Top Infectious Disease News of the Week— March 3, 2019

#5: PrEP Use in Persons With Undetected HIV Infections Contributes to Resistance

With antimicrobial resistance at the top of the World Health Organization’s top 10 global health threats of 2019, it’s only natural that resistance is also at top of mind for those on the frontlines of the HIV epidemic.

The success of pre-exposure prophylaxis (PrEP) in keeping HIV-negative individuals from becoming infected has now triggered fears of possible drug resistance linked to prescribing the prevention treatment to persons with an undiagnosed HIV infection.

Investigators from the New York City Department of Health and Mental Hygiene culled data from cases assigned for partner services from November 2015 to August 2017 in New York City to examine the viral resistance profile and determine rates of mutations in recently diagnosed persons (< 12 months) with a recent history of PrEP (emtricitabine [3TC] [M184I/V/IV/MV] and tenofovir disoproxil fumarate [TDF] [K65R]) use. The team compared acute HIV infection, negative nucleic acid amplification tests (NAAT), and prevalence of viral resistance in pre-diagnosis PrEP users and those who had never taken PrEP before.

Read about PrEP resistance and watch the interview with Dr. Kavita Misra.

#4: Point-of-Care Viral Load Testing Improves Viral Suppression and Care Retention

Point-of-care viral load testing significantly improved viral suppression and retention in care when compared with standard-of-care testing in a study in South Africa. The investigators found that over a 12-month period, there was a 13.9% increase of retention with viral load suppression among participants who received point-of care testing and same-day counseling.

The results of the study were previewed in a press conference Monday and will be presented in full Tuesday, March 5, 2019, in a late-breaking oral abstract session at the Annual Conference on Retroviruses and Opportunistic Infections (CROI 2019).

For the study, a team of investigators from the University of Washington, University of Oxford, and University of KwaZulu-Natal in Durban, South Africa, set out to determine if point-of-care viral load testing was a viable method to monitor people living with HIV on antiretroviral therapy (ART) in resource-limited settings to work towards achieving UNAIDS’s 90-90-90 targets.

Read about point-of-care viral testing and check out the interview with Dr. Paul Drain.

#3: Second Patient Reported to Achieve Long-Term HIV Remission

The absence of viral HIV rebound was observed for 16 months following interruption to antiretroviral therapy at 17 months after a single allogenic CCR5-d32 hematopoietic stem cell transplant using a no irradiation approach with only mild graft-versus-host disease.

According to Reuters, Ravindra Gupta, a professor and HIV biologist who co-led a team of doctors treating the man described his patient as “functionally cured” and “in remission”, but cautioned: “It’s too early to say he’s cured.”

This documentation is similar to only that of the so-called “Berlin patient.”

Details on this patient, referred to as the London patient, were presented March 5, 2019 in a late breaker oral abstract session at the Conference on Retroviruses and Opportunistic Infections (CROI 2019) and published in the journal Nature.

#2: DISCOVER Study: HIV Incidence Rates Low in MSM and Transgender Women Taking F/TAF or F/TDF for PrEP

When taken daily, emtricitabine/tenofovir disoproxil fumarate (F/TDF) for HIV pre-exposure prophylaxis (PrEP) has a high success rate of preventing HIV infection.

When compared with TDF for HIV treatment, tenofovir alafenamide (TAF) has higher intracellular tenofovir-diphosphate levels, lower plasma tenofovir levels, and is associated with improved renal and bone safety.

Now, investigators have set out to research the efficacy and safety of F/TDF (Truvada) when compared with emtricitabine/tenofovir alafenamide (F/TAF; Descovy) in the DISCOVER study.

The study, which enrolled cisgender-men who have sex with men (MSM) and transgender women who are at high risk for HIV acquisition, was presented in a late-breaking oral abstract session at the Annual Conference on Retroviruses and Opportunistic Infections (CROI 2019) on Wednesday, March 6, 2019.

Read about the DISCOVER study and watch the interview with presenter Dr. Brad Hare.

#1: The Botswana Beat Cohort Study: Favorable Outcomes for Dolutegravir-Based Regimens

In June 2016, Botswana became the first country in Africa to employ a dolutegravir-based regimen (DBR) as part of a “treat all” strategy. Now, investigators are reporting 12-month outcomes from the Botswana Epidemiological ART Treatment Cohort Study (BEAT), an observational research cohort tracking virologic and clinical outcomes of people living with HIV who are beginning DBR.

The findings were presented as a late-breaker poster at the Annual Conference on Retroviruses and Opportunistic Infections (CROI 2019) on March 6, 2019.

Investigators sought to analyze the outcomes for treatment-naïve patients, highly treatment-experienced patients, and patients switched to a DBR. Armed with data from the Botswana Ministry of Health and Wellness electronic records, national HIV and laboratory databases from 11 urban and semi-rural facilities, and information obtained from patient files and clinic registeries, the research team ultimately examined health information from 2257 people living with HIV (1523 previously treatment-naïve, 638 treatment switches, and 140 highly treatment-experienced patients).

The median age of people included in the cohort study was 39 years and 63% were women.

Among individuals who began a regimen of dolutegravir within the past year, viral load suppression was high overall. Two treatment-naïve individuals and 1 highly treatment-experienced person experienced adverse events (severe itching and a rash) severe enough to require intervention or a switch from DBR.

Seventy-seven deliveries occurred during the study, and no neural tube defects were reported in any of the infants. Eleven of the expecting mothers had begun dolutegravir prior to conception.

Read about the research in Botswana and an interview with study investigator Dr. Ava Avalos.