Daily HIV Prevention Pill (PrEP): Why It’s Urged for Healthy People at Risk

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With the success of antiretroviral therapy (ART), people living with HIV (PLWH) now enjoy longer life expectancies than ever before. However, this increased lifespan has brought a new challenge: a significantly higher risk of early cardiovascular disease (CVD).

Research shows that HIV-positive individuals are 1.5 to 2 times more likely to develop heart disease at a younger age compared to HIV-negative individuals. This article explores the underlying causes, scientific findings, and most importantly, how to reduce that risk through prevention and lifestyle changes.

Why Does HIV Increase Heart Disease Risk?

Cardiovascular disease in HIV patients is multifactorial, meaning it’s influenced by a mix of biological, lifestyle, and treatment-related factors.

1. Chronic Inflammation & Immune Activation

Even with effective ART and undetectable viral load, HIV causes persistent low-grade inflammation in the body. This leads to:

• Damage to blood vessel linings (endothelium)
• Increased plaque formation
• Accelerated atherosclerosis (hardening of arteries)

2. Immune System Dysfunction

HIV affects CD4+ T-cells, weakening the immune system. This dysfunction can:

• Promote autoimmune reactions
• Make the body less effective at repairing vascular damage

3. Side Effects of Antiretroviral Therapy (ART)

Some older or specific ART drugs (especially protease inhibitors and abacavir) are associated with:

• Increased cholesterol and triglyceride levels
• Insulin resistance
• Elevated risk of metabolic syndrome

4. Higher Prevalence of Traditional Risk Factors in PLWH

People living with HIV often have a higher rate of:

• Smoking
• Diabetes
• Obesity
• Sedentary lifestyle
• Co-infections like Hepatitis B/C, which can indirectly impact cardiovascular health

5. HIV-Associated Lipodystrophy

This condition, caused by some ART medications, leads to abnormal fat distribution and metabolic changes, further increasing the risk of heart disease.

What Does the Research Say?

Several key studies have demonstrated the link between HIV and heart disease:

• The REPRIEVE Trial (NIH, ongoing) is investigating whether statins can prevent heart disease in HIV patients.
• A study published in JAMA Cardiology (2020) found that HIV-positive individuals had a 50–100% higher risk of heart attack than the general population.
• A 2023 report in The Lancet HIV showed increased arterial stiffness and vascular inflammation in young adults with HIV — even those on effective ART.

In short, heart disease now rivals opportunistic infections as a leading cause of morbidity in aging HIV patients.

Early Warning Signs & Screening

HIV patients often experience “silent” heart disease, where symptoms may not be obvious until major events like a heart attack or stroke occur. Regular screening is essential.

Doctors typically monitor:

• Blood pressure
• LDL/HDL cholesterol
• Blood sugar and insulin levels
• C-reactive protein (CRP) — marker of inflammation
• Carotid intima-media thickness (CIMT) — ultrasound measure of artery wall thickening

Prevention Strategies: How to Lower the Risk

Fortunately, many of the risks can be controlled with the right interventions.

1. Stick to Effective ART

• Modern ART regimens are safer and more heart-friendly than earlier generations.
• Staying virally suppressed reduces inflammation and immune activation.
• If you’re on older ART (e.g., abacavir, lopinavir), talk to your doctor about switching.

2. Adopt Heart-Healthy Habits

3. Control Blood Pressure & Cholesterol

• Use statins if needed — they not only lower cholesterol but also have anti-inflammatory benefits in HIV.
• REPRIEVE trial is evaluating long-term statin use in HIV for prevention even in low-risk patients.

4. Manage Diabetes and Insulin Resistance

• Monitor A1C and fasting glucose regularly.
• Adopt a low-glycemic index diet and stay active.

5. Address Mental Health & Stress

• Chronic stress and depression (common in HIV) can raise cortisol and BP.
• Practice mindfulness, therapy, and sleep hygiene.

Summary Table: HIV and Heart Disease

Final Thoughts

People living with HIV now live longer — but with longevity comes greater vulnerability to chronic illnesses like heart disease. The good news is that with early screening, modern ART, and healthy lifestyle choices, heart disease in HIV-positive individuals is largely preventable.

HIV-positive people are living longer than ever because of therapies that prevent the growth of the virus. But these patients deal with more heart troubles and barriers to treatment than other individuals, according to the American Heart Association (AHA).

A scientific statement published in June 2019 in the journal Circulation highlighted that three-quarters of people over the age of 45 who are living with HIV are experiencing significantly more heart attacks, heart failure, and strokes earlier in life compared with those who don’t have HIV.

“Chronic inflammation and immune activation [or response] appear to be the primary drivers of high heart disease risk in HIV,” says Matthew Feinstein, MD, chair of the writing group for the statement and assistant professor of medicine and preventive medicine at the Feinberg School of Medicine at Northwestern University in Chicago.

He stresses that HIV treatment is essential, not only for controlling the virus, but also for reducing chronic inflammation and problems with immune regulation.

“Several studies have now shown that worse HIV control is associated with higher risks for heart disease,” Dr. Feinstein told Everyday Health. “So the first and most important step in preventing heart disease in HIV is getting the HIV under control with the right medications prescribed by HIV specialists and primary care doctors.”

Addressing Common Heart Disease Factors

The statement authors also observed that people living with HIV more often had factors commonly associated with heart troubles, such as heavy alcohol use, substance abuse, mood and anxiety disorders, low levels of physical activity, and poor cardiorespiratory fitness.

About 4 out of 10 are smokers, according to a nationally representative sample of HIV patients.

Quitting tobacco use, eating a balanced diet (such as the DASH diet or Mediterranean diet), and staying physically active can help lower risk, notes Feinstein.

Sarah Samaan, MD, a cardiologist with Baylor Scott & White Legacy Heart Center in Plano, Texas, who was not an author on the statement, has seen many HIV patients benefit from statin drugs to lower cholesterol and medication to lower blood pressure.

“Since some HIV medications can raise the risk of side effects from other drugs, it’s important to discuss the options for treatment with a knowledgeable physician,” say Dr. Samaan. “A good pharmacist can also help to ensure that the drugs that are prescribed are safe and appropriate.”

Living Longer But With More Health Problems

In an accompanying patient perspective published by the American Heart Association, Jules Levin, the founder and executive director of the National AIDS Treatment Advocacy Project (NATAP), expressed his concerns about the high numbers of serious medical problems in older people with HIV compared with the general population.

According to NATAP, those with HIV over 60 years old have an average of three to seven health conditions in addition to being HIV-positive. Comorbidities include heart attacks, strokes, heart failure, kidney disease, frailty, and bone diseases. Also, many take 12 to 15 drugs daily.

“Most people don’t know that HIV is causing accelerated aging,” says Levin, who has been living with HIV for 35 years. “Within a few years of initial infection, the immune system senescence [deterioration with age] sets in right away. Once people with HIV get into their sixties, they really have a double hit — from aging and from the effects of HIV.”

This is why Levin urges HIV-positive individuals to be screened for cardiovascular troubles as well as bone density, kidney disease, and cognitive impairment.

The scientific statement recommends trying the American Heart Association–American College of Cardiology Atherosclerotic Disease Risk Calculator as one way for getting some idea of your heart disease risk.

Overcoming Barriers to Treatment

Both Feinstein and Levin spotlight the need for improving access to healthcare for people living with HIV. The statement authors pointed out that this population is often stigmatized, and federal and local authorities could make more effort to increase care options for these individuals. Many living with HIV are homebound and cognitively impaired to a degree where they have difficulties paying bills and making decisions.

“What’s most needed are support services and better care in the clinics,” says Levin. “We need to actively demand that federal and local officials address this problem.”

He urges people to contact NATAP to explore ways to take action.

A Call for Further Research

Feinstein and his coauthors based this scientific statement on large observational studies investigating HIV and heart disease.

“But we don’t yet have much in the way of large-scale randomized trial data for heart disease prevention and treatment in HIV,” he says. “Although we have a reasonable understanding of why plaque buildup in the arteries occurs in HIV, we do not have as clear of an understanding of why the heart muscle often becomes dysfunctional or why blood clotting may occur more commonly in HIV.”

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The PEC is responsible for overseeing a continuous and comprehensive evaluation of the HPTN. The PEC designs and directs implementation and reporting of the internal evaluation of the HPTN. This includes assessing performance of the CTUs as well as key organizations and entities that are also part of the HPTN (e.g., Leaderships and Operations Center (LOC), SDMC, Laboratory Center (LC) and protocol teams).

The goal of the evaluation is to provide data to assist leadership in making any decisions or changes necessary to improve HPTN functioning. In regard to the CTUs, the primary purpose of the evaluation is to provide data to determine if the sites are contributing effectively to the protocols assigned and to elicit corrective action, if necessary, so that all sites are functioning at peak performance level.

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BIRMINGHAM, Ala. (AP/WIAT) — Alabama’s largest health care unit for treating HIV patients has relocated to a larger location.

The 1917 Clinic at the University of Alabama at Birmingham has moved from its old home in downtown to a new site in Birmingham’s Lakeview district. The clinic has more than doubled in size to 27 examination rooms. It also has added a second room for medical procedures and new space for counseling services.

“This move will allow for increased capacity to meet the existing and burgeoning need for HIV comprehensive multidisciplinary care and support service to people with HIV and the community,” said clinic director James Raper, Ph.D., CRNP. “It also allows us to more effectively do outreach to identify persons with HIV who are not engaged in care, and simultaneously do outreach and provide PrEP services to people at risk for HIV.”

With more than 3,600 active patients, clinic director James Raper says the expansion will help provide comprehensive care for people with HIV, which can cause AIDS.

While the 1917 Clinic occupies the majority of the Dewberry Building, Birmingham AIDS Outreach has space in the building as well, which is indicative of 1917’s mission to work with community partners and agencies to support all patient needs.

“This move will provide renewed synergy between 1917 Clinic and BAO as community partners in the fight to end the HIV epidemic while addressing the immediate needs of the HIV community,” Raper said. “I am excited about the decades of HIV patient care ahead of us in this new space.”

The 1917 Clinic has treated more than 12,000 patients with HIV in its three-decade tenure.

The Associated Press contributed to this report.

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Global solidarity and resilient HIV services

The global HIV epidemic is not over and may be accelerating during the  COVID-19 pandemic, with a devastating impact on communities and countries. In 2019, there were still 38 million people living with HIV infection. One in five people living with HIV were not aware of their infection and one in 3 people receiving HIV treatment experienced disruption to the supply of HIV treatments, testing and prevention services, especially children and adolescents. In 2019, 690 000 people died from HIV-related causes and 1.7 million people were newly infected, with nearly 2 in three (62%) of these new infections occurring among key populations and their partners.

Despite significant efforts, progress in scaling up HIV services was already stalling before the COVID-19 pandemic. Slowing progress means the world will be missing the “90-90-90” targets for 2020, which were to ensure that: 90% of people living with HIV are aware of their status; 90% of people diagnosed with HIV are receiving treatment; and 90% of all people receiving treatment have achieved viral suppression. Missing these intermediate targets will make it even more difficult o achieve the end of AIDS by 2030.

The breakdown in essential HIV services due to COVID-19 threatens lives. COVID makes it difficult and dangerous for frontline health workers to deliver continuous, high quality HIV services to everyone who needs them. Sickness and restricted movement make it difficult for people living with HIV to access services. Economic disruption caused by COVID can make HIV services unaffordable or unobtainable. And the pandemic may interfere with supply chains and service delivery. For example, as of July 2020, one third of people on HIV treatment had experienced drug stockouts or interruptions in supplies. Supply disruptions such as these are devastating; a WHO and UNAIDS modeling study showed that six-month disruption in access to HIV medicines could lead to a doubling in AIDS-related deaths in sub-Saharan Africa in 2020 alone.

Now is the time for us to once again make a leap in our response to work together to end COVID-19 and get back on track to end HIV by 2030. On World AIDS Day 2020, WHO is calling on global leaders and citizens to rally for “global solidarity” to overcome the challenges posed by COVID-19 on the HIV response.  WHO has chosen to focus on “Global solidarity, resilient HIV services” as the WHO theme for World AIDS Day this year.

The key actions are:

1. Renew our fight to end HIV

   The global AIDS response has slowed down: it’s time now to invest, to innovate HIV services with broader health care and the pandemic response to get back on track to end HIV by 2030. Missing the global targets for HIV for 2020 should not be a setback but a renewed call to do better.

2. Use innovative HIV services to ensure continued HIV care.

   There are many new approaches countries are adopting to ensure HIV care during the pandemic. WHO has recommended multi-month prescriptions of HIV medicines to protect the health of people on HIV treatment and to reduce the burden on overburdened health services.

3. Engage and protect our nurses, midwives and community health workers

   We urge policymakers to ensure that frontline health workers, nurses, midwives and community health workers are engaged and protected when delivering services for HIV and COVID-19. 

4. Prioritize the vulnerable – youth and key populations
   We need to ensure that children, adolescents and members of key and vulnerable populations affected by HIV do not fall through the cracks of health care disruptions during COVID-19.  Key populations include people who use drugs, men who have sex with men, sex workers, transgender people and people in prisons that are disproportionately affected by HIV. 
   

Please join us for a webinar to celebrate World AIDS Day on 1 December 2020 from 13:00 to 14:30 Geneva time (Central European Time). The event will cover global efforts to ensure global solidarity and resilient HIV services, including during the COVID-19 pandemic.

The speakers will include:

Dr Tedros Adhanom Ghebreyesus, Director General, World Health Organization (WHO)

Honourable Lizzy Nkosi, Minister of Health, The Kingdom of Eswatini

Mr Peter Sands, Executive Director, The Global Fund to Fight AIDS, Tuberculosis and Malaria

Ms Winnie Byanyima, Executive Director, Joint United Nations Programme on HIV (UNAIDS)

Dr J.V.R. Prasada Rao, Former Secretary of Health, India and Former SG’s Envoy for AIDS in in Asia and the Pacific

Dr Ren Minghui, Assistant Director-General, Universal Health Coverage/Communicable and Noncommunicable Diseases, WHO

Dr Meg Doherty, Director, Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, WHO

Ms Cindy Amaiza, National Coordinator, Y+ Kenya

Ms Sasha Volgina, Programme Manager, Global Network of People Living with HIV (GNP+)

Dr Adeeba Kamarulzaman, President, International AIDS Society (IAS)

Ms Erica Burton, Senior Advisor, International Council of Nurses (ICN)

Dr Alex Schneider, Founder, Life4me+

Mr Asghar Satti, National Coordinator, Association of People Living with HIV (APLHIV), Pakistan

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Among patients with HIV who are in care, the rate of hospitalization for any cause declined substantially during a recent 10-year period, according to study findings published in The Journal of Infectious Diseases.

Hospitalization rates declined despite the potential effects of aging, comorbidities and cumulative exposure to HIV and antiretrovirals, researchers said.

In their study, Thibaut Davy-Mendez, PhD, a post-doctoral fellow in the department of psychiatry and behavioral sciences at the University of California, San Francisco, Stephen A. Berry, MD, PhD, associate professor of medicine at Johns Hopkins University School of Medicine, and colleagues examined trends in all-cause and cause-specific hospitalization rates between 2005 and 2015 to assess the possible impact of ART improvements, aging and comorbidities on hospitalizations among people living with HIV (PLWH) who are receiving care.

The study included PLWH receiving care in six clinical cohorts in the United States and Canada.

Among the 28,057 patients ultimately included in the study, the median CD4 increased from 389 to 580 cells/µL, and the proportion of patients who were virologically suppressed rose from 55% to 85%.

According to the researchers, the unadjusted all-cause hospitalization rate decreased from 22.3 per 100 person years in 2005 (95% CI, 20.6-24.1) to 13 per 100 person years in 2015 (95% CI, 12.2-14). Additionally, unadjusted rates decreased for almost all diagnostic categories, whereas adjusted rates decreased for all-cause, cardiovascular and AIDS-defining conditions. They increased for non-AIDS-defining infection and were stable for most other categories.

According to Davy-Mendez and Berry, previous data showed similar results. Data from the 2000s revealed a decrease in hospitalization rates among PLWH but slight increases in cardiovascular and kidney disease hospitalizations. Additionally, more recent studies in North Carolina and Italy found a continued decrease in hospitalization rates among people with HIV through 2016.

“Our study is the most recent work reporting hospitalization trends across a large number of people living with HIV in the United States and Canada,” they said. “Based on previous studies, we expected that non-AIDS-defining infections would make up a substantial percentage of hospitalization reasons. However, we did not expect to see a small increase in the adjusted hospitalization rate [of] non-AIDS-defining infections.”

They said this finding will require further investigation to understand the drivers of these infections and possible ways to prevent them.

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Source – https://theconversation.com/

Women make up more than half of the people living with HIV around the world. Young women between the ages of 10 and 24 are twice as likely to get HIV as young men in the same age group. In East and Southern Africa young women will acquire HIV on average five to seven years earlier than their male peers.

Researchers have been working hard to find effective HIV prevention measures.

Most notable is the pre-exposure prophylaxis (PrEP) pill known as Truvada. This is a combination of two antiretroviral drugs – tenofovir and emtricitabine. This can be effective in preventing HIV acquisition. But taking a pill every day is not practical for many people.

Scientists from the HIV Prevention Trials Network recently found that a PrEP regimen of long-acting cabotegravir (CAB LA) injections once every eight weeks was better than the daily tablet used for HIV prevention. Ina Skosana spoke to Sinead Delany-Moretlwe, a research professor at the University of the Witwatersrand in South Africa and director of research at the Wits Reproductive Health & HIV Institute to find out more.

Can you tell us about the study?

This study, known as HPTN 084 is the first one to compare the efficacy of two HIV prevention or pre-exposure prophylaxis regimens.

The first regimen consisted of an injection of the long-acting antiretroviral drug, cabotegravir given every eight weeks. The second regimen was the daily oral dose of Truvada. Truvada has been shown to be highly effective for HIV prevention when taken as prescribed in a variety of populations and contexts.

We enrolled over 3,200 sexually active, HIV-uninfected cisgender women at 20 sites in seven countries. Research took place in Botswana, Eswatini, Kenya, Malawi, South Africa, Uganda, and Zimbabwe between November 2017 and November 2020.

Our study randomised participants to one of two arms. One arm received active cabotegravir and a Truvada placebo. The other arm received active Truvada and placebos for cabotegravir. Cabotegravir was administered daily by mouth for 5 weeks and via intramuscular injection at 8-weekly intervals after an initial 4-week interval load.

What did you find?

Preliminary findings show that overall 1% of participants were infected with HIV during the study period. This suggests that both cabotegravir and Truvada are highly effective for HIV prevention in this population.

The 34 incident infections detected in participants assigned to Truvada is equivalent to an incident of 1.79%. And the four infections detected in the participants assigned to cabotegravir is equivalent to an incidence of 0.21%. This confirms a new prevention option for women that offers a significant advantage over existing oral PrEP which requires consistent daily use and is associated with significant adherence challenges.

We observed roughly 9 times the number of incident HIV infections in the Truvada arm compared to the cabotegravir arm. This finding suggests that cabotegravir is much more effective than Truvada in preventing HIV infection in women. And the threshold for early stopping of the trial was met. Based on these findings the independent data and safety monitoring board recommended that the blinded portion of the study be stopped early and the results released to the scientific and broader community.

An earlier sibling study in cisgender men and transgender women called HPTN 083  showed similar results. A prep regimen containing long-acting cabotegravir injectable once every 8 weeks was superior to the daily oral Truvada in that population.

What are the next steps?

The study results are important and timely as more methods to prevent HIV among women at higher risk of HIV are urgently needed. These include methods that do not depend on daily or near-daily pill-taking, condom use or abstention from sex. The development of alternative methods to prevent HIV, and more adherence-friendly schedules than are currently available, will increase the HIV prevention choices and acceptability for women and reduce new HIV infections.

We have communicated with the research ethics committees and national drug regulators overseeing this study, and site investigators and study participants are being notified about the results as soon as possible. Participants will be able to learn about the medication that they were receiving. A protocol amendment will be submitted for regulatory review to allow participants to continue taking their assigned medication or to switch to cabotegravir if they choose.

Participants on Truvada will be offered cabotegravir as soon as the medication can be made available. All participants will be asked to continue on the study. And if they chose not to remain on the study, they will be referred for the best locally available HIV prevention services. We look forward to presenting these results in a peer-review setting at upcoming conferences as we finalise the primary analysis.

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Perry N. Halkitis, dean of Biostatistics and Urban-Global Public Health in the Rutgers School of Public Health, will receive the Hyacinth Award from the Hyacinth Foundation, according to a press release.

The award, meant to honor those who have been advocating for people living with HIV, will be given to Halkitis at the Hyacinth Foundation’s 35th Anniversary Virtual Celebration next Saturday, according to the press release. He said he dedicates his award to the memory of five important people in his life that he lost to HIV during the first two decades of the epidemic.

“Receiving this award means the world to me,” Halkitis said. “I have been doing HIV behavioral research, education, advocacy (and) activism for almost all of my adult life.”

For three decades, Halkitis has researched the intersection between HIV and other sexually transmitted diseases, drug abuse and mental health burden as well as the biological, behavioral, psychosocial and structural factors that predispose the LGBTQ population to these health disparities, among others, according to his website.

Halkitis’s work also focuses on translating this knowledge into interventions to reduce these disparities, such as delivering health care services to gay men within their communities, according to the Rutgers School of Public Health website. His work is being enacted in large urban centers in the U.S., including Newark, New Jersey.

Halkitis is the founder and director of the Center for Health, Identity, Behavior and Prevention Studies, a training site for the next generation of scholars seeking to improve the health of the LGTBQ community, according to the Rutgers School of Public Health website.

“People who are living with HIV are not just a vessel for HIV,” Halkitis said. “They are complex organisms who have complex lives, and so we have to attend to all aspects of their lives if we’re really going to help bring an end to AIDS, and also to prevent further infections.”

He said he has doubts that the U.S. can bring an end to AIDS by 2025 despite the federal administration’s efforts because medications alone are not enough, and discriminatory laws need to change due to their function in perpetuating HIV. Halkitis said he will continue to do work on HIV until the U.S. brings an end to the disease.

“I am dedicated to fighting this disease,” he said. “I am dedicated to fighting the discrimination that HIV positive people face. I am dedicated to advocating for policies that helped us to prevent the further spread of HIV. I think any good public health researcher, any strong public health researcher, has to also be an advocate and an activist because politics and public health are intimately tied to each other.”

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A new report by Public Health England shows that for the first time the number of new HIV diagnoses in gay and bisexual men outnumber new diagnoses in heterosexual adults by only 100 cases.

The number of gay and bisexual men (GBM) with newly diagnosed HIV fell to the lowest point in 20 years, according to a new report from Public Health England (PHE) published today.

The report shows there were 1,700 new HIV diagnoses in GBM in 2019 compared to 1,500 in 2000.

Overall, the number of people with a new HIV diagnoses fell by 10% (from 4,580 in 2018 to 4,139 in 2019). There was also a 34% decline from a peak of 6,312 new diagnoses in 2014.

There were 1,700 new HIV diagnoses in gay and bisexual men (GBM) in 2019 compared to around 1,600 cases in heterosexual adults. This is the lowest number of new HIV diagnoses in GBM since the year 2000 (1,500) and since 1998 in heterosexual adults (1,600).

HIV transmission in GBM has fallen by 80%; newly acquired HIV infections fell from an estimated peak of 2,700 cases in 2011 to an estimated 540 in 2019 (see background information).

While the proportion of people diagnosed late remained high at 42%, the overall number decreased from around 1,900 in 2015 to 1,300 in 2019. People diagnosed late in 2019 had an eight-fold risk of death compared to those diagnosed promptly.

The decline in HIV transmission in GBM can be directly linked to the increase in combination prevention, including:

• the use of condoms

• pre-exposure prophylaxis (PrEP)

• frequent HIV testing in a wide range of settings

• starting antiretroviral therapy (ART) as soon as possible after diagnosis

Treatment is now so effective that 97% of people receiving ART have undetectable levels of virus, which means it is impossible to pass the virus on, even if having sex without condoms. Undetectable = untransmittable (U=U).

HIV testing is vital for preventing HIV-related illness and death and to achieve the goal of ending HIV transmission in the UK by 2030. The UK continues to meet the United Nations Programme on HIV and AIDS (UNAIDS) 90-90-90 targets for the third consecutive year – however, there are opportunities to improve uptake of testing and support those testing positive to continue their treatment.

Almost 300,000 people declined to have an HIV test when they attended a specialist sexual health service. Black African heterosexual women attendees were more likely to decline a test than Black African heterosexual men (20% versus 9% declined testing) but less likely than heterosexual women and men overall (25% versus 13%). More focused conversations on HIV, testing, prevention and treatment in schools and clinical settings can help to combat high rates of declined tests.

By comparison, only 4% of GBM attending specialist sexual health services declined an HIV test – this is the group in which greatest declines in HIV transmission have been achieved.

Dr Valerie Delpech, Head of HIV Surveillance at PHE, said:

In the UK, we have made great progress towards eliminating HIV transmission by 2030. Frequent HIV testing, the offer of PrEP among those most at risk of HIV, together with prompt treatment among those diagnosed, remain key to ending HIV transmission by 2030.

Further progress can only be achieved if we also address the inequalities in reducing HIV transmission that exist around sexuality, ethnicity and geography.

The most common way of getting HIV in the UK is through sex with a person who is unaware of their HIV infection.

You can protect yourself from HIV by consistent and correct condom use with new and casual partners, by using PrEP, or if your partner is on treatment and is undetectable if they are living with HIV. Correct and consistent condom use will also stop you getting or transmitting other sexually transmitted diseases (STIs).

People can get tested through free tests available from sexual health clinics, GP surgeries, as well as through a self-sampling service or by using a self-testing kit.

Background information

Those at risk of HIV and STIs can still access services through sexual health clinics during the COVID-19 pandemic. Many clinics offer online testing, which means people can order tests using clinic websites, take them in the privacy of their own home, return by post and receive results via text, phone call or post.

New HIV diagnoses reflect diagnoses that occurred within a year. Since people can live with HIV for many years without being aware of their HIV infection, trends in diagnoses do not necessarily reflect trends in newly acquired infections. We use models to estimate newly acquired infections (infections acquired recently) for gay and bisexual men only.

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Made-In-Canada INSTI® HIV Self Test Provides Results in 1 Minute and is More Than 99% Accurate

VANCOUVER, British Columbia, Nov. 03, 2020 (GLOBE NEWSWIRE) — For the first time, Canadians will have access to at-home HIV self test kits. bioLytical Laboratories, a world leader in rapid infectious disease tests, announced today that it has received Health Canada Licence to produce and sell its highly accurate, 1-minute INSTI® HIV Self Tests in Canada.

Likened to a home pregnancy test, the INSTI® HIV Self Test allows individuals to screen and monitor for HIV in the comfort of their own home, using easy-to-understand, three-step instructions. Testers collect one drop of blood using a simple fingerstick method and receive results that are more than 99 per cent accurate in only 1 minute. The INSTI® HIV Self Test is part of bioLytical’s world-leading line of 1-minute tests for infectious diseases including HIV, Hepatitis C, Syphilis and now, COVID-19.

Contrary to the popular belief, HIV infections are still on the rise in Canada. It is estimated that 14 per cent of people living with HIV nationwide do not know their status. The introduction of HIV self-testing provides new opportunities to reach the undiagnosed, which can lead to better health outcomes and fewer new HIV transmissions.

“Ending the HIV epidemic starts with testing. By providing innovative options like our 1-minute INSTI® HIV Self Test, we can help people who are unaware of their HIV status to learn the facts and make informed health decisions much faster,” says bioLytical’s Chief Executive Officer, Robert Mackie. “In addition, bioLytical has received approval in Europe and is currently in FDA trials for our COVID-19 Antibody test, which uses the same 1-minute INSTI® self-testing technology.”

The approval of the INSTI® HIV Self Test comes a year after the launch of a ground-breaking field study at three sites across Canada which proved that individuals without medical training could perform the 1-minute self-test and interpret their results accurately. The study was jointly funded by The CIHR Centre for REACH 3.0 and the Canadian Foundation for AIDS Research (CANFAR) and was led by Dr. Sean B. Rourke at the MAP Centre for Urban Health Solutions at St. Michael’s Hospital.

The study provided data to support bioLytical’s application for Health Canada Licence, reporting that users found INSTI® HIV Self Test to be accurate and easy to use. In fact, over 95% of the study participants indicated they would use INSTI again and would recommend it to family, friends, and sexual partners.

Dr. Rourke said, “We are excited to be bringing HIV self-testing to Canada to reach the undiagnosed – it’s long overdue, and without this option, we will not be able to end the HIV epidemic in Canada. Now approved, REACH is working closely with front-line community-based HIV organizations and other health agencies to develop, implement and scale-up a national (online) telehealth platform with peer navigators to support access to, and support with, HIV self-testing as well as linkage to care.”

The test will be available for purchase this week from INSTI.com. For more information and to sign up for updates, please visit insti.com/self-test-canada.

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The high-dose influenza vaccine (HDIV) demonstrated a 50% reduction in influenza-like illness (ILI) compared with the standard dose in HIV-infected patients, according to research presented atIDWeek, held virtually from October 21 to 25, 2020.

In a retrospective cohort study, conducted at the University of Kansas Medical Center, included 219 patients with HIV during the 2017-2018 influenza season. The median age was 53 years and 197 patients (89.9%) were men. Within the cohort, 13.7% had a HIV viral load greater than 40 copies/mL and 5% had CD4 count less than 200 cells/µL. HDIV and standard dose influenza vaccines (SDIV) were administered to 119 patients (54.3%) and 77 patients (35.2%), respectively, and 23 patients (10.5%) were unvaccinated.

A modified CDC definition of ILI, defined as fever and cough, sore throat, or shortness of breath occurred in 8 patients (10.4%) in the SDIV group compared with 6 patients (5.0%) in the HDIV group (P =.16). A broader protocol-defined ILI, defined as sore throat, cough, or shortness of breath with either fever, chills, headache, or myalgia was reported in 16 patients (20.8%) and 12 patients (10.1%) of the SDIV and HDIV groups, respectively (P =.04). There was no difference in confirmed influenza cases between groups. Vaccine side effects were mild, occurring in 11 patients (14.3%) in the SDIV group compared with 13 patients (10.9%) in the HDIV group (P =.5). Vaccine dose (SDIV odds ratio [OR], 2.34; 95% CI, 1.04-5.37; P =.04) and age in years (OR, 0.97; 95% CI, 0.94-1.0; P =.045) were associated with protocol-defined ILI. HDIV remained protective regardless of age.

The CDC reported an influenza attack rate of 14.7% in US adults and an overall vaccine effectiveness of 38% for the 2017-2018 influenza season. This study “demonstrated a 50% relative reduction in protocol-defined ILI with the HDIV compared [with] standard-dose vaccine our HIV clinic in 2017-2018,” study authors concluded. Investigators, therefore, recommended a larger prospective randomized control trial on the effectiveness of the HDIV in HIV patients.

Disclosure: One study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of author’s disclosures.

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This year’s annual U.S. Conference on HIV/AIDS (USCHA) concluded on October 21 with a plenary session featuring several federal HIV leaders and I was honored to be included. I am grateful to NMAC for convening this conference virtually during the COVID-19 pandemic, enabling the community along with federal and state partners to continue to share important information, strategies, and experiences about HIV, sexually transmitted infections, viral hepatitis, leadership, and race. Following are some highlights of what I shared with the participants.

Status and Next Steps for the Ending the HIV Epidemic Initiative

Naturally, participants wanted to know about the status of Ending the HIV Epidemic: A Plan for America (EHE) given all that has happened this year and what lies ahead for this national initiative. I reiterated that EHE remains a priority at the U.S. Department of Health and Human Services and that its agencies and offices are moving forward with implementation activities. Some important EHE developments include:

• The 57 jurisdictions prioritized in the initiative’s first phase are working to revise their EHE Plans based on feedback CDC, HHS, and HRSA shared on the draft plans back in March. Acknowledging the impact of the response to COVID-19 on state and local health departments and their key community partners, the deadline for submitting the revised plans was extended to December 31, 2020.
• The Ready, Set, PrEP program, which provides PrEP medications at no cost to individuals who qualify, made some COVID-related adaptations earlier this year to help ensure patient retention in ongoing PrEP care and adherence to medications, and also reduce the burden on the nation’s health care providers and health care systems. The program authorized 90-day prescription fills and implemented automatic enrollment eligibility extensions between June 1 and September 29. We’ll be making enhancements to GetYourPrEP.com , the enrollment portal for Ready, Set, PrEP in the coming weeks. Soon you’ll see additional Ready, Set, PrEP marketing assets featuring real people who take PrEP telling their stories of how PrEP has affected their lives.
• In August, we launched America’s HIV Epidemic Analysis Dashboard, known as AHEAD. It’s an online data visualization tool designed to help jurisdictions, researchers, public health professionals, HIV service organizations, and others across the country track progress towards meeting EHE goals. AHEAD displays graphical representations of data on the six EHE HIV indicators for the 57 jurisdictions prioritized in the initiative, as well as state data for the 21 states in which EHE counties are located. In collaboration with our partners at CDC, additional data was recently added to the site. The new indicator data includes preliminary 2019 data and data on the first quarter of 2020 on HIV diagnoses and linkage to HIV medical care.
• To continue making progress on EHE’s Diagnose strategy, HHS, CDC, HRSA, IHS, and SAMHSA are encouraging and facilitating HIV self-testing options in communities where there has been a reduction in availability of in-person HIV testing due to COVID-19.  Self-testing can be an effective on-going strategy to help identify and link individuals to needed HIV prevention and care services in a post-COVID-19 world.  Jurisdictions are encouraged to explore ways HIV self-testing can help us meet our EHE targets for HIV diagnoses.
• The Prevention through Active Community Engagement (PACE) officers, a team of U.S. Public Health Service Commissioned Corps officers supporting EHE activities in HHS Regions 4, 6, and 9, continue their work to facilitate broad community involvement in the development and implementation of jurisdictional EHE plans. They are also facilitating discussions about the intersection of HIV disparities and social determinants of health and racial inequality.

Damián Cabrera-Candelaria, Treatment Program Manager at NMAC , the USCHA conference convenor, also asked me about efforts to combat racism in health services, whether employment opportunities for people with or affected by HIV will result from EHE, and responding to HIV in Puerto Rico, which was to have hosted this year’s USCHA.

The closing session also featured remarks from my federal colleagues and partners in the EHE initiative: CDC’s Dr. Jonathan Mermin, HRSA’s Dr. Laura Cheever, SAMHSA’s Dr. Neeraj Gandotra, NIH’S Dr. Maureen Goodenow, and NIH’s Dr. Anthony Fauci.  You can view the closing plenary on YouTube. 

Joining many colleagues from across the HIV community, I commend NMAC for innovating this year to make USCHA possible once again and salute their staff along with the many presenters and participants who shared ideas and learned from one another throughout the conference.

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The prevalence of HIV among patients hospitalized with coronavirus disease 2019 (COVID-19) appears to be higher compared with the general population, suggesting an increased susceptibility to COVID-19 among people with HIV, according to research presented at IDWeek, held virtually from October 21 to 25, 2020.

To determine the prevalence of HIV in patients with COVID-19 and the relationship between people with HIV and higher COVID-19 mortality rates, researchers conducted a meta-analysis using PubMed, Scopus, OVID, Web of Science, and Cochrane Library databases, including grey literature from January 1 to June 15.

Of the 14 studies analyzed, 8 were in the United States, 3 in Spain, 1 in China, 1 in Italy, and 1 in Germany. Of the 144,795 patients hospitalized with COVID-19, 592 included people with HIV.

The pooled prevalence of HIV in patients with COVID-19 was 1.22% (95% CI, 0.61-2.43%), double the prevalence of 0.65% (95% CI, 0.48-0.89%) in the general population. The pooled HIV prevalence among patients with COVID-19 in the United States was 1.43% (95% CI, 0.98-2.07%), which was significantly higher than Spain’s prevalence of 0.26% (95% CI, 0.23-0.29%), but not significantly higher than China’s prevalence of 0.99% (95% CI, 0.25-3.85%).

The pooled mortality rate among hospitalized patients with COVID-19 and HIV was 14.09% (95% CI, 5.78-30.50%), and the rate was highest in the Unites States compared with the other countries.

Findings suggest that people with HIV may have a higher susceptibility to COVID-19. While mortality rates are high, they “vary significantly across countries,” investigators concluded.

Reference

Ssentongo P, Heilbrunn ES, Ssentongo AE, et al. Prevalence of HIV in patients hospitalized for COVID-19 and associated mortality outcomes: a systematic review and meta-analysis. Presented at: IDWeek 2020; October 21-25, 2020. Poster 393.

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