Summaries of news from the last quarter. For full news reports and references to the original sources, visit www.aidsmap.com/news.
The road to PrEP
Over the next three years, up to 33,000 people may take part in 22 studies worldwide of pre-exposure prophylaxis (PrEP – giving HIV-negative people drugs to prevent HIV), the International Association of Physicians in AIDS Care (IAPAC) meeting Controlling the HIV epidemic with antiretrovirals, was told in June. Dr Jim Rooney of Gilead Sciences, the manufacturer of Truvada (tenofovir/FTC, the product used in the vast majority of these studies), said that these studies were crucial to establish whether PrEP may be less, or more, effective in clinical settings than in randomised, placebo-controlled trials. Trials are ongoing or planned in the UK, France, Latin America, Thailand and several African countries, as well as in the US. The US Food and Drug Administration voted for approval of Truvada as PrEP in May this year but confirmation, expected in September, is subject to a Risk Evaluation and Mitigation Strategy document. In Europe, the European Medicines Agency has issued a draft paper on the general requirements for licensing HIV drugs for prevention.
For the full news report see: www.aidsmap.com/page/2403757
Lack of testing fuels UK epidemic
In the UK, most HIV infections in gay men are transmitted by the undiagnosed, Valerie Delpech of the Health Protection Agency (HPA) told the IAPAC meeting. She commented that good access to antiretrovirals in the UK has not led to a reduction in new infections: the annual number of new HIV infections in gay men changed very little between 2001 and 2010, with between 2000 and 3000 new infections each year. The UK performs relatively poorly in testing and diagnosis; it is thought that at least a quarter of people with HIV are undiagnosed and only 15 to 25% of gay men have an HIV test in any one year, she said. HPA modellers have calculated that one-third of the 40,000 UK gay men living with HIV are infectious and nearly two-thirds of those are undiagnosed. Further work by University College London has found that nearly half of new infections are acquired from men who themselves have been infected in the last six months, many of whom will have a very high viral load.
For the full news report see: www.aidsmap.com/page/2393389
Big increases in STIs in England
There was a significant worsening in the sexual health of people in England last year, data released by the Health Protection Agency (HPA) show. Cases of gonorrhoea and syphilis were up by 25 and 10% respectively against a background of a 2% increase in all sexually transmitted infections (STIs). The increase in gonorrhoea is especially worrying as it is becoming hard to treat, owing to the emergence of antibiotic-resistant strains. Gay men and other men who have sex with men (MSM) had high rates of STIs. The number of gonorrhoea cases in gay and bisexual men increased by 61% compared to 2010, chlamydia by 48%, genital herpes by a third, syphilis by over a quarter and genital warts by 23%. Three-quarters of syphilis cases in 2011 were in this group, as were 50% of gonorrhoea diagnoses. Some 16% of infections were in the throat, which may be asymptomatic.
For the full news report see: www.aidsmap.com/page/2374770
Intermittent PrEP may lead to poorer adherence
People may find it significantly more difficult to adhere to pre-exposure prophylaxis (PrEP) if it is taken intermittently than if it is taken daily, according to a study from Kenya. The IAVI E001 study found that average adherence among the individuals taking daily treatment was 83%, but fell to just 55% for those taking intermittent therapy. A total of 67 men who have sex with men and five female sex workers were recruited to the study, which lasted four months. They were divided into four groups: two which took daily Truvada PrEP or placebo and two which took it every Friday and Monday, plus an extra dose after sex if they had it. Adherence to the post-sex dose was especially low, at only 26%. Nevertheless, the authors believe that intermittent dosing may still be appropriate “if intracellular drug levels, which correlate with prevention of HIV acquisition, can be attained with less than daily dosing and if barriers to adherence can be addressed”.
For the full news report see: www.aidsmap.com/page/2379540
NICE: Sperm washing not needed if HIV-positive partner on treatment
Draft UK guidance on fertility treatment says that sperm washing may not be necessary for couples where the man has HIV and the woman does not, as long as the man is on effective antiretroviral treatment and unprotected sex is limited to days when his partner is ovulating. The National Institute for Health and Clinical Excellence (NICE), which issues recommendations to the NHS about the most effective and cost-effective treatments to provide, does not exclude people with HIV from access to fertility treatments, such as intrauterine insemination (IUI) or in vitro fertilisation (IVF). NICE has also removed a previous recommendation that the implications of the parent’s HIV infection for the child’s welfare “should be taken into account”. The authors insist that their recommendation is limited to the situation of a heterosexual couple wishing to conceive who limit unprotected sex to days when the female partner is fertile (ovulating).
For the full news report see: www.aidsmap.com/page/2364056
‘Glandular fever’ symptoms may be HIV
HIV infections in people with suspected glandular fever are often missed, according to a study from the south London boroughs of Lambeth, Southwark and Lewisham – the area of highest HIV prevalence in the UK. Retrospective testing of 1046 blood samples submitted for glandular fever screening showed that 11 people (1.3%) were in fact infected with HIV and that three-quarters of these infections remained undiagnosed after the patient had seen their GP. A request for an HIV test was submitted at the same time as a request for glandular fever screening for 11% of patients. Three of these patients (3%) were found to be HIV-positive. A further 45 patients (4%) had a subsequent HIV test within a year of their glandular fever screen, two of whom had HIV. In the remaining 694 samples, six undiagnosed HIV infections were found, three of which had been recently acquired. Primary care has an important role in the expansion of HIV testing. People with primary HIV infection may experience a seroconversion illness and consult their GP, presenting with symptoms including fever, muscle aches, sore throat and rash.
For the full news report see: www.aidsmap.com/page/2357556
US approves HIV home testing
HIV home testing has become legal in the United States, following approval by the Food and Drug Administration (FDA) for the OraQuick In-Home HIV Test. The test will be available over the counter and is designed to be used without medical supervision. The user swabs an absorbent pad around their outer gums; results take 20 minutes. This is the first home test for any infectious disease available for purchase by US customers. The test kits come with details of free telephone support. While professional kits cost less than $20, the home version is likely to be about $60. Studies found a very low rate of false-positive results from the kit; only two in 10,000 HIV-negative samples tested HIV-positive. There was a rather high number of false HIV-negative results, with seven in 100 samples containing HIV registering as HIV-negative. So a negative result does not completely eliminate the possibility of an infection, especially after a recent encounter. However, the panel of experts advising the FDA felt the benefits of the test outweighed its potential risks and could provide an important way to make HIV testing available to more people.
For the full news report see: www.aidsmap.com/page/2356465
News picks from other sources
As well as writing our news reports, our team of editors regularly select news from other sources for the news pages of our website. Here is a small selection of recent examples. For more of these, visit www.aidsmap.com/news
Police HIV advice 'outdated and stigmatising'
Police forces are perpetuating incorrect stereotypes about people with HIV through guidelines that suggest officers can be infected with the virus through spit and sharing toothbrushes, say campaigners. For the full news report, visit The Guardian website: http://bit.ly/MqQEGq
Nobel-prize winning Barre-Sinoussi optimistic about cure
The scientist who won a Nobel prize for her work in first identifying HIV says she at last believes finding a cure for the virus which causes AIDS might be possible.
For the full news report, visit the BBC website: http://bbc.in/MV3aer
Evidence that man cured of HIV harbors viral remnants triggers confusion
Only one person has ever been cured of an HIV infection, and a presentation about the man at a scientific meeting in Sitges, Spain, has caused an uproar about the possibility that he's still infeted. For the full news report, visit the Science website: http://bit.ly/NwtiNI