17 SEPTEMBER 2021 VOLUME 23 ISSUE 37

Three HIV advocates argue for simplifying access to pre-exposure prophylaxis in the United States.

A review of trial findings from around the world that offered psychosocial support to young people with HIV suggests they were effective at improving young people's adherence to antiretroviral treatment (ART) and viral load but had less impact in other key areas, such as sexual risk taking.

Ghana faces an acute shortage of antiretroviral drugs, endangering the health and the lives of tens of thousands of HIV-positive children and pregnant women. Health officials say this has pushed their efforts to end the AIDS epidemic backward.

If approved by the US Food and Drug Administration (FDA), lenacapavir could be a game changer for people living with HIV (PLWH) who have developed drug resistance on their current regimens and have limited treatment options available to them. The long-acting capsid inhibitor—administered as twice-yearly injections—could also be a convenient option for PLWH who are just starting therapy, and as an alternative to daily pills for pre-exposure prophylaxis (PrEP) as well.

A total of 157 volunteers have so far enrolled in a study happening in Masaka, one of the sites that have been selected to assess effectiveness of a vaccine against HIV in Africa. The study dubbed PrEPVACC is also happening in Mbeya and Dar es Salaam in Tanzania, Maputo in Mozambique and Durban in South Africa, but Uganda has so far registered the biggest number of the 1,700 total participants they are seeking.

With COVID-19 immunisation programmes fuelling vaccine optimism across the world, a candidate for a potential HIV vaccine was thrust into the media spotlight earlier this year. Scientists from the International AIDS Vaccine Initiative (IAVI) and Scripps Research presented data from a phase-one clinical trial, indicating the production of powerful immunoglobulin B cells – a precursor to broadly neutralising antibodies that can protect an individual from numerous strains of HIV.... Although researchers have stressed these results are preliminary, news of the potential vaccine went round the world. This kind of hype, however, has obscured urgent questions about the politics of an HIV vaccine that demand our attention: who, and what, it will be for.

Our results showed that the expressed BibNAbs targeting two distinct epitopes exhibited neutralizing activity against 20 HIV-1 pseudoviruses in vitro. After injecting a single rAAV8 vector, the expression and neutralizing activity of the BibNAbs in serum were sustained for 24 weeks. To the best of our knowledge, very few studies have been published on BibNAb gene delivery using rAAV8 vectors against HIV-1. BibNAb gene delivery using rAAV8 vectors may be promising for passive immunization against HIV-1 infection.

In individuals with a history of proximal renal tubulopathy (PRT) on TDF, 96 weeks of TAF was not associated with recurrent PRT or adverse effects on renal tubular function, bone turnover, or bone mineral density. These data suggest that TAF is a treatment option for this vulnerable population.

In general, trials designed to inform rapidly evolving policy issues should develop mechanisms to revisit social value while recognizing that the value of research varies for diverse stakeholders with legitimate reasons to weigh evidence differently. We conclude by providing four reasons that trials may depart from the standard of care after a change in policy, while remaining ethically justifiable, and by suggesting how to improve existing trial oversight mechanisms to address evolving social value.

HIV controllers exist in Africa at a proportion close to that reported elsewhere. They represent a small fraction of all HIV-1-infected patients but raise important questions. Further studies should assess whether starting ART might represent more risk than benefit for some controllers, and where it does, how to identify these patients before they start ART.

DREAMS substantially increased knowledge of HIV status among AGYW in Nairobi, and among younger but not older AGYW in KwaZulu-Natal. Adolescent girls can be reached early (before age 18) with community-based HIV testing programmes in diverse high-prevalence settings, with a large impact on the proportion who know their HIV status.

University students in South Africa underestimated the prevention benefits of HIV treatment. Low knowledge of TasP could limit demand for HIV testing and treatment among young adults.

The uptake of HIV testing across various districts in South Africa seems to be unequal. Intervention programmes must improve the overall uptake of HIV testing, especially in uMkhanyakude and Ugu in KwaZulu-Natal and Vhembe in Limpopo. Interventions must also focus on enhancing uptake of HIV testing amongst male participants in most districts. Strategies that would improve the uptake of HIV testing include HIV self-testing and community HIV testing, specifically home-based testing.