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This Week in HIV Research: Antiretrovirals for Both Partners in Mixed-Status Relationship Prevent Transmission; and Study Examines As-Needed Rectal Microbicide Gel

November 4, 2016

This week, a study finds that providing antiretrovirals for both partners in a serodiscordant couple -- for both treatment and prevention -- substantially reduces HIV transmission risk. Another study finds that men who have sex with men were just as likely to use a microbicide gel before and after anal sex as they were to take daily pre-exposure prophylaxis. To beat HIV, you have to follow the science!


Antiretrovirals for Serodiscordant Couples Effectively Prevent Transmission

Providing pre-exposure prophylaxis (PrEP) to the partner of someone who is starting antiretroviral therapy substantially reduced HIV transmission rates compared to a computer model, researchers reported in PLOS Medicine.

More than 1,000 heterosexual serodiscordant couples in East Africa who were at high risk of HIV transmission received HIV treatment for the partner living with HIV, and for the first six months that treatment PrEP for the other partner. For ethical reasons, the comparison group was a computer simulation rather than actual people. The simulation suggested an HIV incidence of more than 5% a year, while the actual rate was less than half a percentage point.

The study aimed to simulate "real world" conditions with fewer follow-ups than standard clinical trials and counseling similar to what is provided at local public health facilities. Even so, participants used the medications most of the time (at least 85% adherence), showing that "an integrated strategy of antiretroviral therapy and PrEP can be delivered feasibly to a high-risk African population," study authors concluded.

Related: This Week in HIV Research: Researchers Exonerate Long-Alleged 'Patient Zero,' and Triggering bNAb Production Shows Promise


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Very Good Adherence to As-Needed Rectal Microbicide Gel

Men who have sex with men were just as likely to use a microbicide gel before and after anal sex as they were to take daily PrEP, study results presented by the Microbicide Trials Network at HIVR4P 2016 showed. However, the gel was used less frequently (83%) when participants were expected to apply it daily.

Adherence to the study regimen (daily PrEP, daily gel or pre- and post-coital gel) was determined by "real-time pharmacokinetics" -- measuring the amount of the study drug in participants’ blood. While PrEP has been proven to be effective in preventing the acquisition of HIV, the gel’s efficacy has not yet been established.

High adherence to the microbicide is therefore "remarkable," said Alex Carballo-Diéguez, one of the study authors, adding that the results show "that rectal microbicide gels … could be a potential alternative for people who don’t want to use daily oral PrEP," according to a press release about the study.


Poor Linkage to Care in South African Test-and-Treat Study

While repeat home-based HIV testing was well accepted, linkage to care was poor in a study conducted in rural South Africa and presented at AIDS 2016.

Everyone in 11 communities who was at least 16 years old was offered HIV testing at home every six months. Those who tested positive were referred to a treatment center where they were randomized to an immediate antiretroviral treatment arm or a control arm that started treatment when viral load reached a predefined level. That level changed during the study period because of changes in the national HIV guidelines.

Once people began to take antiretroviral medications, viral suppression rates (


Short Cycle Therapy Viable in Children and Young People

Young people living with HIV who are virally suppressed and take their medications regularly the rest of the time can take weekends off from antiretroviral therapy without compromising their treatment, a study reported in Lancet showed.

Almost 200 study participants aged 8-24 years in 11 countries were randomized to stop treatment on weekends or to continue taking antiretrovirals seven days a week. All were on an efavirenz-based regimen and had been virally suppressed (viral load

At week 48 after randomization, virologic suppression rates did not differ significantly between the two arms, and the short-cycle therapy arm showed a better safety profile than the continuous therapy one. In addition, "participants expressed a strong preference for this short cycle therapy compared with continuous treatment," according to study authors. Participants will be followed for two years to assess whether this strategy is viable in the long term.

Warren Tong is the senior science editor for TheBody.com and TheBodyPRO.com. Follow Warren on Twitter: @WarrenAtTheBody.

Barbara Jungwirth is a freelance writer and translator based in New York. Follow Barbara on Twitter: @reliabletran.


Copyright © 2016 Remedy Health Media, LLC. All rights reserved.


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