June 17, 2016
This week, a study finds that stem cell transplantations are no riskier in people living with HIV than without. Another study finds that for those starting treatment during acute HIV infection, virologic failure is very unlikely. And a computer model study reports that reaching the UNAIDS 90-90-90 targets in South Africa would cost $1,260 per year of life saved. To beat HIV, you have to follow the science!
Forty study participants living with HIV and with relapsed or treatment-resistant lymphoma underwent AHCT with stem cells harvested from their own blood. Participant outcomes were then compared to 151 people who did not have HIV and had received the same treatment. Survival rates after the cell transplants were comparable between the two groups: around 87% after one year.
Furthermore, viral load suppression in those with HIV remained stable, despite a planned interruption in HIV treatment during chemotherapy to avoid drug-drug interactions. Researchers therefore pronounced AHCT "safe and effective in patients with HIV-related lymphoma."
The study was published online in Blood on June 13.
Virologic suppression can be achieved if antiretroviral therapy (ART) is started during acute HIV infection (AHI), but standard criteria for a decline in viral load may need to be adjusted, according to a substudy of the U.S. Military Research Program's HIV study in Thailand. The substudy's results were recently published online in the journal AIDS.
In chronic HIV infection, a one-log reduction in viral load is expected within two weeks of starting treatment, and a two-log reduction is expected within four weeks, study authors said. By week 24, viral load should drop to below 1,000 copies/mL -- or optimally below 200 copies/mL.
The two- and four-week viral load markers were not met by 6.5% and 11% of study participants, respectively, who began ART during AHI. The gap between treatment outcomes for chronic and acute infection virtually disappeared by week 24.
"ART initiation during AHI is efficacious and clinicians can monitor for virologic failure after 24 weeks of therapy," study authors therefore concluded.
The study was published online ahead of print in AIDS on May 9.
The resources required to reach the UNAIDS goal of 90-90-90 -- 90% of people tested for HIV, 90% of people who test positive on treatment and 90% of people on treatment with an undetectable viral load -- in South Africa would cost $1,260 per year of life saved, a computer simulation model published in Annals of Internal Medicine shows.
The UNAIDS targets aim to reduce viral load to an undetectable level (virologic suppression) among 73% of people living with HIV around the world by 2020. By contrast, the current South African HIV strategy would achieve virologic suppression among 36% of people living with HIV, according to the model.
Scaling up HIV testing and treatment efforts to achieve the UNAIDS goals would cost $54 billion, which would save an additional 13 million patient-years of life, the model predicts. The resulting cost per patient-year of life is well within the World Health Organization's threshold of $7,500 per year of life saved, which it would consider a "very cost-effective" intervention.
"Yes it would be very expensive, but it would be worth every penny," lead study author Rochelle P. Walensky, M.D., M.P.H., commented in a press release.
The study was published online in the Annals of Internal Medicine on May 31.
Barbara Jungwirth is a freelance writer and translator based in New York.
Follow Barbara on Twitter: @reliabletran.
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