Yearly Archives: 2019

This report originally appeared on nih.gov. To view the full report, click here.

The HHS Panel on Antiretroviral Guidelines for Adults and Adolescents (the Panel) has just released an updated version of the Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV.

Key updates in this version of the guidelines include:

• Antiretroviral Therapy to Prevent Sexual Transmission of HIV: Clinical trials have shown that using effective antiretroviral therapy (ART) to consistently suppress plasma HIV RNA levels to <200 copies/mL prevents transmission of HIV to sexual partners. When ART is used to prevent HIV transmission, this strategy is called treatment as prevention (TasP). The Panel has added a new section to the guidelines to help providers integrate TasP into their clinical practice.
• The latest data on neural tube defects (NTDs) in infants born to women who received dolutegravir (DTG) around the time of conception have shown that the prevalence of NTDs is lower in these infants than initially reported. Based on the new data, the Panel has revised some recommendations related to the use of DTG in individuals who are of childbearing potential and who are trying to conceive, those who are sexually active and not using contraception, and those who are using effective contraception.
• What to Start: The Panel has added DTG plus lamivudine to the list of Recommended Initial Regimens for Most People with HIV, except for individuals who have pre-treatment HIV RNA >500,000 copies/mL, who are known to have active hepatitis B virus (HBV) coinfection, or who will initiate ART before results of HIV genotype testing for reverse transcriptase or HBV testing are available.
• Cost Considerations and Antiretroviral Therapy: A new sub-section on cost sharing that describes how varying cost-containment practices may impact the out-of-pocket payments for patients with Medicaid, Medicare, and Ryan White (AIDS Drug Assistance Program) coverage has been added. To help clinicians better understand the different ART-related pricing systems in the United States, a new table titled Table 19a. Insurance and Health Program Prescription Drug Pricing and Access was created.
• Acute and Recent (Early) HIV Infection: Bictegravir/tenofovir alafenamide/emtricitabine has been added as a treatment option for persons with acute or recent HIV infection in cases where ART will be initiated before genotypic drug resistance testing results are available.
• Initiation of Antiretroviral Therapy: The Panel recommends that ART be started immediately or as soon as possible after diagnosis to increase the uptake of ART, decrease the time required to achieve linkage to care and virologic suppression for individual patients, reduce the risk of HIV transmission, and improve the rate of virologic suppression among persons with HIV.
• Laboratory Testing for Initial Assessment and Monitoring of People with HIV Receiving Antiretroviral Therapy: The Panel previously recommended monitoring fasting lipid profile and fasting glucose before and after initiating ART. This section now includes a new recommendation that allows for random (nonfasting) tests.
• Tuberculosis/HIV Coinfection: This section now includes newly published data on short-course regimens in the treatment of latent tuberculosis infection and new drug-drug interaction data for antiretroviral drugs and rifampin and rifapentine.

For a complete list of guideline updates, please see What’s New in the Guidelines. Additions and revisions are also highlighted in yellow throughout the PDF version of the guidelines.

To view or download the guidelines, go to the Adult and Adolescent Antiretroviral Guidelines section of AIDSinfo’s website. The guideline tables and the boxed recommendations can also be downloaded as separate PDF files.

This article originally appeared on nih.gov. To view the full article, click here.

Efforts to prevent new HIV transmissions in the United States must be accompanied by advances in addressing HIV-associated comorbidities to improve the health of people already living with HIV, National Institutes of Health experts assert in the third of a series of JAMA commentaries. Previous commentaries detailed the proposed Ending the HIV Epidemic: A Plan for America, which aims to reduce new HIV transmissions in the United States by 75% in five years and 90% in 10 years, and discussed the challenges posed by the emerging opioid injection epidemic in rural areas.

Assuming the aspirational goals of Ending the HIV Epidemic are achieved, at least one million people in the United States still will be living with the virus. With effective antiretroviral therapy (ART), people with HIV can expect a near-normal lifespan.

Read more. 

This report originally appeared on hhs.gov. To view the full report, click here.

The U.S. Department of Health and Human Services (HHS) today launched Ready, Set, PrEP, a national program that makes medications for pre-exposure prophylaxis (PrEP), taken daily to prevent HIV, available at no cost to people without prescription drug insurance coverage.

Although more than one million people at risk for HIV in the United States could benefit from PrEP medications, only a small fraction get them. The Centers for Disease Control and Prevention and the U.S. Preventive Services Task Force  recommend PrEP for individuals at risk of acquiring HIV. When taken as prescribed, PrEP is highly effective at reducing an individual’s risk of acquiring HIV.

Ready, Set, PrEP is a key component of the Ending the HIV Epidemic: A Plan for America (EHE) initiative. EHE aims to reduce the number of new HIV infections in the United States by 75% in five years and by 90% in 10 years. By increasing awareness of PrEP and its access, the Ready, Set, PrEP program can provide thousands of people a safe, effective way to prevent HIV and bring our nation one step closer to ending the HIV epidemic.

Read more. 

A Message from CHIPTS:

On this World AIDS Day, we stand in solidarity with all those living with, at risk for, or affected by HIV across the world.  It is both a sobering and an exciting time.

We are currently faced with a challenge and an opportunity for bending the arc of new HIV infections toward zero in the United States. The U.S. Government has identified “Ending the HIV Epidemic” as a top issue for ​the administration – promising ​resource support necessary to end the domestic HIV epidemic. ​This is a clarion call for cooperation and synergy​ between public health professionals, clinicians, scientists and communities. ​ Bold initiatives are required. Now is the time.

Implementing wider reaching, better and faster HIV ​treatment and prevention will uncover known and unknown challenges to the goal of eliminating HIV. We know the current ​models of treatment and prevention, organized around getting medications into the hands of those who need them – especially people living with HIV – has helped improve health and reduce new transmissions. Pre-exposure prophylaxis, antiretroviral medications used to support remaining HIV-negative, has potential for further reducing new infections.

Disparities in access to care, medical mistrust, racism, sexism, homophobia, transphobia, and HIV-associated stigma are all contributing to unequal benefits of the cornucopia of tools we currently possess to both treat those affected by, and at-risk for HIV.  We must address these as an overarching priority or we will fail:  we will fail ourselves, our colleagues, our patients, our clients, our constituents, and the epidemic writ large.

The potential for an infusion of new resources into ending the HIV epidemic is therefore both exciting and daunting.  We must fight in an environment in which health systems increasingly seem at cross-purposes or even antithetical to these goals and visions.

We must recognize and address that a sizeable minority, perhaps 15%-20% of people living with HIV or with high risks for HIV infection, need more, better, and/or different interventions – now and into the foreseeable future – to ensure consistent adherence with HIV care and persistence with HIV prevention. This part of the strategy recognizes that for many in this minority, chronic and relapsing conditions often interfere with efforts to sustain consistent medication taking, whether for HIV care or HIV prevention. These conditions include mental health and/or substance use disorders, in addition to the “isms” listed above.

We need partnerships and regional responses. We must recognize the impacts of gentrification and other social and economic factors displace large numbers of Americans from affordable housing, which challenges implementation of new resources in HIV-care and prevention so that they reach the people who need them.

We need better, faster, more flexible ways to measure HIV outcomes and current factors that correlate with outcomes from investments across regions. Health jurisdictions are not configured to measure regional outcomes.

Making measurable progress in ending the HIV epidemic in the U.S. is a thrilling possibility. And to reach this objective carries the real possibility that we will learn that improving health outcomes for the most of us are directly tied to ensuring that we improve the health outcomes for all of us.   But only if all involved work together, with redoubled and common resolve, to end these inequities, address the clearly identified social determinants of health, in partnership and on equal footing with more conventional advances in biomedical science.

Here’s to thinking out of the box on this World AIDS Day.