[Viva] Fwd: CROI 2022: New York woman free of HIV 14 months after stem cell transplant, Wednesday 16 February 2022

Margarite Sanchez margaritesanchez at gmail.com
Sat Mar 5 08:55:23 PST 2022 

fyi ...Here are a couple of articles regarding women.
ox
---------- Forwarded message ---------
From: aidsmap bulletins <bulletins at bulletins.aidsmap.com>
Date: Wed, Feb 16, 2022 at 5:47 AM
Subject: CROI 2022: New York woman free of HIV 14 months after stem cell
transplant, Wednesday 16 February 2022
To: <margaritesanchez at gmail.com>


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16 February 2022   |   News from CROI 2022

Contents

   - New York woman free of HIV 14 months after stem cell transplant
   <#m_-1980209405756141393_section-1?utm_source=conference+news-english&utm_medium=email&utm_campaign=2022-02-16>
   - Lifetime risk of HIV in the US decreases, but not for all
   <#m_-1980209405756141393_section-2?utm_source=conference+news-english&utm_medium=email&utm_campaign=2022-02-16>
   - Zero vertical transmissions from over 5000 pregnant women with
   undetectable HIV in France
   <#m_-1980209405756141393_section-3?utm_source=conference+news-english&utm_medium=email&utm_campaign=2022-02-16>
   - Heart attack rates are declining, but not in people with HIV
   <#m_-1980209405756141393_section-4?utm_source=conference+news-english&utm_medium=email&utm_campaign=2022-02-16>
   - What led to the fall in HIV cases in UK gay men?
   <#m_-1980209405756141393_section-5?utm_source=conference+news-english&utm_medium=email&utm_campaign=2022-02-16>
   - Booster vaccine doses protect people with HIV against severe COVID-19
   <#m_-1980209405756141393_section-6?utm_source=conference+news-english&utm_medium=email&utm_campaign=2022-02-16>


New York woman free of HIV 14 months after stem cell transplant
[image: Professor Yvonne Bryson (top centre) at CROI 2022.]
Professor Yvonne Bryson (top centre) at CROI 2022.

A woman in New York City has no detectable HIV 14 months after stopping
antiretroviral therapy following a transplant of HIV-resistant stem cells
<https://www.aidsmap.com/news/feb-2022/new-york-woman-free-hiv-14-months-after-stem-cell-transplant?utm_source=conference+news-english&utm_medium=email&utm_campaign=2022-02-16>
.

Professor Yvonne Bryson of the University of California Los Angeles
described the new case at the Conference on Retroviruses and Opportunistic
Infections (CROI 2022)
<https://www.aidsmap.com/conference/croi-2022?utm_source=conference+news-english&utm_medium=email&utm_campaign=2022-02-16>
.

The woman was diagnosed with HIV in 2013 and with acute myeloid leukaemia
in 2017 and she needed a stem cell transplant. She joined a study designed
to use previously screened umbilical cord blood with the double
CCR5-delta-32 mutation. This rare mutation leads to an absence of CCR5
co-receptors, the gateways most types of HIV use to enter T-cells. Cells
with this mutation have been used previously to rebuild an HIV-resistant
immune system in people with HIV needing stem cell transplants. Being of
mixed race, the woman’s chances of finding an adult donor who was both a
close genetic match and carried the double mutation were slim, especially
given that people of colour are underrepresented among bone marrow donors
in the US.

Doctors performed a new procedure known as a haplo-cord transplant, which
combined CCR5-delta-32 cord blood cells with partially matched adult donor
stem cells from a relative without the mutation. Cord blood does not
require such a close genetic match, but the volume of banked cells is too
small for an adult transplant and cord cells are slower to become
established in the body. The adult donor cells provide enough volume and
faster engraftment, shoring up the immune system and giving the cord blood
cells more time to get established. The woman received intensive
chemotherapy and whole-body radiotherapy prior to the stem cell transplant.

The transplant went well. The woman remained on antiretroviral therapy for
three years before deciding to try a closely monitored treatment
interruption. Fourteen months later – four and a half years after the stem
cell transplant – she has not experienced viral rebound, is HIV antibody
negative and her leukaemia remains in remission.

While it is too soon to declare for certain that she is cured of HIV,
experts are hopeful that the 'New York patient’ will join the 'Berlin
patient'
<https://www.aidsmap.com/news/dec-2010/stem-cell-transplant-has-cured-hiv-infection-berlin-patient-say-doctors?utm_source=conference+news-english&utm_medium=email&utm_campaign=2022-02-16>
and the 'London patient'
<https://www.aidsmap.com/news/mar-2019/london-patient-long-term-hiv-remission-after-stem-cell-transplant?utm_source=conference+news-english&utm_medium=email&utm_campaign=2022-02-16>
as the third person to be free of HIV over the long term after stem cell
transplantation. However, they caution that this is a risky procedure that
is not applicable to most people living with the virus.

   - *Read this news story in full on aidsmap.com*
   <https://www.aidsmap.com/news/feb-2022/new-york-woman-free-hiv-14-months-after-stem-cell-transplant?utm_source=conference+news-english&utm_medium=email&utm_campaign=2022-02-16>
   - *View the abstract on the conference website*
   <https://www.croiconference.org/abstract/hiv-1-remission-with-ccr53232-haplo-cord-transplant-in-a-u-s-womanimpaact-p1107/?utm_source=conference+news-english&utm_medium=email&utm_campaign=2022-02-16>
   - *Visit our conference news pages for all our CROI 2022 coverage*
   <https://www.aidsmap.com/conference/croi-2022?utm_source=conference+news-english&utm_medium=email&utm_campaign=2022-02-16>
   - *Visit the official conference website*
   <https://www.croiconference.org/?utm_source=conference+news-english&utm_medium=email&utm_campaign=2022-02-16>


Lifetime risk of HIV in the US decreases, but not for all
[image: Dr Sonia Singh (left) at CROI 2022.]
Dr Sonia Singh (left) at CROI 2022.

While the overall lifetime risk of receiving an HIV diagnosis in the US has
decreased by 11% when comparing 2010-2014 to 2017-2019, stark racial and
geographic disparities remain, Dr Sonia Singh from the US Centers for
Disease Control and Prevention (CDC) reported to CROI 2022
<https://www.aidsmap.com/news/feb-2022/overall-lifetime-risk-being-diagnosed-hiv-us-decreases-11-stark-racial-and?utm_source=conference+news-english&utm_medium=email&utm_campaign=2022-02-16>
.

At every age, males had a higher lifetime risk of being diagnosed with HIV
than females. The overall lifetime risk was 1 in 76 for males, while it was
1 in 309 for females.

Additionally, lifetime risk is markedly higher for some racial groups:
Black males have a lifetime risk of 1 in 27, whereas for White males it is
1 in 171. Black females have a 1 in 75 risk, compared to 1 in 874 for White
females. Risk also differs dramatically based on where you live in the US,
from a high of 1 in 39 in Washington DC down to 1 in 655 in Wyoming.

Comparing the two time periods showed there has been no improvement in
lifetime HIV risk for groups such as Latinx people, American Indians, and
White females. Lifetime risk continues to be heavily patterned along sex,
racial and geographic lines.

Estimates of risk may be a useful indication of where prevention efforts
need to be strengthened. Singh emphasised the need to urgently attend to
structural factors that predispose certain racial groups to a much higher
lifetime risk than others.

   - *Read this news story in full on aidsmap.com*
   <https://www.aidsmap.com/news/feb-2022/overall-lifetime-risk-being-diagnosed-hiv-us-decreases-11-stark-racial-and?utm_source=conference+news-english&utm_medium=email&utm_campaign=2022-02-16>
   - *View the abstract on the conference website*
   <https://www.croiconference.org/abstract/estimating-the-lifetime-risk-of-a-diagnosis-of-hiv-infection-in-the-united-states/?utm_source=conference+news-english&utm_medium=email&utm_campaign=2022-02-16>


Zero vertical transmissions from over 5000 pregnant women with undetectable
HIV in France
[image: Helen Sushitskaya/Shutterstock.com]
Helen Sushitskaya/Shutterstock.com

Data collected since the year 2000 show an HIV transmission rate of 0%
among some groups of pregnant women with undetectable HIV, researchers from
the National French Perinatal Cohort reported to CROI 2022
<https://www.aidsmap.com/news/feb-2022/zero-vertical-transmissions-over-5000-pregnant-women-undetectable-hiv-france?utm_source=conference+news-english&utm_medium=email&utm_campaign=2022-02-16>
.

If a woman with HIV is not taking treatment, HIV can be passed on to her
baby during pregnancy, labour or breastfeeding. This is sometimes called
‘vertical’ transmission. The statement ‘undetectable equals
untransmittable’ (U=U), meaning that HIV cannot be passed on when someone
has an undetectable viral load, is based on data on sexual transmission,
not vertical transmission. However, this research shows what is possible in
a high-income country with uninterrupted access to health care.

Researchers looked at data from 15,959 babies born to mothers living with
HIV in mainland France between 2000 and 2017. The 0% figure relates to the
5482 infants whose mothers were already taking HIV treatment when they
became pregnant, had an undetectable viral load (below 50) at the time of
delivery and did not breastfeed. In addition, there was a 0% transmission
rate for 2358 infants whose mothers were undetectable during the first
trimester of pregnancy.

The data also confirmed that transmission was frequent when the mother did
not receive treatment and that the earlier treatment was started, the rarer
transmission was. Over the period analysed, the proportion of women taking
HIV treatment has gone up (from 68% in 2000-2005 to 99.2% in 2011-2017) and
the proportion of babies born with HIV has gone down (from 1.1% in
2000-2005 to 0.2% in 2011-2017).

   - *Read this news story in full on aidsmap.com*
   <https://www.aidsmap.com/news/feb-2022/zero-vertical-transmissions-over-5000-pregnant-women-undetectable-hiv-france?utm_source=conference+news-english&utm_medium=email&utm_campaign=2022-02-16>
   - *View the abstract on the conference website*
   <https://www.croiconference.org/abstract/perinatal-hiv-1-transmission-in-france-uu-for-mothers-on-art-from-conception/?utm_source=conference+news-english&utm_medium=email&utm_campaign=2022-02-16>


Heart attack rates are declining, but not in people with HIV
[image: Dr Michael Silverberg (centre) at CROI 2022.]
Dr Michael Silverberg (centre) at CROI 2022.

People living with HIV in two US cities had a 60% higher risk of myocardial
infarction, or heart attack, compared with HIV-negative individuals, with a
widening disparity over time, according to research presented at CROI 2022
<https://www.aidsmap.com/news/feb-2022/heart-attack-rates-are-declining-not-people-hiv?utm_source=conference+news-english&utm_medium=email&utm_campaign=2022-02-16>.
These findings underscore the need for ongoing monitoring and interventions
to manage cardiovascular disease.

Previous research showed that people living with HIV had a higher risk of
cardiovascular events than HIV-negative people, but the risk could be
changing as the HIV population is ageing, people are using different
antiretrovirals, are less likely to have a low CD4 cell count and are more
likely to have well-controlled HIV.

To explore this, researchers looked at HIV-positive and HIV-negative
members of two large US health systems, covering San Francisco and Boston,
in 2005-2009 and 2010-2017.

The analysis included 9401 HIV-positive adults, each matched to three or
four HIV-negative individuals with similar demographic and cardiovascular
risk profiles. Nearly 90% of participants were male, reflecting the HIV
populations in these cities.

During the early period, the cumulative incidence of heart attack over five
years was the same in the HIV-positive and HIV negative groups, at 1.1%
each. But in the later period, the rates diverged, rising to 1.2% in the
HIV-positive group and falling to 0.9% in the HIV-negative group. After
adjusting for demographics and cardiovascular risk factors, people with HIV
had a 60% greater risk of heart attack compared with the HIV-negative group.

The difference appeared to be largely driven by a reduction in risk for the
HIV-negative group rather than increased risk for the HIV-positive group.
The researchers suggested that HIV-specific factors such as a longer
duration of infection and use of newer antiretrovirals may have prevented
people with HIV from realising the same improvement seen in the
HIV-negative group.

For example, integrase inhibitors have been linked to weight gain and
tenofovir alafenamide is associated with elevated blood lipids, unlike the
older tenofovir disoproxil fumarate.

   - *Read this news story in full on aidsmap.com*
   <https://www.aidsmap.com/news/feb-2022/heart-attack-rates-are-declining-not-people-hiv?utm_source=conference+news-english&utm_medium=email&utm_campaign=2022-02-16>
   - *View the abstract on the conference website*
   <https://www.croiconference.org/abstract/trends-in-myocardial-infarction-risk-by-hiv-status-in-2-us-healthcare-systems/?utm_source=conference+news-english&utm_medium=email&utm_campaign=2022-02-16>


What led to the fall in HIV cases in UK gay men?
[image: Lopolo/Shutterstock.com]
Lopolo/Shutterstock.com

A combination of prevention measures has led to the striking decline in new
HIV infections in gay and bisexual men in the UK, according to a poster
presented at CROI 2022
<https://www.aidsmap.com/news/feb-2022/what-led-fall-hiv-cases-uk-gay-men?utm_source=conference+news-english&utm_medium=email&utm_campaign=2022-02-16>
.

There were an estimated 669 new HIV infections in gay and bisexual men in
2021. In 2011, this figure was around 3000. The researchers estimate that
this 75% drop in a decade will continue if current prevention measures are
maintained, leading to new cases of HIV in gay and bisexual men becoming
rare by 2040.

The modelling study used ‘counterfactual’ scenarios to tease out the
contribution of different measures. They found that if condom use in gay
and bisexual men never rose far beyond the levels seen in 1980, the annual
number of infections would be more than doubled. If the number of men
testing for HIV had not increased, even though condom use, the proportion
of men with HIV on treatment and PrEP use were at present levels, there
would be 80% more infections.

If people still only began HIV treatment when their CD4 counts fall below
350, there would be 25% more infections. Finally, if PrEP (regular
medication to prevent HIV infection) had never been introduced, then even
if the other changes had been made, then there would be twice as many
infections in 2021.

The modelling suggested that, had none of these interventions been
introduced, there would have been 7646 new infections in 2021 – eleven
times as many as occurred. The four interventions worked together and had a
synergistic effect.

   - *Read this news story in full on aidsmap.com*
   <https://www.aidsmap.com/news/feb-2022/what-led-fall-hiv-cases-uk-gay-men?utm_source=conference+news-english&utm_medium=email&utm_campaign=2022-02-16>


Booster vaccine doses protect people with HIV against severe COVID-19
[image: Dr Jing Sun (bottom left) at CROI 2022.]
Dr Jing Sun (bottom left) at CROI 2022.

Additional and booster vaccine doses have been effective in preventing
serious COVID-19 in people with HIV and others with immune dysfunction, a
large study from the United States reported this week at CROI 2022
<https://www.aidsmap.com/news/feb-2022/booster-vaccine-doses-protect-people-hiv-against-severe-covid-19?utm_source=conference+news-english&utm_medium=email&utm_campaign=2022-02-16>
.

Several studies have shown that people with HIV – especially those with CD4
counts below 200 – have weaker responses to some COVID vaccines
<https://www.aidsmap.com/news/nov-2021/people-hiv-cd4-counts-below-200-show-weaker-responses-covid-19-vaccines?utm_source=conference+news-english&utm_medium=email&utm_campaign=2022-02-16>.
Health authorities in the US and Europe recommend that people with HIV
should receive an additional vaccine dose if they are immunocompromised.
This additional dose is intended to enable immune responses to vaccination
to reach their full potential, rather than topping up waning responses (a
‘booster’).

At CROI, Dr Jing Sun of Johns Hopkins Bloomberg School of Public Health,
Baltimore, reported on breakthrough infections and severe COVID-19 cases in
people who had received an additional or booster dose after full
vaccination.

The study population consisted of 614,750 people who had been fully
vaccinated. Of these, 174,042 had received a booster dose. Twenty per cent
had immune dysfunction, which included people living with HIV, cancer, or
autoimmune disease or who had undergone a solid organ or bone marrow
transplant.

Booster doses were more effective in people without immune dysfunction.
Nonetheless, when the researchers looked at breakthrough COVID infections
in people with immune dysfunction, nine months after full vaccination,
boosted individuals still had a 44% lower risk of breakthrough infection
than people who had not been boosted.

Receiving a booster dose also reduced the risk of being admitted to
hospital or dying of COVID-19 by approximately 80% in people with immune
dysfunction.

In separate research presented to the conference, Dr Andrea Antinori of the
National Institute for Infectious Diseases in Italy looked more closely at
immune response in people with low CD4 counts following vaccination
<https://www.aidsmap.com/news/feb-2022/covid-19-vaccine-booster-produces-strong-responses-people-hiv-low-cd4-counts?utm_source=conference+news-english&utm_medium=email&utm_campaign=2022-02-16>
.

His research group found that, a median of 175 days after full vaccination,
antibody responses had declined significantly in people with HIV with CD4
counts below 200 compared to those with CD4 counts above 500. T-cell
mediated immunity was also suboptimal.

They then looked at antibody and T-cell responses 15 days after a third
dose of Pfizer or Moderna vaccine in 216 people on antiretroviral therapy
who had a prior AIDS diagnosis or a low CD4 count. Multivariable analysis
that adjusted for age and HIV-related factors including lowest-ever CD4
count and detectable viral load showed that people with current CD4 counts
below 200 did not have a significantly higher risk of non-response to the
third vaccine dose.

However, in an address to the conference's opening session, vaccine
researcher Professor Dan Barouch said, “Boosts are clearly useful and
dominate much current discussion, but the top priority should remain
providing initial vaccines to unvaccinated individuals, both in the United
States and throughout the world.”

   - *Read about the US research in full on aidsmap.com*
   <https://www.aidsmap.com/news/feb-2022/booster-vaccine-doses-protect-people-hiv-against-severe-covid-19?utm_source=conference+news-english&utm_medium=email&utm_campaign=2022-02-16>
   - *View the US abstract on the conference website*
   <https://www.croiconference.org/abstract/covid-19-booster-vaccine-effectiveness-in-people-with-and-without-immune-dysfunction/?utm_source=conference+news-english&utm_medium=email&utm_campaign=2022-02-16>
   - *Read about the Italian research in full on aidsmap.com*
   <https://www.aidsmap.com/news/feb-2022/covid-19-vaccine-booster-produces-strong-responses-people-hiv-low-cd4-counts?utm_source=conference+news-english&utm_medium=email&utm_campaign=2022-02-16>

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