In Brief: HIV and Hepatitis News
 
Early November 2017
 
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.
 
Test Your Knowledge About the U.S. HIV/AIDS Epidemic
 
Scroll to the bottom of this newsletter to find the answers to these questions!
 
1. In the U.S., approximately _________ people were living with HIV infection at the end of 2014 (the latest year for which data are available).
a. 4.5 million
b. 1.1 million
c. 600,000
d. 300,000
e. 85,000
 
2. Gay and bisexual men accounted for about _____ of all new U.S. HIV diagnoses during 2015.
a. two-thirds
b. half
c. one-quarter
d. 10%
e. 5%
 
3. About how many deaths were directly attributed to HIV/AIDS in the U.S. during 2014?
a. 18,500
b. 12,200
c. 6,700
d. 3,900
e. 2,700
 
4. Although African Americans represent about 12% of the U.S. population, they account for about ___ of all new HIV diagnoses.
a. 84%
b. 45%
c. 24%
d. 12%
e. 7%
 
5. True or false: The proportion of people living with HIV who know their HIV status now exceeds the 90% goal set in the U.S. National HIV/AIDS Strategy.
a. true
b. false
The Opioid Crisis
 
President Trump Declares Public Health Emergency in Opioid Crisis
 
In a speech and accompanying statement on October 26, President Donald Trump declared the opioid crisis a public health emergency and said that he is “mobilizing his entire Administration to address drug addiction and opioid abuse.” According to the White House, the declaration allows for:
 
·        shifting of resources within HIV/AIDS programs to allow people eligible for those programs to receive substance abuse treatment;
·        expanded access to telemedicine services, including services involving remote prescribing of medicine commonly used for substance abuse or mental health treatment;
·        HHS to more quickly make temporary appointments of specialists with the capacity to respond effectively to the opioid crisis; and
·        the Department of Labor to issue dislocated worker grants to help workers who have been displaced from the workforce because of the opioid crisis, subject to available funding.
CDC Studies Examine Rising Substance Use and Overdose Deaths in the U.S.
 
Recent issues of the Morbidity and Mortality Weekly Report (MMWR) include two major reports analyzing the rise in U.S. substance use and overdose deaths. In the first report, researchers examined substance use trends in metropolitan and nonmetropolitan areas during the period from 2003-2014, and drug overdose deaths from 1999-2015. Their key findings include the following:
 
·        Although both metropolitan and nonmetropolitan areas experienced significant increases from 2003–2005 to 2012–2014 in self-reported past-month use of illicit drugs, the prevalence was higher in large metropolitan areas than in small metropolitan or nonmetropolitan areas throughout the study period.
·        In 2015, approximately six times as many drug overdose deaths occurred in metropolitan areas than occurred in nonmetropolitan areas (metropolitan: 45,059; nonmetropolitan: 7,345). Drug overdose death rates (per 100,000 population) were initially higher in metropolitan areas than in nonmetropolitan areas in 1999 (6.4 versus 4.0). However, these death rates converged in 2004, and by 2015, the nonmetropolitan rate (17.0) was slightly higher than the metropolitan rate (16.2).
 
For the U.S. as a whole, deaths from synthetic opioids (excluding methadone) skyrocketed from about 3,100 in 2013 to approximately 20,000 last year. The second MMWR report examined opioid-related deaths in 10 states during the period from July through December 2016, and looked at the role of potent synthetic opioids, including fentanyl and fentanyl analogs, in those deaths. According to the authors, this is the first report to examine toxicologic and death scene evidence from multiple states to gain a deeper understanding of overdose deaths.
 
The researchers found that about 56% of the persons who died of overdoses in the study tested positive for fentanyl, and 14% tested positive for fentanyl analogs. In addition, in more than half of deaths involving fentanyl and fentanyl analogs, persons also tested positive for other illicit drugs. The researchers conclude that, “Increasing mixing or co-use of fentanyl, heroin, cocaine, and fentanyl analogs might contribute to increased overdose risk, because users are exposed to drug products that vary substantially in potency and that include some extremely potent products. Surveillance for opioid overdoses needs to expand to track the rapidly changing illicit opioid market.”
HIV Continuum of Care
 
New Reports Focus on Continuum of Care in Hispanics/Latinos and Women
 
During October, MMWR featured two new CDC reports examining different aspects of the HIV continuum of care among Hispanics/Latinos and women in the U.S. In the first report, CDC researchers analyzed data on the HIV care continuum among Hispanics/Latinos from 38 U.S. jurisdictions for which complete laboratory data were available. Nearly 142,000 Hispanics/Latinos aged 13 years or older were living with diagnosed HIV infection in those jurisdictions at the end of 2014. Of this total, about 70% were receiving care, 58% were retained in care, and 58% were virally suppressed.
 
“The lowest levels of care and viral suppression were among males with infection attributed to injection drug use, and the highest levels of care and viral suppression were among heterosexual females,” according to the report. The researchers also noted that Hispanics/Latinos in four age groups ≥25 years had similar percentages of retention and viral suppression. In contrast, young persons aged 13 to 24 years had the highest retention in care among all age groups (about 61%), but had the lowest overall viral suppression (about 55%). The researchers conclude that, “Among Hispanics or Latinos, targeted strategies for different groups, such as persons who inject drugs, might be needed to achieve improvements in linkage, care, and viral suppression.”
 
The second MMWR report examines 2015 data on CDC-funded HIV tests and HIV prevention services from 61 health departments and 123 community-based organizations. The researchers found that, among women identified as having HIV infection, 62% had received an HIV diagnosis prior to the current test, and the vast majority of those women (87%) were not in HIV medical care at the time of the test. Rates for linkage to medical care within 90 days of the current test date were 61% and 58% for women with newly diagnosed and previously diagnosed HIV infection, respectively.
 
Among women with previously diagnosed HIV infection, the linkage-to-care rates were substantially lower among Black women (57%) than among White women (65%). “To reduce and eventually eliminate HIV infection among women in the United States, HIV testing programs need to improve early linkage to HIV medical care among HIV-positive women who are not in care, regardless of their known HIV status at the time of testing,” the researchers conclude. “It is also important for the HIV prevention public health community to increase their focus on identifying women with previously diagnosed HIV infection who are not in care, especially Black women, and promptly link them to care, as well as monitor and evaluate these efforts.”
Response to the Global HIV/AIDS Epidemic
 
The Joint United Nations Programme on HIV/AIDS (UNAIDS) recently published two reports focusing on HIV prevention and HIV-related stigma and discrimination. In HIV Prevention 2020 Road Map – Accelerating HIV Prevention to Reduce New Infections by 75%, UNAIDS “provides the basis for a country-led movement to scale up HIV prevention programmes” as part of a global effort to end AIDS as a public health threat by 2030. “The focus of the Road Map is on HIV primary prevention and the promotion and provision of effective tools to prevent HIV infections,” according to the agency. “It emphasizes the empowerment of adolescent girls, young women, and key populations at risk so that they can protect themselves and stay free of infection.”
 
The report Confronting Discrimination presents recent evidence on the ways in which HIV-related stigma and discrimination “create barriers across the HIV prevention, testing, and treatment cascades and reduce the impact of the AIDS response.” Since the report also summarizes best practices for confronting stigma and discrimination, with a special emphasis on health care settings, it is designed to be a resource for program managers, policy-makers, health care providers, and communities.
Treatment Guidelines
 
HHS Updates Guidelines for Managing Opportunistic Infections and for Preventing Perinatal HIV Transmission
 
 
OI Guidelines: The Candida (thrush) section has been updated to include recommendations concerning: the use of the drug isavuconazole as a treatment for uncomplicated esophageal candidiasis; complications that may develop when the drug fluconazole is used to treat candidiasis during pregnancy; and other information about the treatment of particular Candida strains, drug interactions, and the prevention of mucosal candidiasis.
 
Pregnancy and Perinatal Guidelines: Drawing on recent research findings about the safety and efficacy of different antiretroviral drugs (ARVs) during pregnancy, the pregnancy and perinatal guidelines now include new recommendations concerning the use of the following ARVs:
·        dolutegravir is now classified as an Alternative agent for treating ARV-naïve pregnant women.
·        elvitegravir/cobicistat is now classified as not recommended for initial use in pregnancy; in addition, doctors treating pregnant women who are already being treated with regimens containing elvitegravir/cobicistat are advised to consider switching to a more effective regimen.
Maraviroc and enfuvirtide are also not recommended for use in pregnant women starting HIV treatment.
Conference News
 
Highlights from the AASLD Liver Meeting in Washington
 
On October 20 through 24, an estimated 9,500 persons attended the 2017 Liver Meeting in Washington, D.C. The meeting, which is organized by the American Association for the Study of Liver Diseases (AASLD), was one of the year’s major scientific conferences focusing on basic research, treatment, and health outcomes for liver diseases, including viral hepatitis. A special October supplement issue of the journal Hepatology contains a compilation of abstracts from the meeting’s oral presentations and posters, which are available through open access. In addition, the National AIDS Treatment Advocacy Project (NATAP) has published summaries of selected presentations in the hepatitis B and hepatitis C sections of its website, which are accessible from the NATAP home page. To find the NATAP news summaries from the 2017 Liver Meeting, look for articles with the prefix “AASLD” and with a late October 2017 dateline.
Research on Experimental HIV Drugs and Combinations from IDWeek 2017
 
TheBodyPro site has compiled a review of new HIV drugs and combination pills in the latter stages of clinical testing, based on research presented at IDWeek 2017, which was held this year on October 4 through 8 in San Diego, California. The review includes news on the following antiretroviral drugs and combination pills: 
 
·        cabotegravir, a long-acting integrase inhibitor that is being tested both for HIV treatment and as pre-exposure prophylaxis;
·        ibalizumab, an entry inhibitor that prevents HIV from binding to cells’ CD4 receptors;
·        D/C/F/TAF, a single-pill coformulation of four previously approved HIV drugs – darunavir, cobicistat, emtricitabine (also called FTC), and tenofovir alafenamide (TAF); and
·        B/F/TAF, a single-pill that combines the experimental integrase inhibitor bictegravir with the two previously approved drugs FTC and TAF.
For additional HIV-related news from IDWeek 2017, you can visit the event website and browse through the presentations organized by topic in the approximately 75 sessions of the conference’s HIV-STD-TB track.
 
Test Your Knowledge Answers:
1: B. An estimated 1.1 million people were living with HIV in the U.S. at the end of 2014.
2: A. In 2015, gay and bisexual men accounted for about two-thirds of all new HIV diagnoses in the U.S.
3: C. About 6,700 U.S. deaths were directly attributed to HIV/AIDS during 2014, the latest year for which mortality data are available.
4: B. African Americans accounted for nearly half (45%) of all new U.S. HIV diagnoses during 2015.
5: False. The latest available data indicate that only about 85% of people living with HIV in the U.S. have been diagnosed with the virus. 
Check out some statistics about the global HIV/AIDS epidemic in our next issue of In Brief, coming in mid-November!

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