Further advances in HIV prevention, treatment and cure from PLOS Medicine's special issue

November 30, 2017

This week, guest editors Steven G. Deeks of the University of California San Francisco, USA; Sharon Lewin of the Peter Doherty Institute of Infection and Immunity, University of Melbourne and Royal Melbourne Hospital, Australia; and Linda-Gail Bekker of the Desmond Tutu HIV Centre, University of Cape Town, South Africa sum up PLOS Medicine's special issue on Advances in HIV Prevention, Treatment and Cure in an Editorial published to coincide with World AIDS Day on December 1. While it may appear that "the goal of ending the epidemic is in our grasp", they caution that "the remarkable progress, activism, resources, ingenuity and sheer fortitude that have brought us this far will be needed in at least equal measure to take us to the end."

In an accompanying Perspective, Chris Beyrer and colleagues discuss the growing HIV epidemic in the Russian Federation, where the available prevention measures have failed to stem an increase in HIV infections, particularly in people who inject drugs and men who have sex with men. The authors note that "The continuous growth of the Russian HIV epidemic is a failure of public policy and practice" and warn of the serious consequences of neglecting this epidemic. In a Research Article addressing issues of HIV prevention in India, Sunil Solomon and colleagues present a large study using respondent-driven sampling to identify people with HIV and hepatitis C virus infection in key populations. With global targets seeking to bring about swift progress in bringing the HIV epidemic under control, this method appears promising as a way to efficiently identify people with treatable virus infections.

Continuing the theme of early identification of infection so as to ensure prompt treatment initiation and limit further virus transmission, Katrina Ortblad and colleagues report in their Research Article on a cluster-randomized controlled trial of delivery models for HIV self-testing among female sex workers in Uganda. In one delivery model, peer educators directly provided the HIV self-test to ; in the other model, the peer educators gave the sex workers a coupon that could be exchanged for an HIV self-test at a healthcare facility. Participants in both HIV self-testing arms were significantly more likely to test and re-test for HIV, compared to the standard of care arm. The direct provision delivery model was more effective than passively offering the HIV self-tests for collection at healthcare facilities. The authors conclude that "self-testing can play an important role in supporting interventions that require frequent HIV testing."

In an epidemiological study, Jacob Bor and colleagues studied a large cohort of more than 11,000 people who entered HIV care in South Africa in 2011-2012, when eligibility for antiretroviral treatment was dependent on CD4 cell count. The authors found that patients eligible for immediate antiretroviral treatment had a significantly greater retention in care than those narrowly failing the eligibility criteria. These findings support the current WHO recommendations to provide antiretroviral therapy regardless of CD4 count, and the authors highlight that "the real-world benefits of extending ART eligibility to all patients ... may be larger than previously thought."

Though of great interest, curing HIV infection has been very rarely achieved, to date. In a further research paper, Andrew Badley and colleagues describe the case of a person with HIV who underwent an allogeneic stem cell transplant as treatment for acute lymphoblastic leukaemia, and report analyses of virus sequence and tissue distribution throughout the process. Although the patient's HIV reservoir was diminished by treatment, viral rebound was observed to have occurred after a prolonged period (288 days) without antiretroviral therapy. These findings should be valuable in guiding further attempts to cure HIV infection using stem cell transplantation and other methods.

Explore further: Advances in HIV Prevention, Treatment and Cure: a special issue of PLOS Medicine

More information: Deeks SG, Lewin SR, Bekker L-G (2017) The end of HIV: Still a very long way to go, but progress continues. PLoS Med 14(11): e1002466. doi.org/10.1371/journal.pmed.1002466

Related Stories

Advances in HIV Prevention, Treatment and Cure: a special issue of PLOS Medicine

November 7, 2017
This week, publication of a special issue on Advances in HIV Prevention, Treatment and Cure begins in PLOS Medicine, advised by guest editors Linda-Gail Bekker of the Desmond Tutu HIV Centre, University of Cape Town, South ...

Immediate ART treatment improves retention rates

November 28, 2017
Starting antiretroviral therapy (ART) immediately following an HIV diagnosis dramatically improves retention in clinical HIV care, according to a study led by a Boston University School of Public Health (BUSPH) researcher.

Only one-third of HIV-positive patients remain in care before starting treatment

July 19, 2011
In sub-Saharan Africa, only about one third of patients who test positive for HIV but are not yet eligible for antiretroviral treatment remain in care until they become eligible and start treatment. Some patients never return ...

Controlling the HIV epidemic: A progress report on efforts in sub-Saharan Africa

May 2, 2017
In a Research Article published in PLOS Medicine, Richard Hayes of the London School of Hygiene & Tropical Medicine, UK and colleagues report early findings from PopART—a clinical trial evaluating an intervention to achieve ...

Improved retention and outcomes with same-day HIV testing and treatment

July 25, 2017
Initiating antiretroviral therapy (ART) on the same day as HIV testing is feasible and leads to improved retention and health outcomes, according to a trial published in PLOS Medicine.

Girl's HIV infection seems under control without AIDS drugs

July 24, 2017
A South African girl born with the AIDS virus has kept her infection suppressed for more than eight years after stopping anti-HIV medicines—more evidence that early treatment can occasionally cause a long remission that, ...

Recommended for you

Study suggests a way to stop HIV in its tracks

December 1, 2017
When HIV-1 infects an immune cell, the virus travels to the nucleus so quickly there's not enough time to set off the cell's alarm system.

Discovery puts the brakes on HIV's ability to infect

November 30, 2017
Viewed with a microscope, the virus faintly resembles a pineapple—the universal symbol of welcome. But HIV, the virus that causes AIDS, is anything but that. It has claimed the lives of more than 35 million people so far.

Rising levels of HIV drug resistance

November 30, 2017
HIV drug resistance is approaching and exceeding 10% in people living with HIV who are about to initiate or reinitiate first-line antiretroviral therapy, according to the largest meta-analysis to date on HIV drug resistance, ...

Male circumcision and antiviral drugs appear to sharply reduce HIV infection rate

November 29, 2017
A steep drop in the local incidence of new HIV infections accompanied the rollout of a U.S.-funded anti-HIV program in a large East-African population, according to a study led by researchers at Johns Hopkins Bloomberg School ...

Combination HIV prevention reduces new infections by 42 percent in Ugandan district

November 29, 2017
A study published today in the New England Journal of Medicine provides real-world evidence that implementing a combination of proven HIV prevention measures across communities can substantially reduce new HIV infections ...

Research on HIV viral load urges updates to WHO therapy guidelines

November 24, 2017
A large cohort study in South Africa has revealed that that low-level viraemia (LLV) in HIV-positive patients who are receiving antiretroviral treatment (ART) is an important risk factor for treatment failure.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.