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Healthcare providers should discuss U=U with all their HIV-positive patients

Healthcare providers should inform all patients with HIV they cannot transmit HIV to a sexual partner when their viral load is undetectable, argue the authors of  a strongly worded comment in The Lancet HIV. The authors note that despite overwhelming scientific data supporting the undetectable = untransmittable (U=U) message, significant numbers of healthcare providers do not educate their patients about U=U when telling them their viral load is undetectable.

“Providers caring for patients with HIV should universally inform their patients about U=U as part of their routine care,” write Dr Sarah Calabrese of George Washington University and Professor Ken Mayer of the Harvard Medical School and Fenway Institute. “Conveying benefits and risks surrounding any treatment is fundamental to patients’ decision making, and this HIV treatment benefit should be no exception.”

Four rigorous studies involving HIV serodiscordant couples have failed to find a single proven case of sexual transmission of the virus when the HIV-positive partner is taking antiretroviral therapy and has a stable undetectable viral load. The evidence supporting U=U is robust in both male-female and male-male couples. The World Health Organization (WHO) and more than 750 organisations worldwide agree that people with HIV whose viral load is stably suppressed cannot sexually transmit the virus.

However, recent research suggests that a significant proportion of healthcare providers are not educating their patients about U=U. An international survey involving more than 1000 providers found that only 77% of infectious disease specialists and 42% of primary care physicians communicate the U=U message when telling patients their viral load is undetectable. Reasons included disbelief (i.e. not accepting that U=U), a perception that U=U would undermine personal responsibility and concerns about patients’ behaviour and understanding.

“With evidence supporting undetectable = untransmittable (U=U) now overwhelming, providers should be routinely communicating the message to all of their patients living with HIV,” Calabrese and Mayer say.

The authors note that informing patients about U=U has numerous individual and public health benefits:

  • Encourage patients to start and adhere to antiretroviral therapy, and maintain an undetectable viral load.
  • Psychosocial benefits, enabling individuals to have intimate sexual relationships without fear, reducing internalised stigma and alleviating anxiety about the possibility of transmission.
  • Help reduce HIV incidence by encouraging engagement in the HIV treatment cascade.
  • Accelerate reforms in government policy and the law, especially concerning the criminalisation of HIV exposure and non-disclosure.
  • There is still unawareness and misinformation about U=U in the communities most affected by HIV, including gay communities. Increasing knowledge and understanding of U=U might reduce HIV-related stigma in the broader community, encourage testing and lessen anxiety about acquiring HIV.

The authors express concern that people who cannot access HIV therapy because of cost, criminalisation or discrimination will not benefit from U=U, exacerbating existing health inequalities.

“However, for the U=U message to be withheld from any person living with HIV is inexcusable, particularly in settings where treatment is accessible,” they conclude.

Author: Michael Carter

Source: http://www.aidsmap.com/page/3465661/

Western Cape continues to lead in cutting edge HIV, Aids research

A recent study revealed that in-home HIV testing coupled with referral to HIV care and treatment can reduce infection by up to 30%.

 

 

Cape Town – Western Cape based Desmond Tutu TB Centre (DTTC), in partnership with the Western Cape Government and the City of Cape Town Health department, have formed part of a study that reveals in-home HIV testing coupled with referral to HIV care and treatment can reduce infection by up to 30%.

The findings were shared at the recent annual Conference on Retroviruses and Opportunistic Infections (CROI) in the United States.

Forming part of the largest HIV prevention trial to date, the study involved more than a million people living in urban and peri-urban communities in South Africa and Zambia, with DTTC’s Nulda Beyers and Peter Bock from the Department of Pediatrics and Child Health at Stellenbosch University leading the South African research.

This re-affirms Cape Town and the Western Cape as a leading destination for research in the medical sciences, with huge commitments being made by leading institutions investing billions into the province for further facilitation of research into the medical field.

The recent announcement further endorses the relevance of the destination in hosting related events, to spearhead knowledge sharing and policy-making around pertinent diseases with hostile ramifications for the entire continent.

The International AIDS Society has earmarked Cape Town as a preferred destination on the continent to host the 24th International Aids Conference 2022, with the Society calling on the Cape Town and Western Cape Convention Bureau, a division of Wesgro.

The bid is supported by the South African National Convention Bureau and Cape Town International Convention Centre as host venue.

Celebrated as one of the largest medical conferences globally, the event will welcome an estimated 20 000 delegates and will have an estimated economic impact of R512 000 000 during the region’s traditional low season.

Convened during the peak of the AIDS epidemic in 1985, the conference provides a unique forum for the intersection of science, advocacy, and human rights. Each conference is an opportunity to strengthen policies and programmes, to ensure an evidence-based response to the epidemic.

Linda-Gail Bekker, president of the International Aids Society and the Chief Operating Office from the Desmond Tutu HIV Foundation commented: “A much loved and attended conference that energises and resets the focus of the HIV response every two years, the International AIDS conference is a conference that every single person linked professionally in some way to the AIDS field should attend at least once in a life time.

“For many, it is a career changing event. It has also led to important, history changing shifts in the journey towards an AIDS free world.”

Already scheduled to take place in the Mother City in October 2020, returning for a 2nd time, is the HIV Research for Prevention (HIVR4P) meeting. Convened by the International AIDS Society, the meeting is the only global scientific engagement focused exclusively on the challenging and fast-growing field of biomedical HIV prevention research.

The meeting will bring more than 1 500 of the world’s leading prevention researchers, funders and policymakers for five days of exchange, debate and direction setting for the field.

“Bringing conferences of this nature to the destination further assists in positioning the province as the knowledge hub of Africa, leading the way in latest research to address serious illnesses affecting our country and continent. Cape Town is an award winning meetings destination offering world-class facilities coupled with the capability and attractiveness to host an event such as the International Aids Conference 2022,” said Wesgro CEO, Tim Harris.

“Not only do we have leading researchers such as the DTTC in our midst, but are surrounded by leading academic institutions who have much to contribute to the conversation in curating a cure. We are honoured to be called on to bid for a conference of this magnitude, and hope to welcome leading researchers from across the globe.”

Economic Opportunities MEC, Beverly Schäfer, commented: “The Western Cape has gained a reputation as a leading knowledge hub in Africa, allowing us to attract investment and conferences that boost economic growth for the province. These new research findings prove that we are on the cutting edge of research in the medical field, with leading scientists, researchers and educational institutions driving new discoveries and investment into these areas.”

Executive Mayor, Dan Plato, added: “The conference would come at a time when great advances in science are being made in the fight against HIV. We are pleased that Cape Town is seen as a preferred destination to host conferences and events of this size which discuss such important topics. We are also encouraged by the fact that Cape Town is one of the leading spaces for sharing knowledge and formulating policy.”

Mayco Member for Economic Opportunities and Asset Management, James Vos, stated: “If awarded, the conference would be the biggest event to be hosted in the city yet. Attracting top researchers, doctors and members of the medical fraternity, the knowledge sharing and legacy opportunities that will come from a conference of this magnitude are unsurmountable.”

Source: https://www.iol.co.za/capeargus/news/western-cape-continues-to-lead-in-cutting-edge-hiv-aids-research-19952370

The Latest News on Progress in HIV Prevention —​​​​​​​ and Where to Redouble Efforts

New HIV viral load testing technology on the cards

 

Government will soon adopt new effective and efficient point-of-care HIV viral load testing machines that process results within an hour, it has been learnt.

Previously, blood samples had to be taken to central laboratories for analysis.

The new machines – called m-PIMA HIV – ½ VL – were developed by US-based Abbott Laboratories and are able to establish the effectiveness of antiretroviral treatment.

Health and Child Care Minister Dr Obadiah Moyo told The Sunday Mail recently that Government was “keen” on the new device.

“PEPFAR (US President’s Emergency Plan for AIDS Relief) has the machine in our system and they have been researching on it. We all want evidence-based outcomes these days.

“They (Abbott Laboratories) have indicated that they will come and talk to us and we are waiting for them,” he said.

PEPFAR was formed by the US government in 2003 to offer services to countries affected by the AIDS pandemic.

Dr Moyo said new machines will help manage the disease.

In 2014, the Joint United Nations Programme on HIV/AIDS and its partners launched the UNAIDS 90–90–90 targets, whose aim is to diagnose 90 percent of all HIV-positive persons, provide antiretroviral therapy (ART) for 90 percent of those diagnosed, and achieve viral suppression for 90 percent of those treated by 2020.

The global target is to eliminate AIDS by 2030.

Abbott director of medical and scientific affairs Dr Kuku Appiah said the new point-of-care device will go a long way in containing HIV.

“What our device does is that it is a miniaturised lab which can be placed inside the clinic. It works using a battery and can be transported to the most remote areas.

“Everything that it needs is compacted together, so what this means is that a patient can have the test and get their results in just over an hour and know immediately whether to change their treatment or continue,” she said.

Dr Appiah emphasised the importance of assessing the viral load of HIV positive patients as this was key in managing the pandemic.

“The aim of ARV’s is to stop the replication of the virus. So we measure how effective ARV treatment is by measuring the viral load, which is the measure of the number of copies of the virus in the blood. So when a person is on ARV treatment, the ultimate aim is that the viral load should be undetectable, meaning that the treatment is suppressing the replication of the virus,” she said.

The device is expected to be approved by the World Health Organisation (WHO) soon.

 

Author: Sharon Munjenjema

Source: http://ow.ly/EBb730o6ZNw

LGBT+ health adviser urges Britain to make HIV-prevention drug free

LONDON, March 17 (Thomson Reuters Foundation) – Britain’s first national adviser for LGBT+ health has said the roll-out of a highly effective HIV prevention pill could save hundreds of thousands of pounds for the country’s publicly funded health authority.

In an exclusive interview Michael Brady, who will take up the role on April 1, said a planned roll-out of pre-exposure prophylaxis (PrEP) – a once-daily pill that protects against HIV – in England would prove cost effective “very quickly”.

“For me, the argument has always been one of cost effectiveness not cost,” he told the Thomson Reuters Foundation.

“There is no doubt about the cost effectiveness of PrEP… you actually put money back into the NHS pot very quickly by not having to spend £300,000 on lifetime treatment costs for (a patient living with) HIV.”

At present, NHS (National Health Service) England is in the middle of a three-year trial ending in 2020.

A spokesman for the body said the trial would be expanded to 26,000 people “to help provide a sound basis on which to build a national PrEP programme”.

Brady, currently medical director of the Terrence Higgins Trust (THT), one of Britain’s leading HIV/AIDS charities, said he had three main priorities for the position, which will be an initial 12-month contract.

 

“Broadly, (they are) to improve the health and wellbeing of the LGBT community, improve the experience in the NHS and to reduce inequality,” he said.

Issues surrounding mental health and access to fertility services for the gay and trans community would also be high on his agenda, Brady added.

He also said he was conscious of not allowing the wider issue of trans rights to overshadow his central health remit.

“I have thought about this (as) it is very toxic with all the stuff around gender reassignment,” he said.

“I’m confident it won’t overshadow my work as there is a bit of true blue sky between the two issues.

“I have a very health-focused remit, and some of the more challenging and difficult discussions around the trans issue are separate from the health issue.”

 

Britain is in the midst of an increasingly toxic debate over trans rights, with questions raised as to whether they are compatible with those of other women particularly in terms of access to single-sex spaces.

Based at NHS England, Brady will oversee two full-time staff members and will retain roles within the NHS and THT. (Reporting by Hugo Greenhalgh @hugo_greenhalgh; Editing by Claire Cozens. Please credit the Thomson Reuters Foundation, the charitable arm of Thomson Reuters that covers humanitarian news, women’s and LGBT+ rights, human trafficking, property rights, and climate change. Visit news.trust.org).

Author: Hugo Greenhalgh

Source: https://uk.reuters.com/article/britain-lgbt-health/lgbt-health-adviser-urges-britain-to-make-hiv-prevention-drug-free-idUKL8N2125QS

What is the real link between bacterial vaginosis and HIV risk in women?

IMAGE
IMAGE: AIDS RESEARCH AND HUMAN RETROVIRUSES PRESENTS PAPERS, REVIEWS, AND CASE STUDIES DOCUMENTING THE LATEST DEVELOPMENTS AND RESEARCH ADVANCES IN THE MOLECULAR BIOLOGY OF HIV AND SIV AND INNOVATIVE APPROACHES TO… view more 

CREDIT: MARY ANN LIEBERT, INC., PUBLISHERS

 

New Rochelle, NY, March 15, 2019–An international team of researchers presents a comprehensive and renewed focus on the common, yet poorly understood condition of bacterial vaginosis (BV) and how the microbial make-up of the vagina can affect a woman’s risk of acquiring HIV and AIDS. A Perspectives article, with the goal of standardizing how BV clinical and research findings are discussed, is published in AIDS Research and Human Retroviruses, a peer-reviewed journal from Mary Ann Liebert, Inc., publishers. The article is part of a Special Issue of the Journal, Mucosal Immunology and the Microbiome. Click hereto read the full-text article free on the AIDS Research and Human Retroviruses website through April 14, 2019.

In the Special Issue of the journal entitled Mucosal Immunology and the Microbiome, Lyle McKinnon, University of Manitoba (Winnipeg, Canada) and Centre for the AIDS Programme of Research in South Africa (CAPRISA, Durban, South Africa), Gilda Tachedjian, Burnet Institute (Melbourne, Australia), Monash University (Clayton, Australia), The University of Melbourne, and RMIT University (Melbourne), and a large team of researchers from around the world coauthored the article “The Evolving Facets of Bacterial Vaginosis: Implications for HIV Transmission.”

BV is a common disorder affecting 29% of women in the United States and 52% of women in sub-Saharan Africa, where HIV is also a highly prevalent sexually transmitted infection (STI). This article draws attention to the varied language and definitions used to describe BV and the related genital inflammation and risk of HIV and other STIs. It also discusses the implications of asymptomatic BV and HIV risk. The researchers make specific recommendations related to conventional and newer molecular testing methods to diagnose BV and to characterize the vaginal microbiome.

“This timely Perspectives article makes an important contribution to HIV research as it explores the active debate surrounding the vaginal microbiome, and bacterial vaginosis in particular, and increased risk of HIV acquisition in women,” says Thomas Hope, PhD, Editor-in-Chief of AIDS Research and Human Retroviruses and Professor of Cell and Molecular Biology at Northwestern University, Feinberg School of Medicine, Chicago, IL. “We are proud to feature this article, which helps bring clarity to an evolving field, in our first Special Issue on Mucosal Immunology and the Microbiome.”

Research reported in this publication was supported by the National Institutes of Health under Award Numbers K23AI103044, R21AI122001, UL1TR000454, and UL1TR002378. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Author: MARY ANN LIEBERT

Source: https://www.eurekalert.org/pub_releases/2019-03/mali-wit031519.php

Preventing Non-AIDS-Related Comorbidities in Adults Aging With HIV

To avoid sizeable proportions of non-AIDS-related comorbidities, the focus on maintaining HIV viral suppression after ART initiation must be balanced with screening for traditional risk factors.

Interventions to reduce traditional risk factors such as smoking, elevated total cholesterol, hypertension, and chronic hepatitis C infection can improve the proportion of non-AIDS-defining cancer, myocardial infarction, and end-stage liver and renal diseases in adults aging with HIV, according to a study recently published in the Lancet HIV.

Researchers used data from the North American AIDS Cohort Collaboration on Research and Design to analyze traditional and HIV-related risk factors for 4 validated noncommunicable disease outcomes: non-AIDS-defining cancer, myocardial infarction, end-stage liver disease, and end-stage renal disease. Participants receiving care in academic and community-based outpatient HIV clinics in the United States and Canada from January 1, 2000, to December 31, 2014, were included in the study.

Traditional risk factors were cigarette smoking, elevated total cholesterol, hypertension, type 2 diabetes, stage 4 chronic kidney disease, and hepatitis C and hepatitis B virus infections. HIV-related risk factors included low CD4 cell count (<200 cells/µL), detectable plasma HIV RNA (>400 copies/mL), and history of a clinical AIDS diagnosis.

A population attributable fraction approach was used to quantify the proportion of noncommunicable diseases that could be eliminated if particular risk factors were not present. The population attributable fraction approach accounts for the risk for the outcome associated with a risk factor and also the prevalence of the risk factor in people with the respective outcome. For example, therefore, high population attributable fraction can result from a risk factor with a weak or moderately strong association with the outcome but with a high prevalence; a low fraction can be the result of strong risk factor for an outcome with low prevalence.

Of 61,500 participants, 1405 had non-AIDS-defining cancer, 347 of 29,515 had myocardial infarction, 387 of 35,044 had end-stage liver disease, and 255 of 35,620 had end-stage renal disease. Approximately 17% of participants were older than age 50 years at study entry, approximately 80% were men, and nearly 50% were non-white.

The population attributable fraction for smoking was considerable for non-AIDS-defining cancer (24%; 95% CI, 13-35) and myocardial infarction (37%; 95% CI, 7-66). For the non-AIDS-defining cancer outcome, the population attributable fraction for smoking was greater than that for HIV-related risk factors, even after excluding lung cancer cases.

For myocardial infarction, and again larger than those for HIV-related risk factors, population attributable fractions were higher for elevated total cholesterol (44%; 95% CI, 30-58) and hypertension (42%; 95% CI, 28-56).

For end-stage liver disease, hepatitis C infection had the highest population attributable fraction (33%; 95% CI, 17-48) followed by low CD4 cell count (19%; 95% CI, 12-26) and hepatitis B infection (16%; 95% CI, 11-21).

 

Hypertension had the highest population attributable fraction for end-stage renal disease (39%; 95% CI, 26-51), followed by elevated total cholesterol (22%; 95% CI, 13-31), detectable HIV RNA (19%; 95% CI, 6-31), low CD4 cell count (13%; 95% CI, 4-21), and diabetes (6%; 95% CI, 1-10).

Findings showed that traditional risk factors accounted for a larger share of non-AIDS-defining cancer, myocardial infarction, and end-stage liver and renal diseases incident outcomes than did HIV-related risk factors.

“Modifications to individual-level interventions and models of HIV care, and the implementation of structural and policy-level interventions that focus on prevention and modification of traditional risk factors are necessary to avoid noncommunicable diseases and preserve health among successfully antiretroviral-treated adults aging with HIV,” concluded the investigators.

Author: Sweta Gupta

Source:

Preventing Non-AIDS-Related Comorbidities in Adults Aging With HIV

Canada’s youth need inclusive sexual health curriculum

Once-a-Month HIV Treatment On Its Way to U.S.

Once-a-Month HIV Treatment On Its Way to U.S.

GlaxoSmithKline’s ViiV Healthcare has continued to lead the way when it comes to simplifying drug treatment regimens for those living with HIV, and now they are closer than ever to releasing a once-a-month injectable treatment in the United States, as reported by FiercePharma this week.

Numerous studies have shown that simplifying poz people’s treatment regimens leads to better adherence, and better adherence leads to achieving a suppressed viral load — or “undectable,” which also means it’s virtually impossible for one to transmit the virus to someone else.

This is why the scientific community has continued to focus on making treatment regimens with fewer drugs (which also reduces toxicity).

GlaxoSmithKline has already shown that their two-drug HIV regimen is as effective as its three-drug competitors. Juluca (containing dolutegravir 50mg/rilpivirine 25m) received approval for the treatment of HIV in November of 2017 in the U.S. and in May 2018 in Europe, and is now the most widely prescribed integrase inhibitor worldwide.

But now, the latest data released from ViiV shows that another two-drug combo could also be just as effective with administration only once per month.

Last week, ViiV revealed results from two studies, pairing its own cabotegravir with Johnson & Johnson’s rilpivirine (branded as Edurant). When given once every four weeks, the drugs can maintain viral suppression in HIV-positive adults as well as a standard three-drug regimen taken daily. The data will be part of the approval application ViiV submits to regulatory authorities later this year.

“If approved, this two-drug regimen would give people living with HIV one month between each dose of antiretroviral therapy, changing HIV treatment from 365 dosing days per year to just 12,” John Pottage, Jr., M.D., ViiV’s chief scientific and medical officer, said in a statement.

The studies, named Atlas and Flair, revealed similar efficacy, safety, and tolerability between the two regimens. Pottage also noted that “nearly all participants who switched to the long-acting injectable regimen preferred it over their prior oral therapy.”

Currently ViiV’s biggest competitor is Gilead, with its three-drug cocktail Biktarvy, which made about $1.18 billion in 2018 after its February approval.

If all goes well, this monthly injectable could be available in the U.S. by early 2020.

Author: Desirée Guerrero

Source: https://www.hivplusmag.com/treatment/2019/3/13/once-month-hiv-treatment-its-way-us?fbclid=IwAR2AKCArtu30n1-cWEADVq6_pt_4qhzEX2xhUb9IFC79M8vtC_5B2Cgfe-4

Rural cocktail of isolation and stigma can take heavy mental toll: advocate


Cameron Penny relays his experience of isolation and stigmatization to high school students as part of his advocacy. He also had a recent chance to meet with federal health minister Ginette Pettipas. - Eric Wynne
Cameron Penny relays his experience of isolation and stigmatization to high school students as part of his advocacy. He also had a recent chance to meet with federal health minister Ginette Pettipas. – Eric Wynne – Eric Wynne

 

The room cleared out, leaving one high school student with something to say.

Dalhousie University student Cameron Penny had just hosted another talk at a high school sharing his story of growing up in the closet in rural Cape Breton, reaching the tipping point in university when he flirted with suicidal thoughts, then finding hope and recovery.

“He said, ‘I just wanted to say thank you so much about how being gay affected your mental health, it made me feel some day it will work out and fit perfectly for me,’” Penny said.

“That was just the most powerful and validating moment I probably ever experienced as a tiny human being on this earth, just because I was able, hopefully in some way, negate some of the negative factors that cause that person to struggle, to give that person a role model I never had.”

Penny grew up in a community just outside of Sydney where he always knew he’d be a doctor. No other career choice entered his mind.

He also grew up in a community where he said he was treated as other, ostracized, and disconnected from gay role models and mental health resources.

“I became so anxious of what people would think of me if they knew I was gay, and I was living in a more rural setting where mental health was stigmatized and I possessed a stigmatized identity. My struggle existed at this crossroads where I was bound by either side by feeling I couldn’t speak out about it because in order to receive help with my mental health struggle, I would have to confide my identity which is something I wasn’t ready to do.”

Penny’s anxiety reached a whole new level when he started university. He said the pot boiled over.

“I started thinking about ending my life and how I would do that and that point I realized something was definitely not OK.”

Not enough young people are being invited to the table when policy is being created, said Cameron Penny.- Eric Wynne
Not enough young people are being invited to the table when policy is being created, said Cameron Penny.- Eric Wynne

 

But he also found a new support network and once he opened up to a friend, he was able to get the help he needed. Now he’s in his fourth year of sciences at Dal and has recently applied for medical school.

“This is not a unique story by any means … It’s something that happens to many young people,” Penny said.

“These narratives are not unique and if they are not addressed, young people will continue to die by suicide.”

Three years ago Penny joined jack.org, a national charity launched by parents who lost a university-aged son to suicide. Since then, Penny has learned to become a leader, a speaking at high schools and working as a mental health advocate.

Recently he met with federal health minister Ginette Petitpas Taylor at a jack.org summit in Toronto. Young people from across the country brought specific issues young people in their regions are facing. Penny said he spoke to Petitpas Taylor about long wait times to access mental health resources and how the doctor shortage makes it even worse.

When asked if governments and other institutions listen to young people, Penny said sometimes in some locations, but not much in Nova Scotia. Not enough young people are being invited to the table for policy creation, he said.

“We need to include them now before the position we’re in now continues to worsen.”

Statistics Canada reports there were 134 suicides in Nova Scotia in 2016, compared to 2000 when there were 75 deaths.

Statistics Canada also reported suicide is the second leading cause of death among young Canadians, accounting for almost one quarter of all deaths at ages 15 to 24.

Penny said the biggest priority is installing resources that fit the needs for young people. In some cases young people are waiting for nearly a year to access resources for mental health, he said.

“My big wish is that we work out some of these kinks and we get young people the mental health support they need in a timely manner.”

 

Source: https://www.thechronicleherald.ca/living/rural-cocktail-of-isolation-and-stigma-can-take-heavy-mental-toll-advocate-291247/