While the eyes of the nation are on the coronavirus pandemic, another threat to public health has been steadily growing in the United States. We’ve been battling rising rates of sexually transmitted infections (STI) for the last several years. In fact, 2020 marks the fifth consecutive year of increasing rates of gonorrhea, chlamydia and syphilis in the U.S., due in part to significant funding cuts to more than 50% of the nation’s public health STI programs. And now the COVID-19 pandemic has placed an even greater burden on our strained public health system and supply chains, shifting focus from one major public health issue to another.
We can’t risk losing one critical resource that will be essential to ending the STI epidemic — the availability of free and confidential STI testing for adolescents. Prior to the pandemic, national public health efforts were scaling up to improve STI and HIV testing, and quickly link youth to prevention services. Rapid identification and treatment of STIs not only has public health benefits in terms of lowering transmission, but when left untreated, STIs increase the risk of infertility, severe pelvic infection, chronic pelvic pain, ectopic pregnancy and HIV transmission.
While accounting for 25% of the population, adolescents and young adults comprise over 50% of STIs in the U.S. each year. Black, Latinx, and LGBT youth face the greatest burden of infections and risk of complications. Fortunately, significant advances have been made over the last several decades to improve rates of STI and HIV testing among adolescents and young adults. The American Academy of Pediatrics now recommends HIV screening by the age of 16-18 years for all youth regardless of their sexual activity.
Here’s a friendly reminder for the HIV community: The HHS Office of Infectious Disease and HIV/AIDS Policy (OIDP) invites you to join us on January 27, 2021, for a stakeholder webinar on efforts to implement the Ending the HIV Epidemic: A Plan for America (EHE) initiative. The EHE Stakeholder webinar will be held from 2:00 to 3:30 p.m. (ET).
This webinar is designed to:
Provide updates on major federal activities related to the implementation of the Ending the HIV Epidemic initiative
Highlight ways to improve HIV diagnosis, care and prevention outcomes for Black Women
Opportunity for question and answer from major stakeholders with federal officials
Registration is required for the webinar. This event is open to everyone, please note capacity is limited so register early! This webinar will be audio-recorded and slides will be publicly available for those unable to attend.
The era of once-a-month HIV treatment has begun in the European Union—and it may soon commence in the U.S. as well. Long-acting pre-exposure prophylaxis (PrEP) is also on the horizon.On Dec. 21, the European Commission authorized use of the long-acting injectable HIV treatment regimen of cabotegravir and rilpivirine (LA-CAB+RPV) for combination antiretroviral therapy in the European Union. These two drugs are the first long-acting injectable HIV treatments to enter clinical use. The authorization comes after the European Medicines Agency recommended authorization on Oct. 16.
Cabotegravir is an integrase strand transfer inhibitor (INSTI), and rilpivirine is a non-nucleoside reverse transcriptase inhibitor (NNRTI). The combination regimen is administered by intramuscular injection monthly or every two months. It is indicated for maintenance treatment of adults with HIV who meet the following criteria:
Undetectable viral load (HIV RNA less than 50 copies/mL) on current antiretroviral regimen.
Virus that has not exhibited NNRTI or INSTI resistance.
No history of virologic failure while on an NNRTI- or INSTI-containing regimen.
“I continue to be surprised by the level of enthusiasm by many of our patients for getting their medicines by monthly injection, or injections every two months,” said Susan Swindells, M.B.B.S., the lead investigator of the Antiretroviral Therapy as Long-Acting Suppression (ATLAS) study, which was pivotal in the drug regimen’s eventual approval in Europe. “Taking one pill once a day does not seem that difficult in theory, but for many patients it is a challenge—and, importantly, a daily reminder of the fact that they have HIV. Having this alternative to offer is a great benefit for interested patients.”
As 2020 draws to a close, we asked David Alain Wohl, M.D., a professor of medicine in the Division of Infectious Diseases at the University of North Carolina and a highly respected HIV clinician-researcher, to take stock of the year’s most momentous research developments and other critical events. In this exclusive series of articles, Wohl calls attention to 10 such developments that have tremendous short-term implications for our day-to-day efforts to improve HIV prevention, treatment, patient care, and policy in the U.S., and analyzes each development with his trademark wit and clinical savvy.
“Looking for something we can rely on. There’s got to be something better out there,” Tina Turner sings in her 1980s pop hit “We Don’t Need Another Hero.” That song jumps into my head when I think about new HIV therapies, but in my mind, it’s framed as a question: Do we need another hero?
For those with few antiretroviral options, who are downing multiple pills to keep multidrug-resistant virus from replicating, the answer would be yes: We do need another antiretroviral hero.
Fortunately, the number of people living with HIV who are heavily treatment experienced and have few remaining antiretroviral options is fairly small. Among over 27,000 HIV-positive people in the U.S. who were treatment experienced and in care at one of the HIV clinics contributing to the U.S. Centers of AIDS Research Network of Integrated Clinical Systems (CNICS) cohort from 2000 to 2017, just 916 had limited treatment options (LTO)—a status defined as having two or fewer available antiretroviral classes, as well as two or fewer active drugs per class as determined by resistance testing. After 2007, the proportion of people with LTO fell; it has since remained less than 1% of the cohort’s antiretroviral experienced patients.
Still, for that 1%, things can be rough. Many are straddled with antiretroviral regimens that include pharmacological boosters, inconvenient dosing, and side effects. Some may even still fail to achieve virologic suppression. Therefore, U.S. Food and Drug Administration (FDA) approval of fostemsavir (brand name: Rukobia), an HIV attachment inhibitor, in July is welcome news to these patients and their providers.
For more than 30 years, Gaétan Dugas was blamed for bringing the AIDS epidemic to the United States. A French-Canadian who died in 1984, Dugas was thought to have carried the disease to America and transmitted it to scores of sexual partners while working as a flight attendant.
But this week, scientists finally cleared the name of the man who, in the history of the AIDS epidemic, came to be known as “Patient Zero.”
In a study published in the journal Nature, the researchers found that blood sampled from Dugas in 1983 contained the same strain of HIV that was infecting men in New York City as early as 1971 — three years before he arrived in the U.S. as an employee for Air Canada.
“In short, we found no evidence that Patient 0 was the first person infected by this lineage of HIV-1,” the researchers wrote.
The study builds on decades of research that has sought to answer the medical mystery of how exactly AIDS made its way to the U.S.
The SASH study (Impact of Poor Sleep and Inflammation on the Adenosine Signaling Pathway in HIV Infection) seeks to understand how sleep can affect the health of people living with HIV.
Study participants complete questionnaires before and after getting a watch-like device similar to a Fitbit. Subjects wear the device for two weeks, to track their sleep patterns. Subjects also answer a few questions in a diary each morning about their sleep.
The study involves two visits to Montefiore Hospital. Each visit is about one hour in length. Participants will receive up to $100. Parking vouchers and/or bus fare will also be provided.
Researchers from Duke University School of Nursing in Durham, N.C., are turning to a ubiquitous locale — beauty salons — to help raise HIV prevention awareness among Black women in the South. Salons are often considered safe spaces for intimate conversations.
The numbers highlight the stark need: Black women, who make up 13% of the U.S. population, account for 64% of new HIV infections among U.S. women. They also make up 69% of all new HIV infections in the South, according to the Centers for Disease Control and Prevention.
Schenita D. Randolph, PhD, MPH, RN, CNE, and her research partner, Ragan Johnson, DNP, APRN-BC, both assistant professors at Duke University, developed a strategy to help prevent HIV spread in their region by focusing on Black women who have not been exposed to the virus.
The strategy involves training stylists to start conversations about HIV, educating women about HIV prevention, and linking them to prevention medication (pre-exposure prophylaxis or PrEP).
The research team received two-year funding from Gilead Sciences, which manufactures the HIV prevention medication Truvada, to put a pilot program in place.
Randolph explained that 44% of the people who could benefit from PrEP in the U.S. are African American (500,000). However, only 1% in that group have been prescribed PrEP, despite evidence that if taken once a day it can lower a person’s risk for getting HIV through sex by more than 90%.
In 2018, 37,968 people received an HIV diagnosis in the United States (US) and dependent areas. From 2014 to 2018, HIV diagnoses decreased 7% among adults and adolescents. However, annual diagnoses have increased among some groups.
Gay and bisexual men are the population most affected by HIV, with Black/African American, Hispanic/Latino gay and bi men having the highest rates of new infections.
The number of new HIV diagnoses was highest among people aged 25 to 34.
On 1 December WHO joins partners in paying tribute to all those working to provide HIV services, and in calling on global leaders and citizens to rally for “global solidarity” to maintain essential HIV services during COVID 19 and beyond. It is a call to focus on vulnerable groups who are already at risk and expand coverage to children and adolescents. And in 2020, the International Year of the Nurse and the Midwife, it is a call for more protection and support to these health workers who have long been on the frontline of HIV service delivery. We can all contribute to the effort to end AIDS and make the world a healthier place.