Inside This Issue: Updates on antiretroviral treatment, living with HIV, the U.S. and global epidemic, hepatitis C, and educational resources.
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.
CHAMP Study Finds That About One in Nine People May Achieve Viral Load Control After Stopping HIV Treatment
A collaborative study known as CHAMP – short for Control of HIV after Antiretroviral Medication Pause – has found that about one in nine people may be able to achieve viral load control for at least 48 weeks after stopping antiretroviral treatment (ART). The CHAMP analysis pooled information from 10 randomized controlled trials and four cohort studies conducted in the U.S. and Canada with published results in the period from 2000 through 2017. In particular, the researchers focused on “HIV post-treatment controllers” – persons who start ART but maintain HIV suppression after treatment interruption. For this study, post-treatment controllers were defined as persons who underwent treatment interruption and subsequently had viral loads ≤400 copies per milliliter for at least two-thirds of the time for 24 weeks or more. It is worth noting that a substantial number of the persons who met the study criteria for post-treatment controllers had significantly higher viral loads at some time after stopping treatment. The CHAMP analysis identified a total of 67 post-treatment controllers among the more than 600 persons studied. Nearly 60% of the post-treatment controllers were persons who were treated during early HIV infection. The proportion of persons who were post-treatment controllers was also substantially higher among those treated during early infection (13%) compared to those treated during chronic infection (4%). Among post-treatment controllers followed with weekly viral load monitoring, 45% had a peak viral load greater than 1,000 copies per milliliter after treatment interruption, and 33% had a peak viral load at or above 10,000 copies. The remaining 55% of post-treatment controllers maintained HIV control for 2 years, with about 20% maintaining control for 5 years or more.
Trial of Once-Monthly Injectable HIV Regimen Yields Promising Results
In the not-too-distant future, it may be possible to treat HIV effectively with a once-monthly dose of a two-drug, injectable ART regimen – rather than the three-drug daily (or more frequent) oral regimens that have been the standard of care for HIV treatment since the mid-1990s. On August 15, ViiV Healthcare announced positive results from its international Phase III ATLAS study of a long-acting, injectable ART regimen. ATLAS – short for Antiretroviral Therapy as Long-Acting Suppression – is designed to determine whether persons who have been successfully treated with an oral, three-drug ART regimen for at least six months can maintain HIV viral suppression after switching to an injectable regimen consisting of the non-nucleoside reverse transcriptase inhibitor rilpivirine and the experimental integrase inhibitor cabotegravir. The study showed that persons who switched to the long-acting rilpivirine and cabotegravir regimen had similar levels of viral suppression as a control group who remained on an oral, three-drug regimen. “This novel approach is another step towards potentially reducing the treatment burden for people living with HIV,” noted John Pottage, Jr., ViiV’s chief scientific and medical officer. “The data from ATLAS suggest a long-acting, injectable two-drug regimen of cabotegravir and rilpivirine may offer an alternative to daily, oral three-drug therapy for people who have previously achieved viral suppression. If approved, this regimen would give people living with HIV one month between each dose of antiretroviral therapy, changing HIV treatment from 365 dosing days per year, to just 12.”
Living with HIV
People Living with HIV Have Double the Risk of Developing Cardiovascular Disease
The growing availability of ART worldwide has dramatically reduced both the incidence and the number of deaths from many of the opportunistic infections among people living with HIV (PLWH). Currently, most deaths among PLWH who are receiving ART are the result of non-communicable illnesses, especially cardiovascular disease (CVD). To explore this issue in greater depth, an international team led by researchers from the University of Edinburgh recently completed a meta-analysis of 80 studies from more than 150 countries to determine the pooled rate and risk of CVD in people living with HIV. The meta-analysis included nearly 800,000 people PLWH and a total follow-up of 3.5 million person-years. In this group of PLWH, the crude rate of cardiovascular disease was approximately 62 per 10,000 person-years – about 2.2 times the rate for uninfected persons. In addition, the proportion of global CVD attributable to HIV disease increased from 0.36% in 1990 to 0.92% in 2015, and the number of disability-adjusted life years (DALYs) more than tripled from about 740,000 to 2.57 million. The analysis also revealed that the impact of HIV-associated CVD was particularly high in Sub-Saharan Africa and the Asia-Pacific region – which together accounted for more than two-thirds of the total global burden of HIV-associated CVD. Commenting on the study findings, lead researcher for the study Anoop Shah noted, “This study has important implications when planning cardiovascular preventative policies in low-resource countries where the burden of HIV remains high and that of cardiovascular disease is growing.”
The U.S. and Global HIV Epidemic
New CDC Slide Set Summarizes Trends in HIV Mortality
The U.S. Centers for Disease Control and Prevention (CDC) recently released Mortality Slide Series Through 2015, a 27-slide set tracking trends in HIV mortality from the early epidemic in the 1980s to 2015. The slide set includes graphs and maps that provide breakdowns in HIV mortality by race/ethnicity, age, gender, state, and geographic region over the course of the epidemic. The slides illustrate that, after rising quickly in the 1980s and early 1990s, the annual U.S. death rate due to HIV infection peaked in 1994-1995, then decreased rapidly through 1997 – coinciding with the rapid roll-out of the first effective antiretroviral treatment regimens – and continued to decrease much more slowly thereafter. In recent years, persons dying of HIV infection increasingly consist of:
- women (26% in 2015);
- Blacks/African Americans (52% in 2015);
- residents of the South (53% in 2015); and
- persons 45 years of age or older (74% in 2015)
The slides also show where HIV infection has placed among the six leading causes of death for different population groups from the late 1980s to 2015. Around the peak of the U.S. epidemic, HIV infection was the leading cause of death in the U.S. among all persons 25 to 44 years old. For some groups, including 25- to 44-year old Black/African American men and women, HIV was the leading cause of death for a substantially longer period, and still remains among the 10 leading causes of death.
New IAPAC Podcast Focuses on HIV Response in Urban Areas Worldwide
Last month, the International Association of Providers of AIDS Care (IAPAC) launched a new podcast series designed to tell the story of the urban AIDS response globally. The podcast series is named “Fast-Track Cities,” after an initiative of the same name that involves more than 250 cities worldwide that are intensifying their local HIV efforts to end the epidemic. A total of 12 episodes are planned for the podcast’s first season, and three have already been released: “Darkest Days,” “HIV: Science, Treatment, and the Future,” and “Fast-Track Cities: The Urban Response.” According to IAPAC, each episode features interviews from some of the most prominent voices in the global HIV movement – including people living with and affected by HIV, clinicians, scientists, government officials, and representatives from community organizations. “After spending the last almost four years focused on advancing the Fast-Track Cities objectives, we want to give voice to the inspiring stories about the urban AIDS response that uniquely vary city-by-city,” notes José Zuniga, IAPAC president. “We are excited to launch the Fast-Track Cities podcast to tell these stories in a powerful way through the podcast medium. Our goal is not only to educate our audience about HIV/AIDS globally, but to share the best practices that cities working in partnership with communities are advancing to ensure that no one is left behind as we strive to end AIDS as a public health threat. I would like to personally thank everyone who graciously participated in the first season as we could not have done this without you and your personal anecdotes.”
New York Launches First-in-Nation State Strategy to Eliminate Hepatitis C
Late last month, New York Governor Andrew Cuomo announced a strategic plan to eliminate hepatitis C virus (HCV) infection, which currently affects more than 200,000 New Yorkers. The strategy aims to increase access to antiviral medications that can now cure HCV in the vast majority of persons infected, and to expand programs connecting New Yorkers with HCV prevention, screening, and treatment services. “This holistic, first-in-the-nation approach to eradicating hepatitis C is modeled on our ongoing efforts to end the AIDS epidemic, and will improve the health of many of the most vulnerable among us including people battling drug addiction,” Governor Cuomo said. “We are going to end hepatitis C in New York State.” To increase access to HCV antiviral medications, New York is allocating $5 million in new funding for HCV services, such as education, patient navigation, and care and treatment programs in harm reduction settings.
The HCV elimination strategy specifically addresses the needs of groups disproportionately affected by HCV, including persons who inject drugs and incarcerated persons. The elements of the strategy include:
- establishing a patient navigation program within syringe-exchange programs to link persons living with HCV to care and treatment;
- developing innovative HCV treatment models targeting people who inject drugs that include co-located medication-assisted treatment along with HCV treatment;
- expanding services to criminal justice populations to link inmates with HCV to care, treatment, and supportive services upon release from incarceration; and
- enhancing HCV surveillance to track the epidemic, inform program development, and establish and monitor hepatitis C elimination targets.
More Digital Marketing Tips from HIV.gov
During the past month, the HIV.gov blog has published several new posts in its ongoing digital marketing series, which is designed to help agencies and organizations increase their understanding of digital tools and use them effectively in their HIV-related communications. The most recent posts focus particularly on Americans’ growing use of, and dependence on, smartphones and its implications for health communications:
- Five Trends to Watch in Mobile
- Is Your Website Mobile-Ready?
- Five Tips for Using Mobile Video Effectively
AIDSinfo Releases Updated Edition of HIV/AIDS Glossary
The U.S. Department of Health and Human Services’ AIDSinfo web resource recently released the ninth edition of its Glossary of HIV/AIDS-Related Terms. The updated glossary includes definitions for more than 700 HIV- and AIDS-related terms in English and Spanish. It is designed to serve as a guide for understanding HIV for people living with HIV, their families and friends, healthcare professionals, and students. Many of the glossary’s terms are accompanied by images that illustrate important concepts, such as the structure and life cycle of HIV, how particular classes of drugs work, the progression of HIV disease, and the different phases of clinical trials. The glossary is available online, in print, and as an app. AIDSinfo would like to receive user feedback on the glossary. You can email any questions or comments about this resource to: firstname.lastname@example.org.
Updated HIV Consumer Fact Sheets from AIDSinfo
AIDSinfo has also recently posted updated versions of its consumer fact sheets that provide an introduction to HIV disease, including the basics of HIV testing, treatment, and research. Each fact sheet includes a summary of key points as well as links to additional information and resources.
- HIV/AIDS: The Basics
- The HIV Life Cycle
- The Stages of HIV Infection
- What Is a Latent HIV Reservoir?
- HIV Testing
- FDA-Approved HIV Medicines
- What Is an Investigational HIV Drug?
- What Is a Therapeutic HIV Vaccine?
- What Is a Preventive HIV Vaccine?
- HIV/AIDS Clinical Trials
Updated versions of the fact sheets are also available in Spanish at AIDSinfo’s sister site infoSIDA.