The first week of March I attended CROI in Boston with about 4,000 others from around the world. Here is first article of my annual AIDS update from the Conference on Retroviruses and Opportunistic Infections.
Undetectable = Untransmissible (Uninfectious) was a big theme in the conference. The US and the rest of the world are pushing those taking meds to have an undetectable viral load (defined as <200). This will stop HIV from finding new people to infect.
2 POUNDS OF BACTERIA
It is estimated that people carry around with them about 2 pounds of bacteria. They are present wherever there is an opening to the air: mouth, gut, nose, penis, vagina, skin… When the natural balance is changed by antibiotics, then disease-causing bacteria can take over. This has been found in the vagina: if there is a mild infection, then HIV is transmitted more easily. That’s a problem: infection and it’s treatment can help HIV transmission. Those who have vaginal sex with her are also can receive HIV more easily. The PrEP gel of tenofovir or the dapivirine cervical ring changes the vaginal flora so they are exploring that in more depth. No data was presented on the gel for anal sex. Stay tuned.
MONEY FOR KEEPING HEALTHY?
Some studies use money as an incentive to do the right thing. There have been studies where they gave money to HIV patients if they took the medicine and it brought their virus down to minimal levels. This one study showed that those who were paid and those who weren’t kept their virus down the same; the money didn’t make a difference. More studies need to be done to show this is true. Keeping the virus down to a minimum helps the patient live longer and U=U, they can’t transmit the virus! On the other hand I see people who don’t have good skills or commitment that maybe a little money would push them to do better.
HEPATITIS C IS TRANSMITTED TO FETUSES AT A RATE OF 15%
It is best if the mother has her Hepatitis C treated and cured before pregnancy but the meds are low risk during pregnancy too. Like in HIV you have to wait for the mother’s antibodies to fade away so you are really checking the baby’s antibodies to Hepatitis C at 2-6 months. If the baby is positive, then you must wait 3 years to see if the baby will clear the virus on its own without treatment. In adults we wait ~6 months.
HIV replication without treatment is about 10 billion viruses a day but Hepatitis C produces 100 times more per day which is equal to a trillion. Does that motivate you to get treated? I should hope so!
Is happening more and more as being overweight and obese is getting very common these last few years. Tests should be done to see how close one is to cirrhosis and needing a transplant. I am thinking of telling these patients that this is as serious as cancer since a great number go on to cirrhosis and death unless a transplant is done.
SAN FRANCISCO RAPID HIV TEST TO VIRUS SUPPRESSION INITIATIVE
In 2015 San Francisco initiated the RAPID project where there was more outreach for testing and if positive, the patient was brought in to start treatment that day. They dropped the time from diagnosis to care from 8 to 5 days, from care to treatment from 27 to 1 day, and from starting medication to viral suppression from 70 to 38 days. This is amazing and has resulted in far fewer new infections in San Francisco since the level of virus in the city has gone down with this project. I have been pushing for this to happen in the Inland Empire and through the efforts of many it is beginning. If everyone with HIV has suppressed virus through medication, then there would be no new HIV cases. In fact, in SF, New York, and Cape Town the number of new infections has dropped dramatically over the last couple of years due to these projects.
HOME BASED TESTING CAN GET MORE ON MEDS, QUICKER
If someone had a positive home (mailed) HIV test in Switzerland, they called the hotline and got connected quickly to a provider who prescribed antivirals. This is also a great way to treat very early.
HIV ATTACKS TEEN BRAINS
Adolescents (through age 24) have still to develop their frontal and temporal lobes and that is where HIV attacks, changing who they will become. Their brains are only 80% developed by age 24. Treatment with antivirals does show some recovery; the earlier the better to limit the damage, so get tested regularly.
Meningitis by Cryptococcus can cause permanent brain damage. It can cause seizures and a severe headache when it hits. By checking a blood test in those who seem weak enough to get it and treating when positive, meningitis can be prevented. This is a big deal in the US but more so in Africa. I’ve seen multiple people die of this in Malawi and a few here in the US.
Daniel Pearce, D.O., FACOI, AAHIVMS
Clinical Associate Professor of Medicine, Loma Linda University School of Medicine Adjunct Professor of Internal Medicine and HIV, Touro University California College of Osteopathic Medicine and Midwestern University Arizona College of Osteopathic Medicine HIV Specialist, Borrego Health (Riverside, San Bernardino, San Jacinto) Member, Coachella Valley Clinical Research Initiative.