Authors: Martha Powell, Future Science Group
Find out more about the headlines from the Conference on Retroviruses and Opportunistic Infections 2019 (CROI; 4–7 March, Seattle, WA, USA) below, including:
- Hepatitis C cases reduced by 70% in men living with HIV in London
- Tuberculosis diagnosis in HIV-positive individuals approximately doubles mortality risk within 10 years
- New data revealed on antiretroviral therapy during pregnancy and neural-tube defects
- HIV remission achieved in second patient ever
- Community-wide HIV prevention strategy shows promise for reducing new infections
Hepatitis C cases reduced by 70% in men living with HIV in London
Researchers from Imperial College London (UK) believe that regular screening and improved access to new treatments have greatly reduced hepatitis C cases in HIV-positive men in London. In addition, they state that if progress can be maintained London could achieve targets set by the British HIV association by 2021.
Lead author, Lucy Garvey from Imperial College’s Healthcare NHS Trust commented: “Hepatitis C is a disease that often affects the most marginalized in society. If left untreated it can cause serious liver complications and death. In order to eliminate hepatitis C as a major public health threat we need to reduce the number of people who become newly infected or re-infected with the virus. Our study has shown that greater access to new treatments, closer monitoring and screening can greatly reduce hepatitis C cases, which will lead to better outcomes for the most at-risk patients.”
The team now hope to collect data nationally and believe that there is an on-going need to promote risk reduction and implement appropriate screening policies for HIV-positive men.
Tuberculosis diagnosis in HIV-positive individuals approximately doubles mortality risk within 10 years
Analysis of a Latin American cohort has suggested that those diagnosed with tuberculosis at an initial clinic visit are approximately twice as likely to die within 10 years, compared with those not initially diagnosed with TB.
The research, supported by the National Institute of Allergy and Infectious Diseases (NIAID; MD, USA) suggested that this risk of elevated mortality persisted despite the availability of TB treatment and mirrored patterns seen in HIV-negative populations.
NIAID Director Anthony Fauci commented: “This new analysis shows how devastating TB can be for people with HIV and underscores the need to do more to prevent and treat this coinfection.”
Co-principal investigator, Catherine C. McGowan (Vanderbilt University, TN, USA), concluded: “Many factors may play a role in this increased risk of death among people with HIV. Our study has revealed an important pattern in clinical outcomes, but further research is needed to improve our understanding of the relationship between HIV and tuberculosis coinfection and to guide evidence-based treatment recommendations for this significant population.”
New data revealed on antiretroviral therapy during pregnancy and neural-tube defects
Two posters at CROI have shed more light on the potential association between neural-tube defects (NTDs) and taking antiretroviral therapy during pregnancy. The first poster, from Merck’s (NJ, USA) HIV portfolio, assessed the incidence of NTDs after exposure to raltegravir during pregnancy. The authors reported that there were no incidences of NTDs among the 1991 reports of raltegravir exposure in pregnancy, including 456 cases where raltegravir was taken in the preconception period. The authors suggest there is no data available that would suggest an association between NTDs and this antiretroviral, raltegravir.
The second poster assessed integrase inhibitor exposure and NTDs. Of the 1193 live births with integrase strand transfer inhibitor exposure at any time during pregnancy, a total of 2 CNS defect cases were reported and no NTDs. However, the authors caution that the population assessed isn’t sufficient to detect an increase in relatively rare defects, and is insufficient to confirm or rule out a potential association with NTDs. They encourage healthcare providers to report pregnancies with prospective antiretroviral exposure to the Antiretroviral Pregnancy Registry to provide further data on the issue.
Sources: Shamsuddin H, Raudenbush CL, Scriba BL et al. Evaluation of Neural-Tube Defects After Exposure to Raltegravir During Pregnancy. Presented at CROI 2019, 4–7 March, Seattle, WA, USA. Albano J, Vannappagari V, Scheuerle A et al. InSTI Exposure and Neural-Tube Defects: Data from Antiretroviral Pregnancy Registry. Presented at CROI 2019, 4–7 March, Seattle, WA, USA.
HIV remission achieved in second patient ever
A second individual has achieved sustained remission from HIV-1 after ceasing antiretroviral treatment, according to researchers from University College London (UK).
The individual in the latest study is a UK-based male patient who has had a HIV infection since 2003 and has been on antiretrovirals from 2012. Later in 2012 the patient was diagnosed with Hodgkin’s lymphoma, leading to chemotherapy and a hematopoietic stem cell transplant from a donor with two CCR5 Δ32 alleles. Mild graft-versus-host disease was detected.
Community-wide HIV prevention strategy shows promise for reducing new infections
Researchers have presented results from the HPTN 071 study, which examined the impact of a package of HIV prevention measures on HIV incidence in communities in Zambia and South Africa. The findings demonstrated that the strategy including the provision of in-home HIV testing with immediate referral to HIV care and treatment for people living with HIV based on prevailing in-country guidelines, can substantially reduce new HIV infections.
Richard Hayes (London School of Hygiene and Tropical Medicine, UK) explained: “We saw a highly significant 30% decrease in new HIV infections with a prevention strategy where HIV treatment was started according to in-country guidelines. We did not see a similar reduction in new HIV infections with another strategy where universal HIV treatment was offered from the beginning of the study. Additional analyses are underway to explore the reasons for this finding.”
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