HIV and AIDS: The Highs and Lows of 2018

The Good.

Break-through for Karposi Sarcoma Sufferers
A small but exciting study published in Cancer Immunology Research found that two-thirds of HIV-positive participants with Karposi sarcoma who were treated with immunotherapy experienced partial or complete remission.  Although it is rare, KS can persist or develop in those taking antiretroviral therapy. In fact, all nine men in the study were on ART and seven had undetectable viral loads. The usual treatment for KS, chemotherapy, can cause immune suppression and involves troubling side effects. One person saw a complete remission of his KS, with partial remission observed in five other participants, and three remaining stable.

New Hope for Those with Drug Resistance
This year saw the approval of one new HIV drug, and phase three results on a second, for those who struggle with multidrug resistance. Ibalizumab (brand name Trogarzo) by Theratechnologies is the first drug in the new class called monoclonal antibodies. Designed specifically for those who are suffering through multidrug resistance, it’s a long-acting injectable given every two weeks. ViiV Healthcare’s new drug fostemsavir, an attachment inhibitor, is still in the pipeline but showing success with people facing extensive drug resistance, as well.

Switching While Undetectable Gets Easier
Studies show it’s safe to switch meds even while undetectable, and two newly approved HIV drugs provide good options for those who hope to reduce side effects or the number of medicines they take. ViiV Healthcare’s Juluca is the first two-drug regimen on the market and first not to include a nucleoside reverse transcriptase inhibitor (NRTI). Juluca combines the integrase strand transfer inhibitor dolutegravir and the non-nucleoside reverse transcriptase inhibitor rilpivirine. Gilead’s Biktarvy is also a single-table regimen combining the novel, unboosted integrase strand transfer inhibitor (INSTI) bictegravir, with Descovy (FTC/TAF), two nucleoside reverse transcriptase inhibitors (NRTIs). Biktarvy is approved for both those new to treatment and those who are undetectable and looking to replace their current antiretroviral regimen.

DNA Sequencing Reveals Networks
DNA sequencing is helping researchers identify HIV clusters, transmission networks, and hotspots. Some findings this year: Transgender women in Los Angeles are more likely than any other risk group to be in genetically-connected clusters — probably due to a shared pool of sexual partners. A University of Edinburgh analysis of 14,405 people living with HIV in the U.K. discovered something similar about men who have sex with men but don’t identify as gay or bisexual. They’re passing HIV to each other, but not to gay men or straight women. A new study of clusters found HIV rates particularly high among young, queer Latino men.

Addiction Drugs Lower Viral loads
The drug methadone, used to help addicts break chemical dependency also helps lower their viral loads. Earlier this year, the Journal of Acquired Immune Deficiency Syndromes found that poz people taking extended-release naxeltrone, a drug that treats alcohol use disorder, were more likely to maintain or reduce their viral loads as well.

The Bad.

Fatty Liver Disease Common
At the 9th International Workshop on HIV and Aging, researchers revealed 39 percent of poz people 50 or older and 49 percent of those under 50 have hepatic steatosis (aka fatty liver disease). Those aged 50-plus with the comorbidity were more likely to be women (43 percent versus 29 percent), have hep C, and be long-term survivors who had been on antiretroviral medications for more than a decade. The researchers noted that obesity is also a major factor.

Kidney Disease Rates Rising For 60+ Poz Folks?
At the International AIDS Conference, U.K. researchers revealed that diagnoses of kidney disease and osteopenia or osteoporosis rose for HIV-positive people aged 60 and older at one London clinic. Between 2010 and 2017, the proportion of 60 and older poz folks also more than doubled. Researchers found as of 2017, 99.7 percent of the clinic’s over-60 clients were on ART, and 95.3 percent were virally suppressed. But, they were also increasingly likely to have multiple comorbidities, be on numerous (non-antiretroviral) medications, and have stage-three kidney disease — the latter was particularly common among those who had taken the HIV drug tenofovir disoproxil fumarate.

All Kick No Kill
HIV is able to lie dormant in hidden reservoirs where it avoids detection and treatment but can quickly rebound if someone goes off antiretrovirals. For years we’ve been hearing about kick-and-kill, a strategy meant to prime the body’s immune system, then kick the latent HIV awake for the immune system to eliminate. This strategy is an essential component of many in-development HIV vaccines and functional cures. So it was extremely disappointing when researchers announced at the International AIDS Conference that kick-and-kill had failed to eliminate latent reservoirs better than standard antiretroviral therapy. According to the National AIDS Treatment Advocacy Project, this “underlines the difficulty of reactivating latent virus and killing it with ART or — in this case — with an immune system trained by a double-barreled prime-boost HIV vaccine.”

ASS is Here to Stay
AIDS Survivor’s Syndrome isn’t going away. According to the organization KickASS at this year’s United States Conference on AIDS, nearly 50 percent of poz men experience mental health issues. KickASS says a survey reveals 35 percent of long-term male survivors “still grieve” and 7 percent “still deeply grieve.” A U.K. study of 6,000 people found those living with HIV are three to seven times more likely to suffer from depression and anxiety vs. those without HIV. The rates increase with age and the length of time someone has been living with HIV. A study in AIDS Care earlier this year found that nonprofessional caregivers of poz folks who can no longer care for themselves also struggle with mental health, with 46 percent of caretakers experiencing depression and 27 percent anxiety.

International Efforts to End AIDS Fall Behind
For years, falling HIV rates have made it seem like AIDS could really be eradicated by 2020, but the IAC revealed that goal is fading fast. Last year, the world saw 1.8 million new HIV cases, a far cry from the 500,000 global new diagnoses UNAIDS once hoped we’d reach by 2020. Instead, UNAIDS reports we’re seeing spikes in new HIV diagnoses among key demographics, including drug users in eastern Europe and adolescent girls in sub-Saharan Africa. A recent report by the Bill and Melinda Gates Foundation fears Zimbabwe, where new HIV diagnoses are down by 49 percent since 2010, could see a reversal because 61 percent of Zimbabweans are under 25 years old, and just “entering the age when they are most at risk for infection.” At this critical moment, the Institute for Health Metrics and Evaluation reports funding for the global fight to end HIV dropped $3 billion between 2012 and 2017.