Conference update: Virtual CROI 2021

Is COVID-19 hospitalization more common among people living with HIV (PLHIV)? No. However, most studies have found a greater risk of severe COVID-19 complications among PLWH, but this was dependent upon age and comorbidities (co-existing conditions and illnesses such as diabetes)—the usual suspects for the new pandemic. Still, different groups of researchers saw contradictory findings when looking at COVID-19 in PLWH. It’s a matter of the different comparisons used, which become apples to oranges across studies. For example, some report a higher rate of death due to COVID-19 in PLWH while others don’t. “The Effect of HIV on COVID, Effect of COVID on HIV” symposium featured four speakers from around the world.

Vive la France—again. On-demand PrEP with Truvada was just as good as taking the HIV prevention pill every day, first for one year in a previous report and now with updated results out to three years, according to the ANRS Prevenir study out of France. ANRS noted that on-demand PrEP with Truvada has been recommended as an alternative to daily PrEP for MSM (men who have sex with men) by guidelines from the International AIDS Society-USA, the European AIDS Clinical Society (EACS), and the World Health Organization, “but has not been endorsed yet by CDC due to limited real-world experience.”

Non-Hispanic Black, Hispanic, and non-Hispanic Asian patients with HIV were more likely to contract COVID-19 compared to non-Hispanic White patients,” according to the U.S. National COVID Cohort Collaborative.

Standard HIV testing may not be good enough to find an infection in someone using long-acting cabotegravir (CAB LA) for PrEP (which is still in clinical research). And four participants who acquired HIV still had on-time monthly injections and sufficient drug concentration in their blood to prevent the virus, out of 12 infections found after approximately two and a half years on CAB LA in the HPTN 083 study. Some of the 12 individuals had resistance to the HIV integrase inhibitor drug class, of which cabotegravir is one. With more than 4,000 people in the study (half on the comparator PrEP medication Truvada), the prevention rate shown was tremendously effective.

Cabenuva (CAB LA) was just as good when taken every 8 weeks as it was when taken every 4 weeks, according to the ATLAS-2M study. This was at nearly four years of clinical study with the new injectable HIV drug on the market, with more than 1,000 participants. Tolerability was good, and it was similar between the two groups. See Briefly. (ATLAS stands for “Antiretroviral Therapy as Long-Acting Suppression,” and 2M refers to two months.)

In PLWH with lots of HIV medications under their belt (heavily treatment-experienced), control over their virus was found with a long-acting drug still in development, lenacapavir (LEN). With just two injections in half a year (administered once every six months), 19 out of 26 individuals in the study (73%) were able to achieve undetectable viral load (less than 50 copies). These individuals had extensive drug resistance. People can’t take LEN alone, but need to use other HIV drugs as part of their treatment regimen. Findings are from Phase 2/3 results in the CAPELLA study. See Briefly.

THRIVE: Decreasing HIV in men of color: The THRIVE demonstration project funded seven health departments to establish community collaboratives providing HIV prevention and care services for MSM of color (including the promotion of testing and PrEP). Comparing these jurisdictions with others not funded, THRIVE found significant decreases in new HIV diagnoses for the Black and White MSM in funded jurisdictions, but not for Latinos. Only White MSM had decreases in unfunded areas. THRIVE is funded by the U.S. Centers for Disease Control and Prevention (CDC). (See Abstract 106.)

Gender-affirming surgery and HIV: The title from New York City’s Department of Health and Mental Hygiene and Callen-Lorde Community Health Center says it all: “Gender-affirming surgeries accessed through Medicaid are associated with high and sustained viral suppression among transgender people with HIV in New York City, 2013-2017.” The report from lead researcher Cristina Rodriguez-Hart, PhD, MPH, from the health department, and the study team noted that transgender people living with HIV “have indicated that gender-affirming and non-discriminatory healthcare was their top health concern” and that “mental health outcomes have improved over time after accessing gender-affirming surgery.” (See Abstract 107.)