HIV update - 27th November 2019

A round-up of the latest HIV news, for people living with HIV in the UK and beyond.

HIV transmission during a cure study

A second case of HIV transmission from someone interrupting their HIV therapy as part of a cure study has been published. We reported on a similar case in March.

In both cases, men living with HIV were taking part in studies conducted by researchers working towards an HIV cure. There is only one way of seeing if a possible cure has any effect – by asking the study participant to stop taking their HIV treatment and to see how quickly their viral load becomes detectable again. This is called an ‘analytical treatment interruption’ (ATI).

There are some risks in having an analytical treatment interruption. An increase in viral load, even a brief one, could have an impact on the health of the person, especially if they have other health problems or a weakened immune system. Also, when viral load rises, there is the potential of passing HIV on during sex, if prevention methods are not used.

It's important that people taking part in studies like these are aware of these risks. It’s also valuable for their sexual partners to be aware of them – but it’s not always possible for researchers to make contact with study participants’ partners.

In the new case, a man in Barcelona took an analytical treatment interruption. Four weeks later, his viral load reappeared. However, the researchers still needed to see how far it would rise and how quickly, so he did not re-start treatment until after another four weeks.

Around the same time, his male partner had symptoms of HIV seroconversion, he tested positive and genetic testing showed that his viral strain was identical to his partner’s.

The case raises the issue of prevention support for the partners of people taking part in these studies. The researchers did discuss condoms and post-exposure prophylaxis (PEP) with the two men, but they didn’t talk about pre-exposure prophylaxis (PrEP).

Many people believe that partners in these studies should be offered PrEP as a matter of course, but this is not routine practice.

For more information, read our news article 'How can researchers reduce risks to sexual partners in studies involving treatment interruptions?'

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

Dutch investigators have reported that the incidence of community-acquired pneumonia and invasive pneumococcal disease remains high in people with HIV.

Pneumonia is any infection of the lungs that causes inflammation. To say that it is ‘community acquired’ means that the person got it in the course of their day-to-day life, rather than in hospital. One possible cause of pneumonia is a bacterial infection called Streptococcus pneumoniae. The same infection can cause other problems such as sepsis and meningitis, and these are described as invasive pneumococcal disease.

A large body of historical research, much of which was conducted before the mid-1990s, shows that people with HIV have increased risk of pneumococcal disease. A team of researchers in The Netherlands wanted to know if this increased risk still applies and if so, what might be done about it.

They undertook a case-control analysis to determine the risk factors for community-acquired pneumonia among individuals on antiretrovirals. Each case was matched with a person diagnosed with HIV in the same year who did not develop pneumonia.

The risk factors they identified included being 60 or more years old, having a CD4 cell count below 500, smoking, recreational drug use and chronic obstructive pulmonary disease. Coverage of pneumococcal vaccination was low, both in people who’d had pneumonia and in people who had not (7% vs 4%, although this difference was not statistically significant).

The incidence of community-acquired pneumonia among the HIV-positive individuals was eight times higher than that seen in the general population. Similarly, the incidence of invasive pneumococcal disease among people with HIV was seven times higher than in the general population and 20-times higher than that recorded among healthy people (in this particular case ‘healthy’ means ‘without an immunocompromising condition’).

The researchers point out that currently available pneumococcal vaccines are effective and that they cover all the cultured strains seen in this study, but that rates of vaccination are low. They suggest that their findings provide an argument against this low uptake of pneumococcal vaccination.

For more information, read NAM's pages 'What vaccinations are recommended for people with HIV?' and 'Pneumococcal disease'.

Serosorting in the age of PrEP

A Canadian survey of over 1000 gay and bisexual men suggests that PrEP is making a difference to men’s choices about sexual partners, specifically whether they choose sexual partners who have the same HIV status as themselves. This is sometimes called ‘serosorting’.

The study compared the HIV status of gay men’s recent sexual partners with what would be expected if they chose partners regardless of HIV status. If men didn’t pay attention to HIV status, 76% of their partners would be expected to be HIV negative and 24% HIV positive.

However, 66% of the HIV-positive men’s partners also had HIV. This shows that serosorting is still going on, although it’s not clear whether this is due to choice or because of rejection by HIV-negative men.

HIV-negative men are serosorting too: instead of the 76% of partners who one would expect to be HIV-negative by chance, 88% of the partners of HIV-negative men also did not have HIV.

HIV-negative men who were taking PrEP had more HIV-positive partners (17%) than non-PrEP users did (9%). PrEP users also tended to have sex with other PrEP users.

New treatment for fatty liver

Non-alcoholic fatty liver disease (NAFLD) is a growing cause of liver disease in people living with HIV. Now that hepatitis C can be easily cured, it is likely that fatty liver disease will soon become the greatest cause of liver-related ill health and deaths in people living with HIV.

Fatty liver disease occurs when triglycerides and other fats build up in the liver, which can cause inflammation and interfere with normal liver function. The more overweight you are – especially if you have excess fat around the waistline – the greater your risk of having fatty liver disease.

A small study has found that treatment with tesamorelin, a synthetic growth hormone-releasing hormone, reduced liver fat content and slowed liver fibrosis in people with HIV who had non-alcoholic fatty liver disease.

Tesamorelin was taken as a subcutaneous daily injection. Over a third of people taking it no longer had fatty liver disease after taking it for a year, compared to 4% of people taking a placebo injection.

For more information, read NAM's page 'Fatty liver disease and HIV'.