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In Brief: July 27, 2018
In Brief  is NEAETC's news service covering the latest developments and educational resources about HIV, hepatitis, health disparities, and related topics. To subscribe, please click HERE.

Conference News

2018 International AIDS Conference  
As this issue of In Brief went to press, the 22nd International AIDS Conference (AIDS 2018) was under way in Amsterdam, the Netherlands.  This biennial event is the largest conference on any global health issue in the world. The theme of AIDS 2018 is “Breaking Barriers Building Bridges” – designed to draw attention to the need for rights-based approaches to more effectively reach key populations, including in Eastern Europe and Central Asia and the North-African/Middle Eastern regions where epidemics are growing.

For persons interested in following news from this important conference, we recommend the following websites:

  • AIDS 2018 – the official website for AIDS 2018, has links to the conference program, video recordings, and text summaries of key presentations and workshops.
  • AIDSmap, HIV.gov, NATAP, Poz, Project Inform, and Science Speaks Blog are also providing extensive news coverage from AIDS 2018.  It is worth noting that these news sites often continue publishing conference articles up to several weeks after the event ends.  So you may want to visit those sites repeatedly to see whether additional conference news has appeared.

We plan to summarize selected highlights from AIDS 2018 in the next issue of In Brief.

 

AIDS 2018 Update in Boston
If you live in the New England region, you may also wish to attend NEAETC’s free AIDS 2018 update, which will take place from 6:00-8:30 pm on Tuesday, August 14.  Speakers at the event will include physicians, Kenneth Mayer, Paul Sax, and  Rajesh Gandhi. Topics to be discussed include:

  • Pre-exposure prophylaxis (PrEP)
  • Other biomedical prevention strategies
  • Adult and adolescent antiretroviral treatment
  • Basic science
  • Hepatitis C
  • Non-infection comorbidities of HIV and viral hepatitis

For more information, and to register, please visit the conference update page.


HIV Testing

CDC Report Finds More HIV Testing Is Needed for Black MSM in the South
In an analysis of HIV testing at non-health care facilities in the U.S. South, researchers from the U.S. Centers for Disease Control and Prevention (CDC) found that, while only 6% of the HIV tests in these southern non-health care facilities were among Black men, this group accounted for 36% of all new HIV diagnoses. About two-thirds (67%) of HIV+ Black MSM in these Southern jurisdictions with newly diagnosed infection, and 58% with previously diagnosed infection, were linked to HIV medical care – figures well below of the national goal of 85%. The CDC authors note that, “Increasing HIV testing among Black MSM in the southern U.S. is essential for reducing HIV infection in this disproportionately affected population. However, the efficiency and effectiveness of this approach is contingent upon reaching MSM who are living with undiagnosed HIV infection. HIV testing programs in the southern U.S. can be designed to reach more Black MSM who are unaware of their HIV status either by conducting targeted risk-based testing in non-health care settings (e.g., outreach) or routine screening in agencies that also provide health care services to Black MSM. HIV testing programs in the southern U.S. also need to improve linkage to HIV medical care among HIV-positive Black MSM who are not in care.”

 

Antiretroviral Treatment

FDA Approves Combination Tablet Symtuza for HIV Treatment
On July 17, the U.S. Food and Drug Administration approved Symtuza – a new single-tablet regimen for the treatment of HIV infection. Made by Janssen Pharmaceuticals, Symtuza contains 800 milligrams (mg) of the protease inhibitor darunavir, 150 mg of the booster cobicistat, 200 mg of the nucleoside analogue emtricitabine, and 10 mg of tenofovir alafenamide. The daily tablet should be taken with food.  It can be used by people starting their first HIV regimen or by those who are switching from another regimen, provided that they have no known resistance to tenofovir or darunavir.
 

Guidelines and Recommendations

Updated Guidance on Pediatric Opportunistic Infections and Latent TB Infection
HHS has updated the herpes simplex virus (HSV) section of its Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Exposed and HIV-Infected Children.  The HSV section has been modified to reflect a new recommendation rating system and to add references.  

CDC has released updated recommendations for the use of once-weekly isoniazid-rifapentine for 12 weeks (3HP) for the treatment of latent tuberculosis (TB) infection. The recommendations support expanded use of an effective, shorter treatment regimen to reach more people with latent TB infection, including people living with HIV.

 

HIV Continuum of Care

New Publications Highlight HIV Prevention and Care Outcomes in the U.S.
CDC recently issued several new publications focusing on HIV prevention and care outcomes. Selected National HIV Prevention and Care Outcomes is an extensive slide set summarizing information on diagnosis rates, linkage to care, receipt of care, retention in care, and viral suppression in a series of maps and bar graphs. Breakdowns are provided by state, age, race/ethnicity, and transmission category.

The fact sheet Understanding the HIV Care Continuum provides an overview of the continuum and related key measures – the percentage of persons living with HIV who have been diagnosed; the percentage of those diagnosed who have been linked to care; the percentage who received medical care or were retained in care; and the percentage who achieved viral suppression. The fact sheet also describes how the continuum data are developed, as well as steps that CDC is taking to improve outcomes at each step on the continuum to reach the National HIV Prevention Objectives on HIV Diagnosis and Care.

Another fact sheet, Selected National HIV Prevention and Care Outcomes in the United States, summarizes the latest data on:

  • the proportion of people living with HIV who have been diagnosed (86% overall; 84.6% for males, 88.5% for females);
  • the proportion of persons linked to care within one month after HIV diagnosis (75.9% overall, with nearly identical rates for males and females); and
  • the proportion of persons living with diagnosed HIV infection who are receiving care (73.4% overall), retained in care (57.2% overall), and virally suppressed (59.8% overall).  The rates for receipt of care and retention in care were very similar in males and females.  There were small gender differences in viral suppression rates – 60.5% for males and 57.7% for females.

 

Educational Resources

Digital Marketing Pointers from HIV.gov
During the past month, the HIV.gov blog has published several new posts on digital marketing – part of an ongoing series to help agencies and organizations promote health literacy and make better use of digital tools when communicating about HIV-related topics.  These recent posts include:

 

Three Free CME Courses from Act Against AIDS and Health Education Partners

CDC’s Act Against AIDS campaigns in collaboration with Medscape and the Fenway  Institute, are now offering three new web-based courses with free continuing medical education (CME) credits available for clinicians.   

Advancing PrEP in Practice: Practical Strategies for Everyday Challenges – This course is designed to help primary care physicians increase their knowledge of HIV pre-exposure prophylaxis (PrEP) and identify patients who are appropriate candidates for PrEP.  

Delivering HIV Prevention and Care to Transgender People – This program from Fenway’s National LGBT Health Education Center presents the latest data on transgender people and HIV, describes the roles stigma and discrimination play in contributing to health disparities, and has tips on how to provide patient-centered care specific to the needs of transgender people.

HIV Treatment and Care: A Focus on Mental Health and Substance Use – This CME activity is designed to help physicians and nurses provide improved care to persons living with HIV who have mental health and/or substance use disorders. The course includes strategies for screening and addressing factors related to mental health disorders and substance use during HIV treatment and care.

Please note that courses offered on the Medscape site require registration as a Medscape member, which is free.

 

Updated Fact Sheets from AIDSinfo on Opportunistic Infections, Coinfections, and Conditions
The U.S. Department of Health and Human Services AIDSinfo site has recently updated several consumer fact sheets focusing on opportunistic infections, coinfections, and other conditions occurring in the setting of HIV infection.  These updated fact sheets are:

Spanish-language versions of these fact sheets are available on the AIDSinfo sister site infoSIDA.

 

AIDSource Adds HIV Conference Database to Website
The National Library of Medicine’s AIDSource has added a new searchable abstracts database feature to its website.  The site has abstracts for: 1) the International AIDS Conference starting in 1989, which is when that conference began; 2) IDWeek starting in 2012; and 3) the American Conference for the Treatment of HIV starting in 2017.  AIDSource visitors can search by abstract title, text, or author, and filter by conference name and year.  They may also download and email abstracts identified through their searches. AIDSource plans to add more features to the database, including expanding its scope with abstracts from other HIV conferences. People who wish to provide feedback on the database can email their questions or comments to: NLM_HIV@mail.nlm.nih.gov.

 

Other Reports, Fact Sheets, and Video Resources

From CDC:

  • Living with HIV – This updated web resource contains basic information for people living with HIV, including a Living with HIV 101 fact sheet, materials for persons newly diagnosed with HIV, and sections on understanding care, HIV treatment, AIDS and opportunistic infections, disclosure, protecting others, dealing with stigma and discrimination, mental health, healthy living with HIV, family planning, traveling with HIV, and additional resources.
  • NCHHSTP AtlasPlus Update – The National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention’s (NCHHSTP) AtlasPlus has added 11 new indicators that “increase access to information on HIV and, for the first time, social determinants of health,” according to CDC. AtlasPlus provides access to more than 15 years of CDC’s surveillance data on HIV, viral hepatitis, sexually transmitted diseases, and tuberculosis.
  • Partner Services Annual Report 2016 – This report summarizes the 2016 client-level partner services data from 59 of the 61 CDC-funded jurisdictions in the U.S. and dependent areas (Puerto Rico and U.S. Virgin Islands). During 2016, a total of 49,266 index patients were identified across all HIV Partner Services programs and named a total of 33,294 partners. Of the 6,660 partners tested with a documented HIV test result, 25% (1,670) were newly identified as HIV-positive.
  • HIV in the United States by Geography – This illustrated fact sheet provides breakdowns of new HIV diagnoses by state, geographic region, and race/ethnicity. During 2016, Southern states had disproportional rates of new HIV and AIDS diagnoses.  These states, which make up 38% of the U.S. population, accounted for more than half of the estimated 38,500 new HIV infections during 2016. The rates (per 100,000 people) of HIV diagnoses in 2016 were 16.8 in the South, 11.2 in the Northeast, 10.2 in the West, and 7.5 in the Midwest.
  • Low Prevalence of Hepatitis B Vaccination Among People Receiving HIV Care – In this 3-minute video, CDC epidemiologist John Weiser notes that over one-third of people receiving medical care for HIV have not been vaccinated for hepatitis B virus (HBV). In addition, only one in ten of these vaccination candidates receives a dose of HBV vaccine during one year of ongoing care. CDC notes that meeting the national goals for HBV elimination will require increased vaccination of patients treated for HIV in all practice settings, particularly at non-Ryan White HIV/AIDS Program-funded facilities.

 

From the National Academies of Science, Engineering, and Medicine:

  • Integrating Responses at the Intersection of Opioid Use Disorder and Infectious Disease Epidemics – This publication is the proceedings of a March 2018 public workshop that explored the scope of opioid use, HIV, and viral hepatitis epidemics in the U.S. In panel and open discussions, participants considered strategies to prevent and treat infections in people who inject drugs, as well as strategies to identify patients with these infections who are in need of treatment for their addiction.

 

From the National Institute of Allergy and Infectious Diseases:

  • Approaches to an HIV Cure – This plain-language, 4-minute video describes the process by which HIV infects cells, the reasons why a cure for HIV infection has not yet been achieved, and cure research currently under way. This includes research to eradicate HIV infection completely, as well as approaches for achieving a treatment-free remission – that is, allowing people living with HIV to keep latent virus suppressed without taking daily medication.