Short reports on selected Durban posters
1 October 2016. Related: Conference reports, World AIDS 21 Durban 2016.
Simon Collins, HIV i-Base
IAS conferences include thousands of posters and the majority are only displayed for a day and often only part of a day. The following summaries are from a few studies could easily have warranted oral presentations.
- Elite controllers in an African cohort
- Detecting HIV in primary infection: example of Bangkok cohort
- Rapid viral rebound in five vertically infected children with negative antibody and DNA PCR after two years on ART
- Associations between HIV and high rates of HPV infection in young MSM
- EFdA potential for annual PrEP implant
- Four day a week ART: sub-optimal drug levels but few virological failures
Elite controllers in an African cohort
Out of 245 women aged 21-33 in KwaZuluNatal, 12/245 (5%) were viraemic controllers and 2/245 (<1%) were elite controllers (EC) with viral load kept undetectable without treatment.
Both the EC had initial viraemia (12,000 and 2,000) with the first case presenting during seroconversion with symptoms but have maintained CD4 counts >500 cells/mm3 (average 900) and undetectable viral load for more than six years without ART.
Both had HLA haplotypes well-described as being associated with slow progression, including HLA-B81* and HLA-B57* respectively. Other details, including immunological changes are reported in the poster.
The importance of this finding is that cure-related research can be run in countries with different HIV sub-types and that this inclusion is important for all cure strategies.
Reference:
Moosa Y et al. HIV virological controllers in an African cohort. IDS 2016, Durban. Poster abstract TUPEA013.
http://programme.aids2016.org/Abstract/Abstract/9050 (Abstract)
http://programme.aids2016.org/PAGMaterial/eposters/0_9050.pdf (PDF poster)
Detecting HIV in primary infection: example of Bangkok cohort
From 2009 to 2015, the main community testing centre in Bangkok used viral load testing to find people who were still in primary HIV infection (PHI).
From over 9,000 people testing (and more than 21,000 tests), one third were HIV positive using rapid HIV antibody tests. Subsequent testing with either a viral load test or 4th generation AgAb test in 5,806 people with negative results was able to identify 68 people (1%) with acute HIV infection.
Median age of people in acute infection was 27 years (IQR 23 to 32) and most reported recent high risk activity. Of note, 72% of people with AHI did not report any AHI symptoms.
In the 75% with viral load results, median viral load was 5.4 log copies/mL (IQR: 3.4 to 6.8).
Reference:
Leelawiwat W et al. Acute HIV-1 infection in men who have sex with men attending the clinic for voluntary counseling and testing services in Bangkok, Thailand. AIDS 2016, Durban. Poster abstract TUPEA021.
http://programme.aids2016.org/Abstract/Abstract/666 (Abstract)
http://programme.aids2016.org/PAGMaterial/eposters/0_666.pdf (PDF poster)
Rapid viral rebound in five vertically infected children with negative antibody and DNA PCR after two years on ART
Five cases were reported in a poster describing children who had been infected at birth and started ART (four within a year and one at 21 months). Viral load was undetectable in all children by 21 to 35 months of treatment.
After about two years of ART, HIV antibody and DNA PCR tests turned negative in all cases. This lead to health workers mistakenly telling the parents that their children did not have HIV.
Following the interruption for a median duration of 6 weeks, viral load rebounded to high levels in all children (range 135,000 to 8,400,000 copies/mL). CD4% dropped by up to 15% within 3 months. Treatment was re-started and all children became undetectable within 6 to 9 months and have maintained suppression for 18 to 24 months.
Reference:
Mekonen T et al. Structured antiretroviral treatment interruptions in vertically HIV-1 infected children with complete pro-viral DNA PCR reversions in Namibia, following durable viral suppression, led to rapid rebound viraemias and significant immunologic destruction. AIDS 2016, Durban. Poster abstract TUPEA086.
http://programme.aids2016.org/Abstract/Abstract/3098 (Abstract)
Associations between HIV and high rates of HPV infection in young MSM
A prospective sexual health study of young gay and bisexual men in New York included 104 men provided oral samples and 99 anal samples for HPV testing as part of routine sexual health screening.
Mean age was 24 years old; 48.2% Hispanic/Latino, 32.4% Black, 9.3% White, 10.2% Asian/Pacific Islander or other race.
Prevalence was 13% for HIV, 38% for anal HPV and 6% for oral HPV (all strains).
Approximately 60% of both anal and oral HPV were high risk strains.
Additionally, 11.8% of this sample tested positive for quadrivalent vaccine strains (6,11,16,18) while 21.6% tested positive for the nonavalent vaccine strains (6,11,16,18,31,33,45,52,58).
The presence of anal HPV (any type) was associated with an HIV seropositive status (OR=5.63, 95% CI=1.44, 21.97; p=0.013) as was the presence of oral HPV (OR=12.13, 95% CI=2.37, 62.12; p=0.003).
Reference:
Kapadia F et al. Associations between HPV and HIV among young, gay, bisexual and other men who have sex with men: preliminary findings from the P18 cohort study. AIDS 2016, Durban. Poster abstract TUPE211.
http://programme.aids2016.org/Abstract/Abstract/8947
EFdA potential for annual PrEP implant
Early data from using the investigational NRTI EFdA reported PrEP efficacy against oral and vaginal exposure in humanised BLT mice (bone marrow, liver, thymus).
Although this is early pre-clinical data, the results are important because EFdA is being developed as a slow-release (and removable) implant formulation that has the potential to provide therapeutic drug levels from a once-yearly implant.
Reference:
Wahl A et al. HIV pre-exposure prophylaxis for women and infants prevents vaginal and oral HIV transmission in a pre-clinical model of HIV infection. AIDS 2016, Durban. Poster abstract TUPEA025.
http://programme.aids2016.org/Abstract/Abstract/9652 (Abstract)
Four day a week ART: sub-optimal drug levels but few virological failures
Available as a PDF online and reported above in HTB, this poster reported on low rebound after 48 weeks in people on stable ART who switched to taking treatment for only four consecutive days each week.
This included people on any PI or NNRTI containing combination. Although most people had suboptimal drugs levels of the PI or NNRTI component, there were few viral rebounds, highlighting the likely role of tenofovir-DF/FTC as the main background NRTIs.
Reference:
de Truchis P et al. Efficacy of a maintenance four-days-a-week regimen, the ANRS162-4D trial. AIDS 2016. Poster THPEB063.
http://programme.aids2016.org/Abstract/Abstract/5947 (Abstract)
http://programme.aids2016.org/PAGMaterial/eposters/0_5947.pdf (PDF poster)