This Week in HIV Research: Reawakening Dormant HIV; Real-World PrEP Results; Measuring Bone Loss; and More

There's more promising news from the HIV cure front this week, as researchers have identified a new class of drugs that could work well in combination with other drugs to reawaken and purge dormant HIV. We get results from the PROUD study showing that PrEP works in real-world settings and does not increase the occurrence of other sexually transmitted diseases. Plus, another study compares changes in bone loss in two different treatment regimens. And some researchers are using iTunes song gifting as an effective way to recruit study participants.

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Cure Research

New Class of Drugs Reawakens Dormant HIV in Patient Cells

Early results from scientists at Sanford Burnham Prebys Medical Discovery Institute (SBP) show that a new class of drugs called Smac mimetics can reactivate latent HIV without triggering immune cell death. The researchers were able to do this by coupling the Smac mimetic named SBI-0637142 with panobinostat (a cancer drug that has already shown potential at reawakening dormant HIV).

"This is a one-two punch for HIV," said study author Sumit Chanda, Ph.D., in the study press release, adding that we'll need a cocktail of drugs to cure HIV. This multi-drug approach to an HIV cure sounds familiar because it mirrors the path of combination antiretroviral therapy. The next step for the researchers will be to study the drugs in animal models.


PrEP Works in Real-World Settings: PROUD Study Results

The PROUD study reported results offering more support that pre-exposure prophylaxis (PrEP) works in real-world settings, with no increase in other sexually transmitted diseases (easing concerns of risk compensation), according to results published in The Lancet.

From 2012 to 2014, the study followed 544 HIV-negative men who have sex with men (MSM) who had reported condomless anal sex within the past 90 days. The participants were randomized either to receive immediate PrEP (275) or to defer for a year (269). There were three HIV infections in the immediate group (1.2 per 100 person-years) compared to 20 in the deferred group (9.0 per 100 person-years). Additionally, there was no difference between the groups in cases of other sexually transmitted diseases, including rectal gonorrhea and chlamydia.


Less Bone Loss With Regimens Containing Maraviroc Versus Tenofovir

Treatment regimens containing maraviroc (Selzentry, Celsentri) were associated with less bone loss at the hip and lumbar spine when compared to regimens containing tenofovir (Viread), according to a study published in Clinical Infectious Diseases. Researchers from the AIDS Clinical Trials Group followed 259 patients (130 taking maraviroc and 129 taking tenofovir) for 48 weeks. At the end of the study period, they observed that the median bone loss in the hip was -1.51% for those taking maraviroc, compared to -2.40% for those taking tenofovir (P < .001). In terms of bone loss at the lumbar spine, the median decline was also less for maraviroc at -0.88% than tenofovir at -2.35% (P < .001).

In the Clinic

Simplified HIV Test-and-Treat Program Associated With Better Coverage and Lower Mortality

Researchers in China followed 1,034 HIV-positive patients, 620 of whom were given current standard of care and 414 of whom were offered a simplified test-and-treat intervention, meaning immediate treatment initiation after diagnosis, regardless of CD4+ cell count. They found that offering a simplified test-and-treat intervention promoted higher engagement in care and was associated with a 62% reduction in mortality. The results further support starting treatment as soon as possible for all individuals living with HIV.

iTunes Song-Gifting Is a Low-Cost, Efficient Study Recruitment Tool

Using a novel "iTunes song-gifting" method for study recruitment, researchers were able to recruit 489 men who have sex with men (MSM) in 4.5 months for an Internet-based survey on HIV status, childhood sexual abuse, and adult behavior and functioning. The study, which was published in the journal AIDS and Behavior, found that iTunes song gifting was an efficient and low-cost recruitment tool (at just $1.43 per participant) to reach MSM who may be at high risk of HIV.

Cost and Savings of Linkage-to-Care Program in the U.S.

In response to treatment gaps and HIV care disparities, AIDS United launched a linkage-to-care program called Positive Charge across five sites in New York, Chicago, Louisiana, North Carolina and the San Francisco/Bay Area. A study found that the programs were relatively low cost (ranging from $44 to $545 a month per client from a societal perspective) and had highly achievable cost-saving and cost-effectiveness thresholds.

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