With the support of a multimillion-dollar federal grant, several local organizations are taking part in a groundbreaking study that aims to develop a cure for HIV. The Wistar Institute, in partnership with Philadelphia FIGHT, the University of Pennsylvania, University of California and Merck, is undertaking a trial study based on a therapeutic strategy that has already shown promise at reducing HIV-1 virus levels.
Dr. Luis J. Montaner, a professor at The Wistar Institute and director of Wistar’s HIV-1 Immunopathogenesis Lab, and collaborators received a four-year, $6.2-million grant from the National Institute of Allergy and Infectious Disease of the National Institutes of Health to support the study. Montaner said his team has been pursuing the grant for several years. “There is a lot of preamble before the award is given,” he said. “We have been chasing the opportunity to do this study since 2011.”
The study is based on a prior pilot trial in which a protein called interferon-alpha was shown to reduce persistent HIV-1 in patients being treated with antiretroviral therapy. The grant will pay for the management of the clinical and administrative expenses of the study and for laboratory follow-up, which will allow researchers to calculate the study’s outcome. Montaner said the team will perform an initial evaluation of the study in mid-2016, and it will be finalized in 2018.
Drug-injecting addicts who took a daily antiretroviral pill were half as likely to become infected with H.I.V. as those who did not, a major new study has found, providing the final piece of evidence that such treatments can prevent AIDS in every group at risk. Earlier clinical trials showed that the therapy can sharply reduce the risk of H.I.V. transmission from mother to child, and in gay and bisexual men and heterosexuals.
“This provides the totality of the evidence that the drugs used to treat the infection are also very effective at preventing it,” said Dr. Salim S. Abdool Karim, a prominent South African AIDS researcher who wrote a commentary in The Lancet, which published the new study on Wednesday.
The accumulating evidence from clinical trials means antiretroviral drugs are increasingly seen as another in the arsenal of weapons to prevent AIDS, along with condoms, abstinence and fidelity; early antiretroviral treatment; male circumcision in Africa; microbicide gels; and other options.
More gay and bisexual men infected with HIV are aware they have the virus, at least in 20 major urban areas. On the other hand, the prevalence of the infection has remained “relatively steady” among men who have sex with men (MSM) in those areas, according to Cyprian Wejnert, PhD, of the CDC. But while awareness of the infection rose in most subgroups of the gay and bisexual population, there are still “concerning disparities,” Wejnert told reporters here at the Conference on Retroviruses and Opportunistic Infections. Specifically, blacks were most likely to be HIV-positive and least likely to know about it, he said. The findings are derived from data collected by the National HIV Behavioral Surveillance System in 20 urban areas, ranging from Seattle to San Juan, with a high burden of AIDS, Wejnert said.
In 2011, investigators interviewed participants in dance clubs and bars frequented by MSM and offered them anonymous HIV testing. That year, 8,423 participants had both an interview and a test, compared with 7,847 in 2008. Wejnert told MedPage Today that the research takes place every third year, with similar investigations in other years among heterosexuals and injection drug users, the other two major risk groups for HIV infection.
The researchers found:
Of the 8,423 participants in 2011, 18% were HIV-positive compared with 19% in 2008.
Of those who tested positive, 66% were already aware of the fact, up from 56% in 2008.
Prevalence varied by race and ethnicity, with 30% of blacks testing positive compared with 14% of whites.
Awareness also varied by race and ethnicity, with 54% of blacks knowing their status compared with 86% of whites. But in all racial and ethnic groups, awareness has risen since 2008.
In March 2011, the Institute of Medicine issued its report of the NIH commissioned study on The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. At that time, I asked the NIH institutes, centers, and offices (ICOs) to form the NIH LGBT Research Coordinating Committee (RCC). I charged this committee to consider carefully the report’s recommendations and to suggest strategies for how the ICOs can support research to increase the knowledge base for promoting the health of the LGBT community. I am pleased to say that the RCC has fulfilled their charge. I thank them for their thoughtful analysis of the NIH portfolio on LGBT research and for identifying several important opportunities for promoting research and knowledge in LGBT health. The NIH is now developing a multi-pronged plan to implement a number of these opportunities to extend and advance the knowledge base for promoting LGBT health.
Francis S. Collins, M.D., Ph.D. Director, National Institutes of Health
A quadruple-dose flu vaccine for the elderly also provides better protection for people with HIV, researchers reported Tuesday in the first of several studies to publish results of high-dose vaccine for people with compromised immune systems.
The team of researchers from Philadelphia institutions will ask a federal advisory committee to recommend high-dose vaccination for HIV-positive people, said Pablo Tebas, an infectious-diseases physician at the Hospital of the University of Pennsylvania and senior author of the paper in Annals of Internal Medicine.
In a recent report published on the Centers for Disease Control and Prevention (CDC) Website, researchers concluded that a “disproportionate number of new HIV infections occurs among youths, especially blacks/African Americans, Hispanics/Latinos, and men who have sex with men (MSM).”
The report went on to say that although the number of new HIV infections is highest among men, fewer men have been tested for HIV (as compared to women). Routine HIV testing as part of regular medical care was therefore recommended by the CDC for everyone. In addition, the American Academy of Pediatrics recommends testing for all youths by age 16–18. They also recommend testing for all sexually active youths regardless of age.
Better adherence to these guidelines, especially for men, is needed to increase early HIV diagnosis and treatment. Treatment is not only critical for the health of the person infected, it is also critical in reducing the chances of spreading the infection to others.
Other key points from the CDC report:
Youths aged 13–24 years account for 7% of the estimated 1.1 million persons living with HIV in the United States.
In 2010, 26% of estimated new HIV infections were among youths: 57% among blacks/African Americans, 20% among Hispanic/Latinos, and 20% among whites.
Nearly 75% of the 12,200 new HIV infections among youths were attributable to male-to-male sexual contact.
Only a low percentage of youths have been tested for HIV, and 60% of youths with HIV are unaware of their infection.
Young males who have sex with males are at increased risk for HIV because of high rates of HIV in potential sex partners, and they are more likely to engage in HIV-related risk behaviors (e.g., unprotected sexual intercourse and injection drug use) than other male or female high school students.
The report concludes:
More effort is needed to provide effective school- and community-based interventions to ensure all youths, particularly MSM, have the knowledge, skills, resources, and support necessary to avoid HIV infection. Health-care providers and public health agencies should ensure that youths are tested for HIV and have access to sexual health services, and that HIV-positive youths receive ongoing health-care and prevention services.
California will test an HIV-prevention pill in an attempt to slow the spread of the disease in the state, researchers announced Tuesday.
The pill, which is already used to treat HIV patients, will be prescribed to 700 gay and bisexual men and transgender women in Los Angeles, San Diego and Long Beach who are high-risk but not infected.
“With this new prevention pill, we have another intervention to put in the arsenal to try and impact this epidemic,” said George Lemp, director of the California HIV/AIDS Research Program with the UC president’s office.
The program awarded $11.8 million in state grants for the prevention pill studies and efforts to get about 3,000 HIV-infected people in Southern California into treatment and keep them there. The grants will go to a group of UC schools, local governments and AIDS organizations.
There are an estimated 140,000 people living with HIV or AIDS in California, including about 30,000 who don’t know they are infected, Lemp said.
The pill, under the brand name of Truvada, is already approved by the Food and Drug Administration for treating HIV but not for prophylactic use. In 2010, a study published in the New England Journal of Medicine said that it reduced the risk of contracting HIV by 44% to 73%, depending on how often participants took their medication.