News from IAS 2019

News from the International AIDS Society Conference on HIV Science

NAM was delighted to be selected as official provider of online science news for the recent International AIDS Society Conference on HIV Science (IAS 2019) in Mexico City. Catch up on the news headlines below, or visit our conference webpages for all our reporting.

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High and increasing HIV incidence in young Latin American gay men

In Latin America, 40% of new HIV infections are in men who have sex with men (MSM) and the recent International AIDS Society Conference on HIV Science (IAS 2019) in Mexico City was the appropriate venue for the first data from the largest ever survey of the region’s MSM to be released.

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Cash payments to stay in school reduce HIV incidence in girls and young women, eSwatini study finds

Financial incentives to remain in school reduced HIV incidence among adolescent girls and young women in eSwatini (Swaziland) by 21%, and participants exposed to both financial incentives and a lottery open only to those who remained free of sexually transmitted infections were 37% less likely to acquire HIV infection, a trial has found.

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Punitive laws associated with HIV infections in female sex workers

The presence of laws criminalising sex work is associated with a sevenfold increase in the odds of HIV infection among female sex workers in sub-Saharan Africa, according to research presented to IAS 2019. In settings where sex work was criminalised, female sex workers were also more likely to experience violence and stigma in social and healthcare settings. The research was conducted in ten countries with different approaches to the criminalisation of sex work, and the investigators conclude that criminalisation and stigma are helping drive the HIV epidemic among sex workers.

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Leakages in ART treatment cascades in West Africa and Zambia

Two studies presented at IAS 2019 showed significant leakages in the antiretroviral therapy (ART) treatment cascade. A study of eleven West and Central African countries showed low numbers of viral load tests conducted as well as stock-outs of HIV tests, ART and viral load testing supplies. Another study looked at the cascade of virologically unsuppressed people living with HIV in Zambia and found gaps and substantial delays with provision of follow-up viral load testing.

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Dramatic decline in proportion of people with extensive resistance to anti-HIV medications

The proportion of people in the United States with extensive resistance to antiretroviral therapy (ART) and limited treatment options declined markedly after 2012, in large part thanks to the availability of potent new drugs, according to research presented to IAS 2019. Since 2012, only 1% of people who have taken ART have had extensive resistance.

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Young adults with vertical HIV and hepatitis C co-infection have a high hepatitis C cure rate

Young adults with vertically transmitted HIV and hepatitis C virus (HCV) co-infection can easily be cured with direct-acting antivirals (DAAs), but some already have advanced liver damage by the time they are treated, researchers reported at IAS 2019.

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13% of HIV-positive Europeans who are cured of hepatitis C are reinfected

More than one in ten HIV-positive people in the large EuroSIDA cohort who were cured of hepatitis C were reinfected within two years, according to a report at IAS 2019.

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Could a better understanding of inflammation help research towards an HIV cure?

Michaela Müller-Trutwin of the Institut Pasteur in Paris gave an overview of research on immune activation and HIV-induced inflammation at IAS 2019. She highlighted the links between chronic inflammation and the establishment of the HIV reservoir. She also shared insights from non-human primates which escape inflammation despite high viraemia, suggesting a crucial role for natural killer cells.

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Same-day initiation of PrEP feasible and safe in Latin America

Over 5000 men who have sex with men and transgender women have been enrolled in the ImPrEP demonstration project in Brazil, Mexico and Peru, with early results showing good levels of adherence and continuation, IAS 2019 heard. This was one of several studies reporting on efforts to scale-up pre-exposure prophylaxis (PrEP) in Latin America presented at the conference.

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Without frequent viral load monitoring dolutegravir-based regimens not the best choice for African youth on failing ART

A high proportion of adolescents and young adults living with HIV in Zimbabwe on failing first-line non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimens had clinically significant resistance mutations which could compromise the efficacy of a new regimen of tenofovir, lamivudine and dolutegravir, IAS 2019 heard.

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HIV outcomes for transgender women improved by addressing social and structural issues

An integrated healthcare model providing screening, referral and service provision for transgender women of colour boosted rates of engagement with the HIV care continuum over 24 months, according to research presented to IAS 2019.

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'Mystery shoppers' in Kenyan pharmacies highlight issues with distribution of HIV self-tests

Private sector providers may need more support and training to effectively distribute HIV self-testing kits to adolescents and young adults, according to research conducted in Kenya and presented to IAS 2019.

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Fostemsavir salvage therapy continues to look good at 96 weeks

The novel HIV attachment inhibitor fostemsavir continues to maintain viral suppression in more than half of people with extensive prior treatment experience and highly resistant virus, according to a report at IAS 2019. Study participants, many of whom had advanced immune suppression at baseline, experienced substantial gains in CD4 cells.

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Dolutegravir dual therapy works well for both first line and maintenance treatment

A two-drug combination of dolutegravir and lamivudine – the drugs in the Dovato co-formulation – continued to suppress viral load as well as a standard three-drug regimen in people starting their initial HIV treatment. The combination also maintained viral suppression in those who switched from a standard regimen.

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Dapivirine vaginal ring effective and acceptable with longer use

A silicone vaginal ring containing the antiretroviral drug dapivirine continued to demonstrate moderate effectiveness and remained well tolerated and acceptable to African women over a year-long period, according to a report presented at IAS 2019.

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Does Descovy have a role as PrEP in people who struggle with adherence?

It’s possible that pre-exposure prophylaxis (PrEP) using tenofovir alafenamide/emtricitacine (F/TAF, brand name Descovy) might have a role in providing a more ‘forgiving’ PrEP regimen for people with sub-optimal adherence to PrEP, or who take it intermittently, than the standard regimen of tenofovir disoproxil fumarate (F/TDF, known by its brand name Truvada, though increasingly available as a non-branded generic).

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Policing practices are consistently associated with HIV and risk behaviours among people who inject drugs

Being stopped, beaten or arrested by police, having syringes confiscated and other policing practices are consistently associated with HIV infection and risk behaviours among people who inject drugs in many settings, Pieter Baker of the University of California San Diego told IAS 2019. Regular interactions between the police and people who inject drugs affect how people consume drugs and access HIV prevention programmes, he said.

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First trial results of new immune-modulating drugs presented in Mexico City

Several studies of new types of HIV drug that have previously only been in pre-clinical (laboratory or animal) studies, or in drug level studies in HIV-negative people, were presented at IAS 2019.

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Could integrating HIV prevention into contraceptive services reduce infections among African women?

ECHO, the landmark trial demonstrating that injectable hormonal contraceptives do not raise women’s risk of acquiring HIV, released its results just a month before IAS 2019. While providing reassuring news about contraception, the study also revealed an unacceptably high incidence of HIV among trial participants, despite the prevention services that had been provided.

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Starting PrEP does not lead to more STIs, youth survey in Chicago finds

A survey of young gay and bisexual men and transgender women in Chicago, a proportion of them taking pre-exposure prophylaxis (PrEP), has found no direct relationship between starting PrEP and any increase in subsequent sexually transmitted infections (STIs). It did find that, not unexpectedly, people started having more condomless anal sex after starting PrEP, but this did not translate into more STIs.

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Who stops taking PrEP, and why?

Several studies presented at IAS 2019 looked at who discontinued HIV pre-exposure prophylaxis (PrEP) after starting it as part of a demonstration project.

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Islatravir plus doravirine may offer new dual therapy option

Islatravir, the first nucleoside reverse transcriptase translocation inhibitor, plus the recently approved non-nucleoside reverse transcriptase inhibitor doravirine (Pifeltro) may offer a potent and well-tolerated two-drug regimen for HIV maintenance therapy, according to a study presented at IAS 2019.

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Trial vaccine could protect against HIV for more than five years

New results from a phase IIa vaccine study, APPROACH, announced at IAS 2019, indicate that the antibody and cellular immune responses induced by the vaccine last for at last two years, and that a protective antibody response could last for at least five years, if it declines at a rate typical of other vaccines.

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Four days on, three days off HIV treatment as effective as continuous therapy, French study finds

Taking anti-HIV medication four days a week was as effective as daily treatment for people who already had a fully suppressed viral load, early data from a randomised trial presented at IAS 2019 suggest. The efficacy of the approach, particularly in relation to resistance, will need to be confirmed with longer follow-up than the 48-week data presented at the conference.

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ADVANCE trial shows dolutegravir is highly effective in South Africa

Dolutegravir-based treatment was just as effective as efavirenz-based treatment in a large randomised trial in South Africa, and treatment with the older and cheaper formulation of tenofovir was just as effective and well tolerated as treatment with a newer formulation, according to results of the ADVANCE study presented at IAS 2019.

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Three forms of PrEP stigma in Kenya

Stigma remains a significant barrier to the uptake and continued use of pre-exposure prophylaxis (PrEP) by key populations in Kenya, according to qualitative research presented at IAS 2019 by Dr Daniel Were of the Jilinde Project and Jhpiego.

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PrEP implant could last well over a year

Islatravir is the latest HIV drug name to be added to the ever-growing list of antiretrovirals. The drug formerly known as MK-8591 was the subject of one of the most keenly-awaited studies to be presented at IAS 2019. This showed that an implant containing it, which is inserted under the skin of the upper arm, should provide sustained levels of drug sufficient to prevent HIV infection for over a year.

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WHO endorses event-driven PrEP for gay men

The World Health Organization (WHO) has updated its recommendation for pre-exposure prophylaxis (PrEP) to include event-driven PrEP taken before and after sex – also called on-demand PrEP or the 2+1+1 schedule – as an HIV prevention option for men who have sex with men.

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South Africa saves $326 million on dolutegravir

South Africa’s public sector will save US$326 million over the next three years as a result of competitive tendering exercise that pushed the price of a fixed combination of tenofovir, lamivudine and dolutegravir down to $65 a year. The savings will help South Africa to treat around 2 million extra people, Herbert Musariri of the Clinton Health Access Initiative told IAS 2019.

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Men accounted for two-thirds of HIV transmission in PopART prevention trial

Universal test and treat programmes need to prioritise reaching young people to reduce HIV transmission, an analysis of the PopART HIV prevention trial presented at IAS 2019 shows.

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Dolutegravir leads to weight gain in two African studies

Treatment with dolutegravir resulted in weight gain for participants in two large clinical trials in sub-Saharan Africa and was especially pronounced when dolutegravir was combined with the new formulation of tenofovir (tenofovir alafenamide fumarate, TAF), Dr Michelle Moorhouse of Wits Reproductive Health Institute, Johannesburg, reported at IAS 2019.

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Home tests aren’t an accurate way for people on HIV treatment to check they still have HIV

HIV self-tests (home tests) frequently give false-negative results when used by people with diagnosed HIV who are taking antiretroviral therapy, with implications for the messaging around self-testing, according to a South African study presented at IAS 2019.

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Low harm reduction coverage for people who inject drugs in South Africa

The five most populated cities in South Africa (Cape Town, Durban, Johannesburg, Pretoria and Port Elizabeth) have low coverage of harm reduction services, Dr Andrew Scheibe of the non-profit organisation TB HIV Care told IAS 2019. Needle and syringe services distributed an average of 76 needles per person using the service per year, ranging from 52 per person in Pretoria to 174 in Cape Town.

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Statin therapy did not slow atherosclerosis progression in people with HIV

People with HIV who used the lipid-lowering medication rosuvastatin (Crestor) to prevent progression of cardiovascular disease (CVD) saw no reduction in progression of atherosclerosis, or 'hardening of the arteries', despite the expected reduction in cholesterol, according to a report at IAS 2019.

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People with HIV express high satisfaction with monthly injectable regimen

People who received a combination of two long-acting injectable antiretrovirals once a month expressed a high level of satisfaction with the regimen and almost all said they preferred it to their previous oral therapy, according to two studies presented at IAS 2019.

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Poorer HIV care outcomes for those using alcohol and drugs in sub-Saharan African countries

While it is well-established that alcohol and drug use lead to poorer outcomes for those living with HIV in settings such as Europe and North America, there is a scarcity of data for people living with HIV in sub-Saharan Africa. Two studies presented at IAS 2019 showed poorer engagement with HIV care for those drinking or using drugs.

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Dolutegravir recommended for all in new World Health Organization guidelines

Everyone who starts HIV treatment in lower- and middle-income countries should start treatment with a combination containing dolutegravir, the World Health Organization (WHO) announced at IAS 2019.

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Dolutegravir safety in pregnancy: risk is lower than first reported

Exposure to dolutegravir at the time of conception or during the first three months of pregnancy is associated with a small increased risk of neural tube defects, longer-term follow-up of a national birth cohort in Botswana has found. The risk is lower than preliminary results suggested, and the World Health Organization (WHO) has recommended that dolutegravir should be available for all women.

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UNAIDS outlines progress on HIV, but decries funding cuts

The Joint United Nations Programme on HIV/AIDS (UNAIDS) released its latest report on the status of the HIV epidemic and the global response ahead of IAS 2019.

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Promising HIV vaccine to be tested with gay men and trans people

A new phase III HIV vaccine trial will soon be underway for men who have sex with men and transgender people. The study, called Mosaico, will evaluate a four-shot regimen of a vaccine designed to provide protection against the many different strains of HIV around the world.

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PrEP services could enhance STI control, says World Health Organization

The roll-out of pre-exposure prophylaxis (PrEP) provides an opportunity to bring down the incidence of sexually transmitted infections (STIs), provided that PrEP and STI programmes are better co-ordinated and integrated, representatives from the World Health Organization (WHO) said at IAS 2019.

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Beyond antibodies: conference hears of new molecular tools to kill HIV-infected reservoir cells

The 2019 HIV and Hepatitis B Cure Forum took place on 20-21st July immediately before IAS 2019 in Mexico City.

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Other recent news headlines

How can researchers reduce risks to sexual partners in studies involving treatment interruptions?

As studies working towards a functional cure or HIV eradication are creating risks not only for the HIV-positive people who take part, but also their sexual partners, researchers need to reconsider their ethical obligations and the support they offer to non-participants, leading cure researchers and ethicists argue in a supplement to the August 1 Journal of Infectious Diseases.

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Deportation fears, uncertainty over health insurance and stigma are barriers to accessing HIV services for undocumented African migrants in the US

Qualitative research carried out with undocumented African migrants in New York City revealed that fears of discovery and deportation presented a substantial barrier to seeking out HIV testing services and treatment after diagnosis. Migrants also expressed uncertainty regarding how to go about obtaining health insurance and thought they were not eligible to access health services.

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Hepatitis C does not raise risk of heart disease or cancers in people with HIV

Hepatitis C co-infection does not increase the risk of cardiovascular disease or non-AIDS cancers in people with HIV, an analysis of the large Eurosida cohort published in Clinical Infectious Diseases has found.

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Less than half of adolescents with HIV since birth in the US have an undetectable viral load

Engagement with the HIV care continuum among individuals with perinatally-acquired HIV in the United States falls well below targets, research published in the online edition of the Journal of Acquired Immune Deficiency Syndromes shows. Only three-quarters received any HIV care, 61% were retained in care and 49% were virally suppressed. Those aged 18 to 25 years had especially low levels of engagement with the care continuum.

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What’s the relationship between PrEP, condom use and STIs?

HIV experts and professionals agree that pre-exposure prophylaxis (PrEP) is a valuable addition to HIV prevention, but have varied views of the relationship between PrEP, reduced condom use and sexually transmitted infections (STIs), according to a study published in Sociology of Health & Illness.

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Gay and bisexual men with problematic chemsex are a diverse group with significant sexual and psycho-social risks

Men who have sex with men (MSM) seeking support because of chemsex are a diverse group and have a range of behaviours that pose a high risk to their physical health and psycho-social wellbeing, according to research published in Sexually Transmitted Infections. Analysing the needs of gay and bisexual men seeking support from Antidote (a specialist service supporting LGBT individuals with drug and/or alcohol issues in London), the study showed that MSM engaging in chemsex had a high prevalence of HIV (47%), that many were current or past injectors and that thoughts of suicide were common. But use of specific drugs and their associated health outcomes differed according to several demographic factors, including age, race and HIV infection status.

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Australian gay and bisexual men interested in switching to on-demand PrEP

Half of gay and bisexual men using PrEP in Australia would be interested in switching from taking daily PrEP to taking on-demand PrEP, and this interest was most strongly associated with having sex infrequently and concerns about long-term side-effects. The survey was carried out by Dr Vincent Cornelisse and colleagues and is published in the July issue of Open Forum Infectious Diseases.

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Starting ART at a high CD4 cell count has clear benefits for people with a low viral load

Starting antiretroviral therapy (ART) has significant benefits and entails few risks for individuals with a low pre-treatment viral load, according to analysis of results from a large treatment initiation study published in the Journal of Acquired Immune Deficiency Syndromes. Prompt initiation of ART was associated with robust increases in CD4 cell count, sustained viral suppression and favourable changes in inflammatory biomarkers. The investigators also calculated that treatment would have public health benefits by almost eliminating the risk of onward HIV transmission.

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Editors' picks from other sources

How voluntary licensing agreements are transforming HIV care

from Devex

The rapid timeline for access to WHO-recommended dolutegravir is unprecedented.

The promise and challenge of stem cell transplants in HIV cure

from HIV Cure

Stem cell transplantation will never be the basis for a widespread HIV cure. However, careful study of people living with HIV who need stem cell transplantation can lead to better understanding of HIV persistence and conditions for elimination.

IAS 2019: Data shows indigenous, nonbinary populations among those missed by HIV epidemic ending efforts

from Science Speaks

Indigenous communities in the Americas are largely being left out of efforts to achieve UNAIDS’ 90-90-90 targets. 

Would you want a computer to judge your risk of HIV infection?

from New York Times

A new software algorithm decides which patients are most likely to become infected with the virus. Does the assessment stigmatize patients?