[Viva] Fwd: 6th International AIDS Society Conference, Rome

[Margarite Sanchez]

Update from the IAS conference that is happening right now in Rome.
FYI,
Margarite

---------- Forwarded message ----------
From: <ias2011 at nam.org.uk>
Date: Tue, Jul 19, 2011 at 6:39 AM
Subject: 6th International AIDS Society Conference, Rome
To: margaritesanchez at gmail.com


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  Official provider of online scientific news - IAS 2011
6th IAS Conference on HIV Pathogenesis, Treatment & Prevention 17-20 July
2011
  Tuesday 19th July 2011
 Contents

   - HIV treatment IS prevention – 96% reduction in transmissions with early
   treatment <#131429f829c452b4_item1880483>
   - HIV treatment IS prevention – PrEP protects women from
HIV<#131429f829c452b4_item1880484>
   - HIV treatment – when to start <#131429f829c452b4_item1880481>
   - Side-effects of HIV treatment – bone
disease<#131429f829c452b4_item1880482>
   - Cardiovascular disease and bone loss
connected<#131429f829c452b4_item1880492>
   - HIV and sexual health – bacterial vaginosis and the risk of
   transmission <#131429f829c452b4_item1880489>
   - Colore locale <#131429f829c452b4_item1880491>
   - Clinical Care Options <#131429f829c452b4_item1880490>

 HIV treatment IS prevention – 96% reduction in transmissions with early
treatment

Myron Cohen, University of North Carolina ©IAS/Marcus Rose/Worker's Photos

Results of a major trial showing that HIV treatment dramatically reduces the
risk of transmission were greeted with a standing ovation at the Rome
conference<http://aidsmap.com/Treatment-is-prevention-HPTN-052-study-shows-96-reduction-in-transmission-when-HIV-positive-partner-starts-treatment-early/page/1879665/>
.

The HPTN 052 study
<http://aidsmap.com/The-HPTN-052-study/page/1847774/>showed that early
treatment <http://aidsmap.com/HIV-treatment/page/1044497/> – started at a CD4
count <http://aidsmap.com/CD4-cell-counts/page/1044596/> between 350 and 550
– reduced the risk of HIV transmission to an uninfected partner, by at least
96%. Almost all the study participants were heterosexual couples.

Professor Myron Cohen said: “These are important results to give to a
serodiscordant
couple <http://namlife.org/cms1332369.aspx>.”

The debate on the infectiousness of patients taking HIV therapy was
kick-started by the release of the ‘Swiss statement’ in
2008<http://aidsmap.com/The-Swiss-statement/page/1322904/>,
which said that – in certain circumstances – people taking successful
antiretroviral therapy were not infectious to their sexual partners.

However, caution was urged. Professor Cohen reminded delegates that the
average duration of follow-up in the HPTN 052 study was only 1.7 years.

A total of 28 infections could be genetically linked to an HIV-positive
partner enrolled in the study – only one of these occurred in the
immediate-treatment arm (participants in a deferred-treatment arm only
started treatment once their CD4 count dropped to 250).

The transmission took place during the early weeks of treatment. The
transmitting partner had a baseline viral
load<http://aidsmap.com/Viral-load-and-the-risk-of-transmission/page/1320687/>of
87,202 copies/ml, and after 28 days a viral load below 400 copies/ml.

Professor Cohen said that couples need to be counselled about the possible
differences in risk between the first few months of treatment and later
periods.

The researchers calculated that treatment reduced the risk of transmission
by 96%.

In the deferred-treatment arm, the average viral load when transmissions
occurred<http://aidsmap.com/Viral-load-and-the-risk-of-transmission/page/1320687/>was
approximately 80,000 copies/ml.
  Related links

   - View full news report on
aidsmap<http://aidsmap.com/Treatment-is-prevention-HPTN-052-study-shows-96-reduction-in-transmission-when-HIV-positive-partner-starts-treatment-early/page/1879665/>
   - View the abstract on the conference
website<http://pag.ias2011.org/abstracts.aspx?aid=4735>
   - View the presentation, with audio, on the conference
website<http://pag.ias2011.org/flash.aspx?pid=680>

 HIV treatment IS prevention – PrEP protects women from HIV

Michael C Thigpen, CDC and Jared Baeten, University of Washington
©IAS/Marcus Rose/Worker's Photos

Results<http://aidsmap.com/Pre-exposure-prophylaxis-does-work-for-women-two-studies-find/page/1879841/>from
two pre-exposure
prophylaxis (PrEP)<http://aidsmap.com/Pre-exposure-prophylaxis/page/1065825/>studies
show that taking anti-HIV drugs can protect women against infection
with HIV.

Preliminary results from the studies – called the Partners PrEP trial and
the TDF2 study – were announced last
week<http://www.aidsmap.com/Two-major-studies-show-that-HIV-drugs-prevent-infection/page/1870585/>.
Their results showed that PrEP reduced the risk of transmission by between
62 and 78%.

Therapy consisted of either
tenofovir<http://aidsmap.com/resources/treatmentsdirectory/drugs/Tenofovir-iVireadi/page/1731221/>or
tenofovir/FTC<http://aidsmap.com/resources/treatmentsdirectory/drugs/iTruvadai-tenofovirFTC/page/1731265/>(
*Truvada*), and its protective effects were compared against a placebo.

The new data were keenly anticipated because another study of PrEP in women,
FEM-PrEP <http://www.aidsmap.com/The-FEM-PrEP-study/page/1821879/>, closed
recently after finding zero efficacy for *Truvada*, and it had been
theorised that oral PrEP might not work for women because drug
concentrations in the genital tract were too low.

However, results of these two studies showed that PrEP was equally effective
at preventing infections in men and
women<http://aidsmap.com/Pre-exposure-prophylaxis-does-work-for-women-two-studies-find/page/1879841/#item1879843>
.

Levels of adherence <http://aidsmap.com/Adherence/page/1044469/> to
treatment were high and enrolment in the study didn’t appear to increase
rates of unprotected sex <http://aidsmap.com/Unprotected-sex/page/1044912/>.
  Related links

   - View full news report on
aidsmap<http://aidsmap.com/Pre-exposure-prophylaxis-does-work-for-women-two-studies-find/page/1879841/>
   - View the abstract for the TDF2 study on the conference
website<http://pag.ias2011.org/abstracts.aspx?aid=4631>
   - View the presentation of the TDF2 study, with audio, on the conference
   website <http://pag.ias2011.org/flash.aspx?pid=596>
   - View the presentation of the Partners PrEP study, with audio, on the
   conference website <http://pag.ias2011.org/flash.aspx?pid=886>

 HIV treatment – when to start

Beatriz Grinsztejn, Oswaldo Cruz Foundation, Brazil and Mina Hosseinipour,
UNC Project, Malawi ©IAS/Marcus Rose/Worker's Photos

Early HIV treatment reduced rates of serious illnesses by 40%, results from
the HPTN 052 study
show<http://aidsmap.com/HPTN-052-early-treatment-reduces-serious-illness-by-40/page/1879276/>
.

However, this reduction was almost entirely due to fewer cases of
extrapulmonary
tuberculosis<http://aidsmap.com/Diagnosing-pulmonary-tuberculosis/page/1732078/>(TB
infection outside the lungs, such as in lymph nodes or joints).

Starting HIV treatment<http://aidsmap.com/Starting-HIV-treatment/page/1230814/>early
did not reduce the overall risk of death, or rates of serious
bacterial infections and pulmonary
TB<http://aidsmap.com/Tuberculosis/page/1731745/>(TB infection of the
lungs).

The HPTN 052 study showed that early HIV treatment reduced the risk of HIV
transmission to serodiscordant partners by 96% (see first story).

Researchers also wanted to see what impact earlier therapy had on
HIV-related outcomes. The study recruited participants in Africa, Asia and
the Americas.

All 1763 patients had CD4 cell
counts<http://aidsmap.com/CD4-cell-counts/page/1044596/>between 350
and 550 cells/mm
3.

Patients were randomised to either start HIV therapy immediately, or to wait
until their CD4 cell count fell to below 250 cells/mm3 (the level at which
treatment was recommended to begin, in relevant national guidelines, during
the study recruitment period).

Overall, 105 patients developed a serious illness, and the risk was
significantly higher for patients in the deferred-treatment arm.

However, this was due to higher rates of extrapulmonary TB among patients
who deferred therapy.

Rates of pulmonary TB were the same in the immediate- and deferred-treatment
arms. There were 16 cases of serious bacterial infections in patients who
took immediate treatment, compared to 14 cases in patients who waited to
start treatment.

Mortality rates were also comparable – 13 patients who started immediate
therapy died, compared to ten patients who initiated therapy when their CD4
cell count fell.

In both study arms 14% of patients experienced a serious adverse event.
  Related links

   - View full news report on
aidsmap<http://aidsmap.com/HPTN-052-early-treatment-reduces-serious-illness-by-40/page/1879276/>
   - View abstract MOAX0104 on the conference
website<http://pag.ias2011.org/abstracts.aspx?aid=4723>
   - View the presentation by Mina Hosseinipour, with audio, on the
   conference website <http://pag.ias2011.org/flash.aspx?pid=609>
   - View abstract MOAX0105 on the conference
website<http://pag.ias2011.org/Abstracts.aspx?SID=98&AID=4763>
   - Download the powerpoint presentations for the HPTN 052 session from the
   conference website <http://pag.ias2011.org/Session.aspx?s=98#2>

 Side-effects of HIV treatment – bone disease

A large US study has shown that the relationship between HIV treatment and
bone disease is far from
straightforward<http://aidsmap.com/Doubt-remains-if-HIV-therapy-increases-the-risk-of-fragility-fractures/page/1878712/>.


A number of studies have shown that people with HIV have an increased risk
of bone problems <http://www.aidsmap.com/Bone-problems/cat/1724/>, such as
osteoporosis <http://aidsmap.com/Osteoporosis-and-osteopenia/page/1731726/>.
The exact causes and consequences are uncertain.

Researchers from the US Department of Veterans Affairs looked at rates of
fragility fractures – of the hip, wrist and lower vertebrae – in over 56,000
HIV-positive people between 1988 and 2009.

They found that there was a big leap in the incidence of fractures after
1996, when effective HIV
treatment<http://aidsmap.com/HIV-treatment/page/1044497/>became
available.

Traditional risk factors for fragility fractures – such as older
age<http://www.aidsmap.com/Ageing-and-HIV/cat/1985/>,
smoking <http://aidsmap.com/Smoking/page/1045157/>,
diabetes<http://aidsmap.com/Diabetes/page/1327149/>and co-infection
with hepatitis
C <http://aidsmap.com/Hepatitis-C/page/1045186/> – were all important risk
factors for this group of people.

Indeed, the researchers think that the increased incidence of fractures
after 1996 could simply be because people with HIV are living longer.

However, when they restricted their analysis to people who received care in
the treatment era, they found that treatment with
tenofovir<http://aidsmap.com/resources/treatmentsdirectory/drugs/Tenofovir-iVireadi/page/1731221/>(
*Viread*, also in the combination pills
*Truvada*<http://aidsmap.com/resources/treatmentsdirectory/drugs/iTruvadai-tenofovirFTC/page/1731265/>and
*Atripla*<http://aidsmap.com/resources/treatmentsdirectory/drugs/iAtriplai/page/1730903/>
*)* was a risk factor for fractures, as was therapy with the protease
inhibitor lopinavir/ritonavir
(*Kaletra*<http://aidsmap.com/resources/treatmentsdirectory/drugs/Lopinavirritonavir-iKaletrai/page/1731082/>).


Their results showed that each year of treatment with tenofovir increased
the risk of a fracture by approximately 12%.

Using tenofovir and *Kaletra* in the same combination increased the risk of
fractures further. However, the researchers pointed out that the risk
associated with these drugs was minimal when compared to those associated
with traditional factors.

Indeed, they were far from convinced that HIV therapy was a major cause of
fractures, commenting: “Cumulative antiretroviral exposure likely does not
account for the increased risk in the HAART era.”
  Related links

   - View full news report on
aidsmap<http://aidsmap.com/Doubt-remains-if-HIV-therapy-increases-the-risk-of-fragility-fractures/page/1878712/>
   - View the abstract on the conference
website<http://pag.ias2011.org/abstracts.aspx?aid=1076>
   - View the presentation, with audio, on the conference
website<http://pag.ias2011.org/flash.aspx?pid=314>

 Cardiovascular disease and bone loss connected

Hardening of the arteries is accompanied by bone loss in people with
HIV.<http://aidsmap.com/Marker-of-cardiovascular-disease-also-associated-with-bone-problems-in-patients-with-HIV/page/1878759/>

Italian investigators found that calcification of the coronary artery – an
early warning sign of cardiovascular
disease<http://aidsmap.com/Cardiovascular-risk-factors-among-people-with-HIV/page/1730165/>–
was associated with bone
loss <http://aidsmap.com/Osteoporosis-and-osteopenia/page/1731726/> in the
hip.

Their study involved 812 people who received care between 2006 and 2010.

They found that hardening of the coronary artery was associated with a
number of traditional risk factors, for example
smoking<http://aidsmap.com/Smoking/page/1045157/>,
diabetes <http://aidsmap.com/Diabetes/page/1327149/>, high blood
pressure<http://aidsmap.com/High-blood-pressure/page/1044677/>and
older
age <http://www.aidsmap.com/Ageing-and-HIV/cat/1985/>.

Bone loss in the hip was seen in 22% of people with evidence of
calcification in the coronary artery, and in 15% of those people without
hardening of this artery.

A series of statistical analyses found that a number of risk factors were
associated with coronary calcification and bone loss in the hip – these
included traditional risk factors and some HIV-related factors such as CD4
cell count <http://aidsmap.com/CD4-cell-counts/page/1044596/>, viral
load<http://aidsmap.com/Viral-load/page/1044622/>and treatment with
some anti-HIV drugs (for example,
tenofovir<http://aidsmap.com/resources/treatmentsdirectory/drugs/Tenofovir-iVireadi/page/1731221/>
).

The researchers emphasised that lifestyle changes such as regular
exercise<http://aidsmap.com/Exercise/page/1045096/>,
a good diet <http://aidsmap.com/General-nutritional-advice/page/1060881/>,
and stopping smoking <http://aidsmap.com/Smoking/page/1045157/> could reduce
both cardiovascular and bone problems in patients with HIV.
  Related links

   - View full news report on
aidsmap<http://aidsmap.com/Marker-of-cardiovascular-disease-also-associated-with-bone-problems-in-patients-with-HIV/page/1878759/>
   - View the abstract on the conference
website<http://pag.ias2011.org/abstracts.aspx?aid=4371>

 HIV and sexual health – bacterial vaginosis and the risk of transmission

Images from presentation by Craig Cohen of University of California, San
Francisco

An HIV-positive woman has a higher risk of transmitting HIV to her sexual
partner if she has bacterial vaginosis, a study presented to the conference
shows <http://aidsmap.com/page/1879356/>.

Bacterial vaginosis
<http://aidsmap.com/Bacterial-vaginosis/page/1044636/>(BV) is a
condition which occurs when the normal balance of bacteria in the
vagina becomes disrupted. This can result in an over-growth of certain
bacteria, which may be accompanied by symptoms such as discharge, itching
and pain. It can sometimes cause pelvic inflammatory
disease<http://aidsmap.com/Pelvic-inflammatory-disease/page/1731728/>and
lead to problems with fertility and childbirth.

Earlier research had shown that having BV increases the risk of a woman
becoming infected with HIV<http://aidsmap.com/Bacterial-vaginosis/page/1323441/>
.

Now investigators have found that a man who is in a relationship with an
HIV-positive woman has a three times higher risk of acquiring HIV if his
partner also has BV.

Genital tract viral load <http://aidsmap.com/Viral-load/page/1044622/> was
higher in women with BV but researchers do not think this explains the
increased risk of transmission.

Rather, they suggest that normal levels of vaginal bacteria could kill HIV,
reducing the proportion of virus that is infectious.

The researchers also believe that BV could indirectly increase the male
partner’s susceptibility to HIV. They noted that long-term sexual partners
share genital flora, with men acquiring bacteria from their partners. They
suggested that bacteria may activate Langerhans cells and CD4 cells, making
the man more susceptible to HIV
infection<http://aidsmap.com/Route-and-susceptibility-mucous-membranes-and-target-cells/page/1324028/>
.
  Related links

   - View full news report on aidsmap <http://aidsmap.com/page/1879356/>
   - View the abstract on the conference
website<http://pag.ias2011.org/abstracts.aspx?aid=1862>
   - View the presentation, with audio, on the conference
website<http://pag.ias2011.org/flash.aspx?pid=281>

 Colore locale

Filippo von Schloesser ©IAS/Marcus Rose/Worker's Photos

Caspar Thomson, NAM’s Executive Director, caught up with local community
leader, Filippo von Schloesser. Visit our website to read Caspar’s blogpost
on HIV in Italy, Filippo’s story and the Rome
Declaration<http://www.aidsmap.com/page/1880448/>
.

Filippo says of the declaration, “I have never seen anything like it in the
history of HIV in Italy.”
  Related links

   - Colore locale <http://www.aidsmap.com/page/1880448/>

 Clinical Care Options

Clinical Care Options <http://www.clinicaloptions.com/HIV> is also providing
official conference coverage. For capsule summaries and expert highlights,
visit the Clinical Care Options website.
  Related links

   - Visit the CCO conference
webpage<http://www.clinicaloptions.com/HIV/Conference%20Coverage/Rome%202011.aspx>


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