2nd Annual CFAR HIV in the Southeast Workshop

cfar-workshop-800w

In the decades since the first AIDS cases were reported in Los Angeles and New York City in 1981, the epicenter of the nation’s HIV epidemic has shifted from urban centers along the coasts to the 16 states and District of Columbia that make up the South. The South now experiences the greatest burden of HIV infection, illness, and deaths of any U.S. region, and lags behind in providing quality HIV prevention and care to its citizens.

Southern states today account for an estimated 44 percent of all people living with an HIV diagnosis in the U.S., despite having only about one-third (37%) of the overall U.S. population. Eight of the 10 states with the highest rates of new HIV diagnoses are in the South, as are the 10 metropolitan statistical areas (MSAs) with the highest rates (CDC HIV Surveillance Report, 2014). Diagnosis rates for people in the South are higher than for Americans overall: In 2010, the region had the highest rates of HIV and AIDS diagnoses in the country, as well as the highest number of people living with HIV compared to all other regions (SAS Report, 2015).

2017 marked the second year of the CFAR HIV in the Southeast Workshop, at gathering of researchers and community organizers from CFARs across the country. This year’s event was held in the Cal Turner Family Center at Meharry Medical College in Nashville, Tennessee on March 24, 2017.  The Tennessee CFAR hosted the workshop.

CFAR investigators and staff, along with public health workers and community representatives, collaboratively addressed the nature of the shifting HIV epidemic at the workshop. Discussions and panels identified shared resources and strategies to combat the epidemic, ways to engage the community and methods to influence public health policy to better serve people living with or at risk for HIV in the Southeast. Attendees had the opportunity to hear plenary speakers present on NIH priorities and initiatives relevant to HIV/AIDS in the South, necessary components for collaboration between health departments and CFARs, and use of molecular surveillance data to identify clusters of HIV infection.

The UNC CFAR was well-represented in panel discussions as leaders in the field: Erika Samoff  spoke on the panel “Working with Health Departments, including Rapid HIV Transmission Networks/Phylogenetics”,  Heidi Swygard spoke on the panel “PrEP Implementation, Linkage, Retention, and Rapid ART Initiation”, Bill Zule shared on the panel “HIV and the Opioid Epidemic”, and Caressa White led a discussion on “Effective Approaches to Community Engagement”. Following the panel discussions, attendees joined in conversation about priorities and action items for the future.

Workshop planners are now collecting information from participants in the Southeast CFAR Workshops (Atlanta 2016 and/or Nashville 2017) to assist all participating CFARs, justify supplemental funding for a potential third workshop, and maintain momentum for the organization. The work to address the epidemic in the Southeast is essential to the health of people in the region and to our nation’s long-term goal of ending the epidemic. – Caressa White, SCEED Office Director

UNC to Test Injectable Long-Acting Implant to Prevent HIV

Researchers at the University of North Carolina at Chapel Hill have received a three-year, $1.8 million grant from the National Institutes of Health to develop a new implantable drug delivery system for long-lasting HIV-prevention.

Scientists in the UNC School of Medicine’s Division of Infectious Diseases and the UNC Eshelman School of Pharmacy are developing an injectable drug delivery system that forms an implant that steadily releases anti-HIV medication over long periods of time.

The injectable formulation includes an anti-HIV drug, a polymer and a solvent. The three-compound liquid will solidify once injected under the skin. As the polymer slowly degrades, the drug is released. Efficacy of the new formulation to prevent HIV transmission will be evaluated using state of the art pre-clinical models developed at UNC.

Currently, a once-daily pill exists to prevent HIV infection. However, adherence to this daily regimen can be challenging for some people.

“This long-acting injectable formulation could provide a discrete and efficient method to protect against HIV infection and improve adherence, which is one of the major challenges of oral pre-exposure prophylaxis, or PrEP,” said Rahima Benhabbour, Ph.D., assistant professor in the UNC Eshelman School of Pharmacy and one of the study’s co-principal investigators. “The formulation is adaptable to a number of drugs alone or in combination and can be fine tuned to meet a targeted release regimen.”

Read more here..

PLOS Medicine Special Issue: Advances in HIV Prevention, Treatment and Cure

HIV-AIDS-education-690x320

The editors of PLOS Medicine are delighted to announce a forthcoming Special Issue focused on HIV research, along with guest editors Drs Linda-Gail Bekker, Steven Deeks and Sharon Lewin. Submissions are now being invited, with a deadline of June 9, 2017.

PLOS Medicine, the leading open access medical journal published by PLOS, welcomes submission of reports of high-quality research studies to be considered for publication in a special issue covering advances in the prevention, treatment and cure of HIV infection. This special issue, to be published at the end of 2017, will be guest edited by Dr Linda-Gail Bekker of the Desmond Tutu HIV Centre, University of Cape Town; Dr Steven Deeks of the University of California, San Francisco; and Dr Sharon Lewin of the Peter Doherty Institute of Infection and Immunity, University of Melbourne and Royal Melbourne Hospital. Alongside research papers, the special issue will include commissioned content contributed by leaders in the field.

HIV infection continues to pose a critical risk to health in many countries, with 2.1 million people (including 150,000 children) estimated by UNAIDS to have been newly infected in 2015. Due to intensive efforts to diagnose and treat people with HIV, 18.2 million people were receiving antiretroviral therapy according to the most recent estimates. However, given an estimated total HIV-infected population of 36.7 million at the end of 2015, a substantial treatment gap leaves many millions of people at risk of AIDS-related diseases and, if unaware of their status, likely to infect others.

For this issue, the editors are inviting reports of high-quality research studies with the potential to inform clinical practice or thinking, focused on:

  • State of the global HIV epidemic—large-scale epidemiological studies addressing important topics, including progress towards UNAIDS’ 90-90-90 targets and the status of key populations
  • HIV prevention—clinical research aimed at development of vaccines, drugs and biomedical approaches
  • Clinical and epidemiological studies seeking to characterize and improve management of HIV infection and co-morbidities
  • Scientifically rigorous and practically relevant implementation research studies focused on HIV prevention and treatment, especially in low- and middle-income countries
  • Towards a cure for HIV infection—translational and clinical studies aiming to achieve control or elimination of HIV

Please submit your manuscript at: http://journals.plos.org/plosmedicine/s/submit-now. The deadline is June 9th, 2017.

Presubmission inquiries are not required, but do indicate your interest in the special issue in your cover letter. Questions about the special issue can be directed to plosmedicine@plos.org.

Publication of HPTN 052 Final Results: HIV Treatment Offers Durable Prevention of HIV Transmission in Serodiscordant Couples

The HIV Prevention Trials Network (HPTN) announced that the final results of the HPTN 052 study were published in the New England Journal of Medicine (NEJM). This pivotal study demonstrated that antiretroviral therapy (ART) for HIV infection provides durable and reliable protection against the sexual transmission of the virus from infected men and women to their HIV-uninfected sexual partners.

The final results showed a 93 percent reduction of HIV transmission when the HIV-infected person started ART when their immune system was relatively healthy. HIV transmission from HIV-infected study participants to their partners was not observed when viral replication in the treated individual was stably suppressed by ART.

“The HPTN 052 study confirms the urgent need to treat people for HIV infection as soon as it is diagnosed to protect their health and for public health,” said Myron S. Cohen, M.D., principal investigator for HPTN 052 and director of the Institute for Global Health and Infectious Diseases at the University of North Carolina at Chapel Hill. “This study represents more than a decade of effort by a worldwide team of investigators, and the tremendous courage and generosity of more than 3,500 clinical trial participants.”

HPTN 052 began in 2005 and enrolled 1,763 HIV-serodiscordant couples – where one person was HIV infected and the other was not – at 13 sites in nine countries (Botswana, Brazil, India, Kenya, Malawi, South Africa, Thailand, the United States, and Zimbabwe). The majority of the couples were heterosexual (97 percent). HIV-infected participants were assigned at random to start ART at the beginning of the study when their immune system was relatively healthy (called the “early” arm), or later in the study when they had immune system decline (called the “delayed” arm).

In 2011, interim study results demonstrated significant benefit of early ART, with a 96 percent reduction in HIV transmission from early ART compared to delayed ART. This finding was reported based on the recommendation of the study’s data safety and monitoring board; presented at the 6th International AIDS Society (IAS) Conference on HIV Pathogenesis, Treatment and Prevention in Rome, Italy; and published in NEJM.

All HIV-infected participants in the study were then offered ART and the study was continued until May 2015 to understand the magnitude and durability of “treatment as prevention”; 87 percent of the HIV-infected participants remained in the study for its 10-year duration.

The HPTN 052 results have helped to galvanize a worldwide commitment to a universal “treatment as prevention” strategy for combatting the HIV/AIDS epidemic, with ART offered to all HIV-infected people, regardless of CD4 cell count.

About HPTN 052

HPTN 052 was a randomized, controlled trial designed to evaluate the effectiveness of antiretroviral therapy (ART) to prevent the sexual transmission of HIV in serodiscordant couples. The trial was conducted by the HIV Prevention Trials Network (HPTN) and funded by the U.S., National Institute of Allergy and Infectious Diseases (NIAID), part of the U.S. National Institutes of Health (NIH). Additional support was provided by the NIAID-funded AIDS Clinical Trials Group. The antiretroviral drugs used in the study were made available by Abbott Laboratories; Boehringer Ingelheim Pharmaceuticals, Inc.; Bristol-Myers Squibb; Gilead Sciences; GlaxoSmithKline; and Merck & Co., Inc.

2BeatHIV Educates Public About HIV

Our understanding of human immunodeficiency virus (HIV) has come a long way since it was first named in 1986. Yet little of this new information about the virus, which still infects 50,000 new people each year in the United States, seems to have made its way into the general public. A research project out of UNC called 2BeatHIV is trying to change that.

Infection with HIV, which causes acquired immunodeficiency syndrome (AIDS) over time, was once a death sentence. But thanks to three decades of intensive study by researchers all over the world, HIV/AIDS has become a manageable chronic infection. With proper treatment, HIV-positive individuals enjoy a near normal life expectancy and researchers are hopeful that an effective vaccine could be developed in the coming years.

But no one, it seems, has told the general public. Despite landmark study results about treatment as prevention being released in 2011 and 2015 by UNC researchers, 44 percent of Americans believe that anti-HIV medications do not prevent the spread of HIV. The survey, conducted by The Washington Post and Kaiser Family Foundation, also found that more than a third of respondents (34 percent) incorrectly thought HIV could be transmitted by sharing a drinking glass, touching a toilet seat or swimming in a pool with someone living with HIV.

This has obvious repercussions for people living with the virus and the stigma that continues to be associated with it. The goal of 2BeatHIV is to get the public informed about HIV and invested in finding a cure for the disease.

The project, which is nested within UNC’s searcHIV working group, is headed up by Allison Mathews, PhD, a post-doc with a dual appointment in both the Institute for Global Health & Infectious Diseases and the Department of Social Medicine.

Read more here…

 

UNC bioethicist addresses lack of HIV studies in pregnant women

UNC School of Medicine’s Anne Lyerly is addressing the urgent need for effective HIV prevention and treatment for the estimated 1.5 million women worldwide with HIV who give birth each year. With a $3 million NIH grant, Dr. Lyerly is leading an interdisciplinary team of researchers to determine what barriers prevent investigators from studying the virus in pregnant women.

Lyerly, associate director of the UNC Center for Bioethics and associate professor of social medicine at the UNC School of Medicine, is also an obstetrician/gynecologist who studies ethically complex clinical and policy issues related to women’s reproductive health.

In the August issue of the Journal of the International AIDS Society, Lyerly addresses the lack of research of HIV-positive pregnant women and pregnant women who are at risk of contracting HIV, which has “led to a dearth of evidence to guide safe and effective treatment and prevention of HIV in pregnancy,” Lyerly wrote.

In the research on the HIV-positive pregnant women that has been done, most outcomes focus entirely on the health of the fetus. Pregnant women are excluded from the vast majority of studies, including studies on how to best prevent HIV.

Read more here…

Early HIV Treatment Can Prevent Transmission to Uninfected Partners

cohenAntiretroviral therapy (ART) for HIV infection provides consistent protection against the sexual transmission of the HIV virus from infected men and women to their HIV-uninfected sexual partners.

These findings were announced on Monday, July 20 by researcher Dr. Myron Cohen at the 8th International AIDS Society (IAS) Conference on HIV Pathogenesis, Treatment & Prevention in Vancouver, Canada. Cohen, UNC’s chief of the Institute for Global Health & Infectious Diseases, has headed the HPTO 052 global research project for a decade and studied more than 1,700 couples.

HPTN 052 began in 2005 and enrolled 1,763 HIV sero-discordant couples – where one person is HIV-infected and the other is not – at 13 sites in nine countries. The majority of the couples were heterosexual (97 percent). HIV-infected partners were assigned to start ART at the beginning of the study, called the “early” arm, or later in the study, called the “delayed” arm. Those on the delayed arm started ART when their bodies’ immune systems were declining. HPTN 052 was funded primarily by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH).

The IAS 2015 Conference

The IAS 2015 Conference

“These findings demonstrate that antiretroviral therapy, when taken until viral suppression is achieved and sustained, is a highly effective, durable intervention for HIV prevention,” said Myron Cohen, Principal Investigator for HPTN 052. “The HPTN 052 trial was designed to address two questions: whether providing antiretroviral therapy to an HIV-infected person would prevent HIV transmission to a sexual partner, and whether earlier antiretroviral therapy offered long-lasting health benefits, and the answer to both is a
resounding yes.”

The significance of the research findings cannot be understated – when used consistently, medication can break the chain of HIV transmission and has the potential to eradicate the virus when all infected people die natural deaths. For the foreseeable future, however, such a medical strategy will disproportionately benefit industrialized countries whose residents have wider, though far from universal, access to modern health care.

Read the full article from the News and Observer Newspaper here.

Click here to see all the UNC IAS coverage.

2015 Conference on Retroviruses and Opportunistic Infections (CROI)

2015 Conference on Retroviruses and Opportunistic InfectionsCROI

February 23 to February 26, 2015
Washington State Convention Center
Seattle, Washington

The annual Conference on Retroviruses and Opportunistic Infections (CROI) brings together top basic, translational, and clinical researchers from around the world to share the latest studies, important developments, and best research methods in the ongoing battle against HIV/AIDS and related infectious diseases. CROI is a global model of collaborative science and the premier international venue for bridging basic and clinical investigation into clinical practice in the field of HIV and related viruses.

Abstract submission and registration dates can be found here.

Dr. Margolis Featured in New Yorker Article on HIV Cure

Dr David MargolisThe New Yorker recently featured the research of UNC School of Medicine researcher David Margolis, MD, in this article about the search for a cure to HIV infection.

Margolis, a professor of medicine, epidemiology, and microbiology and immunology, serves as director of the School of Medicine’s Program in Translational Clinical Research.

Dr. Margolis currently leads the largest collaboration of HIV researchers, working to force HIV out of “latency” so they can attempt to kill virus particles that typically lay dormant, hidden from therapies. Margolis was among the first researchers to explore methods to force HIV particles out of latency, which is considered a major obstacle to finding curative therapies.

Read the full story here.

UNC CFAR Investigators Featured at CROI 2015

CROI 2015Five abstracts from UNC CFAR have been accepted for presentation at the poster session at the Conference on Retroviruses and Opportunistic Infections (CROI) 2015, each of which were supported by the UNC CFAR’s Biostatistics Core. This annual collaborative science conference brings together top basic, translational, and clinical researchers from around the world to share the latest studies, important developments, and best research methods in the ongoing battle against HIV/AIDS and related infectious diseases. CROI 2015 will be held from February 23 to February 26, 2015, in Seattle, Washington, at the Washington State Convention Center. Congratulations to all our CFAR investigators for their hard work and dedication!

Poster presentations that will feature UNC CFAR investigators at the conference this year:

Davis N, Miller W, Hudgens M, Chasela C, Sichali D, Nelson J, Rigdon J, Ellington S, Kourtis A, and van der Horst C. ARV adherence associated with reduced breastmilk HIV viral load and HIV transmission. 22nd Conference on Retroviruses and Opportunistic Infections, Seattle, Washington, 2015.

Jensen K, Van Rompay K, Jacobs W, Fennelly G, Mollan K, Hudgens M, Piatak M, Larsen M, De Paris K. The potential of BCG and HIV-TB vaccines to exacerbate HIV-1 pathogenesis in infants. 22nd Conference on Retroviruses and Opportunistic Infections, Seattle, Washington, 2015.

Joseph S, Kincer L, Bowman N, Menezes P, Robertson K, Anderson A, Loring D, Eron J, Price R, Swanstrom R. HIV-1 Replication in the CNS is Associated With Increased Neurocognitive Impairment. 22nd Conference on Retroviruses and Opportunistic Infections, Seattle, Washington, 2015.

King C, Nelson J, Ziemniak C, Hudgens M, Tegha G, Chasela C, Jamieson D, Persaud D, van der Horst C, Kourtis A. Delayed HIV Detection in Infants Exposed to ARV Prophylaxis During Breastfeeding. 22nd Conference on Retroviruses and Opportunistic Infections, Seattle, Washington, 2015.

Nelson J, Fokar A, Hudgens M, Compliment K, Tegha G, Kamwendo D, Kourtis A, Jamieson D, van der Horst C, Fiscus S. NVP Resistance in Infants Infected by HIV-1 via Breastfeeding in the BAN Study. 22nd Conference on Retroviruses and Opportunistic Infections, Seattle, Washington, 2015.