People with HIV who switch from a stable antiretroviral (ARV) regimen to Delstrigo (doravirine/tenofovir disoproxil fumarate/lamivudine) had a high rate of full suppression of the virus at the three-year mark in a large Phase III clinical trial.
Princy Kumar, MD, of Georgetown University, presented findings from the open-label, randomized, active-controlled, noninferiority DRIVE-SHIFT trial at the virtual HIV Drug Therapy Glasgow meeting.
Delstrigo contains the relatively new non-nucleoside reverse transcriptase inhibitor (NNRTI) Pifeltro (doravirine), which, like Delstrigo, was approved in September 2019.
The HIV population in the United States is aging. This can be seen as a sign of success as people with HIV are living longer because they are engaged in care and benefiting from effective treatments. Consider these data from the HRSA Ryan White HIV/AIDS Program (RWHAP) fact sheet, Older Adult Clients: Ryan White HIV/AIDS Program, 2018
46.1% of individuals getting RWHAP care are over 50 years old, similar to the age demographics of all Americans diagnosed with HIV
91.5% of those aged over 50 are virally suppressed, exceeding the RWHAP average of 87%.
The aging trend has been underway for many years and is projected to continue. In 2018, RWHAP clients aged 55 and older accounted for 31% of all clients, up significantly from 16.6% in 2010. A large proportion of RWHAP clients (45-54 years old) are on the cusp of joining the 55+ age group.
Initial data from a large NIH-supported clinical trial offer a detailed look at the health status of people aging with HIV around the world. With 7,770 participants enrolled in 12 countries across five continents, the Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE ) is evaluating the ability of a statin medication, pitavastatin, to reduce the risk of heart disease among people with HIV. By leveraging data collected from this diverse group of study participants, researchers also are learning more about the long-term health effects of HIV. They report their initial findings in an August supplement for The Journal of Infectious Diseases.
For women, accelerated reproductive aging—a natural process that eventually leads to menopause—may heighten risk for heart disease and stroke. Among women with HIV in the REPRIEVE study, more advanced reproductive age was associated with two risk factors for cardiovascular disease: high waist circumference and high blood levels of hemoglobin. Women living in sub-Saharan Africa or Latin America and the Caribbean were more likely to experience accelerated reproductive aging than those living in high-income countries.
The initial REPRIEVE findings also provide insight into the relationship between HIV and heart disease among transgender people, about which little is known. Transgender people are disproportionately affected by HIV, and studies have suggested that hormone use as part of gender-affirming therapy may increase cardiovascular disease risk. By collecting data on gender identity and use of gender-affirming therapy, the REPRIEVE investigators aim to address this knowledge gap. Notably, their initial analysis revealed that high waist circumference was more common among transgender women, particularly those who were receiving gender-affirming therapy.
[On July 2, 2020], the U.S. Food and Drug Administration approved Rukobia (fostemsavir), a new type of antiretroviral medication for adults living with HIV who have tried multiple HIV medications and whose HIV infection cannot be successfully treated with other therapies because of resistance, intolerance or safety considerations.
“This approval marks a new class of antiretroviral medications that may benefit patients who have run out of HIV treatment options,” said Jeff Murray, M.D., deputy director of the Division of Antivirals in the FDA’s Center for Drug Evaluation and Research. “The availability of new classes of antiretroviral drugs is critical for heavily treatment-experienced patients living with multidrug resistant HIV infection—helping people living with hard-to-treat HIV who are at greater risk for HIV-related complications, to potentially live longer, healthier lives.”
A team of scientists from St. Michael’s Hospital, Sinai Health and Sunnybrook Health Sciences Centre have launched a clinical trial to understand whether an existing drug used for HIV treatment and prevention may work to prevent COVID-19 infection.
Dr. Darrell Tan
The trial will examine whether post-exposure prophylaxis (PEP), which is a medication a person takes once they’ve been exposed to a virus to prevent infection, could halt or slow the spread of COVID-19 in groups of people who have been exposed to a confirmed case. The drug in question – Kaletra (lopinavir/ritonavir as PEP)- has long been used in this capacity to prevent HIV in those who have been exposed to the virus.
“Early studies of the use of this medication as post-exposure prophylaxis therapy in other coronaviruses such as SARS and MERS have been promising,” says Dr. Darrell Tan, the study’s lead investigator who is also a scientist at the MAP Centre for Urban Health Solutions and an infectious disease physician at St. Michael’s. “These are so-called ‘cousin’ viruses to COVID-19 and we want to understand whether lopinavir/ritonavir as PEP could impact its spread as well.”
CenterLink is working with a coalition of more than 25 LGBTQ organizations across the state of Pennsylvania to collect data for the 2020 PA LGBTQ Needs Assessment. This information will be used to fuel new and existing community-based programs designed to close gaps in service and address the unique health needs of our population.
Every person who partakes in the survey will be helping Pennsylvania’s department of health learn more about how to promote the health and well-being of LGBTQ people and helping our coalition to build a stronger network of LGBTQ community supports across the state.
Thank you for your participation.
People living with HIV are one step closer to having a once-a-month treatment alternative to downing two or more pills a day.
Once-a-month injection of antiretrovirals works just as well as a daily pill regimen, trials show
There is no cure for HIV, the virus that causes AIDS. But combination antiretroviral therapy, or ART, can effectively halt the replication of the virus, nearly eliminating it from the bloodstream and prolonging life expectancy (SN: 11/15/19). For the therapy to work, though, people must stick to a daily regimen of two or more pills, which experts say can be a challenge for many.
Now, the results of two phase III clinical trials suggest that a monthly shot of antiretroviral drugs works just as well as daily pills, researchers report March 4 in two studies in the New England Journal of Medicine. If approved by regulators, the therapy could be a more convenient treatment for the estimated 1.1 million people living with HIV in the United States.
“From a patient perspective, these results are very positive,” says Elizabeth Tolley, an epidemiologist at FHI 360, a public health nonprofit based in Durham, N.C. Stigma can make people reluctant to keep HIV drugs around the house or to take them each day in front of a loved one, she says. A monthly alternative could be a better option for many.
Young sexual minority men — including those who are gay, bisexual, queer or straight-identified men who have sex with men — do not fully understand their risk for human papillomavirus (HPV) due to a lack of information from health care providers, according to Rutgers researchers.
Doctors need to expand communication on risks and the importance of vaccination, Rutgers researchers say
A Rutgers study published in the Journal of Community Health, examined what young sexual minority men — a high-risk and high-need population — know about HPV and the HPV vaccine and how health care providers communicate information about the virus and vaccine.
About 79 million Americans are infected with HPV, with about 14 million becoming newly infected each year, according to the Centers for Disease Control and Prevention. As a sexually transmitted infection, HPV can lead to several types of cancer, including anal and penile cancer, and is particularly concerning for sexual minority men due to the high prevalence of HIV and smoking in this community and the low HPV vaccination rates overall among men.
“Particularly in light of the decades-long focus on gay men’s health care as HIV care, there is a missed opportunity for HPV prevention in the community,” said study co-author Caleb LoSchiavo, a doctoral student at the Rutgers School of Public Health.
Today’s powerful antiretroviral therapy (ART) helps fight back HIV infection and restore normal immune function. However, clinical evidence suggests that people with HIV who are virologically suppressed still have higher rates of comorbid viral infections than the general population.
Now, a new study in the Journal of Infectious Diseases suggests that ART does not restore the immune system completely back to normal. Instead, people with HIV may experience “immune amnesia,” in which the immune system slowly loses its capacity to recognize and fight off viral infections introduced during childhood or through a vaccine.
“Even with therapy, there’s something not quite fixed about the immune system,” said lead author Michael Augenbraun, M.D., FACP, FIDSA, who is vice chair of the Department of Medicine and director of the Division of Infectious Diseases at SUNY Downstate Health Sciences University and Kings County Hospital Center.
In the study, Augenbraun and his colleagues compared immune response among a group of 50 HIV-negative women and a group of 50 HIV-positive women on ART with low viral load. Each of these women had been vaccinated against smallpox during childhood, so they should all theoretically have similar levels of lingering protection against the smallpox virus.
Both relationship-specific and structural factors influence whether coupled gay men living in New York City choose to use pre- and post-exposure prophylaxis (PrEP/PEP) for HIV prevention. Some men – particularly those in monogamous relationships – felt that discussing PrEP and PEP in the context of a relationship could threaten the relationship by raising issues of trust, while others felt that it had the potential to enhance sexual health and satisfaction.
Stigma from the gay community and healthcare providers around promiscuity also presented barriers to PrEP uptake. This qualitative research was conducted by Stephen Bosco, Dr Tyrel Starks and colleagues at City University New York and published in the Journal of Homosexuality.
Gay and bisexual men accounted for 66% of all new HIV diagnoses in the US in 2017. It is estimated that 35-68% of these infections happen within the context of a long-term relationship. This indicates that coupled gay men have the potential to benefit significantly from biomedical prevention strategies, such as PrEP (taken on an ongoing basis) and PEP (taken shortly after a suspected infection). However, only 7% of the potential 1.1 million gay and bisexual men who could benefit from PrEP were prescribed it in 2016. Black and minority men in the US remain most at-risk for HIV infection, while also having the lowest rates of PrEP uptake.