Aids 2016: Seven lessons

The 21st International Aids Conference that recently took place in Durban raised important issues on ARVs and treatment as prevention.

1. HIV is winning at hide-and-seek

The single biggest barrier to finding a cure forHIV is the virus’s ability to hide in "reservoirs" in the body. Attempts to “shock” the latent virus out of these reservoirs and kill it have failed. Ebola and Zika viruses are also able to hide in reservoirs, bouncing back in patients previously declared to be cured.

2. Early ARVs preserve your immune system

There is consensus that people should get onto ARVs as soon as possible to preserve their immune systems. This is why the SA government is moving to “universal test and treat” from September.

3. But it is hard to keep healthy people on ARVs

While there is a move to “universal test and treat”, studies show that young, healthy people get tired of taking ARVs. A big study that followed pregnant women in Zimbabwe found that they were very good at taking their ARVs during pregnancy and breastfeeding but ditched the pills soon afterwards. Teenagers on ARVs since birth also tire of taking their pills, because they don’t feel sick.

4. Injectable ARVS?

There is a lot of excitement about the possibilities offered by injectable ARVs that could replace daily pills. Trials of long-acting injectionable ARVs (dolutegravir and rilpivirine) given once every four to six months are as safe and effective as oral ARVs. Drug companies are also looking at long-acting ARV implants. Injectable contraceptives are the most popular form of contraceptives in South Africa.

5. A new ARV is talk of the town

Doluteguvir was the talk of the conference. It has few side effects and people don’t develop much resistance. It is also a slow-release drug, so patients who forgot one or two doses had enough of the drug in their blood to control the virus even 72 hours after they missed their medication. Dolutegravir is only available in South Africa privately for around R720 a month, but generic manufacturer Aspen is working on getting a generic.

6. “Treatment as prevention” (TAP) isn’t as easy as it sounds

ARV treatment has virtually eliminated HIV transmission in “discordant” couples, where one has HIV and the other doesn't. Once the HIV positive partner was on ARVs and their viral load was suppressed, they did not transmit HIV, according to a massive Partners study involving 1,166 discordant couples.

But a four-year trial by the French National Research Agency (ANRS) and the Africa Centre in northern KwaZulu-Natal cast doubt on whether “universal test and treat” can be implemented fast enough to protect young people from HIV infection in high prevalent areas. The study tested over 27,000 people, 37 percent of whom were HIV positive. Half of those who tested positive were offered immediate ARVs and the other half were offered ARVs only if their CD4 count (measure of immunity) was under 350. In both groups, there was no difference in the rate of HIV transmission (around 2% a year) leading researchers to conclude that people were getting ARV treatment too slowly to influence HIV incidence (only 40 percent were on ARVs within six months of testing positive).

7. 'Sugar uncles' are lethal

A breakthrough study conducted by the Centre for the Aids Programme of Research in SA (Caprisa) has finally proven that men in their late 20s to early thirties are infecting young women, after being infected by women their own age. The Vulindlela study tested the genetic make-up of people’s viruses though a process called phylogenetics. Viruses with very little genetic diversity enabled researchers to link 123 women to 103 men. Five men in particular were linked to 30 women. The men had high viral loads and were not on ARVs. Young HIV positive women aged 16-20 were linked to men around 11 years older than them, while those aged 21-25 were generally linked with men seven years older than them, but women over 26 were linked to men their same age. The sexual links between men aged 25 to 40 and both women their own age and young women as “the engine that is driving the cycle of HIV infection”, according to Caprisa. – Health-e News.