IAS 2014

MELBOURNE – High-grade squamous intraepithelial lesions are prevalent among HIV-positive gay men and a significant number of these anal lesions resolve spontaneously, according to data from a longitudinal observational cohort study.

The Study of the Prevention of Anal Cancer (SPANC) is a 3-year prospective study of the natural history of anal HPV infection, which has so far enrolled 350 homosexual men over 35 years old. Dr. Andrew Grulich from the Kirby Institute, University of New South Wales, Sydney, presented trial data at the 20th International AIDS Conference that showed a 42% clearance rate for high-grade squamous intraepithelial lesions (HSIL).

Bianca Nogrady/Frontline Medical News

Anal lesions that result from human papillomavirus infection are difficult to treat, and there is no evidence for the effectiveness of treatment, Dr. Grulich said. Further, anal lesions are far less likely than cervical lesions to progress to cancer. However, questions remain about which men are more likely to have persistent high-grade disease and therefore are at a higher risk of progression to cancer.

Interim data from the SPANC study found a 46% prevalence of HSIL among HIV-positive gay men and a 34% prevalence among HIV-negative gay men. The higher rate among HIV-positive individuals was largely driven by a higher prevalence of more advanced anal intraepithelial neoplasia.

Men with persistent infections due to human papillomavirus (HPV) 16 – the subtype most commonly associated with anal cancer – were much less likely to clear the high-grade lesions (hazard ratio = 0.22, 95% confidence interval, 0.11-0.46), as were men with multiple subtypes of HPV.

"What we’ve been able to show is that high-grade disease is very dynamic, with one in six [gay] men getting it and of those who get it about 40% clearing it each year," Dr. Grulich told the conference.

"Not all high-grade disease requires treatment," he said. "These data suggest that treatment can be targeted at those with persistent high-grade disease because much high-grade disease diagnosed on a single occasion will simply go away."

Treatment practices for HSIL vary with some choosing a ‘watch and wait’ approach and others choosing ablative treatment. Dr. Grulich suggested treatment based on "red flags" that suggest a higher risk of progression to cancer.

"If [the patient] is HPV 16–positive, that’s a definite red flag because 90% of anal cancer is caused by that one subtype," Dr. Grulich said. Also, high-grade disease that doesn’t clear is another red flag.

"I think it’s perfectly reasonable, given the state of the science, if you’re doing high-resolution anoscopy and you diagnose (HSIL), to explain to the patient that it’s highly likely to go away but it may not, and therefore get the patient back in about a year," he said.

The study is funded by the National Health and Medical Research Council of Australia, and the Cancer Council NSW. Some authors declared financial ties to pharmaceutical companies including a manufacturer of HPV vaccines.

MELBOURNE – High-grade squamous intraepithelial lesions are prevalent among HIV-positive gay men and a significant number of these anal lesions resolve spontaneously, according to data from a longitudinal observational cohort study.

The Study of the Prevention of Anal Cancer (SPANC) is a 3-year prospective study of the natural history of anal HPV infection, which has so far enrolled 350 homosexual men over 35 years old. Dr. Andrew Grulich from the Kirby Institute, University of New South Wales, Sydney, presented trial data at the 20th International AIDS Conference that showed a 42% clearance rate for high-grade squamous intraepithelial lesions (HSIL).

Bianca Nogrady/Frontline Medical News

Anal lesions that result from human papillomavirus infection are difficult to treat, and there is no evidence for the effectiveness of treatment, Dr. Grulich said. Further, anal lesions are far less likely than cervical lesions to progress to cancer. However, questions remain about which men are more likely to have persistent high-grade disease and therefore are at a higher risk of progression to cancer.

Interim data from the SPANC study found a 46% prevalence of HSIL among HIV-positive gay men and a 34% prevalence among HIV-negative gay men. The higher rate among HIV-positive individuals was largely driven by a higher prevalence of more advanced anal intraepithelial neoplasia.

Men with persistent infections due to human papillomavirus (HPV) 16 – the subtype most commonly associated with anal cancer – were much less likely to clear the high-grade lesions (hazard ratio = 0.22, 95% confidence interval, 0.11-0.46), as were men with multiple subtypes of HPV.

"What we’ve been able to show is that high-grade disease is very dynamic, with one in six [gay] men getting it and of those who get it about 40% clearing it each year," Dr. Grulich told the conference.

"Not all high-grade disease requires treatment," he said. "These data suggest that treatment can be targeted at those with persistent high-grade disease because much high-grade disease diagnosed on a single occasion will simply go away."

Treatment practices for HSIL vary with some choosing a ‘watch and wait’ approach and others choosing ablative treatment. Dr. Grulich suggested treatment based on "red flags" that suggest a higher risk of progression to cancer.

"If [the patient] is HPV 16–positive, that’s a definite red flag because 90% of anal cancer is caused by that one subtype," Dr. Grulich said. Also, high-grade disease that doesn’t clear is another red flag.

"I think it’s perfectly reasonable, given the state of the science, if you’re doing high-resolution anoscopy and you diagnose (HSIL), to explain to the patient that it’s highly likely to go away but it may not, and therefore get the patient back in about a year," he said.

The study is funded by the National Health and Medical Research Council of Australia, and the Cancer Council NSW. Some authors declared financial ties to pharmaceutical companies including a manufacturer of HPV vaccines.

MELBOURNE – High-grade squamous intraepithelial lesions are prevalent among HIV-positive gay men and a significant number of these anal lesions resolve spontaneously, according to data from a longitudinal observational cohort study.

The Study of the Prevention of Anal Cancer (SPANC) is a 3-year prospective study of the natural history of anal HPV infection, which has so far enrolled 350 homosexual men over 35 years old. Dr. Andrew Grulich from the Kirby Institute, University of New South Wales, Sydney, presented trial data at the 20th International AIDS Conference that showed a 42% clearance rate for high-grade squamous intraepithelial lesions (HSIL).

Bianca Nogrady/Frontline Medical News

Anal lesions that result from human papillomavirus infection are difficult to treat, and there is no evidence for the effectiveness of treatment, Dr. Grulich said. Further, anal lesions are far less likely than cervical lesions to progress to cancer. However, questions remain about which men are more likely to have persistent high-grade disease and therefore are at a higher risk of progression to cancer.

Interim data from the SPANC study found a 46% prevalence of HSIL among HIV-positive gay men and a 34% prevalence among HIV-negative gay men. The higher rate among HIV-positive individuals was largely driven by a higher prevalence of more advanced anal intraepithelial neoplasia.

Men with persistent infections due to human papillomavirus (HPV) 16 – the subtype most commonly associated with anal cancer – were much less likely to clear the high-grade lesions (hazard ratio = 0.22, 95% confidence interval, 0.11-0.46), as were men with multiple subtypes of HPV.

"What we’ve been able to show is that high-grade disease is very dynamic, with one in six [gay] men getting it and of those who get it about 40% clearing it each year," Dr. Grulich told the conference.

"Not all high-grade disease requires treatment," he said. "These data suggest that treatment can be targeted at those with persistent high-grade disease because much high-grade disease diagnosed on a single occasion will simply go away."

Treatment practices for HSIL vary with some choosing a ‘watch and wait’ approach and others choosing ablative treatment. Dr. Grulich suggested treatment based on "red flags" that suggest a higher risk of progression to cancer.

"If [the patient] is HPV 16–positive, that’s a definite red flag because 90% of anal cancer is caused by that one subtype," Dr. Grulich said. Also, high-grade disease that doesn’t clear is another red flag.

"I think it’s perfectly reasonable, given the state of the science, if you’re doing high-resolution anoscopy and you diagnose (HSIL), to explain to the patient that it’s highly likely to go away but it may not, and therefore get the patient back in about a year," he said.

The study is funded by the National Health and Medical Research Council of Australia, and the Cancer Council NSW. Some authors declared financial ties to pharmaceutical companies including a manufacturer of HPV vaccines.

MELBOURNE – One-third of HIV-positive children treated with antiretroviral therapy before 3 months of age will become HIV antibody–negative, but still be HIV positive, according to data presented at the 20th International AIDS Conference.

Presenter Louise Kuhn, Ph.D., professor of epidemiology at the Mailman School of Public Health at Columbia University, N.Y., said these perinatally infected children were likely to encounter clinical confusion in their later life because of their antibody-negative status.

Dr. Kuhn and her colleagues found around 30% of children who began antiretroviral therapy (ART) before 3 months of age had undetectable HIV antibodies when tested between 3-6 years of age using a standard enzyme-linked immunosorbent assay (ELISA).

The frequency of antibody-negative status decreased with increasing age of ART initiation – overall, 16% of children who began treatment before 6 months of age had low or no HIV antibodies, but there were no antibody-negative children among those who began treatment after 6 months of age.

The retrospective study initially enrolled 104 HIV-infected children aged 3-6 years from Johannesburg, South Africa, who were under 15 months of age when they started ART but were now virally suppressed with a viral load below 50 copies/mL. Researchers later added another 122 children who had begun treatment before 6 months of age.

Dr. Kuhn said standard HIV antibody tests are usually considered diagnostic, however, it was not previously expected that some individuals would revert to being antibody negative.

"In the pediatric field, there have been anecdotal reports of treated children known to be HIV infected but who have lost their HIV-positive status over time, including the Mississippi baby, as well as several other well-treated children who started therapy early," Dr Kuhn said at the conference.

The phenomenon is likely to cause some confusion in the clinical setting, for example when it comes to disclosure or children wanting to be retested, and the clinical significance of HIV antibody–negative status is unclear.

"One doesn’t want to by any means be telling the parents that their child is now negative and they can stop treatment, so I think addressing that confusion potentially might be a bigger problem going forward," Dr. Kuhn said in an interview.

"It’s about the health care workers being really educated and attuned to the subtleties of this, which I think we’re only beginning to appreciate as HIV turns out to be more complicated than we hoped," she said.

Dr. Kuhn said the standard practice of testing children 4-6 weeks after birth may be too late because by the time treatment is usually initiated, they are already around 3 months old.

"I was trying to make that point that we’re too late with what we’re doing currently, they’ve got to shift it earlier," she said.

"We’re learning more and more about what’s going on with early treatment, and so it’s opening up a whole area of research that we really need to look at in more detail in terms of what is happening with neonatal immune development, which may be related to HIV control," she concluded.

There were no disclosures.

MELBOURNE – One-third of HIV-positive children treated with antiretroviral therapy before 3 months of age will become HIV antibody–negative, but still be HIV positive, according to data presented at the 20th International AIDS Conference.

Presenter Louise Kuhn, Ph.D., professor of epidemiology at the Mailman School of Public Health at Columbia University, N.Y., said these perinatally infected children were likely to encounter clinical confusion in their later life because of their antibody-negative status.

Dr. Kuhn and her colleagues found around 30% of children who began antiretroviral therapy (ART) before 3 months of age had undetectable HIV antibodies when tested between 3-6 years of age using a standard enzyme-linked immunosorbent assay (ELISA).

The frequency of antibody-negative status decreased with increasing age of ART initiation – overall, 16% of children who began treatment before 6 months of age had low or no HIV antibodies, but there were no antibody-negative children among those who began treatment after 6 months of age.

The retrospective study initially enrolled 104 HIV-infected children aged 3-6 years from Johannesburg, South Africa, who were under 15 months of age when they started ART but were now virally suppressed with a viral load below 50 copies/mL. Researchers later added another 122 children who had begun treatment before 6 months of age.

Dr. Kuhn said standard HIV antibody tests are usually considered diagnostic, however, it was not previously expected that some individuals would revert to being antibody negative.

"In the pediatric field, there have been anecdotal reports of treated children known to be HIV infected but who have lost their HIV-positive status over time, including the Mississippi baby, as well as several other well-treated children who started therapy early," Dr Kuhn said at the conference.

The phenomenon is likely to cause some confusion in the clinical setting, for example when it comes to disclosure or children wanting to be retested, and the clinical significance of HIV antibody–negative status is unclear.

"One doesn’t want to by any means be telling the parents that their child is now negative and they can stop treatment, so I think addressing that confusion potentially might be a bigger problem going forward," Dr. Kuhn said in an interview.

"It’s about the health care workers being really educated and attuned to the subtleties of this, which I think we’re only beginning to appreciate as HIV turns out to be more complicated than we hoped," she said.

Dr. Kuhn said the standard practice of testing children 4-6 weeks after birth may be too late because by the time treatment is usually initiated, they are already around 3 months old.

"I was trying to make that point that we’re too late with what we’re doing currently, they’ve got to shift it earlier," she said.

"We’re learning more and more about what’s going on with early treatment, and so it’s opening up a whole area of research that we really need to look at in more detail in terms of what is happening with neonatal immune development, which may be related to HIV control," she concluded.

There were no disclosures.

MELBOURNE – One-third of HIV-positive children treated with antiretroviral therapy before 3 months of age will become HIV antibody–negative, but still be HIV positive, according to data presented at the 20th International AIDS Conference.

Presenter Louise Kuhn, Ph.D., professor of epidemiology at the Mailman School of Public Health at Columbia University, N.Y., said these perinatally infected children were likely to encounter clinical confusion in their later life because of their antibody-negative status.

Dr. Kuhn and her colleagues found around 30% of children who began antiretroviral therapy (ART) before 3 months of age had undetectable HIV antibodies when tested between 3-6 years of age using a standard enzyme-linked immunosorbent assay (ELISA).

The frequency of antibody-negative status decreased with increasing age of ART initiation – overall, 16% of children who began treatment before 6 months of age had low or no HIV antibodies, but there were no antibody-negative children among those who began treatment after 6 months of age.

The retrospective study initially enrolled 104 HIV-infected children aged 3-6 years from Johannesburg, South Africa, who were under 15 months of age when they started ART but were now virally suppressed with a viral load below 50 copies/mL. Researchers later added another 122 children who had begun treatment before 6 months of age.

Dr. Kuhn said standard HIV antibody tests are usually considered diagnostic, however, it was not previously expected that some individuals would revert to being antibody negative.

"In the pediatric field, there have been anecdotal reports of treated children known to be HIV infected but who have lost their HIV-positive status over time, including the Mississippi baby, as well as several other well-treated children who started therapy early," Dr Kuhn said at the conference.

The phenomenon is likely to cause some confusion in the clinical setting, for example when it comes to disclosure or children wanting to be retested, and the clinical significance of HIV antibody–negative status is unclear.

"One doesn’t want to by any means be telling the parents that their child is now negative and they can stop treatment, so I think addressing that confusion potentially might be a bigger problem going forward," Dr. Kuhn said in an interview.

"It’s about the health care workers being really educated and attuned to the subtleties of this, which I think we’re only beginning to appreciate as HIV turns out to be more complicated than we hoped," she said.

Dr. Kuhn said the standard practice of testing children 4-6 weeks after birth may be too late because by the time treatment is usually initiated, they are already around 3 months old.

"I was trying to make that point that we’re too late with what we’re doing currently, they’ve got to shift it earlier," she said.

"We’re learning more and more about what’s going on with early treatment, and so it’s opening up a whole area of research that we really need to look at in more detail in terms of what is happening with neonatal immune development, which may be related to HIV control," she concluded.

There were no disclosures.

MELBOURNE – One-third of HIV-positive children treated with antiretroviral therapy before 3 months of age will become HIV antibody–negative, but still be HIV positive, according to data presented at the 20th International AIDS Conference.

Presenter Louise Kuhn, Ph.D., professor of epidemiology at the Mailman School of Public Health at Columbia University, N.Y., said these perinatally infected children were likely to encounter clinical confusion in their later life because of their antibody-negative status.

Bianca Nogrady/Frontline Medical News

Dr. Kuhn and her colleagues found around 30% of children who began antiretroviral therapy (ART) before 3 months of age had undetectable HIV antibodies when tested between 3-6 years of age using a standard enzyme-linked immunosorbent assay (ELISA).

The frequency of antibody-negative status decreased with increasing age of ART initiation – overall, 16% of children who began treatment before 6 months of age had low or no HIV antibodies, but there were no antibody-negative children among those who began treatment after 6 months of age.

The retrospective study initially enrolled 104 HIV-infected children aged 3-6 years from Johannesburg, South Africa, who were under 15 months of age when they started ART but were now virally suppressed with a viral load below 50 copies/mL. Researchers later added another 122 children who had begun treatment before 6 months of age.

Dr. Kuhn said standard HIV antibody tests are usually considered diagnostic, however, it was not previously expected that some individuals would revert to being antibody negative.

"In the pediatric field, there have been anecdotal reports of treated children known to be HIV infected but who have lost their HIV-positive status over time, including the Mississippi baby, as well as several other well-treated children who started therapy early," Dr Kuhn said at the conference.

The phenomenon is likely to cause some confusion in the clinical setting, for example when it comes to disclosure or children wanting to be retested, and the clinical significance of HIV antibody–negative status is unclear.

"One doesn’t want to by any means be telling the parents that their child is now negative and they can stop treatment, so I think addressing that confusion potentially might be a bigger problem going forward," Dr. Kuhn said in an interview.

"It’s about the health care workers being really educated and attuned to the subtleties of this, which I think we’re only beginning to appreciate as HIV turns out to be more complicated than we hoped," she said.

Dr. Kuhn said the standard practice of testing children 4-6 weeks after birth may be too late because by the time treatment is usually initiated, they are already around 3 months old.

"I was trying to make that point that we’re too late with what we’re doing currently, they’ve got to shift it earlier," she said.

"We’re learning more and more about what’s going on with early treatment, and so it’s opening up a whole area of research that we really need to look at in more detail in terms of what is happening with neonatal immune development, which may be related to HIV control," she concluded.

There were no disclosures.

MELBOURNE – One-third of HIV-positive children treated with antiretroviral therapy before 3 months of age will become HIV antibody–negative, but still be HIV positive, according to data presented at the 20th International AIDS Conference.

Presenter Louise Kuhn, Ph.D., professor of epidemiology at the Mailman School of Public Health at Columbia University, N.Y., said these perinatally infected children were likely to encounter clinical confusion in their later life because of their antibody-negative status.

Bianca Nogrady/Frontline Medical News

Dr. Kuhn and her colleagues found around 30% of children who began antiretroviral therapy (ART) before 3 months of age had undetectable HIV antibodies when tested between 3-6 years of age using a standard enzyme-linked immunosorbent assay (ELISA).

The frequency of antibody-negative status decreased with increasing age of ART initiation – overall, 16% of children who began treatment before 6 months of age had low or no HIV antibodies, but there were no antibody-negative children among those who began treatment after 6 months of age.

The retrospective study initially enrolled 104 HIV-infected children aged 3-6 years from Johannesburg, South Africa, who were under 15 months of age when they started ART but were now virally suppressed with a viral load below 50 copies/mL. Researchers later added another 122 children who had begun treatment before 6 months of age.

Dr. Kuhn said standard HIV antibody tests are usually considered diagnostic, however, it was not previously expected that some individuals would revert to being antibody negative.

"In the pediatric field, there have been anecdotal reports of treated children known to be HIV infected but who have lost their HIV-positive status over time, including the Mississippi baby, as well as several other well-treated children who started therapy early," Dr Kuhn said at the conference.

The phenomenon is likely to cause some confusion in the clinical setting, for example when it comes to disclosure or children wanting to be retested, and the clinical significance of HIV antibody–negative status is unclear.

"One doesn’t want to by any means be telling the parents that their child is now negative and they can stop treatment, so I think addressing that confusion potentially might be a bigger problem going forward," Dr. Kuhn said in an interview.

"It’s about the health care workers being really educated and attuned to the subtleties of this, which I think we’re only beginning to appreciate as HIV turns out to be more complicated than we hoped," she said.

Dr. Kuhn said the standard practice of testing children 4-6 weeks after birth may be too late because by the time treatment is usually initiated, they are already around 3 months old.

"I was trying to make that point that we’re too late with what we’re doing currently, they’ve got to shift it earlier," she said.

"We’re learning more and more about what’s going on with early treatment, and so it’s opening up a whole area of research that we really need to look at in more detail in terms of what is happening with neonatal immune development, which may be related to HIV control," she concluded.

There were no disclosures.

MELBOURNE – One-third of HIV-positive children treated with antiretroviral therapy before 3 months of age will become HIV antibody–negative, but still be HIV positive, according to data presented at the 20th International AIDS Conference.

Presenter Louise Kuhn, Ph.D., professor of epidemiology at the Mailman School of Public Health at Columbia University, N.Y., said these perinatally infected children were likely to encounter clinical confusion in their later life because of their antibody-negative status.

Bianca Nogrady/Frontline Medical News

Dr. Kuhn and her colleagues found around 30% of children who began antiretroviral therapy (ART) before 3 months of age had undetectable HIV antibodies when tested between 3-6 years of age using a standard enzyme-linked immunosorbent assay (ELISA).

The frequency of antibody-negative status decreased with increasing age of ART initiation – overall, 16% of children who began treatment before 6 months of age had low or no HIV antibodies, but there were no antibody-negative children among those who began treatment after 6 months of age.

The retrospective study initially enrolled 104 HIV-infected children aged 3-6 years from Johannesburg, South Africa, who were under 15 months of age when they started ART but were now virally suppressed with a viral load below 50 copies/mL. Researchers later added another 122 children who had begun treatment before 6 months of age.

Dr. Kuhn said standard HIV antibody tests are usually considered diagnostic, however, it was not previously expected that some individuals would revert to being antibody negative.

"In the pediatric field, there have been anecdotal reports of treated children known to be HIV infected but who have lost their HIV-positive status over time, including the Mississippi baby, as well as several other well-treated children who started therapy early," Dr Kuhn said at the conference.

The phenomenon is likely to cause some confusion in the clinical setting, for example when it comes to disclosure or children wanting to be retested, and the clinical significance of HIV antibody–negative status is unclear.

"One doesn’t want to by any means be telling the parents that their child is now negative and they can stop treatment, so I think addressing that confusion potentially might be a bigger problem going forward," Dr. Kuhn said in an interview.

"It’s about the health care workers being really educated and attuned to the subtleties of this, which I think we’re only beginning to appreciate as HIV turns out to be more complicated than we hoped," she said.

Dr. Kuhn said the standard practice of testing children 4-6 weeks after birth may be too late because by the time treatment is usually initiated, they are already around 3 months old.

"I was trying to make that point that we’re too late with what we’re doing currently, they’ve got to shift it earlier," she said.

"We’re learning more and more about what’s going on with early treatment, and so it’s opening up a whole area of research that we really need to look at in more detail in terms of what is happening with neonatal immune development, which may be related to HIV control," she concluded.

There were no disclosures.

MELBOURNE – A regimen of ABT-450 coformulated with ritonavir, ombitasvir, and dasabuvir, plus ribavirin, resulted in high rates of sustained virologic response in hepatitis C patients co-infected with HIV. Further, the treatment approach did not have a negative effect on HIV viral load.

Data from the open-label study, presented at the 20th International AIDS Conference, showed that nearly 94% of patients treated with the three-dose (3D) interferon-free regimen plus ribavirin for 12 weeks had a sustained virologic response at 4 weeks after treatment cessation. Nearly 97% of those treated for 24 weeks achieved a sustained virologic response at 4 weeks after treatment cessation.

Biance Nogrady/Frontline Medical News

The TURQUOISE-I study assessed the 3D plus ribavirin regimen in 63 patients with hepatitis C genotype 1 infection plus HIV-1 infection. The treatment group included treatment-naive patients and patients previously treated with interferon.

Dr. Mark S. Sulkowski, who presented the data, said earlier phase III studies of the 3D regimen, both with and without ribavirin, showed greater than 96% sustained virologic response rates in HCV-1–infected patients treated for 12 weeks, and 92%-96% response rates in patients with cirrhosis treated for 12-24 weeks.

"Drug interactions with hepatitis C and HIV regimens are the foremost question when approaching treatment in this group," Dr. Sulkowski, professor of medicine at Johns Hopkins University, Baltimore, told conference attendees.

Virologic failure occurred in two patients. Both had previously not responded to treatment and had compensated cirrhosis, and both also had resistance-associated HCV variants that had not been present at baseline.

The majority of adverse events were mild. The most common was fatigue, affecting 58% of patients in the 12-week arm and 37% in the 24-week arm. Other adverse events included insomnia, nausea, and headache. No patients discontinued therapy because of adverse events.

Researchers also observed grade 3 elevations in total bilirubin levels in more than 35% of patients in the 12-week arm of the study and nearly 19% of patients in the 24-week arm. Most of the grade 3 elevations occurred in patients receiving the antiretroviral atazanavir for their HIV infections.

Dr. Sulkowski said side effects and drug interactions associated with interferon therapy have largely accounted for problems in treating patients co-infected with HIV and hepatitis C.

The emerging data suggest the interferon-free regimen "works just as well in HIV-positive patients as in HIV-negative patients, so the barriers really come down to potential interactions with antiretroviral drugs," Dr. Sulkowski said in an interview.

"We now believe that HIV in and of itself is not a factor in predicting success with interferon-free regimens," he said.

Dr. Sulkowski said the Food and Drug Administration is considering applications for the 3D regimen, with and without ribavirin, with a decision expected in the fall.

Dr. Sulkowski declared grant support, consultancies, and advisory board positions with several companies, including study sponsor AbbVie.

MELBOURNE – A regimen of ABT-450 coformulated with ritonavir, ombitasvir, and dasabuvir, plus ribavirin, resulted in high rates of sustained virologic response in hepatitis C patients co-infected with HIV. Further, the treatment approach did not have a negative effect on HIV viral load.

Data from the open-label study, presented at the 20th International AIDS Conference, showed that nearly 94% of patients treated with the three-dose (3D) interferon-free regimen plus ribavirin for 12 weeks had a sustained virologic response at 4 weeks after treatment cessation. Nearly 97% of those treated for 24 weeks achieved a sustained virologic response at 4 weeks after treatment cessation.

Biance Nogrady/Frontline Medical News

The TURQUOISE-I study assessed the 3D plus ribavirin regimen in 63 patients with hepatitis C genotype 1 infection plus HIV-1 infection. The treatment group included treatment-naive patients and patients previously treated with interferon.

Dr. Mark S. Sulkowski, who presented the data, said earlier phase III studies of the 3D regimen, both with and without ribavirin, showed greater than 96% sustained virologic response rates in HCV-1–infected patients treated for 12 weeks, and 92%-96% response rates in patients with cirrhosis treated for 12-24 weeks.

"Drug interactions with hepatitis C and HIV regimens are the foremost question when approaching treatment in this group," Dr. Sulkowski, professor of medicine at Johns Hopkins University, Baltimore, told conference attendees.

Virologic failure occurred in two patients. Both had previously not responded to treatment and had compensated cirrhosis, and both also had resistance-associated HCV variants that had not been present at baseline.

The majority of adverse events were mild. The most common was fatigue, affecting 58% of patients in the 12-week arm and 37% in the 24-week arm. Other adverse events included insomnia, nausea, and headache. No patients discontinued therapy because of adverse events.

Researchers also observed grade 3 elevations in total bilirubin levels in more than 35% of patients in the 12-week arm of the study and nearly 19% of patients in the 24-week arm. Most of the grade 3 elevations occurred in patients receiving the antiretroviral atazanavir for their HIV infections.

Dr. Sulkowski said side effects and drug interactions associated with interferon therapy have largely accounted for problems in treating patients co-infected with HIV and hepatitis C.

The emerging data suggest the interferon-free regimen "works just as well in HIV-positive patients as in HIV-negative patients, so the barriers really come down to potential interactions with antiretroviral drugs," Dr. Sulkowski said in an interview.

"We now believe that HIV in and of itself is not a factor in predicting success with interferon-free regimens," he said.

Dr. Sulkowski said the Food and Drug Administration is considering applications for the 3D regimen, with and without ribavirin, with a decision expected in the fall.

Dr. Sulkowski declared grant support, consultancies, and advisory board positions with several companies, including study sponsor AbbVie.

MELBOURNE – A regimen of ABT-450 coformulated with ritonavir, ombitasvir, and dasabuvir, plus ribavirin, resulted in high rates of sustained virologic response in hepatitis C patients co-infected with HIV. Further, the treatment approach did not have a negative effect on HIV viral load.

Data from the open-label study, presented at the 20th International AIDS Conference, showed that nearly 94% of patients treated with the three-dose (3D) interferon-free regimen plus ribavirin for 12 weeks had a sustained virologic response at 4 weeks after treatment cessation. Nearly 97% of those treated for 24 weeks achieved a sustained virologic response at 4 weeks after treatment cessation.

Biance Nogrady/Frontline Medical News

The TURQUOISE-I study assessed the 3D plus ribavirin regimen in 63 patients with hepatitis C genotype 1 infection plus HIV-1 infection. The treatment group included treatment-naive patients and patients previously treated with interferon.

Dr. Mark S. Sulkowski, who presented the data, said earlier phase III studies of the 3D regimen, both with and without ribavirin, showed greater than 96% sustained virologic response rates in HCV-1–infected patients treated for 12 weeks, and 92%-96% response rates in patients with cirrhosis treated for 12-24 weeks.

"Drug interactions with hepatitis C and HIV regimens are the foremost question when approaching treatment in this group," Dr. Sulkowski, professor of medicine at Johns Hopkins University, Baltimore, told conference attendees.

Virologic failure occurred in two patients. Both had previously not responded to treatment and had compensated cirrhosis, and both also had resistance-associated HCV variants that had not been present at baseline.

The majority of adverse events were mild. The most common was fatigue, affecting 58% of patients in the 12-week arm and 37% in the 24-week arm. Other adverse events included insomnia, nausea, and headache. No patients discontinued therapy because of adverse events.

Researchers also observed grade 3 elevations in total bilirubin levels in more than 35% of patients in the 12-week arm of the study and nearly 19% of patients in the 24-week arm. Most of the grade 3 elevations occurred in patients receiving the antiretroviral atazanavir for their HIV infections.

Dr. Sulkowski said side effects and drug interactions associated with interferon therapy have largely accounted for problems in treating patients co-infected with HIV and hepatitis C.

The emerging data suggest the interferon-free regimen "works just as well in HIV-positive patients as in HIV-negative patients, so the barriers really come down to potential interactions with antiretroviral drugs," Dr. Sulkowski said in an interview.

"We now believe that HIV in and of itself is not a factor in predicting success with interferon-free regimens," he said.

Dr. Sulkowski said the Food and Drug Administration is considering applications for the 3D regimen, with and without ribavirin, with a decision expected in the fall.

Dr. Sulkowski declared grant support, consultancies, and advisory board positions with several companies, including study sponsor AbbVie.

MELBOURNE – Men who have sex with men should consider pre-exposure prophylaxis with antiretroviral medications as an additional option to prevent HIV infection, according to the latest World Health Organization guidelines on HIV prevention, diagnosis, treatment, and care in high-risk populations.

The guidelines, released at the 20th International AIDS Conference, also introduce a new recommendation on providing access to naloxone and instructions on its use for anyone likely to witness an opioid overdose in a friend or relative, as part of a broader harm-reduction effort.

These are the first WHO guidelines on HIV/AIDS that bring together advice on five key population groups: men who have sex with men, injection drug users, sex workers, transgender people, and people in prisons.

Dr. Rachel Baggaley, guidelines coordinator from the HIV department at WHO, said the latest UNAIDS estimates suggest up to 50% of new infections are occurring among these groups because they are not getting the services they need.

While the idea of pre-exposure prophylaxis (PrEP) among men who have sex with men was first raised 3 years ago, Dr. Baggaley said the evidence now justified a strengthening of the recommendation.

"We’re just opening the door to suggest that this can be considered as an additional prevention choice, given the high incidence rates we are continuing to see in this population," Dr. Baggaley said in an interview.

"At the moment PrEP is a daily dose, and so for gay men who would want to use it, it would be offered as a daily dose for a period of time and it would be reviewed ... in consultation with the health care provider," she said.

Other recommendations included voluntary medical male circumcision, particularly in areas with hyperendemic HIV and low prevalence of circumcision, for the prevention of heterosexually acquired HIV in men, and daily oral pre-exposure prophylaxis – tenofovir alone or tenofovir and emtricitabine – for uninfected partners of HIV-positive individuals if additional HIV prevention choices are needed.

Dr. Chris Beyrer, director of the Johns Hopkins Center for Public Health and Human Rights, Baltimore, said that the recommendation on PrEP was about providing more options for HIV prevention.

"PrEP is not being recommended as a lifetime approach – it is important for men to consider as an option for prevention when they are sexually active and at risk of HIV exposure," Dr. Beyrer told the conference.

The guidelines also recommended routine screening and management of mental health disorders such as depression and psychosocial stress among HIV-positive people from these key populations, to optimize health outcomes and improve antiretroviral adherence.

For injection drug users, the guidelines recommended all people should have access to sterile injection equipment through needle and syringe programs, as well as a recommendation for availability and training in naloxone use for opioid overdose.

Dr. Beyrer described the naloxone recommendation as a lifesaving intervention and a public health and human rights advance.

The guidelines were funded by UNAIDS, the U.S. President’s Emergency Plan for AIDS Relief, and the Global Fund to Fight AIDS, Tuberculosis, and Malaria. There were no relevant conflicts of interest declared.

MELBOURNE – Men who have sex with men should consider pre-exposure prophylaxis with antiretroviral medications as an additional option to prevent HIV infection, according to the latest World Health Organization guidelines on HIV prevention, diagnosis, treatment, and care in high-risk populations.

The guidelines, released at the 20th International AIDS Conference, also introduce a new recommendation on providing access to naloxone and instructions on its use for anyone likely to witness an opioid overdose in a friend or relative, as part of a broader harm-reduction effort.

These are the first WHO guidelines on HIV/AIDS that bring together advice on five key population groups: men who have sex with men, injection drug users, sex workers, transgender people, and people in prisons.

Dr. Rachel Baggaley, guidelines coordinator from the HIV department at WHO, said the latest UNAIDS estimates suggest up to 50% of new infections are occurring among these groups because they are not getting the services they need.

While the idea of pre-exposure prophylaxis (PrEP) among men who have sex with men was first raised 3 years ago, Dr. Baggaley said the evidence now justified a strengthening of the recommendation.

"We’re just opening the door to suggest that this can be considered as an additional prevention choice, given the high incidence rates we are continuing to see in this population," Dr. Baggaley said in an interview.

"At the moment PrEP is a daily dose, and so for gay men who would want to use it, it would be offered as a daily dose for a period of time and it would be reviewed ... in consultation with the health care provider," she said.

Other recommendations included voluntary medical male circumcision, particularly in areas with hyperendemic HIV and low prevalence of circumcision, for the prevention of heterosexually acquired HIV in men, and daily oral pre-exposure prophylaxis – tenofovir alone or tenofovir and emtricitabine – for uninfected partners of HIV-positive individuals if additional HIV prevention choices are needed.

Dr. Chris Beyrer, director of the Johns Hopkins Center for Public Health and Human Rights, Baltimore, said that the recommendation on PrEP was about providing more options for HIV prevention.

"PrEP is not being recommended as a lifetime approach – it is important for men to consider as an option for prevention when they are sexually active and at risk of HIV exposure," Dr. Beyrer told the conference.

The guidelines also recommended routine screening and management of mental health disorders such as depression and psychosocial stress among HIV-positive people from these key populations, to optimize health outcomes and improve antiretroviral adherence.

For injection drug users, the guidelines recommended all people should have access to sterile injection equipment through needle and syringe programs, as well as a recommendation for availability and training in naloxone use for opioid overdose.

Dr. Beyrer described the naloxone recommendation as a lifesaving intervention and a public health and human rights advance.

The guidelines were funded by UNAIDS, the U.S. President’s Emergency Plan for AIDS Relief, and the Global Fund to Fight AIDS, Tuberculosis, and Malaria. There were no relevant conflicts of interest declared.

MELBOURNE – Men who have sex with men should consider pre-exposure prophylaxis with antiretroviral medications as an additional option to prevent HIV infection, according to the latest World Health Organization guidelines on HIV prevention, diagnosis, treatment, and care in high-risk populations.

The guidelines, released at the 20th International AIDS Conference, also introduce a new recommendation on providing access to naloxone and instructions on its use for anyone likely to witness an opioid overdose in a friend or relative, as part of a broader harm-reduction effort.

These are the first WHO guidelines on HIV/AIDS that bring together advice on five key population groups: men who have sex with men, injection drug users, sex workers, transgender people, and people in prisons.

Dr. Rachel Baggaley, guidelines coordinator from the HIV department at WHO, said the latest UNAIDS estimates suggest up to 50% of new infections are occurring among these groups because they are not getting the services they need.

While the idea of pre-exposure prophylaxis (PrEP) among men who have sex with men was first raised 3 years ago, Dr. Baggaley said the evidence now justified a strengthening of the recommendation.

"We’re just opening the door to suggest that this can be considered as an additional prevention choice, given the high incidence rates we are continuing to see in this population," Dr. Baggaley said in an interview.

"At the moment PrEP is a daily dose, and so for gay men who would want to use it, it would be offered as a daily dose for a period of time and it would be reviewed ... in consultation with the health care provider," she said.

Other recommendations included voluntary medical male circumcision, particularly in areas with hyperendemic HIV and low prevalence of circumcision, for the prevention of heterosexually acquired HIV in men, and daily oral pre-exposure prophylaxis – tenofovir alone or tenofovir and emtricitabine – for uninfected partners of HIV-positive individuals if additional HIV prevention choices are needed.

Dr. Chris Beyrer, director of the Johns Hopkins Center for Public Health and Human Rights, Baltimore, said that the recommendation on PrEP was about providing more options for HIV prevention.

"PrEP is not being recommended as a lifetime approach – it is important for men to consider as an option for prevention when they are sexually active and at risk of HIV exposure," Dr. Beyrer told the conference.

The guidelines also recommended routine screening and management of mental health disorders such as depression and psychosocial stress among HIV-positive people from these key populations, to optimize health outcomes and improve antiretroviral adherence.

For injection drug users, the guidelines recommended all people should have access to sterile injection equipment through needle and syringe programs, as well as a recommendation for availability and training in naloxone use for opioid overdose.

Dr. Beyrer described the naloxone recommendation as a lifesaving intervention and a public health and human rights advance.

The guidelines were funded by UNAIDS, the U.S. President’s Emergency Plan for AIDS Relief, and the Global Fund to Fight AIDS, Tuberculosis, and Malaria. There were no relevant conflicts of interest declared.

MELBOURNE – Men who have sex with men should consider pre-exposure prophylaxis with antiretroviral medications as an additional option to prevent HIV infection, according to the latest World Health Organization guidelines on HIV prevention, diagnosis, treatment, and care in high-risk populations.

The guidelines, released at the 20th International AIDS Conference, also introduce a new recommendation on providing access to naloxone and instructions on its use for anyone likely to witness an opioid overdose in a friend or relative, as part of a broader harm-reduction effort.

These are the first WHO guidelines on HIV/AIDS that bring together advice on five key population groups: men who have sex with men, injection drug users, sex workers, transgender people, and people in prisons.

Dr. Rachel Baggaley, guidelines coordinator from the HIV department at WHO, said the latest UNAIDS estimates suggest up to 50% of new infections are occurring among these groups because they are not getting the services they need.

While the idea of pre-exposure prophylaxis (PrEP) among men who have sex with men was first raised 3 years ago, Dr. Baggaley said the evidence now justified a strengthening of the recommendation.

"We’re just opening the door to suggest that this can be considered as an additional prevention choice, given the high incidence rates we are continuing to see in this population," Dr. Baggaley said in an interview.

"At the moment PrEP is a daily dose, and so for gay men who would want to use it, it would be offered as a daily dose for a period of time and it would be reviewed ... in consultation with the health care provider," she said.

Other recommendations included voluntary medical male circumcision, particularly in areas with hyperendemic HIV and low prevalence of circumcision, for the prevention of heterosexually acquired HIV in men, and daily oral pre-exposure prophylaxis – tenofovir alone or tenofovir and emtricitabine – for uninfected partners of HIV-positive individuals if additional HIV prevention choices are needed.

Dr. Chris Beyrer, director of the Johns Hopkins Center for Public Health and Human Rights, Baltimore, said that the recommendation on PrEP was about providing more options for HIV prevention.

"PrEP is not being recommended as a lifetime approach – it is important for men to consider as an option for prevention when they are sexually active and at risk of HIV exposure," Dr. Beyrer told the conference.

The guidelines also recommended routine screening and management of mental health disorders such as depression and psychosocial stress among HIV-positive people from these key populations, to optimize health outcomes and improve antiretroviral adherence.

For injection drug users, the guidelines recommended all people should have access to sterile injection equipment through needle and syringe programs, as well as a recommendation for availability and training in naloxone use for opioid overdose.

Dr. Beyrer described the naloxone recommendation as a lifesaving intervention and a public health and human rights advance.

The guidelines were funded by UNAIDS, the U.S. President’s Emergency Plan for AIDS Relief, and the Global Fund to Fight AIDS, Tuberculosis, and Malaria. There were no relevant conflicts of interest declared.

MELBOURNE – Men who have sex with men should consider pre-exposure prophylaxis with antiretroviral medications as an additional option to prevent HIV infection, according to the latest World Health Organization guidelines on HIV prevention, diagnosis, treatment, and care in high-risk populations.

The guidelines, released at the 20th International AIDS Conference, also introduce a new recommendation on providing access to naloxone and instructions on its use for anyone likely to witness an opioid overdose in a friend or relative, as part of a broader harm-reduction effort.

These are the first WHO guidelines on HIV/AIDS that bring together advice on five key population groups: men who have sex with men, injection drug users, sex workers, transgender people, and people in prisons.

Dr. Rachel Baggaley, guidelines coordinator from the HIV department at WHO, said the latest UNAIDS estimates suggest up to 50% of new infections are occurring among these groups because they are not getting the services they need.

While the idea of pre-exposure prophylaxis (PrEP) among men who have sex with men was first raised 3 years ago, Dr. Baggaley said the evidence now justified a strengthening of the recommendation.

"We’re just opening the door to suggest that this can be considered as an additional prevention choice, given the high incidence rates we are continuing to see in this population," Dr. Baggaley said in an interview.

"At the moment PrEP is a daily dose, and so for gay men who would want to use it, it would be offered as a daily dose for a period of time and it would be reviewed ... in consultation with the health care provider," she said.

Other recommendations included voluntary medical male circumcision, particularly in areas with hyperendemic HIV and low prevalence of circumcision, for the prevention of heterosexually acquired HIV in men, and daily oral pre-exposure prophylaxis – tenofovir alone or tenofovir and emtricitabine – for uninfected partners of HIV-positive individuals if additional HIV prevention choices are needed.

Dr. Chris Beyrer, director of the Johns Hopkins Center for Public Health and Human Rights, Baltimore, said that the recommendation on PrEP was about providing more options for HIV prevention.

"PrEP is not being recommended as a lifetime approach – it is important for men to consider as an option for prevention when they are sexually active and at risk of HIV exposure," Dr. Beyrer told the conference.

The guidelines also recommended routine screening and management of mental health disorders such as depression and psychosocial stress among HIV-positive people from these key populations, to optimize health outcomes and improve antiretroviral adherence.

For injection drug users, the guidelines recommended all people should have access to sterile injection equipment through needle and syringe programs, as well as a recommendation for availability and training in naloxone use for opioid overdose.

Dr. Beyrer described the naloxone recommendation as a lifesaving intervention and a public health and human rights advance.

The guidelines were funded by UNAIDS, the U.S. President’s Emergency Plan for AIDS Relief, and the Global Fund to Fight AIDS, Tuberculosis, and Malaria. There were no relevant conflicts of interest declared.

MELBOURNE – Men who have sex with men should consider pre-exposure prophylaxis with antiretroviral medications as an additional option to prevent HIV infection, according to the latest World Health Organization guidelines on HIV prevention, diagnosis, treatment, and care in high-risk populations.

The guidelines, released at the 20th International AIDS Conference, also introduce a new recommendation on providing access to naloxone and instructions on its use for anyone likely to witness an opioid overdose in a friend or relative, as part of a broader harm-reduction effort.

These are the first WHO guidelines on HIV/AIDS that bring together advice on five key population groups: men who have sex with men, injection drug users, sex workers, transgender people, and people in prisons.

Dr. Rachel Baggaley, guidelines coordinator from the HIV department at WHO, said the latest UNAIDS estimates suggest up to 50% of new infections are occurring among these groups because they are not getting the services they need.

While the idea of pre-exposure prophylaxis (PrEP) among men who have sex with men was first raised 3 years ago, Dr. Baggaley said the evidence now justified a strengthening of the recommendation.

"We’re just opening the door to suggest that this can be considered as an additional prevention choice, given the high incidence rates we are continuing to see in this population," Dr. Baggaley said in an interview.

"At the moment PrEP is a daily dose, and so for gay men who would want to use it, it would be offered as a daily dose for a period of time and it would be reviewed ... in consultation with the health care provider," she said.

Other recommendations included voluntary medical male circumcision, particularly in areas with hyperendemic HIV and low prevalence of circumcision, for the prevention of heterosexually acquired HIV in men, and daily oral pre-exposure prophylaxis – tenofovir alone or tenofovir and emtricitabine – for uninfected partners of HIV-positive individuals if additional HIV prevention choices are needed.

Dr. Chris Beyrer, director of the Johns Hopkins Center for Public Health and Human Rights, Baltimore, said that the recommendation on PrEP was about providing more options for HIV prevention.

"PrEP is not being recommended as a lifetime approach – it is important for men to consider as an option for prevention when they are sexually active and at risk of HIV exposure," Dr. Beyrer told the conference.

The guidelines also recommended routine screening and management of mental health disorders such as depression and psychosocial stress among HIV-positive people from these key populations, to optimize health outcomes and improve antiretroviral adherence.

For injection drug users, the guidelines recommended all people should have access to sterile injection equipment through needle and syringe programs, as well as a recommendation for availability and training in naloxone use for opioid overdose.

Dr. Beyrer described the naloxone recommendation as a lifesaving intervention and a public health and human rights advance.

The guidelines were funded by UNAIDS, the U.S. President’s Emergency Plan for AIDS Relief, and the Global Fund to Fight AIDS, Tuberculosis, and Malaria. There were no relevant conflicts of interest declared.

Tuberculosis, HIV, and malaria incidence and mortality have all declined significantly since the formulation of Millennium Development Goal 6 in 2000, which focused global attention on these three diseases and made them a priority.

Analysis of data from the Global Burden of Disease Study 2013 showed that annual deaths from tuberculosis among HIV-negative individuals decreased 1.4% from 1.8 million in 1990 to 1.3 million in 2013, while the global incidence of malaria appears to have peaked at 232 million in 2003 and since dropped 29% to 165 million new cases in 2013.

©Elizabeth

The study was published July 21 in JAMA coincident with the start of the 20th International AIDS Conference in Melbourne.Interventions such as prevention of mother-to-child transmission, and antiretroviral therapy (ART), have seen HIV deaths fall from 1.7 million in 2005 to 1.3 million in 2013 – a decline of 3.1% – representing 19.1 million life-years saved, mostly in developing countries, according to data published online July 22 in the Lancet.

However the prevalence of HIV-positive individuals has risen to 29.2 million in 2013, having increased at a rate of 1.2% per year since 2000 (Lancet 2014 July 22 [doi: 10.1016/ S0140-6736(14)60844-8]).

"There is substantial variation both in levels and trends for all three diseases across countries," wrote Dr. Christopher J. L. Murray, the director of the Institute for Health Metrics and Evaluation and professor of global health at the University of Washington, Seattle, and his associates.

"HIV and malaria incidence and death are concentrated in sub-Saharan Africa, whereas tuberculosis burden is more widespread but most pronounced in south and southeast Asia."

The authors pointed out that their estimates of the number of people living with HIV were 18.7% smaller and estimates for HIV mortality were 14.5% smaller than UNAIDS’s estimates for 2012.

"Revisions of the global epidemiology of HIV of this magnitude – in view of the weakness of direct measurement of incidence and death – should not be surprising," the authors wrote.

They suggested that the differences between their figures and those from UNAIDS could be partly attributed to their significantly lower estimates of mortality from concentrated epidemics such as those in Panama, Colombia, and Russia.

The Global Burden of Disease Study also selected epidemic curves for large generalized epidemics that were consistent with prevalence data, all-cause mortality, and data on survival with and without ART, which the authors said had shifted median survival up.

"For example, in southern Africa, median survival off ART for the age-group 25-34 years increased from 10.5 years to 11.5 years."

Similarly, the authors noted significant differences between their estimates and those from the World Health Organization in the prevalence of tuberculosis, commenting that in general they estimated higher mortality, lower prevalence and incidence, and a smaller fraction of tuberculosis related to HIV infection.

The study showed that HIV infections in children have declined by 62.4% since their peak in 2002; however, the authors said the continued 1.7 million new infections in adults each year were a stark reminder that the Millennium Development Goal’s work was far from done.

"The focus of the global health community on action to reduce HIV/AIDS, tuberculosis, and malaria, enshrined in MDG6 [Millennium Development Goal 6], was not only appropriate in 2000 at the Millennium Declaration, but is increasingly relevant now in view of the slow but important progress that disease control strategies have yielded, particularly since 2005.

"Much remains to be done, however: although evidence now exists that the implementation of known interventions is beginning to have an effect, it is probably less than is widely believed, or hoped."

In an accompanying editorial, Dr. Rifat Atun, professor of global health systems and director of the global health systems cluster at Harvard University’s School of Public Health, Boston, called for a revolution in the reporting of global health data, with new standards to make data, methods, and models available for all, enabling greater transparency, scrutiny, and accountability in global health research.

Describing the paper as "a bold and welcome action" in its efforts to clarify the reasons for differences in estimates between the global burden of disease data, and data from UNAIDS and WHO, Dr. Atun said that global health studies should strive for rigor of data, methods, and results.

"By providing detailed information on key data sources, key adjustments to data, modeling strategies, and uncertainty analyses, Murray and colleagues have pushed the boundaries of reporting in global health to levels expected of other disciplines and areas of health research – an important step in the right direction," Dr. Atun wrote.

The Global Burden of Disease Study is funded by the Bill & Melinda Gates Foundation. Some authors declared consultancies, lecture fees, honoraria, and grants from public funding sources and private industry. The editorial author declared no conflicts of interest.

Tuberculosis, HIV, and malaria incidence and mortality have all declined significantly since the formulation of Millennium Development Goal 6 in 2000, which focused global attention on these three diseases and made them a priority.

Analysis of data from the Global Burden of Disease Study 2013 showed that annual deaths from tuberculosis among HIV-negative individuals decreased 1.4% from 1.8 million in 1990 to 1.3 million in 2013, while the global incidence of malaria appears to have peaked at 232 million in 2003 and since dropped 29% to 165 million new cases in 2013.

©Elizabeth

The study was published July 21 in JAMA coincident with the start of the 20th International AIDS Conference in Melbourne.Interventions such as prevention of mother-to-child transmission, and antiretroviral therapy (ART), have seen HIV deaths fall from 1.7 million in 2005 to 1.3 million in 2013 – a decline of 3.1% – representing 19.1 million life-years saved, mostly in developing countries, according to data published online July 22 in the Lancet.

However the prevalence of HIV-positive individuals has risen to 29.2 million in 2013, having increased at a rate of 1.2% per year since 2000 (Lancet 2014 July 22 [doi: 10.1016/ S0140-6736(14)60844-8]).

"There is substantial variation both in levels and trends for all three diseases across countries," wrote Dr. Christopher J. L. Murray, the director of the Institute for Health Metrics and Evaluation and professor of global health at the University of Washington, Seattle, and his associates.

"HIV and malaria incidence and death are concentrated in sub-Saharan Africa, whereas tuberculosis burden is more widespread but most pronounced in south and southeast Asia."

The authors pointed out that their estimates of the number of people living with HIV were 18.7% smaller and estimates for HIV mortality were 14.5% smaller than UNAIDS’s estimates for 2012.

"Revisions of the global epidemiology of HIV of this magnitude – in view of the weakness of direct measurement of incidence and death – should not be surprising," the authors wrote.

They suggested that the differences between their figures and those from UNAIDS could be partly attributed to their significantly lower estimates of mortality from concentrated epidemics such as those in Panama, Colombia, and Russia.

The Global Burden of Disease Study also selected epidemic curves for large generalized epidemics that were consistent with prevalence data, all-cause mortality, and data on survival with and without ART, which the authors said had shifted median survival up.

"For example, in southern Africa, median survival off ART for the age-group 25-34 years increased from 10.5 years to 11.5 years."

Similarly, the authors noted significant differences between their estimates and those from the World Health Organization in the prevalence of tuberculosis, commenting that in general they estimated higher mortality, lower prevalence and incidence, and a smaller fraction of tuberculosis related to HIV infection.

The study showed that HIV infections in children have declined by 62.4% since their peak in 2002; however, the authors said the continued 1.7 million new infections in adults each year were a stark reminder that the Millennium Development Goal’s work was far from done.

"The focus of the global health community on action to reduce HIV/AIDS, tuberculosis, and malaria, enshrined in MDG6 [Millennium Development Goal 6], was not only appropriate in 2000 at the Millennium Declaration, but is increasingly relevant now in view of the slow but important progress that disease control strategies have yielded, particularly since 2005.

"Much remains to be done, however: although evidence now exists that the implementation of known interventions is beginning to have an effect, it is probably less than is widely believed, or hoped."

In an accompanying editorial, Dr. Rifat Atun, professor of global health systems and director of the global health systems cluster at Harvard University’s School of Public Health, Boston, called for a revolution in the reporting of global health data, with new standards to make data, methods, and models available for all, enabling greater transparency, scrutiny, and accountability in global health research.

Describing the paper as "a bold and welcome action" in its efforts to clarify the reasons for differences in estimates between the global burden of disease data, and data from UNAIDS and WHO, Dr. Atun said that global health studies should strive for rigor of data, methods, and results.

"By providing detailed information on key data sources, key adjustments to data, modeling strategies, and uncertainty analyses, Murray and colleagues have pushed the boundaries of reporting in global health to levels expected of other disciplines and areas of health research – an important step in the right direction," Dr. Atun wrote.

The Global Burden of Disease Study is funded by the Bill & Melinda Gates Foundation. Some authors declared consultancies, lecture fees, honoraria, and grants from public funding sources and private industry. The editorial author declared no conflicts of interest.

Tuberculosis, HIV, and malaria incidence and mortality have all declined significantly since the formulation of Millennium Development Goal 6 in 2000, which focused global attention on these three diseases and made them a priority.

Analysis of data from the Global Burden of Disease Study 2013 showed that annual deaths from tuberculosis among HIV-negative individuals decreased 1.4% from 1.8 million in 1990 to 1.3 million in 2013, while the global incidence of malaria appears to have peaked at 232 million in 2003 and since dropped 29% to 165 million new cases in 2013.

©Elizabeth

The study was published July 21 in JAMA coincident with the start of the 20th International AIDS Conference in Melbourne.Interventions such as prevention of mother-to-child transmission, and antiretroviral therapy (ART), have seen HIV deaths fall from 1.7 million in 2005 to 1.3 million in 2013 – a decline of 3.1% – representing 19.1 million life-years saved, mostly in developing countries, according to data published online July 22 in the Lancet.

However the prevalence of HIV-positive individuals has risen to 29.2 million in 2013, having increased at a rate of 1.2% per year since 2000 (Lancet 2014 July 22 [doi: 10.1016/ S0140-6736(14)60844-8]).

"There is substantial variation both in levels and trends for all three diseases across countries," wrote Dr. Christopher J. L. Murray, the director of the Institute for Health Metrics and Evaluation and professor of global health at the University of Washington, Seattle, and his associates.

"HIV and malaria incidence and death are concentrated in sub-Saharan Africa, whereas tuberculosis burden is more widespread but most pronounced in south and southeast Asia."

The authors pointed out that their estimates of the number of people living with HIV were 18.7% smaller and estimates for HIV mortality were 14.5% smaller than UNAIDS’s estimates for 2012.

"Revisions of the global epidemiology of HIV of this magnitude – in view of the weakness of direct measurement of incidence and death – should not be surprising," the authors wrote.

They suggested that the differences between their figures and those from UNAIDS could be partly attributed to their significantly lower estimates of mortality from concentrated epidemics such as those in Panama, Colombia, and Russia.

The Global Burden of Disease Study also selected epidemic curves for large generalized epidemics that were consistent with prevalence data, all-cause mortality, and data on survival with and without ART, which the authors said had shifted median survival up.

"For example, in southern Africa, median survival off ART for the age-group 25-34 years increased from 10.5 years to 11.5 years."

Similarly, the authors noted significant differences between their estimates and those from the World Health Organization in the prevalence of tuberculosis, commenting that in general they estimated higher mortality, lower prevalence and incidence, and a smaller fraction of tuberculosis related to HIV infection.

The study showed that HIV infections in children have declined by 62.4% since their peak in 2002; however, the authors said the continued 1.7 million new infections in adults each year were a stark reminder that the Millennium Development Goal’s work was far from done.

"The focus of the global health community on action to reduce HIV/AIDS, tuberculosis, and malaria, enshrined in MDG6 [Millennium Development Goal 6], was not only appropriate in 2000 at the Millennium Declaration, but is increasingly relevant now in view of the slow but important progress that disease control strategies have yielded, particularly since 2005.

"Much remains to be done, however: although evidence now exists that the implementation of known interventions is beginning to have an effect, it is probably less than is widely believed, or hoped."

In an accompanying editorial, Dr. Rifat Atun, professor of global health systems and director of the global health systems cluster at Harvard University’s School of Public Health, Boston, called for a revolution in the reporting of global health data, with new standards to make data, methods, and models available for all, enabling greater transparency, scrutiny, and accountability in global health research.

Describing the paper as "a bold and welcome action" in its efforts to clarify the reasons for differences in estimates between the global burden of disease data, and data from UNAIDS and WHO, Dr. Atun said that global health studies should strive for rigor of data, methods, and results.

"By providing detailed information on key data sources, key adjustments to data, modeling strategies, and uncertainty analyses, Murray and colleagues have pushed the boundaries of reporting in global health to levels expected of other disciplines and areas of health research – an important step in the right direction," Dr. Atun wrote.

The Global Burden of Disease Study is funded by the Bill & Melinda Gates Foundation. Some authors declared consultancies, lecture fees, honoraria, and grants from public funding sources and private industry. The editorial author declared no conflicts of interest.

Tuberculosis, HIV, and malaria incidence and mortality have all declined significantly since the formulation of Millennium Development Goal 6 in 2000, which focused global attention on these three diseases and made them a priority.

Analysis of data from the Global Burden of Disease Study 2013 showed that annual deaths from tuberculosis among HIV-negative individuals decreased 1.4% from 1.8 million in 1990 to 1.3 million in 2013, while the global incidence of malaria appears to have peaked at 232 million in 2003 and since dropped 29% to 165 million new cases in 2013.

©Elizabeth

The study was published July 21 in JAMA coincident with the start of the 20th International AIDS Conference in Melbourne.Interventions such as prevention of mother-to-child transmission, and antiretroviral therapy (ART), have seen HIV deaths fall from 1.7 million in 2005 to 1.3 million in 2013 – a decline of 3.1% – representing 19.1 million life-years saved, mostly in developing countries, according to data published online July 22 in the Lancet.

However the prevalence of HIV-positive individuals has risen to 29.2 million in 2013, having increased at a rate of 1.2% per year since 2000 (Lancet 2014 July 22 [doi: 10.1016/ S0140-6736(14)60844-8]).

"There is substantial variation both in levels and trends for all three diseases across countries," wrote Dr. Christopher J. L. Murray, the director of the Institute for Health Metrics and Evaluation and professor of global health at the University of Washington, Seattle, and his associates.

"HIV and malaria incidence and death are concentrated in sub-Saharan Africa, whereas tuberculosis burden is more widespread but most pronounced in south and southeast Asia."

The authors pointed out that their estimates of the number of people living with HIV were 18.7% smaller and estimates for HIV mortality were 14.5% smaller than UNAIDS’s estimates for 2012.

"Revisions of the global epidemiology of HIV of this magnitude – in view of the weakness of direct measurement of incidence and death – should not be surprising," the authors wrote.

They suggested that the differences between their figures and those from UNAIDS could be partly attributed to their significantly lower estimates of mortality from concentrated epidemics such as those in Panama, Colombia, and Russia.

The Global Burden of Disease Study also selected epidemic curves for large generalized epidemics that were consistent with prevalence data, all-cause mortality, and data on survival with and without ART, which the authors said had shifted median survival up.

"For example, in southern Africa, median survival off ART for the age-group 25-34 years increased from 10.5 years to 11.5 years."

Similarly, the authors noted significant differences between their estimates and those from the World Health Organization in the prevalence of tuberculosis, commenting that in general they estimated higher mortality, lower prevalence and incidence, and a smaller fraction of tuberculosis related to HIV infection.

The study showed that HIV infections in children have declined by 62.4% since their peak in 2002; however, the authors said the continued 1.7 million new infections in adults each year were a stark reminder that the Millennium Development Goal’s work was far from done.

"The focus of the global health community on action to reduce HIV/AIDS, tuberculosis, and malaria, enshrined in MDG6 [Millennium Development Goal 6], was not only appropriate in 2000 at the Millennium Declaration, but is increasingly relevant now in view of the slow but important progress that disease control strategies have yielded, particularly since 2005.

"Much remains to be done, however: although evidence now exists that the implementation of known interventions is beginning to have an effect, it is probably less than is widely believed, or hoped."

In an accompanying editorial, Dr. Rifat Atun, professor of global health systems and director of the global health systems cluster at Harvard University’s School of Public Health, Boston, called for a revolution in the reporting of global health data, with new standards to make data, methods, and models available for all, enabling greater transparency, scrutiny, and accountability in global health research.

Describing the paper as "a bold and welcome action" in its efforts to clarify the reasons for differences in estimates between the global burden of disease data, and data from UNAIDS and WHO, Dr. Atun said that global health studies should strive for rigor of data, methods, and results.

"By providing detailed information on key data sources, key adjustments to data, modeling strategies, and uncertainty analyses, Murray and colleagues have pushed the boundaries of reporting in global health to levels expected of other disciplines and areas of health research – an important step in the right direction," Dr. Atun wrote.

The Global Burden of Disease Study is funded by the Bill & Melinda Gates Foundation. Some authors declared consultancies, lecture fees, honoraria, and grants from public funding sources and private industry. The editorial author declared no conflicts of interest.

Tuberculosis, HIV, and malaria incidence and mortality have all declined significantly since the formulation of Millennium Development Goal 6 in 2000, which focused global attention on these three diseases and made them a priority.

Analysis of data from the Global Burden of Disease Study 2013 showed that annual deaths from tuberculosis among HIV-negative individuals decreased 1.4% from 1.8 million in 1990 to 1.3 million in 2013, while the global incidence of malaria appears to have peaked at 232 million in 2003 and since dropped 29% to 165 million new cases in 2013.

©Elizabeth

The study was published July 21 in JAMA coincident with the start of the 20th International AIDS Conference in Melbourne.Interventions such as prevention of mother-to-child transmission, and antiretroviral therapy (ART), have seen HIV deaths fall from 1.7 million in 2005 to 1.3 million in 2013 – a decline of 3.1% – representing 19.1 million life-years saved, mostly in developing countries, according to data published online July 22 in the Lancet.

However the prevalence of HIV-positive individuals has risen to 29.2 million in 2013, having increased at a rate of 1.2% per year since 2000 (Lancet 2014 July 22 [doi: 10.1016/ S0140-6736(14)60844-8]).

"There is substantial variation both in levels and trends for all three diseases across countries," wrote Dr. Christopher J. L. Murray, the director of the Institute for Health Metrics and Evaluation and professor of global health at the University of Washington, Seattle, and his associates.

"HIV and malaria incidence and death are concentrated in sub-Saharan Africa, whereas tuberculosis burden is more widespread but most pronounced in south and southeast Asia."

The authors pointed out that their estimates of the number of people living with HIV were 18.7% smaller and estimates for HIV mortality were 14.5% smaller than UNAIDS’s estimates for 2012.

"Revisions of the global epidemiology of HIV of this magnitude – in view of the weakness of direct measurement of incidence and death – should not be surprising," the authors wrote.

They suggested that the differences between their figures and those from UNAIDS could be partly attributed to their significantly lower estimates of mortality from concentrated epidemics such as those in Panama, Colombia, and Russia.

The Global Burden of Disease Study also selected epidemic curves for large generalized epidemics that were consistent with prevalence data, all-cause mortality, and data on survival with and without ART, which the authors said had shifted median survival up.

"For example, in southern Africa, median survival off ART for the age-group 25-34 years increased from 10.5 years to 11.5 years."

Similarly, the authors noted significant differences between their estimates and those from the World Health Organization in the prevalence of tuberculosis, commenting that in general they estimated higher mortality, lower prevalence and incidence, and a smaller fraction of tuberculosis related to HIV infection.

The study showed that HIV infections in children have declined by 62.4% since their peak in 2002; however, the authors said the continued 1.7 million new infections in adults each year were a stark reminder that the Millennium Development Goal’s work was far from done.

"The focus of the global health community on action to reduce HIV/AIDS, tuberculosis, and malaria, enshrined in MDG6 [Millennium Development Goal 6], was not only appropriate in 2000 at the Millennium Declaration, but is increasingly relevant now in view of the slow but important progress that disease control strategies have yielded, particularly since 2005.

"Much remains to be done, however: although evidence now exists that the implementation of known interventions is beginning to have an effect, it is probably less than is widely believed, or hoped."

In an accompanying editorial, Dr. Rifat Atun, professor of global health systems and director of the global health systems cluster at Harvard University’s School of Public Health, Boston, called for a revolution in the reporting of global health data, with new standards to make data, methods, and models available for all, enabling greater transparency, scrutiny, and accountability in global health research.

Describing the paper as "a bold and welcome action" in its efforts to clarify the reasons for differences in estimates between the global burden of disease data, and data from UNAIDS and WHO, Dr. Atun said that global health studies should strive for rigor of data, methods, and results.

"By providing detailed information on key data sources, key adjustments to data, modeling strategies, and uncertainty analyses, Murray and colleagues have pushed the boundaries of reporting in global health to levels expected of other disciplines and areas of health research – an important step in the right direction," Dr. Atun wrote.

The Global Burden of Disease Study is funded by the Bill & Melinda Gates Foundation. Some authors declared consultancies, lecture fees, honoraria, and grants from public funding sources and private industry. The editorial author declared no conflicts of interest.

Tuberculosis, HIV, and malaria incidence and mortality have all declined significantly since the formulation of Millennium Development Goal 6 in 2000, which focused global attention on these three diseases and made them a priority.

Analysis of data from the Global Burden of Disease Study 2013 showed that annual deaths from tuberculosis among HIV-negative individuals decreased 1.4% from 1.8 million in 1990 to 1.3 million in 2013, while the global incidence of malaria appears to have peaked at 232 million in 2003 and since dropped 29% to 165 million new cases in 2013.

©Elizabeth

The study was published July 21 in JAMA coincident with the start of the 20th International AIDS Conference in Melbourne.Interventions such as prevention of mother-to-child transmission, and antiretroviral therapy (ART), have seen HIV deaths fall from 1.7 million in 2005 to 1.3 million in 2013 – a decline of 3.1% – representing 19.1 million life-years saved, mostly in developing countries, according to data published online July 22 in the Lancet.

However the prevalence of HIV-positive individuals has risen to 29.2 million in 2013, having increased at a rate of 1.2% per year since 2000 (Lancet 2014 July 22 [doi: 10.1016/ S0140-6736(14)60844-8]).

"There is substantial variation both in levels and trends for all three diseases across countries," wrote Dr. Christopher J. L. Murray, the director of the Institute for Health Metrics and Evaluation and professor of global health at the University of Washington, Seattle, and his associates.

"HIV and malaria incidence and death are concentrated in sub-Saharan Africa, whereas tuberculosis burden is more widespread but most pronounced in south and southeast Asia."

The authors pointed out that their estimates of the number of people living with HIV were 18.7% smaller and estimates for HIV mortality were 14.5% smaller than UNAIDS’s estimates for 2012.

"Revisions of the global epidemiology of HIV of this magnitude – in view of the weakness of direct measurement of incidence and death – should not be surprising," the authors wrote.

They suggested that the differences between their figures and those from UNAIDS could be partly attributed to their significantly lower estimates of mortality from concentrated epidemics such as those in Panama, Colombia, and Russia.

The Global Burden of Disease Study also selected epidemic curves for large generalized epidemics that were consistent with prevalence data, all-cause mortality, and data on survival with and without ART, which the authors said had shifted median survival up.

"For example, in southern Africa, median survival off ART for the age-group 25-34 years increased from 10.5 years to 11.5 years."

Similarly, the authors noted significant differences between their estimates and those from the World Health Organization in the prevalence of tuberculosis, commenting that in general they estimated higher mortality, lower prevalence and incidence, and a smaller fraction of tuberculosis related to HIV infection.

The study showed that HIV infections in children have declined by 62.4% since their peak in 2002; however, the authors said the continued 1.7 million new infections in adults each year were a stark reminder that the Millennium Development Goal’s work was far from done.

"The focus of the global health community on action to reduce HIV/AIDS, tuberculosis, and malaria, enshrined in MDG6 [Millennium Development Goal 6], was not only appropriate in 2000 at the Millennium Declaration, but is increasingly relevant now in view of the slow but important progress that disease control strategies have yielded, particularly since 2005.

"Much remains to be done, however: although evidence now exists that the implementation of known interventions is beginning to have an effect, it is probably less than is widely believed, or hoped."

In an accompanying editorial, Dr. Rifat Atun, professor of global health systems and director of the global health systems cluster at Harvard University’s School of Public Health, Boston, called for a revolution in the reporting of global health data, with new standards to make data, methods, and models available for all, enabling greater transparency, scrutiny, and accountability in global health research.

Describing the paper as "a bold and welcome action" in its efforts to clarify the reasons for differences in estimates between the global burden of disease data, and data from UNAIDS and WHO, Dr. Atun said that global health studies should strive for rigor of data, methods, and results.

"By providing detailed information on key data sources, key adjustments to data, modeling strategies, and uncertainty analyses, Murray and colleagues have pushed the boundaries of reporting in global health to levels expected of other disciplines and areas of health research – an important step in the right direction," Dr. Atun wrote.

The Global Burden of Disease Study is funded by the Bill & Melinda Gates Foundation. Some authors declared consultancies, lecture fees, honoraria, and grants from public funding sources and private industry. The editorial author declared no conflicts of interest.

Allogeneic hematopoietic stem cell transplantation from HIV-naive individuals to HIV-1–positive individuals may achieve temporary antiretroviral-free remission of infection and loss of detectable HIV-1, a study showed.

Two men with chronic HIV-1 infection received allogeneic hematopoietic stem cell transplants (HSCTs) from susceptible donors to treat Hodgkin’s and non-Hodgkin’s lymphoma, and achieved temporary remission of HIV despite stopping antiretroviral therapy (ART), with the virus undetectable in both blood and rectal mucosa.

© Dr. A. Harrison; Dr. P. Feorino / CDC

However, both experienced viral rebound – one at 12 weeks after stopping ART and one at 32 weeks – with both developing the usual symptoms of acute retroviral syndrome, according to a paper published online July 22 in the Annals of Internal Medicine.

"In summary, our results suggest that allogeneic HSCT with CCR5 wild-type donor cells may lead to loss of detectable HIV-1 from blood and rectal mucosa, but viral rebound may nevertheless occur after ART interruption despite a significant reduction in reservoir size," wrote Dr. Timothy J. Henrich of Brigham and Women’s Hospital, Boston, and his colleagues.

The researchers had previously reported the reduction in peripheral blood HIV-1 reservoirs in these two patients (Ann. Intern. Med. 2014 July 22 [doi:10.7326/M14-1027]).

"However, extensive sampling of tissues and large numbers of peripheral blood mononuclear cells for the presence of HIV-1 is necessary to understand the full effect of allogeneic HSCT on HIV-1 persistence," they wrote, arguing that treatment interruption was also necessary to establish if the virus was in remission.

Antiretroviral-free remission had previously been achieved in a patient who received an HSCT from a donor with a homozygous 32–base pair deletion in the gene encoding CCR5, a coreceptor for HIV-1. In this patient – known as "the Berlin patient" – remission has been maintained for more than 7 years, representing the only known functional cure of HIV infection.

The authors of the study suggested that while allogeneic HSCT may lead to significant and sustained reductions in the HIV-1 reservoir, the virus appears to persist in infected tissue or bound into cells, and those small numbers of infected cells were enough to restart HIV-1 replication.

Although both patients did experience rebound infection, that occurred much slower than it would have under normal circumstances, the authors said.

"Despite frequent sampling, neither of our patients had detectable HIV-1 in [peripheral blood mononuclear cells] or plasma for several months after ART discontinuation before viral rebound," they wrote.

Both patients received treatment for graft versus host disease after the transplant.

The study was supported by the Foundation for AIDS Research and the National Institute of Allergy and Infectious Diseases. Dr. Henrich had no disclosures. Some of the study’s other authors, as well as the editorial author, Dr. Lewin, declared grant support, speakers fees, and consulting fees from agencies and pharmaceutical companies.

Allogeneic hematopoietic stem cell transplantation from HIV-naive individuals to HIV-1–positive individuals may achieve temporary antiretroviral-free remission of infection and loss of detectable HIV-1, a study showed.

Two men with chronic HIV-1 infection received allogeneic hematopoietic stem cell transplants (HSCTs) from susceptible donors to treat Hodgkin’s and non-Hodgkin’s lymphoma, and achieved temporary remission of HIV despite stopping antiretroviral therapy (ART), with the virus undetectable in both blood and rectal mucosa.

© Dr. A. Harrison; Dr. P. Feorino / CDC

However, both experienced viral rebound – one at 12 weeks after stopping ART and one at 32 weeks – with both developing the usual symptoms of acute retroviral syndrome, according to a paper published online July 22 in the Annals of Internal Medicine.

"In summary, our results suggest that allogeneic HSCT with CCR5 wild-type donor cells may lead to loss of detectable HIV-1 from blood and rectal mucosa, but viral rebound may nevertheless occur after ART interruption despite a significant reduction in reservoir size," wrote Dr. Timothy J. Henrich of Brigham and Women’s Hospital, Boston, and his colleagues.

The researchers had previously reported the reduction in peripheral blood HIV-1 reservoirs in these two patients (Ann. Intern. Med. 2014 July 22 [doi:10.7326/M14-1027]).

"However, extensive sampling of tissues and large numbers of peripheral blood mononuclear cells for the presence of HIV-1 is necessary to understand the full effect of allogeneic HSCT on HIV-1 persistence," they wrote, arguing that treatment interruption was also necessary to establish if the virus was in remission.

Antiretroviral-free remission had previously been achieved in a patient who received an HSCT from a donor with a homozygous 32–base pair deletion in the gene encoding CCR5, a coreceptor for HIV-1. In this patient – known as "the Berlin patient" – remission has been maintained for more than 7 years, representing the only known functional cure of HIV infection.

The authors of the study suggested that while allogeneic HSCT may lead to significant and sustained reductions in the HIV-1 reservoir, the virus appears to persist in infected tissue or bound into cells, and those small numbers of infected cells were enough to restart HIV-1 replication.

Although both patients did experience rebound infection, that occurred much slower than it would have under normal circumstances, the authors said.

"Despite frequent sampling, neither of our patients had detectable HIV-1 in [peripheral blood mononuclear cells] or plasma for several months after ART discontinuation before viral rebound," they wrote.

Both patients received treatment for graft versus host disease after the transplant.

The study was supported by the Foundation for AIDS Research and the National Institute of Allergy and Infectious Diseases. Dr. Henrich had no disclosures. Some of the study’s other authors, as well as the editorial author, Dr. Lewin, declared grant support, speakers fees, and consulting fees from agencies and pharmaceutical companies.

Allogeneic hematopoietic stem cell transplantation from HIV-naive individuals to HIV-1–positive individuals may achieve temporary antiretroviral-free remission of infection and loss of detectable HIV-1, a study showed.

Two men with chronic HIV-1 infection received allogeneic hematopoietic stem cell transplants (HSCTs) from susceptible donors to treat Hodgkin’s and non-Hodgkin’s lymphoma, and achieved temporary remission of HIV despite stopping antiretroviral therapy (ART), with the virus undetectable in both blood and rectal mucosa.

© Dr. A. Harrison; Dr. P. Feorino / CDC

However, both experienced viral rebound – one at 12 weeks after stopping ART and one at 32 weeks – with both developing the usual symptoms of acute retroviral syndrome, according to a paper published online July 22 in the Annals of Internal Medicine.

"In summary, our results suggest that allogeneic HSCT with CCR5 wild-type donor cells may lead to loss of detectable HIV-1 from blood and rectal mucosa, but viral rebound may nevertheless occur after ART interruption despite a significant reduction in reservoir size," wrote Dr. Timothy J. Henrich of Brigham and Women’s Hospital, Boston, and his colleagues.

The researchers had previously reported the reduction in peripheral blood HIV-1 reservoirs in these two patients (Ann. Intern. Med. 2014 July 22 [doi:10.7326/M14-1027]).

"However, extensive sampling of tissues and large numbers of peripheral blood mononuclear cells for the presence of HIV-1 is necessary to understand the full effect of allogeneic HSCT on HIV-1 persistence," they wrote, arguing that treatment interruption was also necessary to establish if the virus was in remission.

Antiretroviral-free remission had previously been achieved in a patient who received an HSCT from a donor with a homozygous 32–base pair deletion in the gene encoding CCR5, a coreceptor for HIV-1. In this patient – known as "the Berlin patient" – remission has been maintained for more than 7 years, representing the only known functional cure of HIV infection.

The authors of the study suggested that while allogeneic HSCT may lead to significant and sustained reductions in the HIV-1 reservoir, the virus appears to persist in infected tissue or bound into cells, and those small numbers of infected cells were enough to restart HIV-1 replication.

Although both patients did experience rebound infection, that occurred much slower than it would have under normal circumstances, the authors said.

"Despite frequent sampling, neither of our patients had detectable HIV-1 in [peripheral blood mononuclear cells] or plasma for several months after ART discontinuation before viral rebound," they wrote.

Both patients received treatment for graft versus host disease after the transplant.

The study was supported by the Foundation for AIDS Research and the National Institute of Allergy and Infectious Diseases. Dr. Henrich had no disclosures. Some of the study’s other authors, as well as the editorial author, Dr. Lewin, declared grant support, speakers fees, and consulting fees from agencies and pharmaceutical companies.

MELBOURNE – Speakers at the opening plenary of the 20th International AIDS Conference struggled with their emotions as they paid tribute to colleagues – including former International AIDS Society President Dr. Joep Lange – who were killed when Malaysian Airlines flight MH17 crashed in Ukraine.

Dr. Lange was instrumental in research and implementation of mother-to-child transmission therapy, and as president of the society, showed a rare combination of enthusiasm, commitment, and perseverance, Lambert Grijns, Dutch Ambassador for Sexual and Reproductive Health and Rights and HIV/AIDS, said July 20.

Bianca Nogrady/Frontline Medical News

Dr. Lange’s partner, Jacqueline van Tongeren, of the Amsterdam Institute for Global Health and Development, also was killed in the incident, along with Lucie van Mens, who Mr. Grijns said had advocated the cause of sex workers at a time when few other were doing so.

"She was a driving force in advocacy for the female condom, she gave the product its rightful place in the field of sexual reproductive health and rights, and her impact will continue to be felt," Mr Grijns told the packed auditorium.

Other high-profile researchers on the flight included Martine de Schutter, program manager for Bridging The Gap, who Mr. Grijns said had been a staunch defender of human rights and the right to good health; Glenn Thomas from the World Health Organization’s communications team; and Pim de Kuijer, a prominent AIDS campaigner and lobbyist for Stop AIDS Now!

Prof. Françoise Barré-Sinoussi, IAS president and the director of the regulation of retroviral infections unit at the Institut Pasteur in Paris, called for a moment’s silence in their memory, during which the audience spontaneously rose to its feet.

"Our colleagues were traveling because of their dedication to bringing an end to AIDS, and our determination to continue their work honors their commitment," she said.

MELBOURNE – Speakers at the opening plenary of the 20th International AIDS Conference struggled with their emotions as they paid tribute to colleagues – including former International AIDS Society President Dr. Joep Lange – who were killed when Malaysian Airlines flight MH17 crashed in Ukraine.

Dr. Lange was instrumental in research and implementation of mother-to-child transmission therapy, and as president of the society, showed a rare combination of enthusiasm, commitment, and perseverance, Lambert Grijns, Dutch Ambassador for Sexual and Reproductive Health and Rights and HIV/AIDS, said July 20.

Bianca Nogrady/Frontline Medical News

Dr. Lange’s partner, Jacqueline van Tongeren, of the Amsterdam Institute for Global Health and Development, also was killed in the incident, along with Lucie van Mens, who Mr. Grijns said had advocated the cause of sex workers at a time when few other were doing so.

"She was a driving force in advocacy for the female condom, she gave the product its rightful place in the field of sexual reproductive health and rights, and her impact will continue to be felt," Mr Grijns told the packed auditorium.

Other high-profile researchers on the flight included Martine de Schutter, program manager for Bridging The Gap, who Mr. Grijns said had been a staunch defender of human rights and the right to good health; Glenn Thomas from the World Health Organization’s communications team; and Pim de Kuijer, a prominent AIDS campaigner and lobbyist for Stop AIDS Now!

Prof. Françoise Barré-Sinoussi, IAS president and the director of the regulation of retroviral infections unit at the Institut Pasteur in Paris, called for a moment’s silence in their memory, during which the audience spontaneously rose to its feet.

"Our colleagues were traveling because of their dedication to bringing an end to AIDS, and our determination to continue their work honors their commitment," she said.

MELBOURNE – Speakers at the opening plenary of the 20th International AIDS Conference struggled with their emotions as they paid tribute to colleagues – including former International AIDS Society President Dr. Joep Lange – who were killed when Malaysian Airlines flight MH17 crashed in Ukraine.

Dr. Lange was instrumental in research and implementation of mother-to-child transmission therapy, and as president of the society, showed a rare combination of enthusiasm, commitment, and perseverance, Lambert Grijns, Dutch Ambassador for Sexual and Reproductive Health and Rights and HIV/AIDS, said July 20.

Bianca Nogrady/Frontline Medical News

Dr. Lange’s partner, Jacqueline van Tongeren, of the Amsterdam Institute for Global Health and Development, also was killed in the incident, along with Lucie van Mens, who Mr. Grijns said had advocated the cause of sex workers at a time when few other were doing so.

"She was a driving force in advocacy for the female condom, she gave the product its rightful place in the field of sexual reproductive health and rights, and her impact will continue to be felt," Mr Grijns told the packed auditorium.

Other high-profile researchers on the flight included Martine de Schutter, program manager for Bridging The Gap, who Mr. Grijns said had been a staunch defender of human rights and the right to good health; Glenn Thomas from the World Health Organization’s communications team; and Pim de Kuijer, a prominent AIDS campaigner and lobbyist for Stop AIDS Now!

Prof. Françoise Barré-Sinoussi, IAS president and the director of the regulation of retroviral infections unit at the Institut Pasteur in Paris, called for a moment’s silence in their memory, during which the audience spontaneously rose to its feet.

"Our colleagues were traveling because of their dedication to bringing an end to AIDS, and our determination to continue their work honors their commitment," she said.