At the ASM Microbe meeting in June, researchers from Gilead Sciences presented data on use of TDF/FTC (Truvada) PrEP in the United States according to sex and race. They evaluated national pharmacy databases to identify prescriptions of TDF/FTC given for PrEP between January 2012 and September 2015; they eliminated prescriptions given for ART, PEP, and HBV.
This publication presents the results of San Francisco General Hospital's Ward 86 pilot study of immediate ART initiation. This RAPID program systematically offered ART to patients upon diagnosis of HIV; patients were referred from HIV testing sites in San Francisco. Of the 39 patients who participated in the pilot, 95% of them started ART within 24 hours.
The PARTNER Study, a multisite European study, evaluated rates of HIV transmissions within serodifferent heterosexual and MSM couples (n = 548 and n = 340, respectively, contributed eligible data). The HIV-positive partners were on ART with HIV RNA levels of <200 copies/mL, and the couples engaged in ongoing condomless sex (vaginal and/or anal) during a median of 1.3 years per couple (1,238 "couple years"). It was noted that 33% of HIV-negative MSM had outside partners, compared with 4% of HIV-negative heterosexual subjects).
We know that very early treatment in acute HIV infection decreases HIV RNA; this study shows it also greatly decreases proviral DNA (and reservoir size). Researchers investigated 2 small cohorts of patients in Thailand with acute (and very early) HIV infection, 1 untreated and 1 treated with ART very early; patients were followed for 144 weeks. They found that DNA integration occurs early and rapidly, and that with early and continued ART, total and integrated HIV DNA drops quickly and continues to decrease over time.
With HIV and drug addiction, we often focus on injection drug use (IDU) as a risk factor for HIV transmission. Only 2.6% of the country’s population over the age of 13 reports having injected drugs at some point during their lives1. Approximately10% of new HIV infections occur through shared injection equipment2. 22% of people with HIV were infected through IDU.3 These numbers do not account for people who use non-injection drugs, who experience HIV prevalence similar to that of people who inject drugs.4
HIV-positive men and women can now live longer than ever before. A 2013 study found that a newly diagnosed 20 year old on effective antiretroviral therapy (ART) can expect to live into their 70s. A lifespan only slightly lower than in people without HIV. While this is great news, physicians are learning that chronic HIV infection can place their patients at a higher risk of developing certain health problems earlier in life. One example is heart disease.
Tenofovir disoproxil fumarate (TDF) may cause decreases in bone mineral density (BMD). In both HIV-infected patients treated with TDF-containing ARV regimens, and in HIV-uninfected persons who use it for PrEP.
Dolutegravir has several characteristics that, in theory, suggest it will not be significantly removed by dialysis:
I have been working on website accessibility for many years in my role as Production Manager at the UCSF Center for HIV Information. Despite that experience, I still encounter problems that confound me. I recently reached out to an accessibility expert for ideas on how to manage a particularly difficult compliance problem.
Three studies presented at the 2016 Conference on Retroviruses and Opportunistic Infections (CROI) explored the pharmacokinetics of antiretrovirals administered during pregnancy. These studies support the use of standard-dose efavirenz, once-daily dolutegravir, and BID ritonavir-boosted darunavir during pregnancy.