18 DECEMBER 2020 VOLUME 22 ISSUE 49

The first trial in Africa to test two new vaccines to protect against HIV got under way in Uganda this week, raising hopes of an end to the epidemic that affects millions of people across the continent. The African-led PrEPVacc study will test two experimental combination vaccines to see if they can provide any protection against HIV in people most at risk of infection.

Nigeria’s steady progress in the prevention of new HIV infections annually, is attracting deserved attention by stakeholders, a latest study by some civil society organizations (CSOs) has indicated.

In March, right before COVID-19 hit hard, the activist-initiated but Trump administration–approved plan to End the HIV Epidemic (EHE) in the US was proceeding apace. At the time, targeted jurisdictions across the country were just starting to get their initial federal funding to start drafting their plans, and there was some concern about whether and how state and county health departments would truly engage people from the most affected communities (gay Black men, Black transgender women, rural injection-drug users, etc.) in their planning.

My community has been at the centre of my work all my life. So, it was a great joy to me when the Joint United Nations Programme on HIV/AIDS (UNAIDS) identified community-led interventions as key to a successful pandemic response.

Last month, the US Department of Health and Human Services (HHS) released an 87-page draft of its HIV National Strategic Plan for 2021 through 2025, setting in motion more ambitious targets than the previous strategic plan released in 2015. The draft has been posted on HIV.gov for public comment; the deadline for feedback is Dec. 14.

In patients diagnosed with bacterial STI outside of sexual health clinics, gaps in HIV prevention exist. HIV screening, multisite STI screening, and discussion of PrEP were particularly infrequent among women.

Evidence on the protective effect of VMMC against acquisition and transmission of common STIs is available for heterosexual men and women but more evidence is required for MSM. This review supports policy recommendations for the protective benefits of VMMC against STIs.

This cross-sectional survey from the HIV practices of an urban academic medical center assessed perceptions and preferences using Likert scales toward overall acceptability, proposed frequencies, injection-site reaction durations, and distribution venue. Fifty-nine percent of surveys were completed resulting 202 respondents. Patients self-categorized as likely (57 percent) or unlikely (43 percent) to accept LAI-ARV. Both decreasing frequencies between injections and durations of injection-site reactions resulted higher acceptability scores.

To achieve the largest reductions in HIV, both prevalence of the risk factor and strength of association with HIV must be considered. Additionally, intervening on more risk factors may not necessarily result in larger reductions in HIV incidence.

Participants considered the early breastfeeding period as one of high HIV transmission risk for women. They explained that male partners tend to seek outside sexual partners during this period because women need time to recover from delivery, women focus their attention on the child, and some men are disgusted by breast milk. Participants highlighted concerns about the drugs in oral PrEP transferring to the child through breast milk, but fewer worried about the effects of the vaginal ring because the drug is localized. Women, grandmothers and key informants were supportive of women using these HIV prevention methods during breastfeeding, while male partners had mixed opinions. These findings can be used to tailor messages for promoting the use of PrEP or the vaginal ring during breastfeeding in sub-Saharan Africa.

Health disparities for Black MSM are hypothesized to be driven by structural racism and barriers to care. Observational studies are important to document and quantify the specific factors within the socioecological framework that account for disparities in viral suppression. In the meantime, it is also critical to push for steps to improve access to care, including Medicaid expansion in Southern states, including Georgia, which have not yet moved to expand Medicaid.

A heterologous prime-boost-boost regimen employing the two FP8-VLP vaccines and native envelope trimer was the most effective approach for eliciting HIV-1 neutralizing antibodies. Given the potent immunogenicity of VLP-based vaccines, this vaccination strategy—inspired by bnAb-guided epitope mapping, VLP bioengineering, and prime-boost immunization approaches—may be a useful strategy for eliciting bnAb responses against HIV.

TFV-release can be sustained for several days after film administration and all the drug is released in a few hours in conditions simulating ejaculation. The films’ mechanical properties were also deemed suitable for comfortable vaginal administration. Two optimized films were further assessed using HEC-1-A and Ca Ski cell monolayer models and were found to possess favourable drug permeability profiles and drug levels associated to cell monolayer as compared to free TFV.

we used Lactobacillus, a natural commensal in the healthy vaginal microbiome, to express bn nanobodies (VHH) against HIV-1 that we reported previously. After demonstrating that recombinant VHHA6 expressed in E. coli was able to protect humanized mice from mucosal infection by HIV-1Bal, we expressed VHHA6 in a soluble or in a cell-wall-anchored form in Lactobacillus rhamnosus DSM14870. This strain is already clinically applied for treatment of bacterial vaginosis. Both forms of VHHA6 neutralized a set of primary epidemiologically relevant HIV-1 strains in vitro. Furthermore, VHHA6 was still active at an acidic pH. Thus, lactobacilli expressing bn VHH potentially represent an attractive vector for the passive immunization of women in cohorts at high risk of HIV-1 transmission.

Identification of viral immune escape mutations that compromise HIV's ability to replicate may aid rational attenuation-based vaccine design. Previously we reported amino acids associated with altered viral replication capacity (RC) from a sequence-function analysis of 487 patient-derived RT-integrase sequences. In this study, site-directed mutagenesis experiments were performed to validate the effect of these mutations on RC.

The efficacy and safety profiles of dosing every 8 weeks and dosing every 4 weeks were similar. These results support the use of cabotegravir plus rilpivirine long-acting administered every 2 months as a therapeutic option for people living with HIV-1.

This discussion paper addresses the safety of HIV cure studies, particularly those involving stopping antiretroviral therapy, known as an analytic treatment interruption (ATI) in the context of the SARS-CoV-2 pandemic. More than 30 studies listed on ClinicalTrials.gov include an ATI and many others were planned to begin over the next 12 months but most were halted due to the COVID-19 pandemic.