5 February 2016 VOLUME 17 ISSUE 5

The Queensland Health Minister has not ruled out an expansion to the state’s current PrEP trial in light of recent expansions in NSW and Victoria. The news comes as Queensland AIDS Council’s executive director said the state ran the risk of falling behind with access to PrEP and would struggle to meet national targets of zero new transmissions of HIV by 2020.

A research project...at the Department of Immunology and Microbiology at the University of Copenhagen, shows that the so-called ILCs (innate lymphoid cells) -- a component of the immune system crucial to maintaining immune system balance -- are destroyed in patients infected with HIV. This study highlights the importance of early treatment during an acute HIV infection.

Sexually transmitted diseases are becoming increasingly common throughout the country, and thousands of people in Los Angeles County have been infected. Many of them don’t know it. Regular testing for STDs can help prevent their spread and stop them from causing irreparable harm. It can be difficult to navigate your way through testing in Los Angeles. Here’s everything you need to know.

Daily police harassment is undermining efforts to prevent HIV in people who inject drugs. This is according to the TB/HIV Care Association (THCA), which has recorded 246 cases of “abuses” of this group – the vast majority by police - in just three months in Pretoria, Cape Town and Durban. Some local councillors, community policing forums and gangsters were also implicated in the alleged abuses....Most of the “abuses” recorded by the THCA involved police confiscating or destroying the clean needles and syringes they had just been given.

All 69 of the United States' National Cancer Institute-designated centers have joined together to issue a statement urging an increase in HPV vaccinations, declaring the vaccines "tragically underused" and calling low uptake a "public health threat"....The Centers said countries such as Australia, the United Kingdom and Rwanda have demonstrated high vaccination rates are possible, as each of those countries [has] above a 75% vaccination rate.

Can a piece of film half the size of a standard Band-Aid protect women from HIV and genital herpes? That’s the promise of MB66, a “multipurpose prevention technology” being developed by San Diego–based firm Leaf Bio....MB66 is a quick-dissolving film that carries antiviral human monoclonal antibodies—grown in plants—to the mucosal surface of the vagina. In preclinical tests, the film has worked to block viral transmission for 12 to 24 hours.

New research findings published in the February 2016 issue of the Journal of Leukocyte Biology, suggest that a new therapeutic strategy for HIV may already be available by repurposing an existing prescription drug. The drug, an enzyme called adenosine deaminase, or ADA, ultimately may be able to activate the immune system against HIV and to help the immune system "remember" the virus to prevent or quickly eliminate future infection.

More than half of people who experienced failure of a tenofovir-based antiretroviral regimen in sub-Saharan Africa had resistance to tenofovir, a meta-analysis of drug resistance studies published in Lancet Infectious Diseases has shown. The study found that the prevalence of tenofovir resistance after first-line failure ranged from 20% in Western Europe and North America to 56% - 60% in sub-Saharan Africa....[T]he researchers made two findings that may explain regional variations in tenofovir resistance.

The formal addition of the 9-valent human papillomavirus vaccine, along with the serogroup B meningococcal (MenB) vaccine for certain adolescents, are just two of the updates to the 2016 recommended vaccine schedule for [US] children and adolescents released by the American Academy of Pediatrics,...the first time the vaccine has been formally added to the AAP-endorsed schedule. The group now recommends immunization with the HPV vaccine for children as young as age 9 if they have a history of sexual abuse.

In the vernacular of the US Food and Drug Administration, personal lubricants are classified as Class II medical devices [and]....not explicitly required to undergo mammalian safety testing. But the FDA Center for Devices and Radiological Health informed lube industry stakeholders last year that all products would be required by December 31, 2015 to submit premarketing notifications that would include safety testing in rabbits and guinea pigs....People for the Ethical Treatment of Animals (PETA) and product manufacturers have registered objections.

Access to a drug lauded for halting the spread of HIV will be provided to more than 2500 people in a push to wipe out new infections. A major expansion of a trial for the Pre-exposure Prophylaxis (PReP) drug will begin later this year for people at high risk of contracting the disease. The [Victoria] state government has revealed it will increase the number of participants in the trial from 100 to 2600 people.

Nearly half of HIV infected patients suffer from impaired neurocognitive function. The HIV protein transactivator of transcription (Tat) is an important contributor to HIV neuropathogenesis because it is a potent neurotoxin that continues to be produced despite treatment with antiretroviral therapy.

Long-term therapy with the antiretroviral drug tenofovir (Viread, also in several coformulations including Truvada and Atripla) increases the risk of end-stage liver disease and liver cancer, according to the D:A:D study published in the January 18 online edition of AIDS. Researchers found that 5-year cumulative use of the drug increased the relative risk of serious liver disease by 46%....The relationship between tenofovir and serious liver disease surprised the study’s authors, who call for further research.

"PrEP.” Those four letters stand for a daily medical regimen in which healthy individuals take a blue oval pill to lower their risk of becoming infected with HIV. The treatment, known as pre-exposure prophylaxis, has become so common in the Bay Area’s gay community that it’s frequently mentioned in social media profiles....As many as 10,000 San Franciscans could now be on PrEP. The treatment has been transformative here.

Protein microbicides containing neutralizing antibodies and antiviral lectins may help reduce the infection of HIV if its components are manufactured in large quantities at affordable cost....Scientists, led by Evangelia Vamvaka, University of Lleida-Agrotecnio Center in Spain, expressed the antiviral lectin griffithsin (GRFT)...in transgenic rice ...[and] established a one-step purification protocol...which could be developed into a larger-scale process to facilitate inexpensive downstream processing.

We conducted a retrospective, longitudinal study of the 50 US states over 2000–2009 using a dataset of HIV/AIDS case rates and AIDS deaths per 100 000 people matched with a unique dataset of state-level spending on social services and public health per person in poverty. States with higher spending on social services and public health per person in poverty had significantly lower HIV and AIDS case rates and fewer AIDS deaths, both 1 and 5 years post expenditure.

This is a nested study within the Women's Interagency HIV Study, a multicenter, prospective cohort of HIV-infected women. Through intensive TFV pharmacokinetic sampling, we found a strong association between greater TFV exposure and subsequent decline in kidney function. Variations in TFV drug exposure may partially account for subsequent nephrotoxicity in persons infected with HIV.

In 13 out of 18 countries the prevalence ratio was higher for the younger age group compared to the age group 25–49 years and this difference did not change over time....The gender disparity was greater among those who were married/living together than among the never-married....Women continue to carry the greater burden of HIV in Sub-Saharan Africa and there is no clear pattern of change in the gap between men and women.

To assess a novel vaccine platform as a prophylactic HIV-1 regimen....Randomized, double-blind, placebo-controlled trial. Both participants and study personnel were blinded to treatment allocation.

We recruited newly diagnosed HIV-infected women, who were 32 or less weeks pregnant, from 89 antenatal care clinics in Kinshasa, Democratic Republic of Congo. Among women with newly diagnosed HIV, small, incremental cash incentives resulted in increased retention along the PMTCT cascade and uptake of available services. The cost-effectiveness of these incentives and their effect on HIV-free survival warrant further investigation.

Patients with HIV and tuberculosis in eastern Europe have a risk of death nearly four-times higher than that in patients from western Europe and Latin America. This increased mortality rate is associated with modifiable risk factors such as lack of drug susceptibility testing and suboptimal initial antituberculosis treatment in settings with a high prevalence of drug resistance. Urgent action is needed.

In this issue, Ravindra Gupta and colleagues present compelling findings of the epidemiology of HIV drug resistance. Based on results of a collaborative study termed TenoRes, the researchers clearly document that prevalence of HIV drug resistance against the commonly used antiretroviral drug tenofovir is far higher than expected, especially in sub-Saharan Africa. This result is disconcerting because it was previously thought that tenofovir might be less prone to development of drug resistance than other compounds.

The TenoRes collaboration comprises adult HIV treatment cohorts and clinical trials of HIV drug resistance testing in Europe, Latin and North America, sub-Saharan Africa, and Asia. Our primary outcome was tenofovir resistance....We recorded drug resistance in a high proportion of patients after virological failure on a tenofovir-containing first-line regimen across low-income and middle-income regions. Prevalence of tenofovir resistance was highest in sub-Saharan Africa.

We investigated HIV-specific IgG and IgA responses to envelope glycoproteins, p24 Gag and p66, in the genital tract (GT) and plasma following HIV acquisition in women assigned to tenofovir gel (n=24) and placebo gel (n=24) in the CAPRISA 004 microbicide trial to assess if this topical antiretroviral had an impact on mucosal and systemic antibody responses....Taken together, [our] data suggest that humoral immune responses are increased in blood and GT of individuals who acquire HIV infection in the presence of tenofovir gel.