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Coverage of the 15th Conference on Retroviruses and Opportunistic Infections, Boston

CROI: Married people should be primary target for HIV prevention in Uganda, national study shows

Uganda has undergone a striking change in the profile of people becoming newly infected, with older and married individuals now making up the vast majority of new infections, according to findings from a national study of HIV incidence conducted in 2004-5 and presented last week at the Fifteenth Conference on Retroviruses and Opportunistic Infections in Boston.

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CROI: MDR TB cases in South Africa - person-to-person spread likely to be chief cause

Glossary

observational study

A study design in which patients receive routine clinical care and researchers record the outcome. Observational studies can provide useful information but are considered less reliable than experimental studies such as randomised controlled trials. Some examples of observational studies are cohort studies and case-control studies.

herpes simplex virus (HSV)

A viral infection which may cause sores around the mouth or genitals.

extensively drug-resistant TB (XDR-TB)

A form of drug-resistant tuberculosis in which bacteria are resistant to isoniazid and rifampicin, the two most powerful anti-TB drugs, plus any fluoroquinolone and at least one injectable second-line drug. 

mother-to-child transmission (MTCT)

Transmission of HIV from a mother to her unborn child in the womb or during birth, or to infants via breast milk. Also known as vertical transmission.

serodiscordant

A serodiscordant couple is one in which one partner has HIV and the other has not. Many people dislike this word as it implies disagreement or conflict. Alternative terms include mixed status, magnetic or serodifferent.

Further evidence that infection control in South African hospitals is vital for containment of the country’s growing epidemic of drug-resistant tuberculosis was presented to the Fifteenth Conference on Retroviruses and Opportunistic Infections on Wednesday, with the finding that every case of multi-drug resistant TB analysed in one rural hospital was the result of re-infection, not poor drug adherence.

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CROI: Symptom checklist may help rule out advanced HIV in infants

Infants suffering from at least two of the following symptoms - oral thrush, swollen lymph nodes, nappy rash, weight in the bottom ten per cent of all children, enlarged liver or spleen, or gastric reflux – are more likely to be suffering advanced HIV disease, according to a review of clinical symptoms in a South African study of children with confirmed HIV infection designed to help doctors spot children in need of immediate treatment where HIV DNA testing and CD4 counting is not readily available.

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CROI: HAART Breastfeeding study detects drug resistance in HIV-infected infants

Although studies have shown that taking antiretroviral therapy (ART) while breastfeeding significantly reduces the chances that HIV-infected mothers will transmit the virus to their infants, the babies who are infected (and not put on ART soon enough or left untreated) may be at risk of developing resistance to some of the antiretroviral drugs the mother is taking, according to a late-breaker presentation Tuesday at the Fifteenth Conference on Retroviruses and Opportunistic Infections in Boston.

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CROI: Door-to-door Ugandan VCT programme finds more HIV-positive males than females among serodiscordant couples

Home-based, voluntary counselling and testing has found that over 2% of cohabiting couples in the Bushenyi region of Uganda are serodiscordant for HIV. The men in these partnerships are more likely than the women to be HIV-positive, and condom use in these couples is very low, according to a presentation to the Fifteenth Conference on Retroviruses and Opportunistic Infections in Boston on Wednesday.

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CROI: Tenofovir plus emtricitabine safe and effective when added to nevirapine for PMTCT

Addition of one week of postpartum treatment with tenofovir and emtricitabine to single dose nevirapine given at childbirth was safe and prevented the emergence of nevirapine resistance in mothers, according to the findings of a small pilot study presented this week at the Fifteenth Conference on Retroviruses and Opportunistic Infections in Boston.

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CROI: Large cohorts show excellent responses to ART in developing countries

The positive impacts of antiretroviral programmes in several African countries and other resource-poor areas were highlighted in a series of oral presentations to the Fifteenth Conference on Retroviruses and Opportunistic Infections in Boston on Wednesday. These studies, which represent some of the first longer-term data on treatment response in low-income countries, pointed toward successes in patient retention, immune recovery, and reductions in mortality.

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CROI: Untreated HIV-positive individuals have a higher risk of death even at CD4 counts over 350

Even with CD4 counts above 350 cells/mm3, untreated HIV-positive individuals have an increased risk of death compared with the general population, according to data presented on Wednesday at the Fifteenth Conference on Retroviruses and Opportunistic Infections in Boston.

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CROI: Three children in US infected with HIV from pre-chewed food

Three cases of HIV infection in small children in the United States are being linked to the practice of pre-chewing solid food before giving it to small children. In each case the children appear to have been exposed to blood from the mouth of an adult caregiver, investigators from the US Centers for Disease Control reported on Wednesday at the Fifteenth Conference on Retroviruses and Opportunistic Infections in Boston.

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CROI: Herpes virus suppression with valaciclovir lowers viral load in HIV positive women: could work for gay men too

A small study in Lima, Peru has found that giving the drug valaciclovir to women who are co-infected with HIV and genital herpes (HSV-2) significantly reduced the amount of HIV they had both in their blood and in their genital tract, as well as reducing the frequency and amount of HSV-2 virus shed.

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CROI: Delaying HAART while treating opportunistic infections increases the risk of disease progression and death

Waiting to start combination antiretroviral therapy until after treatment of acute opportunistic or bacterial infections is associated with an increased risk of death compared with immediate HAART, according to a presentation Wednesday at the at the Fifteenth Conference on Retroviruses and Opportunistic Infections in Boston.

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CROI: Sustained response to hepatitis C treatment lowers liver complications and death in HIV/HCV coinfected people

HIV/HCV coinfected people who achieve sustained response to hepatitis C treatment have a decreased long-term risk of liver-related complications and death, researchers reported Monday at the Fifteenth Conference on Retroviruses and Opportunistic Infections in Boston.

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CROI: People receiving TB treatment no more likely to die than others who start ARVs

People receiving treatment for pulmonary TB are no more likely to die if they start antiretroviral treatment than their counterparts without TB, according to findings from South Africa presented today at the Fifteenth Conference on Retroviruses and Opportunistic Infections in Boston. The only exception to this finding is malnourished people with TB who start ART less than 30 days after starting TB treatment.

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CROI: Darunavir found effective and tolerable in treatment-experienced children and adolescents at 24 weeks

Week 24 results from a study of darunavir (Prezista) in a treatment experienced, HIV-infected pediatric population have shown the drug to be virologically effective and generally well tolerated, with a pharmacokinetic profile comparable to that in treatment-experienced adults.

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CROI: AIDS vaccine: additional infection risk restricted to uncircumcised men

The Merck ad5 candidate AIDS vaccine, which appears to have increased the HIV infection risk of some trial participants (see this report), may have done so because it specifically increased the vulnerability of uncircumcised men to infection through insertive anal sex, the Fifteenth Conference on Retrovirues and Opportunistic Infections was told today in Boston.

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CROI: Extended infant nevirapine prophylaxis reduces HIV transmission through breastfeeding

Giving nevirapine prophylaxis to infants born to HIV-positive mothers for six to 14 weeks can reduce the risk of HIV infection through breastfeeding by half, according to findings from randomised studies conducted in Malawi, Ethiopia, India and Uganda presented on Monday at the Fifteenth Conference on Retroviruses and Opportunistic Infections in Boston.

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CROI: HAART use in mothers substantially reduces HIV infections in breastfeeding infants in Kisumu, Kenya

In a Monday afternoon session at the Fifteenth Conference on Retroviruses and Opportunistic Infections in Boston, several investigators reported successes in preventing of mother-to-child transmission (PMTCT). In the Kisumu Breastfeeding Study, low rates of HIV infection were seen in children when mothers were kept on three-drug HAART regimens from late pregnancy through six months of breastfeeding.

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CROI: Unplanned pregnancy frequent among women after starting ARVs, need for family planning

Unwanted or unplanned pregnancy is a significant risk for women with HIV within 18 months of starting antiretroviral therapy, and in Uganda few were being offered family planning methods in order to avoid pregnancy, researchers reported on Tuesday at the Fifteenth Conference on Retroviruses and Opportunistic Infections in Boston.

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CROI: DAD cohort finds increased risk of heart attack in people taking abacavir or ddI

One of the more surprising reports at the Fifteenth Conference on Retroviruses and Opportunistic Infections in Boston on Monday was that the nucleoside analogue abacavir (Ziagen) appears to increase the risk of myocardial infarction (MI), or heart attack, by 90%, and didanosine (ddI, Videx) by 49%, No such increase was seen with zidovudine (AZT), stavudine (d4T, Zerit), and the additional risk due to abacavir and ddI largely disappeared after the drugs were discontinued. These findings were drawn from the large, multi-cohort DAD observational study.

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CROI: Lactobacillus supplementation could help reduce vaginal HIV

The composition of the vaginal microflora affects the viral load within the vaginal secretions of HIV-positive women, according to a late-breaking abstract presented on Monday at the Fifteenth Conference on Retroviruses and Opportunistic Infections in Boston.

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CROI: ARV provision in Africa could cut HIV transmission by 90 per cent

The provision of antiretrovirals (ARVs), along with comprehensive sexual risk behaviour and ARV adherence support programmes, cut the risk of HIV transmission by 91% over a three year period in a study from eastern Uganda, the Fifteenth Conference on Retroviruses and Opportunistic Infections heard today in Boston.

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CROI: Aciclovir treatment for genital herpes does not reduce HIV acquisition in men or women, major trial shows

Another study has confirmed that twice daily aciclovir treatment to suppress HSV-2 (the virus that causes genital herpes), does not reduce the risk of HIV infection. The findings, from the HIV Prevention Trials Network study 039 were presented on Monday at the Fifteenth Conference on Retroviruses and Opportunistic Infections in Boston.

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CROI: Circumcising HIV positive men may increase HIV infections in female partners, but fewer STIs seen

There was a trend towards higher HIV incidence in the wives of HIV positive men who were circumcised compared with wives of men left uncircumcised, in the latest prevention study conducted in Rakai province, Uganda, investigators revealed at a press conference on the opening day of the Fifteenth Conference on Retroviruses and Opportunistic Infections in Boston.

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Other recent news headlines

South Africa : updated PMTCT guidelines still lag behind international standards, say experts

The South African Department of Health this week published new guidelines for prevention of mother to child transmission in South Africa. However activists and doctors say they still leave South Africa out of step with poorer and less well resourced nations.

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Boehringer-Ingelheim begins trial of once-daily extended release nevirapine

Anxious not to be left behind in the move towards once-daily HIV treatment, Boehringer-Ingelheim announced yesterday that it is beginning recruitment to an international study of an extended-release, once-daily formulation of its antiretroviral drug nevirapine (Viramune).

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FDA approves generic atazanavir

A generic version of atazanavir, manufactured by the Indian company Emcure Pharmaceuticals, has received tentative approval from the US Food Drug Administration, it was announced last week.

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HIV/hepatitis B coinfection in Africa posing dilemma for 3TC-based ART

Over 10% of infants in Cote D'Ivoire are coinfected with HIV and hepatitis B virus, according to the findings of a study published in the February 1st edition of Clinical Infectious Diseases. Furthermore, 40% of coinfected infants have chronic hepatitis B.

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HIV more than doubles the rate of deaths in Zambian children hospitalised with measles

HIV-infected Zambian children had over twice the risk of dying in hospital with measles than Zambian children who were not HIV-1-infected, according to the findings of an observational study published in the February 15th edition of Clinical Infectious Diseases. The HIV-infected children hospitalised with measles were more likely to be younger than 9 months than HIV-1-uninfected children.

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WHO expert panel wants fewer second-line ART choices

Expert advisers to the World Health Organization have concluded that treatment programmes in resource-limited settings should prioritise a small number of second-line antiretroviral drugs, in order to make programmes simpler to run, to speed up drug approvals and to drive down costs of second-line drugs.

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Swiss experts say individuals with undetectable viral load and no STI cannot transmit HIV during sex

Swiss HIV experts have produced the first-ever consensus statement to say that HIV-positive individuals on effective antiretroviral therapy and without sexually transmitted infections (STIs) are sexually non-infectious. The statement is published in this week’s Bulletin of Swiss Medicine (Bulletin des médecins suisses). The statement also discusses the implications for doctors; for HIV-positive people; for HIV prevention; and the legal system.

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HIV risk growing among sub-Saharan Africa's least educated

HIV is becoming most prevalent among sub-Saharan Africans at the lowest educational levels, according to a systematic review of published studies. Most data from before1996 indicated that HIV prevalence was either unrelated to education, or higher among more the highly educated. Since 1996, prevalence has been falling among the most educated while rising in the least educated. The review was published in January 30th edition of AIDS.

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Key European committee gives the nod to new Kaletra tablet for kids

The European Committee for Medicinal Products for Human Use (CHMP) has provided a positive opinion on a new lower-dose tablet formulation of the protease inhibitor Kaletra (lopinavir/ritonavir) for paediatric use.

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Very low levels of HIV testing amongst women in rural India

Levels of HIV testing amongst pregnant women in rural India are very low, and even women who have symptoms of sexually transmitted infections or tuberculosis are not being referred for HIV voluntary counselling or testing, according to a study published in the February 1st edition of the Journal of Acquired Immune Deficiency Syndromes. The study also found that few women were aware of the existence of voluntary counselling and testing facilities.

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Less risk of AIDS for patients with low CD4 cell count and no treatment options who stay on failing therapy

HIV-positive patients with a low CD4 cell count and no new treatment options who are taking antiretroviral therapy which is not controlling their viral load should remain on their therapy rather than interrupt treatment, French researchers report in the January 15th edition of Clinical Infectious Diseases.

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Spread of HIV continues in rural areas of Tanzania

Samples taken over the past ten years indicate that HIV prevalence in rural northwest Tanzania increased steadily from 6.0% in 1994/1995 to a little over 8% in 2000/2001, levelling out thereafter. Incidence rose sharply from 0.8% to 1.2% per year over the same periods, remaining at 1.1% per year as of 2000/2003. Most recently, HIV incidence has been declining in Tanzanian roadside rural areas, especially among women, but has continued to rise slightly in more remote rural areas. The figures were reported in a paper published in the Journal of Acquired Immune Deficiency Syndromes in December 2007.

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Targeted HIV research and care programmes may improve care for all pregnant women in Zambian clinics

A review of records from antenatal clinics in Lusaka, Zambia has found that pregnant women were screened for syphilis more commonly after prevention of mother-to-child HIV transmission (PMTCT) research and service programmes were implemented at the clinics. This increase in screening was interpreted as a marker of improved routine clinical services for pregnant women. The increase was only seen when research and service programmes had both been implemented; neither research nor service programs alone had a positive effect. The study was published in the January issue of the Journal of Acquired Immune Deficiency Syndromes.

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Higher mortality in HIV-positive and HIV-negative children born to mothers with lower CD4 cell counts

Children in sub-Saharan Africa born to mothers with CD4 cell counts under 350 cells/mm3 are more likely to die, whether or not the children themselves are HIV-positive, according to a study published in the Journal of Acquired Immune Deficiency Syndromes in December 2007. Child malnutrition and low maternal haemoglobin were associated with higher child mortality rates.

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Voluntary counselling and testing for couples: successes in Zambia

A voluntary counselling and testing programme specifically aimed at couples was widely used when actively promoted in Lusaka, Zambia, according to a paper published in the January 1st issue of the Journal of Acquired Immune Deficiency Syndromes. Over a six-year period, 8500 married or cohabiting couples were tested for HIV through the programme, of whom 23% were found to be serodiscordant. The authors believe that, as part of African HIV prevention efforts, couples should be widely encouraged to participate in couples' voluntary testing and counselling (CVCT).

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Two XDR TB cases reported in Botswana

The government of Botswana announced yesterday that two cases of extensively drug-resistant tuberculosis (XDR TB) have been identified in the country. They are the first cases to be reported in sub-Saharan Africa outside South Africa.

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Kenya : Drug resistance risk as displaced HIV patients skip ARV doses

After a fortnight of political violence during which an estimated 250,000 Kenyans were displaced, health workers are scrambling to ensure that HIV-positive people on life-prolonging anti-retroviral (ARV) therapy continue to receive their drugs and adequate food supplies.

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