From the opening keynote plenary speech on “The Science and Practice of HIV Prevention in the US,” delivered by Dr. Jonathan Mermin, director of the Division of HIV/AIDS Prevention in CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, to a closing symposium on “The HIV Epidemic at 30,” presenters and participants at CROINon-CDC Web Link promoted a better understanding of the prevention and treatment of HIV/AIDS and its complications. Highlighted topics included HIV immunology, HIV transmission and primary/acute infection, preventive HIV vaccines, antiretroviral therapy, HIV drug resistance, AIDS-related malignancies, epidemiology of HIV infection, sexually transmitted infections, and prevention studies on microbicides, pre-exposure prophylaxis, circumcision, and behavioral interventions.
In his speech, Dr. Mermin covered the epidemiology of HIV infection; effective interventions for persons with HIV infection and those who are not infected; high impact prevention—incorporating the components of effectiveness, cost, coverage, feasibility, scale, and prioritization—to maximize the effect of HIV prevention and advance the science of implementation; and implications for research and practice. He concluded that a successful HIV prevention strategy requires prioritizing, targeting, and coordinating resources to maximize effect on incidence and health equity.
Here are synopses of a few of the research presentations:
* Results of a National Institutes of Health study showed that adding one or two drugs to the standard zidovudine (ZDV) treatment reduces the chances by more than 50% that infants born to women whose HIV infections were not diagnosed until they were in labor will develop an HIV infection. >From 100 to 200 infants are born with HIV infection in the United States each year (Mother-to-Child (Perinatal) HIV Transmission and Prevention), many to women who either were not tested in early pregnancy or who did not receive treatment during pregnancy. Pregnant women who do not know that they have HIV infection miss the chance for drug treatment that can benefit not only their own health, but could also prevent them from transmitting the virus to their infants.
* Preliminary research suggests that an HIV-fighting gel has the potential to become another weapon in the fight against HIV infection when applied to the rectum before anal intercourse. This is the first time scientists have found evidence that people would tolerate using a gel form of the commonly used antiretroviral drug tenofovir in the rectum. In the new study, the first of three phases needed before the treatment can get approval from the U.S. Food and Drug Administration, researchers tested tenofovir gel, the oral tenofovir pill, and a placebo gel in 18 HIV-negative people who abstained from sex. They took small samples of cells from the rectums of the volunteers, and sent those to a laboratory where they were tested to see how they defended themselves against HIV. Researchers found that a 7-day treatment with the gel performed the best.
* CDC investigators had previously shown that a simple regimen with an oral dose of Truvada given 3 days before virus exposure followed by a second dose 2 hours after exposure protected macaques against repeated rectal exposures with wild-type simian-human immunodeficiency virus (SHIV). Current results show that the same Truvada regimen offered complete protection against rectal transmission of an emtricitabine-resistant SHIV isolate containing the M184V reverse transcriptase mutation.
* Test and treat strategy successes and challenges were explored during a series of presentations. Data from two new studies—one that looked at 1,700 HIV-infected persons in San Francisco and one that followed a large community-based cohort of injection drug users in Baltimore—showed that reduced community viral loads were strongly associated with declines in HIV transmission and incidence. Test and treat programs are based on the premise that using aggressive methods to test and diagnose all people with HIV infection, link them to care, and, when appropriate, get them on antiretroviral treatment will reduce the rate of new HIV infections.
* A rapid HIV testing algorithm (RTA)—in which tests are conducted and provisionally confirmed while the client is present—was implemented in 9 publicly funded HIV counseling and testing sites. In this CDC study, results of testing at these sites were compared with 23 sites conducting rapid HIV testing with off-site confirmatory testing (OSCT). From August 2007 to March 2009, 43,393 persons were tested at OSCT sites and 17,701 were tested at RTA sites. The positive predictive value was 90% for a single test and 100% for the RTA. At OSCT sites, 47% of clients with preliminarily positive results returned for confirmatory test results; all clients with positive RTA results received referral to care in the same visit. Persons who received a referral were more likely (67%) to be in care within 90 days than those who received a preliminarily positive result but did not return for their laboratory results and referrals (49%). Investigators estimated that an additional 189 HIV-positive clients may have been linked to HIV care had the RTA been available at all sites during the study.
Abstracts Non-CDC Web Link and webcastsNon-CDC Web Link of all sessions, including poster discussions, are available on the CROI website.Non-CDC Web Link
open here and see the abstracts from the conference:
CROI 2011 - 18th Conference on Retroviruses and Opportunistic Infections - Webcast Sessions
Mother-to-Child (Perinatal) HIV Transmission and Prevention | Factsheets | Resources | Pregnancy and Childbirth | Topics | CDC HIV/AIDS
Mother-to-Child (Perinatal) HIV Transmission and Prevention | Factsheets | Resources | Pregnancy and Childbirth | Topics | CDC HIV/AIDS
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