Category Archives: HIV care

HIV drug prices keep rising – Why is no one talking about it?

From thebody.com

The state of the HIV epidemic in the United States is a global embarrassment. Currently, we spend more than any other country per person on domestic HIV treatment, yet by almost every metric, our epidemic is worse than that of other wealthy nations. So why the discrepancy between cost and outcome? The problems are multifactorial, including systemic racism, classism, transphobia, and homophobia. Oddly enough, however, egregious price gouging by the pharmaceutical industry has gotten almost no attention, despite its central role in hampering America’s HIV response. High drug prices distort our nation’s fight against AIDS, forcing the health care system to pay massive markups to pharmaceutical companies and leaving relatively little for other vital services. As a result, we continue to line the pockets of pharmaceutical executives rather than addressing the broad social and environmental barriers to effective HIV treatment and prevention.

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Five ways to flip the script on HIV

From HIVplusmag.com

According to the Centers for Disease Control and Prevention’s 2017 HIV Surveillance Report, African-Americans represent 41 percent of new HIV diagnoses yet comprise only 12 percent of the U.S. population. In 2018, an article in Journal of Racial and Ethnic Health Disparities offered a five-point “action plan” for community leaders to address and reduce that disparity.

Be Immersive: Although the authors don’t go as far as suggesting all efforts must arise from black communities, they do note the need for work to be done in collaboration with those communities, and for answers to these challenges to be culturally relevant to African-Americans. (Pointing to an “unavailability of access to HIV healthcare and testing,” the researchers also call for “free or reduced-cost testing.”)

Be Nonjudgmental: The authors call for leaders and service providers to work to eliminate prejudices and unconscious biases that may interfere with HIV diagnoses and treatment. After all, they point out, some of the most-impacted populations are those who face stigma, including LGBTQ people, drug users, and those currently or formerly incarcerated. In particular, the researchers call out “cultural HIV/AIDS stigma” and “homo-negativity.”

Be Knowledgeable: The authors stress the importance of understanding “new approaches” to prevention and treatment—clearly referencing the recent consensus that undetectable equals untransmittable (U=U, which shows that once an HIV-positive person in treatment reaches viral suppression they are no longer at risk of transmitting the virus to a partner), and explicitly mentioning the use of pre-exposure prophylaxis (PrEP) as a highly effective barrier to transmission.

Be an Advocate: The authors want community leaders to become more vocal in calling attention to the epidemic and its impact on the black community. But that’s just the beginning. The action plan notes that much larger social issues must also be addressed in order to “eradicate secondary factors such as incarceration rates, poverty, STDs, and other factors that increase the chances of contracting HIV.” Essentially, they are calling for intersectional activism.

Be Innovative: The plan says to be “proactive and create solutions that evolve with the times and the changing needs of the affected populations.” Certainly, that includes new technologies and treatments, but the authors also point to innovative programs such as Many Men, Many Voices (3MV), aimed at black men who have sex with men who may or may not identify as gay or bi, in which small groups talk about cultural, social, and religious norms; sexual relationship dynamics; and how racism and homophobia influence HIV risk behaviors.

Online intervention effective in the treatment of depressive symptoms in people with HIV

From aidsmap.com

An online self-help intervention is effective in the treatment of mild to moderate depressive symptoms in people with HIV, according to a randomized clinical trial conducted in the Netherlands and published in the September issue of The Lancet HIV.

The trial compared the outcomes in a group who received the online self-help intervention and a control group. The internet-based intervention, available in Dutch and English, consisted of a cognitive behavioral therapy program called “Living Positive with HIV” and developed from a self-help booklet that had previously proved effective in decreasing depressive symptoms. Participants also received minimal telephone coaching by a Masters student in psychology. The control group received the telephone coaching and could access the online intervention after the trial was completed.

Sanne van Leunen and colleagues randomly assigned 188 eligible participants to the intervention (97) or the control group (91) in 2015. Depression was assessed at baseline, Month 2, Month 5 and Month 8 (the control group did not take the last assessment).

As detailed below, results show that more participants in the intervention group than in the control group demonstrated significant change in their symptoms and that this effect was maintained for six months. Anxiety symptoms were also decreased. No adverse events were reported, the rate of satisfaction with the intervention was high, and most participants reported that they would recommend “Living Positive with HIV” to others.

Optimizing HIV care

A session at the 2018 ID Week Annual Meeting in San Francisco explored various strategies to optimize the delivery of care to those infected with HIV. Globally, almost 37 million people are living with HIV, with close to 2 million newly infected annually; about 22 million are treated using antiretroviral therapy.1

Antiretroviral therapy can be interrupted for various reasons; however, whether this practice is wise is a contentious issue, and a trial that would directly address this is ethically dubious. To approach the issue in an ethically palatable way, investigators from the University Hospital of Cologne, Germany, and the German Center for Infection Research, also in Cologne, conducted a systematic review and meta-analysis of the literature to try to provide some clarity as to the safety and tolerability of treatment interruption.

“The meta-analysis was done to examine current evidence about treatment interruption,” explained presenter Melanie Stecher, MSc during the session attended by MD Magazine®. “These data might help in strategies for safe treatment interruption and in designing future clinical trials aimed at curing HIV infection.”

The end of HIV transmission: A once-unthinkable dream becomes an openly discussed goal

From statnews.com

“We have the science to solve the AIDS epidemic,” Dr. Robert Redfield, the director of the CDC, himself a longtime HIV researcher and clinician, told STAT in a recent interview. “We’ve invested in it. Let’s put it into action.‘’

Other leaders in the HIV field have been musing about the idea, buoyed by the astonishing impact effective HIV medications have wrought, both on the lives of people infected with or at risk of contracting the virus, and on the trajectory of the epidemic.

“It’s certainly doable in the United States,” said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and a researcher whose study focused on HIV from the earliest days of the AIDS epidemic.

Fauci and other health experts are quick to point out that the goal of stopping transmission entirely is largely theoretical. There will always be some new cases, and the barriers to providing treatment to existing cases remain significant. There are still just under 40,000 people in the U.S. each year contracting HIV. As Fauci put it: “We live in a real world, we don’t live in a theoretical world.”

But “if we implement all the tools that we have and if we can theoretically, conceptually, get everybody who’s HIV infected on antiretroviral drug so that they will not transmit the infection to anyone else, theoretically you could end the epidemic tomorrow by doing that,” he added.

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NIH study: combination antibody treatment for HIV

From Medicalxpress.com

A clinical trial testing infusions of combination antibodies in people living with HIV has begun at the National Institutes of Health. The early-phase clinical trial will evaluate whether periodic infusions of two highly potent, HIV-specific, broadly neutralizing antibodies (bNAbs)—3BNC117 and 10-1074—are safe in people living with HIV. The study also will gather preliminary data on how effectively the bNAb infusions, delivered together every two to four weeks, suppress HIV following discontinuation of antiretroviral therapy (ART).

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