News from aidsmap

Awareness of U=U increasing, but HIV-negative MSM still less likely to believe in its accuracy

Two recent US studies find growing awareness and acceptability of the Undetectable = Untransmittable (U=U) message among men who have sex with men (MSM). However, a misunderstanding of transmission risk remains, with many still believing that HIV-positive partners can transmit the virus sexually, despite having an undetectable viral load.

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PrEP users in Scotland are almost all gay and bisexual men

Over 3000 gay and bisexual men have been prescribed PrEP in the first two years of Scotland’s PrEP programme, with fewer than 100 individuals from other groups taking PrEP, according to a report published this week by Health Protection Scotland.

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Most women in low- and middle-income countries find vaginal rings acceptable and easy to use

A systematic review published last month in PLOS ONE provides strong evidence that most women using the vaginal ring found it to be highly acceptable and easy to use, although a few women had some concerns. With increased use, women became more comfortable and satisfied with the ring, and also recommended it to others.

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Many people living with HIV unwilling to interrupt treatment for prolonged periods during HIV cure trials

A study assessing the opinions of people living with HIV and their healthcare providers about analytic treatment interruptions (ATIs) has found that patients had limited understanding of how ATIs are usually conducted in HIV cure studies. These findings are reported by Dr Jillian Lau and colleagues in AIDS Research and Retroviruses.

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Drug-resistance or viral load testing required before switch to dolutegravir in Togo

Dolutegravir-based antiretroviral therapy (ART) in combination with an NRTI backbone will not be effective in Togo, due to high levels of resistance to the NRTI class of drugs, according to a study presented by Professor Mounerou Salou of the Laboratoire Biolim in Togo at the recent 20th International Conference on AIDS and STIs in Africa (ICASA) in Kigali, Rwanda.

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Marked changes in gay men’s relationship agreements and condom use in the PrEP era

A recent Australian study found that gay couples’ agreements regarding casual sex outside their relationships have changed markedly in the era of pre-exposure prophylaxis (PrEP). Nearly 40% of PrEP users in relationships had agreements that allowed for condomless sex with casual partners. Additionally, 34% of PrEP users engaged in condomless casual sex despite being in relationships with agreements prohibiting it, and 13% of men not taking PrEP also engaged in condomless sex outside of their relationship when there was no agreement allowing for this.

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Community-led research finds poor quality of HIV services in 14 low-and middle-income countries

Poor quality HIV services for diagnosis, linkage to care and monitoring, as well as pervasive stigma, continue to exist, according to a survey focused on barriers to quality HIV treatment among 2777 people living with HIV in 14 low- and middle-income countries, presented by the International Treatment Preparedness Coalition at the 20th International Conference on AIDS and STIs in Africa (ICASA) in Kigali, Rwanda.

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Lipid increases after switching from TDF to TAF are reversible when treatment is changed back to TDF

Switching from tenofovir disoproxil fumarate (TDF) to tenofovir alafenamide (TAF) is associated with an increase in lipids, but this is reversed when switching back to TDF, German investigators report in the December 1 issue of AIDS. Lipids increased in over two-thirds of those making the switch, but both cholesterol and triglyceride levels fell back again after reverting to TDF, especially in individuals who had experienced the biggest increases in lipids when switching to TAF.

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Will post-treatment controllers guide us towards an HIV cure?

There exists a few people living with HIV who, after stopping antiretroviral therapy (ART), manage to sustain the viral load suppression – no viral rebound – achieved while on treatment, for months or even years. This is commonly described as an HIV functional cure or ART-free HIV remission.

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Chemsex is an emerging issue in the Middle East and eastern Europe

As the massive European MSM Internet Survey (EMIS) 2017 recently demonstrated, sexualised drug use among gay men is not just a phenomenon in the affluent cities of western Europe. Chemsex in the past four weeks was reported by 2.9% of respondents in Ukraine, 3.5% in Russia, 4.1% in Turkey and 2.8% in Lebanon. (The two European countries with the largest proportion of chemsex users were Belgium and the Netherlands, with 11 and 15% respectively.)

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Flawed definitions of unsafe sex massively over-estimate how many people are having it

The proportion of HIV-positive gay and bisexual men having ‘unsafe sex’ falls from 42% to 2% when a nuanced definition of the term is used, Dr Keith Horvath of the University of Minnesota and colleagues report in the Archives of Sexual Behaviour.

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Editors' picks from other sources

Urgent action needed on routine commissioning of PrEP

from Terrence Higgins Trust

Thirty organisations have written to Matt Hancock to demand he delivers his promise for routine PrEP access by April 2020.

Stigma, politics, and an epidemic: HIV in the Philippines

from The Lancet (requires free registration)

Incidence is increasing in the Philippines faster than anywhere else in the world, driven by discrimination and the policies of President Duterte.

ViiV Healthcare files submissions to the FDA and EMA for the first-ever dispersible formulation of dolutegravir for children living with HIV

from ViiV press release

If approved, this new formulation of dolutegravir will be the first integrase inhibitor available as a dispersible tablet for children living with HIV – closing the gap between treatment options available for adults and children.

The Government's free PrEP isn't (necessarily) free

from TheBody

Ready, Set, PrEP expands access to pre-exposure prophylaxis meds, but it doesn't cover other costs.

China’s CRISPR babies: read exclusive excerpts from the unseen original research

from MIT Technology Review

An unpublished manuscript describing the creation of the first gene-edited babies is replete with expansive claims of a medical breakthrough that can “control the HIV epidemic.” It claims “success” in using a “novel therapy” to render the girls resistant to HIV. Yet it makes little attempt to prove that the twins really are resistant to the virus.

The moon landing of HIV vaccine research: RV144, ten years later

from MedPage Today

Buried within a 2009 New England Journal of Medicine article on an HIV vaccine regimen was a sentence that would change the face of HIV vaccine research for the next decade: "the modified intention-to-treat analysis showed a significant, though modest reduction in the rate of HIV-1 infection as compared with placebo."