15 JANUARY 2021 VOLUME 23 ISSUE 2

Media Coverage

• First PrEP, Now the COVID-19 Vaccine: Why I Faced Medical Mistrust Head On

  My running joke for the past several months when asked if I’m worried about the possible side effects of the COVID-19 vaccine has been, “If the side effects are that I might grow an extra arm out of my forehead, that’s just a risk I’m willing to take to get my life back.” Though a joke, the sentiment is not too far from the truth.

  January 14, 2021

  General, PrEP

  The Body

• Anthony Fauci: “I Don’t Do This Because I’m a Hero. I Do It Because It’s Necessary.”

  “The enormity of the problem is how I keep going,” Dr Anthony Fauci told a meeting of global health journalists yesterday. “I haven’t had a single day off since 20th January last year, but the necessity of dealing with the COVID epidemic is an anaesthetic against fatigue.”

  January 14, 2021

  HIV Vaccine, PrEP

  aidsmap

• UN Urges Respect for LGBT+ Ugandans Ahead of Polls

  Sexual minorities face widespread persecution in Uganda, where gay sex is punishable by life imprisonment, and LGBT+ rights groups fear politicians exploiting anti-gay sentiment to win votes could stoke fresh attacks on the community. Winnie Byanyima, head of UNAIDS, the UN agency for HIV and AIDS, said the vilification of LGBT+ people could worsen violence and discrimination and reduce their access to HIV/AIDS treatment.

  January 13, 2021

  General

  Reuters

• PrEP Use Stagnant Among Gay and Bi Men Despite Increase in Awareness

  A nationwide UCLA study found that gay and bisexual men became more aware of PrEP—a regimen that is highly effective at preventing HIV—between 2016 and 2018, but the use of PrEP among those men remained low and inconsistent during that time period.

  January 13, 2021

  PrEP

  Gay City News

• Injectable Contraceptives May Impact HIV Acquisition, but Only for Some Women

  Women with vaginal microbiomes dominated by the bacterial family Lactobacillus were three times more likely to acquire HIV while using Depo Provera than women using other contraceptives, according to new study results.

  January 12, 2021

  Hormonal Contraceptives and HIV

  POZ

• After COVID-19 Success, Moderna Is Going After an HIV Vaccine

  Arguably the most important outcome of the COVID-19 vaccines produced by Pfizer and Moderna isn’t ending the pandemic. Instead, it’s what the innovative mRNA technology used to make the vaccine could do next.

  January 11, 2021

  HIV Vaccine

  Quartz

• African Countries Differ Widely in Prenatal HIV Testing: Why It Matters

  The introduction of antiretroviral drugs has resulted in a remarkable decline in mother-to-child transmission of HIV. New infections among children declined by 52 percent worldwide and 55 percent in sub-Saharan Africa between 2010 and 2019.

  January 11, 2021

  Treatment

  The Conversation

• Rates of HIV in Female Sex Workers in Kenya Decreased by Two-Thirds Over a Ten-Year Period

  Research from specialist HIV prevention and treatment clinics for female sex workers in Nairobi has found that the number testing positive for HIV dropped by more than two-thirds between 2008 and 2017. While no single intervention can be identified as to the underlying cause in the decreasing numbers, it suggests that increasing HIV awareness, testing and treatment in Kenya are reaching this population of women, despite the criminalisation of sex work.

  January 11, 2021

  General, Treatment

  aidsmap

• As the New CDC Chief, I’ll Tell You the Truth

  Last Wednesday, the same day our nation’s Capitol was in the grips of an insurrection, the United States recorded 3,964 deaths from COVID-19, a record high. That day, COVID-19 claimed a life every 22 seconds. The Centers for Disease Control and Prevention predicts that this month the country will surpass more than 400,000 deaths from COVID.

  January 11, 2021

  General

  New York Times

• Linda-Gail Bekker: The Doctor With Healing Hands and a Warrior Spirit

  The HIV/AIDS pandemic taught us about equitable access to treatment and the need for transparency, accountability and protecting the most vulnerable. Linda-Gail Bekker stands as a reminder that this applies in a time of COVID-19 too.

  January 10, 2021

  General

  Daily Maverick

Published Research

• Medical Male Circumcision and HIV Prevention Among Men in Kwazulu-Natal, South Africa: A Propensity Score Analysis

  The adjusted odds ratios (OR) provided evidence of a protective effect of MMC against HIV acquisition. There is a need to create more programmes that emphasise MMC as an important HIV preventive intervention.

  March 1, 2021

  Voluntary Medical Male Circumcision

  Scientific African

• Declines in HIV Prevalence in Female Sex Workers Accessing an HIV Treatment and Prevention Programme in Nairobi, Kenya Over a 10-Year Period

  HIV prevalence has decreased among female sex workers (FSWs) accessing Sex Worker Outreach Programme (SWOP) in Nairobi, Kenya. This decline is consistent with the scale-up of HIV prevention and treatment efforts, both in FSWs and in the general population.

  February 2, 2021

  General

  AIDS

• Transcriptional Response of Vaginal Epithelial Cells to Medroxyprogesterone Acetate Treatment Results in Decreased Barrier Integrity

  The effects of MPA on vaginal epithelial cells seen in this study may help explain the increase of HIV-1 infection in women who use MPA as a hormonal contraceptive.

  February 1, 2021

  Hormonal Contraceptives and HIV

  Journal of Reproductive Immunology

• The High-Affinity Immunoglobulin Receptor FcγRI Potentiates HIV-1 Neutralization via Antibodies Against the gp41 N-Heptad Repeat

  Here, we show that the neutralization activity of the well-characterized NHR-targeting antibody D5 is potentiated >5,000-fold in TZM-bl cells expressing FcγRI compared with those without, resulting in neutralization of many tier-2 viruses (which are less susceptible to neutralization by sera from HIV-1-infected individuals and are the target of current antibody-based vaccine efforts). Further, antisera from guinea pigs immunized with the NHR-based vaccine candidate (ccIZN36)3 neutralized tier-2 viruses from multiple clades in an FcγRI-dependent manner.

  January 19, 2021

  HIV Vaccine

  PNAS

• Primary Care and Pre-exposure Prophylaxis Services in Publicly Funded Family Planning Clinics in the Southern United States

  Among publicly funded Southern family planning clinics, current PrEP provision was higher among clinics with concomitant primary care. Among clinics not providing PrEP, those with concomitant primary care services have lower perceived cost and resource barriers and therefore may be optimal for expanding PrEP among women.

  January 14, 2021

  PrEP

  Journal of General Internal Medicine

• Perceived Interruptions to HIV Prevention and Treatment Services Associated With COVID-19 for Gay, Bisexual, and Other Men Who Have Sex With Men in 20 Countries

  More stringent responses were associated with decreased perceived access to services. To minimize increases in HIV-related morbidity and mortality, innovative strategies are needed to minimize service interruptions to the community of gay men and other MSM during this and future waves of COVID-19.

  January 13, 2021

  PrEP, Treatment

  JAIDS

• Using Longitudinal Genetic-Network Study To Understand HIV Treatment-as-Prevention: A Population-Based Observational Study

  Our study results support the feasibility of treating all HIV patients for future reductions in HIV transmission at the population level in real-world settings. Comprehensive intervention prevention programs are urgently needed.

  January 13, 2021

  AIDS

• Estimating the Percentage of European MSM Eligible for PrEP: Insights From a Bio-Behavioural Survey in Thirteen Cities

  Our findings showed the impact of different scoring systems on the estimation of the percentage of MSM who may benefit from PrEP in European cities. Although our primary aim was not to compare the performance of different HIV risk scores, data show that a considerable percentage of MSM in each city should be offered PrEP in order to reduce HIV infections. As PrEP is highly effective at preventing HIV among MSM, our findings provide useful, practical guidance for stakeholders in implementing PrEP at city level to tackle HIV infections in Europe.

  January 13, 2021

  PrEP

  Sexually Transmitted Infections

• Implementation of a National HIV Pre-Exposure Prophylaxis Service Is Associated With Changes in Characteristics of People With Newly Diagnosed HIV: A Retrospective Cohort Study

  The sexual health clinic–based national PrEP delivery model appeared to best suit men who have sex with men and white indigenous individuals but had limited reach into other key vulnerable groups. Enhanced models of delivery and HIV combination prevention are required to widen access to individuals not benefiting from PrEP at present.

  January 13, 2021

  PrEP

  Sexually Transmitted Infections

• The Intact Non-Inducible Latent HIV-1 Reservoir is Established In an In Vitro Primary TCM Cell Model of Latency

  Here we demonstrate the generation of defective, intact and intact non-inducible latent HIV-1 in a TCM model of latency using different HIV-1 strains. Thus, the mechanisms which control inducibility can be studied using this primary cell model of latency, which may accelerate our understanding of the latent reservoir and the development of curative strategies.

  January 13, 2021

  Cure

  Journal of Virology

• Picturing Participation: Catalyzing Conversations About Community Engagement in HIV Community-Based Organizations

  Through collaborative analysis, we identified seven themes that may catalyze conversations about engagement within organizations. Having frank and transparent discussions that are grounded in stakeholders’ subjective experiences, and the sociopolitical and structural conditions of involvement, can help organizations take a more intersectional and nuanced approach to community engagement.

  January 12, 2021

  General

  Health Education & Behavior

• The Contribution of HIV Testing Funded by the Centers for Disease Control and Prevention to HIV Diagnoses in the United States, 2010-2017

  When compared to total diagnoses in the United States from 2010 to 2017, a large proportion resulted from CDC-funded tests, particularly among young individuals and blacks/African Americans. CDC’s contribution to new HIV diagnoses was previously unknown. CDC-funded testing is an important part of the national effort to diagnose all people with HIV as early as possible after infection.

  January 12, 2021

  General

  Journal of Community Health

• A Comparison of Different Community Models of Antiretroviral Therapy Delivery With the Standard of Care Among Stable HIV+ Patients: Rationale and Design of a Non-Inferiority Cluster Randomized Trial, Nested in the HPTN 071 (PopART) Study

  This trial was designed to provide rigorous randomized evidence of safety and efficacy of non-facility-based delivery of ART for stable PLHIV in high-burden resource-limited settings. This trial will inform policy regarding best practices and what is needed to strengthen scale-up of differentiated models of ART delivery in resource-limited settings.

  January 12, 2021

  Treatment

  Trials

• Pre-Exposure Prophylaxis Care Continuum, Barriers, and Facilitators among Black Men Who Have Sex with Men in the United States: A Systematic Review and Meta-Analysis

  We meta-analytically summarized the prevalence and qualitatively synthesized key barriers/facilitators of the stages of the PrEP continuum among a pooled sample of 42,870 BMSM aggregated from 56 published studies. Our random-effect models indicated a pooled prevalence of PrEP awareness, willingness/intention and uptake. Qualitative summary revealed that perception of HIV risk, intersectional/PrEP-related stigma and medical mistrust were among the most quoted factors that influence PrEP use. BMSM remain underrepresented in key stages of the PrEP continuum.

  January 12, 2021

  PrEP

  AIDS and Behavior

• Estimating HIV Pre-Exposure Prophylaxis Need and Impact in Malawi, Mozambique and Zambia: A Geospatial and Risk-Based Analysis

  A large proportion of new HIV infections in these 3 African countries were estimated to occur among people who had either an STI or an NP in the past year, providing a straightforward means to set PrEP targets. Greater prioritisation of PrEP by district, sex, age, and behavioural risk factors resulted in lower NNPs thereby increasing PrEP cost-effectiveness, but also diminished the overall impact on reducing new infections.

  January 11, 2021

  PrEP

  PLOS Medicine

• Stem Cell–Derived CAR T Cells Traffic to HIV Reservoirs in Macaques

  Here, we quantified the engraftment of HSC-derived, virus-directed CAR T cells within HIV reservoirs in a macaque model of HIV infection, using potentially novel IHC assays. HSC-derived CAR cells trafficked to and displayed multilineage engraftment within tissue-associated viral reservoirs, persisting for nearly 2 years in lymphoid germinal centers, the brain, and the gastrointestinal tract. Our findings demonstrate that HSC-derived CAR+ cells reside long-term and proliferate in numerous tissues relevant for HIV infection and cancer.

  January 11, 2021

  Cure

  JCI Insight

• Development of Antibody-Dependent Cell Cytotoxicity Function in HIV-1 Antibodies

  We reconstructed the developmental pathways of six human HIV-specific ADCC antibodies using longitudinal antibody sequencing data. Most of the inferred naïve antibodies did not mediate detectable ADCC. Gain of antigen binding and ADCC function typically required mutations in complementarity determining regions of one or both chains. Enhancement of ADCC potency often required additional mutations in framework regions. Antigen binding affinity and ADCC activity were correlated, but affinity alone was not sufficient to predict ADCC potency.

  January 11, 2021

  Antibody Related Research

  eLife

• Uptake of Antiretroviral Treatment and Viral Suppression Among Men Who Have Sex With Men and Transgender Women in Sub-Saharan Africa in an Observational Cohort Study: HPTN 075

  Over 12 months, ARV drug use in the cohort more than doubled and viral suppression increased nearly three-fold without a significant increase in ART failure or drug resistance. These results suggest that ART can be successfully scaled up for HIV prevention and treatment in this high-risk population.

  January 10, 2021

  Treatment

  International Journal for Infectious Diseases

• Brief Report: Identified Barriers and Proposed Solutions for Recruiting Young Black Sexual Minority Men in HIV-Related Research

  We propose several solutions for recruitment including geospatial technology, social media, and community spaces of trust (i.e., churches and schools). Additional larger scale solutions include destigmatizing youths' sexuality and prioritizing the advancement of Black scholars in academia and research endeavors.

  January 9, 2021

  General

  Journal of Adolescence

• Conducting Virtual, Synchronous Focus Groups in HIV Prevention Research Among Black Sexual Minority Men

  Conducting virtual, synchronous focus groups in HIV prevention research among BSMM is feasible. However, thorough oral informed consent with multiple opportunities for questions, culturally relevant facilitation procedures, and appropriate incentives are needed for optimal focus group participation.

  January 9, 2021

  General

  JMIR Public Health and Surveillance

• ART Use and HIV Transmission Among Discordant Couples in Non-Research Settings in Kigali, Rwanda

  Couples in a government clinic couples' HIV testing and follow-up program in Rwanda had an 89 percent reduction in HIV incidence when index partners were using antiretroviral treatment, slightly lower than efficacy estimates from randomized trials. ART for prevention should be prioritized for key populations including discordant couples identified via couples' voluntary counseling and testing (CVCT), with increased efforts to improve uptake, adherence, and viral load monitoring.

  January 8, 2021

  Treatment

  Sexually Transmitted Diseases

• Integrating Prevention of Mother-to-Child Transmission of HIV Care into General Maternal Child Health Care in Western Kenya

  The results from this study highlight areas that need to be addressed to maximize the effectiveness and clinical flow of the pMTCT-MCH integration model. The lessons learned from this integration may be applied to other settings in sub-Saharan Africa attempting to integrate HIV care into the broader public-sector health system.

  December 30, 2020

  Treatment

  IJMA

• Vaginal Microbiome-Hormonal Contraceptive Interactions Associate With the Mucosal Proteome and HIV Acquisition

  We characterized the vaginal microbiomes in 685 women from the CAPRISA-004 trial, who utilized three major types of hormonal contraceptives including injectable depot medroxyprogesterone acetate (DMPA), norethisterone enanthate (NET-EN), and combined oral contraceptives (COC). In the 40 percent of women with Lactobacillus-depleted microbiomes, HIV acquisition was not different between contraceptive groups. However, in the 60 percent of women with Lactobacillus as the dominant bacterial taxa, HIV acquisition risk was 3-fold higher (in women using DMPA relative to women using NET-EN and COC). Higher serum medroxyprogesterone acetate levels in Lactobacillus dominant women associated with increased cervicovaginal inflammation pathways in the mucosal proteome, biomarkers of which associated with HIV susceptibility. This study provides data suggesting an interaction between the microbiome, hormonal contraceptives, and HIV susceptibility.

  December 23, 2020

  Hormonal Contraceptives and HIV

  PLOS Pathogens

• Operationalizing Human Immunodeficiency Virus Cure-related Trials with Analytic Treatment Interruptions During the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Pandemic: A Collaborative Approach

  In this viewpoint, we discuss our approach to reopening an HIV cure trial in this context, with a focus on key considerations regarding study design, informed consent and participant education, and study implementation. These recommendations might be informative to other groups seeking to resume HIV cure research in settings similar to ours.

  October 8, 2020

  Cure

  Clinical Infectious Diseases

Announcements