This Week in HIV Research: How Low (an Atripla Dose) Can You Go?

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The HIV research beat rolls ever onward, and this week's selection of featured studies from peer-reviewed journals strikes a varied and eclectic rhythm. Here's what has our brains humming this week -- that is, outside of all the blaring headlines you've likely seen about a new case of HIV remission and other important findings presented at CROI 2019:

  • Efavirenz/tenofovir/emtricitabine (Atripla) may be just as effective when taken every other day as it is when taken daily.
  • Hospitalized people with HIV -- especially marginalized people -- all too often fail to fill their antiretroviral prescriptions after discharge.
  • As the U.S. vows to end its HIV epidemic by 2030, its progress against UNAIDS targets is mixed.
  • Clustering -- and HIV coinfection -- was extremely common in hepatitis C outbreaks within a major French city.

Get those fingers tapping, and let's scroll through each of these four studies in more detail. To beat HIV, you have to follow the science!

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 and TheBodyPRO. Follow Myles on Twitter: @MylesatTheBody.

Less-Than-Daily Dosing of Atripla Effective in Virally Suppressed People

Taking efavirenz/tenofovir/emtricitabine (Atripla) three times a week or every other day is non-inferior to daily dosing of the drug, two studies published in AIDS showed.

Italian researchers compared every-other-day to daily dosing in 197 participants, while a small Spanish study randomized five dozen participants to pills three days a week or daily dosing. Both trials enrolled people who were already virally suppressed.

At week 48, the Italian study found significantly lower levels of efavirenz when the antiretroviral was taken every second day, but virologic response was nonetheless similar between the arms. Meanwhile, the Spanish proof-of-concept study found a lower proportion of naive CD4 T cells at week 24 among many participants in the three-day arm compared to the daily dosing arm -- but noted that there appeared to be no deleterious effect on viral load. Extended follow-up did not show a clinical impact of this CD4 cell abnormality at week 48.

Both studies concluded that taking Atripla 3 or 3.5 times a week could be a viable option. However, despite the apparent success of a less-frequent dosing approach, authors of the Italian study warned that such a dosing reduction could be problematic in pregnant women or people who take rifampicin for tuberculosis.

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Among Medically Complex Patients, Few HIV Prescriptions Filled Promptly After Hospital Discharge

Few medically complex, socially marginalized people living with HIV filled their antiretroviral prescriptions within a week of hospital discharge, a Canadian study published in Open Forum Infectious Diseases showed.

The retrospective study combined data from various systems to include only participants who had multiple comorbidities and access to doctors, hospitals, and prescription drug coverage through the Ontario Health Insurance Plan, Ontario province’s version of Medicare/Medicaid. The study site hospital also provides comprehensive discharge planning.

While 69% of the 206 participants filled a prescription during the first seven days after leaving the hospital, only 11% did so for HIV medications, compared to 26% and 15% for antidepressants and antipsychotics, respectively. Seventy-six percent of the 164 participants who did not die or were not readmitted to the hospital followed up with a primary care or HIV provider during the first 30 days after discharge.

Study authors noted that some people may still have had antiretrovirals at home, but said that treatment interruptions were likely to occur for many. They called for additional research into the barriers to treatment access faced by this population.

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U.S. Meets Some, But Not All, UNAIDS Metrics for Ending AIDS by 2030

While the U.S. has achieved several UNAIDS metrics for ending AIDS by 2030, goals involving the number of new infections have not been met, an assessment of U.S. Centers for Disease Control and Prevention data from 2010-2015 that was published in Clinical Infectious Diseases showed.

The aims yet to be met include a reduction in the HIV incidence rate to less than 1 per 1,000 adults and a reduction in the incidence-mortality ratio less than 1 per 10,000 adults. New seroconversions would need to fall by another 31% annually to achieve the first goal, and by 77% from 2010 levels to reach the second goal, study authors calculated.

Furthermore, progress against HIV has been uneven across geographic locations, as well as racial/ethnic and socioeconomic groups, study authors and a related commentary pointed out. In 2017, for example, HIV diagnosis rates varied from 46 per 100,000 people in Washington, D.C., to 0 in American Samoa, and diagnoses are increasing among young African-American men who have sex with men.

Scaling up HIV testing and providing sufficient medications must be part of a comprehensive effort that also considers social determinants and cultural challenges, comment authors argued.

Hepatitis C Was Mostly Transmitted Within Clusters During Outbreak in Lyon, France

Between 2014 and 2017, nearly all of the 108 hepatitis C (HCV) infections in men who have sex with men (MSM) diagnosed at a Lyon, France, hospital were transmitted within just 11 transmission clusters, a study published in Clinical Infectious Diseases found.

Researchers tested HCV genotypes in MSM diagnosed at Lyon University Hospital and constructed phylogenetic trees based on the results. All clusters began with a person living with HIV; clusters ranged in size from 2 to 27 men.

Among those not living with HIV, MSM taking pre-exposure prophylaxis (PrEP) accounted for 67% of HCV cases, possibly because that population is regularly screened for this virus, the authors theorized. Since MSM who do not live with HIV and do not take PrEP are not regularly tested for HCV, they may unwittingly transmit the infection to other populations, study authors suggested.

The researchers called for screening all MSM who report practices that put them at risk for hepatitis C, regardless of HIV status, and for providing direct-acting antivirals to those diagnosed with HCV. Harm reduction interventions also need to be offered if this local HCV epidemic is to be curbed, they added.