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HIVR4P 2016: Rings, Films or Inserts? Prevention Products Need to Make Sense in Women's Lives

"We need to think outside of the box," Sharon Hillier of the Microbicide Trials Network told participants at the HIV Research for Prevention (HIVR4P 2016) conference this week in Chicago. Researchers should not be aiming to develop the most scientifically elegant solution for HIV prevention, but should "figure out how to make products that can really fit into people’s lives."


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HIVR4P 2016: New Microbicide Enema Achieves High Levels of Drug in Rectal Tissues in Monkeys

Rectal microbicides that protect against HIV transmission via anal sex are a bigger technical challenge than vaginal ones. The rectal lining is more delicate than the vaginal lining, so safety has been an issue; research has shown that many of the gel formulations used in lubricants damage rectal cells and may actually enhance HIV transmission.


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HIVR4P 2016: Second Case Report of PrEP Failure Due to Drug-Resistant Virus

A PrEP user in New York City has become HIV-positive with virus that is resistant to Truvada and other antiretroviral drugs, according to a report presented Tuesday at the HIV Research for Prevention (HIVR4P 2016) conference in Chicago. This is only the second such case that has been reported, highlighting the rarity -- but not the impossibility -- of HIV infections among people who adhere to their pre-exposure prophylaxis (PrEP) medication schedule.


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HIVR4P 2016: Vaginal and Rectal Bacteria May Influence HIV Transmission and Microbicide Efficacy

A number of presentations at the HIV Research for Prevention Conference (HIVR4P 2016) this week in Chicago looked at the influence of vaginal bacteria on HIV susceptibility, with one study finding that vaginal bacteria may have profound effects on levels of certain drugs used as microbicides -- but not others. A poster at the conference also looked at bacteria in the rectum in gay men, finding a correlation between condomless anal sex and changes in the predominant bacterial species which may similarly increase susceptibility to HIV infection.


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Life Expectancy for People with HIV Increases, But Does Not Match HIV-Negatives

People with HIV are living longer thanks to improvements in treatment, but life expectancy varies substantially across countries and even people who start antiretroviral therapy early have about an 8-year shorter life expectancy, on average, than the HIV-negative general population, according to recently published reports.


The advent of effective antiretroviral therapy (ART) in the mid-1990s dramatically reduced HIV-related mortality and increased survival for people living with HIV worldwide. Some studies have suggested that HIV-positive people who receive prompt treatment in countries with good access to care can have a life expectancy similar to that of HIV-negative individuals. But many people -- especially those who contracted HIV earlier in the epidemic and those in resource-limited countries -- may have reached very low CD4 T-cell counts before starting treatment and may have use poorly tolerated older antiretrovirals, leading to long-term detrimental health consequences.

Life Expectancy Among People in Care

As described in the September 1 Journal of Acquired Immune Deficiency Syndromes, Julia Marcus from Kaiser Permanente Northern California and colleagues aimed to determine whether a survival gap remains between HIV-positive and HIV-negative individuals with similar access to care.

The researchers conducted a cohort study of members of Kaiser Permanente California -- a non-profit integrated managed care organization -- using abridged life tables to estimate the expected number of years of life remaining at age 20.

The analysis included 24,768 HIV-positive and 257,600 HIV-negative Kaiser participants in care during 1996-2011.

There were a total of 2229 deaths among HIV-positive people, yielding a mortality rate of 1827 per 100,000 person-years (PY). Among HIV-negative people there were 4970 deaths, for a death rate of 326 per 100,000 PY.

Life expectancy among people with HIV increased over time. During 1996-1997, HIV-positive people at age 20 could expect to live 19.1 more years -- much less than the 63.4 years for HIV-negative individuals.

Life expectancy for HIV-positive people at age 20 increased to 47.1 years in 2008 and to 53.1 years in 2011, while it stayed about the same for HIV-negative people (64.9 years in 2011), narrowing the survival gap from 44.3 years in 1996-1997 to 11.8 years in 2011.

However, some groups had a shorter life expectancy, including African Americans and people with a history of injection drug use (45.8 and 46.0 more years at age 20, respectively, during 2008-2011). In contrast, white people, Hispanics, gay men, and heterosexuals had longer life expectancies (50.4, 52.2, 51.1, and 51.3 more years, respectively). Life expectancy at age 20 was similar for women (50.5 years) and men (49.2 years) -- notable because women in the HIV-negative population live longer than men, on average.

Among people who started ART early, with a CD4 count of 500 cells/mm3 or higher, life expectancy at age 20 was 54.5 years during 2008-2011 (vs 49.3 for all people with HIV), narrowing the gap to 7.9 years less than the HIV-negative population. Within this group, life expectancy increased further among people who did not smoke (56.9 years), did not have drug or alcohol abuse problems (55.7 years), and were not coinfected with hepatitis B or C (55.1 years).

"Even with early treatment and access to care, an 8-year gap in life expectancy remains for HIV-infected compared with HIV-uninfected individuals," the study authors concluded.

"These findings confirm that ART has had a substantial impact on the survival of HIV patients, and suggest that early ART initiation and risk reduction strategies, such as smoking cessation, may further reduce the remaining gap in survival relative to HIV-uninfected individuals," they added. "As lifespan lengthens and AIDS-related deaths decline among HIV patients, the impact on survival of smoking and other risk factors is likely to increase."

Life Expectancy Across Countries

In a related study, published in the August 31 advance edition of HIV Medicine, Sirinya Teeraananchai from the Kirby Institute at the University of New South Wales and colleagues did a meta-analysis of life expectancy after starting HIV treatment in countries with different income levels.

The authors identified 8 cohort studies, with a total of 154,670 participants, from the U.S., Canada, Europe, the U.K., Rwanda, South Africa and Uganda. Studies in high-income countries included mostly gay men, while those in low-income countries had a more even mix of men and women. Participants started ART with relatively low CD4 counts overall, between 100 and 300 cells/mm3.

The studies estimated life expectancy among HIV-positive people initiating combination ART at age 14 or older, again using abridged life tables. The researchers calculated pooled estimates of life expectancy overall and by country income level.

HIV-positive people in high-income countries had a life expectancy of 43.3 more years if they started ART at age 20 and 32.2 more years if they started at age 35. In low- and middle-income countries, however, life expectancy fell to 28.3 years at age 20 and 25.6 years at age 35.

Life expectancy was similar for men and women in high-income countries -- as seen in the Kaiser Permanente study -- but in low- and middle-income countries men starting ART at age 20 had a shorter life expectancy than women (22.9 vs 33.0 more years).

At all income levels life expectancy increased over time, likely reflecting improvements in ART, guidelines recommending earlier treatment, better adherence and support programs, and scale-up of treatment access.



JL Marcus, CR Chao, WA Leyden, et al. Narrowing the Gap in Life Expectancy Between HIV-Infected and HIV-Uninfected Individuals With Access to Care. Journal of Acquired Immune Deficiency Syndromes 73(1):39-46. September 1, 2016.

S Teeraananchai, SJ Kerr, J Amin, et al. Life expectancy of HIV-positive people after starting combination antiretroviral therapy: a meta-analysis. HIV Medicine. August 31, 2016 (online ahead of print).

HIVR4P 2016: Policymakers' Inaction is Leading People to Take "PrEP in the Wild"

An increasing number of gay men and others at risk for HIV are seeking to protect their health with pre-exposure prophylaxis (PrEP), but the lack of PrEP provision and regulatory approval in many countries is leading people to take it without medical supervision and on an ad-hoc basis. This will undermine the safety and effectiveness of PrEP, said Jerome Galea as he presented results of the PrEP in the Wild survey at the HIV Research for Prevention conference (HIVR4P 2016) this week in Chicago.


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HIVR4P 2016: Anal Sex May Transmit 4 in 10 HIV Infections Among High-Risk U.S. Women

A study presented at the HIV Research for Prevention conference this week in Chicago suggests that among women at high risk for HIV infection, 40% or more infections might be transmitted via anal intercourse. Because HIV is transmitted, according to different estimates, from 2 to 18 times more easily via anal than vaginal sex (the Centers for Disease Control and Prevention's estimate is 12 times), anal intercourse could be a major -- or even predominant -- contributor to HIV infections in heterosexual women, even if anal sex accounts for only 5%-10% of all sex.


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HIVR4P 2016: More Viral Suppression Needed to Reduce HIV Infections Among Gay Men

HIV suppression on antiretroviral therapy (ART) would need to increase substantially among men who have sex with men in order to take advantage of "treatment as prevention" to reduce the rate of new HIV infections, according to a mathematical modeling study presented at the HIV Research for Prevention conference (HIVR4P 2016) taking place this week in Chicago.


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Researchers Observe Sustained Remission in Monkeys with HIV-Like Virus

Researchers have induced sustained remission of simian immune deficiency virus (SIV), a relative of HIV, in macaque monkeys treated with antiretroviral therapy (ART) and an antibody-based therapy used to treat inflammatory bowel disease, according to a report in the October 14 edition of Science. The monkeys not only had undetectable viral load for up to nearly 2 years after stopping treatment, but they also showed replenishment of key immune cells in the gut.


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