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In-Brief: May 24th, 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.

Cancer and HIV

Prostate and Lung Cancers Expected to Be Most Common Cancers Among HIV+ Persons by 2030

Based on current trends in cancer diagnoses, the National Cancer Institute (NCI) projects that prostate and lung cancers will be most commonly diagnosed cancers among persons living with HIV (PLWH) in the U.S. by 2030.  In a recent report published in the Annals of Internal Medicine, researchers from NCI and the Centers for Disease Control and Prevention (CDC) note that total annual new cancer diagnoses among U.S. PLWH are expected to decline 18% from approximately 8150 cases in 2010 to 6690 by 2030 – largely the result of and 80% decrease in the number of AIDS-defining cancer (ADCs) – such as Kaposi’s sarcoma and non-Hodgkin lymphoma – arising from the earlier diagnosis and major advances in the treatment of HIV infection since the mid- to late 1990s.  During this period, the proportion of cancer deaths from ADCs versus non-AIDS defining cancers (NADCs) has fallen dramatically.  The researchers note, however, that with the aging of the HIV-infected population in the U.S., the incidence of some NADCs associated with aging and lifestyle will likely increase, with the total number of NADC diagnoses rising from an estimated 5420 in 2010 to 5980 in 2030.  By that time, prostate cancer and lung cancer are expected to be the most frequently diagnosed cancers among PLWH, with 1590 and 1030 cases, respectively.

 In another study published in the Journal of the American Academy of Dermatology, Danish researchers reported that HIV infection may significantly increase the risk of skin cancer. They found that Danish PLWH had about a 1.8 times higher rate of basal cell carcinoma (BCC) and a 5.4 times high risk of squamous cell carcinoma (SCC) than the general population. The study also indicated that PLWH’s lowest ever CD4 T-cell count – but not their current CD4 count – was associated with the increased risk of SCC.

HIV Transmission

Meta-Analysis: Spitting Presents No Risk & Biting Negligible Risk of HIV Transmission

Spitting presents no risk and biting only a negligible risk of HIV transmission, according to a meta-analysis published in the journal HIV Medicine.  According to the article, “The perceived threat of HIV transmission through spitting and biting is evidenced by the increasing use of ‘spit hoods’ by Police Forces in the U.K.” In addition, the U.K. parliament has considered adopting a bill that would increase penalties for assaults on emergency workers, citing the risk of communicable disease transmission as one justification.  

For their analysis, an international research team reviewed 742 abstracts, yielding 32 articles for full?text review and 13 case reports/series. The researchers found no reported cases of HIV transmission related to spitting and nine cases identified following a bite, in which the majority (6 of 9) occurred between family, in fights involving serious wounds (3 of 9), or to untrained first?aiders placing fingers in the mouth of someone having a seizure (2 of 9). Only 4 of the cases were classified as highly plausible or confirmed transmission, and none of the cases related to emergency workers.

“There is no risk of transmitting HIV through spitting, and the risk through biting is negligible,” the research team concluded. “Post?exposure prophylaxis is not indicated after a bite in all but exceptional circumstances. Policies to protect emergency workers should be developed with this evidence in mind.”

Organ Transplantation 

Clinical Trial to Track Outcomes of Kidney Transplants Between HIV+ Donors and Recipients

The first large-scale clinical trial to study kidney transplantations between HIV+ donors and HIV+ recipients has begun at 19 clinical centers across the U.S. The purpose of the HOPE in Action Multicenter Kidney Study is to determine the safety of HIV+ to HIV+ kidney transplants by evaluating recipients for potential transplant-related and HIV-related complications following surgery. The study is sponsored by Johns Hopkins University in collaboration with the National Institute of Allergy and Infectious Diseases.

While organ transplants between donors and recipients with HIV have been successfully completed in South Africa since 2008, such transplants were illegal in the U.S. until the passage of the HIV Organ Policy Equity (HOPE) Act in 2013. The HOPE Act allows U.S. transplant teams with an approved research protocol to transplant organs from donors with HIV into qualified recipients with end-stage organ failure who are also living with HIV, a practice that may shorten the time people living with HIV wait to receive a transplant. The transplantation of organs from donors who have HIV to individuals uninfected with HIV remains illegal in the U.S.

The Hope in Action clinical trial will track the clinical outcomes of 160 kidney transplants. All transplant recipients in the study will be living with HIV; 80 of them will receive kidneys from deceased donors who had HIV, and 80 will receive kidneys from HIV-uninfected deceased donors serving as the control group. Health care teams and study participants will be made aware of the HIV status of the organ donor.  The study began in mid-April 2018 and is expected to be completed by August 2022.  

“A kidney transplant can mean a second chance at a normal life for a person with end-stage renal disease who may otherwise need hours-long dialysis sessions, multiple times per week,” notes Johns Hopkins researcher Christine Durand, the principal investigator for the clinical trial. “If proven safe and effective in our study, kidney transplants between people with HIV may result in people living with HIV receiving donated organs sooner and the overall organ transplant waiting list shrinking — to the benefit of everyone who needs a kidney transplant, regardless of HIV status.” 

Social Determinants and Health Equity 

Kaiser Brief Examines Role of Social Determinants in Promoting Health and Health Equity

A new Kaiser Family Foundation (KFF) issue brief provides an overview of social determinants of health – the “conditions in which people are born, grow, live, work and age that shape health” – and their role in health equity. Social determinants include factors like socioeconomic status, education, neighborhood and physical environment, employment, and social support networks, as well as access to health care. “Addressing social determinants of health is important for improving health and reducing longstanding disparities in health and health care,” according to the brief.

“There are a growing number of initiatives to address social determinants of health within and outside of the health care system,” the brief notes. “Outside of the health care system, initiatives seek to shape policies and practices in non-health sectors in ways that promote health and health equity. Within the health care system, there are multi-payer federal and state initiatives as well as Medicaid-specific initiatives focused on addressing social needs. These include models under the Center for Medicare and Medicaid and Innovation, Medicaid delivery system and payment reform initiatives, and options under Medicaid. Managed care plans and providers also are engaged in activities to identify and address social needs.”

Despite these advances, “Many challenges remain to address social determinants of health, and new directions pursued by the Trump Administration could limit resources and initiatives focused on these efforts,” according to the brief. “The Trump Administration is pursuing a range of new policies and policy changes, including enforcing and expanding work requirements associated with public programs and reducing funding for prevention and public health. These changes may limit individuals’ access to assistance programs to address health and other needs and reduce resources available to address social determinants of health.”

Access to PrEP

Latino Commission on AIDS Seeks Information on PrEP Providers Serving Hispanic/Latinx Communities

Although approximately one-quarter of all new U.S. HIV diagnoses in 2015 were among Latinos, this group accounted for only 12% of the prescriptions for HIV pre-exposure prophylaxis (PrEP) issued between 2012 and 2015, according to the Latino Commission on AIDS (LCA).  To help address this disparity in PrEP access, LCA is requesting assistance to develop list of PrEP providers throughout the U.S., including Puerto Rico and the U.S. Virgin Islands, who serve Hispanic/Latinx communities. If you’d like to help, you can complete a brief form with the name of medical providers, clinics, and community centers that are providing services to Hispanic/Latinx communities – and the different populations they work with.

Fact Sheets and Other Resources

Information on Investigational HIV Drugs from AIDSinfo

If you want to learn about new HIV medicines in development, then it’s worth checking out the AIDSinfo Drug Database, which has fact sheets on more than 60 investigational HIV vaccines and drugs used to treat HIV infection itself and a wide range of opportunistic infections and other illnesses that may affect people living with HIV.  These investigational drugs and vaccines are currently being studied in clinical trials and have not yet been approved by the Food and Drug Administration (FDA) for sale in the U.S. to treat or prevent HIV and related conditions.  Database users can browse by drug names or do filtered searches by drugs’ FDA approval status – which includes a category for investigational drugs – as well as drug classes and the conditions for which particular drugs are used.  AIDSinfo provides information for both patients and health professionals. Each patient fact sheet includes an overview of the drug and information on clinical trials studying the drug.  A corresponding health professional fact sheet includes more detailed, scientific information about the drug, including details on the pharmacology of the drug and on adverse events identified in clinical trials. For example, the latest investigational drug fact sheets added to the database include VRC-HIVADV014-00-VP and VRC-HIVDNA016-00-VP, both of which are therapeutic HIV vaccines. AIDSinfo’s lefitolimod, romidepsin, and VAC-3S fact sheets have recently been updated based on research that was presented at the 2018 Conference on Retroviruses and Opportunistic Infections (CROI). 

New and Updated CDC Reports, Fact Sheets, and Flyers

During the past few weeks, CDC has published several new reports, fact sheets, and flyers related to HIV, affected populations, and harm reduction.  These include:

Diagnoses of HIV Infection among Adults and Adolescents in Metropolitan Statistical Areas – United States and Puerto Rico, 2016 – This 87-page surveillance report focuses on HIV diagnoses in Metropolitan Statistical Areas (MSAs) with breakdowns by gender, age, race-ethnicity, and transmission category.  Information on HIV prevalence rates is also provided. 

Access to Syringe Services Programs – Kentucky, North Carolina, and West Virginia, 2013-2017 – This research report, published in MMWR, describes the expansion of syringe services programs (SSPs) in Kentucky, North Carolina, and West Virginia between 2013 and 2017, and the care that has been provided by these programs.

How to Clean Your Syringes – This illustrated fact sheet with detailed step-by-step instructions for rinsing and disinfecting syringes.

Used Syringes Are Dangerous – This illustrated flyer that users can customize to include contact information for their local health department.

HIV Among Native Hawaiians and Other Pacific Islanders in the United States and 6 Dependent Areas – This updated fact sheet has information on HIV diagnoses, prevalence, prevention challenges, and what CDC is doing to address in this population group.