Latest HIV Cure Data Expected at AIDS 2014, More Hep C News

Pam Harrison

July 11, 2014

MELBOURNE, Australia — New information about a so-called functional cure for HIV will be released at the 20th International AIDS Conference, being held from July 20 to 25. In addition, scientists and policy makers are anticipating more breaking hepatitis C news at the largest global HIV get-together, where results from TURQUOISE-1 and PHOTO-2 will be presented.

At a briefing for reporters held in advance of the AIDS 2014 meeting, chair Françoise Barré-Sinoussi, MD, said the studies emphasize the importance of early treatment.

Canadian researchers will report on a series of infants started on triple antiretroviral therapy in the first 48 hours of life. Another study to be presented, of South African children who did not meet the World Health Organization criteria for initiating treatment but who received treatment because of high viral loads, has demonstrated that low levels of immune system activation, as reflected by cell counts, are a key determinant in the slow progression of HIV in these children.

"Activation and the HIV reservoirs are really the 2 critical determinants of HIV pathogenicity," Dr. Barré-Sinoussi told reporters. "This is another study showing that activation should be considered as a future strategy aiming for a cure, or at least a sustainable remission, in HIV patients without any treatment."

 
This has long been considered the critical first step toward generating a cure.
 

Steven Deeks, MD, from the University of California, San Francisco, who also spoke at the briefing, said there will be a fascinating series of studies that approach the potential for a sustainable remission through other means.

It is believed that reservoirs of latently infected CD4 cells are the source of HIV re-emergence after the discontinuation of therapy. Standard antiretrovirals do not prevent the establishment of these latent reservoirs, and HIV is inaccessible for expression in part because of histone deacetylases. Purging these latent reservoirs using histone deacetylase inhibitors could open the possibility for sustained remission, Dr. Deeks explained.

Danish investigators will report findings indicating that the inhibitor romidepsin reverses HIV latency in patients on longstanding treatment. "This has long been considered the critical first step toward generating a cure that would treat people on a global level, not just bone marrow transplant patients," Dr. Deeks said. "This presentation will generate interest and excitement."

The same class of agents has also been shown to markedly reduce chronic inflammation in HIV-infected patients, he added.

Hepatitis C Coinfections

Direct-acting antivirals appear to have produced sustained virologic responses in most patients with hepatitis C, noted Stefano Vella, MD, from the Istituto Superiore di Sanita in Rome. Results from 2 clinical trials — TURQUOISE-1 and PHOTO-2 — will address whether patients coinfected with HIV respond as well.

Coinfection with tuberculosis (TB) is another challenge in the management of HIV. Investigators say excitement is mounting about a novel triple drug regimen that appears to be better than standard regimens in HIV patients with drug-sensitive or drug-resistant TB.

Peter Godfrey-Faussett, MD, from the London School of Tropical Medicine and Hygiene in the United Kingdom, told reporters that a new analysis has found that women who had sex only with circumcised men had a significantly lower risk for HIV than women who had sex with uncircumcised partners.

"We know that circumcision protects men from acquiring HIV; mathematical models predict that it will be good for women as well," Dr. Godfrey-Faussett reported. "This is the first direct evidence we have that women are protected by having partners who are circumcised."

Studies will also be presented that support various incentives, including financial rewards, to entice men to get circumcised.

New Repressive Laws

Despite significant scientific advances in HIV, "there is a wave of new repressive laws and policies to criminalize HIV, marginalize people with it, and further restrict evidence-based HIV programs," Chris Beyrer, MD, from the Johns Hopkins Center for Global Health in Baltimore, Maryland, told reporters.

Indications that these repressive laws are already having a negative effect on HIV prevention and treatment services will be presented at AIDS 2014.

One study will show that a Nigerian law banning sex between men and outlawing gay societies and organizations has already had a negative effect on HIV prevention and care in the country's capital. In fact, a significant proportion of men who had been participating in an ongoing study of HIV treatment dropped out once the antigay laws were enacted.

In a large-scale online survey of men who have sex with men, criminalizing same-sex behavior was found to be extremely harmful to public health because respondents who had been arrested for their sexual orientation were significantly less likely to be tested and treated for HIV and other sexually transmitted infections. Conversely, where antistigma laws have been introduced, greater awareness and acceptance of HIV by the general public has been demonstrated.

"We are all very concerned about countries that take these repressive measures, and we must try to put as much pressure on the decision makers as we can to reverse these measures," Dr. Barré-Sinoussi said. "The impact that these kinds of policies have on the health of people is not acceptable. We have to make these countries respect human rights."

The Melbourne Declaration: Nobody Left Behind was prepared in response to these repressive measures. It is expected that the paper, to be released at the conference, will heighten awareness of the impact that antigay policies have on HIV testing, treatment, and care in countries where HIV is being stigmatized.

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