This Week In HIV Research


This Week in HIV Research: You Don't Know Jak

January 5, 2018

What better way to usher in a new year than with fresh findings regarding Jak inhibitors, an exciting experimental class of HIV medications? Elsewhere in our brief tour of recent HIV research this week, we gain important insight into the need for better gynecological care in women with HIV, read reassuring findings regarding HIV transmission risk and genital virus shedding in women, and learn more about the relative effects of viremia on non-AIDS event risk stratified by age.

Also, a reminder: 2017 may be over, but many of the HIV research developments it brought will reverberate through 2018 and beyond. Be sure to join David Wohl, M.D., for his engaging exploration of the top 10 HIV clinical developments of 2017.

To beat HIV, you have to follow the science!

Jak Inhibitors May Block Seeding of HIV Reservoir

Jak inhibitor drugs block the spread of HIV from latently infected cells not only in vitro, but ex vivo as well, a small study published in PLOS One found.

Jak inhibitors have been used against other inflammatory diseases, but have not been extensively studied against HIV. Researchers showed that two of these medications, ruxolitinib and tofacitinib, act on specific cytokines (IL-7 and IL-15), thereby inhibiting T-cell activation.

Samples were tested from 37 people living with HIV whose viral loads were below 50 copies/mL and whose CD4+ cell counts varied from <350 cells/mm3 to >500 cells/mm3. The study drugs targeted HIV-infected cells, but did not affect cell responses to other infections -- an important safety aspect. Results were achieved at drug concentrations that have been approved for other uses, i.e., are considered safe.

"Jak inhibitors are unique since they are highly selective agents that keep the lid on smoldering infection through anti-inflammatory properties. If the lid is on the smoldering fire long enough, it is our hope that the fire will be extinguished," study author Christina Gavegnano, Ph.D., explained in an associated press release.

A phase 2a trial is currently evaluating ruxolitinib in people living with HIV.

Related: Estimating the Total Size of the HIV Reservoir


Treatment of Gynecological Cancers in Women Living With HIV Is Often Lacking

Half of advanced gynecological cancers in women living with HIV were not treated in line with guidelines, a data review published in AIDS showed.

Twenty-eight of 57 women living with HIV, most of whom were African American, received National Comprehensive Cancer Network guideline-compliant care for their cancer. Most of that care was among those with stage I malignancies: 22 of the 30 women with such cancers received compliant care). The main reasons for non-compliant care were patient-related factors (e.g., social reasons or loss to follow-up) or toxicity. Sixty percent of the women whose care met guidelines were still alive 48 months after starting cancer treatment, compared to 28% of those who were not treated according to the standard.

Researchers noted that guidelines, including those from the National Comprehensive Cancer Network used in this study, do not address the potential interaction of HIV and cancer therapies. "This study highlights the critical need to expand our understanding of best practices for the treatment of HIV-infected women with gynecologic cancers, particularly those with advanced disease," they concluded.

Little Genital Shedding Among Women With Suppressed HIV Viral Load

Women may shed HIV in their genital tract despite taking antiretroviral drugs, but such shedding is much less likely when their viral load is undetectable, a prospective cohort study published in The Journal of Infectious Diseases found.

Genital shedding is believed to increase the risk of an HIV-positive person transmitting the virus through condomless sex. In this study of 1,114 women in several African countries, HIV was found in genital swabs during 5.8% of visits where plasma viral load was undetectable, compared to 23.6% of visits where the plasma viral load was detectable.

Women at later stages of HIV disease progression, as well as those with genital ulcers or cervical tenderness, were more likely to shed the virus than women with early-stage HIV or without these conditions.

While study authors warned that women may still transmit HIV despite effective treatment, a related editorial commentary noted that neither this nor other studies have observed such seroconversions. "Therefore, the low rates of HIV shedding observed by King et al should be reassuring to those who are implementing test-and-treat strategies of HIV prevention," the commentary concluded.

HIV Viremia Increases Risk for Non-AIDS Events Among Young People

Poorly controlled HIV appears to have a greater relative impact on non-AIDS event risk among people age 30 or younger than it does among older people, a study published in AIDS found.

In the study, HIV control (or, conversely, risk of HIV progression) was defined by CD4+ cell count (≤350 cells/μL versus ≥500 cells/μL) and viral load (≥10,000 copies/mL versus <50 copies/mL). Data on 16,839 people living with HIV across Europe were analyzed in four age groups from under 30 years to over 50 years.

Those at high risk of HIV progression in the youngest group were six times as likely to experience cardiovascular events, end-stage liver or renal disease, or non-AIDS malignancies than those at low risk of a similar age. By comparison, older participants at high risk were only two to three times as likely to experience non-AIDS events than their low-risk counterparts.

Study authors hypothesized that these results may be explained by the generally higher prevalence of non-AIDS comorbidities among older people, which tempered the extent to which HIV viremia played a role in increasing their event risk.

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 and Follow Myles on Twitter: @MylesatTheBody.

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This Week in HIV Research: Looking Forward, Looking Back
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This article was provided by TheBodyPRO.

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