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@Mike_Fozz: ‘Having HIV isn’t the end; fight on’

Meet HIV-positive @Mike_Fozz, who says that the best lesson others like him can learn is to fight on. “This is not the end. There are so many living proofs that there’s life after HIV,” he said. “Love yourself, and believe me… you’ll be okay; we will be okay.”

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IMAGE BY EFES; USED HERE FOR ILLUSTRATION PURPOSE ONLY (PHOTO FROM PIXABAY.COM)

This is part of “More than a Number”, which Outrage Magazine launched on March 1, 2013 to give a human face to those infected and affected by the Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) in the Philippines, what it considers as “an attempt to tell the stories of those whose lives have been touched by HIV and AIDS”. More information about (or – for that matter – to be included in) “More than a Number”, email editor@outragemag.com; or call (+63) 9287854244,  (+63) 9157972229 and (+632) 536-7886.

By Stephen Christian Quilacio

On December 1, 2013, @Mike_Fozz decided to take the HIV test, just as the world observed the annual World Aids Day, by going to the now closed RITM satellite clinic in Malate, Manila.

“I always had myself tested even before (that),” he recalled, “and I (was) very confident with my HIV-negative status.”

But he recalled prior to getting tested that day that – in the third week of November 2012 – “I met someone and we engaged into a ‘No Strings Attached’/‘Friends with Benefits’ relationship. He’s guwapo, borta, makinis (handsome, muscular and had clear complexion) and looked perfectly fine and healthy. You wouldn’t think that he has (HIV). Every time we see each other, siyempre hindi nawawala ang (of course we always had) sex. And tried both protected and unprotected sex. We ended our NSA relationship in February of 2013.”

In the summer of 2013, “I started to have rashes on my skin. I thought it was just bungang araw (prickly heat) because of the very hot weather. But after a few days it turned out to be a chicken pox; I was so worried because it was my first time to have it.”

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While he was getting treatment, @Mike_Fozz said he read every info about chicken pox. And then he came across one that stated that one of the causes of having chicken pox is a “weak immune system”.

“That was the time I started reading articles about HIV,” he recalled.

It also got him so scared that he stopped having sex from May to November of 2013.

Instead, because he said he already felt something happening in his body, he became a voracious reader on everything related to HIV. He planned to get tested, and “I needed to prepare myself for the result, whatever it may be.”

When his reactive result was given him, “nalungkot ako (I was sad), of course,” @Mike_Fozz recalled. “But life must go on.”

That very day, @Mike_Fozz said his way of looking changed. “I promised myself to be more positive in every aspect of life. Whatever negative thing is happening, as much as possible, I try to turn the situation into something positive.”

This is why “I became closer to my family,” he said. Also, “I became more focused on everything that I do. I also quit smoking; don’t party as often; and everyday, I make sure that I get eight hours or more of sleep. In short, I became more disciplined.”

@Mike_Fozz’s CD4 count was 403 when he was diagnosed to be HIV-positive, so he chose not to start his antiretroviral therapy immediately. But in June 2014, when his CD4 count went down to 356, he started his taking his ARVs immediately. With his regimen (Lamivudize, Zidovudine and Efaverinz; LZE), “thankfully, I did not experience any side effects,” he said. He was able to raise his CD4 count again, and he now has undetectable viral load.

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“You just need to be committed,” he said. “Never skip and religiously take your meds and you’ll be fine.”

For @Mike_Fozz, the biggest challenge an HIV-positive person can experience is still “discrimination from our society,” he said. And so “I try to teach and educate (people) sa abot ng makakaya ko (to the extent of my capabilities). I tell them that today, PLHIVs can actually live normal lives; that you cannot get it by shaking hands hugging, kissing, and so on.”

He is glad, of course, that there are other PLHIVs who helped him go through life; on top of “the strength I get from my family”.

@Mike_Fozz actually had a chance to confront the person he suspected to have infected him. Right after his tests in RITM (his treatment hub), he created a faux Facebook account and looked for his ex-sexual partner. When he found him, he started chatting with the guy; but this time, he was upfront with him, asking him “saan ang treatment hub mo (where is your treatment hub)?”

The guy allegedly said “RITM”, and that he knew of his status since 2008, thereby confirming @Mike_Fozz’s suspicion.

And so he came out to the guy.

That guy was apologetic, claiming that he had undetectable viral load, so he didn’t know how he could have infected @Mike_Fozz.

Everything at that point became “he said, he said”, and “me, who committed to continue with my journey and just go on with my life, decided to just forgive him. Inisip ko na lang na hindi naman ako gagaling na kahit saktan or ipakulong ko pa siya (I thought that I won’t be cured if I hurt him or have him jailed).”

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As an HIV-positive person, the best lesson @Mike_Fozz can teach others who are also HIV-positive is to fight on. “This is not the end. There are so many living proofs that there’s life after HIV,” he said. “Just learn to live a balanced life, live healthy, take your meds on time, listen to your doctor, love yourself, and believe me… you’ll be okay; we will be okay.”

And for HIV-negative people out there?

“Please stay negative,” @Mike_Fozz said. “Huwag makipagsapalaran sa isang gabing sarap (Don’t play with your life for fun for just one night). Think before you fuck!” (with Michael David C. Tan)

Follow @Mike_Fozz on Twitter.

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Holes in the immune system left unrepaired despite HIV drug therapy

A study showed that ART leaves unrepaired holes in the immune system’s wall of defence. This suggests that some of these long-lasting defects may contribute to the lack of viral control once the antiretroviral therapy is interrupted.

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Photo by Drew Hays from Unsplash.com

If they don’t receive antiretroviral therapy (ART), most HIV patients see a progressive weakening of their immune system. But a very small percentage of patients–0.3%–spontaneously control the virus themselves, without ART. Could an explanation lay partly in the sets of genes expressed by scarce white blood cells that recognize HIV? Yes, according to a study published in Nature Immunology and conducted by researchers at the University of Montreal Hospital Research Centre (CRCHUM).

Critical for the coordination of immune responses, CD4 T cells are important white blood cells (lymphocytes) that help control chronic infections like HIV. But on average only about one cell in 1,000 in the CD4 T cell population can recognize the virus.

“With my research team and my collaborators, we comprehensively determined the entire set of genes expressed by these rare cells from the blood of people chronically infected with HIV in whom the virus was abundant prior to ART,” said Daniel Kaufmann, a CRCHUM researcher and an infectious disease specialist. “We then compared it to the cells of HIV controllers, infected people who control the virus in the absence of therapy. This type of powerful approach, also called genome-wide transcriptional profiling, measures the activity of thousands of genes at once, thus creating a global picture of cellular function.”

Using sophisticated cell analysis techniques, lead author Antigoni Morou, a postdoctoral fellow in Kaufmann’s lab, identified major functional differences between the two groups of patients in the study. The HIV controllers had much more robust immune responses, known as Th17 and Th22, which are important for the defense of the gastrointestinal tract, for example. But chronically infected patients with high levels of viral replication showed dysregulated CD4 T cells targeting HIV, and some of their cell subsets showed signs of abnormal functioning.

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Continuing their investigation, the CRCHUM scientists wondered whether ART leads to an immune response akin to the one found in HIV controllers. “We followed up chronically infected patients after control of the virus by ART and checked if the treatment can ‘repair their immune system’ and allow them to have CD4 T cells with features similar to those of the HIV controllers,” said Kaufmann, a professor at Université de Montréal.

The result was double-edged: some gene modules were sensitive to ART, while others turned out to be expressed very differently than in HIV controllers.

“We showed that ART leaves unrepaired holes in the immune system’s wall of defence,” said Kaufmann. “Our results suggest that some of these long-lasting defects may contribute to the lack of viral control once the antiretroviral therapy is interrupted. We now know which holes linger in the immune system. Do we have to fill them in, and if so, how? This is another science question.”

Paving the way to new therapies that could complement ART, Kaufmann’s team identified important features of an effective HIV specific immune response compared to a dysfunctional one and showed how the response can be affected by ART.

The next step will be to study the underlying programming of these CD4 T cells (epigenetics) in the hope of developing new targeted strategies to reverse immune dysfunction and complement ART. Kaufmann’s lab is now using the same approach to evaluate candidates for an HIV vaccine.

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In 2017, nearly 37 million people were living with HIV. Every day, 5,000 new infections are reported to health authorities around the world.

“Altered differentiation is central to HIV-specific CD4+ T cell dysfunction in progressive disease” by Antigoni Morou et al. was published July 15, 2019 in Nature Immunology. The research was funded by the US National Institutes of Health; the Canadian Institutes of Health Research; the AIDS and Infectious Diseases Network of the Fonds de Recherche du Québec-Santé; and a Canada Foundation for Innovation Program Leader grant.

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For children born with HIV, adhering to medication gets harder with age

Researchers found that from preadolescence to young adulthood, the prevalence of non-adherence increased from 31% to 50%. In addition, the prevalence of detectable viral load among the same age groups increased from 16% to 40%.

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Paolo (not his real name), now nine years old, doesn’t know he has HIV.

Ang alam niya lang, kailangan niya uminom ng gamot gabi-gabi (He just knows he has to drink his meds every night),” his aunt, Virginia, said. “‘Di niya alam para saan ‘yun; basta gamot lang na kailangan niya (He doesn’t even know what they’re for; just that they’re meds that he needs).”

Paolo calls Virginia “mama”, but his biological mother – Virginia’s younger sister Vicky* – already passed away over eight years ago. And when his biological mother died, Vicky’s child Paolo was given to Virginia, the ate (elder sister).

And now that Paolo is growing up, this – the taking of medicines – continues to be an issue that Virginia said is one of those that “we continue to face.”

Apparently, though, this issue is not exactly surprising.

A new study in the US found that children born with HIV were “less likely to adhere to their medications as they aged from preadolescence to adolescence and into young adulthood.” The study – led by researchers at Harvard T.H. Chan School of Public Health – found that additionally, the prevalence of detectable viral load – an indication that the virus is not being managed by medications and a factor that’s often associated with non-adherence – also increased with age.

The study is one of the first to examine why different age groups stop adhering to treatment (non-adherence). While the factors related to non-adherence varied by age group, youth who were concerned about side effects of the drugs were less likely to be adherent at most ages.

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“As they approach adulthood, many youth face challenges, such as entering new relationships, managing disclosure of their HIV status, and changing to an adult HIV care provider. Ensuring successful HIV medication adherence before and throughout adolescence is critical,” said lead author Deborah Kacanek, research scientist in Harvard Chan School’s Department of Biostatistics. “We found that the factors that either supported adherence and a suppressed (undetectable) viral load, or made it harder for youth to adhere to treatment, varied depending on their age.”

The study was published in AIDS.

This study is worth highlighting in the Philippines because HIV continues to also affect younger Filipinos.

In April 2019, there were 38 newly diagnosed adolescents 10-19 years old at the time of diagnosis. Further, two cases were 17 years old and 36 cases were 18-19 years old. Almost all (95%) were infected through sexual contact (six male-female sex, 19 male-male sex, and 11 had sex with both males and females), one was infected through sharing of needles and one had no data on mode of transmission. In addition, there were three diagnosed cases less than 10 years old and all were infected through vertical (formerly mother-to-child) transmission.

Globally, 1.8 million adolescents live with HIV; and adhering to regimens of antiretroviral therapy (ART) is key to managing the disease and reducing the risk of transmission. And yet “sticking to a daily regimen of medicine, however, is especially challenging for adolescents and young adults, who are navigating a range of physical, cognitive, social and emotional changes.

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“Adherence can be more complicated for youth growing up with perinatal HIV, whose lifelong experiences with HIV, stigma, and multiple antiretroviral medications may pose challenges to achieving viral suppression that are different from youth who acquire HIV later in life.”

To better understand these challenges and why young people may not adhere to their medications, the researchers followed 381 youth with perinatally acquired HIV for an average of 3.3 years. The youth were participants in the Pediatric HIV/AIDS Cohort Study, which follows children and youth born with HIV or born exposed at birth to HIV to determine the impact of lifelong HIV and the long-term safety of antiretroviral regimens.

The preadolescents, adolescents and young adults in the study ranged from age 8 to 22 and were recruited from 15 different clinical sites in the US, including Puerto Rico. As part of the study, the researchers examined results from blood tests that measured viral loads, and they examined nearly 1,200 adherence evaluations in which study participants or their caregivers self-reported any missed doses of medication in the prior seven days.

The researchers found that from preadolescence to young adulthood, the prevalence of non-adherence increased from 31% to 50%. In addition, the prevalence of detectable viral load among the same age groups increased from 16% to 40%.

For each age group, different factors were associated with nonadherence. For example, during middle adolescence (15-17 years old), alcohol use, having an unmarried caregiver, indirect exposure to violence, stigma, and stressful life events were all associated with nonadherence.

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“It is important to talk with youth about how to take medications properly, but our study highlights the need for those who care for these youths to focus also on age-related factors that may influence adherence,” Kacanek said. “Services to help support adherence need to address both the age-related risks and build on the sources of strength and resilience among youth at different stages of development.”

Other Harvard Chan School researchers who contributed to the study include Claire Berman, Yanling Huo, and Katherine Tassiopoulos.

Back in the Philippines, Virginia said that “mabuti ngang may gamot na (si Paolo)… pero marami pa ring isyu na di nasasagot, di nagagawan ng paraan (it’s good Paolo’s already taking antiretroviral medicine… but there are still numerous unanswered/unresolved issues).”

And with dealing with children living with HIV, this still continues to be the case…

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Antiretroviral agent such as rilpivirine could improve pre-exposure prophylaxis

In an ex vivo model of HIV PrEP using tissue samples in the laboratory, the drug was associated with significant inhibition of HIV replication in rectal tissue, which persisted for up to four months after the last dose of rilpivirine. The drug was not, however, associated with viral suppression in cervicovaginal tissue.

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A long-acting antiretroviral agent such as rilpivirine could further improve pre-exposure prophylaxis (PrEP), already shown to be safe and effective at preventing AIDS in high risk populations, as it could overcome problems with poor medication adherence.

This is according to a new study examining the safety, acceptability, and effectiveness of multiple doses of injected rilpivirine, published in AIDS Research and Human Retroviruses, a peer-reviewed journal from Mary Ann Liebert, Inc., publishers.

The article entitled “A Multiple Dose Phase 1 Assessment of Rilpivirine Long Acting in a Model of Preexposure Prophylaxis Against HIV” was coauthored by Ian McGowan, Orion Biotechnology (Ottawa, Canada) and an international team of researchers from University of Pittsburgh (PA), Magee Women Research Institute (Pittsburgh, PA), Alpha StatConsult (Damascus, MD), University of Liverpool (U.K.), University of Pittsburgh Graduate School of Public Health, Janssen Research and Development (Beerse, Belgium), The Translational Science Corp. (Los Angeles, CA), and University of Miami, Miller School of Medicine (Miami, FL).

In this phase 1 study, women and men received three intramuscular doses of rilpivirine eight weeks apart. The injections were shown to be safe and well tolerated, with injection site pain being the most common adverse effect. In an ex vivo model of HIV PrEP using tissue samples in the laboratory, the drug was associated with significant inhibition of HIV replication in rectal tissue, which persisted for up to four months after the last dose of rilpivirine. The drug was not, however, associated with viral suppression in cervicovaginal tissue.

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Thomas Hope, PhD, Editor-in-Chief of AIDS Research and Human Retroviruses and Professor of Cell and Molecular Biology at Northwestern University, Feinberg School of Medicine, Chicago, IL states: “There is currently a significant effort to develop long-acting formulations of drugs that prevent HIV replication and can be utilized to prevent HIV acquisition (PrEP). PrEP works if properly taken. Long-acting formulations can eliminate problems when high risk individuals forget to take their pills every day. The development of successful long-acting PrEP formulations will decrease new HIV infections by providing improved protection from HIV acquisition by eliminating problems for individuals who don’t like pills or can’t remember to take their pill every day.”

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PLHIV who have compassionate care providers start, remain in treatment longer

Rutgers researchers find patients who perceive their primary care providers as lacking empathy and not willing to include them in decision making are at risk for abandoning treatment or not seeking treatment at all.

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Photo used for illustration purpose only. Photo by Vittore Buzzi from Unsplash.com.

Adults with HIV are more likely to continue life-saving treatments if their primary health care providers show respect, unconditional empathy without judgement and demonstrate an ability to partner with patients in decision making to address their goals, a Rutgers study finds.

The systematic review appears in the Joanna Briggs Institute Database of Systematic Reviews and Implementation Reports.

The findings showed that the complexity of the illness, treatment regimen and overall healthcare system frequently overwhelms the patient and fear of stigma often prevents them from beginning or continuing treatment. The researchers found that patients need help in understanding their illness and care needs using understandable language to translate complex information, letting patients know what to expect and reinforcing that HIV is now a treatable, yet complex, chronic illness.

“Today, HIV is considered a chronic, treatable condition. However, this study found that many patients continue to view it as a death sentence,” said lead author Andrea Norberg, executive director of the François-Xavier Bagnoud Center at Rutgers School of Nursing, which provides care for people with HIV, infectious diseases and immunologic disorders. “We know that people who are knowledgeable about HIV, who are engaged in care and taking antiretroviral therapy medications remain relatively healthy. Our challenge is to reach those people diagnosed with HIV and who are not retained or engaged in ongoing care. In the United States, this is approximately 49 percent of the 1.1 million people diagnosed.”

The researchers included 41 studies published between 1997 to 2017. The sample populations included adults with HIV and their healthcare providers. All adults with HIV were between the ages of 18 and 65, represented diverse races and ethnicities, sexual orientations and gender identities. Healthcare providers included physicians, nurse practitioners, physician assistants, pharmacists, social workers and others. The included studies had 1,597 participants.

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They found that many patients experience stigma and a lack of compassion that is often grounded in primary care providers’ ignorance about HIV and transmission risks. The resulting poor communication between providers and patients results in many patients’ failure to seek or remain in care and adhere to antiretroviral therapy medications.

Patients reported feeling “grilled” by providers who often assumed they were not taking medications. Norberg suggested providers would be more successful in getting information from patients by allowing them to be honest, inquiring about their health goals and telling them how other patients have managed treatment.

Conversely, the researchers found that patients were more inclined to adhere to HIV treatment when their primary care providers showed empathy, true listening, trust, consideration of the whole person and involvement in decision making. However, many patients reported that healthcare providers viewed care only as “prescribing antiretroviral therapy medicine.”

“Providers should use common language, not medical jargon, to educate patients about HIV, medications and how they can live a healthy life,” Norberg said. “They should thoroughly teach them about the disease, the medications and side effects, and the meaning of the tests.”

The researchers noted that providers who help patients navigate the health system, offer one-stop location of services and provide connections to psychological support, health insurance, medicine, transportation and other services, can help their patients stay engaged in care.

Primary healthcare providers can enroll in professional education to improve their knowledge about HIV, use of motivational interviewing skills and seek opportunities for experiential learning, observation and hands-on practice working directly with patients with HIV, Norberg said.

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Other Rutgers authors included John Nelson, Cheryl Holly, Sarah T. Jewell and Susan Salmond.

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Persistent HIV DNA in spinal fluid may be associated with cognitive challenges

Individuals who harbored HIV DNA in the cerebrospinal fluid were more likely than other study participants to experience cognitive deficits on neurocognitive testing.

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Photo by Emiliano Vittoriosi from Unsplash.com

A study found that HIV DNA remained in the cerebrospinal fluid of half of participants with well-managed HIV (virologic suppression in the plasma), confirming that the central nervous system (CNS) is a major reservoir for latent HIV. Individuals who harbored HIV DNA in the cerebrospinal fluid were more likely than other study participants to experience cognitive deficits on neurocognitive testing.

This was disclosed by investigators from the AIDS Clinical Trials Group (ACTG), the world’s largest and longest-established HIV research network, as announced in the Journal of Clinical Investigation from the ACTG HIV Reservoirs Cohort Study (A5321).

“The persistence of HIV in sanctuary sites in the human body, even in the presence of long-term therapy, is a challenge to HIV remission and cure that the ACTG is actively working to address,” said ACTG Chair Judith Currier, M.D., MSc, University of California Los Angeles. “Because neurocognitive function can be compromised even in individuals whose HIV is well treated, it is very important that we understand HIV persistence in the CNS so that we can develop strategies to treat it. This study provides preliminary insights into these challenges.”

This substudy in the ACTG HIV Reservoirs Cohort Study (A5321) was led by Serena Spudich, M.D., Yale University, the late Kevin Robertson, Ph.D., University of North Carolina at Chapel Hill, and John Mellors, M.D., University of Pittsburgh.

The study included 69 participants with well-treated HIV who had their cerebrospinal fluid and blood collected and underwent neurocognitive assessments, which included tests of memory, learning, motor function, and more.

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Participants were mostly male (97 percent) and had been on HIV treatment for a median of almost nine years, with a good response to medications (HIV viral loads in the plasma were all <100 copies/mL and median CD4 counts were in the normal range).

Using highly sensitive methods to detect HIV, researchers found that almost half of these participants harbored viral DNA in cells found in the cerebrospinal fluid. Of those, 30 percent met the criteria for cognitive impairment.

While the study established an association between HIV DNA in cerebrospinal fluid with poorer performance on cognitive tests, researchers stressed that it did not establish a causal relationship, noting that there could be several explanations for the findings. Further studies will help determine strategies to reverse this persistence and improve neurological functioning in individuals with long-standing HIV.

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New studies, WHO guidance clarify way forward for use of dolutegravir in women of childbearing age

Additional research from Botswana has found that the risk of NTDs is less than was signalled last year. To help clinicians and health ministries act on these findings, WHO issued updated recommendations on antiretroviral therapy and DTG use.

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Photo by pina messina from Unsplash.com

The safety of the HIV treatment drug, dolutegravir (DTG), during pregnancy has been one of the most urgent questions in global health for the past year.

At the 22nd International AIDS Conference (AIDS 2018) last year, data from the Tsepamo study in Botswana suggested that the use of DTG in early pregnancy may be linked to neural tube defects (NTDs), serious birth defects of the brain and spine.

As a result, some countries have paused their plans to make DTG-based regimens their preferred first-line therapy and the World Health Organization (WHO) issued a note of caution about the use of DTG by women of childbearing age as part of its interim guidelines recommending DTG as the preferred first- and second-line antiretroviral therapy for people living with HIV.

At the 10th IAS Conference on HIV Science (IAS 2019), additional research from Botswana has found that the risk of NTDs is less than was signalled last year. To help clinicians and health ministries act on these findings, WHO issued updated recommendations on antiretroviral therapy and DTG use.

To inform these recommendations, a number of community and scientific forums were held to discuss the issue directly with women of reproductive age who have the least access to obtaining DTG. 

“Community engagement, including input from women living with HIV, has played a key role in updating these recommendations and will be critical to rolling them out,” Jacque Wambui, African Community Advisory Board (AFROCAB) member, Kenya, said.

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“Ultimately, what is most important is offering women the choice to make informed decisions,” Anton Pozniak, International AIDS Society President and IAS 2019 International Scientific Chair, said.

WHO updated these recommendations based on new evidence.

Botswana’s Tsepamo study analysed more than 119,000 deliveries from August 2014 to April 2019, including nearly 1,700 among women who were taking DTG-based therapy around conception. With more data, the researchers have found the risk in the prevalence of NTDs among women taking DTG is less than originally signalled. Specifically, NTDs occurred in three per 1,000 deliveries among women on DTG from conception – compared with one per 1,000 deliveries among women taking other ARV regimens.

A second analysis from Botswana analysed health facilities that were not included in the Tsepamo study. Examining data from 22 facilities from October 2018 to March 2019, researchers confirmed one case of NTDs in pregnancies of 152 mothers who had been taking DTG-based therapy at conception. By comparison, two cases of NTDs occurred among pregnancies of more than 2,300 HIV-negative mothers.

Meanwhile, a surveillance-based analysis from Brazil included 1,468 women who became pregnant while taking antiretroviral therapy – 382 of whom were taking DTG at conception. In this case, no cases of NTDs were seen. This evidence backs up the overall conclusion that even if DTG-based therapy is associated with an elevated risk of NTDs, the risk remains quite low.

To help put these findings in context and to provide urgently needed guidance, WHO issued updated recommendations on antiretroviral treatment. These guidelines reconfirm the recommendation to use DTG-containing regimens as the preferred option for first-line and second-line antiretroviral treatment (ART) across all populations.

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The guidelines development group also emphasized the need for ongoing monitoring of the risk of NTDs and the importance of supporting women’s autonomy in decision making and informed choice. 

“There is still a risk that we and countries need to monitor closely, but at this point, dolutegravir should be accessible for women of childbearing age due to the overwhelming benefits it offers,” Meg Doherty, Coordinator of Treatment and Care in the Department of HIV/Hepatitis and STIs at WHO, said. “What treatment options to pursue is a decision that a woman should make in consultation with her healthcare provider.”

Ambassador Deborah L. Birx, U.S. Global AIDS Coordinator and U.S Special Representative for Global Health Diplomacy, commented that the President’s Emergency Plan for AIDS Relief (PEPFAR) was committed to supporting countries in their continued transition to DTG. “DTG offers many benefits, including that it is better tolerated by the patient, leads to improved outcomes, such as faster viral suppression, and often costs less,” she said. “It is clear that transitioning to DTG will accelerate our progress toward controlling the HIV epidemic.”

Earlier this month, Pozniak, Doherty and Wambui alongside several other coauthors, released a commentary entitled “Optimizing responses to drug safety signals in pregnancy: the example of dolutegravir and neural tube defects.” Published in the Journal of the International AIDS Society (JIAS), the piece provided additional context before the new data shared at IAS 2019 became available.

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