30 October 2015 VOLUME 16 ISSUE 44
-- any Prevention Options -- Antibody Related ResearchSTI VaccinesHIV VaccineCombination PreventionMale and Female CondomsCureGeneralHormonal Contraceptives and HIVHPV VaccinesLubricantMicrobicidesMultipurpose Prevention TechnologiesPrEPTherapeutic VaccinesTreatmentVoluntary Medical Male Circumcision
Duke Uni: Holy Grail of HIV vaccine in sight using 'paradoxical' bnAbs
A successful HIV vaccine will have to induce several broadly neutralising antibodies to mimic some patients' immune response to HIV infection, according to the Duke Human Vaccine Institute....Lead researcher Tony Moody told the BioProcess International conference keynote audience [that] the enormous genetic diversity of HIV pathogens requires a completely novel approach....Creating a new vaccine every season or for different regions is unfeasible: "We make a new vaccine every year for flu because of the virus's diversity. The differences in HIV strains are orders of magnitude greater."
Why microbicides for HIV prevention are still necessary in the treatment-as-prevention era
During ID Week 2015 in San Diego, I caught up with Jeanne Marrazzo, a lead investigator on VOICE, and an infectious disease specialist and HIV/STI researcher at the University of Washington in Seattle...for a webcast featuring slides and commentary from Marrazzo's engaging presentation on microbicides....Read on for her thoughts about how failure can create opportunity, why we still urgently need a topical HIV prevention method that works, and how microbicides could benefit from an image makeover.
TheBodyPro.com
US budget deal could ease uncertainty over science spending
Leaders in the US Congress and President Barack Obama have agreed on a deal that could avoid a December showdown over government funding — and a possible shutdown....The deal would raise caps on defence and non-defence spending by US$25 billion each for fiscal year 2016, which began on 1 October.... But it is not yet clear how the extra $25 billion would be split among all discretionary programmes, including those that fund scientific research and development....With increased budget caps, the US NIH could stand to win big.
More than half the world has herpes
A new report from the WHO, published in PLOS ONE, reports that 3.7 billion people under age 50 carry the herpes type 1 (HSV-1) virus, which is is primarily transmitted through mouth-to-mouth contact and usually manifests as cold sores....Herpes simplex virus type 2 (HSV-2) is nearly always transmitted through skin-to-skin contact and commonly causes genital herpes....The new estimates show that HSV-1 also is a notable cause of genital herpes when transmitted through oral sex.
Does Truvada as PrEP stunt bone growth in young men?
Researchers conducted an analysis of bone density changes among 18-to-22-year-old gay male participants in the ATN open-label demonstration project of PrEP. Findings were presented at the 15th European AIDS Conference and the 17th International Workshop on Comorbidities and Adverse Reactions in HIV.
aidsmeds
WHO early 2016 guidelines expand ART to all HIV-infected patients
WHO issued an early release of the organization's 2016 guidelines, recommending that all patients with HIV should immediately initiate ART regardless of their CD4 cell counts and that all patients at high risk for HIV should receive daily pre-exposure prophylaxis....The feasibility, acceptability, cost-effectiveness and impact of treatment will be explored in the SEARCH and MaxART studies; results are not expected before 2017 or 2018.
Infectious Disease News
Teen sex in South Africa: dangerous, undesired and condemned
Decriminalising sex among consenting young people is a move in the right direction for South Africa, according to Professor Deevia Bhana. She said teenage sexuality is often considered dangerous, undesired and stigmatised, creating panic and moral condemnation. "This...leads to an underground sexual culture where teenagers hide, are discreet, and often deny sexual interests and activities," said Bhana who presented her study "Sex, gender and money in African teenage conceptions of love in the HIV context" at UKZN's Public Health Department Wednesday.
Tuberculosis caused more deaths than HIV in 2014
Tuberculosis surpassed HIV as the leading cause of death from infectious disease in the world in 2014, according to a WHO report released Wednesday. But it's not because more people are getting infected. Global health officials said on Wednesday that they are able to better track cases to report more accurate numbers....WHO estimates overall totals could be even higher, with nearly 40 percent of cases undiagnosed worldwide.
Tenofovir alafenamide single-tablet regimen shows good efficacy with improved kidney and bone safety
Research presented at the 15th European AIDS Conference last week shows improved safety for a combination containing a new formulation of tenofovir, recently granted scientific approval for marketing in the European Union. Gilead Sciences' tenofovir alafenamide (TAF) is a new pro-drug formulation that delivers the active agent to HIV-infected cells more efficiently than the current tenofovir disoproxil formulation)....Based on favourable study findings to date, Gilead has requested US and European regulatory approval of the elvitegravir/cobicistat/emtricitabine/TAF single-tablet regimen, which will be marketed as Genvoya.
aidsmap
Risk of heart attack rises with length of HIV infection, regardless of age
Ten years after acquiring HIV, a person living with HIV has approximately twice the risk of heart attack compared to someone who has just acquired HIV, regardless of the age at which they seroconvert, and after taking into account the effects of ageing, an analysis of 18,468 people living with HIV has shown. The study was carried out by the CASCADE collaboration in EuroCoord, and looked at eight cohorts in Europe and North America. The findings were presented at the 15th European AIDS Conference in Barcelona last week.
GSK chief: We don't need a breakup or a Pfizer deal. Just look at ViiV's sales surge
GlaxoSmithKline surpassed Wall Street's earnings estimates in Q3, with lower spending in vaccines and consumer health largely driving the beat. But that's not to say it didn't turn in a couple of standout sales performances. In particular, its HIV drugs unit--ViiV Healthcare--shot up by 67% year-over-year, with Tivicay delivering sales that expanded by 101%.
Kenya launches nutrition interventions for people living with HIV/AIDS
"Nutrition plays a critical role in HIV treatment adherence, wellness and health outcomes of people living with this condition. It boosts the immune system and is a safeguard against opportunistic infections," said Principal Secretary in the Ministry of Health Khadijah Kassachoon. The Ministry of Health and partners have developed nutrition guidelines to boost HIV/AIDS management in the country.
Truvada study yields surprising STI finding
While the Truvada study is encouraging about a future free of HIV, it highlights the need for more safe sex education regarding other STIs. Justin Lehmiller, a social psychologist at Ball State University and author of the blog Sex and Psychology,said he becomes concerned when people seem nonchalant about sexually transmitted diseases other than HIV.
ForMen.com
More Zimbabwean men get circumcised to reduce HIV risk
Zimbabwe...officials are pushing the newly-introduced ring method that makes the procedure easier....In 2009, the government set the target to have 1.3 million men circumcised by 2017 to slow the spread of HIV. Zimbabwe was falling short of this target with the surgical method, according to Malvern Nyamana – the chief medical officer in Shurugwi rural district. He says the ring method, introduced this year, has made a big difference.
Malaysia: halting HIV and drug use with compassion
Malaysia's 10-year-old harm reduction programme...has helped curb a disturbing rise in HIV infections among injecting drug users....Yet,... global funding for such initiatives...is under threat as donor priorities shift...."All of this is occurring in a broader global context where what we call HIV fatigue is happening at the international donor level," Rick Lines, executive director at Harm Reduction International, told Al Jazeera.
With EACS release, all international HIV treatment guidelines agree on when to start – for the first time since 2006
The new European AIDS Clinical Society (EACS) HIV clinical guidelines, released last week at the 15th European AIDS Conference, bring Europe into line with the rest of the world by recommending HIV treatment upon diagnosis for all patients. This is the first time since 2006 that all internationally-written guidelines have agreed on their 'when to start' recommendations....The guidelines show much less harmony when it comes to what to start with, however.
The NIH still isn't doing enough to advance women's health
Despite a 1993 mandate that women and people of color be represented in all [NIH-funded] clinical trials,...[a] new GAO report...reveals a critical dearth of data on how the NIH is meeting its targets for gender balance in test subjects and analysis of results....The NIH does not provide demographic data any more specific than aggregate sex breakdowns of enrollees at each center it funds, [so that] it's impossible...to determine whether women are sufficiently represented in individual trials or research on specific diseases.
Drug enforcement vs. AIDS treatment issue hits UN
Is the war on drugs crippling the war on AIDS? And might the AIDS epidemic make governments more willing to treat drug abusers as suffering patients rather than as hardened criminals? Those questions came to the fore last week because of a fumbled news story...that the United Nations Office on Drugs and Crime...was about to advocate ending penalties for personal use of all drugs. The schisms revealed by the news...showed how the debate is shifting, in part because of HIV.
CHMP adopts positive opinion of Edurant in adolescents with HIV-1
The CHMP has adopted a positive opinion recommending a change to the terms of the marketing authorisation for Janssen's Edurant (rilpivirine) in the EU to extend the indication to adolescent patients aged 12 to <18 years with human immunodeficiency virus-1 (HIV-1) infection....If approved by the European Commission, Edurant will become available for the treatment of adolescents with HIV-1 for the first time. It is estimated that one in seven of all new HIV infections occur in adolescence and young adulthood.
European Pharmaceutical Review
ViiV Healthcare awards 23 small grants to help alleviate the stigma of HIV and AIDS in the MSM and transgender community globally
ViiV Healthcare today awarded its first round of small grants to support men who have sex with men and transgender community-led interventions to reduce stigma and discrimination....23 non-governmental and community-based organisations will receive up to £25,000 per year over a two year period through the Positive Action for MSM and Transgender programme. Grantees...were selected from 237 applications received from 79 countries.
CNW
Health Minister warns Russia's HIV epidemic could spiral out of control
Russia's HIV epidemic could spiral out of control by the end of the decade if treatment for the life-threatening virus is not expanded, the nation's health minister warned Friday, the TASS news agency reported. Proclaimed government support in Russia for controlling HIV's spread and treating those infected is notoriously ineffective. Health Minister Veronika Skvortsova [warned that], without funding increases "by 2020 the number of patients in the HIV-AIDS epidemic could increase by 250 percent."
PreP Now Recommended in Europe, but Faces Big Challenges
Preexposure prophylaxis (PreP) for HIV was endorsed for high-risk populations in new guidelines issued Thursday by the European AIDS Clinical Society, but there are significant barriers to widespread use, experts said here at the 15th European AIDS Conference.
Finger-prick hero falls from grace
In a rare case of Silicon Valley scandal,...31-year-old Elizabeth Holmes, chief executive of biotech start-up Theranos, fell from her pedestal. The $US9 billion start-up she founded claims it can perform a range of blood tests to diagnose conditions such as high cholesterol, HIV and diabetes — using just a few drops of blood....The hype allowed Ms Holmes to raise $US400 million....Last week, The Wall Street Journal conducted an investigation that claimed Theranos' blood-testing system didn't really work as advertised.
Dr. Beny Primm, pioneer in addiction and AIDS prevention, dies at 87
Beny J. Primm, a doctor who started some of New York City's first methadone clinics to treat heroin addicts in the 1960s and who, during the AIDS epidemic in the 1980s, became a nationally prominent advocate for changing public health policy toward intravenous drug users, died on Oct. 16 in New Rochelle, NY. He was 87....He wrote in his 2014 memoir, The Healer: A Doctor's Crusade Against Addiction and AIDS,..."I knew that behind this devastation was the scourge of drugs, and I made a promise to myself that I would work to stop these black kids from going down."
Face to face with Cambodia's HIV fighters
Cambodia's efforts in HIV prevention and treatment have shown significant results in the past ten years....Thanks to heavy government investment and international aid, Cambodians now have free access to HIV tests, antiretroviral drugs and counselling. As a result, new HIV infections have dropped from 3,500 in 2005 to 1,300 in 2013. The fight against HIV is gaining momentum, with NGOs such as Friends-International and Mith Samlanh carrying out harm reduction activities among marginalised communities such as slum dwellers and sex workers.
SciDev.net
Kenya: WHO Guidelines On HIV Treatment Good News for Kenya
The guideline recommends initiation of ART in adults living with HIV, regardless of CD4 cell count, and offer of PrEP as a prevention option to all people at increased risk of acquiring HIV. Considering that the most at risk populations account for more than 100,000 (more than a third of all) new HIV infection in Kenya, this is indeed good news.
Immune responses provide clues for HIV vaccine development
Recent research has yielded new information about immune responses associated with -- and potentially responsible for -- protection from HIV infection, providing leads for new strategies to develop an HIV vaccine. Results from the RV144 trial, reported in 2009, provided the first signal of HIV vaccine efficacy: a 31 percent reduction in HIV infection among vaccinees....A new review outlines findings that hint at the types of immune responses a preventive HIV vaccine may need to induce.
Health economists call for strategies for universal access to medicines
In The Lancet, Louis Niessen and Jahangir Khan argue that strategies to make medicines more available and affordable are critical in increasing their use in low- and middle- income countries. There is a double burden of infectious and chronic diseases, while awareness of the benefits of prevention and treatment has grown....Their comment [follows] publication of the PURE study [which] shows that secondary prevention is unavailable and unaffordable in the surveyed 94,919 communities across the world.
EACS Treatment Guidelines updated
The EACS Treatment Guidelines have been updated. Version 8.0 - October 2015 is now available online and includes major revisions to almost all sections. Most notably, the antiretroviral treatment recommendation of when to start ART has changed based on the results of the START study, and the co-infections section has been updated to reflect the major advances in anti-HCV treatment with direct acting antivirals and the phasing out of interferon-containing treatment.
European AIDS Clinical Society
Free the tweet at scientific conferences
Social media are acknowledged more and more as tools to communicate science and influence policies.... Twitter, for instance, has proved itself highly effective in disseminating the main ideas and results presented at a conference to both attendees and those who could not attend....Such rapid communication has the potential to make science more inclusive, fostering collaboration and results. However, there is a new and controversial trend to limit the free use of social media in scientific conferences.
Using molecular HIV surveillance data to understand transmission between subpopulations in the United States
This analysis is the first use of US surveillance data to infer an HIV transmission network. Our data suggest that HIV infections among heterosexual women predominantly originate from MSM, followed by heterosexual men. Although few MSM were linked to women, suggesting that a minority of MSM are involved in transmission with heterosexual women, these transmissions represent a substantial proportion of HIV acquisitions by heterosexual women.
JAIDS
Implementation and operational research: integration of PMTCT and antenatal services improves combination antiretroviral therapy uptake for HIV-positive pregnant women in Southern Zambia: a prototype for Option B+?
624 pregnant women [were] enrolled. The proportion of HIV-positive pregnant women receiving CD4 counts increased from 50.6% to 77.2%. The proportion of cART-eligible pregnant women initiated on cART increased from 27.5% to 71.5%. The proportion of eligible HIV-exposed infants with documented 6-week HIV PCR test increased from 41.9% to 55.8%. Conclusions: Integration of HIV care into ANC and community-based support improved uptake of CD4 counts, proportion of cART-eligible women initiated on cART, and infants tested.
Duration of antiretroviral therapy adherence interruption is associated with risk of virologic rebound as determined by real-time adherence monitoring in rural Uganda
This article is the first demonstration of HIV RNA rebound during adherence interruptions objectively measured in real time. We followed 479 participants (median: 25 months per participant). Most were women (72%), median age 36 years. Odds of viral rebound increased by 25% with each day beyond 48 hours. Real-time adherence monitoring was feasible in a sub-Saharan African setting. Further research should assess the potential for real-time adherence interventions to sustain adherence to affordable first-line regimens.
A 15-year study of the impact of community antiretroviral therapy coverage on HIV incidence in Kenyan female sex workers
1,404 FSWs contributed 4335 woman-years of follow-up, with 145 acquiring HIV infection. Increasing general population ART coverage was associated with lower HIV incidence in FSWs. The association with HIV incidence, but not herpes simplex virus type-2 incidence, suggests that the effect of community ART coverage may be specific to HIV. Interventions such as preexposure prophylaxis and antiretroviral-containing microbicides have produced disappointing results in HIV prevention trials with FSWs.
Editorial Review: HIV transmission biology: translation for HIV prevention
Here, we review our current understanding of the biology of HIV transmission based on data from animal models, cell culture, and viral sequence analysis from human infection. We summarize studies of the bottleneck in viral transmission; characteristics of transmitted viruses; establishment of infection; and contribution of cell-free and cell-associated virus. We highlight the implications of HIV-transmission biology for development of prevention interventions, and discuss the limitations of existing preclinical models.
Phase 1 safety, pharmacokinetics, and pharmacodynamics of dapivirine and maraviroc vaginal rings: a double-blind randomized trial
In this first study of a combination microbicide vaginal ring, all 4 rings were safe and well tolerated. Tissue DPV concentrations were 1000 times greater than plasma concentrations and single drug rings had more stable pharmacokinetics. Dapivirine, but not maraviroc, demonstrated concentration-dependent inhibition of HIV-1 infection in cervical tissue. Because MVC concentrations were consistently detectable only in CVF and not in plasma, improved drug release of MVC rings is needed.
Recruiting male partners for couple HIV testing and counselling in Malawi's option B+ programme: an unblinded randomised controlled trial
We aimed to compare two strategies for recruiting male partners for CHTC in Malawi's option B+ prevention of mother-to-child transmission programme: invitation only versus invitation plus tracing....An invitation plus tracing strategy was [found to be] highly effective at increasing uptake of couples HIV testing and counselling (CHTC). Invitation plus tracing with CHTC could have many substantial benefits if brought to scale.
Onward to 2030: sexual and reproductive health and rights in the context of the Sustainable Development Goals
Sexual and reproductive health and reproductive rights issues are currently featured on the SDG agenda, but opportunities exist to expand their presence at both the global and national levels, by establishing sexual and reproductive health and rights (SRHR)–specific indicators to measure progress toward the SDGs....The United States has a major role to play over the next 15 years—through the lending of technical expertise and financial investment—to make SRHR priorities related to the SDGs a reality.
Guttmacher Policy Review
Bringing the Common Rule into the 21st century
On September 8, 2015, the Department of Health and Human Services and 15 other federal departments and agencies issued a proposal to revise the regulations governing the ethical conduct of research involving humans,....regulations [that] have changed little since their inception, while the research landscape has changed radically....The NIH urges all stakeholders to closely review the proposed changes and participate in the comment process by the deadline of December 7, 2015.
Inflammatory cytokine biomarkers to identify women with asymptomatic sexually transmitted infections and bacterial vaginosis who are at high risk of HIV infection
Supplementing syndromic management with an assessment of IL-1β and IP-10 as biomarkers of genital inflammation may improve STI/BV management for women, enabling more effective treatment of asymptomatic infections and potentially reducing their risk of HIV infection.
BMJ
Prevalence, incidence, and associated risk factors of tuberculosis in children with HIV living in the UK and Ireland (CHIPS): a cohort study
Tuberculosis rates in HIV-infected children in the UK and Ireland were higher than those reported in the general pediatric population. Further study is warranted of tuberculosis screening and preventive treatment for children at high-risk of this disease to avoid morbidity and mortality in this population.
Disclosure of pharmacokinetic drug results to understand nonadherence
MTN-003D, an ancillary study using in-depth interviews and focus group discussions, together with retrospective disclosure of plasma tenofovir pharmacokinetic [PK] results, explored adherence challenges during VOICE, a phase IIB trial of oral and vaginal tenofovir for HIV prevention. We interviewed 127 participants from South Africa, Uganda and Zimbabwe. Retrospective provision of PK results seemingly promoted candid discussions around nonadherence and study participation.
Single oral dose of maraviroc does not prevent ex-vivo HIV infection of rectal mucosa in HIV-1 negative human volunteers
Eight HIV-1-negative healthy volunteers received a single oral dose of maraviroc {MVC], and two additional volunteers received tenofovir disoproxil fumarate/emtricitabine for 10 days. A significant loss of MVC during the virus incubation (about 60%) and a low CCR5 occupancy (approximately 45%) were detected in rectal cells. An ex-vivo challenge with a single oral dose of MVC does not prevent ex-vivo infection of human rectal mucosa [and] suggests that 'on demand' MVC preexposure prophylaxis would not prevent rectal HIV-1 transmission.
Self-reported nonadherence to antiretroviral therapy as a predictor of viral failure and mortality
Self-report of two or more missed doses of ART is associated with an increased risk of both viral failure and death. A simple adherence question helps identify patients at risk for negative clinical outcomes and offers opportunities for intervention.
Pregnancy rates in HIV-positive women using contraceptives and efavirenz-based or nevirapine-based antiretroviral therapy in Kenya: a retrospective cohort study
Although HIV-positive women using implants and efavirenz-based ART had a three-times higher risk of contraceptive failure than did those using nevirapine-based ART, these women still had lower contraceptive failure rates than did those receiving all other contraceptive methods except for intrauterine devices and permanent methods. Guidelines for contraceptive and ART combinations should balance the failure rates for each contraceptive method and ART regimen combination against the high effectiveness of implants.
Postpartum maternal and neonatal hospitalizations among women with HIV: a population-based study
In Ontario, Canada [between] 2002/2003 and 2010/2011, the proportion of postpartum maternal hospitalizations was higher among women with HIV; the proportions of neonates hospitalized within 30 and 60 days of discharge were similar among infants born to women with and without HIV....The effect of HIV infection was attenuated by multivariable adjustment, suggesting that sociodemographic or health care factors are responsible for much of the difference in outcomes.
The Weekly NewsDigest is a compilation of HIV prevention research media coverage and relevant science in peer-reviewed journals; material on other reproductive health issues; and matters of policy and politics relevant to HIV prevention research, development and advocacy.
Its purpose is to raise awareness around the range of opinions and information about HIV prevention research disseminated in the press and scientific journals and provide a neutral, objective basis for decision-making and evidence-based advocacy.
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