Stem-cell transplants may purge HIV

(Nature)

Two men with HIV may have been cured after they received stem-cell transplants to treat the blood cancer lymphoma, their doctors announced today at the International AIDS Society Conference in Kuala Lumpur.

One of the men received stem-cell transplants to replace his blood-cell-producing bone marrow about three years ago, and the other five years ago. Their regimens were similar to one used on Timothy Ray Brown, the ‘Berlin patient’ who has been living HIV-free for six years and is the only adult to have been declared cured of HIV. Last July, doctors announced that the two men — the ‘Boston patients’ — appeared to be living without detectable levels of HIV in their blood, but they were still taking antiretroviral medications at that time.

Timothy Henrich, an HIV specialist at Brigham and Women’s Hospital in Boston, Massachusetts, who helped to treat the men, says that they have now stopped their antiretroviral treatments with no ill effects. One has been off medication for 15 weeks and the other for seven. Neither has any trace of HIV DNA or RNA in his blood, Henrich says.

If the men stay healthy, they would be the third and fourth patients ever to be cured of HIV, after Brown and a baby in Mississippi who received antiretroviral therapy soon after birth.

But Henrich and Daniel Kuritzkes, a colleague at Brigham who also worked with the men, caution that it is still too early know whether or not the Boston patients have been cured. For that, doctors will need to follow the men closely for at least a year, because the virus may be hiding out in ‘reservoirs’ — parts of the men’s bodies, such as their brain or gut, that can harbour the virus for decades.

“We’re being very careful not to say that these patients are cured,” Kuritzkes says. “But the findings to date are very encouraging.”

HIV researcher Steven Deeks of the University of California, San Francisco, says that doctors might need to wait at least two years before declaring that a cure has been achieved. “Any evidence that we might be able to cure HIV infection remains a major advance,” Deeks says. But, he adds, “there have been cases of patients who took many weeks off therapy before the virus took off”.

Read the full article here.

ESRD rate almost fourfold higher in HIV population

(Healio)

The rate of end-stage renal disease was nearly four times greater in HIV-infected adults relative to the general population in the United States, according to new data presented at the 2013 International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention in Kuala Lumpur, Malaysia.

Researchers said the data indicate “the need for greater surveillance, prevention, and treatment of comorbidities among HIV-infected adults.”

Keri N. Althoff, PhD, MPH, assistant professor in the department of epidemiology at Johns Hopkins Bloomberg School of Public Health, and colleagues identified participants from the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) with at least two estimated glomerular filtration rates less than 30 mL/min/1.73 m³ measured more than 90 days apart or a diagnosis of renal disease from 2000 to 2009. The researchers validated end-stage renal disease (ESRD), defined as dialysis or renal transplant, through medical record review and used Poisson regression analyses to determine crude incidence rates (IR) and incident rate ratios (aIRRs) adjusted for age, sex, race, HIV transmission risk, antiretroviral treatment, clinical AIDS diagnosis, undetectable HIV viral load, and CD4 count. Age- and sex-standardized incidence ratios (SIRs) were estimated to compare the HIV-infected adults from the NA-ACCORD to the general population using ESRD rates from the US Renal Database System (USRDS).

Read the full article here.

New HIV Treatment Guidelines to Cut Millions of Deaths

(Medscape)

KUALA LUMPUR, Malaysia — The World Health Organization has unveiled its much-anticipated new HIV treatment guidelines. Officials say the new approach will prevent 3 million deaths by 2025 and will stop 3.5 million new infections.

“The WHO estimates that these new guidelines will have an unprecedented impact,” director-general Margaret Chan, MD, told a packed room here at the 7th International AIDS Society (IAS) Conference on HIV Pathogenesis, Treatment and Prevention.

An estimated 17 million people are eligible to take antiretroviral drugs, but under the new recommendations this number will increase to 26 million.

The approach reflects the growing body of evidence that treating patients earlier at higher CD4 cell counts, when immune systems are still largely intact, can greatly reduce mortality and prevent HIV transmission.

“Prior WHO guidelines had been for treatment at much later stages of disease,” IAS president-elect Chris Beyrer, MD, professor and associate director for public health, Johns Hopkins Center for Global Health, Baltimore, Maryland, toldMedscape Medical News. “These revisions are based on our new understanding that earlier treatment can have a huge impact on the clinical care of the patient,” he said. “It also turns out that it has a big impact on reducing tuberculosis morbidity and mortality, which is very important in the Asia-Pacific region and Africa.”

The other critical improvement with these new recommendations, said Dr. Beyrer, is the reduction in HIV transmission. “This is a very important announcement, really. WHO guidelines play a normative roll — they’re paid attention to by global ministers of health, and that really matters.”

The new guidelines recommend starting antiretroviral therapy in all patients with a CD4 cell count of 500 cells/mm² or less. Other people should be started on antiretrovirals right away — regardless of CD4 counts — such as HIV-positive serodiscordant couples, patients with hepatitis-B coinfection, women pregnant or breast-feeding, and children younger than 5 years of age.

Read the complete article here.

Malaysia Meeting at ‘Exciting Time for HIV’

(Medpage)

KUALA LUMPUR — The 2013 meeting of the International AIDS Society, here in Malaysia, comes at an “exciting time for HIV science,” according to society president Francoise Barre-Sinoussi, PhD.

The meeting, held in the years between the biennial International AIDS Conferences, focuses on the science needed to combat the pandemic — basic, clinical, prevention, and implementation research.

This year, Barre-Sinoussi told reporters in a telephone briefing, a central focus will be on early treatment of HIV with antiretroviral drugs.

That because evidence has been mounting that early treatment has a cascade of benefits: better health for patients, a lower risk of transmission, and — intriguingly — the possibility of a cure.

“Cure is one of the priorities of the IAS,” Barre-Sinoussi said, and the conference will hear more details of two important studies that seem to show that very early treatment can lead to cure.

In the first, a baby born to an HIV-positive mother was given antiretroviral therapy within an hour of birth, after tests showed she carried the virus.

Mother and daughter fell off the radar screen and their treatment lapsed, but — as reported earlier this year — when physicians next saw the baby, she had no sign of HIV infection.

Investigator Deborah Persaud, MD, of Johns Hopkins University School of Medicine is to give a more detailed report in an invited lecture on July 3.

Read the full article here

IAS Governing Council: Update on haze condition in Kuala Lumpur

As you may be aware, Kuala Lumpur is currently experiencing increased pollution levels due to forest fires in Indonesia. The below message has been sent to all conference delegates, and the IAS 2013 website will continue to be updated as the situation changes.

Haze in Kuala Lumpur:

We would like to reassure all delegates that IAS 2013 is taking place as planned. The city of Kuala Lumpur is functioning as usual and no flights are currently cancelled by the pollution. The convention centre has a modern air conditioning system. In addition, most hotels are located nearby and many have undercover air conditioned walkways taking them to the area of the convention centre.

However, as a precaution and for your comfort, masks will be available for free in the registration area, for the delegates wishing to go outside.

 

We advise delegates with previous respiratory problems to consult their doctor before travelling to Kuala Lumpur.

We look forward to welcoming you to Malaysia for what we know will be an exciting conference with the latest HIV science, research and news.