Lauren Santye, Assistant Editor

indicated that an estimated 200,000 lives could be saved over the next 2 decades if the National HIV/AIDS Strategy targets are achieved.

are for 90% of HIV-positive individuals to know their diagnosis, and for 80% of those patients to achieve virologic suppression via antiretroviral therapy (ART) by 2020.

, Massachusetts General Hospital (MGH) analysts found that meeting the goals of NHAS would save more than 2 million years of life over the next 2 decades.

“If nearly everyone with HIV in the US were in care, on medication, and virally suppressed, we would stop the epidemic in its tracks,” said senior author Rochelle P. Walensky, MD, MPH, chief of the MGH Division of Infectious Diseases. “Achieving the NHAS goals would bring us one step closer to that goal.”

The NHAS was released in 2015 to better align US HIV/AIDS policies with the Joint United Nations Programme on HIV/AIDS

, which states that by 2020, 90% of all individuals living with HIV will know their status, 90% of HIV-positive individuals will receive sustained ART, and 90% of all individuals receiving ART will achieve viral suppression.

If the NHAS targets are met, 72% of HIV-positive individuals would successfully achieve virologic suppression compared with current estimates of 49%.

An estimated 1.1 million individuals in the United States are living with HIV, and 1 of every 7 are unaware of their status. According to the CDC, men who have sex with men (

) and bisexual men are most affected, particularly African Americans.

For the study, MGH investigators sought to identify the expected return on investment for the programs required to achieve NHAS goals, and to highlight the impact that failing to achieve the goals would have on illness and death. A separate analysis was conducted on the impact of NHAS among

The investigators used a mathematical model to assess the cost efficacy of HIV/AIDS prevention, and compared the forecasted results of continuing at the current pace of HIV diagnosis, linkage to and retention in treatment, and viral suppression to achieving NHAS goals. They projected both the clinical benefits and costs over a 20-year period.

The findings showed that if the United States remained at its current pace, then 750,000 deaths from HIV/AIDS would occur over 20 years. Contrastingly, if NHAS goals were achieved, it would reduce total deaths to 551,000, preventing approximately 200,000 deaths.

Among the black MSM patient population, achieving NHAS targets would reduce the number of deaths from 110,000 to 65,000.

“Achieving NHAS goals is entirely feasible,” said co-author Kenneth Freedberg, MD, MSc. “One of the biggest barriers is retaining patients in care, but our projections would be enough to reach these goals. This study is only the latest contribution to the large evidence base demonstrating conclusively that we have it in our clinical and economic power to bring the HIV/AIDS epidemic in the US to a halt. Now is the time to do so.”

Over the next 20 years, meeting NHAS targets would cost an estimated $645.7 billion compared with $525.3 billion under the current pace; however, the number of lives saved would result in a cost effectiveness ratio of $68,900 per quality-adjusted life year (QALY). According to the authors, this is well within the US cost effectiveness standard of 100,000/QALY.

Findings from the separate analysis of the black MSM population revealed that achieving the NHAS targets would produce a ratio of $38,300/QALY.

The authors noted that reducing the cost of ART could lead to even greater cost effectiveness because almost 75% of costs are attributable to ART.

“Achieving NHAS won’t be cheap, but it would be affordable and cost effective,” Freedberg said. “It would make good public health and economic sense to first focus NHAS implementation on black MSM, since they are at considerably higher risk than the general population. Overall, fully implementing NHAS could avert more than 200,000 deaths and prevent more than 250,000 HIV infections over the next 20 years.”

Articles

A study recently published in the Journal of Infectious Diseases indicated that an estimated 200,000 lives could be saved over the next 2 decades if the National HIV/AIDS Strategy targets are achieved. 

National HIV/AIDS Strategy Goals Could Save 200k Lives

The Zika virus could potentially be directed to kill brain cancer stem cells that are most resistant to treatment, according to findings of a study published recently in

is a mosquito-borne flavivrus transmitted primarily by

mosquitos, according to the World Health Organization. The virus is associated with Guillain-Barré syndrome and a cause of congenital brain abnormalities, including microcephaly.

In the study, researchers removed stem cells from patients diagnosed as having glioblastoma, and infected the tumors with 1 of 2 Zika virus strains.

The results of the study showed that after both strains infected the tumors, the virus killed the cancer stem cells and left other tumor cells alone.

“We showed that Zika virus can kill the kind of glioblastoma cells that tend to be resistant to current treatments and lead to death,” co-senior author Michael S. Diamond, MD, PhD said in a press release.

An estimated 12,000 individuals are diagnosed with gliobastoma

annually in the United States. Standard treatment involves surgery, followed by chemotherapy and radiation; however, most tumors recur within 6 months because a small population of glioblastoma stem cells often survive treatment and continue to divide.

The findings of the study suggest the Zika virus combined with chemotherapy-radiation have complementary effects. Standard treatment kills most of the tumors cells, whereas the Zika virus swoops in to attack the leftover stem cells.

“We see Zika one day being used in combination with current therapies to eradicate the whole tumor,” said co-senior author Milan G. Chheda, MD.

The investigators examined whether the virus could treat cancer in living animals. Zika virus or placebo were injected into the brain tumors of 18 and 15 mice, respectively. Mice treated with Zika had significantly smaller tumors 2 weeks after injection, and survived significantly longer compared with mice given the placebo, according to the study authors.

Additional studies of the virus were conducted using brain tissue from patients with epilepsy, which showed the virus did not infect noncancerous brain cells.

The investigators also introduced 2 mutations that suppressed the virus’ ability to combat the cell’s defenses against infection. The mutant viral strain and the original parental strain in glioblastoma stem cells were tested, revealing the original strain was more potent. However, the mutant strain was also able to successful kill the cancerous cells.

“We’re going to introduce additional mutations to sensitize the virus even more to the innate immune response and prevent the infection from spreading,” Diamond said. “Once we add a few more changes, I think it’s going to be impossible for the virus to overcome them and cause disease.”

1.  Zika Virus kills brain cancer stem cells [news release]. St Louis. Washington University School of Medicine in St. Louis. Sept. 5, 2017.

https://medicine.wustl.edu/news/zika-virus-kills-brain-cancer-stem-cells. Accessed Sept. 11, 2017.

This article originally appeared on Specialty Pharmacy Times.

Zika Virus to Treat Brain Cancer?

Home-based HIV test kits could be an effective strategy in curbing the epidemic by reaching individuals who have never been tested, new findings suggest.

Scientists from LSU Health New Orleans School of Public Health conducted a survey regarding respondents’ feelings towards a

There were 470 respondents surveyed as part of the New Orleans arm of the CDC National HIV Behavioral Surveillance of Heterosexuals at increased risk for HIV study in 2013.

The participants were required to be 18 years or older, reside in the New Orleans metropolitan area, able to take the survey in English, and have had sex with an individual of the opposite gender within the past 12 months.

The results of the analysis, published in the

, show that 85.56% of respondents would be willing to take a home-based test mailed by a research study or health department. Of those willing respondents, 54.19% reported they would return the results back to the provider.

Journal of Acquired Immune Deficiency Syndrome

Forty-three percent of participants reported they would prefer to only tell their physician, and 1.7% said they would not reveal the results to anyone.

“In 2014, 24% of new HIV infections were attributed to heterosexual activity,” said lead investigator William Robinson, PhD. “Yet many at-risk individuals do not test routinely or have never been tested.

“Our findings demonstrate that home-based testing could be an effective means to reach some heterosexuals who have never been tested.”

Limitations to the study were that the data were self-reported and the participants were recruited through respondent-drive sampling, according to the authors.

Although further research is needed to evaluate the epidemiologic context and the ethical and logistical considerations, the author concluded that their findings indicated that increased testing is a critical component of controlling the HIV epidemic.

Home-Based HIV Test Kit Could Improve Testing Rates

The University of Maryland School of Medicine has received a $2 million

to conduct a 5-year study that explores how HIV exposure affects the immune systems of infants in utero.

More than 13.8 million women of childbearing age are estimated to be living with HIV in sub-Saharan Africa, and each year, more than 1.5 million HIV-positive women give birth, according to a university press release. Furthermore, nearly 30% of all infants born in sub-Saharan Africa are exposed to HIV in utero, but are uninfected at birth.

Sub-Saharan women are routinely screened for HIV during their pre-natal visit, typically in the second or third trimester. If diagnosed, the patients receive antiretroviral treatment to get the virus under control.

Most infants prenatally exposed to HIV do not become infected due to ART, but they still have higher morbidity and mortality during the first 2 years of life because of common infections, according to the release.

Although, the precise mechanism of this increased susceptibility to infection remains unclear, scientists hope the study will provide one of the most in-depth immunological investigations to begin to understand why this occurs.

“Our long-term goal is to identify an approach for preventing

of HIV that also minimizes the impact of maternal infection on the immune development of infants exposed to HIV but not infected,” said principal investigators Cristiana Cairo, PhD, and Miriam K. Laufer, MD, MPH.

For the study, investigators will analyze the infants’ adaptive immune response with different HIV exposure in utero. They will compare infants born to HIV-infected mothers on ART prior to conception with mothers first diagnosed with HIV and treated during pregnancy to determine if there are any differences.

The first group of infants will be exposed to very low levels of HIV, whereas the second group will be exposed to high levels throughout most of the mother’s pregnancy.

“It is of critical importance to clearly understand the impact of maternal HIV infection on exposed uninfected infant immunity, in order to identify the right strategy to improve the health of HIV-exposed infants throughout the world,” Dr Cairo said.

The investigators hope the study leads to earlier HIV testing and related prenatal care.

“Early HIV testing in all women of child bearing age may have a significant impact on infant health and survival,” Dr Laufer said.

Researchers to Explore Impact of HIV on Infants In Utero

Interventions that promote healthier sexual behavior among black women and Latinas may help prevent HIV infection; especially interventions that address the broader social and structural contexts that nurture risk environments, according to a study.

Although HIV has the highest prevalence among black bisexual men and men who have sex with men, approximately 1 of 4 individuals living with HIV are women. Furthermore, significant racial disparities among women remain. In 2014, approximately 62% of all HIV diagnoses among women were in non-Hispanic black women and 17% in Latinas.

Several factors associated with HIV risk behavior are responsible for these

, including high-risk sexual networks, assortative partner selection practices, incarceration, low awareness of HIV status or partner’s status, low male-to-female sex ratios, poverty, low education levels, and lack of access to health care.

, investigators sought to examine HIV-related sexual risk behaviors among women by race/ethnicity.

“Sexual risk behaviors like inconsistent condom use, anal intercourse, and concurrent sex partnerships are associated with increased HIV transmission and prevalence among women,” the authors wrote. “[Furthermore,] being in a high-risk sexual network and engaging in assortative partner selection patterns coupled with low awareness of partners’ status increase the probability of encountering an HIV-infected partner and a higher risk of HIV acquisition even with less risky sexual behavior.”

The investigators used data from the National Survey of Family Growth (NSFG), an in-person health survey of the civilian, noninstitutionalized population of the United States. They examined HIV-related sexual risk behaviors among sexually active women, aged 18 to 44 years, from the 2006-2008, 2008-2010, and 2011-2013 cycles.

Weighted percentages and performed logistic regression were estimated to measure adjusted prevalence ratios and 95% confidence intervals for associations between selected behaviors and sociodemographic covariates, according to the report.

The total study sample was comprised of 13,588 sexually active women. Of whom, 1.1% reported concurrent opposite-sex partners, 10.3% reported male partners they perceived as being non-monogamous, and 21.1% reported using a condom at last vaginal or anal sex.

Compared with non-Hispanic white women, black women and Latinas were more likely to report condom use at either last vaginal or anal sex. Black women were also more likely to report concurrent opposite-sex partnerships and perceived non-monogamous sex partners compared with white women.

Limitations to the study included social desirability biases that may have affected responses to questions regarding concurrent sexual behaviors, perceptions about a partner’s non-monogamous sexual behaviors, and condom use; analyzed data from the NSFG were from 3 different time points and, therefore, did not account for data during the gaps; the analysis did not include adolescent women younger than 18 years nor women older than 44 years; respondents’ perceptions of their male partners’ non-monogamous sexual behaviors may be inaccurate and may cause under- or overestimation of male partner concurrency; the relatively small sample size used of other non-Hispanic women made it challenging to discuss them when compared with other subpopulations in the analysis; and other contraceptive use was not considered in the analysis, which may impact condom use for some women and should be a consideration in future studies.

“The relationships that we observed between demographic and HIV risk factors are important, and heightened efforts for disproportionately affected non-Hispanic black women are warranted as part of HIV prevention strategies,” the authors concluded. “Interventions that promote healthier sexual behaviors among women could help prevent

in this population. Moreover, prevention efforts that address the broader social and structural contexts that nurture risk environments might be especially beneficial for non-Hispanic black women and Latinas.

“Better access to culturally acceptable and affordable medical and social services may offer improved solutions for addressing HIV among women, especially in non-Hispanic black women and Latinas. Furthermore, and enhanced understanding of factors that promote women’s sexual risk behaviors, and development of interventions that improve protective behaviors, could help to further decrease HIV among US women.”

HIV-Related Gaps Among Women: Promoting Healthy Sexual Behavior Can Help Minimize these Disparities

The FDA today granted approval for Vosevi to treat adult patients with chronic hepatitis C virus (HCV) genotypes 1 to 6 without cirrhosis or mild cirrhosis.

Vosevi is a fixed-dose, combination tablet containing sofosbuvir and velpatasvir, as well as the new drug voxilaprevir, according to a press release.

The approval was based on safety and efficacy data of Vosevi in 2, phase 3 clinical trials that included approximately 750 adults with mild cirrhosis or without cirrhosis.

The first 12-week trial compared Vosevi with placebo in adults with HCV genotype 1 who previously failed treatment with an NS5A inhibitor. Patients with genotypes 2, 3, 4, 5, or 6 all received Vosevi, according to the release.

In the second trial, investigators examined Vosevi versus sofosbuvir and velpatasvir in adults with HCV genotypes 1, 2, or 3 who previously failed treatment with sofosbuvir, but not an NS5A inhibitor drug.

The results of both clinical trials showed that 96% to 97% of patients administered Vosevi had no viral detection 12 weeks after treatment, suggesting that the infection had been cured, according to the release.

The most common adverse events observed with Vosevi were headache, fatigue, diarrhea, and nausea.

“Direct-acting antiviral drugs prevent the virus from multiplying and often cure HCV,” Edward Cox, MD, director of the Office of Antimicrobial Products, FDA’s Center for Drug Evaluation and Research, said in the release. “Vosevi provides a treatment option for some patients who were not successfully treated with other HCV drugs in the past.”

Recommendations for Vosevi vary depending on a patient’s viral genotype and prior treatment history. Approximately 75% of Americans with HCV have genotype 1; 20% to 25% have genotypes 2 or 3, respectively; and a small proportion of patients have genotypes 4, 5, or 6.