21 October 2016 VOLUME 17 ISSUE 42
Why hospital infections are a bigger threat than HIV, influenza and tuberculosis
Six healthcare-associated infections are a bigger burden on hospitals than influenza, HIV/AIDS and tuberculosis together....The big six are pneumonia, urinary tract and surgical site infections, Clostridium difficile..., neonatal sepsis, and primary bloodstream infections. That's the conclusion of a study on Tuesday in PLOS Medicine.
HIV: hepatitis coinfection may increase lymphoma risk
Coinfection with chronic hepatitis B virus or hepatitis C virus is associated with a significantly increased risk for non-Hodgkin's lymphoma among patients with HIV who are receiving antiretroviral therapy, according to a study published online October 18 in the Annals of Internal Medicine.
Vaginal and rectal bacteria may have a big influence on HIV transmission and microbicide efficacy
A number of presentations at the 2016 HIV Research for Prevention Conference (HIVR4P) in Chicago looked at the influence of vaginal bacteria on HIV susceptibility....One presentation found that vaginal bacteria may have profound effects on levels of certain drugs used as microbicides, but not on others, [and] a poster found a correlation between condomless anal sex and changes in the predominant bacterial species that may similarly increase susceptibility to HIV infection.
PrEP attitudes 'paradoxical' among docs in training
In a survey-based study, medical students were more likely to say they'd be willing to prescribe PrEP if a hypothetical patient was consistently using condoms and planned to continue, according to Susan Calabrese, Yale University School of Public Health. But that's "paradoxical," since patients who don't use condoms and don't plan to start, and those who currently use them and plan to stop, are precisely those at greatest need for PrEP.
MedPage Today
Pre-teens need only two HPV shots, not three, CDC recommends
Two doses of a vaccine that protects against cervical and several other types of cancer are enough for 11-to 12-year-olds, rather than the previous three-shot regimen...."Safe, effective, and long-lasting protection against HPV cancers with two visits instead of three means more Americans will be protected from cancer, [and]...make it simpler for parents to get their children protected in time," CDC Director Tom Frieden said.
Second case emerges of someone on daily prep getting HIV
The results were presented by Cleveland Clinic HIV specialist Howard Grossman, who unveiled the finding at the 2016 HIV Research for Prevention conference in Chicago Tuesday....Grossman found that the patient's strain of HIV was resistant to both of the drugs in Truvada, as well as all of the other drugs in its class.
Anal sex may transmit four in ten HIV infections in US women at high risk
A study presented at the 2016 HIV Research for Prevention (HIVR4P) Conference suggests that, in women at high risk of HIV infection, 40% or more of the HIV infections in this group might be transmitted via anal intercourse....Nearly 10,000 'high risk' HIV-negative, non-drug-injecting women aged 18-60 who had been in the 2010/2013 National HIV Behavioural Surveillance Survey were...surveyed.
Rare case shows PrEP not perfect
Pre-exposure prophylaxis...is highly effective...but not perfect, as illustrated by a rare case of infection with a multidrug-resistant HIV strain, Howard Grossman of the Cleveland Clinic...told reporters at the HIV Research for Prevention conference....The case is the second reported this year of HIV infection despite adherence to daily PrEP, but Grossman said the reports have to be put in the context of more than 100,000 people in North America taking PrEP. "Those are pretty good odds," he told MedPage Today.
HIV resistance rare with preventive ring
Analysis of a major HIV prevention trial among women suggests that developing drug resistance while using a vaginal ring that delivers antiretroviral medication is not an issue. On the other hand, a less clinical factor -- domestic violence -- affects how women use the ring and therefore how well they are protected from HIV, researchers told reporters at the HIV Research for Prevention conference.
Policy makers' inaction is leading people to take PrEP 'in the wild'
An increasing number of gay men and others at risk of HIV are seeking to protect their health with PrEP, 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 HIVR4P 2016 conference.
PrEP success breeds complexity in HIV prevention trials
HIV researchers and advocates have worked toward a gold-standard method of HIV prevention that is more effective than condoms, a robust HIV-prevention pipeline that features a variety of investigational medications and novel delivery methods, and advances no one could have predicted. "We worked for decades to get to this place," Jim Pickett, AIDS Foundation of Chicago, told Medscape....But "this place" is complicated...[and] means the design of next-generation HIV-prevention trials has to change.
2 people got HIV despite PrEP -- and millions get HIV without it
This year, two cases have been reported of people getting HIV while adherent to PrEP. The most recent was revealed this week at the HIV Research for Prevention conference in Chicago. In this same year, about 50,000 people in the US (plus many, many more worldwide) will have acquired HIV while not taking PrEP. Why do we focus so much on these rare cases of transmission among people who are adherent to PrEP?
7 insurers alleged to have discriminated against HIV patients
The Affordable Care Act prohibits insurers from discriminating against people with serious illnesses, but some marketplace plans sidestep that taboo....Complaints filed with the Department of Health and Human Services' Office for Civil Rights by Harvard Law School's Center for Health Law and Policy Innovation charge that plans offered by seven insurers in eight states are discriminatory because they don't cover drugs essential to the treatment of HIV or require high out-of-pocket spending for covered drugs.
Antiretroviral clubs support patients with HIV
New models for the delivery of ART to patients with HIV in Sub-Saharan Africa are reducing the burden of care for both patients and healthcare workers. One model presented at the Controlling the HIV Epidemic With Antiretrovirals Summit 2016 in Geneva changed the delivery of treatment by creating clubs that were not only treatment distribution points, but also community support centers. The idea caught on quickly.
Beyond Tuskegee: a case for a racial justice agenda in treatment and research
The Tuskegee Syphilis study remains a primary citation in both the scientific literature and popular conversations to explain the reluctance of African Americans to engage with the US healthcare system.....Unfortunately, this places the onus of health disparities onto African Americans, and not on the systems responsible for both the legacy of mistrust of health care and biomedical research and the continued inequalities in access to care.
CDC calls on doctors to pitch HPV shots as cancer prevention, not STD protection
Shot-makers and health organizations have been laboring to boost lagging HPV vaccination rates, and now the CDC is weighing in again: Doctors should talk up the vaccines' ability to prevent deadly cancers, rather than dwelling on STD prevention, as a way to persuade skeptical parents to protect their kids.
Global burden of disease report shows gains made from HIV response, work that remains to respond to infectious disease
Global life expectancy has increased by 10.2 years since 1980, with the most marked increases occurring...in Sub-Saharan Africa, where expansion of antiretroviral therapy and prevention of mother-to-child transmission of HIV have expanded life expectancy by more than 10 years in countries with the highest HIV burdens,... according to the Global Burden of Disease report published in The Lancet.
Science Speaks
PrEP and sex workers: a chance to do better
Finally, we have a highly effective HIV prevention method that isn't a condom!...Given its effectiveness, one might expect PrEP to be widely used among sex workers. But it isn't. Why?...Very few health-care providers create an environment in which sex workers feel comfortable discussing their occupational, as well as personal, health, and safety needs....The solution...is staring us right in the face. It's just a matter of being willing to respect those classified as not respectable.
Rewire News
Percentage of Hispanics receiving prompt HIV care below national target
The percentage of Hispanics with HIV in the United States and its territories receiving medical care within the first 90 days of their diagnosis is below the goal established by the National HIV/AIDS Strategy to link 85% of the population to care. Although Hispanics represent only 16% of the U.S. population, they accounted for 23% of HIV diagnoses in 2014, according to the CDC. In addition, they are less likely to receive care and achieve viral suppression compared with whites.
Crohn's disease drug produces long-lasting viral undetectability and T-cell restoration off treatment in monkeys
Scientists from Emory University have used a monkey-adapted version of vedolizumab (Entyvio), used to treat gut inflammation, to produce persistent viral load control and T-cell restoration in monkeys taken off ART....The researchers are uncertain why the drug works, but saw increases in a kind of Natural Killer cell that appears enabled by the drug to deal with HIV infection better, and an immune response to HIV envelope protein that resembles one of the responses seen in the RV144 HIV vaccine trial.
NIH recognizes LGBTQ community as 'Health Disparity Population'
In an effort to begin the process of rectifying health-related issues that disproportionately affect the LGBTQ community, the National Institutes of Health (NIH) announced on Thursday they will formally designate "sexual and gender minorities (SGMs) as a health disparity population for NIH research."
Unique South African children may chart new path for HIV vaccines
An extremely rare subset of HIV-positive children can live with the virus well enough to stay healthy for years. Now, the world's largest study into how these children fend off sickness may have unlocked important clues that may influence the world's quest for a vaccine.
Bhekisisa
Experiment in monkeys raises hopes of "functional cure" for HIV
A new drug combination helped stave off a monkey version of HIV for nearly two years after stopping all treatments....The treatment involved standard HIV drugs...plus an experimental antibody that hits the same target as Takeda Pharmaceutical's Entyvio, approved in [over] 50 countries for ulcerative colitis and Crohn's disease. The findings are promising enough that the NIH, which funded the research, have begun testing the Takeda drug, known generically as vedolizumab, in people newly infected with HIV.
A drug used to treat Crohn's disease could suppress HIV, monkey study suggests STAT, 13 October 2016
The drug, vedolizumab, appears to have reduced simian immunodeficiency virus, or SIV, to virtually undetectable levels in infected macaques and kept them there for two years, even after they were taken off antiretroviral therapy, said senior author Aftab Ansari. "These monkeys are basically controlling the virus themselves," said Ansari, a pathologist at Emory University.
STDs hit historic high: CDC
The combined total of reported chlamydia, gonorrhea, and syphilis cases was more than 1.8 million in 2015, the CDC said in its annual Sexually Transmitted Disease Surveillance Report,...probably an underestimate since most STD cases are undiagnosed and untreated. But the treated cases have reached an all-time -- and expensive -- high: nearly $16 billion annually. The reported incidence...rose from 2014 by 5.9% for chlamydia, 12.8% for gonorrhea, and a whopping 19% for syphilis.
Increased antiretroviral therapy use and virologic suppression in the Bronx in the context of multiple HIV prevention strategies
Among 7,196 patients, we identified consistent increases [between 2007 and 2014]...in the percent prescribed ART and with virologic suppression. Sustained virologic suppression improved markedly beginning in 2011, coinciding with local test-and-treat initiatives and adoption of expanded treatment guidelines. While disparities among population groups were most pronounced for sustained virologic suppression, those aged 13–24 fared relatively poorly for all outcomes examined.
AIDS Research and Human Retroviruses
Intracellular tenofovir and emtricitabine anabolites in genital, rectal, and blood compartments from first dose to steady state
Together, [our] findings demonstrate cell-type and tissue-dependent cellular pharmacology, preferential accumulation of TFV-DP in rectal mononuclear cells, and rapid distribution into rectal and genital compartments.
Expression of human immunodeficiency virus Type 1 neutralizing antibody fragments using human vaginal Lactobacillus
We tested the feasibility of expressing single-chain and single-domain antibodies (dAbs) in Lactobacillus to be used as a topical microbicide/live biotherapeutic....Our results indicate that stable expression of anti-HIV-1 antibody fragments is possible using a common Lactobacillus in the vaginal microbiota as a [topical microbicide)/recombinant live biotherapeutic.
Achieving the 90–90–90 target: incentives for HIV testing
We recommend consideration of HIV testing that is incentivized through associated cash transfer, or a culturally and socially appropriate non-financial incentive. The relatively small cost associated with providing financial incentives to people to be tested would probably be vastly eclipsed by the averted costs associated with the prevention of ongoing transmission. Enhanced diagnosis is the first step to ensuring that the U.N. 90-90-90 target will be realized.
Primary care clinicians' experiences prescribing HIV pre-exposure prophylaxis at a specialized community health centre in Boston: lessons from early adopters
In a primary care clinic with specialized expertise in HIV prevention, clinicians perceived that PrEP provision to large numbers of patients was safe, feasible and potentially effective. Efforts to engage generalist primary care clinicians in PrEP provision could facilitate scale-up of this efficacious intervention.
JIAS
Global implementation of PrEP as part of combination HIV prevention – Unsolved challenges
SEE: Special JIAS issue on Global implementation of PrEP as part of combination HIV prevention – Unsolved challenges.
High HIV incidence in men who have sex with men following an early syphilis diagnosis: is there room for pre-exposure prophylaxis as a prevention strategy?
A diagnosis of early syphilis carries a high risk of consequent HIV seroconversion and should warrant prioritised access to prevention measures such as PrEP and regular STI screening to prevent HIV transmission.
Editorial--No one left behind: how are we doing in the roll-out of PrEP as part of combination HIV prevention?
NEMUS, in collaboration with UNAIDS, has followed its first supplement on PrEP.... with this new collection of papers focused on PrEP roll-out, identifying barriers and solutions, again with a focus on regions and populations not considered before. In this editorial, we highlight the main messages of the papers included in this new series. Together with other tools that will be published soon, this publication will help to document progress and guide implementers through a rapidly changing field.
Safety, efficacy, and pharmacokinetics of a single-tablet regimen containing elvitegravir, cobicistat, emtricitabine, and tenofovir alafenamide in treatment-naive, HIV-infected adolescents: a single-arm, open-label trial
The elvitegravir, cobicistat, emtricitabine, and tenofovir alafenamide regimen was well tolerated and achieved component plasma pharmacokinetic exposures similar to those in adults. Although non-comparative with a small sample size, these data support the use of this regimen in HIV-infected adolescents and its timely assessment in younger children.
US and Cuban biomedical researchers are free to collaborate
Regulations unveiled today and set to take effect on 17 October are sure to please...researchers in biomedicine and public health...One open question is whether...many of Cuba's top scientists, who have forged collaborations with colleagues in Europe and elsewhere, will embrace working with a country that sought to isolate them for so long.
Shock and kill with caution
The idea of clearing latent infection has prompted strategies aimed at an HIV-1 cure. Although this approach should continue to be tested, other approaches, including those that seek to permanently suppress the latent virus, should also be explored. Different strategies may target different viral reservoirs, and may turn out to be complementary.
Sustained virologic control in SIV+ macaques after antiretroviral and α4β7 antibody therapy
For many infected individuals, ART means that an HIV-1 diagnosis is no longer a death sentence. But the virus persists in treated individuals, and complying with the intense drug regime...can be challenging. Seeking an alternative, Byrareddy et al. treated ART-suppressed monkeys with antibodies targeting α4β7 integrin. When ART was halted in the antibody-treated animals, viral loads stayed undetectable, and normal CD4 T cell counts were maintained for over 9 months—and persisted—even after stopping the antibody therapy.
Antibody treatment surprisingly 'cures' monkeys of HIV-like infection
"Fascinating." "A complete first." "Striking." "Too amazing to be real." Those are some of the reactions researchers are having to a provocative, baffling monkey study suggesting that a monoclonal antibody used to treat inflammatory bowel disease in humans might lead to a "functional" cure of an infection with the AIDS virus....[I]mmunologist Rafick-Pierre Sékaly predicts the apparent success will trigger a bevy of new studies. Indeed, NIAID began studies of it in HIV-infected people 3 weeks ago.
How are scientists using social media in the workplace?
This study investigates how a surveyed sample of 587 scientists from a variety of academic disciplines, predominantly the academic life sciences, use social media to communicate. Our results demonstrate that while social media usage has yet to be widely adopted, scientists in a variety of disciplines use these platforms to exchange scientific knowledge....Our data provides a baseline from which to assess future trends in social media use within the science academy.
Developing a framework for evaluating ethical outcome of good participatory practices in TB clinical drug trials
Good Participatory Practice Guidelines for TB Drug Trials (GPP-TB) were issued in 2012....Working with a diverse group of global TB stakeholders..., we develop(ed) an evaluation framework for GPP-TB that includes a clearly defined ethical goal, powerful strategies...for achieving the goal, and outcomes connecting strategies to goal,...as a first step in systematically evaluating participatory research in clinical trials.
J Empirical Research on Human Research Ethics