Monitoring HIV treatment with laboratory testing introduces delays for providing appropriate care in resource-limited settings. The aim of this study was to determine whether point-of-care HIV viral load testing with task shifting changed treatment and care outcomes for adults on antiretroviral therapy (ART) when compared with standard laboratory viral load testing.

Researchers did an open-label, non-inferiority, randomized controlled trial in a public clinic in Durban, South Africa, enrolling HIV-positive adults (aged ≥18 years) who presented for their first routine HIV viral load test 6 months after ART initiation.

The primary outcome was combined viral suppression (<200 copies per mL) and retention at 12 months after enrollment.

The post POINT-OF-CARE HIV VIRAL LOAD TESTING COMBINED WITH TASK SHIFTING TO IMPROVE TREATMENT OUTCOMES (THE LANCET – INCLUDES PAUL DRAIN, RUANNE BARNABAS, AND CONNIE CELUM) appeared first on MyMedicPlus.

Researchers working to overcome the reservoir of dormant HIV within CD4 T cells have discovered two methods with which to stimulate HIV to re-emerge from latency into the blood stream. Two separate papers, both published in Nature, detail the differing techniques which could lead to a cure for HIV in future.

The research papers, both funded by the US National Institutes of Health (NIH), show promising results disrupting viral latency. While not a cure, the researchers claim combining this therapy with existing antiretrovirals could be the future of HIV treatment.

Both approaches were tested at Yerkes National Primate Research Center of Emory University in monkeys infected with SIV, the primate form of HIV and treated with antiretroviral drugs. At the University of North Carolina at Chapel Hill (UNC), tests were also conducted in mice transplanted with human immune cells.

One paper describes how AZD5582 activates an intracellular pathway that leads to HIV and SIV reactivation. The drug showed minimal toxicity in non-human primates – just one of twelve treated monkeys experienced a temporary fever and loss of appetite.

“AZD5582 was remarkable in its ability to reactivate latent SIV from resting CD4+ T cells and to induce continued virus production in the blood when monkeys were still receiving daily antiretroviral therapy,” said Dr Ann Chahroudi, co-senior author on both papers, associate professor of paediatrics and director of the Center for Childhood Infections & Vaccines at Emory and Children’s Healthcare of Atlanta.

In the other study, researchers stimulated the cells that are the main viral hosts (CD4+ T cells) while depleting CD8+ T cells, which normally fight the virus.

This combination was especially potent according to the study; however, both components were necessary to see SIV re-emerge.

“The old paradigm is that you need CD8 cells to clear other infected cells,” said Dr Guido Silvestri, paper senior author, interim chair of pathology and laboratory medicine at Emory University School of Medicine and chief of microbiology and immunology at Yerkes National Primate Research Center. “We’re showing that CD8 cells are also involved in repressing latency reversal.”

The main obstacle to a cure for HIV infection is the immune cell reservoir of the dormant virus following treatment with antiretroviral drugs. No interventions have been proven to reduce the size of the reservoir, because once the animals were taken off antiretroviral drugs, viral levels rebounded. The scientists think that post re-emergence, the virus needs to be treated with other targeted modes of treatment, such as antibodies.

“The exciting thing about these papers being published together are the concordance of the results in two animal models with both approaches and the opening up of new avenues for research towards the goal of an HIV cure,” said Chahroudi.

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 An American man who leaked confidential details of thousands of HIV-positive people in Singapore, most of them foreigners, has been jailed in the United States for two years.

Combination HIV interventions in HIV-hyperendemic fishing communities in Uganda resulted in increased testing, male circumcision and ART coverage, as well as increased population HIV viral load suppression, according to findings from a prospective cohort study published in The Lancet HIV.

“Decreases in HIV incidence with combination HIV intervention scale-up have been reported in some lowerrisk populations, but to our knowledge this is the first report of prospectively observed declines in overall HIV incidence with rapid scale-up of combination HIV interventions in HIV-hyperendemic communities,” Joseph Kagaayi, MBChB, director of the Institute of Public Health at Makerere University in Kampala, Uganda, and colleagues wrote.

HIV-hyperendemic geographical areas have specific social-behavioral, demographic and structural characteristics — including high levels of mobility, transactional sex and large proportions of men — that may hinder interventions.

The researchers conducted a prospective cohort study from 2011 to 2017 to determine the effect of combination HIV interventions on HIV incidence and evaluate trends in coverage of combination HIV interventions. They administered five surveys to collect self-reported demographic, behavioral and service-uptake data from patients aged 15 to 49 years who lived in four HIV-hyperendemic fishing communities in Uganda. They provided free HIV testing at each interview and offered referrals to combination HIV intervention services when appropriate. implemented Interventions that included establishing a new community-based HIV clinic in the largest of the four fishing communities, providing male circumcision through mobile camps and initiating ART in these communities.

A total of 8,942 patients contributed data, of 52% were . The researchers reported an HIV prevalence of 41% in the 2011-2012 baseline survey, which declined to 37% at the final survey in 2016-2017 (< .0001). From the first to the last survey, HIV testing coverage increased from 68% to 96%. Male circumcision coverage increased from 35% to 65% and ART coverage increased from 16% to 82%. They noted that population HIV viral load suppression in all HIV-positive patients increased from 34% to 80%. However, risky sexual behaviors did not decrease over the study period.

According to Kagaayi and colleagues, HIV incidence decreased from 3.43 per 100 person-years (95% CI, 2.45-4.67) at the first survey to 1.59 per 100 person-years (95% CI, 1.19-2.07) at the final survey for an adjusted incidence rate ratio (IRR) of 0.52 (95% CI, 0.34-0.79). They noted that declines in incidence were similar for men (IRR = 0.53; 95% CI, 0.3-0.93) and women (IRR = 0.51; 95% CI, 0.27-0.96). Circumcised men had a lower risk of incident HIV infection than uncircumcised men (IRR = 0.46; 95% CI, 0.32-0.67).

“Despite surpassing 90-90-90 goals and almost reaching 95-95-95 goals of around 86% population viral suppression, HIV incidence in the Ugandan fishing communities remained 15times higher than the suggested incidence required for HIV epidemic control (ie, 0.1 per 100 person-years) from previous modeling studies,” the researchers wrote.

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