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Presenter Anton Pozniak. Image from the International AIDS Conference in Vienna, 2010. ©IAS/Steve Forest/Workers' Photos

Lersivirine, an investigational NNRTI, had the same virological potency as efavirenz (Sustiva), in a phase 2b clinical trial.

The study involved 195 people starting HIV treatment for the first time, in Europe, the Americas, Australia and South Africa. Study participants were randomised to take either lersivirine or efavirenz (also in the non-nucleoside reverse transcriptase inhibitor, or NNRTI class of  HIV drugs) in combination with FTC/tenofovir (Truvada).

Lersivirine doses of 500 or 750mg, once daily, were tested.

After a year of treatment, 79% of people treated with lersivirine had an undetectable viral load compared to 89% of people treated with efavirenz. This difference was not statistically significant.

CD4 cell count increases were good, regardless of which NNRTI patients received.

Lersivirine didn’t appear to work as well in people with a high viral load (above 100,000 copies/ml at baseline).

Further analysis showed that most treatment failures in this group occurred in South Africa. Whether or not this was due to poor adherence or other factors is not clear.

Rates of neuropsychiatric side-effects were lower among the patients taking lersivirine, but nausea was more common.

Phase 3 trials examining the safety and effectiveness of lersivirine are now planned.

Map of study sites. Image from presentation by Renee Heffron.

Using hormonal contraception increases the risk of a woman becoming infected with HIV, or passing on HIV, according to the results of an international study.

The study involved 3790 serodiscordant couples (where one partner has HIV and the other does not) in sub-Saharan Africa.

HIV incidence among the women who were HIV negative at the start of the study was almost twice as high in women using hormonal contraception as that observed in women who were not using this method of birth control.

The use of hormonal contraception almost doubled the risk of an HIV-positive woman passing on HIV to a male partner.

Researcher Renee Heffron recommended that women and couples should be counselled about HIV risks and the importance of HIV prevention alongside choosing a contraception method – recommending condom use in conjunction with hormonal contraceptive use.

Médecins Sans Frontières project in Malawi. Image by Laurence Binet/MSF.

A nurse-led service can effectively deliver antiretroviral therapy, studies conducted in Malawi and South Africa show.

The South African study showed that nurses could effectively manage patients on established antiretroviral therapy.

The Malawian study showed that outcomes for patients managed by nurses were at least as good as those of people cared for by doctors.

However, some delegates in Rome emphasised that it was important nurses were not overburdened. The importance of adequate training and support for nurses was also highlighted.

Image from presentation by Susan Zoller-Pasner.

Researchers have been working towards a vaccine for HIV ever since the virus was first identified nearly 30 years ago. It has proved hugely problematic. This is largely because HIV mutates so readily and quickly – that’s why the immune system can’t mount an effective response to it. Neither can a conventional vaccine, and it’s not yet been possible to develop a vaccine that can work against a virus that changes as constantly as HIV does.

However, a symposium held at the Rome conference heard yesterday how researchers are slowly moving towards developing an effective vaccine.

There have only been three large studies looking at an HIV vaccine in humans in the last 15 years. The first two were unsuccessful, and it was a great surprise when, in 2009, a third trial showed some promising results.

The findings of this trial renewed efforts to develop a vaccine, but it’s still not certain how the vaccine studied in it produced the immune response it did. Because of this, there will be no large efficacy trials until researchers are sure they have a promising product to test.

There are currently about 50 trials of 42 different types of vaccines going on around the world, but many of these are in very early stages. The most promising results recently have been in animal studies, but some of these have then been tested in humans and not been successful (for example, the STEP trial).

In a trial testing a vaccine on monkeys, although the animals became infected with SIV (the equivalent of HIV in monkeys), half of them developed an infection with no detectable virus in their bodies. If we could achieve this in people, it would be a ‘vaccine cure’. But there is still much more work to be done on this concept.

Researchers are exploring new types of vaccines, including ones that include small pieces of DNA, which then produce pieces of HIV protein, so that the body makes the vaccine itself. Another vaccine, using a type of antibody called broadly neutralising antibodies, is promising but proving very difficult to develop.

Important progress is being made, but there’s no sign of an effective vaccine being developed in the near future.