[Viva] Fwd: News from AIDS 2016 – HIV update, 3 August 2016

[Margarite Sanchez]

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From: HIV Update <bulletins at bulletins.aidsmap.com>
Date: Wed, Aug 3, 2016 at 6:30 AM
Subject: News from AIDS 2016 – HIV update, 3 August 2016
To: margaritesanchez at gmail.com


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03 August 2016

   - News from AIDS 2016 <#m_-8793818735987151963_item3076515>
   - Treatment as prevention: more confidence in zero transmission risk
   <#m_-8793818735987151963_item3076503>
   - Progress towards a cure <#m_-8793818735987151963_item3076502>
   - Injectable HIV therapies <#m_-8793818735987151963_item3076505>
   - Other treatment news <#m_-8793818735987151963_item3076506>
   - Stigma and resilience <#m_-8793818735987151963_item3076507>
   - PrEP judicial review ruling <#m_-8793818735987151963_item3076516>
   - Editors' picks from other sources <#m_-8793818735987151963_item3076508>

<http://www.aidsmap.com/page/1036964/?utm_source=NAM-Email-Promotion&utm_medium=hiv-update&utm_campaign=hiv-update>
News from AIDS 2016

This edition of *HIV update* focuses on research from the recent
International AIDS Conference (AIDS 2016) that is particularly relevant to
people living with HIV in the UK.
Treatment as prevention: more confidence in zero transmission risk

New data from the PARTNER study looking at the infectiousness of people
taking HIV treatment has added to confidence that individuals with an
undetectable viral load are extremely unlikely to transmit HIV to their
sexual partners – the risk may even be zero
<http://www.aidsmap.com/More-confidence-on-zero-risk-still-no-transmissions-seen-from-people-with-an-undetectable-viral-load-in-PARTNER-study/page/3072326/?utm_source=NAM-Email-Promotion&utm_medium=hiv-update&utm_campaign=hiv-update>
.

The research involves couples in which one person is living with HIV and
one person is not. The researchers are interested in the effectiveness of HIV
treatment as prevention
<http://www.aidsmap.com/Infectiousness-and-treatment-as-prevention/cat/1624/?utm_source=NAM-Email-Promotion&utm_source=NAM-Email-Promotion&utm_medium=conference-bulletin&utm_medium=hiv-update&utm_campaign=English&utm_campaign=hiv-update>
.

Early results released in 2014
<http://www.aidsmap.com/No-one-with-an-undetectable-viral-load-gay-or-heterosexual-transmits-HIV-in-first-two-years-of-PARTNER-study/page/2832748/?utm_source=NAM-Email-Promotion&utm_source=NAM-Email-Promotion&utm_medium=conference-bulletin&utm_medium=hiv-update&utm_campaign=English&utm_campaign=hiv-update>
showed no transmissions after sex without a condom when the HIV-positive
partner had an undetectable viral load. Now the researchers have more data
on more couples, so can state their conclusions with more confidence.

The latest data were collected from 888 couples, 38% of them gay men. Each
couple was followed for an average of 1.6 years.

They had sex without a condom a total of 58,213 times, but on no occasion
was HIV passed on.

Nonetheless, there were eleven new HIV infections. Genetic analysis showed
that in every case the virus acquired by the HIV-negative partner was quite
different from their partner’s virus, suggesting it had been acquired from
sex outside the relationship.

The vagaries of statistical analysis mean that researchers are not yet
prepared to say that an undetectable viral load means a zero risk of
transmission – although that may well be the case. The researchers are
continuing to collect more data from gay men so that they can give firmer
conclusions on the risk of transmission during anal sex.

Nonetheless, the lack of any transmissions in couples – gay or heterosexual
– in the context of an undetectable viral load is remarkable.

*For more information on this topic, read NAM’s factsheet, **‘Viral load
and transmission – a factsheet for people with HIV’.*
<http://www.aidsmap.com/Viral-load-and-transmission-a-factsheet-for-people-with-HIV/page/1044617/?utm_source=NAM-Email-Promotion&utm_medium=hiv-update&utm_campaign=hiv-update>
Progress towards a cure

A cure for HIV is a research priority and the conference heard about
several different approaches.

A particularly interesting study involved 24 young South African women who
started HIV treatment within 15 days of acquiring HIV
<http://www.aidsmap.com/Young-women-treated-in-very-early-HIV-infection-stay-HIV-negative-and-preserve-immune-function/page/3071827/?utm_source=NAM-Email-Promotion&utm_source=NAM-Email-Promotion&utm_medium=conference-bulletin&utm_medium=hiv-update&utm_campaign=English&utm_campaign=hiv-update>.
Aged between 18 and 23, the participants were recruited to the study when
they were HIV-negative but identified as being at high-risk of acquiring
HIV. As the women tested for HIV twice a week, the researchers could
identify participants with very recent HIV infection and give them
antiretroviral treatment immediately.

This very early treatment has had a powerful effect: whereas viral loads
are usually exceptionally high soon after infection, they were far lower in
this group of women. Moreover, their CD4 counts remained good and key
immune system functions were preserved.

The women will remain on HIV treatment for at least another two or three
years. The women and their doctors will then have to decide whether or not
to interrupt HIV treatment to see if the women can maintain control of HIV
without the need for treatment.

Another study, using a different approach, had disappointing results
<http://www.aidsmap.com/HIV-will-only-be-cured-with-combinations-too-conference-delegates-hear/page/3072999/?utm_source=NAM-Email-Promotion&utm_medium=hiv-update&utm_campaign=hiv-update>,
producing no significant change in the viral load or number of infected
cells in people taking part. The approach attempts to ‘flush’ HIV out of
the long-lived reservoir cells that make HIV infection lifelong. Three
drugs were used – the cell-stimulating drug vorinostat, the anti-malaria
drug hydroxychloroquine, which dampens inflammation, and the HIV entry
inhibitor maraviroc. This study disproves the idea that the immune system
itself will kill off HIV-infected reservoir cells if they are activated. It
appears cytotoxic (cell-killing) drugs will need to be used to target
reactivated reservoir cells.

Another approach is known as gene editing.
<http://www.aidsmap.com/HIV-will-only-be-cured-with-combinations-too-conference-delegates-hear/page/3072999/?utm_source=NAM-Email-Promotion&utm_medium=hiv-update&utm_campaign=hiv-update>
This is a very hi-tech therapy in which the immune system is deliberately
infected with an artificially-generated virus which, once inside immune
cells, then targets, cuts and destroys DNA in the cells’ nucleus at
specific points. Gene therapy is at a very early stage of development and
in the case of HIV has not even been tried in animals yet. Results from
laboratory experiments so far are mixed, but the conference heard some
encouraging results.

Finally, there is work to use so-called broadly neutralising antibodies
(bNAbs)
<http://www.aidsmap.com/HIV-will-only-be-cured-with-combinations-too-conference-delegates-hear/page/3072999/?utm_source=NAM-Email-Promotion&utm_medium=hiv-update&utm_campaign=hiv-update>
as long-acting HIV drugs. However, HIV either acquires resistance to single
bNAbs quickly or, in many cases has pre-existing resistance. Preliminary
results from studies using combinations of two, three or four of these
antibodies have better results. Combining these antibodies with certain
other drugs could lead to a therapy that might be used as a once- or
twice-yearly injection.

Because of the problem of HIV developing resistance to single agents, a
senior scientist told the conference
<http://www.aidsmap.com/HIV-will-only-be-cured-with-combinations-too-conference-delegates-hear/page/3072999/?utm_source=NAM-Email-Promotion&utm_medium=hiv-update&utm_campaign=hiv-update>
that curing people of HIV will have to involve combinations of drugs and
approaches, just as HIV treatment does. Dr Anthony Fauci said that HIV cure
research was roughly at the stage HIV treatment was at in 1990. Early
experience with the first HIV drug AZT suggested that single agents might
only have a limited effect, and dual combinations were starting to show
more promise.
Injectable HIV therapies

A study in which two anti-HIV drugs were taken as injections every four or
every eight weeks had good results.
<http://www.aidsmap.com/Long-acting-injectable-drugs-work-well-for-HIV-maintenance-therapy/page/3073708/?utm_source=NAM-Email-Promotion&utm_medium=hiv-update&utm_campaign=hiv-update>
People taking part in the study had not taken HIV treatment before but
needed to take HIV treatment as daily tablets for a few months before they
could switch to the injections.

The injectable antiretrovirals were cabotegravir (a new integrase
inhibitor) and rilpivirine (a non-nucleoside reverse transcriptase
inhibitor).

In the study, one third of participants took these two injections every
four weeks, one third took them every eight weeks (at a higher dose) and
one third took daily tablets instead.

After almost a year, around nine in ten people had an undetectable viral
load. Results were similar in all groups.

Nobody taking the injections had serious side-effects, although almost all
had injection-site reactions (for example pain or swelling at the injection
site, usually lasting a day or two). In interviews, most participants said
that the injection side-effects were worthwhile when compared to taking
daily pills.

Participants said that long-acting injectables were more simple, convenient
and discreet than daily pills. Some said they helped reduce stigma and gave
them relief from the daily reminder of living with HIV.
Other treatment news

Among the other studies on treatments:

   - The integrase inhibitor raltegravir can be taken once a day,
   <http://www.aidsmap.com/Once-daily-raltegravir-works-as-well-as-twice-daily-for-initial-HIV-treatment/page/3074500/?utm_source=NAM-Email-Promotion&utm_medium=hiv-update&utm_campaign=hiv-update>
   rather than twice a day (as is current practice). But a different dose
   needs to be given.


   - A small study (with only 20 participants, all new to HIV treatment)
   suggested that a two-drug regimen
   <http://www.aidsmap.com/Dolutegravir-plus-lamivudine-dual-therapy-works-well-as-initial-HIV-treatment/page/3074283/?utm_source=NAM-Email-Promotion&utm_medium=hiv-update&utm_campaign=hiv-update>
   of the integrase inhibitor dolutegravir and the nucleoside reverse
   transcriptase inhibitor (NRTI) lamivudine can suppress viral load to
   undetectable levels. We reported earlier results from this study last
   year.
   <http://www.aidsmap.com/HIV-update-4th-November-2015/page/3012231/?utm_source=NAM-Email-Promotion&utm_medium=hiv-update&utm_campaign=hiv-update>


   - A new hepatitis C treatment,
   <http://www.aidsmap.com/Sofosbuvirvelpatasvir-shows-high-cure-rate-in-HIVHCV-co-infection-study/page/3073223/?utm_source=NAM-Email-Promotion&utm_medium=hiv-update&utm_campaign=hiv-update>
   a tablet containing sofosbuvir and velpatasvir *(Epclusa)* is effective
   for people living with HIV who have hepatitis C. The treatments works for
   all hepatitis C genotypes.

Stigma and resilience

In an era of widespread HIV treatment and undetectable viral load, stigma
remains a persistent feature in the lives of almost half of people living
with diagnosed HIV in the UK,
<http://www.aidsmap.com/Stigma-persists-in-the-undetectable-era/page/3074736/?utm_source=NAM-Email-Promotion&utm_medium=hiv-update&utm_campaign=hiv-update>
according to a study presented at the conference. Anticipated stigma (the
person with HIV expecting someone else to have a poor opinion or bad
reaction to them) was frequently reported, especially in the context of
disclosing to potential sexual partners.

Nonetheless, the majority of people living with HIV scored highly on
measures of psychological resilience, enabling them to cope better with
stigma. For example, in response to the statement “I tend to bounce back
after hardships”, two-thirds said this was often or nearly always true. In
relation to “I am able to handle unpleasant or painful feelings”, half said
this was often or nearly always true.

Overall, 27% of respondents had low resilience, 39% had medium resilience
and 34% had high resilience. People with low resilience were more likely to
experience stigma and to report negative experiences of living with HIV.

As an example of a person with high resilience, the researchers included
this quote from an interview:

*“I do not feel I require others’ acceptance or approval. I do not feel
this status fundamentally changes the person I am but my willingness to
believe in myself as undiminished has required of me to dig deep within and
be courageous.”*

*For more information on stigma and how to deal with it, read NAM’s booklet
**‘HIV, stigma & discrimination’*
<http://www.aidsmap.com/stigma?utm_source=NAM-Email-Promotion&utm_medium=hiv-update&utm_campaign=hiv-update>
*.*
PrEP judicial review ruling

A judicial review in the High Court
<http://www.aidsmap.com/High-Court-rules-NHS-England-is-responsible-for-funding-PrEP/page/3076337/?utm_source=NAM-Email-Promotion&utm_medium=hiv-update&utm_campaign=hiv-update>
has ruled that NHS England is responsible for funding pre-exposure
prophylaxis (PrEP)
<http://www.aidsmap.com/PrEP/cat/1623/?utm_source=NAM-Email-Promotion&utm_medium=hiv-update&utm_campaign=hiv-update>
and decisively rebutted all the arguments used by NHS England to avoid
paying for the use of PrEP.

On 31 May, NHS England confirmed that it would not commission PrEP.
<http://www.theguardian.com/society/2016/may/31/nhs-refusal-fund-hiv-aids-prevention-treatment-shameful-say-charities>
NHS England said it does not have the legal power to commission PrEP as
local authorities are the responsible commissioner for HIV prevention
services.

In response National AIDS Trust sought a judicial review of the decision.
This week Mr Justice Green said that NHS England was mistaken in its
interpretation of its responsibilities. Furthermore, since the NHS pays for
post-exposure prophylaxis (PEP), it should pay for PrEP too. The NHS is
wrong to argue that the two interventions are different: they work in
exactly the same way, by preventing infection from becoming established
after transmission has taken place, the judge concluded.

NHS England said in response that the High Court ruling does not mean the
medication will end up being funded by the NHS, and that in any case it
will appeal against the ruling. NHS England says that a group of
medications for various conditions, including PrEP, will now be assessed
for prioritisation on the grounds of cost and impact. As part of this
process manufacturers will have to submit new price offers to determine
which of the interventions offer best value for money. This process is
unlikely to be completed before the end of October. Only then will the NHS
decide whether or not it will provide PrEP.

The health policy editor of *The Guardian *commented this week
<https://www.theguardian.com/society/2016/aug/02/prep-rationing-is-symptomatic-of-nhs-bid-to-cut-costs-at-all-costs>
that the NHS’s handling of PrEP is symptomatic of a drive “to cut costs, at
all costs.”

National AIDS Trust is seeking support to cover the legal costs of the
judicial review. You can contribute to their crowdfunding campaign here.
<http://uk.virginmoneygiving.com/charity-web/charity/displayCharityCampaignPage.action?campaignId=2419&charityId=1000275>
Editors' picks from other sources
Art of the AIDS years: what took museums so long?
<http://www.aidsmap.com/Aggregator.ashx?type=bulletin&url=http%3a%2f%2fwww.nytimes.com%2f2016%2f07%2f29%2farts%2fdesign%2fart-of-the-aids-years-addressing-history-absorbing-fear.html%3fhp%26action%3dclick%26pgtype%3dHomepage%26clickSource%3dstory-heading%26module%3dsecond-column-region%26region%3dtop-news%26WT.nav%3dtop-news%26_r%3d0&utm_source=NAM-Email-Promotion&utm_medium=hiv-update&utm_campaign=hiv-update>

from New York Times

For my generation of American gay men, the AIDS epidemic was a second
Vietnam War. A long-overdue historical survey of the era has finally
arrived.
Association of British Insurers guide on life insurance to support
customers with HIV
<http://www.aidsmap.com/Aggregator.ashx?type=bulletin&url=https%3a%2f%2fwww.abi.org.uk%2fNews%2fNews-releases%2f2016%2f07%2fABI-guide-on-life-insurance-to-support-customers-with-HIV&utm_source=NAM-Email-Promotion&utm_medium=hiv-update&utm_campaign=hiv-update>

from Association of British Insurers

A new guide has been produced by the Association of British Insurers to
inform customers with HIV about life insurance. It lets people living with
HIV know that they can get life insurance, and that they do not need to
cancel an existing policy if they become HIV positive.
Prince Harry's HIV test inspired a 500% increase in people checking their
status, says charity
<http://www.aidsmap.com/Aggregator.ashx?type=bulletin&url=http%3a%2f%2fwww.mirror.co.uk%2f3am%2fcelebrity-news%2fprince-harrys-hiv-test-inspired-8498353&utm_source=NAM-Email-Promotion&utm_medium=hiv-update&utm_campaign=hiv-update>

from Daily Mirror

The Terrence Higgins Trust described the effect of the prince’s social
media appeal as a “groundbreaking moment in the fight against HIV”. The
charity was running a pilot scheme offering people the chance to find out
their status by sending off for a 15-minute HIV self-testing kit when Harry
sat down for his test on Thursday 14 July.
Preventing HIV in transgender people
<http://www.aidsmap.com/Aggregator.ashx?type=bulletin&url=https%3a%2f%2fwww.sciencedaily.com%2freleases%2f2016%2f07%2f160720122840.htm&utm_source=NAM-Email-Promotion&utm_medium=hiv-update&utm_campaign=hiv-update>

from Science Daily

Programmes to reduce the high risk of HIV infection among transgender
people are urgently needed – but efforts are hindered by a lack of accurate
information on HIV prevalence, HIV incidence, and specific risk factors
facing this key population, say experts. A special journal supplement
presents essential information to meet the challenges of HIV prevention in
the transgender population.
21st International AIDS Conference (AIDS 2016)
<http://www.aidsmap.com/page/3035050/?utm_source=NAM-Email-Promotion&utm_medium=hiv-update&utm_campaign=hiv-update>
<http://www.aidsmap.com/page/3035050/?utm_source=NAM-Email-Promotion&utm_medium=hiv-update&utm_campaign=hiv-update>

NAM was an official conference media partner for the 21st International
AIDS Conference (AIDS 2016), which took place in Durban, South Africa, from
18-22 July.

Visit our conference webpages
<http://www.aidsmap.com/page/3035050/?utm_source=NAM-Email-Promotion&utm_medium=hiv-update&utm_campaign=hiv-update>
for news from AIDS 2016 and all our conference bulletins.

All the conference sessions, abstracts, satellite symposia and webcasts can
be found in the AIDS 2016 online programme <http://programme.aids2016.org/>.
NAM announces new Executive Director
<http://www.aidsmap.com/page/3072878/?utm_source=NAM-Email-Promotion&utm_medium=hiv-update&utm_campaign=hiv-update>
<http://www.aidsmap.com/page/3072878/?utm_source=NAM-Email-Promotion&utm_medium=hiv-update&utm_campaign=hiv-update>

NAM is delighted to announce the appointment of Matthew Hodson as its new
Executive Director.

Matthew will take up his appointment on 1 September 2016.

Read more in the NAM blog >>
<http://www.aidsmap.com/page/3072878/?utm_source=NAM-Email-Promotion&utm_medium=hiv-update&utm_campaign=hiv-update>
Equal access, free choice <http://www.hivt4p.org/> <http://www.hivt4p.org/>

Eight global HIV advocacy groups have released a consensus statement
setting out basic principles for provision of HIV treatment and
pre-exposure prophylaxis (PrEP).

You can read, sign and share the statement at: www.hivt4p.org

Find out more on the NAM blog >>
<http://www.aidsmap.com/Respect-our-rights-and-we-can-end-HIV/page/3071055/?utm_source=NAM-Email-Promotion&utm_medium=hiv-update&utm_campaign=hiv-update>
HIV & travel
<http://www.aidsmap.com/page/3048737/?utm_source=NAM-Email-Promotion&utm_medium=hiv-update&utm_campaign=hiv-update>
<http://www.aidsmap.com/page/3048737/?utm_source=NAM-Email-Promotion&utm_medium=hiv-update&utm_campaign=hiv-update>

Planning a trip? Our factsheets on HIV and travel
<http://www.aidsmap.com/page/1045163/?utm_source=NAM-Email-Promotion&utm_medium=hiv-update&utm_campaign=hiv-update>
might be helpful.

A new factsheet on Travelling with HIV medications
<http://www.aidsmap.com/page/3048737/?utm_source=NAM-Email-Promotion&utm_medium=hiv-update&utm_campaign=hiv-update>
across several time zones is based on recommendations published recently in
a journal.
NAM blog: The importance of voluntary in-house HIV testing
<http://www.aidsmap.com/page/3075172/?utm_source=NAM-Email-Promotion&utm_medium=hiv-update&utm_campaign=hiv-update>
<http://www.aidsmap.com/page/3075172/?utm_source=NAM-Email-Promotion&utm_medium=hiv-update&utm_campaign=hiv-update>

In this guest blogpost, Stefaan Van der Borght, Global Head of Health at
Anglo American, explores the importance of companies offering in-house HIV
testing and treatment programmes.

Read the guest blogpost >>
<http://www.aidsmap.com/page/3075172/?utm_source=NAM-Email-Promotion&utm_medium=hiv-update&utm_campaign=hiv-update>
PrEP legal challenge
<http://uk.virginmoneygiving.com/charity-web/charity/displayCharityCampaignPage.action?campaignId=2419&charityId=1000275>
<http://uk.virginmoneygiving.com/charity-web/charity/displayCharityCampaignPage.action?campaignId=2419&charityId=1000275>

The National AIDS Trust (NAT) has won the judicial review challenging NHS
England's decision not to fund PrEP.

Can you support NAT's crowdfunding campaign to help cover the legal costs?

Visit NAT's Virgin Giving page to donate >>
<http://uk.virginmoneygiving.com/charity-web/charity/displayCharityCampaignPage.action?campaignId=2419&charityId=1000275>
ASM Microbe 2016
<http://www.aidsmap.com/page/3070594/?utm_source=NAM-Email-Promotion&utm_medium=hiv-update&utm_campaign=hiv-update>
<http://www.aidsmap.com/page/3070594/?utm_source=NAM-Email-Promotion&utm_medium=hiv-update&utm_campaign=hiv-update>

The ASM Microbe 2016 <http://www.asmmicrobe.org/> conference was held in
Boston, USA from 16-20 June 2016.

Visit our conference webpages >>
<http://www.aidsmap.com/page/3070594/?utm_source=NAM-Email-Promotion&utm_medium=hiv-update&utm_campaign=hiv-update>
HIV & sex booklet
<http://www.aidsmap.com/page/3033623/?utm_source=NAM-Email-Promotion&utm_medium=hiv-update&utm_campaign=hiv-update>
<http://www.aidsmap.com/page/3033623/?utm_source=NAM-Email-Promotion&utm_medium=hiv-update&utm_campaign=hiv-update>

The new edition of our *HIV & sex*
<http://www.aidsmap.com/page/1060003/?utm_source=NAM-Email-Promotion&utm_medium=hiv-update&utm_campaign=hiv-update>
booklet is now available online.

This booklet is an introduction to sexual health for people living with HIV.

Find out more about this booklet in our blog >>
<http://www.aidsmap.com/page/3033623/?utm_source=NAM-Email-Promotion&utm_medium=hiv-update&utm_campaign=hiv-update>

NAM is an award-winning, community-based organisation, which works from the
UK. We deliver reliable and accurate HIV information across the world to
HIV-positive people and to the professionals who treat, support and care
for them.

Make a donation, make a difference at www.aidsmap.com/donate
<http://www.aidsmap.com/donate?utm_source=NAM-Email-Promotion&utm_medium=hiv-update&utm_campaign=hiv-update>

*For more details, please contact NAM*
tel: +44 (0)20 7837 6988
fax: +44 (0)20 7923 5949
email: info at nam.org.uk
web: www.aidsmap.com
<http://www.aidsmap.com/?utm_source=NAM-Email-Promotion&utm_medium=hiv-update&utm_campaign=hiv-update>

*NAM Publications*
Registered office: Acorn House, 314-320 Gray’s Inn Road, London, WC1X 8DP
Company limited by guarantee. Registered in England & Wales, number: 2707596
Registered charity, number: 1011220

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