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This Week in HIV Research: Test-and-Treat Ain't Just for HIV

November 3, 2017

This week, we learn encouraging news on a range of topics across the HIV research realm. We take a quick look at how the test-and-treat approach so widely employed in HIV can be of value in addressing hepatitis C coinfection as well; the latest data regarding a late-stage fixed-dose combination drug; a dramatically falling HIV incidence rate among gay men in London; and new findings that explore HIV's ability to hijack effector memory T-cells.

To beat HIV, you have to follow the science!


Test-and-Treat Works for People With HIV -- Against Hepatitis C

Systematically testing HIV-positive men who have sex with men (MSM) for hepatitis C (HCV) and immediately starting treatment for the latter virus cures almost all HCV infections, according to studies presented at the 16th European AIDS Conference in Milan, Italy, Aidsmap reports.

All MSM in a large Swiss study were screened for active HCV, according to Aidsmap. Fewer than 5% had chronic HCV, and most of those who did had been previously diagnosed with the virus. All but one of the 122 men who ultimately participated in the test-and-treat study achieved sustained virologic response to treatment with grazoprevir/elbasvir (Zepatier).

Aidsmap also reported on a substudy that investigated a four-session behavioral intervention to prevent onward HCV transmission from test-and-treat study participants who reported condomless anal sex. Most of the 51 men enrolled in this substudy completed the intervention and none re-acquired HCV, Aidsmap reported.


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Darunavir/Cobicistat-Based Combo Drug Advances in Trial

A fixed-dose combination of darunavir (Prezista), cobicistat (Tybost), and tenofovir alafenamide (TAF)/emtricitabine (Descovy), which is approved in Europe as Symtuza, is effective and safe through 48 weeks of study in treatment-naive individuals, according to data presented at the 16th European AIDS Conference and reported by Aidsmap.

More than 700 people who had never taken antiretrovirals before were randomized to receive either the fixed-dose combination or a multi-pill regimen of the same drugs -- except for TAF, which was swapped for tenofovir disproxil fumarate (TDF, Viread) in the multi-pill arm. Virologic suppression, defined as a viral load < 50 copies/mL, was similar between the two arms.

Those in the fixed-dose combination group had better kidney function and bone mineral density, but worse cholesterol values after 48 weeks of treatment. These differences in renal and lipid effects have been previously reported in studies comparing TAF and TDF.


New HIV Diagnoses Down Sharply Among Gay Men in London

Pre-exposure prophylaxis (PrEP), quick start of HIV treatment after seroconversion, and non-judgmental services focused on clinic users' needs can dramatically lower rates of new HIV diagnoses, according to findings from a central London clinic reported by Aidsmap at the 16th European AIDS Conference and published in The Lancet.

The clinic, 56 Dean Street, diagnoses a third of new seroconversions in the city, according to the Lancet report. Diagnoses at the clinic have dropped by 80% since 2015, while the number of HIV tests performed has remained stable, the researchers found. The clinic supports and monitors PrEP use, but its patients must purchase the medication itself elsewhere, because it is not provided by the British health system.

56 Dean Street offers antiretroviral treatment within 48 hours of diagnosis, Aidsmap reported. Fewer of the men who use its services have detectable viral loads than men elsewhere in the country, contributing to lower HIV transmission rates.

The clinic also operates a satellite that provides automated screenings for sexually transmitted diseases with text message notification of results. The texts also allow users to book an appointment, if necessary.


HIV Provirus Hides in Effector Memory T-Cells

A newly developed assay identified intact HIV virus hiding in effector memory T-cells, Australian researchers reported in Cell Reports. The insights gained were based on samples from six participants.

Effector memory T-cells "remember" previous infections, providing lifelong immunity against illnesses such as chicken pox. By inserting itself within these T-cells, replication-competent HIV prevents the body's immune system from fully eradicating the virus, the researchers report. The infected cells lay dormant and can be reactivated if antiretroviral treatment is stopped, lead author Sarah Palmer, Ph.D., explained in a related press release.

The assay, dubbed FLIPS (Full-Length Individual Proviral Sequencing), lets researchers identify the genetic characteristics of latent provirus, which can help predict whether the virus is capable of replicating. One strategy for curing HIV is to reactivate the latent virus and target it with antiretroviral drugs. FLIPS could be used, for example, to identify specific regions in HIV's genetic sequence that respond better to the latency-reversing agents used in that strategy, study authors noted.

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

Myles Helfand is the executive editor and general manager of TheBody.com and TheBodyPRO.com. Follow Myles on Twitter: @MylesatTheBody.


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