As we are now used to, CROI or Conference on Retroviruses and Opportunistic Infection took place in the shape of a virtual conference. However, as usual, the conference brought together several of the most reputable researchers in HIV. Here is a selection from some of the studies and news announced at the conference.
Reduced prevalence of HAND among people living with HIV
An Italian study by the National Institute for Infectious Disease in Rome conducted 2,383 neurocognitive tests in a group of 1,365 people with HIV to find out how common HAND was and how it evolved over time. HAND stands for HIV associated neurocognitive disorder and is a catch-all term for a number of impairments that concern, among other things, memory, cognitive functions, behavior and movement functions. Before the treatment of HIV was available, HAND was associated with AIDS, but as treatment for HIV became available in 1996 and medicines gradually improved, HAND has become less common, but has not yet completely disappeared among people living with hiv.
In the study, which was conducted between 2009 – 2020, Dr Ilaria Mastrorosa and colleagues studied not only HAND but also other factors such as socioeconomic status, type of treatment and CD4 levels to understand if these could explain the existence of HAND.
The results showed that the prevalence of HAND among all study participants decreased from 38% to 16% over a ten-year period. Older age and detected hepatitis C antibodies were associated with a higher risk of HAND. Longer education, higher CD4 counts and treatment with integrase inhibitors were linked to a reduced risk of HAND. Dr Mastrorosa says in a comment that an explanation for the lower prevalence of HAND can to some extent probably be explained by the fact that newer HIV medicines are more effective and have fewer side effects than their predecessors.
Comment: From a patient perspective, it may be helpful to discuss treatment with your physician, especially for those who have experienced HAND symptoms. Integrase inhibitors are a modern class of medicines that have been around for almost 15 years. The class has with time been developed further with several new, even better alternatives, such as Dolutegravir and Bictegravir. Integrase inhibitors are today also part of the standard treatment given to someone who starts HIV treatment.
Anal cancer is more common among people living with HIV, but screening and treatment reduce the risk
The study ANCHOR, or Anal Cancer HSIL Outcomes Research studied whether screening and treatment of high-grade intraepithelial disc epithelial lesions or HSIL could reduce the risk of anal cancer among people living with HIV. HSIL is a type of abnormal cell change caused by certain types of HPV virus, which can lead to anal cancer. The HPV virus itself is a very common virus that exists in about 200 types, a majority of all who have been sexually active have been infected with some type of HPV. An infection with the HPV virus is usually asymptomatic and heals on its own, but some people living with HIV may have difficulty healing the infection from HPV.
The study lasted between 2014 – 2021 and tested 10,723 people with HIV over the age of 35 for HSIL using a cell sample. 54% of men, 46% of women and 63% of transgender people had HSIL at the first screening. During the study, the participants with HSIL were divided into two groups, a group that received treatment immediately where HSIL was removed by laser treatment, ointment or, in more severe cases, surgery and a group where the symptoms were actively monitored without treatment.
Immediate treatment was shown to reduce the risk of developing anal cancer by 57% and the study was terminated prematurely to treat all participants instead of waiting and monitoring. The treatment of HSIL is quick, easy and few reported side effects or any problems from the treatment. Professor Joel Palefsky at the University of California in San Francisco comments that screening and treatment for HSIL should be part of the standard of care for people living with HIV over the age of 35.
Comment: The vaccination rate of HPV for girls has gradually improved in Sweden, when boys now also will receive the vaccine, it is a step in the right direction to reduce the risk of certain HPV-caused cancers in the future. For those who are 35 years and older, it may be a good idea to take a cell sample to detect and reduce the risk of HSIL developing into anal cancer.
Undetectable virus for more than 3.5 years with new experimental treatment
A person in Denmark has been able to maintain a virus level close to zero through a treatment of antibodies. The person was part of eClear, a study that through the method “kick-and-kill” investigated a number of different treatments that could potentially be part of curing HIV. The study recruited 59 participants who had recently contracted HIV in Denmark and the United Kingdom, the participants were then divided into four different groups where all received standard antiretroviral HIV treatment and a combination of various more experimental treatments. After 400 days, participants were asked if they wanted to take a 12-week monitored break with the antiretroviral HIV treatment and investigate whether the experimental treatment might have had any effect. 20 participants said yes and seven participants met the criteria for the entire 12-week break as their virus levels did not exceed 5,000 copies per ml or CD4 levels dropped below 350. Perhaps most remarkable is that one person has been under supervised break for more than 3.5 years, with very low virus levels of 0.2 copies per ml of blood. In a comment, Dr Ole Schmeltz Søgaard says that it is still early and that it can be described as possibly a case of functional cure or extreme post-viral control of HIV. The person will continue to be examined and followed up by a medical team.
Comment: Much has been written and continues to be written about potential HIV cures. Progress has been made in recent years and there are today several theories and test studies to develop a safe cure that can also be scaled up and be applied on a wider scale. The examples of documented cases where people have been cured of HIV have often occurred in people who have suffered from a disease other than HIV, such as cancer, and were in need of invasive, high-risk, medical interventions. In these cases it has been ethically defensible to try to cure HIV in connection with such treatment. The antibody treatment with so-called bNAb, broadly neutralizing antibodies is still in its infancy, but an advantage is that it is a treatment that seems to be applicable with relatively few side effects.