#IAS2015 Day 3 Recap

Yesterday was a big day for AIDS Vancouver at #IAS2015. Get the full recap below.

Undetected HIV Under ART. What Does it mean and how can we measure HIV persistence.

Keynote Speaker: David Margolis, Katherine Luzuriaga, Timothy Schacker, Lars Ostegaard
Represented Organizations: University of Montreal, University of North Carolina

With regards to ART, it is very important to have medication compliance to keep the viral load at lower levels. Viral reservoirs may keep feeding the body with new and possibly mutated HIV copies into the bloodstream.

Key Points

  • Mother to child transmission initiated early ART to help lessen HIV reservoirs under 6 weeks of age.
  • Reservoirs replenishment is a topic of investigation in order to try for HIV remission or eradication.
  • Major reservoirs looked at are the gut, the lymph nodes, brain and the blood systems.
  • There needs to be a more standardized testing method to find latent reservoirs.

Prospective Questions

  • Are there any researchers injecting anti-retroviral medication directly into viral reservoirs, for example lymph nodes?

Gender Matters: When, Why and How

Keynote Speaker: Sarah Kagan, Carol Camlin, Anne Schely, Matthew Golden, Jennifer Mark, Christopher Pina
Represented Organizations: University of San Fran, Bill and Melinda Gates Foundation

In general the session illustrates the differences in gender for accessing resources and willingness to test. It was noted, that males have a bias towards testing which is prevalent throughout developing countries. In general males feel they would prefer to self-test rather than testing at clinics. Also men generally felt that outreach programs, clinics and mobile testing were geared towards a women friendly service.

Key Points

  • Men are less likely to test and more likely to report
  • Women living in communities where there was less stigma were more likely to get tested.
  • 5% decrease in community stigma lead to 15% increase in women testing.
  • Testing is still something entrenched with social norms.
  • Mobile testing reduces but does not eliminate barriers in the test and treat efforts.
  • Mothers are more likely to test infants where the partners HIV status was known.
  • Mozambique pilot project- assisted partner services had community health workers offer support to tested partners. APS significantly improved HIV testing when HIV testing was requested.
  • Kenya: male partner acceptance of home based Syphilis and HIV testing (88-94%) acceptance when offered to couples during pregnancy.
  • Mumbai, India: HIV positive MSM and TGW adherence and treatment uptake needs more support interventions for adherence.

Prospective Questions

  • What is motivating the movement of male socio norms and biases to get tested?

Minor Issues, Major Consequences: Ensuring Adolescents’ Access to proven prevention methods

Keynote Speaker: Linda Gail Becket, Cybil Holbek, Leda Rosenburg, Katherin Burye
Represented Organizations: MTN, ATN, IPM, AVAC

Several preventative studies presented involved minor adolescent population of men who have sex with men and girls who have penile-vaginal intercourse. Adolescents at risk need access to new prevention technologies and trails involving consent of minors still an issue.

Key Points

  • Youth face more barriers to accessing services and have less knowledge about STI and HIV transmission.
  • Epidemic in which 2.1 million adolescents between the ages of 10-19 years old are living with HIV, 2/3 of which are girls.
  • Worries that regarding adolescents as minors who cannot consent would leave out high risk groups, which was addressed by removing the need for parental consent in the ATN 115 study on MSM aged 15-17.
  • New trials are being run in the United States on vaginal silicone ring containing dapivirin on adolescent girls.
  • However there are concerns by some bodies of governments over the studies promoting sex and it is more difficult to enroll girls.

Prospective Questions

  • It seems to be easier to enrol MSM in treatment as prevention studies than adolescents girls: how can we create successful social media campaigns geared towards adolescent girls?

Using Mobile Technology to support HIV Prevention, Care and Research

Keynote Speaker: Richard Lester, Lawrence Mbuagbaw
Represented Organizations: Weltel

In general the session reiterates the use of mobile technology in accessing HIV resources. It approached whether or not technology was an accessible, affordable, scalable and acceptable form of HIV treatment adherence. Overall systematic review found that SMS specific interventions were useful in adherence to treatment and follow up for clinic visits and outcomes (such as viral suppressions). For example what seemed to be most effective were weekly, interactive, personalized messages, while confidentiality, automation of service and health care involvement were key to success.

Key Points

  • mHealth is mobile health service considering medicine and public health technologies.
  • Can be used as care/reminder/ motivation and outreach.
  • Pilot studies are suggested to determine whether or not technology works in real life settings.
  • SMS technologies seem to be cost effective, example on average it takes $4 per year per patient.
  • Outcome of trials and studies are dependent on socio-economic climate in middle income countries.
  • These technologies can be incorporated to other health condition such a long term chronic illness because the hypothesis is that HIV long term survivors are susceptible to non-communicable disease.
  • The flip side: several countries who used strategies that were not personalized resulted in less adherence.

Prospective Questions

  • Is the technology able to reach those who are highest risk for HIV transmission?

Treatment as Prevention: Just do it!

Keynote Speaker: Myron Cohen, Susan Eshleman, Vasarhely, Collins Iwuji, Barnabas
Represented Organizations: University of North Carolina

A key piece from the session was that viral suppression works with ART. Also early introduction of ART to HIV positive individuals yields a better long term results. The former echoes the “Early Detection, Early Response” vibrant campaign in British Columbia. Even though ART’s is an efficient form of treatment, certain segments of at risk populations such as female sex workers are not only at risk for HIV transmission but also show lack of access to ART.

Key Points

  • HPTN 052 conclusions of ART in HIV preventions is durable and feasible.
  • Treatment as prevention for partner infections.
  • Viral level suppression and cascade of care in south Africa.
  • Benefit of increasing ART coverage in female sex workers (study done in Panama).
  • Community based HIV testing and linkage effectively delivers combination HIV presentation results.

Prospective Questions

  • 90-90-90 is the new goal that will be facilitated by the cascade of care model. How can we engage governments to support the former goal?

PrEP: Demonstration for Implementation

Keynote Speaker: Robert Grant, Albert Liu, Faith Henderson, Sysil Hosek, Beatriz G
Represented Organizations: Gladstone Institute, San Francis Department of Public Health, Columbia University

There are several studies were on young people and adherence levels. Those who choose to not use condoms and have sex showed a higher rate of PrEP adherence. Also, the cascade of care model is shown to be important and supportive for PrEP maintenance and to increase adherence.

Key Points

  • Even through there is a high prevalence rate of STI’s there is a low HIV seroconversion rate with the use of Prep.
  • Adherence rates stay high for PrEP, even with STI infections.
  • Key populations are MSM and transgendered women.
  • Condomless sex partners all had higher levels of tenofovir.
  • Race and ethnicity still make a difference with access to healthcare.

Prospective Questions

  • Will PrEP be funded by the BC government for key populations (MSM, transgendered women, and sex workers)?
  • PrEP reduction studies show a marked decrease in HIV transmission.

Survival of the fittest: HIV Evolution and Adaptation

Keynote Speaker: Jeffrey Joy, Katja Klein, Natalie Kinloch, Rik G, Rami Thomas
Represented Organizations: BCCDC, SFU, University of Western Ontario, US Military HIV Research Program, KU Leuven University

This seminar’s aim is to show less the clinical aspect of HIV, but rather the evolution of the virus and how that could impact treatment. They found that by mapping the virus phylogeny researchers could hypothesize that those individuals who were treated, the virus showed to have less diversification i.e. less variability between ancestral and current viruses. Also, when analyzing the evolutionary process one begins to broach the subject of resistance .Thus far, Dolutegravir (a particular HIV medication) seems to be immune to resistance. The former is the only ART that is not associated with resistant mutations in treatment naive individuals.

Key Points

  • Phylodynamics means how epidemiological and immunological processes act to shape viral phylogenies, shows epidemic dynamics.
  • Hypothesis of the mapping the phylogeny of the HIV virus is that treated HIV lineages will show a slower diversification rates.
  • Quantifying where or not treatment is a success has remained a challenge.
  • Diversification rate: rate of splitting of the branches on a phylogenetic tree.
  • Treated HIV linages on a phylogenetic tree showed less branching, which means slower diversification rates.
  • Treated infection have a signification less transmission rate.
  • Independent confirmation that treatment significantly reduced HIV transmission regardless of kind of treatment and populations.

Prospective Questions

  • Does diversification rates show any relationship with infection rates?
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