Documentary 5B shows the real heroes of the AIDS epidemic

From People.com

This was a time when people weren’t even touching patients with HIV,” says Priyanka Chopra, a prominent supporter of the film on behalf of the AIDS charity RED, which will receive 30 percent of all box office proceeds. “They would lay in their soiled bedsheets for days where nobody would come and even enter their room to feed them. At that time, these nurses chose to not think about whether they would live or die and actually the nobility of the profession is what you see in this movie.”

The film, which received a four-minute standing ovation at the Cannes Film Festival last month, features the nurses of ward 5B at San Francisco General Hospital who didn’t allow societal ignorance, prejudice and fear curtail their drive to administer compassionate health care to patients who had otherwise been cast aside. These were patients who most health care professionals wouldn’t touch without wearing gloves, even a hazmat suit.

Read the full article.

 

Once a month treatment for HIV on the horizon

According to the U.S. Centers for Disease Control and Prevention, 38,000 people in the U.S. were newly infected with HIV in 2017. For more than 15 years, the first line of therapy has been a suite of antiretroviral drugs in pill form, taken once a day. Although this treatment has transformed HIV from a certain killer to a chronic disease in much of the developed world, there are problems. For example, some people have trouble taking their pill every day. Therefore, pharmaceutical companies are developing injectable HIV drugs that target different components of the virus and can be administered once every few weeks, writes Senior Editor Megha Satyanarayana.

Currently, at least nine long-acting injectable therapies for HIV are in clinical development. Recently, ViiV Healthcare released data from two Phase III clinical trials of a combination treatment of two drugs that inhibit different parts of the virus. When given as an intramuscular injection, the therapy was as effective as pills and persisted in the body for at least a month.

Read the full article.

Truvada going generic

Get PrEP-ared for generic Truvada in the next year, according to an official document that Gilead, the pharmaceutical company that manufactures the drug, released on their website.

According to a quarterly report filed to the Securities and Exchange Commission, Gilead announced that it reached an agreement to allow a generic version of Truvada to be manufactured in the United States on September 30, 2020.

In a statement, Aaron S. Lord, a physician and member of PrEP4All, called the decision a “victory for the LGBTQ+ community, for HIV activists, and for U.S. taxpayers,” and cautioned that the fight for widespread PrEP access is not over. Lord specifically pointed to the fact that only Teva will be allowed to manufacture generic PrEP.

“This will do little to reduce price in a way that will increase access and PrEP4All remains suspicious of the terms and lack of transparency surrounding the Teva settlement,” Lord wrote in the statement. “I have to ask, what’s to stop them — other than a desire for profit margins — from releasing the rights now?”

Read the full article.

New immunotherapy kills HIV: Pitt Men’s Study participants “vital to the success of this study”

In a first on the quest to cure HIV, University of Pittsburgh Graduate School of Public Health scientists report today in EBioMedicine that they’ve developed an all-in-one immunotherapy approach that not only kicks HIV out of hiding in the immune system, but also kills it. The key lies in immune cells designed to recognize an entirely different virus.

The discovery, made in the laboratory using cells from people with HIV, is yet to be tested in clinical trials, but could lead to the development of a vaccine that would allow people positive for HIV to stop taking daily medications to keep the virus in check.

“A lot of scientists are trying to develop a cure for HIV, and it’s usually built around the ‘kick and kill’ concept – kick the virus out of hiding and then kill it,” said senior author Robbie Mailliard, Ph.D., assistant professor of infectious diseases and microbiology at Pitt Public Health. “There are some promising therapies being developed for the kill, but the Holy Grail is figuring out which cells are harboring HIV so we know what to kick.”

Antiretroviral therapy (ART) typically controls HIV infections so well that the virus is virtually undetectable in the blood and cannot easily infect other people. But if a person with HIV stops taking the daily regimen of medications, which come with many side-effects, the virus can rage back and turn into full-blown AIDS. This is because the virus goes into a latent, inactive phase where it incorporates itself into the DNA of certain immune cells called “T helper cells,” and lurks while a person is taking ART.

Mailliard and his team decided to look at a different virus that also goes latent and infects more than half of adults – and 95 percent of those with HIV: Cytomegalovirus (CMV), which can cause eye infections and other serious illnesses, but is usually controlled by a healthy immune system.

“The immune system spends a lot of time keeping CMV in check; in some people, 1 one out of every 5 T cells are specific to that one virus,” said co-author Charles Rinaldo, Ph.D., professor and chair of Pitt Public Health’s Department of Infectious Diseases and Microbiology. “That got us thinking – maybe those cells that are specific to fighting CMV also make up a large part of the latent HIV reservoir. So we engineered our immunotherapy to not only target HIV, but to also activate CMV-specific T helper cells.”

To run the experiment, the team needed blood – and lots of it – from people with HIV controlled by ART. Nearly two dozen participants stepped up from the Pitt Men’s Study, the Pittsburgh  site of the Multicenter AIDS Cohort Study (MACS), a research study of the natural history of treated and untreated HIV/AIDS in men who have sex with men.

“The MACS participants were vital to the success of this study,” said first author Jan Kristoff, M.S., a doctoral candidate at Pitt Public Health. “You have to collect a lot of blood to find T cells latently infected with functional HIV in people on ART – it could be as few as 1 out of every 10 million cells. So the men would sit for as long as four hours hooked up to a machine that processed their blood and came back multiple times to give more samples.”

Read more on the UPMC Website.

Dr. Anthony Fauci discusses the case of the London Patient

From NBC News

Dr. Anthony Fauci, one of the nation’s top HIV/AIDS doctors, cautioned that the highly publicized case of the so-called London Patient — the second person in the world confirmed to be cured of HIV infection — does not mean a widely available cure is on the horizon anytime soon.

“To think that bone marrow transplantation is going to be a scalable, feasible, safe way to treat infections is really, unfortunately, misleading, because it is not,” Fauci, director of the National Institute for Allergy and Infectious Disease, said Tuesday on MSNBC.

The ‘London Patient’ was cured of HIV in the process of being treated for a much deadlier disease: Hodgkin’s Lymphoma. This cancer of the lymphatic system can be treated with a risky bone marrow transplant from a donor whose marrow matches. “This was really his last chance of survival,” Dr. Ravindra Gupta, the patient’s doctor, told Reuters.

Watch the video here.

 

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

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.

Read the full article.

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.”

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).

Read the full article.

Today’s HIV meds are not linked to high blood pressure

From Poz Magazine online

The antiretrovirals (ARVs) in common usage today are not associated with an increased risk of high blood pressure, aidsmap reports.

Publishing their findings in HIV Medicine, researchers from the D:A:D study, a large, ongoing multi-cohort observational study of people with HIV, updated their 2005 paper in which they were unable to identify a clear link between ARVs and high blood pressure.

For this new analysis, the researchers analyzed data on 33,278 HIV-positive study participants who were in medical care for the virus in Europe, Australia and the United States between 1999 and 2013. They looked for a relationship between hypertension diagnoses and 18 ARVs as well as various other risk factors.

A high blood pressure diagnosis was defined as developing blood pressure of 140 over 90, receiving a blood pressure medication or both.

Three out of four of the participants were male, and 44 percent of the participants overall were men who likely contracted the virus through sex with another man. The median age upon entry into the study was 38 years old. About half of the study members were white and one in five had received an AIDS diagnosis. The median CD4 count was 429. Almost 40 percent had a fully suppressed viral load and 68 percent had received ARVs.

As for cardiovascular risk factors, 60 percent had a history of smoking, 16 percent had a body mass index (BMI) over 26 (between 25 and 29.5 indicates overweight), 18 percent had lipodystrophy (the irregular distribution of body fat associated with some of the earliest ARVs) 4 percent were on medication to lower their blood lipids and 2 percent had diabetes.

During a cumulative 223,000 years of follow-up, 7,636 members of the study (23 percent) developed high blood pressure, for a rate of 3.42 diagnoses per 100 cumulative years of follow-up.

When the researchers analyzed the data without adjusting for any non-ARV factors associated with high blood pressure, they found that all the HIV medications were linked to the condition except for Norvir (ritonavir)-boosted Prezista (darunavir) and Emtriva (emtricitabine).

Then the study authors adjusted for demographic risk factors for high blood pressure and found that the only ARVs still linked to the condition were Ziagen (abacavir), Viramune (nevirapine), Norvir and Norvir-boosted Crixivan (indinavir).

Finally, after the investigators adjusted the data to account for differences in metabolic risk factors, Ziagen and Norvir were no longer associated with high blood pressure. Each five years of exposure to Norvir-boosted Crixivan was associated with a 12 percent increase in the risk of high blood pressure, and Viramune was associated with an 8 percent increase per five years of exposure.

The most prominent risk factors for high blood pressure included being male, being older, being Black, engaging in injection drug use and having an AIDS diagnosis, diabetes, high blood lipids, lipodystrophy, obesity and impaired kidney function.

To read the aidsmap article, click here.

To read the study abstract, click here.