{"id":8270,"date":"2017-01-01T14:49:10","date_gmt":"2017-01-01T19:49:10","guid":{"rendered":"http:\/\/blogs.nejm.org\/hiv-id-observations\/?p=8270"},"modified":"2017-01-01T14:49:10","modified_gmt":"2017-01-01T19:49:10","slug":"top-five-hiv-stories-2016","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/top-five-hiv-stories-2016\/2017\/01\/01\/","title":{"rendered":"Top Stories in HIV Medicine for 2016"},"content":{"rendered":"

\"new-year\"<\/a>A lot of these “Best of …” or “Top Stories in …” lists have already been published, as they seem to be appearing\u00a0earlier and earlier each year. Pretty soon we’ll start reading them around the same time they sell Halloween Candy — and that’s just too early, sorry.<\/p>\n

Now this<\/em>\u00a0list, however, appears just as\u00a02016 is in the books, all 365 days accounted for and scrupulously reviewed. And I chose five because, well, five follows the rules.<\/em><\/a><\/p>\n

(I just finished a block on service and can’t resist linking that post, since the rules came up literally every day.)<\/p>\n

Of course by choosing only 5, I’ve necessarily had to leave off\u00a0some big HIV stories this year in research, clinical care, or policy, so feel free to enter your top story in the comments section.<\/p>\n

Drum roll, please.<\/p>\n

Number 5. \u00a0TAF\/FTC Approved.<\/strong><\/p>\n

With approval this year of co-formulated TAF\/FTC,<\/a> we now have the ideal NRTI pair to use in treatment of, well, pretty much\u00a0everyone. Yes, we already had TAF\/FTC as part of the single tablet treatments of TAF\/FTC\/RPV and TAF\/FTC\/EVG\/c, but those aren’t appropriate for all patients — both must be taken with food, RPV has high viral load and low CD4 restrictions, and EVG\/c has a long list of drug interactions. The availability of TAF\/FTC\u00a0provides greater flexibility when, for example, you want to use it with a different 3rd drug — dolutegravir, or raltegravir, or yes\u00a0even efavirenz — or as part of a more complex salvage regimen, where it’s generally given with\u00a0DRV\/r.<\/p>\n

Number 4. HIV cure research inches forward.<\/strong><\/p>\n

Admittedly, we’re still stuck on 1 person cured — the famous Timothy Ray Brown, he of the CCR5-negative\u00a0stem cell transplant<\/a> (and cute dog<\/a>).\u00a0But that “n of 1” has led to\u00a0extensive pre-clinical and clinical research on HIV cure, with lots of very smart people working on the\u00a0problem. Here’s one notable (and surprising) example —\u00a0antibodies directed against alpha4\/beta7 integrin given to SIV-infected primates led\u00a0to sustained viral suppression after stopping ART.<\/a>\u00a0This finding\u00a0led to rapid initiation of a human study at the NIH using the drug anti-alpha4\/beta7 drug\u00a0vedolizumab<\/a>, which is already approved by FDA. One caveat on all this research — HIV cure studies are notorious click-bait, as demonstrated here.<\/a><\/p>\n

Number 3. First large HIV vaccine study in 7 years starts in South Africa.<\/strong><\/p>\n

It’s called HVTN 702<\/a>, and it will enroll 5400 seronegative people in South Africa, arguably the country in greatest need of\u00a0an HIV vaccine. Participants\u00a0will be randomized to receive either placebo or a vaccine series modeled after the RV144 clinical trial<\/a> in Thailand. The HVTN 702 strategy, however, modifies\u00a0the vaccine to provide greater and more sustained immunogenecity than RV144,\u00a0and has been further adapted to the HIV subtype that predominates in southern Africa. Fingers crossed!<\/p>\n

Number 2. PrEP gains traction — but it isn’t perfect.<\/strong><\/p>\n

When TDF\/FTC for pre-exposure prophylaxis (PrEP) was approved in 2012, I thought it was going to remain a niche intervention, rarely requested by patients or ordered by clinicians. However, since the presentation of the PROUD and IPERGAY studies in early 2014, and the release of guidelines by the CDC, use of PrEP\u00a0has taken off — around 80,000 people in the USA are now receiving PrEP<\/a>, a more than 700% increase since 2012. Most of the use, not surprisingly, is in MSM from affluent urban areas. Two\u00a0cautionary notes: \u00a0First, the highest risk patients — young MSM of color, especially in the south — aren\u2019t getting\u00a0it nearly enough; second, PrEP isn\u2019t perfect, with two failures (here<\/a> and here<\/a>) despite good adherence, likely due to transmission of NRTI-resistant\u00a0strains.<\/p>\n

Number 1. Treatment as prevention really really<\/em> REALLY<\/span> works.<\/strong><\/p>\n

Did I make that clear enough?\u00a0Publication of two major papers proved this point: 1) The final results of HPTN 052<\/a>\u00a0showed\u00a0ZERO transmissions from an HIV-infected study subject to his seronegative partner if the blood HIV RNA was undetectable, and; 2) The PARTNERS study<\/a>, which explicitly recruited serodiscordant couples not\u00a0using condoms, again demonstrated ZERO\u00a0transmissions. We all thought that ART would be effective in preventing HIV transmission — but the degree of protection is way beyond what any of us could have hoped. It’s this effect that’s probably leading to a decline in new HIV diagnoses in certain major cities that have a high proportion of patients on treatment, such as San Francisco, New York, and London.<\/p>\n

Happy New Year, everyone!<\/p>\n

And in honor of the setting for HVTN 702 (see #3 above), here’s 2016’s\u00a0most popular Youtube video in South Africa.<\/p>\n

[youtube https:\/\/www.youtube.com\/watch?v=lm1cuHMCMIg&w=560&h=315]<\/p>\n

(Thanks to NPR.org for the video reference.)<\/a><\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

A lot of these “Best of …” or “Top Stories in …” lists have already been published, as they seem to be appearing\u00a0earlier and earlier each year. Pretty soon we’ll start reading them around the same time they sell Halloween Candy — and that’s just too early, sorry. Now this\u00a0list, however, appears just as\u00a02016 is […]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3],"tags":[423,464,1148,748,1147],"class_list":["post-8270","post","type-post","status-publish","format-standard","hentry","category-health-care","tag-hiv","tag-hptn-052","tag-hvtn-702","tag-prep","tag-top-stories"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/8270","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/comments?post=8270"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/8270\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/media?parent=8270"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/categories?post=8270"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/tags?post=8270"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}