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HIV and Hepatitis C Highlights from AIDS 2014

Latest Positive Pulse Newsletter

Paul Sax from Harvard Medical School and Mark Sulkowski from Johns Hopkins School of Medicine discuss highlights from this summer's International AIDS Conference, the largest and most comprehensive global meeting on the medical, public health, and social aspects of HIV and AIDS.

Highlights of this overview include the HIV cascade of care, developments in antiretroviral therapy, pre-exposure prophylaxis (PrEP) and other HIV prevention news, and new hepatitis C treatment for people with HIV/HCV coinfection.

10/22/14

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IDWeek 2014: Earlier Treatment, NNRTI Use Predict Slower HIV Rebound After Stopping ART

HIV viral load usually begins to rise again within 4 to 8 weeks after stopping antiretroviral therapy (ART), though starting treatment earlier in the course of infection and using a non-nucleoside reverse transcriptase inhibitor (NNRTI) may delay viral rebound, according to study findings presented at IDWeek 2014 last week in Philadelphia.

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Entire Female Reproductive Tract May Be Susceptible to HIV Infection

HIV may infect T-cells throughout the female reproductive tract including the vagina, ovaries, and surrounding lymph nodes -- not only the cervix, which has been the focus of most previous research, according to a study of macaque monkeys published in the October 9 edition of PLoS Pathogens.

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IDWeek 2014: NNRTIs and Protease Inhibitors Both Good for First ART, Channeling Affects Choices

Non-nucleoside reverse transcriptase inhibitors (NNRTIs) and boosted protease inhibitors work equally well for people starting HIV treatment for the first time, with similar viral suppression, CD4 cell gains, and disease progression, according to a large meta-analysis presented at IDWeek 2014 last week in Philadelphia. A related study shed light on factors affecting choice of initial antiretroviral regimen.

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IDWeek 2014: HIV Attachment Inhibitor BMS-663068 Works Well Across Patient Subgroups

An experimental attachment inhibitor that binds to the surface of the HIV envelope and prevents it from attaching to and entering CD4 T-cells demonstrated good virological response rates and tolerability regardless of age, sex, or race/ethnicity, according to research presented at IDWeek 2014, now underway in Philadelphia.

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IDWeek 2014: Longer Use, Age, Low Body Weight Raise Risk of Tenofovir Kidney Problems

Abnormal kidney biomarkers are common but rarely progress to serious kidney dysfunction in HIV positive people taking tenofovir, and longer duration of use, older age, and having diabetes or high blood pressure raise the risk, researchers reported at IDWeek 2014 last week in Philadelphia. A related study found that people with low body weight experienced progressive kidney function decline while taking tenofovir.

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IDWeek 2014: Social Network Strategies Encourage HIV Testing

Face-to-face social networking among peers is a more effective and proactive way to identify people with HIV infection than standard counseling, testing, and referral methods, according to study findings presented yesterday at the IDWeek 2014 conference in Philadelphia. In an analysis of 45 sites in Wisconsin, researchers found that social networking strategies identified a higher proportion of people who tested HIV positive than traditional methods.

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HIV Positive Stimulant Users Benefit from Antiretroviral Therapy

People with HIV who use methamphetamine or other stimulant drugs do well on antiretroviral therapy (ART) and appear not to be at greater risk than non-users for AIDS-related or all-cause death overall, but those who use stimulants more than half the time did have a higher risk of progression to AIDS or death, according to a study published in the September 30 Journal of Acquired Immune Deficiency Syndromes.

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IDWeek 2014: HIV Care Cascade at Kaiser Permanente Varies by Sex and Age

Though there has been improving performance of healthcare delivery at each point of the HIV care cascade, from linkage to care through viral suppression, "success varies significantly by age and gender, even in an integrated care system with equal access to care,” Michael Horberg of the Mid-Atlantic Permanente Research Institute reported yesterday at IDWeek 2014 in Philadelphia.

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High Effectiveness Seen in English PrEP Trial, All Will Be Offered Truvada

An interim analysis of the English PROUD study data has shown that daily Truvada pre-exposure prophylaxis (PrEP) is highly protective against HIV for gay men and other men who have sex with men (MSM) at high risk of infection. On this basis, the PROUD Trial Steering Committee has announced that participants currently on the deferred arm of the study will be offered the opportunity to begin PrEP ahead of schedule.

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Researchers Capture Images of HIV Spike Proteins that Allow Cell Entry

A team of researchers from the National Institutes of Health, Yale University, and Weill Cornell Medical College has found a way to visualize the activity of "spikes" on the surface of the HIV-1 envelope that change structure to enable the virus to enter host cells, according to reports published simultaneously in the October 8 editions of Science and Nature.

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Coverage of IDWeek 2014

HIVandHepatitis.com coverage of IDWeek 2014, October 8-12, in Philadelphia.

Conference highlights include the HIV cascade of care, experimental antiretroviral therapies, interferon-free hepatitis C treatment, and news about other infectious diseases including Ebola virus and enterovirus D68.

Full listing of coverage by topic

IDWeek 2014 website

10/17/14

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Second Potentially Cured Baby Has HIV Relapse Soon After Stopping Treatment

An Italian child who started antiretroviral treatment soon after birth and had undetectable plasma viral load, no apparent HIV DNA, and tested HIV antibody negative nevertheless experienced viral rebound shortly after a treatment interruption, once again disappointing hopes for a cure, researchers reported in the October 4 edition of The Lancet.

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October 15 is National Latino AIDS Awareness Day

October 15 is National Latino AIDS Awareness Day(NLAAD), an opportunity to raise awareness about HIV/AIDS among Latino and Hispanic people in the U.S. According to the Centers for Disease Control and Prevention (CDC), while Latinos/Hispanics make up approximately 16% of the total U.S. population, they accounted for about 21% of all new HIV infections in 2010. The incidence rate for Latinos is about 3 times higher than that of whites, with a majority of cases occurring among young men who have sex with men.

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HIVMA Issues Guidelines for Managing Chronic Kidney Disease in People with HIV

The HIV Medical Association (HIVMA) of the Infectious Diseases Society of America (IDSA) has released updated recommendations for HIV positive people with chronic kidney disease. The guidelines, published in the September 17 issue of Clinical Infectious Diseases, state that antiretroviral therapy (ART) is beneficial for such patients, but they should avoid tenofovir (Viread, also in the Truvada, Atripla, Complera, and Stribild coformulations), which can cause kidney impairment.

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IDWeek 2014: Efavirenz Not Linked to Suicide in Analysis of Insurance Records

The non-nucleoside reverse transcriptase inhibitor efavirenz (Sustiva, also in the Atripla single-tablet regimen) was not associated with a higher rate of suicidal thoughts or attempts in an analysis conducted by manufacturer Bristol-Myers Squibb (BMS), researchers reported at the 2014 IDWeek meeting last week in Philadelphia.

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UNAIDS: "Fast Track" Strategy Could Help End AIDS Epidemic by 2030

A rapid acceleration of HIV prevention and treatment efforts over the next 5 years directed at people most at risk in high prevalence areas could help turn the tide in the AIDS epidemic, according to participants at a recent high-level meeting during the 69th United Nations General Assembly. If fully implemented, this approach could potentially prevent 18 million new HIV infections and 11 million deaths by 2030, as well as reducing future costs.

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IDWeek 2014: Complera Matches Atripla for Women Starting HIV Treatment

The Complera (rilpivirine/tenofovir/emtricitabine) single-tablet regimen worked as well as Atripla (efavirenz/tenofovir/emtricitabine) for treatment-naive women and was somewhat better tolerated in the open-label STaR trial, according to a report at the IDWeek 2014 meeting last week in Philadelphia.

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USCA 2014: U.S. Conference on AIDS Underway in San Diego

The 18th annual U.S. Conference on AIDS, sponsored by the National Minority AIDS Council, is taking place this week in San Diego. While other conferences focus on new data about antiretroviral therapy and biomedical prevention, USCA emphasizes the social, economic, and cultural aspects of HIV/AIDS.

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IDWeek 2014: Behavioral and Financial Incentives May Improve HIV Treatment Outcomes

While making medications free can remove barriers to access for individuals who cannot pay for treatment, data suggest that for most people accessing care in industrialized countries, "making medications available for free or low cost will not solve problems with medication non-adherence," according to a presentation by Kevin Volpp from the University of Pennsylvania last week at IDWeek 2014 in Philadelphia.

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Monkey Transplant Study Rules Out Possible HIV Cure Mechanism

Macaque monkeys that received transplants of their own stem cells after undergoing intensive radiation that killed off their existing SHIV-infected immune cells experienced viral rebound soon after stopping antiretroviral drugs, indicating that pre-transplant "conditioning" was not solely responsible for the only known case of a person cured of HIV.

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