HIVandHepatitis.com
HIVandHepatitis.com
Efavirenz Appears Associated with Elevated Suicide Risk in START Trial

Participants in the START treatment-timing trial who took antiretroviral regimens containing efavirenz (Sustiva) had an increased risk of suicidal and self-injuring behavioral than those not using efavirenz, though the number of events was low and the effect was mainly seen among people with a prior psychiatric diagnosis, according to research presented at the 21st International AIDS Conference last month in Durban.

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START Analysis Looks at Who Benefits Most from Early HIV Treatment

Starting antiretroviral therapy (ART) soon after HIV diagnosis led to better outcomes than delayed treatment in all population subgroups in the START trial, researchers reported at the 21st International AIDS Conference (AIDS 2016) last week in Durban. But some people saw greater risk reductions, including those over age 50, those with a lower CD4:CD8 ratio and higher viral load, and those with cardiovascular risk factors.

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Early HIV Treatment -- Mothers Say They Need Time to Think

Findings from the first randomized controlled trial to date evaluating postpartum antiretroviral therapy (ART) for women with high CD4 cell counts (over 400 cells/mm3) highlight a critical need to increase treatment acceptance in this population, according to research presented at the 21st International AIDS Conference (AIDS 2016) last week in Durban.

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Starting Treatment on the Day of HIV Diagnosis Improves Outcomes

Interventions to improve linkage to HIV care and retention in treatment which speed up the start of antiretroviral therapy (ART) or provide intensive support to people before starting treatment produce better retention than standard practices, researchers reported at the 21st International AIDS Conference (AIDS 2016) last week in Durban.

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Once-Daily Raltegravir Works as Well as Twice-Daily For Initial HIV Treatment

A new formulation of the integrase inhibitor raltegravir (Isentress) taken once daily suppressed HIV viral load as well as the older formulation taken twice a day in people being treated for the first time, according to findings from the ONCEMRK study presented in a late-breaker session at the 21st International AIDS Conference (AIDS 2016) last week in Durban.

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Dolutegravir Plus Lamivudine Works Well as First-Line HIV Treatment

A 2-drug regimen of dolutegravir and the well-tolerated NRTI lamivudine led to sustained viral suppression for most people starting antiretroviral therapy (ART) for the first time in a small pilot study, according to a late-breaker presentation at the 21st International AIDS Conference (AIDS 2016) last week in Durban.

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Study Looks at Comprehensive HIV Treatment and Prevention Services for Sex Workers

A randomized trial of female sex workers in Zimbabwe, offering enhanced access to HIV treatment and pre-exposure prophylaxis (PrEP), has failed to show that the extra services helped reduce the proportion with detectable viral load, Frances Cowan reported at the 21st International AIDS Conference (AIDS 2016) last week in Durban. However, it appears that the comprehensive set of sex worker-friendly services offered in the control arm may have already been enough to substantially improve the health of participants.

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Long-Acting Injectable Drugs Work Well for HIV Maintenance Therapy

A pair of long-acting injectable antiretrovirals -- cabotegravir and rilpivirine -- administered once every 4 or 8 weeks maintained viral suppression in people who switched regimens with undetectable viral load, according to 48-week results from the LATTE-2 trial presented at the 21st International AIDS Conference (AIDS 2016) this week in Durban. A related qualitative analysis showed that study participants preferred long-acting injectables over pills for several reasons.

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HIV Will Only Be Cured with Combined Approaches, Conference Delegates Hear

Curing people of HIV infection will have to involve combinations of drugs and approaches, just as HIV treatment does, delegates heard at the Towards an HIV Cure workshop held in advance of the recent 21st International AIDS Conference (AIDS 2016) in Durban. The reason is the same, too: HIV can easily develop resistance to single agents, even ones as sophisticated as broadly neutralizing antibodies and gene-editing enzymes.

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Realism Needed About the Benefits and Risks of Taking Part in HIV Cure Research

A significant proportion of people living with HIV would be willing to take part in a study towards a cure for HIV, according to research presented at the recent 21st International AIDS Conference (AIDS 2016) in Durban. However, some potential participants may not fully understand that taking part in an early-phase study is highly unlikely to afford any personal clinical benefit, but might have the potential to cause harm.

HIVandHepatitis.com
International AIDS Society Releases New HIV Cure Research Strategy

The International AIDS Society (IAS) released an update to its strategy to guide HIV cure research. The strategy, authored by the leading researchers in the field, was published in the July 11 online edition of Nature Medicine and discussed at the IAS Towards an HIV Cure Symposium preceding the 21st International AIDS Conference last month in Durban.

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Seeking a Cure, Doctors Document Bone Marrow Transplant Recipients with HIV

The "Berlin patient," Timothy Ray Brown, has now survived 7 years off antiretroviral therapy (ART) with no sign of HIV reappearing in his body, and as time passes his position as "the person cured of HIV" becomes more secure. However, participants at the 2016 Towards a Cure Symposium, held in advance of the recent 21st International AIDS Conference (AIDS 2016) in Durban, heard about the work of a consortium of physicians and researchers who are searching for, and documenting, the fates of patients with HIV who, like Brown, have been given stem cell transplants for cancer, in an effort to abolish Brown's distinction as the only person to be cured of HIV.

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Young Women Treated Very Early Stay HIV Negative and Preserve Immune Function

A group of youngSouth African women who were diagnosed during very HIV early infection and immediately given antiretroviral therapy (ART) preserved their CD4 cell counts and the function of cells that HIV normally disrupts, according to a study presented at the 2016 Towards an HIV Cure Symposium, which preceded the 21st International AIDS Conference this week in Durban, South Africa. The majority of them never seroconverted, staying HIV-negative despite having evidence of low levels of HIV infection in their cells.

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Vaginal Ring for HIV Prevention is Effective and Acceptable

An updated adherence analysis from the ASPIRE study indicates that consistent users of a vaginal ring containing dapivirine experienced 65% fewer HIV infections, according to a presentation at the recent 21st International AIDS Conference (AIDS 2016) in Durban. Moreover, African women who took part in the study told researchers that they liked the product, found it easy to use, and preferred it to possible alternatives such as tablets or vaginal gels.

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Infection Prophylaxis Reduces Risk of Death for People Starting HIV Treatment Late

A package of enhanced prophylaxis against infections significantly reduced the risk of death for adults and children with advanced HIV disease after starting antiretroviral treatment in a randomized study, James Hakim from the University of Zimbabwe reported at the 21st International AIDS Conference (AIDS 2016) last month in Durban. Another analysis showed that intensifying treatment by adding raltegravir did not offer added benefits.

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Study Looks at Use of HIV PrEP During Pregnancy and Breastfeeding

Truvada for pre-exposure prophylaxis (PrEP) when it was offered as an additional tool for preventing HIV infection during the pre-conception period, pregnancy, and breastfeeding, according to study findings presented at the 21st International AIDS Conference (AIDS 2016) last month in Durban and published in the July 19 online edition of the American Journal of Obstetrics and Gynecology.

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No New HIV Infections Seen in San Francisco's Strut PrEP Program

A community-based sexual health clinic in San Francisco has offered nurse-led pre-exposure prophylaxis (PrEP) services to more than 1200 clients and seen no HIV infections to date, according to a presentation last month at the 21st International AIDS Conference (AIDS 2016) in Durban.

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Vaginal Bacteria May Increase HIV Susceptibility and Reduce PrEP Effectiveness

Overgrowth of a certain species of vaginal bacteria was associated with a 13-fold higher likelihood of becoming infected with HIV, while another species was found to lower tenofovir levels and may contribute to reduced efficacy of pre-exposure prophylaxis (PrEP) delivered in a vaginal gel, according to a set of presentations at the 21st International AIDS Conference (AIDS 2016) last month in Durban.

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PrEP Rollout in France Tops 1000, Ipergay Shows 97% Effectiveness

Through July 2016, a total of 1077 people -- 96.4% of them gay men -- have started HIV pre-exposure prophylaxis (PrEP) through the public healthcare system in France, Jean-Michel Molina, principal investigator of the Ipergay trial, told delegates at the 21st International AIDS Conference (AIDS 2016) last week in Durban. 90 clinics now offer PrEP assessment and prescription, and 273 doctors have been accredited as PrEP physicians.

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Large Test-and-Treat Study Fails to Show Impact on New HIV Infections

The first major research study of "test and treat" as a public health intervention to report its final results -- ANRS 12249 -- has found that the strategy failed to reduce new HIV infections in the African communities where it was provided, according to a report at the 21st International AIDS Conference (AIDS 2016) last week in Durban.

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Bone Loss Recovers After Stopping PrEP, Biannual Kidney Monitoring Enough for Most

Young adults taking Truvada for pre-exposure prophylaxis (PrEP) experienced a modest decrease in bone mineral density early on, but this stabilized after a year and those who stopped taking it began to see a reversal of the decline, researchers reported last week at the 21st International AIDS Conference (AIDS 2016) in Durban. Another study found that clinically relevant declines in kidney function among Truvada PrEP users are rare and monitoring every 6 months is adequate for most people.

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More Confidence on Zero Risk -- Still No Linked HIV Infections in PARTNER Study

The PARTNER study, which 2 years ago generated headlines by establishing that the chance of an HIV-positive person with an undetectable viral load transmitting the virus was very low and quite possibly zero, released new data last week at the 21st International AIDS Conference (AIDS 2016) that further refined this estimate. The findings were also published in the July 12 New England Journal of Medicine.

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Study Looks at Comprehensive HIV Treatment and Prevention Services for Sex Workers

A randomized trial of female sex workers in Zimbabwe, offering enhanced access to HIV treatment and pre-exposure prophylaxis (PrEP), has failed to show that the extra services helped reduce the proportion with detectable viral load, Frances Cowan reported at the 21st International AIDS Conference (AIDS 2016) last week in Durban. However, it appears that the comprehensive set of sex worker-friendly services offered in the control arm may have already been enough to substantially improve the health of participants.

HIVandHepatitis.com
Australia Adopts Ambitious Plan to Use PrEP to "Virtually Eliminate" HIV

Australia plans an ambitious program of pre-exposure prophylaxis (PrEP) provision for gay men at high risk of HIV, with the aim of "virtually eliminating" HIV in the gay community by 2020, Iryna Zablotska from the University of New South Wales told delegates at the 21st International AIDS Conference (AIDS 2016) this week in Durban. PrEP roll-out is also underway in some countries in Kenya and South Africa.

HIVandHepatitis.com
South Africa Has Driven Mother-to-Child HIV Transmission Down to 4%

Mother-to-child transmission (MTCT) of HIV at a population level was just over 4% at 18 months of follow-up in a national evaluation in South Africa, Ameena Goga, presenting on behalf of the South African prevention of mother-to-child transmission Evaluation Group, told participants at the 21st International AIDS Conference (AIDS 2016) this week in Durban.

HIVandHepatitis.com
New HIV Vaccine Efficacy Trial Set to Start this Year

A new efficacy trial for an HIV vaccine -- only the seventh ever conducted in the history of the epidemic -- will start this November, delegates heard at the 21st International AIDS Conference (AIDS 2016) taking place this week in Durban. The HVTN 702 study will enroll 5400 men and women in southern Africa, and is planned to last for 4 years. In May it was announced that a pilot study, HVTN 100, had met the criteria for the vaccine being taken forward into the larger study. But this week was the first time researchers revealed how well it had met those criteria.

HIVandHepatitis.com
PrEP Can Further Reduce HIV Risk After Partner Starts Antiretroviral Treatment

Offering Truvada pre-exposure prophylaxis (PrEP) to the HIV-negative partner in a serodiscordant couple during the first 6 months after the HIV-positive partner starts antiretroviral therapy (ART) can serve as a "bridge" to further reduce the likelihood of HIV infection, researchers reported at the 21st International AIDS Conference (AIDS 2016) taking place this week in Durban, South Africa.

HIVandHepatitis.com
Young Gay Men Can Do Well on PrEP, But May Need More Support

Young gay and bisexual men had good adherence to Truvada for pre-exposure prophylaxis (PrEP) during the first few months of a demonstration project with close monitoring, but adherence slipped once follow-up switched from monthly to quarterly, suggesting that young people using PrEP may require more on-going support, according to a presentation at the 21st International AIDS Conference (AIDS 2016) this week in Durban.

HIVandHepatitis.com
PrEP Use Exceeds 79,000 in U.S., But Some Groups Lagging Behind

More than 79,000 people in the U.S. have started Truvada for pre-exposure prophylaxis (PrEP) over the past 4 years, according to the latest results from a survey of retail pharmacies by Gilead Sciences, presented today at the 21st International AIDS Conference (AIDS 2016) in Durban. Yet while large gains in PrEP use have been seen among men in cities with large gay communities, some groups are not benefitting as much as they could.

HIVandHepatitis.com
Researchers Now Focusing on Best Ways to Get PrEP to People Who Need It

Speaking to a pre-conference meeting on HIV pre-exposure prophylaxis (PrEP) ahead of the 21st International AIDS Conference (AIDS 2016), International AIDS Society president Chris Beyrer reminded delegates that when the International AIDS Conference was last held in Durban in the year 2000, the event was notable for drawing attention to the enormous gap in access to HIV treatment between rich and poorer countries. That conference began the treatment access era. "Now is really the time to start the PrEP access era," Beyrer said.

HIVandHepatitis.com


Access to Home Testing Doubles Frequency of HIV Testing Among Australian Gay Men

A randomized trial conducted with Australian gay men has shown that easy access to self-testing kits can double the frequency with which men test for HIV, with an even greater increase among men who used to test infrequently, Muhammad Jamil of the Kirby Institute reported at the 21st International AIDS Conference (AIDS 2016) last month in Durban.

HIVandHepatitis.com
NYC Clinic Outlines How to Improve PrEP Uptake by Transgender People

Dedicated efforts are needed to engage transgender men and women with clinical services and to encourage them to use pre-exposure prophylaxis (PrEP), Asa Radix from the Callen-Lorde Community Health Center in New York said during a presentation at the recent 21st International AIDS Conference (AIDS 2016) in Durban.

HIVandHepatitis.com
How Can Clinical Services Engage Men Who Have Sex With Men in Africa?

Men who have sex with men (MSM) living in African countries have an extremely high burden of HIV, Stefan Baral of Johns Hopkins University reminded delegates at the recent 21st International AIDS Conference (AIDS 2016) in Durban. But in situations often marked by widespread social disapproval of homosexual behavior, health services for MSM are few and far between.

HIVandHepatitis.com


Neglect of Infectious Disease in Prisons Highlighted at Conference

A special issue of The Lancet was published to coincide with the recent 21st International AIDS Conference in Durban, containing a comprehensive seriesof reviews on the burden of HIV, hepatitis B, hepatitis C, and tuberculosis (TB) among prisoners worldwide.

HIVandHepatitis.com


New HIV Infections Have Stopped Declining Worldwide, Now Rising in Some Regions

After a decade of rapidly declining HIV incidence following the introduction of effective antiretroviral treatment, progress in reducing new infections has stalled worldwide and in some areas incidence has started to increase, according to a new analysis from the Global Burden of Disease Study presented at the 21st International AIDS Conference (AIDS 2016) last month in Durban and published in the August 2016 edition of The Lancet HIV.

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Mapping Local HIV Epidemics Can Help Target Resources to Areas with Greatest Need

Global health agencies have recently put a new emphasis on geography. UNAIDS has called for programs to focus on "location and population." PEPFAR (the U.S. President's Emergency Plan for AIDS Relief) says there is a "need to do the right things in the right places at the right time." The Global Fund believes there is a need to "target resources to areas with the greatest need." But how can these principles be applied in practice? Speakers at the 21st International AIDS Conference (AIDS 2016) last month in Durban outlined examples of how maps and geographical analyses have helped improve HIV services in the U.S. and South Africa.

HIVandHepatitis.com
Reducing Clinic Visits Supports Retention in Care, African Studies Show

Interventions which reduce the need for people with HIV to attend clinics are proving highly successful in retaining people in care and supporting adherence to HIV medication in southern Africa, according to reports presented at the 21st International AIDS Conference (AIDS 2016) last month in Durban.

HIVandHepatitis.com
New Strategy Aims to End AIDS in Children by 2020

A new strategy to end pediatric AIDS, launched last month at the 21st International AIDS Conference (AIDS 2016) in Durban, calls for antiretroviral treatment services to reach 1.6 million children and 1.2 million adolescents by 2018. The "Super-Fast-Track" strategy is intended to close the gap between adult and pediatric treatment access, according to UNAIDS, and will pull together the actions of numerous agencies.

HIVandHepatitis.com
Viral Load Pilot Study Shows Roll-Out Will Depend on an Educated Workforce

For viral load testing to prevent HIV treatment failure, drug resistance, and onward transmission, treatment programs will need to invest in better record-keeping and clinic procedures, human resources, demand creation, and decentralization of second-line treatment provision, a large pilot study of viral load test provision in southern Africa has found. Findings were presented last month at the 21st International AIDS Conference (AIDS 2016) in Durban.

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Progress Towards 90-90-90 Targets in Southern Africa -- Find the Men!

Studies of treatment cascade performance in South Africa and Namibia show large variations between districts and highlight the need for up-to-date information on performance to guide programming, advocacy, and funding, according to presentations at the 21st International AIDS Conference (AIDS 2016) last week in Durban. In particular, the studies emphasized the low rates of HIV diagnosis among men in the region, and low rates of viral suppression, especially among men.

HIVandHepatitis.com
HIV Treatment Programs Need to Prepare for a "Youth Bulge"

Treatment programs in sub-Saharan Africa must prepare for a growing population of adolescents over the next few years as children born with HIV grow up and begin a transition from child health services to adult clinics, Mhairi Maskew from the University of Witwatersrand told participants at the 21st International AIDS Conference (AIDS 2016) this week in Durban.

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SEARCH Study Exceeds 90-90-90 Targets After 2 Years of HIV Test-and-Treat

A large study that embeds "'test-and-treat" for HIV within a larger multi-disease prevention campaign in rural Kenya and Uganda has achieved 82% viral suppression after 2 years, and has already exceeded UNAIDS targets for viral suppression after 1 year of activity, investigators from the SEARCH study reported at the 21st International AIDS Conference (AIDS 2016) this week in Durban.

HIVandHepatitis.com
Gains in Curbing HIV Could Be Lost Without Continued Commitment

Participants at the 21st International AIDS Conference (AIDS 2016), taking place this week in Durban, South Africa, reviewed the remarkable gains that have been made in access to HIV treatment and new prevention tools since the conference was last held here 16 years ago. But researchers, activists, and government leaders agreed that this progress could be reversed if stakeholders do not commit to increased funding and respect for the human rights of key populations at risk.

HIVandHepatitis.com
Progress Towards 90-90-90 Targets is Promising, but Funding Is the Critical Step

The United Nations 90-90-90 targets for HIV testing, treatment, and viral suppression are achievable by 2020 in many high-burden countries, but donor retreat is now the biggest threat to widespread success, delegates agreed at the UN 90-90-90 Target Workshop ahead of the 21st International AIDS Conference (AIDS 2016) in Durban.

HIVandHepatitis.com
HIV Criminalization on the Rise, Especially in Sub-Saharan Africa

Globally, 72 countries have adopted laws that specifically allow for HIV criminalization, either because the law is specific to HIV, or because it names HIV as one (or more) of the diseases covered by a broader law. This total increases to 101 jurisdictions when the HIV criminalization laws in 30 of the states that make up the U.S. are counted individually. The findings were presented at the Beyond Blame pre-conference held in advance of the 21st International AIDS Conference (AIDS 2016) last month in Durban.

HIVandHepatitis.com
HIV Stigma Persists in the Undetectable Era

In an era of widespread HIV treatment and undetectable viral load, stigma remains a persistent feature in the lives of almost half of people living with diagnosed HIV in the U.K., according to findings from The People Living with HIV Stigma Survey UK 2015, reported at the 21st International AIDS Conference (AIDS 2016) last week in Durban. Nonetheless the majority of people with HIV score highly on measures of psychological resilience, enabling them to cope better with stigma.

HIVandHepatitis.com


Neglect of Infectious Disease in Prisons Highlighted at Conference

A special issue of The Lancet was published to coincide with the recent 21st International AIDS Conference in Durban, containing a comprehensive seriesof reviews on the burden of HIV, hepatitis B, hepatitis C, and tuberculosis (TB) among prisoners worldwide.

HIVandHepatitis.com
AbbVie 3D and 2D Hepatitis C Combos Work Well for HIV/HCV Coinfected People

AbbVie's paritaprevir-based 3D regimen for hepatitis C virus (HCV) genotype 1 and 2D regimen for genotype 4 were shown to be highly effective and well-tolerated for HIV-positive people with HCV coinfection in the TURQUOISE-I trial, according to a report at the 21st International AIDS Conference last week in Durban.

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Sofosbuvir/Velpatasvir Shows High Cure Rate in HIV/HCV Coinfection Study

The once-daily coformulation of sofosbuvir and velpatasvir was highly effective against all hepatitis C virus (HCV) genotypes and was safe and well tolerated by HIV/HCV coinfected patients in the ASTRAL-5 trial, according to results presented at the 21st International AIDS Conference (AIDS 2016)this week in Durban. A related analysis showed that sofosbuvir/velpatasvir can be safely combined with most widely used antiretrovirals, with the exception of efavirenz.

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Ongoing Hepatitis B Virus Replication Raises Mortality for People with HIV

People with HIV and hepatitis B virus (HBV) coinfection have more than double the risk of death if they have ongoing high-level HBV replication, indicating a need for prompt treatment, according to an analysis from the Temprano trial presented at an HIV and viral hepatitis coinfection session at the 21st International AIDS Conference (AIDS 2016) last month in Durban.

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Neglect of Infectious Disease in Prisons Highlighted at Conference

A special issue of The Lancet was published to coincide with the recent 21st International AIDS Conference in Durban, containing a comprehensive seriesof reviews on the burden of HIV, hepatitis B, hepatitis C, and tuberculosis (TB) among prisoners worldwide.

HIVandHepatitis.com
New WHO Algorithm Aims to Prevent TB Deaths in People with Advanced HIV

The World Health Organization (WHO) has released a new diagnostic algorithm to reduce the likelihood of seriously ill people with HIV dying of undiagnosed and untreated tuberculosis (TB). The algorithm was presented at a scientific workshop at the 21st International AIDS Conference last month in Durban.

 

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High-Dose Rifampicin for TB May Improve Survival of HIV+ People with Low CD4 Counts

More aggressive tuberculosis (TB) treatment using a high dose of rifampicin, in addition to antiretroviral therapy (ART), could reduce mortality among people with HIV/TB coinfection who are severely immunocompromised, according to results from the 3-arm RAFA trial presented at the 21st International AIDS Conference (AIDS 2016) last month in Durban.

HIVandHepatitis.com
Does Detectable CMV Signal High Mortality Risk for Older People with HIV and TB?

A study conducted in a cohort of hospitalized adults with HIV-associated tuberculosis (TB) in Khayelitsha found that having a detectable cytomegalovirus (CMV) viral load was associated with higher mortality within the first 12 weeks on TB treatment, according to Amy Ward from the University of Cape Town, who presented the findings at the 21st International AIDS Conference last month in Durban.

HIVandHepatitis.com
Training Community Health Workers Leads to Surge in TB Diagnoses in Malawi

An intervention using community health workers -- who normally provide case management support for HIV-positive pregnant women and their families -- to also provide intensified tuberculosis (TB) case finding was associated with a dramatic 20-fold increase in TB detection at a very busy antiretroviral therapy (ART) clinic in rural Malawi, according to a study presented at the 21st International AIDS Conference last week in Durban.

HIVandHepatitis.com
TB 2016 Demands a Global Commitment to End Tuberculosis

While much of the TB 2016 meeting, held ahead of the 21st International AIDS Conference (AIDS 2016) in Durban, was devoted to the rapidly evolving science in the fight against tuberculosis (TB), the meeting also highlighted the failure of the world, including the international HIV community, to adequately respond to the TB epidemic -- which last year surpassed HIV as the leading infectious cause of death in the world.

HIVandHepatitis.com
Shortened Regimen for MDR-TB Shows Good Results for Children

The use of a shortened 9-month treatment regimen for multidrug-resistant tuberculosis (MDR-TB), known as the "Bangladesh regimen," was shown to be successful in 83% of children and adolescents diagnosed with rifampicin-resistant TB, researchers reported at the TB 2016 meeting, held ahead of the 21st International AIDS Conference (AIDS 2016) this week in Durban. A second study presented at the meeting showed that the antibiotic levofloxacin can be used to treat MDR-TB in children.