March/April 2015: Volume 16 Number 3/4
This issue of HIV includes our first reports from CROI 2015 which as usual was a conference that was rich with new data.
The detailed results from the UK PROUD trial and the French/Canadian “on demand” IPERGAY show that oral PrEP is an extremely effective option for gay men and transgender women at high risk of HIV. Many other PrEP studies reported effective implementation results, but low adherence seems to explain much lower efficacy rates for African women using tenofovir gel.
The TEMPRANO study looking at timing of ART and isoniazid prophylaxis in the Ivory Coast was a significant achievement, but our comments caution against interpreting the results to support universal ART at CD4 counts above 500. Instead, the details of the comparator group further highlights the continued importance of the ongoing START study.
We include a worrying report of unintended pregnancies with the levonorgestral implant in women taking efavirenz. As efavirenz-based first line is likely to remain widely recommended for a large proportion of women of child bearing age, effective contraception for women receiving this treatment is a public health priority.
Also concerning, was that in a three-country survey conducted by Médecins Sans Frontières (in Malawi, Kenya and South Africa), a large proportion of pregnant or breastfeeding women were HIV positive with viral load greater than 1000 copies/mL.
Results from the PROMISE study showed ART is best for preventing vertical transmission – supporting WHO and other guidelines.
Good news from the BREATHER study reported that weekend-off ART is non-inferior to continuous treatment in young people taking efavirenz-based regimens. A key result was an improved quality of life, without jeopardising their care.
Finally, an important UK case of HIV remission in somone who started treatment during seroconversion and that cautiously might be categorised as functional cure. With important differences to the VISCONTI cohort, the challenge is now to explain the mechanism.
This issue also includes reports from the XXIV International Drug Resistance Workshop – held just before CROI – particularly on the implications of antiretroviral resistance in resource-limited settings.
More to follow from CROI 2015 and related meetings in the next issue of HTB, but we will continue to post ahead-of-press articles to the i-Base website, for those who want news a little earlier.