HIV/AIDS: Is the Tide Turning? Part 2

With National HIV Testing Day recently behind us and the 19th International AIDS conference happening this week in Washington, DC, I would like to share some recent HIV/AIDS statistical, research, and policy highlights.

• Of the 1.1 million living with HIV in the US, a remarkable 82% know they are infected.

Anne Landry

• Of > 50,000 individuals newly diagnosed with HIV in the US, many of the 60% who reported having a previous negative test had been tested only a few years prior, so their HIV was diagnosed early. However, certain patient groups were least likely to have a prior negative HIV test and mostlikely to quickly progress to AIDS-including black individuals, those ≥ 50 years of age, those with heterosexual contact as the sole risk factor, and males reporting injection-drug use.

• In late June, the CDC announced a 2-year HIV-screening pilot project with US pharmacies and retail clinics in selected high-risk urban and rural areas. The CDC will provide staff with training in rapid HIV testing and counseling/referral to treatment and support services for people who test positive for HIV. Jonathan Mermin, MD, MPH, the CDC’s Director of HIV/AIDS, say he hopes expansion of the program will “make HIV testing as routine as a blood pressure check.” It will be interesting to see how these support services may be utilized by people who choose at-home rather than in-pharmacy testing, after a newly FDA-approved at-home HIV test kit becomes available in the fall.

• Dr. Mermin and Dr. Peter H. Kilmarx wrote in JAIDS on July 1 highlighting effective strategies for screening/prevention. They note “new [CDC] HIV/AIDS treatment guidelines recommend offering [antiretroviral therapy] at any CD4 count to reduce the risk of HIV transmission” and mention eight interventions found to effectively increase adherence to HIV medication.

• The updated CDC “Guidelines for Use of Antiretroviral Agents in HIV-1 Infected Adults and Adolescents,” released in late March, include a new section, “HIV and the Older Patient.” As the number of HIV-infected people over age 50 increases, care concerns related to older patients (eg, drug-drug interactions, comorbidities) need to be addressed.

• The US Supreme Court Ruling on the Affordable Care Act, in full effect by 2014, will increase the number of HIV-infected people newly eligible for Medicaid coverage. The law is projected to increase the number of insured Americans by 30 million by 2014, with an increase of 17 million via Medicaid. States are not required to expand Medicaid coverage, and about half (26) indicated they will opt out; nevertheless, the nonprofit Urban Institute estimates that, through lobbying and other patient advocacy efforts, 9 million people in those 26 states will have access to Medicaid.

• The Ryan White Care Act, (1990) to bridge care gaps for people with HIV/AIDS, has been reauthorized several times and will expire in 2013. HIV/AIDS advocacy groups like the Treatment Access Expansion Project emphasize that its full funding is critical to support seamless HIV/AIDS-related care until the Affordable Care Act becomes fully effective.

• Globally, PEPFAR, “the US President’s Emergency Plan for AIDS relief,” has done much to support HIV-infected and vulnerable populations. As of September 2011, PEPFAR supported antiretroviral treatment for > 3.9 million in 23 countries; supported HIV counseling for 40 million; and supported care for 13 million, one-third of whom were orphans and vulnerable children. In 2011, PEPFAR tested 9.8 million pregnant women for HIV; it provided > 660,000 HIV-positive mothers with services to keep them alive and prevent HIV transmission to their children, enabling 200,000 babies to be born HIV-free.

• A notable development in AIDS treatment research is the announcement in late May of the first human dose-finding phase I/II clinical trials of an anti-HIV vaccine, vacc-c5, at Oslo University Hospital, Norway. The vacc-c5 vaccine has shown promise in studies in rabbits and sheep. It generates antibody production via modified, manufactured peptides from the C5 region of gp 120 at the HIV-virus surface. Studies suggest anti-C5 antibodies may be essential to the ability of some people (called natural viral suppressors) to control their HIV infection without needing HIV medication. Future studies may investigate Vacc-C5 in combination with Vacc-4x, which appears to kill HIV-infected, virus-producing cells.

• And in a promising chemotherapy–AIDS connection, a small study presented by UNC Chapel Hill researchers at AIDS 2012 (the 19th International AIDS Conference) found the HDAC inhibitor vorinostat (Zolinza, used to treat certain types of lymphoma) can turn on dormant HIV-infected immune system cells to clear hidden reservoirs of HIV-a critical step towards a cure for AIDS. Daria Hazuda, PhD, the head of infectious disease research at Merck, the manufacturer of vorinostat, said the goal of current investigations is to use vorinostat as a prototype for more potent compounds that are better at flushing HIV out of infected patients. The eight-patient study was reported online on July 25 in Nature.