: 19 October 2016

An increasing number of gay men and others at risk of HIV are seeking to protect their health with PrEP (pre-exposure prophylaxis), but the lack of PrEP provision and lack of regulatory approval in many countries is leading people to take PrEP without medical supervision and on an ad-hoc basis. This will undermine the safety and effectiveness of PrEP, Jerome Galea said as he presented results of the PrEP in the Wild survey to the HIV Research for Prevention (HIVR4P 2016) conference in Chicago yesterday.

“The official authorities are playing catch up and failing in their duty to protect public health,” commented the authors of a separate report on PrEP Access in Europe.

The PrEP in the Wild researchers wanted to gain a better understanding of the characteristics of PrEP users and of their practices, to inform the implementation of PrEP. The internet survey recruited a convenience sample of people who responded to recruitment on social media, through advocacy groups and on websites such as

The survey was launched in February 2016 and remains open to new participants. Interim results, with data up to the end of July, were presented.

The survey was completed by 262 PrEP users as well as 52 ‘frustrated users’ – individuals who had been unable to obtain PrEP at all. The vast majority of respondents were gay men. One quarter had a primary partner who was living with HIV.

While there were some responses from all parts of the world, most participants came from Western countries in which there has been PrEP activism, including the UK (90 respondents), the US (48), Australia (31) and France (13).

People who had been able to get hold of PrEP had a variety of motivations for use – and individuals often expressed more than one. They included wanting to ‘let go’ during sex (80%), to facilitate sex with partners of an unknown HIV status or partners who said they were HIV negative (76%), because they preferred sex without a condom (71%), because of fear of HIV (67%), as a back-up for condom use (48%), to facilitate sex with HIV-positive partners (47%), to use during a sex party (43%) and because a sexual partner preferred not to use condoms (27%).

Only 13% had been advised to use PrEP by a health professional.

People were resourceful in the ways they obtained PrEP. Just over half ordered generic medicines online, without a prescription. (This may partly reflect the strong participation in the survey of people living in the UK and Australia; importing medicines is legal in these countries but it is not in many others.)

A third obtained pills from a friend or someone they knew. This could be medicines that were prescribed for HIV treatment and which were no longer needed; some HIV-positive patients may have also obtained extra pills by stating that they had “lost their prescription”. One in five obtained medications for use as post-exposure prophylaxis (PEP) but used some of them as pre-exposure prophylaxis (PrEP).

Others ordered online with a prescription, went to a retail pharmacy with a prescription or obtained them in another country.

Whereas 192 people saw a medical provider before starting PrEP, 62 did not. Among those who began PrEP without medical consultation, many omitted key procedures including kidney function monitoring (only done by 29%), HIV testing (done by 87%) and sexual health counselling (25%).

Most people were using either Truvada or a generic equivalent. While 5% did report using Atripla (which includes efavirenz alongside tenofovir disoproxil fumarate and emtricitabine), few people reported using other antiretrovirals.

One in five were following non-daily dosing. For some individuals this may reflect genuine choice, but for others it probably reflects the cost and difficulty of getting medication. Around a third of those aiming for daily dosing in fact had interruptions in their use. One in seven had shared pills with others.

The 52 respondents who couldn’t obtain PrEP cited a number of barriers, including its cost (mentioned by 60%), doctors’ refusal or inability to prescribe PrEP (50%) and importing PrEP being against the law in their country (35%).

“PrEP is not a DIY intervention,” commented Jerome Galea. He said that for PrEP to be safe and effective, regular medical monitoring and sexual health counselling is required. It is particularly important that the drugs are not taken after HIV seroconversion, which risks the development of drug resistance.

These problems were also described in PrEP Access in Europe, a report by the PrEP in Europe Initiative (a coalition of HIV organisations including NAM) that was launched at the conference. There is anecdotal evidence from countries across Europe of gay men obtaining PrEP in the ways described above.

In some countries, HIV doctors are prescribing Truvada off-label to small numbers of affluent HIV-negative people who can pay the full cost of the drug (around €400 or €500 a month). In countries with more restrictive policies or attitudes, individuals are smuggling drugs from other countries or obtaining them in underhand ways, as these respondents described:

“The only legal way to do this is to travel to the UK and bring the pills with you in your own luggage. That’s quite a barrier, so people are asking friends in the UK to receive the order and send on privately, or using parcel forward delivery services that use a UK PO box then forward the parcel to Germany from there.”

“There are anecdotal stories about some people living with HIV giving their Truvada to negative friends and asking for an extra bottle saying they have lost it. It is possible this is happening, but at a very small scale, as it would be noticed by the clinic if it were on larger scale. We only have one clinic and pharmacy with HIV drugs in Croatia.”

“We did hear stories of people selling Truvada on a party bus coming from Paris going to Brussels to a gay party.”

“Without official PrEP approval and roll-out within health care and community settings, many gay men will end up taking a few pills of Truvada without knowing their HIV status, STI status, renal health and risk factors,” the authors comment. “Many of them may take PrEP needlessly, or worse, within an acute HIV infection phase. These men may also be vulnerable to being sold counterfeit versions of Truvada as a black market emerges.”

The PrEP in Europe Initiative calls on European governments to make PrEP available to populations at imminent risk of HIV, as a matter of urgency.

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aidsmap news from Achieving the 90-90-90 target




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HIV update – 5th January 2017

Large drop in HIV diagnoses in London gay men

Four sexual health clinics serving large numbers of gay men in London have reported that they diagnosed far fewer gay men with HIV during 2016 than they did during 2015. These are preliminary figures and have not been fully analysed, but many doctors believe that the use of pre-exposure prophylaxis (PrEP) is part of the explanation for these reductions.

Such large drops in new diagnoses are unprecedented. 56 Dean Street had 40% fewer diagnoses overall, the Mortimer Market Centre 50% fewer, Homerton Sexual Health 40% fewer in gay men, and Barts Sexual Health Centre 36% fewer diagnoses in gay men.

On their Facebook page, 56 Dean Street summed up the factors which they believe may have contributed to the fall: “Condoms, PrEP, early diagnosis, immediate treatment.” They noted that they were testing as many people as the previous year and that rates of other sexually transmitted infections were as high as ever. Getting people who have HIV diagnosed and on to treatment as quickly as possible is probably part of the explanation – but clinics have been working towards this goal for several years already.

What appears to be new in 2016 is individuals importing PrEP medication from abroad and getting support on using PrEP safely. Dr Mags Portman of the Mortimer Market Centre said: “We made a decision to actively support those buying PrEP online early in 2016. This approach has been embraced by all staff from nurses to health advisors to doctors. We ensure that our patients at higher risk of HIV are fully informed about the use of PrEP and have access to safe monitoring alongside good sexual health advice and regular STI screening.”

The number of men taking PrEP may only be a few hundred or a few thousand, but these men may be key to slowing the epidemic. “The important thing is whether awareness and usage of PrEP is reaching the right people,” commented Dr Alan McOwan of 56 Dean Street. “If the ‘nodal’ gay men who have a lot of partners and who would have previously been at the centre of a cluster of infections are now not becoming infected, they are not passing it on to anyone else.”

For more information on PrEP, read NAM’s factsheets ‘Pre-exposure prophylaxis (PrEP)’ and ‘How to get PrEP in the UK’.

Hepatitis C virus often found in rectal fluid

Our understanding of how hepatitis C can be passed on during sex between men continues to evolve.

It has generally been thought that sexual transmission is mostly linked to sexual practices that involve some contact with blood (including tiny traces of blood you don’t notice). This makes sense as it is well known that hepatitis C is present in infectious quantities in blood. These sexual practices may include anal sex (especially when it goes on for a long time) as well as fisting and using sex toys.

But last year, American researchers reported that the virus can often be found in semen. In a group of men who had both HIV and hepatitis C, one third of the men had detectable hepatitis C in their semen. It was present in levels that were plausibly high enough to transmit the virus.

Now the same group of researchers have reported that they have also found hepatitis C in the men’s rectal fluid (in other words, secretions in the rectum). Just under half the group had detectable levels of hepatitis C in their rectal fluid. Men with higher hepatitis C viral loads in their blood tended to have higher levels in their rectal fluid.

This means that blood is not required for hepatitis C to be passed on. During anal sex without a condom, hepatitis C can be transmitted. If the insertive partner (the top) has hepatitis C, it may be present in his semen, so he could pass the infection on to the other man. Or if the receptive partner (the bottom) has hepatitis C, it could be present in his rectal fluid, so he could pass the infection on.

The researchers say that health organisations need to update the information they provide on hepatitis C. Educational resources and campaigns need to reflect what we now know about how hepatitis C is transmitted. In line with this, NAM has just updated its illustrated leaflet, ‘How hepatitis C is passed on during sex’.

More medical conditions in people living with HIV as they get older

People living with HIV are increasingly experiencing a range of medical conditions and co-morbidities as they get older, according to a large American study.

Thanks to effective HIV treatment, more HIV-positive people are surviving to older ages. But they may be at higher risk of developing a range of health problems. This may be because of lifestyle factors and the immune system’s response to HIV, but there is scientific debate about the precise causes.

The American researchers looked at data on 37,000 people living with HIV, comparing each individual with up to three HIV-negative people who they were matched with, based on their age, sex, ethnicity and type of health coverage. Just over half the participants had commercial health insurance (typically the healthiest people in the United States, with the best access to healthcare) while the others were covered by Medicaid (a programme for people on low incomes, who may have had problems accessing healthcare in the past).

Data were included from 2003 to 2013. The average age of people living with HIV increased during this period – as did the number of people with additional medical conditions.

People living with HIV had more medical conditions than HIV-negative people. People on Medicaid generally had more health problems than those with commercial coverage.

For example, amongst those with commercial insurance, 7% of HIV-positive people and 4% of HIV-negative people had heart disease. The figures for those covered by Medicaid were 11% and 8% respectively.

Figures were also high for kidney disease – amongst those with commercial insurance, 9% of HIV-positive people, compared with 3% of HIV-negative people. They were also elevated for osteoporosis (brittle bones) and fractures.

But rates of some health conditions were no higher in HIV-positive than HIV-negative people. And these were the most common health conditions – high blood pressure (31% of HIV-positive people with commercial insurance), raised cholesterol or triglycerides (31% of HIV-positive people with commercial insurance), diabetes and other endocrine disorders (21% of HIV-positive people with commercial insurance). Rates were similar in HIV-negative people.

A separate study, comparing people with HIV and people with HIV/hepatitis C co-infection, found that people in the second group were more likely to have kidney disease and osteoporosis. People who had hepatitis C that had not been brought under control by treatment had higher rates of diabetes. But it’s unclear whether these raised rates are due to the impact of hepatitis C or due to lifestyle factors – for example, people who had hepatitis C were more likely to inject drugs, drink heavily and smoke.

Editors’ picks from other sources

How close are we to a cure for HIV? A Q&A with HIV cure scientific superstars
from BETA blog

What’s going on in HIV cure research? Is it ethical to take people off HIV antiretrovirals if they participate in HIV cure research? These were some of the questions that lead researchers who are part of the amfAR Institute for HIV Cure Research at UCSF tackled at a forum on World AIDS Day last year.

This First Dates contestant was told he had to reveal he was HIV positive
from BuzzFeed News

When Alex Causton-Ronaldson applied to be on the Channel 4 show, his HIV status was leaked to the production team, who tried to pressure him into disclosing it. He tells BuzzFeed News what effect this had and how he fought back.

Five reasons ‘HIV undetectable’ must equal ‘untransmittable’

“We are not dirty, we are not a threat, and we are not disease vectors. In fact, we are the solution. People living with HIV who achieve viral suppression, who become undetectable, are the solution to the end of new HIV infections in the United States… When we look back 20 years from now we’re going to judge ourselves in terms of how well we responded to this opportunity.” How wonderful that something many of us have assumed for years has been proven to be true. So now we can spread the news and encourage people with HIV to seek treatment and stick with it. However, there is some strong resistance to a message that equates undetectable to untransmittable, and it’s not coming from where you might think.

London-wide HIV prevention programme to face 10% budget cuts
from Public Sector Executive

The programme is due to expire in March 2017 – council leaders were asked to approve it for a further two years, but with a cut in the total funding from borough councils from £1.2m a year to £1.08m. The report said that the cuts were needed because of national cuts to public health budgets.

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