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Phl now has 32 new HIV cases per day, up from 22 HIV cases per day in 2015

From January 1984 to October 2018, the Philippines already had a total of 60,207 HIV cases. It is worth noting that 9,605 of that figure was reported from January to October 2018 alone.

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October highlighted the continuing disturbing worsening HIV situation in the Philippines, with an estimated 32 new HIV cases now happening in the country every day. For October, there were 1,072 new HIV cases reported to the HIV/AIDS & ART Registry of the Philippines (HARP).

It was in September when this number (i.e. 32 new HIV cases per day) was first reported. Prior to that, the country “only” had 31 new HIV cases reported daily, though even this figure was already considered high compared to figures from past years. In 2009, the country only had two new HIV cases per day. By 2015, the number increased to 22; and in the early part of 2018, the number was 31.

From January 1984 (when the first HIV case was reported in the country) to October 2018 (when the latest figures were belatedly – as usual – released by the HARP), the Philippines already had a total of 60,207 HIV cases. It is worth noting that 9,605 of that figure was reported from January to October 2018 alone.

MALES IN FOCUS

Those newly infected continue to be male – in October, of the 1,072 newly infected, 1,016 (95%) were male. The median age was 28 years old (age range: 2 – 67 years old). Half of the cases (50%, 537) were 25-34 years old and 29% (306) were 15-24 years old at the time of testing.

GEOGRAPHICAL DISTRIBUTION

Based on where those who tested HIV-positive originated, one third (32%, 343) were from the National Capital Region (NCR). Region 4A (17%, 187 cases), Region 3 (11%, 121), Region 7 (8%, 82), and Region 6 (7%, 76), round off the top five regions with the most number of newly diagnosed cases for the month, together accounting for 75% of the total.

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Sexual contact remains the main mode of transmission (97%, 1,044). Among this, 86% were males who have sex with males (MSM). Other modes of transmission were needle sharing among injecting drug users (1%, 15) and vertical (formerly, mother-to-child) transmission (<1%, 2). There were 11 cases that had no data on mode of transmission.

Among the newly diagnosed females in October, eight were pregnant at the time of diagnosis. Five cases were from NCR and one case each from Regions 3, 4A and 7.

ACCESSING TREATMENT

In October, there were 831 patients who were initiated on antiretroviral therapy (ART). This is close to the figure registered in September, when 804 patients were initiated on ART. To date, a total of 32,324 people living with HIV (PLHIV) are on ART as of October; and this figure is still only a few thousand over the total number (60,207) of those who reported to have HIV in the country.

FOCUS ON THE YOUNG

Those getting infected continue to be also younger.

In October, 306 (29%) cases were among youth 15-24 years old; 94% were male. Almost all (98%, 300) were infected through sexual contact (31 male-female sex, 197 male-male sex, 72 sex with both males and females). There were six cases that had no data on mode of transmission.

There were also 41 newly diagnosed adolescents 10-19 years old in October. Almost all (95%) were infected through sexual contact (3 male-female sex, 31 male-male sex, and 5 had sex with both males and females); two had no data on mode of transmission. There were two newly diagnosed child less than 10 years old, and both were infected through mother-to-child transmission.

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OFWs IN FOCUS

Even among overseas Filipino workers who tested HIV-positive, more were infected from male-to-male sexual contact.

Eighty-one people who worked overseas within the past five years of diagnosis, whether on land or at sea, were diagnosed HIV-positive in October. They comprise 8% of the total newly diagnosed cases for the month. Among them, 89% (72) were male. Almost all were infected through sexual contact (27 male-female sex, 32 male-male sex, and 21 sex with both males and females). The ages of male OFWs ranged from 23 to 55 years (median: 32 years). More than half (57%) of the cases belonged to the 25-34 year age group. Among the female OFWs diagnosed in October 2018, four cases were from the age groups 25-34 and 35-49; and one case was from 50 years old & older age group. The age range among diagnosed female OFWs were 28 to 61 years (median: 35 years).

ENGAGEMENT IN TRANSACTIONAL SEX

In October 2018, 14% (147) of the newly diagnosed engaged in transactional sex. Ninety-five percent (140) were male and aged from 20 to 64 years old (median: 30 years). More than half of the males (57%, 80) reported paying for sex only, 31% (43) reported accepting payment for sex only and 12% (17) engaged in both. Among the female cases who engaged in transactional sex, majority (71%, 5) were reported accepting payment in exchange for sex and 29% (2) reported paying for sex only.

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Reporting on people who engage in transactional sex – or those who reported that they either pay for sex, regularly accept payment for sex, or do both – was only included in the HARP starting December 2012.

PREGNANT AND HIV-POZ

In October 2018, eight newly diagnosed cases were reported to be pregnant. Five were from NCR and one each from Regions 3, 4A and 7. The age of diagnosis ranged from 19 to 34 (median age: 23).

Reporting of pregnancy status at the time of testing was included in the HARP from the year 2011.

DEATHS AMONG PEOPLE WITH HIV

In October 2018, there were 30 reported deaths due to any cause among people with HIV. Ninety-seven percent (29) were males. One case (4%) was less than 15, four cases (13%) were 15-24, 12 cases (40%) were from 25-34, 10 cases (33%) were from 35-49, and three cases (10%) were 50 years and older age group. Almost all of the cases were reported to have acquired the infection through sexual contact (97%) (3 through male-female sex, 19 through male-male sex, and seven through sex with both males and females); while one case (3%) was infected through vertical transmission.

The 30 deaths are lower than the number reported in August, with reached 159 HIV-related deaths. But the figures are still believed to be be higher because of under- or non-reporting.

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Virus characteristics predict HIV treatment efficacy with antibody treatment

HIV-1 virus characteristics were identified to predict treatment efficacy with a specific antibody treatment using sequence-based methods. The identified virus characteristics may be used to determine if a patient is a good or poor candidate for specific antibody-based treatments in the future, reducing time and cost involved in treating the virus.

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Current HIV-1 therapies have been proven to be highly effective in slowing the progression of the virus in the body with only minimal side effects. The daily antiretroviral therapy (ART) uses a combination of HIV-1 medicines. A proportion of patients diagnosed with HIV-1, however, cannot take the ART for many reasons. An alternative option includes antibody-based treatments that are currently being developed; however it is difficult to predict those that would be most appropriate for these more expensive treatments.

Now published in the Journal of Virology, research at Boston Medical Center (BMC) discovered specific virus characteristics that can help predict the efficacy of HIV-1 treatments using antibody-based treatments.

Led by Manish Sagar, MD, an infectious diseases physician at BMC, HIV-1 virus characteristics were identified to predict treatment efficacy with a specific antibody treatment using sequence-based methods. The identified virus characteristics may be used to determine if a patient is a good or poor candidate for specific antibody-based treatments in the future, reducing time and cost involved in treating the virus.

Antibody treatments bind the HIV-1 envelope protein that protects the virus and helps it avoid the immune system response. These envelope proteins also have extensive DNA sequence variation that provides virus information and whether a treatment would be effective or not. It is difficult to predict if an antibody-based therapy will be effective based on knowing the envelope sequence alone, so sequence information is commonly obtained before patients are started on HIV-1 treatments to confirm that their virus will be susceptible to the prescribed therapies.

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In the study, HIV-1 envelope sequence motifs were identified that predict treatment efficacy with a certain type of antibody treatment.

“These findings will allow physicians to make better-informed decisions on treatment plans for patients with HIV-1, ultimately treating the virus to slow it down earlier, ” says Sagar, also an associate professor of medicine and microbiology at Boston University School of Medicine. “Making this process more efficient will only improve patient care, while reducing the time and money spent on finding the right treatment for these patients.”

Antibody-based therapies that require less frequent doping are effective against drug-resistant variants, and may strengthen humoral responses, essential for defense against bacterial pathogens.

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Determinants of employability of people living with HIV

We knew this all along: People living with HIV may face discrimination in employers’ hiring practices, according to a study that specifically found that medical and socioeconomic factors may hinder their employment.

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A newer study backing what we knew all along: HIV-related discrimination.

People living with HIV may face discrimination in employers’ hiring practices, according to a study published in the American Journal of Industrial Medicine, which specifically found that medical and socioeconomic factors may hinder their employment.

This particular study included 170 people living with HIV in Turkey. It found that younger persons with HIV had a much higher probability of participation in the labor force, as did those who were wealthier and generated a higher income. Also, individuals who were working at the time of diagnosis were more likely to be employed. Illicit drug use, a longer time since diagnosis, and low CD4 T cells counts were negatively associated with employment.

“We can easily control HIV virus with anti-retroviral medication, but it is almost impossible to control socioeconomic factors such as the stigma and the prejudices, which are fueled by ignorance and the lack of awareness campaigns,” said the study’s author Durmu Özdemir, PhD, a professor at Yasar University. “There is a serious role for governments and non-governmental organizations to explain the positive impact of anti-retroviral treatment and the need for a normal life for people living with HIV.”

Earlier, in 2014, the UNAIDS (Joint United Nations Programme on HIV/AIDS) reported that on average, one in eight PLHIV report being denied health services, and one in nine is denied employment because of their HIV-positive status. Also, an average of 6% reported experiencing physical assault because of their HIV status. People living with HIV who are members of key populations also face “double stigma” since they get discriminated not only because of their HIV status, but also because of their sexual orientation and gender identity, drug use or engagement in sex work.

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New HIV strain recorded under same group that caused pandemic

The discovery marks the first time a new subtype of HIV-1 has been identified since 2000. To stress, though: Existing treatments for HIV are effective against variants of the HIV virus, including the new subtype.

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A team of its scientists identified a new subtype of the human immunodeficiency virus (HIV), called HIV-1 Group M, subtype L. This marks the first time a new subtype of “Group M” HIV virus has been identified since guidelines for classifying new strains of HIV were established in 2000.

Group M viruses are responsible for the global pandemic, which can be traced back to the Democratic Republic of Congo (DRC) in Sub-Saharan Africa.

The findings of the study – titled “Complete genome sequence of CG-0018a-01 establishes HIV-1 subtype L” – was published in the Journal of Acquired Immune Deficiency Syndromes (JAIDS).

“In an increasingly connected world, we can no longer think of viruses being contained to one location,” said Carole McArthur, Ph.D., M.D., professor in the departments of oral and craniofacial sciences, University of Missouri — Kansas City, and one of the study’s authors. “This discovery reminds us that to end the HIV pandemic, we must continue to outthink this continuously changing virus and use the latest advancements in technology and resources to monitor its evolution.”

Since the beginning of the global AIDS pandemic, 75 million people have been infected with HIV and 37.9 million people today are living with the virus.

To determine if a virus is in fact a new HIV subtype, three cases must be discovered independently. In this case, the first two samples of this subtype were discovered in DRC in the 1980s and the 1990s. The third, collected in 2001, was difficult to sequence at that time because of the amount of virus in the sample and the existing technology.

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With next-generation sequencing technology now available, researchers can build an entire genome at higher speeds and lower costs. In order to utilize this technology, Abbott scientists had to develop and apply new techniques to help narrow in on the virus portion of the sample to fully sequence and complete the genome.

“Identifying new viruses such as this one is like searching for a needle in a haystack,” said Mary Rodgers, Ph.D., a principal scientist and head of the Global Viral Surveillance Program, Diagnostics, Abbott, and also a co-author of the study. “By advancing our techniques and using next generation sequencing technology, we are pulling the needle out with a magnet. This scientific discovery can help us ensure we are stopping new pandemics in their tracks.”

Now this is worth stressing: Existing treatments for HIV that can suppress viral load so that people living with HIV can no longer transmit it, are effective against variants of the HIV virus, including the new subtype. This means – again to emphasize – that a new strain is not a new public health crisis. With the identification of the strain, though, doctors can now test for it.

Abbott created its Global Viral Surveillance Program 25 years ago to monitor HIV and hepatitis viruses and identify mutations to ensure the company’s diagnostic tests remain up to date. In partnership with blood centers, hospitals and academic institutions around the world, Abbott has collected more than 78,000 samples containing HIV and hepatitis viruses from 45 countries, identified and characterized more than 5,000 strains, and published 125 research papers to date to help the scientific community learn more about these viruses. 

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12% of new HIV cases in Phl in July are people who engaged in transactional sex

In total, in July, there were 1,111 newly confirmed HIV-positive individuals reported to the HIV/AIDS & ART Registry of the Philippines. This was 29% higher compared with the diagnosed cases (859) in the same period last year.

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Twelve percent (134 of 1,111) of the new HIV cases reported to the HIV/AIDS & ART Registry of the Philippines (HARP) in July engaged in transactional sex, highlighting the behavior as a driver in the still-continuing worsening HIV situation in the country.

The percentage of the newly infected who engaged in transactional sex is similar to June’s figures (also 12%, or 123 of 1,006). Even earlier, in May, it was higher at 13% (or 144 of 1,092).

For July, 94% (126) of those who engaged in transactional sex were male and aged from 15 to 58 years old (median: 29 years). Forty-eight percent (61) of the males reported paying for sex only, 37% (46) reported accepting payment for sex only, and 15% (19) engaged in both.

Also, among the eight female cases who engaged in transactional sex, 88% (7) were reported to have accepted payment for sex only; while one female reported paying and accepting payment for sex.

Surprisingly, reporting of transactional sex was included in the HARP only in December 2012. HARP identifies people who engage in transactional sex as those who reported that they either pay for sex, regularly accept payment for sex, or do both.

This is not the only population gravely affected by HIV in the Philippines.

For one, the number of diagnosed HIV infections among females has been increasing. The number of diagnosed (402) females from January to July 2019 tripled, compared to the diagnosed (131) cases in the same period of 2014, five years prior. Ninety-two percent (4,012) of all female cases since 1984 were in the reproductive age group (15-49 years old) at the time of diagnosis.

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As FYI: In the early years of the HIV epidemic in the Philippines (1984-1990), 62% (133 of 216 cases) of the diagnosed were female. But since 1991, the proportion of diagnosed males has been greater than that of females each year. From 1991 to present, males comprised 94% (65,079) of the 69,296 diagnosed cases. Also,from January 2018 to July 2019, 3% (551) of 17,909 diagnosed people are transgender women.

Second, HIV continues to greatly impact young Filipinos.

As per HARP: “The predominant age group among those diagnosed has shifted to 25-34 years old starting 2006 from 35-49 years old in 2001 to 2005.” But “the proportion of HIV positive cases in the 15-24 year age group nearly doubled in the past 10 years, from 17% in 2000 to 2009 to 29% in 2010 to 2019.”

In July, there were 59 newly diagnosed adolescents, 10-19 years old at the time of diagnosis. Further, one case was 10-14 years old, 15 cases were 15-17 years old, and 43 cases were 18-19 years old. All were infected through sexual contact (eight male-female sex, 37 male-male sex, and 14 had sex with both males and females).

There were two diagnosed cases less than 10 years old and both were infected through vertical (nee mother-to-child) transmission.

Also in July, 348 (31%) cases were among youth 15-24 years old; 95% were male. All were infected through sexual contact (34 male-female sex, 233 male-male sex, 81 sex with both males and females).

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Third, 82 Filipinos who worked overseas within the past five years, whether on land or at sea, were diagnosed in July. They comprised 7% of the total newly diagnosed cases for the month. Of these, 90% (74) were male. All were infected through sexual contact (15 male-female sex, 39 male-male sex, and 28 sex with both males and females).

Fourth, in July, 10 pregnant women were diagnosed with HIV. Six cases were from NCR and one case each from Regions 1, 4A, 7 and 11. The age of diagnosis ranged from 16 to 39.

Reporting of pregnancy status at the time of testing was also only added recently, from the year 2011. And since 2011, a total of 333 diagnosed pregnant women were reported. More than half (54%, 180) were 15-24 years old at the time of diagnosis, and 38% (127) were 25-34 years old.

HIV can be managed via taking of antiretroviral medicines. But to date, only approximately half of the total 69,512 Filipinos living with HIV are on ART.

So perhaps not surprisingly, in July2019, there were 55 reported deaths due to any cause among people with HIV. Ninety-eight percent (54) were males. Two (4%) were less than 15 years old at the time of death, six (11%) cases were 15-24 years old, 30 (54%) were 25-34 years old, and 17 (31%) were 35-49 years old. Ninety-two percent of these cases were reported to have acquired the infection through sexual contact.

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Severe anti-LGBT legislations associated with lower testing and awareness of HIV

A meta-analysis involving 44,993 men who have sex with men finds that anti-LGBT legislation is associated with lower HIV testing and awareness.

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A meta-analysis involving 44,993 men who have sex with men finds that anti-LGBT legislation is associated with lower HIV testing and awareness.

This first systematic review to investigate HIV testing, treatment and viral suppression in men who have sex with men in Africa finds that among the most recent studies (conducted after 2011) only half of men have been tested for HIV in the past 12 months. In addition, only a quarter of men living with HIV were on antiretroviral therapy or virally suppressed.

The analysis, published in The Lancet HIV journal, found that testing for HIV was higher where there was more protective and progressive legislation and fewer or no LGBT-related arrests.

Although rates of testing are substantially higher than before 2011, they are not sufficient to achieve the targets set by the UN (to have 90% of people living with HIV aware of their status, 90% of those aware also on antiretroviral therapy, and 90% of these achieving viral suppression by 2020). The findings support previous country-level studies suggesting an association between anti-LGBT legislation and access to testing and treatment.

Globally, men who have sex with men are about 28 times more likely to be living with HIV than are men in the general population, and this is particularly apparent in sub-Saharan Africa where human rights of these men are often violated. Anti-LGBT discrimination creates barriers to implementing effective HIV research, policy and health programs along with disruption of services provided by community and non-governmental organizations.

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Professor Marie-Claude Boily of Imperial College London, UK says: “Nearly one million people living with HIV still die annually because they cannot or do not get tested and engage in treatment. Our results suggest that despite improvements in recent years in Africa, engagement in HIV testing and treatment among men who have sex with men is still low, and additional efforts are urgently needed. With an estimated 67% of men who have sex with men in Africa surveyed after 2011 having ever tested for HIV, we are still a long way off achieving the UNAIDS 90-90-90 targets.”

The review used 75 independent studies conducted between 2004 and 2017 from 28 African countries to estimate HIV testing, status awareness, engagement in care, antiretroviral therapy use, and viral suppression in the men.

Over all studies conducted after 2011, the estimated proportion of participants ever tested for HIV was 67%, which was 1.3 times higher than before 2011, and was highest in southern Africa (80%) and lowest in northern Africa (34 %). In comparison, the proportion of men tested in the last 12 months was 50% in studies after 2011, which was 1.6 times higher than before 2011, and again was highest in southern but lowest in eastern Africa (67% vs 40%).

The proportion of men who have sex with men who are HIV positive and aware of their status was much lower at just 19%, and was particularly low in eastern Africa even after 2011 (9%). Overall, less than 24% of men living with HIV were currently on antiretroviral therapy, and an estimated 25% of men living with HIV were currently virally suppressed. It was not possible to look at changes over time as there was not enough data in the studies on these outcomes.

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Levels of HIV testing ever, in the past 12 months, and HIV status awareness were lower in countries with the most severe anti-LGBT legislation, compared with countries with the least severe legislation. Men were more likely to have ever been tested for HIV in countries with more protective and progressive legislation and no LGBT-related arrests from 2014-17.

The authors note some limitations, including that there were no studies in 26 African countries, including 13 countries where same-sex relations are illegal, so the new findings may not apply to the entire African continent and results may be worse in countries with more severe anti-LGBT legislation. Despite a substantial increase in the number of studies on testing for HIV, treatment and viral suppression, data remains scarce for all outcomes except HIV testing, especially from central and northern Africa. This means the study may underestimate or overestimate engagement, especially for antiretroviral therapy use and viral suppression. The authors note that this reflects the challenges of doing research among key populations that face substantial stigma.

The anti-LGBT legislation index used in the study only includes information about legislation, not how it is implemented so may not have captured the full picture. Because most of the studies included were self-reported and used non-confidential interview methods, underreporting and reporting biases are possible.

In a linked Comment article, Dr Jean Joel Bigna of the Centre Pasteur of Cameroon, Yaoundé, Cameroon, says: “Stannah and colleagues have provided important updates on the current situation regarding the HIV care cascade among men who have sex with men in Africa, and highlight areas where urgent action is needed. Governments in Africa should develop comprehensive programs and holistic interventions to provide care, support, and preventive services for this hard-to-reach stigmatized and discriminated vulnerable population. Community mobilization, health-care worker education to decrease stigma and discrimination and engagement remain crucial to end the HIV/AIDS pandemic both globally and at its epicenter in Africa. Human rights are universal and sexual orientation is no grounds for exclusion.”

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HIV-negative babies of women with HIV may have compromised health

A study found that maternal HIV infection leaves “profound and lasting impacts” on the HIV-exposed uninfected (HEU) infant. These impacts include: increased mortality and morbidity, immunological changes, and developmental delays compared to their HIV-unexposed (HU) counterparts.

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A study found a link between prenatal HIV exposure and decreased infant immunity despite HIV-negative status at birth.

Analysis of the TCR Repertoire in HIV-Exposed but Uninfected Infants” was written by Benjamin Gabriel, Carey Medin, Jeremiah Alves, Ruth Nduati, Rose Kerubo Bosire, Dalton Wamalwa, Carey Farquhar, Grace John-Stewart and Barbara L. Lohman-Payne, and appeared in Scientific Reports.

The study found that maternal HIV infection leaves “profound and lasting impacts” on the HIV-exposed uninfected (HEU) infant. These impacts include: increased mortality and morbidity, immunological changes, and developmental delays compared to their HIV-unexposed (HU) counterparts.

Exposure to HIV or antiretroviral therapy may influence immune development, which could increase morbidity and mortality. But a direct link between the increased mortality and morbidity and the infant’s immune system has not been identified.

And so to arrive at their conclusions, the researchers compared the T-cell receptor beta-chain repertoire of cord blood samples of HEU yet uninfected infants to samples collected from mother-child pairs unaffected by HIV, but who were living in the same communities.

The researchers found that while the TRB repertoire of HU infants was broadly diverse, in line with the expected idea of a naïve T cell repertoire, samples of HEU infants showed a significantly reduced TRB diversity.

Simply put, “despite the success of antiretroviral therapies in helping to suppress the risk of HIV being passed from mother to child, globally, HIV-exposed uninfected infants are a vulnerable population characterized by increased morbidity and mortality, higher rates of hospitalizations and childhood infections with more severe outcomes.”

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More than anything, the findings of the study emphasizes the need for special care and attention to this group.

Support for this work came from the National Institute of General Medical Sciences of the National Institutes of Health (NIH).

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