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In-Brief: March 22nd, 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.

Highlights from the 25th Conference on Retroviruses and Opportunistic Infections

The 25th Conference on Retroviruses and Opportunistic Infections (CROI) was held in Boston, Massachusetts, between March 4 and 7.  Each year, CROI is one of the world’s major scientific conferences on HIV/AIDS, opportunistic illnesses, and related conditions.  Much of this issue of In Brief will be devoted to highlights from CROI in the form of headlines from the HIV, medical, and scientific press, together with links to more detailed coverage.  For your convenience, we have curated the headlines by topic, so that you may quickly review important developments and then explore in depth the news of greatest interest to you.  

Webcasts from CROI

The CROI Webcasts page provides the titles, authors, and links to more than 1,500 conference presentations.  Visitors to the page can browse through and sort presentations by date, session or presentation title, and speaker name.  Visitors may then stream or download presentation videos, audio tracks, and slides.  

General News Summaries from CROI

Abstracts from CROI Press Conferences: This page on the official CROI website has links to the abstracts of approximately 35 key studies presented at CROI on a range of topics, including: HIV surveillance and epidemiology; the HIV reservoir and viral replication; antiretroviral treatment; prevention and treatment of tuberculosis; approaches to expand access to HIV treatment and care; non-AIDS complications seen in persons living with HIV; pre-exposure prophylaxis; other HIV prevention tools – HIV testing and vaginal rings; women’s health and treatment of pediatric infection; hepatitis C and liver disease; and HIV-associated cancers.

Blog Posts and Videos from The Department of Health and Human Services (HHS) site has published a series of blog posts and associated videos summarizing news from CROI:  

Really Rapid Review – CROI 2018, Boston
: This brief summary by Paul Sax was published in NEJM Journal Watch shortly after the conference ended.  It includes a series of two- to four-sentence summaries of 25 developments in the prevention, treatment, and management of HIV infection, viral hepatitis, opportunistic infections, and related health conditions.

HIV Prevention

Broadly Neutralizing Antibody Treatment May Target Viral Reservoir in Monkeys (National Institute of Allergy and Infectious Diseases – NIAID); related coverage from AIDSmap

HIV Prevention Pill Not Reaching Most Americans Who Could Benefit – Especially People of Color (CDC Newsroom); related coverage from AIDSmap and Poz 

High Uptake and Use of Vaginal Ring for HIV Prevention Observed in Open-Label Study (NIAID); related coverage from Healio and Science Speaks Blog 

Four Models of PrEP Service Provision to Enhance Access and Uptake (TheBodyPro)

Powerful New PrEP and Treatment Drug Should Be Effective as a Small Weekly Pill (AIDSmap); related coverage from Poz

Another Likely Case of PrEP ‘Breakthrough’ Infection Reported (AIDSmap)

How Much ‘PrEP-Resistant’ HIV Is Out There? (AIDSmap)

Compared with HIV Transmission Trends, PrEP Use Lags Greatly in the South (Poz)

New South Wales Puts 9000 People on PrEP, Achieves a One-Third Decline in New HIV Infections (AIDSmap); related coverage from Poz

Access to and Integration of Care

Separate and Unequal Access Frames Discussion at CROI Panel on U.S. HIV Care Cascade (TheBodyPRO)

Rapid Entry HIV Program Reduces Time to Viral Suppression in Vulnerable Populations (Healio)

Average Time from HIV Diagnosis to Treatment Fell to Six Days in 2016 in San Francisco (AIDSmap); related coverage from Poz

HIV Field Can Lead Steps to Integrate Care, Recognize Human Right to Mental Health (Science Speaks Blog)

HIV in Specific Population Groups

CDC Identifies Clusters of Rapidly Transmitting HIV Nationwide (Poz)

Transgender Women in Los Angeles Are More Likely to Be in High HIV Incidence Clusters Than Any Other Group (AIDSmap); related coverage from Poz

U.S. Genotyping Survey Finds Rapid HIV Infection Rate in Young and Latino Gay Men (AIDSmap)

Naltrexone Improves HIV Care in Freed Inmates (Healio); related coverage from AIDSmap and Poz

Very Early Treatment in Children Limits HIV Reservoir (AIDSmap); related coverage from Poz

Viral Hepatitis, Opportunistic Illnesses, and Other Health Conditions

The Latest Hepatitis C and HIV Conference News (Poz)

Most HIV/HCV Coinfected Patients Do Not Clear HCV Spontaneously (Healio)

One-Month Tuberculosis Prophylaxis as Effective as Nine-Month Regimen for People Living with HIV (NIAID); related coverage from AIDSmap

New TB Screening Methods Cut Deaths in People with HIV (AIDSmap)

Statin Users Have Lower Rates of Many Types of Cancer (AIDSmap); related coverage from Poz

HIV Is Independently Associated with Peripheral Artery Disease (Poz)

HIV Is Linked to the Progression of Coronary Plaque Among Men (Poz)

People with HIV and Kidney Disease Have Major Health Risks (Poz)

Among Gay & Bi Men, Syphilis Is Much More Common in Those with HIV (Poz)

New HIV Treatment

FDA Approves Ibalizumab for Multidrug-Resistant HIV

On March 6, the U.S. Food and Drug Administration (FDA) approved a new drug – the long-acting monoclonal antibody ibalizumab-uiyk (trade name Trogarzo) – for the treatment of multidrug-resistant (MDR) HIV in adults whose current treatment regimens are ineffective. According to the drug makers – TaiMed Biologics USA Corp.  and Theratechnologies – Trogarzo is the first HIV treatment with a new mechanism of action to be approved by FDA in over 10 years. The drug is described as “a CD4-directed post-attachment HIV-1 inhibitor that binds to CD4+ receptors on host cells,” thereby blocking HIV infection of those cells.  Theratechnologies expects to launch Trogarzo in April. The wholesale acquisition cost of the drug is expected to be $118,000 per year.

Trogarzo is injected intravenously every 14 days and is used in combination with other antiretroviral drugs (ARVs). “While most patients living with HIV can be successfully treated using a combination of two or more ARVs, a small percentage of patients who have taken many HIV drugs in the past have multidrug resistant HIV, limiting their treatment options and putting them at a high risk of HIV-related complications and progression to death,” noted Jeff Murray, a deputy director in FDA’s Center for Drug Evaluation and Research. “Trogarzo is the first drug in a new class of antiretroviral medications that can provide significant benefit to patients who have run out of HIV treatment options.”

The safety and efficacy of Trogarzo were evaluated in a clinical trial of about 40 heavily treatment-experienced patients with MDR HIV-1 who continued to have high HIV viral loads while on antiretroviral treatment. Many of the study participants had previously been treated with 10 or more ARVs. A majority of people in the trial experienced a significant decrease in their HIV viral load one week after Trogarzo was added to their failing ARV regimens. After 24 weeks of treatment with Trogarzo and other ARVs, nearly half (43%) of the trial’s participants achieved HIV viral suppression.

HIV Guidelines and Fact Sheets 

HHS Updates Opportunistic Infections Guidelines with New Information for Human Papillomavirus

HHS’s Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents have recently been updated with new information about Human Papillomavirus (HPV). The guidelines’ revised HPV section recommends the use of 9-valent HPV vaccine for women and men, as well as continued Pap and HPV testing for women who are over 65 and living with HIV. In addition, the revised text includes more information about the occurrence of oropharyngeal warts and cancer related to HPV.

New and Updated CDC Fact Sheets

CDC recently published several new and updated HIV resources:

HIV Among Women: This fact sheet provides information about recent HIV diagnoses and trends among U.S. women, the factors that place women at risk for HIV infection, and steps CDC is taking to address HIV infection among women.

HIV Prevention with Health Departments: This fact sheet provides a breakdown of CDC's domestic funding for HIV in 2018 and the programs for which that funding will be used. Total funding awards for states and selected metropolitan areas are also provided.

HIV Prevention in the South: This 2-page fact sheet provides information about HIV infection in the U.S. South – a region with disproportionately high rates of persons living with HIV, new HIV diagnoses, and undiagnosed HIV infections. It includes regional data about the epidemiology of HIV, knowledge of HIV status, HIV in rural areas, and the intersection of the opioid crisis, HIV, and hepatitis. The fact sheet also provides information about regional and state-by-state funding for domestic HIV surveillance, prevention, and other programs in the South.