News from the 17th European AIDS Conference

Weight gain on HIV treatment: drug combinations, not single drugs, need to be focus of quest for cause

Weight gain after starting antiretroviral treatment probably has multiple causes but appears strongly linked to specific drugs, and to combinations of drugs, Dr Andrew Hill of the University of Liverpool told the 17th European AIDS Conference (EACS 2019) in Basel, Switzerland. He highlighted some of the problems with the ways in which the phenomenon has been studied so far and called for greater inclusion of women and black people in clinical trials of new drugs and currently prescribed agents, so that side effects of antiretroviral drugs can be studied in different population groups.

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ADVANCE study shows high frequency of major weight gain in women receiving dolutegravir with TAF

Metabolic syndrome – including obesity – developed significantly more frequently in people who received dolutegravir, tenofovir alafenamide (TAF) and emtricitabine compared to other regimens in the South African ADVANCE study, Dr Michelle Moorhouse reported at the conference.

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Weight gain after switching to integrase inhibitor treatment is small in Dutch and Swiss cohorts

People with suppressed viral load who switched to an integrase inhibitor-based regimen experienced only small gains in weight and do not appear to gain more weight than HIV-negative people or people who continued taking other regimens, two large cohort studies presented at the conference reported.

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Dolutegravir and raltegravir cause changes to fat cells

The integrase inhibitors dolutegravir (Tivicay, also in Triumeq and Dovato) and raltegravir (Isentress) cause changes in the structure of fat cells that may promote obesity, and can cause insulin resistance, studies of cells sampled from people living with HIV and monkeys exposed to the drugs have found.

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Options for two-drug simplification expand

Further evidence on the efficacy of two-drug antiretroviral regimens as simplification options for people with suppressed viral load on three-drug regimens was presented at the conference. However, German HIV specialist Professor Hans-Jürgen Stellbrink of the University of Hamburg sounded a note of caution about two-drug treatment during a discussion session at the conference, warning that “we're practising evolutionary biology on the virus by treatment, exerting the maximum selective pressure on the virus, and what I’ve learnt over 33 years is not to reduce that selective pressure on the virus.”

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How do we deal with apparent cases of PrEP failure?

The conference heard about another case of a PrEP user who caught HIV despite being apparently adherent to PrEP. These cases are likely to keep on happening, Dr Hans Benjamin Hampel of Zürich University Hospital told EACS 2019, and we perhaps need to move beyond trying to establish which – if any – cases of PrEP failure have watertight evidence of 100% adherence. 

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96-week results of DISCOVER PrEP trial presented at European AIDS Conference

The 96-week results of the DISCOVER trial, which compared the efficacy and safety of two different formulations of the antiretroviral drug tenofovir when used as daily PrEP by gay and bisexual men, were announced at the conference.

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Tenofovir (TDF) does not increase risk of kidney disease in people at low risk

Antiretroviral treatment containing the older formulation of tenofovir (TDF) did not increase the risk of chronic kidney disease in previously untreated people with HIV at low risk for kidney disease, a large American cohort study reported at the conference.

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HIV-positive gay men in England report highest chemsex rates in four-country survey

A study presented at the recent conference comparing reported drug use among HIV-positive men attending clinics in England, Spain, Greece and Italy, has found higher rates of drug use in England than in other countries and considerably higher usage of the drugs used in chemsex (sexualised drug use) – methamphetamine, GHB/GBL, mephedrone and ketamine.

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French study finds one in six stops PrEP within 12 months, one in three after 30 months

PREVENIR, the French open-label study looking at PrEP use in gay and bisexual men in the Paris region, has found that 16% of study participants either told clinicians they were stopping PrEP or disappeared from the study within a year, and that 32% had discontinued PrEP after 30 months.

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New European HIV guidelines cater for multiple needs

The tenth edition of the European AIDS Clinical Society Guidelines was launched at the conference. Its expansion in size – from 109 pages in the ninth print edition first published two years ago to 283 pages today, plus numerous online-only supplementary tables – is evidence of the complexity of needs it seeks to address. In particular, as the average age of people with HIV increases, much of its new material has been developed with the needs of the ageing person with HIV in mind.

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Anal cancer: Australian study of precancerous tissues in gay men shows little increased risk in positive men, almost no cancer cases

An Australian study of gay men recruited in community settings in Sydney, Australia has found a very high prevalence of HSIL (high-grade squamous intraepithelial lesions – precancerous changes in the cells of the anal lining that may indicate a risk of developing cancer). Yet in three years of follow-up, only one man out of 617 progressed to anal cancer, the conference heard.

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Progress on 90-90-90 HIV targets shows stark gap between eastern and western Europe

The 90-90-90 targets for HIV diagnosis, treatment and viral suppression will be missed in much of eastern Europe due to poor access to HIV treatment, the conference heard on its opening day.

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Rugby star Gareth Thomas speaks out against HIV stigma at European AIDS Conference

In his first public speech since announcing that he is living with HIV in September, Wales rugby star Gareth Thomas spoke of the need to confront HIV stigma at the conference. He spoke at a symposium organised by Gilead Sciences on the conference's opening day.

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Other aidsmap news

Rates of pneumonia and pneumococcal disease remain high among people with HIV

The incidence of invasive pneumococcal disease and community-acquired pneumonia remains high among people living with HIV, investigators from the Netherlands report in Clinical Infectious Diseases. Rates of these serious lung infections were highest among people not taking anti-HIV drugs and with CD4 cell count below 500. Incidence was also much higher than that seen in the general population. 

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Hepatitis C incidence is low among Canadian men on PrEP

New cases of hepatitis C virus (HCV) infection among Canadian gay and bisexual men taking pre-exposure prophylaxis (PrEP) were uncommon compared with rates previously reported in Europe, according to research presented at the AASLD Liver Meeting in Boston.

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Coalition of liver associations call for simplifying hepatitis C care

Leaders of liver disease associations from Europe, the United States, Latin America and Asia issued a global call to action at the Liver Meeting in Boston, aiming to advance toward the goal of eliminating hepatitis C as a public health threat.

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PrEP services in France are changing in order to engage more people

A recurring theme at last month’s PrEP in Europe Summit in Warsaw was that the formal approval of PrEP by regulatory agencies is not enough to make PrEP a success. Much more needs to be done in order for the people who need PrEP to actually have access to it.

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Editors' picks from other sources

‘Critically low’ awareness of HIV status among gay men in Africa

from Avert

Men who have sex with men in Africa are more likely to test for HIV than other African men, but are significantly less likely to be on treatment or virally suppressed.

Untangling the Trump administration's lawsuit over an HIV prevention drug

from Science

The US government says in a lawsuit that Gilead, the maker of the anti-HIV drug Truvada, owes the US public royalty money. Science reviewed the litigation filed by both sides in the dispute and spoke with leading researchers and HIV/AIDS advocates to try to clarify the arguments in this messy and long-running battle.

Misleading ads about PrEP are threatening progress to end the HIV epidemic. They must be removed

from TheBodyPro

Pre-exposure prophylaxis (PrEP) is a vital part of ending HIV, but ads targeting people to join lawsuits are planting needless fears in patients, three leading HIV specialists write.

Six highlights from a week of important TB developments

from Spotlight

Earlier this month, researchers, policymakers and activists gathered in Hyderabad, India for the 50th Union World Conference on Lung Health. We picked six of the week’s most important stories.

Ten years of 56 Dean Street, the pioneering LGBTQ+ health clinic 

from VICE

Located in the heart of Soho, the NHS centre offers free sexual health testing and counselling services. A decade on, patients tell us why we can’t take it for granted.