May 29, 2015
This week we read a case report about a patient who was seemingly HIVfree after receiving a stem cell transplant using cord blood. We look at a few updates on HIV vaccine developments. Meanwhile, a study estimates the lifetime cost of treatment and looks at ways to reduce that amount. Plus, a major study found that starting treatment early led to considerably lower risk of developing AIDS or other serious illnesses. To beat HIV, you have to follow the science!
A patient who was living with HIV and lymphoma appeared to be in HIV remission after receiving a cord blood transplant from a donor whose CD4+ cells contain a mutation of the CCR5 receptor, making the cells resistant to HIV, according to a case report from Spain. The patient remained on antiretroviral therapy during the procedure. Seventy-six days after transplantation, he had no detectable HIV DNA in peripheral CD4 cells, based on ultrasensitive assays. Unfortunately, the patient died due to lymphoma progression, so other parts of the latent reservoir could not be measured.
Recent advances have led to identifying and isolating even more broadly neutralizing antibodies (bNAbs). At the same time, newer technology has allowed for better mapping of the HIV envelope. This review provides an update of recent findings on broadly neutralizing antibody targets, as well as implications for future HIV treatment and prevention.
Some of the latest research efforts involve engineering or "redesigning" antibodies to make them stronger and more potent against HIV. This review provides an update on recent developments in HIV antibody engineering and how increased potency may come with shorter antibody half-lives.
Using calculations based on costs of treating a 30-year-old gay man infected in 2013 who would live to 72, researchers in the U.K. performed 10,000 simulations and found an estimated mean lifetime cost of treatment to be £360,800 (about $550,000). Reductions in follow-up and monitoring lowers costs to some degree, but switching to generic drugs cuts estimated lifetime cost by half or more.
Population-level evidence shows that differences in "migration intensity" are not key factors in differences in HIV prevalence. But migration could increase behaviors that confer higher individual HIV risk, including multiple sexual partners, casual partners and concurrency, among women migrants than nonmigrants. Mobility could also affect adherence to HIV treatment, which could lead to interruptions in antiretroviral therapy use, poor outcomes and the transmission of resistant HIV strains. Ecological level studies could clarify the role of migration in variations of HIV rates worldwide.
A major international randomized clinical trial found that HIV-infected individuals have a considerably lower risk of developing AIDS or other serious illnesses if they start taking antiretroviral drugs sooner, when their CD4+ cell count is higher, instead of waiting until the CD4+ cell count drops to lower levels.
One in four of those in the Zurich Primary HIV Infection Study displayed a broad range of atypical and frequently serious or even life-threatening symptoms in early infection. The most commonly seen were gastrointestinal and neurological. Diagnoses received prior to the correct identification of acute HIV infection included other viral infections such as Epstein-Barr virus, bacterial infections such as streptococcus, syphilis, and gastroenteritis of unknown cause. However, the atypical symptoms or misdiagnoses didn't significantly delay HIV diagnosis.
U.S. HIV treatment guidelines currently recommend an altered tenofovir disoproxil fumarate (TDF, Viread) dosing schedule -- one 300-mg pill every 48 hours, instead of every 24 hours -- for adults with relatively high creatinine clearance (between 30 and 49 mL/min). An international team of researchers asked: What if we made things more convenient for these renally-impaired patients by allowing them to take TDF daily, just with a recently approved 150-mg formulation? The verdict: The lower, daily TDF dose still yielded desirable levels of drug exposure, while maintaining viral suppression.
Geriatric syndromes -- such as falls, frailty, urinary incontinence and functional impairment -- are common among HIV-positive people over the age of 50, according to University of California at San Francisco researchers. In a study newly published in JAIDS, and presented at CROI 2015 earlier this year, the researchers find that geriatric syndromes appear more likely among those with a lower CD4 nadir, as well as two key non-HIV factors: comorbidities and nonwhite race.
The much-heralded "90-90-90" campaign aims to get 90% of the world's HIV-positive people diagnosed, 90% of those individuals on consistent treatment, and 90% of those people virologically suppressed -- all by 2020. Commenting in The Lancet HIV, scientists from British Columbia, Canada, lauded the goal, but warned that it requires the establishment of a worldwide, standardized definition of steps in the HIV care continuum -- as well as a global system to consistently monitor those steps.
Is there a development this week in HIV research that you think we missed? Send us a tip!
Warren Tong is the senior science editor for TheBody.com and TheBodyPRO.com.
Follow Warren on Twitter: @WarrenAtTheBody.
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