News from IAS 2023
Antibodies that ‘wait and pounce’ generated by promising HIV vaccine candidate
An HIV vaccine candidate has proved it can guide B-cells, the part of the immune system that makes antibodies, into being able to produce broadly neutralising antibodies (bnAbs) with the ability to block the entry into T-cells of many strains of HIV. Dr Wilton Williams of Duke University described the vaccine candidate in a plenary talk at July’s 12th International AIDS Society Conference on HIV Science (IAS 2023).
“We went back to the community and told them it didn’t work” – lessons learned from a trial of youth-friendly health services
A large cluster randomised trial which offered community-based health services to young people in Zimbabwe failed to demonstrate improvements in the HIV care cascade but did showcase the positive impact of integrated health services.
Thai key population-led organisations give hope for sustainable HIV financing
A study presented by Satayu Sittikarn of the Caremat Foundation in Thailand shows how eleven key population-led organisations sustained themselves despite their international funding being slashed from 84% of their budget in 2016 to 50% in 2022.
Undetectability as a ‘weird superpower’: experiences of people living with HIV in Australia
In the Undetectable = Untransmittable (U=U) era, undetectability is experienced in varied ways by people living with HIV, including as a way of gaining control over HIV and evidence that treatment is working. Beyond this, the biomedical marker of viral load becomes associated with the identities of many people living with HIV.
Injectable PrEP requires new testing procedures, IAS conference hears
Speakers urged the use of RNA test technology in PrEP users and especially those on injectable PrEP. This is primarily due to continuing concerns about the occurrence of drug resistance in people who acquire HIV infections despite taking PrEP, often because such HIV ‘breakthrough’ infections take a long time to detect.
Resistance history does not affect response to dolutegravir / lamivudine
A history of virologic failure on antiretroviral treatment does not affect the response when people who are virally suppressed switch to a two-drug regimen of dolutegravir and lamivudine (Dovato), even if they have resistance to lamivudine, results of the SOLAR-3D study show.
Exposure to tenofovir-based PrEP in the womb does not affect children’s bone density
Children whose mothers used tenofovir-based pre-exposure prophylaxis (PrEP) during pregnancy did not have reduced bone density or stunted growth as compared with unexposed infants.
Are peer approaches the 'silver bullet' for increasing PrEP uptake in low-resource settings?
A peer-to-peer method to increase PrEP use among female sex workers in Zambia was highly effective, resulting in 97% new PrEP uptakes, compared to only 22% for the routine approach.
Breaking down the silos: integrating hepatitis C 'test and treat' services into ART clinics is possible
Integrating hepatitis C screening, diagnostics, and treatment into antiretroviral therapy (ART) clinics in Nigeria and Vietnam led to a 98% and 99% hepatitis treatment completion rate for those who initiated treatment in the two countries.
Mumbai shows triaging those with advanced HIV disease in government centres is feasible
A study presented by Dr Shrikala Acharya of the Mumbai District AIDS Control Society shows that it is feasible to integrate an advanced HIV care package in 17 government-run ART centres in Mumbai, India, without any additional human resources. More importantly, it helps save lives.
Immediate ART associated with fewer deaths in Thailand, but starting a week or two later may lead to less virological failure
Does giving people their first HIV medications the day they are diagnosed work better than if they start them later? Or are results better if people have time to come to terms with their diagnosis? A huge study from Thailand finds it’s usually better to start in the first month – but that getting your medication the day you are diagnosed is not so clearly beneficial.
Immune-modulating medication may help clear HIV reservoir
Ruxolitinib (Jakavi), an immunomodulating drug used to treat graft-versus-host disease, may reduce the size of the HIV reservoir and reverse immune dysfunction, according to study findings presented at the conference and at the preceding HIV Cure & Immunotherapy Forum. What’s more, the drug may be helping to maintain long-term remission in a man who appears to have been cured after a stem cell transplant.
Injectable HIV treatment unlikely to be arriving soon in the global south
While there is a path to injectable PrEP becoming available in the next five years, the widespread use of injectables to treat people living with HIV in low- and middle-income countries is unlikely in the near future. The combination of injectable cabotegravir and rilpivirine has only been approved by a handful of countries, it’s not clear whether rilpivirine will be available as a generic, and the regimen has complexities which make it less attractive than the preferred oral regimens.
Top news stories from IAS 2023
The 12th International AIDS Society Conference (IAS 2023) was held in Brisbane, Australia, in July. NAM aidsmap was an official scientific media partner for the conference.
We've put together round-ups of the top 5 stories presented at IAS 2023 on HIV treatment, co-infections and co-morbidities, PrEP, and HIV in Africa and in Asia.
aidsmapLIVE: HIV and maximising your health
Join us tomorrow, Tuesday 12 September, at 5pm (UK time) for our aidsmapLIVE broadcast on HIV and maximising your health.
NAM aidsmap's Susan Cole will be talking to Dr Tristan Barber, Consultant Physician in HIV Medicine at the Royal Free Hospital; Leasuwanna Griffith, nursing associate and HIV activist; Jack Summerside, Head of Health and Wellbeing at Positive East; Dr Claire Dewsnap, president of the British Association for Sexual Health & HIV (BASHH); and Michelle Bockor, Youth Programme Coordinator at Positively UK.
Watch live on NAM aidsmap's Facebook and Twitter pages.
Other aidsmap news
HIV is more than twice as common in mental health service users
People who access mental health services in south London are 2.5 times more likely to have HIV than the general population in the same geographical area, according to a recent study. Researchers found that 25 in 1000 people who use mental health services had a recorded HIV diagnosis, compared with the 10 in 1000 rate in the general population.
More people using government programmes for opioid addiction in Ukraine since the war started
Following the Russian invasion of Ukraine, disruption to the supply of medications for opioid addiction put people at risk of withdrawal. Population migration to different regions, Russian occupation of specific areas and disruption to supply chains all created problems that endangered the treatment of people addicted to opioids in Ukraine.
Homelessness linked to 44% lower odds of progressing through HIV care cascade
Fifteen years of data from a cohort of people living with HIV who use drugs in Vancouver, Canada shows that periods of homelessness are associated with a 44% decrease in the odds of overall progression through the HIV care cascade. Specific impacts were recorded for being on HIV treatment, adhering to it and being virally suppressed.
Chinese MSM need a multi-layered approach to improve PrEP uptake and adherence
A Chinese qualitative PrEP study shows multiple barriers to PrEP uptake among men who have sex with men (MSM). The men in the study expressed concerns about PrEP efficacy, the authenticity of pills purchased informally and lack of governmental endorsement, as well as concerns about side effects, financial costs and managing PrEP care. They also shared that they were motivated to take PrEP because it would improve their quality of sex and give them greater control of their health.
New genetic variant found in those of African ancestry halves HIV viral load
A genetic variant found by an international team of scientists present only in people of African ancestry seems to halve the set point viral load in people with HIV who are not on treatment. The set point is where viral load stabilises after the early stage of infection, and it determines how fast HIV damages the immune system. This variant may be protective against quick disease progression and lessen transmission.
More evidence that non-alcoholic fatty liver disease raises cardiovascular risk in people with HIV
People with HIV who have non-alcoholic fatty liver disease have a higher risk of serious cardiovascular outcomes including heart attack, heart failure and stroke, a large study of people with HIV in the United States has found.
HIV is a “disease of shame” but diabetes is often harder to manage for African migrants in France
A qualitative study explored how migrants from sub-Saharan Africa in France who were living with both HIV and type 2 diabetes managed the two conditions. The study found that participants most often managed both conditions in a similar way, more commonly an ‘emotion-based’ strategy such as spirituality to manage the stress of the conditions, rather than ‘problem-solving’ strategies such as lifestyle and diet changes.
No antiretroviral protects against COVID-19, Dutch study finds
Single question on maternal HIV status most effective for identifying children with undiagnosed HIV
Defective HIV contributes to detectable viral load despite effective treatment
NRTI-sparing regimen effective for children and adolescents
HIV treatment coverage in children lags behind adults in the 'treat all' era
Trans women with HIV in South Africa far from reaching 95-95-95 targets
Intersecting social factors and forms of oppression create disparities in HIV viral suppression
No link between weight gain on integrase inhibitors and diabetes
Integrase inhibitors more likely to be linked to depression and suicidality than other HIV drugs
Undetectable = Untransmittable (U=U)
If you have had an undetectable viral load for at least six months and you continue to take your HIV treatment as prescribed, there is no risk of passing on HIV during sex. This is what is meant by ‘undetectable = untransmittable’ (U=U).
Find out more in our new, easy-to-read and illustrated page on aidsmap. An A4 printable version of this page is available on our clinic portal for members of our patient information subscription scheme.
Editors' picks from other sources
Can solidarity keep the HIV/AIDS community independent from drug companies? | TheBody
Longtime activist Suzy Subways asks us to keep our criticism of Big Pharma strong – even when that’s where we get our funding.
'Motherhood is hard': young, HIV-positive mums in South Africa open up about regret and anger | The Conversation
Negative emotions, especially regret, are seldom expressed when talking about motherhood.
Global Fund agreements substantially reduce the price of first-line HIV treatment to below US$45 a year | The Global Fund
Through its competitive tenders, The Global Fund will be able to offer tenofovir disoproxil fumarate, lamivudine and dolutegravir (TLD), a first-line HIV treatment for under US$45 per person, per year for the first time.
Uganda’s anti-gay bill leads a terrifying domino effect across Africa | The Daily Beast
Uganda’s draconian bill has set a dangerous precedent, with Kenya, Ghana, Tanzania, and South Sudan adopting similar policies – and intensifying existing homophobic sentiments.
How do we support Black women in an HIV arena once run by gay White men? | My Fabulous Disease
Mark S. King: In the early days of the AIDS crisis, as a young gay white man finding my way in the emerging HIV arena, I was King of the Mountain even if I wasn’t conscious of it. I worked with people who looked like me, on behalf of people like me, at organisations founded and led by people like me.
US: Insurers must cover injectable HIV prevention drug – unless courts void mandate | NBC News
The federal judiciary could strip a health task force’s effective authority to require insurers cover preventive interventions, including the HIV PrEP drug Apretude.
Pharma pricing secrecy runs amok | Health GAP (Global Access Project)
Big Pharma is now trying to expand its secrecy shield where full medicines price disclosure had previously been the norm. ViiV has insisted on price and contract-provision non-disclosure for its attempted purchase of pitiably small quantities of long-acting cabotegravir (CAB-LA) for PrEP for use in low- and middle-income countries.
Fight HIV Stigma at the World AIDS Day RED RUN!
Join team aidsmap on Saturday 25 November 2023 for the World AIDS Day RED RUN in Victoria Park, east London. This annual 5km or 10km run (or walk!) is about fighting HIV stigma and raising awareness and vital funds to support HIV charities across the UK.