More News from the 25th Conference on Retroviruses and Opportunistic Infections (CROI)

Since the volume of HIV research reported at major conferences such as CROI is vast, the specialty HIV, medical, and scientific press typically continue to summarize key research findings for several weeks after these events conclude.  In the last issue of In Brief, we curated earlier news coverage from CROI, and here we continue with later reports.  For your convenience, we have again curated news headlines by topic, so that you may quickly review important developments and then explore in depth the news of greatest interest to you.  

Summary Article

The Best of CROI 2018 (Poz) – This article summarizes highlights of research presented at the recent 25th CROI in Boston.  It includes sections on HIV treatment, cure research, pre-exposure prophylaxis, comorbid conditions, HIV in Africa, HIV among incarcerated persons, HIV transmission, and hepatitis C.  The article also includes hyperlinks to more detailed coverage for each of the topics listed.

HIV in Different Population Groups

Treatment Rates Rise, But Adherence Does Not for Young Black Men with HIV (Poz)

Injection Drug Use Among People Living with HIV: A Missed Opportunity to Save Lives (TheBodyPro)

Older People in United States More Likely to Have AIDS at the Time of HIV Diagnosis (AIDSmap); additional coverage in Poz

Age Difference in HIV Infection Matters – But It’s Not Always the Younger Person Who Is at Risk (AIDSmap)

Case Management Improves Linkage to Care for People Living with HIV Post-Release from Prison or Jail, New Study Shows (TheBodyPro)

Research Is Still Exploring Best Treatment Strategies for Pregnant and Breastfeeding Women, Interactions with Contraceptives (TheBodyPro)

Pre-Exposure Prophylaxis (PrEP)

PrEP at CROI 2018 - Part 1: Access in Australia and the U.S.

PrEP at CROI 2018 - Part 2: Animal Studies for Future Drugs (HIV i-Base)

Reported PrEP ‘Failure’ Most Likely a Lack of Proper Testing and Adherence (TheBodyPro)

Transmissible HIV That Is Resistant to PrEP Is Rare (Poz)

Cure Research

Cure Research at CROI 2018: Defining and Reducing the Reservoir and the Risks from Interrupting Treatment (HIV i-Base)

Inching Towards an HIV Cure: bNAb and TLR-7 Agonist Reduce Viral Rebound Off-ART in Macaques (HIV i-Base)

Hepatitis C

HIV/HCV Coinfection: New Data Has Implications for Treatment-as-Prevention Efforts (TheBodyPro)

Adding Sovaldi and Ribavirin to Retreatment with Mavyret Beats Hep C (Poz)

Hepatitis C Rarely Clears Spontaneously in Those with HIV (Poz)

Systematic Hep C Test-and-Treat Lowers Rate in Gay Men with HIV (Poz)

How HIV Alters Cells May Facilitate Sexual Transmission of Hepatitis C (Poz)

HIV Comorbidities and Treatment Side Effects

Integrase Inhibitors Do Not Raise Risk of IRIS in Severely Immunocompromised People (AIDSmap); additional coverage in Poz

Switching from Abacavir to TAF Improves Platelet Function (AIDSmap)

Research Sheds More Light on Cardiovascular Risk in People with HIV (AIDSmap)

Rate of Bone Loss on ART Slows After the First Year (HIV i-Base)

Statin Use May Reduce Risk of Cancer in HIV Positive People (HIV i-Base)

HIV/AIDS Epidemiology 

IHS Provider Data Show Higher HIV Diagnosis Rates Among American Indian/Alaska Natives Than NHSS Data

The rates of new HIV diagnoses among American Indian/Alaska Natives (AI/ANs) reported in a recent study of provider data from the Indian Health Service (IHS) were nearly twice as high as figures for the AI/AN population reported in the National HIV Surveillance System (NHSS) data. For their study, a research group from IHS, CDC, and other agencies serving AI/ANs analyzed provider data from IHS’s National Patient Information Reporting System (NPIRS) during the 10-year period from 2005 through 2014.  NPIRS includes 45 hospitals and more than 300 health centers located in 34 U.S. states and consists mainly of primary care clinics in rural areas that are federally or tribally operated. 

In contrast to the NHSS data, which estimated AI/AN HIV diagnosis rates as rising from 7.4/100,000 in 2010 to 8.8/100,000 in 2015, the IHS study found substantially higher but relatively stable rates – averaging 15.1/100,000 annually from 2005 to 2014. Of AI/ANs served by IHS facilities, males accounted for about two-thirds of new HIV diagnoses during the entire period studied, and the rate of new diagnoses among males was more than twice that in females (21.3 versus 9.5 per 100,000).  AI/ANs in the Southwest region of the U.S. accounted for nearly half (45%) of the total new HIV diagnoses reported in the study, and had higher annual diagnosis rates (19.9/100,000) than any other region. 

The authors noted that racial/ethnic misclassification may account, in part, for the roughly two-fold higher HIV diagnosis rates seen in the NPIRS data compared to NHSS estimates. “Racial misclassification among AI/ANs is rare in the IHS because documentation of AI/AN status is required to determine patient eligibility. Therefore, from the point of view of racial misclassification, we consider IHS NPIRS data to be a more accurate representation of the AI/AN population.” They concluded, “AI/ANs aged 20-54, particularly men, may benefit from increased HIV prevention and screening efforts. Our findings on HIV trends may help tribal, federal, and state health entities serving tribal nations better target efforts on HIV prevention, screening, and linkage to care among AI/ANs.” 

Pre-Exposure Prophylaxis

New State-by-State PrEP-Use Map from AIDSVu

AIDSVu recently released the first-ever, interactive, state-level maps summarizing trends in the use of PrEP across the U.S. According to the data, PrEP use increased at an average rate of about 73% annually during the period from 2012 through 2016, rising to a total of more than 77,000 PrEP users nationwide by 2016. The AIDSVu site provides interactive maps illustrating HIV prevalence, new HIV diagnoses, and mortality – and now PrEP use – across the United States. AIDSVu is a project of Emory University’s Rollins School of Public Health in partnership with Gilead Sciences and the Center for AIDS Research (CFAR) at Emory. Selected highlights of PrEP data on the AIDSVu site are summarized below.  Please note that, unless otherwise indicated, the data presented are for 2016 – the latest year for which detailed data are available.

• the number of PrEP users increased 880% between 2012 and 2016, rising from about 8,768 users to 77,120 users during the period;
• 93% of all PrEP users were male, and 7% were female;
• nearly half of all PrEP users were located in just five states: New York, California, Florida, Texas, and Illinois;
• the highest rates of PrEP use – as measured by the number of persons using PrEP per 100,000 population – were in New York, Massachusetts, Rhode Island, Washington, and Illinois; and 
• the Northeast region had the highest rate of PrEP use per 100,000 population (47.4) – approximately double that in the West (28.1), the Midwest (23.5), and the South (22.6).
  

To mark the launch of its PrEP maps, the AIDSVu blog posted several recent interviews in which HIV experts discuss PrEP usage trends, access, and gender disparities in question-and-answer format. 

Public Health Service Updates Its Clinical Practice Guidelines for PrEP

The U.S. Public Health Service (PHS) recently published updated Clinical Practice Guidelines on the use of PrEP for HIV prevention in the United States. The revised guidelines include new data on the safety and efficacy of PrEP, indications for PrEP use, laboratory tests and diagnostic procedures, and considerations – such as potential drug interactions – when providing PrEP to persons at risk for HIV infection.  PHS notes that recent updates to the guidelines are highlighted in yellow throughout the document and “are intended solely to update the developing evidence base or to clarify specific points in clinical care. No changes were made to the graded recommendations for the use of PrEP in the U.S.”

HIV Guidelines and Drug Guide 

Biktarvy Now Classified as a Recommended Initial Regimen for HIV

On March 7, the Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living with HIV panel issued a statement indicating that the fixed-dose combination pill Biktarvy is now classified as one of the recommended initial regimens for most people living with HIV.  Biktarvy combines the integrase strand transfer inhibitor (INSTI) bictegravir (BIC) with the drugs tenofovir alafenamide (TAF) and emtricitabine (FTC).  According to AIDSinfo, “BIC/TAF/FTC [marketed as the combination pill Biktarvy] is an effective and well-tolerated INSTI-based regimen for initial therapy in adults with HIV, with efficacy that is noninferior to DTG/ABC/3TC and DTG [dolutegravir]plus TAF/FTC for up to 48 weeks. On the basis of these clinical trial results, the Panel classifies BIC/TAF/FTC as one of the Recommended Initial Regimens for Most Adults with HIV.”

Perinatal Guideline Panel Adds Guidance on Breastfeeding

The DHHS guidance document, Recommendations for the Use of Antiretroviral Drugs in Pregnant Women with HIV Infection and Interventions to Reduce Perinatal HIV Transmission in the United States, has been updated to include a section on counseling and managing the care of HIV+ women who wish to breastfeed.  According to AIDSinfo, “While the Panel does not recommend breastfeeding for women with HIV, this section is intended to provide tools to help providers counsel women living with HIV on the potential risks associated with breastfeeding and to provide a harm-reduction approach for women who choose to breastfeed despite intensive counseling. This section is not intended to be an endorsement of breastfeeding, nor is it a recommendation to breastfeed for women living with HIV in the United States.”

TPAN Publishes 2018 HIV Drug Guide 

As part of its March/April issue of Positively Aware, TPAN has published its 22nd annual HIV Drug Guide. The Guide is composed of several sections:

• “Getting the Most out of Your Drug Guide” has tips on using the guide to make informed HIV treatment decisions;
• “State of the Art” is a review of the available antiretroviral therapies for treating HIV and an HIV specialist’s suggestions to help persons living with HIV choose regimens tailored to their needs;
• “Standard Practice” is a summary of the DHHS HIV treatment guidelines; 
• “Know Where to Look” is a guide to finding copay and patient assistance programs to help cover the cost of HIV medications; 
• “Down the Road” is a look at new HIV drugs, HIV treatment strategies, and other expected developments in 2018 and beyond; and 
• “Find Your Drug Below” is an A to Z listing of all single-drug and combination pills currently used for the treatment of HIV.  
  

For each medication, the Guide provides information about the drug maker, wholesale price, standard dosing, potential side effects and toxicity, potential drug interactions, and additional relevant information. The drug listings also include different perspectives on each drug and combination through physician and activist comments.

Recent Fact Sheets and Reports from CDC and AIDSinfo

In recent weeks, CDC and AIDSinfo have published several new or updated reports and fact sheets.  These include: 

Managing HIV and Hepatitis C Outbreaks Among People Who Inject Drugs – A Guide for State and Local Health Departments: This 102-page CDC guidance document provides detailed information on preparing for, detecting, investigating, and responding to HIV and hepatitis C outbreaks among persons who inject drugs.

Estimated HIV Incidence and Prevalence in the United States, 2010-2015: This 77-page CDC report provides recent data on HIV incidence and prevalence among persons age 13 and older in the U.S., with breakdowns by race/ethnicity, gender, age, transmission category, and region.  An associated infographic provides a concise visual summary of key incidence and prevalence data in the report.

HIV in the United States by Geography: This 2-page CDC fact sheet provides estimates of new HIV infections and diagnosis rates by region (Northeast, Midwest, South, and West) and by state (including the District of Columbia). 

HIV Among Pregnant Women, Infants, and Children: This 2-page CDC fact sheet provides data on perinatal infections in the U.S., describes why pregnant women and their babies are at risk for infection, and summarizes CDC efforts to address mother-to-child transmission of HIV and improve perinatal care.

Ibalizumab: This new AIDSinfo fact sheet in question-and-answer format includes information about what ibalizumab (trade name Trogarzo) is, its indications for use, and potential side effects. A Spanish-language version of the fact sheet is also available.