August 5, 2016
This week, a study identifies immunologic markers that provide storage for the HIV reservoir and could offer clues for cure research. Another study examines factors associated with pre-exposure prophylaxis (PrEP) adherence among black men who have sex with men. To beat HIV, you have to follow the science!
Researchers have identified three immunologic markers of cells that provide storage for the latent HIV reservoir that persists even among people who are taking effective antiretroviral medications, according to a study published in PLOS Pathogens.
Scientists at the University of Montreal and collaborating institutions hope that their discovery of specific proteins expressed on the surface of such latently infected cells will bring one strategy for an HIV cure closer to its ultimate goal. That strategy, "shock and kill," relies on activating -- and then disabling -- the latent HIV reservoir in those whose virus is effectively suppressed because of antiretroviral therapy.
Anti-cancer drugs targeting the identified cell markers already exist. If they are proven to also work against HIV, regulatory approval may be easier to obtain because their safety and tolerability have already been documented. To this end, the researchers will conduct laboratory experiments to test specific immune checkpoint blockers that bind to these marker proteins.
Black men who have sex with men (MSM) who had a primary partner and did not use multiple psychoactive drugs were significantly more likely to report consistently taking daily oral pre-exposure prophylaxis (PrEP) than other participants in the HPTN 073 study, Darrell Wheeler, Ph.D., M.P.H., reported at AIDS 2016 in Durban, South Africa.
This self-reported high adherence was corroborated by analyzing study drug concentrations in volunteers' blood. The trial enrolled 226 HIV-negative black MSM in three large U.S. cities; 79% of them accepted the offer of tenofovir/emtricitabine (Truvada) once a day.
The majority (60%) of those taking PrEP had medication levels that confer protection against HIV infection (at least four doses per week) in their blood. Other factors associated with lower adherence to the study regimen were younger age (less than 25 years), less than full-time employment and no formal education beyond high school.
Financial incentives and patient care navigators did not significantly help hospitalized patients who were living with HIV and had substance use disorders to achieve viral suppression of HIV, a study published in JAMA found.
The clinical trial enrolled 801 patients at 11 U.S. hospitals and randomized them to receive health care coordination services and financial incentives for reaching behavioral goals related to reducing substance use and improving HIV care engagement, only health care coordination services or treatment as usual.
Viral loads of 200 copies/mL or less, which the study defined as viral suppression, were achieved by 34.1% of participants in the regular treatment arm compared with 35.7% in the coordination services-only arm and 38.6% in the arm that received care coordination and financial incentives.
This lack of success may be partly explained by other issues participants faced, such as unstable housing, incarceration or racism, as well as the fact that substance use treatment was not available near all study site areas, according to a press release about the study.
Barbara Jungwirth is a freelance writer and translator based in New York.
Follow Barbara on Twitter: @reliabletran.
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