28 JUNE 2019 VOLUME 20 ISSUE 25

A number of universities are rolling out critical antiretroviral therapy (ART) medication to their students living with HIV. This means students don’t have to travel far, spend money, miss classes or face the stigma that comes with going off campus for the life-saving treatment. “We usually see low numbers of people, especially young people, being able to stay on treatment. One of the reasons for this is inaccessibility of clinics that provide ART. Having ART provided on campus means that students would not have to miss a day of school waiting at the clinic for their treatment, they can just go in between classes. Students will also not have to spend on transport.” said Thuthukile Mbatha, a researcher at the nonprofit organisation, Section27.

According to a new international poll, the United States is now seen as less likely to use its influence for good than it was 10 years ago. While presidential candidates have only begun to lay out their priorities for U.S. foreign policy, reaffirming positive American leadership in the world will be a crucial task for the next U.S. President.

Vaccines against the human papillomavirus have sharply reduced infections, genital and anal warts, and precancerous lesions in young women and girls in more than a dozen wealthy countries, a major new study has found — powerful evidence that these vaccines will ultimately cause major drops in cervical cancer.

The debate on depo-provera increasing the risk of HIV acquisition started in 1996 when scientists discovered that monkeys injected with high concentration levels of depo-provera also known as DMPA by scientists had their biological make-up weakening, thereby allowing easy penetration of SIV, an equivalent of HIV in humans, into their system.

When Cyclone Idai hit Mozambique’s coastal city of Beira in March, heavy winds and torrential rain tore off roofs and destroyed buildings across the city. Many of the city’s residents, particularly those in informal settlements, were forced to flee their homes in search of shelter.

In high-income countries like the U.S., the standard of care for people infected with HIV is to provide antiretroviral pills when the virus is found, even when there are no symptoms of AIDS. The strategy staves off the disease and has a second — big — benefit. It has been shown to prevent the spread of HIV in sexual encounters. It's called "treatment as prevention" (TasP in medical jargon), or "test and treat." But in low-income countries, "test and treat" is not the typical approach to prevention. There has been no research to support it.

Twenty years ago, thousands of Africans died of AIDS each day as pharmaceutical companies looked on, murmuring sympathy but claiming that they could not afford to cut the prices of their $15,000-a-year HIV drugs.

The HIV Vaccine Trials Network (HVTN) has announced it has fully enrolled its four ongoing large-scale HIV vaccine efficacy trials. The clinical trials, under way in 12 countries on four continents, are made possible by 12 669 study participants and the collaborative efforts of HVTN study teams, all on a journey to find a safe and effective HIV vaccine.

Factors associated with willingness to use female condoms were (a) the female partner reporting having experienced forced sex by the male partner, (b) applying a lubricant to the penis, (c) understanding the correct application method, (d) being married more than 20 years, and (e) experiencing no difficulty during the first use. Most HIV-serodiscordant couples found female condoms to be acceptable. Increasing access to female condoms could be an acceptable alternative barrier method to male condoms for preventing HIV transmission.

HIV screening remains suboptimal for persons residing in the 57 jurisdictions that will constitute the initial geographic focus of the Ending the HIV Epidemic initiative. These data provide a baseline from which to measure changes in screening in these jurisdictions and other parts of the United States over time. To achieve national goals and end the HIV epidemic in the United States, innovative and novel screening approaches might be needed to reach segments of the population that have never been tested for HIV.

This analysis offers a wide range of scenarios given the considerable uncertainty over ring uptake, consistency of use, and effectiveness, as well as HIV testing, prevention, and treatment use over the next two decades. This could help inform donors and implementers as they decide where to allocate resources in order to maximize the impact of the dapivirine ring in light of funding and implementation constraints.

The goal of this work was to evaluate the feasibility of using HME for DPV vaginal film manufacturing and to develop a robust manufacturing process using HME by evaluating the effect of process parameters on film quality and performance. DPV was successfully incorporated into a vaginal film using HME and maintained acceptable characteristics. Three process parameters (zone temperature, screw speed, and feed rate) had an impact on film quality and performance.

The rapid ART scale-up and inadequate switching to second-line treatment were the key drivers of the spread of NNRTI resistance in South Africa. However, even though some interventions could have substantially reduced the level of NNRTI resistance, no policy including NNRTI-based first line regimens could have prevented this spread. Thus, by combining epidemiological data on HIV in South Africa with biological data on resistance evolution, our modelling approach identified key factors driving NNRTI resistance, highlighting the need of alternative first-line regimens.

The DIFFER strategy demonstrated that SRH service uptake can occur in conjuction with HIV services offered to sex workers. This model of integrated service delivery has been accepted by policy makers and needs further analysis for scaling up.

PrEP has strong potential to decrease HIV incidence. However, disparities in access must be addressed to ensure equity and impact for PrEP. While drug resistance and risk compensation can occur with PrEP use, these are not valid reasons to withhold PrEP from patients given its substantial protective benefits.

A substantial proportion of transmasculine individuals meet PrEP eligibility criteria, but few are receiving adequate PrEP services. Enhanced efforts should be made by providers, programs, and systems to assess HIV-related risk in transmasculine patients and engage them in comprehensive sexual health care.

Several strategies have been proposed to combat HIV latency, including bone marrow transplantation to replace blood cells with CCR5-mutated stem cells, gene editing to disrupt the HIV genome, and “Shock and Kill” to reactivate latent HIV followed by an immune clearance. However, high risks and limitations to scale-up in clinics, off-target effects in human genomes or failure to reduce reservoir sizes in patients hampered our current efforts to achieve an HIV cure. This necessitates alternative strategies to control the latent HIV reservoirs.

Our findings suggest that a curative intervention for HIV would have the greatest impact if the epidemic is not under control by 2030, particularly if the intervention is targeted to those who are more likely to transmit virus, and if it maintained durable viral suppression, even upon exposure to re-infection. These considerations underscore the need to carefully consider the “target product profiles” for an HIV cure in the context of how and where it would be used, and suggest that such profiles may require revision as the epidemic evolves in the coming years.