This Week in HIV Research: Can 2-Drug Treatment Regimens Become the New Gold Standard?
This week, researchers argue that newer two-drug treatment regimens may be enough to suppress HIV. A study finds that a new DNA-based nanomachine can deliver drugs to precise locations within the body when triggered by disease markers, such as an HIV antibody. And a home-based, test-and-treat strategy significantly increased new diagnoses and linkage to care in Zambia. Finally, a new analytical method may help identify hepatitis C hot spots. To beat HIV, you have to follow the science!
Two Antiretrovirals May Be Enough
Triple-drug therapy for HIV is not necessarily the gold standard for everyone, a perspective in AIDS argued.
Newer antiretrovirals, earlier treatment start and a history of virologic control may allow some people living with HIV to take only two medications. The newer drugs are more potent and immediate antiretroviral treatment limits viral replication. Reduced drug strategy trials have shown that viral loads can continue to be suppressed on fewer than three antiretrovirals.
Many people living with HIV want to limit their exposure to antiretrovirals, the authors posited, so further research is needed into a "less is more" approach to treatment that is adjusted to the specific individual. After more than two decades of highly active antiretroviral therapy, we need to shed the dogma of triple therapy and understand that only "maximal viral suppression and improved immune restoration are our goals," they concluded.
Antibody Triggers Drug Release From Nanomachine
A new antibody-powered DNA-based nanomachine can release a cargo of molecules when it binds to a specific antibody, researchers reported in Nature Communications.
One of the triggers used during testing was an HIV antibody. The design of this protein-inspired nanomachine allows it to be easily adapted to a variety of antibodies, as well as different molecular cargos. It features two ends that bind to the antibody and a "rubber band" that is loaded with the cargo.
When the nanomachine encounters the antibody, the center section acts as a slingshot, precisely deploying its molecular load. Because of the specificity of these ends, the cargo is not released unless a specific antibody is present. This means several such nanomachines could be used concurrently, each one with a different target and load.
Researchers will now test this approach with a specific disease and drug in vitro before moving on to mouse models, according to a related press release.
Home-Based Intervention Substantially Increases HIV Testing and Treatment Rates in Zambia
A home-based test-and-treat strategy in Zambia substantially increased the proportion of people who were aware of their HIV status and the number of those living with HIV who were on antiretroviral therapy, a study published in PLOS Medicine found.
The intervention consisted of annual home visits by community HIV care providers offering HIV testing. The providers then linked people who tested positive for the virus to HIV clinics, where they were offered immediate antiretroviral therapy. The study included almost 47,000 households in four communities, and data were extrapolated to the entire population of the country.
Testing coverage was significantly higher in women than men, mainly because women were more likely to be at home when the provider arrived. Other studies have suggested additional workplace or mobile testing facilities to overcome this hurdle, study authors said.
A related opinion piece noted the substantial resources required for such interventions and the challenges faced due to "the current gloomy political environment."
New Analytical Method Identifies Hepatitis C Hot Spots in Massachusetts
A new analytical method to identify geographic locations with greater rates of hepatitis C (HCV) may help to better target interventions and inform policy, researchers reported in BMC Infectious Diseases.
They applied a combination of geographic information systems, spatial epidemiology and statistical modeling to data from Massachusetts and identified nine HCV clusters in the state. The data included reported HCV cases and sociodemographic information from the census over a period of 10 years, a related press release explained.
HCV hot spots were more likely in areas with a greater proportion of Latinos or those where more people received food stamps. Conversely, neighborhoods where more people had at least a high school education or had identified their ethnicity as "other" were less likely to have high HCV rates. Geographic data were based on the location of people when their hepatitis was reported, which may be different from where they contracted the virus, study author Tom Stopka, Ph.D., M.H.S., cautioned in the press release. As a result, current transmission patterns may be slightly different from those predicted by the analysis.
Warren Tong is the senior science editor for TheBody.com and TheBodyPRO.com. Follow Warren on Twitter: @WarrenAtTheBody.