Yearly Archives: 2015

As infections spread among intravenous drug users, officials reconsider syringe exchanges

Evidence that HIV and hepatitis C are spreading among intravenous drug users is prompting more state and local officials to consider setting up needle exchanges—including some who had been resistant to such programs.

The problem comes in tandem with rising intravenous use of heroin and prescription painkillers nationwide.

In Kentucky, Democratic Gov. Steve Beshear last week signed a bill into law aimed at combating the state’s epidemic of heroin and painkiller abuse. One provision allows local health departments to set up needle exchanges after obtaining approval from city and county governments.

To read the full article, click here.

An outbreak of H.I.V. in a rural Indiana county prompted the state’s governor on Thursday to declare a public health emergency as officials worked to stop the spread of the virus that causes AIDS.

The 80 cases in Scott County, in the state’s southeast, were attributed to intravenous drug use.

Gov. Mike Pence said the infections constituted an epidemic, and he pledged state resources to help local health officials contain the virus. In his emergency declaration, which lasts 30 days, Governor Pence authorized a short-term, state-supervised needle exchange program that would provide drug users with access to safe needles.

To read the full article, click here.

Thirty-four years ago, doctors in Los Angeles discovered that some of their patients were succumbing to a normally harmless fungus. It soon became clear that they belonged to a growing number of people whose immune systems were hobbled by a virus, eventually known as human immunodeficiency virus, or H.I.V.

To date, an estimated 78 million people have become infected, 39 million of whom have died.

As the true scale of the virus’s devastation began to emerge, a number of scientists set out to investigate its origins. Piece by piece, year after year, the scientists reconstructed its history. Their research slowly revealed that the virus did not make a single leap from animals, but several.

To read the full article, click here.

On Tuesday, February 24, 2015 – Dr. Thomas Coates, Director of CHIPTS’ Global Capacity Building Core, presented at the Conference on Retroviruses and Opportunistic Infections (CROI) in Seattle, Washington. Dr. Coates’ presentation, entitled “An Expanded Behavioral Paradigm for Treatment and Prevention of HIV-1,” was part of an invited panel on “Current Imperatives in HIV Prevention and Treatment.”

To view Dr. Coates’ presentation, please click here.

To view other presentations on the “Current Imperatives in HIV Prevention and Treatment” panel, please click here.

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CROI 2015, February 23-26, 2015, Seattle, Washington

Mark Mascolini

FACTS 001, a double-blind placebo-controlled phase 3 trial, found that tenofovir 1% vaginal gel did not protect South African women who used it before and after sex from acquiring HIV infection [1]. As in the VOICE trial [2], poor adherence appeared to contribute to tenofovir gel’s failure in the 2000-woman FACTS study. So far only a 900-woman phase 2b study, CAPRISA 004 [3], found that tenofovir gel protects women from HIV. FACTS findings proved particularly disappointing because the trial went to some length to encourage good adherence to gel use.

FACTS 001 enrolled 18- to 30-year-old HIV-negative sexually active women willing to use effective contraception and condoms. Researchers randomized over 2000 women to tenofovir 1% gel or to placebo and instructed women to apply the gel 12 hours before and within 12 hours after sex, the same schedule used in CAPRISA 004. All women received intensive ongoing counseling on gel adherence and HIV risk reduction. Study participants made monthly visits for HIV testing, safety checks, and new gel. A case-cohort substudy of 214 women assessed tenofovir levels in cervicovaginal fluid collected monthly.

The FACTS efficacy analysis involved 1015 women randomized to tenofovir and 1014 randomized to placebo More than 90% of women attended study visits. Median age of the study group stood at 23, collectively younger than women in VOICE or CAPRISA 004. Almost 90% of women were single, and almost two thirds were living with parents or siblings, so they probably were not having sex at home, where applying gel before and after sex would be more convenient.

In both study arms 56% of women had secondary or higher education. Only one third of women reported consistent condom use, and only 1% reported anal sex. Few study participants–18% in the tenofovir arm and 17% in the placebo arm–said they perceived greater than usual HIV risk in the past 28 days. Women had a median of 1 sex partner in the past 28 days.

After more than 1500 person-years of follow-up, the investigators counted 61 HIV infections in the tenofovir group and 62 in the placebo group. HIV incidence was precisely the same in both study arms–4.0 per 100 person-years (95% confidence interval [CI] 3.1 to 5.2). As a result the incidence rate ratio comparing the tenofovir group with the placebo group sat squarely at 1.0 (95% CI 0.7 to 1.4).

In the case-cohort analysis of 1075 samples from 214 women, tenofovir could be detected in 64% of cervicovaginal samples. Two thirds of women had detectable tenofovir at some quarterly visit, 22% had detectable drug at all quarterly visits, and 13% never had detectable tenofovir.

In an analysis adjusted for age, HSV-2 status, living with parents, and baseline factors related to HIV incidence, women who had detectable tenofovir in cervicovaginal samples and reporting sex in the past 10 days had lower HIV incidence that women using placebo (adjusted hazard ratio 0.48, 95% CI 0.23 to 0.97). That result indicated 52% protection with tenofovir (P = 0.04).

Considering all adherence data, the FACTS 001 team calculated that women used gel for an average of 50% to 60% of sex acts. The investigators concluded that “the majority of participants were not able to achieve sufficiently high levels of gel coverage required for protection.” They stressed the “urgent need for a range of HIV prevention options for young women which may be easier to integrate into their lives.”

References
1. Rees H, Delany-Moretlwe SA, Lombard C, et al. FACTS 001 phase III trial of pericoital tenofovir 1% gel for HIV prevention in women. CROI 2015. February 23-26, 2015. Seattle, Washington. Abstract 26LB.
2. Marrazzo JM, Ramjee G, Richardson BA, et al. Tenofovir-based preexposure prophylaxis for HIV infection among African women. N Engl J Med. 2015;372:509-518. http://www.nejm.org/doi/full/10.1056/NEJMoa1402269
3. Abdool Karim Q, Abdool Karim SS, Frohlich JA, et al. Effectiveness and safety of tenofovir gel, an antiretroviral microbicide, for the prevention of HIV infection in women. Science. 2010;329:1168-1174. http://www.sciencemag.org/content/329/5996/1168.long

Click here for the webcast.

On Tuesday, February 24, 2015 – Dr. Raphael Landovitz, Co-Director of the CHIPTS Combination Prevention Core, gave an open plenary presentation at this year’s annual Conference on Retroviruses and Opportunistic Infections (CROI) in Seattle, Washington.   His presentation was focused on orally-administered Pre-Exposure Prophylaxis (PrEP) for HIV prevention.  In his talk, Dr. Landovitz provided an update on the state-of-science of PrEP and provided evidence to support the urgent need to mobilize clinical efforts, service delivery, education, implementation research, and policy to optimize PrEP access and use.  To view his presentation, please click here.

To learn more about Dr. Landovitz, please visit https://chipts.ucla.edu/people/raphael-landovitz/

For other presentations from CROI 2015, please visit http://www.croiconference.org/

SEATTLE — A major study testing whether Americans would take their H.I.V. drugs every day if they were paid to do so has essentially failed, the scientists running it announced Tuesday at an AIDS conference here.

Paying patients in the Bronx and in Washington — where infection rates are high among poor blacks and Hispanics — up to $280 a year to take their pills daily improved overall adherence rates very little, the study’s authors said.

The hope was that the drugs would not only improve the health of the people taking them, but help slow the spread of H.I.V. infections. H.I.V. patients who take their medicine regularly are about 95 percent less likely to infect others than patients who do not. The Centers for Disease Control and Prevention estimates that only a quarter of all 1.1 million Americans with H.I.V. are taking their drugs regularly enough to not be infectious.

Click here for the full article.

Los Angeles County officials cut back Tuesday on contracts to provide medical care to AIDS and HIV patients, citing increased numbers of people now insured under the federal government’s overhaul of healthcare.

The move to cut $4 million from the contracts, paid for with federal money, marked the latest clash between the county and the nonprofit AIDS Healthcare Foundation, one of the largest providers of medical services to HIV patients in the region.

The foundation and the county have tangled politically and in court over other contracts and issues, including enforcement of requirements for adult film actors to use condoms and a foundation drive to create a breakaway public health department serving the city of Los Angeles.

Read the full article here.

Reports of people in Cuba infected by new strain developing AIDS in less than three years

A recently-discovered form of HIV in Cuba has been found to progress into AIDS some three times faster than the most common strains of the virus, according to a recent study.

The study, conducted by researchers from the University of Leuven in Belgium, followed several reports of HIV-infected people in Cuba developing AIDS in less than three years, far faster than the usual 10 years it typically takes. All patients infected with CRF19, a recently-discovered strain of the HIV virus, had higher levels of it in their body.

Read the full article here.