August 19, 2016
This week, we learn about the immunological profile of people living with HIV who naturally produce broadly-neutralizing antibodies (bNAbs). We also find out that efforts to eradicate HIV worldwide will require a much greater emphasis on prevention, and learn that zoledronic acid may prevent bone loss in those who start antiretroviral therapy. To beat HIV, you have to follow the science!
People who naturally produce broadly neutralizing antibodies have a different immunologic profile than those whose bodies do not make bNAbs, a study reported in Science Immunology found.
Broadly neutralizing antibodies are used in one approach to develop an HIV vaccine, and ultimately an HIV cure. The study compared blood samples from 102 people living with HIV, half of whom had many bNAbs in their blood and half with few or none. Those with the highest levels of bNAbs had a higher frequency of antibodies that attack a person's own cells, a lower level of immune regulatory T-cells (which were also less active), and a higher frequency of memory T follicular helper immune cells than did the low bNAb group. Such an immune system profile may allow immune cells that produce antibodies to work better, leading to greater production of bNAbs, which in turn fight HIV infection. The challenge now is to find a way to replicate these specific immune system changes in a vaccine.
The rate of new HIV infections did not fall substantially between 2005 and 2015, even though deaths due to HIV declined sharply during that time, a paper published in The Lancet shows. The analysis is part of the Global Burden of Disease study, which provides estimates on a variety of diseases and injuries to help policymakers better make decisions on allocating health resources around the world.
The greatest number of new HIV infections worldwide was recorded in 1997, when 3.3 million new infections were estimated. That number fell quickly through 2005, but has remained level since, and there were large variations among countries during the entire period. By 2015, three quarters of new HIV infections around the world occurred in sub-Saharan Africa.
If UNAIDS and WHO goals for the eradication of HIV are to be met, more resources must be devoted to preventing new infections, says Haidong Wang, Ph.D., one of the study authors.
Administering a shot of zoledronic acid (ZOL) at the start of antiretroviral therapy prevented bone loss resulting from taking antiretrovirals during the first 48 weeks of HIV treatment, a clinical trial published in Clinical Infectious Diseases reported.
Previous studies have shown that most people who begin antiretroviral therapy experience bone loss. Researchers randomized 63 people living with HIV to receive an infusion of 5 mg ZOL or a placebo when they began to take atazanavir/ritonavir (Reyataz/Norvir) plus tenofovir/emtricitabine (Truvada). The ZOL arm showed a 65% lower bone resorption rate than the placebo arm at 24 weeks after starting therapy, and that rate was still 57% lower in the ZOL arm at week 48. Similarly, bone mineral density was 8% higher at 12 weeks and 11% higher at 48 weeks in those who had received the active shot compared to the placebo group.
This was a small proof-of-concept study, but the results warrant a larger clinical trial, study authors concluded.
Barbara Jungwirth is a freelance writer and translator based in New York.
Follow Barbara on Twitter: @reliabletran.
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