Each year, about 50,000 new HIV infections occur in the United States, a statistic that has not changed since 2006. Despite efforts to promote safer sex education and expand access to condoms, the number of new infections in gay men is increasing, especially in young, black gay men. To this end, research has focused on new ways to reduce the number of new HIV infections.
At this year’s “Conference on Retroviruses and Opportunistic Infections” (CROI) HIV researchers, HIV clinicians, community representatives, and activists at the Georgia World Congress Center met to hear about the latest findings in HIV research.
HOPE FOR A CURE
There has been a great deal of media attention focused on the case of an infant from Mississippi who was “cured” of HIV. The mother arrived to the hospital in labor, and was diagnosed with HIV. Testing on the infant found evidence of HIV infection and medication was started within thirty hours of birth. The infant responded well, but the medication was later stopped at the request of the mother. In people who have HIV, the virus usually rebounds in the blood soon after HIV medications are stopped. However, in this case, doctors could not find evidence of HIV in this infant’s blood after several months. Further testing by researchers at Johns Hopkins University and the University of Mississippi concluded that no evidence of HIV infection could be found.
Does this mean there is a cure? This case gives us hope that there may be one in the near future. But it remains to be seen whether these results can be repeated. Keep in mind that adults are very different from infants in that they have more developed immune systems. Infants do not have well developed immune systems (meaning fewer hiding places for the HIV virus) which may explain why this particular infant was able to be “cured” by early treatment with HIV medication. Even when people are treated with powerful HIV medication that suppresses the virus to the point where it is undetectable in the bloodstream, the virus is still able to hide out in certain cells. This is why the virus comes back after medication is stopped (and also why it is so important to take medication everyday if you have HIV). There is ongoing research to try to figure out all the different locations in the body where the virus may hide, and how to remove HIV from these places.
TREATMENT = PREVENTION, BUT YOU HAVE TO TAKE THE MEDICINE!
A 2011 study called HPTN-052 looked at heterosexual couples where one person was HIV positive and the other was HIV negative. It showed that treating the HIV positive partner with HIV medication could reduce HIV transmission by 95%. This study proved that HIV treatment is a very effective form of HIV prevention.
Similarly, there has been interest in treating HIV negative people to prevent HIV, also called pre-exposure prophylaxis or PrEP. The iPrEX study (the Pre-exposure Prophylaxis Initiative Study) followed gay men and transgender women who received either daily Truvada (a medication used to treat HIV) or a sugar pill. The results showed that Truvada reduced the rate of HIV by 44%. One of the challenges of the study was that not everyone took the medication. In people who actually had measurable levels of medication in their blood (meaning that they took some of their medication), Truvada reduced HIV risk by over 90% These results influenced the Food While a vaccine is on the horizon HIV infection rates continue upward 39 EqualMagazine.org and Drug Administration’s landmark decision to approve Truvada for the prevention of HIV in July 2012.
Adhering to proper medication instructions continues to be a critical but elusive piece to the HIV prevention puzzle. Medications only work if people use them! The results of the recently completed VOICE study (Vaginal and Oral Interventions to Control the Epidemic) showed that neither daily Truvada nor a daily anti-HIV lubricant used vaginally, called tenofovir gel, were effective in reducing HIV infections in over 5,000 African women. Both of these products reduced HIV infections in prior studies. Further analysis revealed that less than half of the women were using the prevention products given to them. The findings suggest that we need to learn more about why people do not take their medication so that we can develop interventions that people at risk will use consistently. For example, there are studies looking at long acting injectable medications which may be effective for several weeks to months.
The University of Pittsburgh is actively involved in HIV prevention research, and is recruiting and enrolling study participants for several studies. HPTN-069 is a study looking at Truvada and another medication (called Maraviroc) as pre-exposure prophylaxis in HIV negative gay men and transgender women. This study is actively enrolling and looking for volunteers. MTN-017 is a study opening soon that will assess the safety and acceptability of rectal tenofovir gel (a lubricant containing the HIV medication tenofovir) in sexually active HIV negative men. HIV research will give us information on how we can keep our community safe and healthy.
Dr. Ken Ho is an Instructor of Medicine in the Division of Infectious Diseases at UPMC. He is the medical director of the Pitt Men’s Study, a site principal investigator for an HIV prevention trial called HPTN-069, and is also a safety physician for the NIH funded Microbicide Trials Network. Dr. Ho’s current interests lie in HIV prevention with a focus on oral pre-exposure prophylaxis.
For more information about the research at the University of Pittsburgh and to find out whether you may qualify to be a part of an HIV prevention study, please call (412) 383-1313 or join our research registry at www.hivregis. pitt.edu. For information on studies for HIV-infected persons, please call 412-647-0322.
