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In Brief: August 26, 2019

Inside This Issue: HIV prevention and care among persons who inject drugs; progress toward ending the global epidemic; benefits of HCV treatment for liver cancer survivors; new treatment for drug-resistant TB; and more. 


HIV Prevention and Care

CDC Study Underscores Need for Improved HIV Prevention and Care Among HIV+ Persons Who Inject Drugs

During 2016, 6% of newly diagnosed HIV infections in the U.S. were attributed to injection drug use. To gain insight into the prevalence of high-risk injection practices and sexual behaviors among HIV+ persons who inject drugs (PWID), CDC researchers recently analyzed data from the Medical Monitoring Project (MMP) for the period from 2015 through 2017. The analysis revealed that approximately 10% of HIV+ PWID reported sharing injection equipment. Nearly one-third (29%) of those surveyed said they sometimes kept used needles for reuse, and more than half (53%) said they sometimes disposed of used syringes in trash, in the street, or in containers not designed for medical waste.

Although 57% of HIV+ PWID reported that they needed drug or alcohol treatment, only 20% had received such treatment. HIV+ PWID were also more likely to have a detectable viral load than HIV+ persons who did not inject drugs (48% versus 35%). They were also more likely to engage in high-risk sexual behaviors, including condomless sex (63% versus 31%, exchange sex (17% versus 2%), and other high-risk sex (18% versus 6%).

“These findings underscore the importance of implementing a multipronged intervention approach to reducing HIV transmission among HIV-positive persons who inject drugs,” according to the CDC study researchers. “Continued efforts to reduce sexual and injection HIV transmission risk through support for expanding access to sterile injection equipment, drug treatment services, PrEP [pre-exposure prophylaxis], and education around harm reduction and condom use might strengthen HIV prevention programs and directly support the national initiative to end the HIV epidemic.”



The Global Epidemic

UNAIDS Reports Mixed Results in Efforts to End the Global Epidemic

Progress in reducing new HIV infections, increasing access to treatment, and ending HIV-related deaths is slowing down, according to a recent report on the global HIV/AIDS epidemic from UNAIDS. The report, Communities at the Center, documents wide variations in different nations’ progress toward ending the epidemic, with some countries making impressive gains while others are experiencing rises in new HIV infections and AIDS-related deaths.

Key population groups – including people who inject drugs, gay men and other men who have sex with men, transgender persons, sex workers, and prisoners – and their sexual partners now account for more than half (54%) of new HIV infections globally, according to the report. In Eastern Europe, Central Asia, the Middle East, and North Africa these key population groups accounted for the vast majority (95%) of new infections in 2018.

Unfortunately, less than 50% of these key population groups were reached with combination HIV prevention services in more than half of the countries that reported data for the report. “This highlights that key populations are still being marginalized and being left behind in the response to HIV,” according to UNAIDS.

“We urgently need increased political leadership to end AIDS,” notes Gunilla Carlsson, UNAIDS executive director. “This starts with investing adequately and smartly and by looking at what’s making some countries so successful. Ending AIDS is possible if we focus on people, not diseases, create road maps for the people and locations being left behind, and take a human rights-based approach to reach people most affected by HIV.”

Mapping HIV Laws and Policies Around the World

UNAIDS has launched a new Laws and Policies Analytics website that compiles and summarizes national laws and policies in response to the HIV/AIDS epidemic. The website aims to provide a detailed overview of HIV legal and policy data from more than 140 countries. According to UNAIDS, the site covers issues as diverse as different countries’ capacity to diagnose HIV among young babies, the existence of laws that discriminate against transgender people, and laws that allow people to be prosecuted for carrying condoms. “We must better understand legal and policy environments to drive effective responses to the HIV epidemic, notes Shannon Hader, UNAIDS deputy executive director. “This new tool will provide access to data on national laws and policies and allow for joint analysis with data on the epidemic and response, so that we can drive more deeply informed decision-making.” Countries that ratified the 2016 United Nations Political Declaration on HIV and AIDS committed to accelerate their efforts to increase the availability of high-quality data on HIV.  “Through making policy data widely available, UNAIDS seeks to promote transparency and an increased use of policy data in analyses of the HIV epidemic and the response to HIV in countries worldwide,” according to UNAIDS.


Hepatitis C and Tuberculosis 

Effective HCV Treatment Cuts Liver-Related Deaths by Nearly Half in Liver Cancer Survivors

Although direct-acting antivirals (DAAs) have revolutionized the treatment of chronic hepatitis C (HCV) – including for persons coinfected with HIV and HCV – many physicians have been reluctant to prescribe DAAs to treat HCV in patients with a history of liver cancer.  It was commonly believed that HCV, while very damaging, activated the immune system when it infected the liver, thereby reducing the likelihood of liver cancer recurrence. However, this assumption now appears to be false, according to the findings from a recent study published in the journal Gastroenterology.  

In this retrospective study, researchers compared the liver-related death rates of 797 patients from 31 healthcare systems in the U.S. and Canada who were successfully treated for HCV-related hepatocellular carcinoma (HCC) from 2013 through 2017. A total of 383 patients were later treated with DAA therapy for their chronic HCV infection and the remaining 414 patients were not treated with DAAs. 

The researchers found that the death rates from cirrhosis and liver cancer in liver cancer survivors treated with DAAs were 46% lower than among those who were not treated. “Not only are these drugs safe in this patient population [of liver cancer survivors], but we have now demonstrated that they are helpful,” notes Amit Singal, lead researcher for the study. “Our study changes the paradigm from ‘you could treat a patient’s hepatitis C’ to ‘you should treat it.’”


FDA Approves Drug to Treat Highly Drug-Resistant Tuberculosis

Tuberculosis (TB) is one of the leading causes of death among people living with HIV in the U.S. and worldwide. Having more treatment options, particularly for drug-resistant strains of TB, could help save the lives of many people coinfected with HIV and TB. On August 14, the U.S. Food and Drug Administration (FDA) approved the new antibacterial drug pretomanid for the treatment of highly drug resistant tuberculosis (TB). Pretomanid was developed by TB Alliance, a non-profit organization dedicated to the discovery and development of new, faster-acting and affordable TB medicines. FDA approved Pretomanid as part of a three-drug, six-month, all-oral regimen for treating people with extensively drug-resistant TB (XDR-TB) or multidrug-resistant TB (MDR-TB) who are unable to tolerate or are unresponsive to the currently available TB treatments. This three-drug treatment consists of bedaquiline, pretomanid, and linezolid and is sometimes referred to as the BPaL regimen.

“FDA approval of this treatment represents a victory for the people suffering from these highly drug-resistant forms of the world’s deadliest infectious disease,” notes Mel Spigelman, the president and CEO of TB Alliance. “The associated novel regimen will hopefully provide a shorter, more easily manageable and highly efficacious treatment for those in need.”

Pretomanid is only the third new anti-TB drug to be approved by FDA in more than 40 years. The drug is expected to be available in the U.S. by the end of this year.


Educational Resources

New and Updated Fact Sheets on the HIV Care Continuum and HIV Prevention

The CDC and HHS’s AIDSInfo site have recently published new and updated fact sheets focusing on HIV care and prevention issues.  The CDC publications are:

Understanding the HIV Care Continuum – This four-page fact sheet that includes an overview of what the HIV care continuum is, how it fits into the National HIV/AIDS Strategy (NHAS) objectives for HIV care, and approaches for monitoring the different elements of the continuum and progress toward achieving NHAS goals.

Selected National HIV Prevention and Care Outcomes in the United States – This 3-page fact sheet describes key indicators used to track progress toward NHAS goals, and summarizes recent national data on the proportion of persons diagnosed with HIV who are receiving HIV medical care, are retained in care, and who have achieved viral suppression.

Four updated AIDSinfo consumer fact sheets focus on different aspects of HIV prevention. Each fact sheet includes a summary of key points and links to additional information and resources.  Spanish versions of each fact sheet are also available.


July PACHA Meeting Examined the Impact of the HIV Epidemic on the South

The Presidential Advisory Council on HIV/AIDS (PACHA) met last month in Jackson, Mississippi, to discuss efforts to end the U.S. HIV/AIDS epidemic, with particular emphasis on the South – a region disproportionately impacted by the epidemic. The PACHA website has posted several presentations from the meeting, including: