1 APRIL 2022 VOLUME 24 ISSUE 13

In the case of HIV, countries in sub-Saharan Africa have the highest HIV infection rates, particularly among African teen girls and young women. And around the world female sex workers and men who have sex with men contract HIV at considerably higher rates than non-sex workers and heterosexual men. So when studies showed that an injection called CAB-LA (long-acting cabotegravir) — you take it once every two months — works so well that it virtually wiped out the risk of getting infected with HIV through sex, doctors, researchers and activists were ecstatic.

The world’s first long-acting treatment for HIV, Cabenuva has been listed on the Pharmaceutical Benefits Scheme (PBS) for Australians living with HIV.

One remarkable thing about the COVID-19 pandemic was how quickly a vaccine was developed to combat the virus. A process that normally spans a decade or more — dozens of clinical trials, terse patent negotiations, complex roll-out strategies — was condensed into less than one year. mRNA, messenger ribonucleic acids that elicit an immune response from cells before degrading, provided a quick and safe solution to a global health threat.

With its landscape focus on reducing the excess burden of disease in vulnerable populations, the Biden administration has clearly renewed its commitment to ending the HIV epidemic by 2030. The path forward must make HIV prevention, care and treatment more accessible and routine. This path includes the importance of drug discovery for new and easier to administer long-acting, antiretroviral treatments (ARVs) to prevent, treat and possibly one day even cure HIV infection.

Biopharma has been quickly ramping up investment in messenger RNA (mRNA), the defining technology behind the Moderna and Pfizer-BioNTech SARS-CoV-2 vaccines. With big plans for mRNA-based therapies, companies are racing to apply this technology to treat many illnesses, including influenza, shingles and cancer.

A group of Gen Z students are working around the clock to get HIV and gender-affirming meds to people who need them in Ukraine. Three students based in Poland and the Netherlands, along with friends in Berlin, are collecting the meds and coordinating deliveries across the Poland-Ukraine border, reaching people in Ukraine who are struggling to access their prescriptions because of the war.

HIV advocates have much to praise in the Biden-Harris administration’s proposed budget for fiscal year 2023. The budget seeks a $377 million increase in funding for the Ending the HIV Epidemic in the United States initiative, devoting a total of $850 million to the programs. What’s more, the budget seeks to invest $9.8 billion over 10 years in expanding access to PrEP, or pre-exposure prophylaxis, which refers to pills and injections that prevent HIV.

In the HIV care field, the current UNAIDS strategy is to “test and treat”. This approach involves widespread, community-based HIV testing. People testing positive for HIV are immediately placed on antiretroviral therapy. This strategy has two key benefits: protection from HIV infected persons progressing to AIDS, and a lowered risk of infecting others. What if the global TB management community adopted a similar strategy?

As pre-exposure prophylaxis (PrEP) approaches its tenth birthday, there is much to celebrate. In populations with high PrEP coverage, HIV incidence is declining. PrEP use is associated with reduced anxiety and increased intimacy, pleasure, and sexual satisfaction. PrEP connects users to other prevention services and gives them a sense of control over their health. PrEP is a biomedical win, with health benefits that extend well beyond HIV prevention.

Adolescents and young people (AYP) anticipated that daily pill taking would be very stressful, requiring a lot of effort and would interrupt their daily routine. Therefore, while both on-demand and daily PrEP were acceptable and beneficial to these AYP, preferences for either regimen depended on self-perceived risk. Thus, oral PrEP use should be tailored to end-user preferences and risk profiles.

The RAPID model can be applied to a diverse range of clinical contexts. The operational structure of RAPID programs is shaped by the clinical setting in which they function, and therefore the essential elements identified may not apply equally to all programs. Based on the seven essential elements described above we recommend future implementers identify where these elements currently exist within a practice; leverage them when possible; strengthen them when necessary or develop them if they do not yet exist; and look to these elements when challenges arise for potential solutions.

In this study, we analyzed the humoral determinants of HIV-1 gp41 PID binding using biophysical, structural, and computational methods. In complex with a patient-derived near-germline antibody fragment, the PID motif adopts an elongated random coil, whereas the PID bound to affinity-matured Fab adopts a strand-turn-helix conformation. Molecular dynamics simulations showed that the PID is structurally plastic suggesting that the PID can form an ensemble of structural states recognized by various non-neutralizing antibodies, facilitating HIV-1 immunodominance observed in acute and chronic HIV-1 infections. An improved understanding of how the HIV-1 gp41 PID misdirects the early humoral response should guide the development of an effective HIV-1 vaccine.

Some FP clinics may be “lower-hanging fruit” than others for PrEP implementation. Approaching PrEP implementation as a behavioral intervention for FP providers may help ensure that providers have the requisite capability, opportunity, and motivation to adopt the clinical innovation. In particular, PrEP implementers should assess the need for implementation strategies that support providers’ clinical decision-making, establish worker expectations and accountability, and address workload constraints.

Here, we report cross-reactivity of glycan-binding bnAbs with self- and non-self N-glycans and glycoprotein antigens from different life-stages of Schistosoma mansoni. We show that the unmutated common ancestor of the N332/V3-specific bnAb lineage PCDN76, isolated from an HIV-infected donor with S. mansoni seropositivity, binds to S. mansoni cercariae while lacking reactivity to gp120. Overall, these results present a strategy for elicitation of glycan-reactive bnAbs which could be exploited in HIV-1 vaccine development.

Oral rapid HIV and HCV testing for TGW-SW in outreach settings were feasible and acceptable and led to a considerable number of new diagnoses. Interventions tailored to TGW-SW, focused on HIV prevention, testing and engagement in care, are fundamental.

Most South African women successfully persisted with moderate or high-level of use. Encouraging ring replacement with completion of menses may help to decrease concerns about hygiene and improve persistence. Associations between contraception and persistent low adherence suggest efforts may be needed to ensure contraceptive method choice does not interfere with ring use.

Here, we provide an overview of unique primary care considerations affecting transgender and gender-nonbinary individuals, including screening and treatment of HIV and other sexually transmitted infections as well as cancer screening and fertility preservation options. We also seek to review current literature and clinical practice guidelines related to drug–drug interactions between antiretroviral therapy (ART) and gender-affirming hormonal therapy (GAHT).

TFV/LNG IVR use did not change the vaginal microbiota nor increase the incidence of community state type IVA/B. Vaginal microbiota, and in particular community state type IVA/B, possibly through increased vaginal pH, impacted in vivo TFV release and cervicovaginal (CV) pharmacokinetics, but both pharmacokinetics and pharmacodynamics data suggest CV protection against HIV-1.