International AIDS Society Research Articles

Improving Lives by Accelerating the Sustainable Development Goals for Adolescents Living with HIV

Background: The lives of adolescents in low and middle income countries would be improved by countries attaining the multifaceted Sustainable Development Goals (SDGs). For the most vulnerable young people this presents a major challenge. In response, the UNDP has proposed a new concept of 'development accelerators': provisions that simultaneously impact multiple SDGs. These may represent an opportunity for policy and provision to maximise the return on health and social investments. This study is the first to empirically test this concept, using a highly vulnerable sample of adolescents living with HIV in South Africa. Methods: Longitudinal data from 1060 adolescents living with HIV were gathered using community tracing from clinical records in 52 government clinics (90·1% reached, 93·5% 18-month retention). Standardised measures recorded eleven SDG-aligned targets across four goals, six potential accelerator provisions, and nine socio-demographic and HIV-related covariates. Associations of provisions with SDG outcomes were established by multivariable logistic regressions controlling for baseline outcomes, with adjustment for multiple outcome testing, and potential cumulative effects were tested by marginal effects modelling. Findings: Three provisions were 'development accelerators': each associated with positive outcomes across at least three SDGs: schools without physical violence ('safe schools'), government cash transfers and high parental monitoring (all p<0·05). For 9 out of 11 SDG-aligned targets, a combination of two of these accelerators showed cumulative positive associations, suggesting 'super-accelerator' effects of combination provisions. Interpretation: Findings suggest the validity of UNDP's 'accelerator' concept, identifying and providing services with multi-SDG impacts; and extend it to super-accelerators, that have cumulative effects. For adolescent sub-populations at elevated risk, development accelerators may provide a pathway to achieving health-focused SDG targets, and simultaneously impacting multiple SDG goals. Funding Statement: Nuffield Foundation, UKAID, Janssen Pharmaceutica, International AIDS Society, John Fell Fund, Economic and Social Research Council, European Research Council, Philip Leverhulme Trust, UNICEF. Declaration of Interests: LC, MO, LCa, ET, LS, AC and DW declare no conflicts of interest. LS reports grants from Sweden/Norad, grants from NIH, grants from MRC, personal fees from Gilead, other from AIDSImpact, editorial fees from Taylor and Francis, outside the submitted work. LC reports grants from Nuffield Foundation, UKAID and Sweden-Norad, Janssen Pharmaceutica South Africa, International AIDS Society, UNICEF Eastern and Southern Africa, John Fell Fund, European Research Council, Philip Leverhulme Trust, Economic and Social Research Council during the conduct of the study. Dr Webb is an employee of the UN Development Programme. Ethics Approval Statement: Ethical approval was given by the University of Cape Town (CSSR 2013/4), Oxford University (CUREC2/12-21), Provincial Departments of Health and Education and participating hospitals. All adolescents and their primary caregivers gave written informed consent at both time points in their language of choice (Xhosa or English), and read aloud in cases of low literacy.

Primary antifungal prophylaxis for cryptococcal disease in HIV-positive people.

BackgroundCryptococcal disease remains one of the main causes of death in HIV‐positive people who have low cluster of differentiation 4 (CD4) cell counts. Currently, the World Health Organization (WHO) recommends screening HIV‐positive people with low CD4 counts for cryptococcal antigenaemia (CrAg), and treating those who are CrAg‐positive. This Cochrane Review examined the effects of an approach where those with low CD4 counts received regular prophylactic antifungals, such as fluconazole.ObjectivesTo assess the efficacy and safety of antifungal drugs for the primary prevention of cryptococcal disease in adults and children who are HIV‐positive.Search methodsWe searched the CENTRAL, MEDLINE PubMed, Embase OVID, CINAHL EBSCOHost, WHO International Clinical Trials Registry Platform (WHO ICTRP), ClinicalTrials.gov, conference proceedings for the International AIDS Society (IAS) and Conference on Retroviruses and Opportunistic Infections (CROI), and reference lists of relevant articles up to 31 August 2017.Selection criteriaRandomized controlled trials of adults and children, who are HIV‐positive with low CD4 counts, without a current or prior diagnosis of cryptococcal disease that compared any antifungal drug taken as primary prophylaxis to placebo or standard care.Data collection and analysisTwo review authors independently assessed eligibility and risk of bias, and extracted and analysed data. The primary outcome was all‐cause mortality. We summarized all outcomes using risk ratios (RR) with 95% confidence intervals (CI). Where appropriate, we pooled data in meta‐analyses. We assessed the certainty of the evidence using the GRADE approach.Main resultsNine trials, enrolling 5426 participants, met the inclusion criteria of this review. Six trials administered fluconazole, while three trials administered itraconazole.Antifungal prophylaxis may make little or no difference to all‐cause mortality (RR 1.07, 95% CI 0.80 to 1.43; 6 trials, 3220 participants; low‐certainty evidence). For cryptococcal specific outcomes, prophylaxis probably reduces the risk of developing cryptococcal disease (RR 0.29, 95% CI 0.17 to 0.49; 7 trials, 5000 participants; moderate‐certainty evidence), and probably reduces deaths due to cryptococcal disease (RR 0.29, 95% CI 0.11 to 0.72; 5 trials, 3813 participants; moderate‐certainty evidence). Fluconazole prophylaxis may make no clear difference to the risk of developing clinically resistant Candida disease (RR 0.93, 95% CI 0.56 to 1.56; 3 trials, 1198 participants; low‐certainty evidence); however, there may be an increased detection of fluconazole‐resistant Candida isolates from surveillance cultures (RR 1.25, 95% CI 1.00 to 1.55; 3 trials, 539 participants; low‐certainty evidence). Antifungal prophylaxis was generally well‐tolerated with probably no clear difference in the risk of discontinuation of antifungal prophylaxis compared with placebo (RR 1.01, 95% CI 0.91 to 1.13; 4 trials, 2317 participants; moderate‐certainty evidence). Antifungal prophylaxis may also make no difference to the risk of having any adverse event (RR 1.07, 95% CI 0.88 to 1.30; 4 trials, 2317 participants; low‐certainty evidence), or a serious adverse event (RR 1.08, 95% CI 0.83 to 1.41; 4 trials, 888 participants; low‐certainty evidence) when compared to placebo or standard care.Authors' conclusionsAntifungal prophylaxis reduced the risk of developing and dying from cryptococcal disease. Therefore, where CrAG screening is not available, antifungal prophylaxis may be used in patients with low CD4 counts at diagnosis and who are at risk of developing cryptococcal disease.12 April 2019Up to dateAll studies incorporated from most recent searchAll eligible published studies found in the last search (31 Aug, 2017) were included

Early versus delayed antiretroviral treatment in HIV-positive people with cryptococcal meningitis.

BackgroundThere remains uncertainty about the optimum timing of antiretroviral therapy (ART) initiation in HIV‐positive people with cryptococcal meningitis. This uncertainty is the result of conflicting data on the mortality risk and occurrence of immune reconstitution inflammatory syndrome (IRIS) when ART is initiated less than four weeks after cryptococcal meningitis treatment is commenced.ObjectivesTo compare the outcomes of early initiation of ART (less than four weeks after starting antifungal treatment) versus delayed initiation of ART (four weeks or more after starting antifungal treatment) in HIV‐positive people with concurrent cryptococcal meningitis.Search methodsWe searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and Embase for trials published between 1 January 1980 and 7 August 2017. We additionally searched international trial registries, including ClinicalTrials.gov and WHO International Clinical Trials Registry Platform (ICTRP), and conference abstracts from the International AIDS Society (IAS) and the Conference on Retroviruses and Opportunistic Infections (CROI) for ongoing or unpublished studies between 2015 and 2017. We reviewed reference lists of included studies to identify additional studies.Selection criteriaWe included randomized controlled trials (RCTs) that compared early versus delayed ART initiation in HIV‐positive people with cryptococcal meningitis. Children, adults, and adolescents from any setting were eligible for inclusion.Data collection and analysisTwo review authors independently applied the inclusion criteria and extracted data. We presented dichotomous outcomes as risk ratios (RR) with 95% confidence intervals (CIs). We presented time‐to‐death data as hazard ratios with 95% CIs. We assessed the certainty of the evidence using the GRADE approach.Main resultsFour trials including 294 adult participants met the inclusion criteria of this review. Participants were predominantly from low‐ and middle‐income countries. Two trials treated cryptococcal meningitis with amphotericin B and fluconazole; a third trial used fluconazole monotherapy; and the fourth trial did not specify the antifungal used.Early ART initiation may increase all‐cause mortality compared to delayed ART initiation (RR 1.42, 95% CI 1.02 to 1.97; 294 participants, 4 trials; low‐certainty evidence). Early ART initiation may reduce relapse of cryptococcal meningitis compared to delayed ART initiation (RR 0.27, 95% CI 0.07 to 1.04; 205 participants, 2 trials, low‐certainty evidence). We are uncertain whether early ART initiation increases or reduces cryptococcal IRIS events compared to delayed ART initiation (RR 3.56, 95% CI 0.51 to 25.02; 205 participants, 2 trials; I2 = 54%; very low‐certainty evidence). We are uncertain if early ART initiation increases or reduces virological suppression at six months compared to delayed ART initiation (RR 0.93, 95% CI 0.72 to 1.22; 205 participants, 2 trials; I2 statistic = 0%; very low‐certainty evidence).We were unable to pool results related to rate of fungal clearance for the two trials that reported this outcome; individual trial results indicated that there was no difference in cerebrospinal fluid fungal clearance between trial arms. Similarly, we were unable to pool results on adverse events for the trials reporting on this outcome; individual trial results indicated no difference in the occurrence of grade 3 to 5 adverse events between trial arms.Three of the four included trials had an overall low or unclear risk of bias related to the primary outcome of all‐cause mortality. However, we assessed one trial as at high risk of bias due to selective outcome reporting and other bias. This, in addition to the few clinical events and imprecision of effect estimates, led to downgrading of the evidence to low or very low certainty.Authors' conclusionsThe results of this review are relevant to HIV‐positive adults with cryptococcal meningitis in low‐ and middle‐income countries. These data suggest a higher risk of mortality among people who initiate ART within four weeks of cryptococcal meningitis diagnosis. However, it is unclear if this higher mortality risk is related to cryptococcal meningitis‐IRIS.11 April 2019Up to dateAll studies incorporated from most recent searchAll eligible published studies found in the last search (7 Aug, 2017) were included

Setting Global Research Priorities in Pediatric and Adolescent HIV Using the Child Health and Nutrition Research Initiative (CHNRI) Methodology.

Background:WHO and the Collaborative Initiative for Paediatric HIV Education and Research (CIPHER) of the International AIDS Society (IAS) led a collaborative process to set global prioritized research agendas, aiming to focusing future research, funding, and stakeholder's efforts. This study describes the methodology used to establish the research agendas.Methods:The Child Health and Nutrition Research Initiative methodology was adapted in parallel exercises on pediatric and adolescent HIV. After definition of scope by an expert working group, priority questions were collected from stakeholders through an online survey. Submitted questions were coded, analyzed, and collated. The same respondents were asked to score the collated lists through a second online survey. The top 10 ranked questions per thematic area (testing, treatment, and service delivery) were reviewed and priority themes developed with consideration of existing policy, systematic reviews, and planned, ongoing, and recently published research.Results:A total of 375 respondents submitted 1735 priority research questions. The majority of respondents were from Africa; 55% self-identified as researchers. The final collated lists included 51 and 61 research questions for pediatric and adolescent HIV, respectively. The response rate for the second survey was 48%. The final research agendas include 5 priority research themes per area, discussed in 2 separate publications.Conclusions:To date, this is the largest example of the Child Health and Nutrition Research Initiative method in pediatric and adolescent HIV in terms of stakeholders reached, and the first to incorporate top thematic areas based on current evidence. Its impact on improving outcomes for these populations will require strong political and financial commitment.

Emergence of uncommon HIV-1 non-B subtypes and circulating recombinant forms and trends in transmission of antiretroviral drug resistance in patients with primary infection during the 2013-2015 period in Marseille, Southeastern France.

Primary HIV-1 infections (PHI) with non-B subtypes are increasing in developed countries while transmission of HIV-1 harboring antiretroviral resistance-associated mutations (RAMs) remains a concern. This study assessed non-B HIV-1 subtypes and RAMs prevalence among patients with PHI in university hospitals of Marseille, Southeastern France, in 2005-2015 (11 years). HIV-1 sequences were obtained by in-house protocols from 115 patients with PHI, including 38 for the 2013-2015 period. On the basis of the phylogenetic analysis of the reverse transcriptase region, non-B subtypes were identified in 31% of these patients. They included 3 different subtypes (3A, 1C, 4F), 23 circulating recombinant forms (CRFs) (CRF02_AG, best BLAST hits being CRF 36_cpx and CRF30 in 7 and 1 cases, respectively), and 5 unclassified sequences (U). Non-B subtypes proportion increased significantly, particularly in 2011-2013 vs in 2005-2010 (P = .03). CRF02_AG viruses largely predominated in 2005-2013 whereas atypical strains more difficult to classify and undetermined recombinants emerged recently (2014-2015). The prevalence of protease, nucleos(t)ide reverse transcriptase, and first-generation nonnucleoside reverse transcriptase inhibitors-associated RAMs were 1.7% (World Health Organization [WHO] list, 2009/2.6% International AIDS Society [IAS] list, 2017), 5.2%/4.3%, and 5.2%/5.2%, respectively. Etravirine/rilpivirine-associated RAM (IAS) prevalence was 4.3%. Men who have sex with men (MSM) were more frequently infected with drug-resistant viruses than other patients (26% vs 7%; P = .011). The recent increase of these rare HIV-1 strains and the spread of drug-resistant HIV-1 among MSM in Southeastern France might be considered when implementing prevention strategies and starting therapies.

Trends in HIV Terminology: Text Mining and Data Visualization Assessment of International AIDS Conference Abstracts Over 25 Years.

BackgroundThe language encompassing health conditions can also influence behaviors that affect health outcomes. Few published quantitative studies have been conducted that evaluate HIV-related terminology changes over time. To expand this research, this study included an analysis of a dataset of abstracts presented at the International AIDS Conference (IAC) from 1989 to 2014. These abstracts reflect the global response to HIV over 25 years. Two powerful methodologies were used to evaluate the dataset: text mining to convert the unstructured information into structured data for analysis and data visualization to represent the data visually to assess trends.ObjectiveThe purpose of this project was to evaluate the evolving use of HIV-related language in abstracts presented at the IAC from 1989 to 2014.MethodsOver 80,000 abstracts were obtained from the International AIDS Society and imported into a Microsoft SQL Server database for data processing and text mining analyses. A text mining module within the KNIME Analytics Platform, an open source software, was then used to mine the partially processed data to create a terminology corpus of key HIV terms. Subject matter experts grouped the terms into categories. Tableau, a data visualization software, was used to visualize the frequency metrics associated with the terms as line graphs and word clouds. The visualized dashboards were reviewed to discern changes in terminology use across IAC years.ResultsThe major findings identify trends in HIV-related terminology over 25 years. The term “AIDS epidemic” was dominantly used from 1989 to 1991 and then declined in use. In contrast, use of the term “HIV epidemic” increased through 2014. Beginning in the mid-1990s, the term “treatment experienced” appeared with increasing frequency in the abstracts. Use of terms identifying individuals as “carriers or victims” of HIV rarely appeared after 2008. Use of the terms “HIV positive” and “HIV infected” peaked in the early-1990s and then declined in use. The terms “men who have sex with men” and “MSM” were rarely used until 1994; subsequently, use of these terms increased through 2014. The term “sex worker” steadily increased in frequency throughout conference years, whereas the term “prostitute” decreased over time.ConclusionsThe results of this study highlight changes in HIV terminology use over 25 years, including the addition, disappearance, and changing use of terms that reflect advances in HIV research and medical practice and destigmatization of the disease. Coupled with findings from related quantitative research, HIV-related terminology recommendations based on results of this study are included. Adoption of these recommendations will further efforts to use less stigmatizing language and facilitate effective communication between health professionals and people affected by HIV.

David Cooper: brought HIV research and treatment to resource- poor settings

David Cooper was a leader in the fight against AIDS, from its early days until the time of his death at age 68. His initial work took place in Sydney,...

Optimal Antiretroviral Prophylaxis in Infants at High Risk of Acquiring HIV: A Systematic Review.

The risk of perinatal HIV infection can be dramatically reduced through maternal antiretroviral (ARV) therapy and infant ARV postnatal prophylaxis. The 2013 World Health Organization guidelines recommended 4-6 weeks of nevirapine or zidovudine as postnatal prophylaxis, with possible extension to 12 weeks for high-risk breastfed infants. A systematic review was undertaken to determine if there is evidence for the World Health Organization to recommend enhanced or extended prophylaxis for high-risk infants. Cochrane CENTRAL, EMBASE, PubMed databases from 2005 to 2015, as well as conference on retroviruses and opportunistic infections and international aids society abstracts were searched. Cohort studies and randomized controlled trials examining the use of combination or prolonged regimens in HIV-exposed infants were included. A total of 1185 studies were screened by title and abstract and 45 full-text articles were examined in further detail. Of the 4 included studies, 3 examined multidrug prophylaxis regimens in formula-fed, high-risk HIV-exposed infants. Multidrug regimens were shown to significantly reduce transmission rates, compared with single-drug regimens; however, there was no significant difference between 2- and 3-drug regimens. An randomized controlled trial examining prolonged ARV prophylaxis in a breastfed population showed that 6 months of nevirapine resulted in lower HIV transmission rates compared with a standard 6-week nevirapine regimen. The limited available evidence suggests that using combination ARV regimens in high-risk infants reduces intrapartum transmission and that using prolonged prophylaxis in breastfed infants reduces breastfeeding transmission rates. However, the additional benefit of combination or prolonged regimens in the context of maternal ARV therapy remains unclear.

Comparison of antiretroviral drug resistance among treatment-naive and treated HIV-infected individuals in Shiraz, Iran.

The use of anti-retroviral therapy has been effective in controlling the spread of HIV-1, and has prolonged life expectancy, but this success can be affected by the emergence of drug resistance. The main goal of this study was to investigate drug resistance in the reverse transcriptase (RT), and protease (PR) genes among HIV-1 infected individuals. We systematically selected 59 HIV-1 infected individuals from Shiraz Voluntary Counseling and Testing Center (29 treatment- naïve and 30 treated). In this study intravenous drug users older than 18 were included in this study. Using specific primers, nested RT-PCR was performed on RNA extracted from patient samples. The genes targeted for RT and PCR were successfully amplified and sequenced. The sequences of these two genes were compared with mutations related to drug resistance against nucleotide reverse transcriptase inhibitors (NRTI), non-nucleotide reverse transcriptase inhibitors (NNRTI) and protease inhibitors (PI) using the latest database from the International AIDS society - USA, Stanford University, and the patterns were recorded. Among treatment-naïve, the detected NRTI and NNRTI resistance mutations were V179T, V75M and E138A. V179T causes high level resistance to Efavirenze and Nevirapin. V75M causes intermediate resistance to Stavudine. Regarding NRTI and NNRTI resistance mutations among treated patients, the most frequent mutation (7%) was M184V, which causes high level resistance to zidovudin and emtricitabine. The interesting result from this study was the detection of NRTI and NNRTI resistance mutations before the initiation of treatment, which signifies the transmission of resistant strains of virus between individuals. This mutation highlights the importance of drug resistance HIV-1 genotyping before commencing treatment.

The International AIDS Society—Lancet Commission on the future of the HIV response and global health

The International AIDS Society—Lancet Commission on the future of the HIV response and global health

Dr. Mark A. Wainberg (1945-2017): Provocateur, Activist, and Champion for AIDS Care and Research.

Dr. Mark A. Wainberg (1945-2017): Provocateur, Activist, and Champion for AIDS Care and Research.

Highlights from the 3rd international HIV/viral hepatitis Co-infection meeting - HIV/viral hepatitis: improving diagnosis, antiviral therapy and access

The International AIDS Society convened the 3rd International HIV/Viral Hepatitis Co-Infection Meeting on 17 July 2016 as part of the pre-conference program preceding the 21st International AIDS Conference held in Durban, South Africa. The meeting brought together a diversity of scientific, technical and community interests to discuss opportunities and challenges for increased prevention, diagnosis and treatment of viral hepatitis in people living with HIV, particularly in low- and middle-income settings.The objectives of the meeting were:To review the latest therapeutic developments in viral hepatitis;To identify challenges such as high cost of medications for hepatitis C virus (HCV) and risk of developing viral resistance, and successes, such as the provision of HCV treatment in community-based settings, movements to reduce drug costs and increasing access, in relation to scaling up diagnosis, screening, antiviral treatment and prevention of viral hepatitis;To advance the agenda for elimination of viral hepatitis as a public health problem.Discussions centred around the six key interventions outlined by the World Health Organization Global Health Sector Strategy on Viral Hepatitis 2016–2021: hepatitis B virus (HBV) vaccination (including birth dose); safe injection practices plus safe blood; harm reduction among people who inject drugs; safer sex practices; hepatitis B treatment; and hepatitis C cure.This article summarizes the main issues and findings discussed during the pre-conference meeting. One of the recommendations from the meeting delegates is universal implementation of birth dose vaccination for HBV without further delay to prevent mother-to-child transmission of infection. There is also the need to implement screening and treatment of hepatitis among pregnant women. A call was made for concerted efforts to be put together by all stakeholders towards addressing some of the structural barriers, including criminalization of drug use, discrimination and stigma that people living with viral hepatitis face. Finally, the need for greater advocacy was highlighted to enable access to therapy of viral hepatitis at lower cost than currently prevails. Implementation of these resolutions will help in achieving the target of eliminating viral hepatitis as a public health threat.

Tenofovir Alafenamide Versus Tenofovir Disoproxil: Systematic Review and Meta-analysis (Protocol)

Highly active antiretroviral therapy (HAART) has greatly reduced morbidity and mortality, resulting in high survival rates among infected patients. Despite the impact of HAART, mortality in successfully treated HIV infected patients remains higher than in the general uninfected population. The effects of persistent inflammation and drug toxicity on comorbidities that are considered non-HIV related, including metabolic, cardiovascular and renal disease, contribute to these differences in the health of infected individuals New Reference. Among antiretroviral moleculars, tenofovir disoproxil is widely used. Tenofovir alafenamide is a new oral prodrug of tenofovir, a nucleotide analogue that inhibits HIV-1 transcription. Tenofovir alafenamide has potential intracellular accumulation; lower extracellular exposures of tenofovir may be realized with the potential to reduce off-target toxicities. Specifically, lower drug exposures to kidney cells may provide for fewer renal complications as observed in a minority of patients treated with tenofovir disoproxil fumarate. Objectives To investigate whether Tenofovir alafenamide based regimens are less nephrotoxic than Tenofovir disoproxil based regimens. To evaluate whether Tenofovir alafenamide contained regimens could decrease mineral bones loss. To investigate the efficacy of TAF in co-infection HIV/hepatitis. Search methods: We will search the following electronic databases: CENTRAL (Cochrane Central Register of Controlled Trials), Scorpus, Web of science, LILACS, PubMed and CINAHL. We will also search conference abstract archives on the web sites of the Conference on Retroviruses and Opportunistic Infections (CROI), the International AIDS Conference (IAC), and the International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention (IAS). Analysis: If include studies are as similar as possible, we will undertake meta-analysis using Cochrane’s Review Manager Software (RevMan 2014). If included studies are heterogeneous, the results will be summarized in a narrative manner. GRADE evidence profiles and summary of findings tables will be generated. Conclusion: This study could influence HIV management. TDF is largely used as first line regimen in HIV management. Therefore toxicity is restricted its use. This systematic review will find out whether TDF could be swift by TAF when TDF is contraindicated.

Mobile Phone Communication for Improving Uptake of Antiretroviral Therapy in HIV-infected Pregnant Women: Review

Background About 1.4 million pregnant women are living with HIV in low and middle income countries with about 91% of these women residing in sub-Saharan Africa. HIV-infected pregnant women face several challenges that could decrease antiretroviral therapy adherence. Studies reported challenges such as poor mental health, lack of social support, fears of infecting children, medication side effects, cultural factors, economic instability, nausea and vomiting during pregnancy. This review investigated whether mobile phone text messaging could improve antiretroviral therapy in during and after pregnancy. Objectives To assess the effectiveness mobile phone text messaging for improving adherence to antiretroviral therapy in HIV-infected pregnant women. To investigate whether mobile phone text messaging could improve follow up in HIV-exposed infants. Search methods We searched Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, MEDLINE via PubMed, Web of Science, CINAHL (EBSCO). Furthermore, we searched studies through HIV/AIDS conferences websites: International AIDS conferences, The European AIDS Clinical Society (EACS) conferences, International AIDS Society conference on HIV Pathogenesis and Treatment (IAS). Two authors extracted data in the study eligibility form. Selection criteria We selected randomized controlled trials (RCTs) assessing mobile phone text messaging as reminders for antiretroviral therapy uptake in HIV-infected pregnant women. Data collection and analysis Two authors independently identified and assessed all studies that met inclusion criteria. Study design, characteristics of study populations, interventions and controls and study results were extracted by two review authors. In addition, the risk of bias of included studies was assessed independently by two reviewers. We reported the results narratively as meta-analysis was not feasible because of differences in the study design. We reported the odds ratio with 95% confidence intervals for the different outcomes. Main results We identified five eligible studies; three ongoing and two completed studies. Findings from the included studies showed that mobile phone text messaging did not increase antiretroviral therapy initiation (OR 1.79 95%CI 1.09 to 2.94, 307 participants, 1 study). However, there was an increase in maternal clinic attendance and HIV tested infants; (RR 1.66 95%CI 1.02 to 2.70, 381 participants, 1 study) and (OR 2.01 95%CI 1.03 to 3.92, 325 participants, 1 study), respectively. The overall quality of evidence was assessed as moderate. None of the included studies reported on adherence to antiretroviral therapy. Authors' conclusions The review revealed that mobile phone text messaging may improve maternal clinic attendance and number infants tested for HIV compared to the standard care. Mobile phone communication did not improve ART initiation compared to standard care. Further studies are needed to evaluate the value of mobile phone communication in promoting adherence to antiretroviral drugs among pregnant women and reduction of mother-to-child transmission of HIV.

REVIEW OF THE 9th INTERNATIONAL SCIENTIFIC AND PRACTICAL CONFERENCE ON HIV INFECTION (PARIS, FRANCE, 23-26 JULY 2017)

From July 23 to July 26, 2017, the 9th Scientific and Practical Conference on HIV was held in Paris (France) on the initiative of the International AIDS Society (IAS) and the French National Agency for AIDS Research (ANRS). The latest scientific developments in the field of HIV research were presented, with an emphasis on translating scientific achievements into practice and the development of science in the context of politics. Particular attention was paid to innovative approaches aimed at reducing immune activation, which are a priority in the strategy for the treatment of HIV infection and in improving care for HIV infected patients. One of the key topics of the conference was the use of new long-acting antiretroviral drugs, as well as preparations with nanoparticles. The researchers reported that the monthly use of the vaginal ring and daily per oral in-taking (Truvada) was safe and acceptable for adolescents. The main focus was on preventing HIV infection. An online study conducted in Europe showed a low level of knowledge about PrEP among risk groups, while high interest in PrEP is emphasized, but low coverage. Significant interest was caused by the results of patients who, after reaching undetectable viremia, stopped taking ARV drugs for approximately 210 days in the first case and 8 years in the second. Experts note the high prevalence of HIV infection among transgender women and anxiety about the problems associated with the spread of drugs in this environment, which may negatively affect their adherence to treatment. The scientific conference has acquired an unexpected political overtones: scientists fear a reduction in the funding of international programs to fight HIV and AIDS by the US. In 2016, thanks to public funding and private investment, it was possible to take in more than $ 19 billion to fight HIV and AIDS. It lacks about 7 billion to achieve the goals set by the UN by 2020.

In memoriam: Mark Wainberg, PhD (1945–2017)

“When I look back on my career, I always feel that the most important contribution of my life was political and not scientific” – Mark Wainberg It is with a heavy heart that the scientific community learned of the passing of Mark Wainberg, who died at the age of 71 in Bal Harbour, Florida. At the time of his death, Mark was a lead investigator at the Lady Davis Institute for Medical Research at the Jewish General Hospital, the director of the McGill University AIDS Centre and an Editor-in-Chief of the Journal of the International AIDS Society (JIAS). Mark devoted his life to AIDS research, and his work has contributed directly to the saving of millions of lives around the planet. In 1989, Mark's team characterized the antiviral activity of 3TC or lamivudine, which played a fundamental role in curving the HIV epidemic. Mark served as the president of the International AIDS Society (IAS) between 1998 and 2000. Hoping to draw media attention and to achieve political commitment to the lack of access to antiretroviral drugs in developing countries, Mark oversaw the first conference to take place in South Africa in 2000: the 13th International AIDS Conference. In Durban, alongside Nelson Mandela, he urged African governments and international institutions to become more involved in the response to the epidemic: an historic moment in HIV in Africa and the world. The AIDS 2000 Conference became a turning point in the history of HIV and AIDS as it led a global movement to bring life-saving HIV treatment to developing countries, leading to the first United Nations Declaration on HIV/AIDS from 2001 and the creation of The Global Fund to Fight AIDS, Tuberculosis and Malaria and PEPFAR. In 2004, Mark Wainberg pioneered the idea for a new journal devoted to HIV and AIDS: the Journal of the International AIDS Society (JIAS). In the years that followed, he was an outstanding Editor-in-Chief, enthusiastic, committed and passionate. Mark was central to the journal's growing success and he was instrumental in ensuring that social, behavioural, political and economic research was included alongside biomedical and clinical research. The JIAS is one of the very few international HV/AIDS journals to do so. The publication of the impact factor of JIAS was always a much awaited moment by Mark. For JIAS, this impact factor continues to increase, from 3.256 in 2012 to 6.296 in 2016: an outcome for which Mark deserves much applause and appreciation. As well as wanting the JIAS to be a first-class journal, Mark also envisioned that the journal would enable young and inexperienced researchers, especially from resource-limited settings, to publish their biomedical, epidemiological, and social and political science, health economics and operational research. To this end with the support of the JIAS, Mark participated on a regular basis in the organization of skills-building workshops on scientific writing and publishing at international conferences. These workshops were often organized during the major international conferences of the IAS, with a significant participation of young African and other researchers from middle- and low-income countries. Mark was also co-organizer of INTEREST Workshop, whose main objective was to enable African researchers to present their research and remain continually up to date on research developments and best practices. He did his best to travel to Africa each year and participate in INTEREST meetings, contributing to the training and capacity building of young African researchers. Mark received many African microbiologists in his laboratory at McGill University with a Canadian Cooperation grant for their Master and PhD training. These researchers on their return home continued to benefit from the scientific and technical support of Mark and his team; they significantly contributed to patient management in terms of microbiology and virology (viral load and resistance monitoring). Mark will always be remembered as a brilliant scientist whose research contributed in saving the lives of people living with HIV, but first and foremost as a fierce advocate for access to treatment and human rights giving a voice to the voiceless. More than ever, political commitment to the HIV response is a critical issue and Mark's true legacy will be the new generation of researchers he worked with and inspired, and who will keep up the momentum to end HIV. He will be sorely missed. None. PPS, SK and KM are Editors-in-chief of the Journal of the International AIDS Society, MB is the Executive Editor, LGB and CB are Editorial Board members, and current President and Immediate Past President of IAS, respectively.All authors have contributed to the preparation of the manuscript, read and approved the final draft.

Systematic review and meta-analysis of the adolescent HIV continuum of care in South Africa: the Cresting Wave

ContextSouth Africa has the most HIV infections of any country in the world, yet little is known about the adolescent continuum of care from HIV diagnosis through viral suppression.ObjectiveTo determine...

IAS Towards an HIV Cure Symposium: people focused, science driven 18–19 July 2015, Vancouver, Canada

The International AIDS Society (IAS) convened the Towards an HIV Cure Symposium on 18–19 July 2015 in Vancouver, Canada, bringing together researchers and community to discuss the most recent advances in our understanding of HIV latency, reservoirs and a summary of the current clinical approaches towards an HIV cure.The symposium objectives were to: (1) gather researchers and stakeholders to present, review, and discuss the latest research towards an HIV cure; (2) promote cross-disciplinary global interactions between basic, clinical and social scientists; and (3) provide a platform for sharing information among scientists, clinicians, funders, media and civil society. The symposium examined basic molecular science and animal model data, and emerging and ongoing clinical trial results to prioritise strategies and determine the viral and immune responses that could lead to HIV remission without antiretroviral therapy. This report summarises some of the major findings discussed during the symposium.

Discontinuing Pneumocystis jirovecii Pneumonia Prophylaxis in HIV-Infected Patients With a CD4 Cell Count

To review the evidence for discontinuing primary and secondary Pneumocystis jirovecii pneumonia (PJP) prophylaxis in HIV-infected patients with a CD4 count <200 cells/mm(3). We conducted a literature search in MEDLINE, EMBASE, Cochrane Library, Google Scholar, and the International Aids Society Library (up to August 2015) using the following key search terms: Pneumocystis jirovecii, pneumonia, human immunodeficiency virus, primary prophylaxis, secondary prophylaxis, and discontinuation. All English-language studies that evaluated discontinuation of primary and/or secondary PJP prophylaxis in HIV-infected patients with CD4 count <200 cells/mm(3) were included. Five studies were identified, which varied in design, sample size, outcomes, and duration of follow-up. Three studies examined discontinuation of primary and secondary PJP prophylaxis; 1 study evaluated discontinuing primary PJP prophylaxis; and 1 study evaluated stopping secondary PJP prophylaxis. Two out of the 5 studies pooled data for all opportunistic infections. Overall, there was a low incidence of PJP among HIV-infected patients who discontinued primary PJP prophylaxis and were well controlled on antiretroviral therapy (ART). Discontinuation of primary PJP prophylaxis appears to be safe in patients on combination ART with a suppressed HIV viral load and a CD4 count >100 cells/mm(3). Additional data are needed to support the safety of discontinuing secondary PJP prophylaxis. Decisions to discontinue PJP prophylaxis in patients with a CD4 count <200 cells/mm(3) should be done on an individual patient basis, taking into consideration clinical factors, including ongoing adherence to ART.

Progress towards an HIV cure: update from the 2014 International AIDS Society Symposium.

Biomedical research has led to profound advances in the treatment of HIV infection. Combination antiretroviral therapy (ART) now provides the means to readily control viral infection, and people living with HIV who receive timely and effective ART can expect to benefit from a life expectancy comparable to uninfected individuals. Nevertheless, despite effective treatment, ART does not fully restore the immune system and importantly HIV persists indefinitely in latent reservoirs, resulting in the need for life-long treatment. The challenges and limits of life-long treatment have spurred significant scientific interest and global investment into research towards an HIV cure. The International AIDS Society (IAS) 2014 Towards an HIV cure symposium brought together researchers and community to discuss the most recent advances in our understanding of latency and HIV reservoirs, and the clinical approaches towards an HIV cure under current investigation. This report summarizes and reviews some of the major findings discussed during the symposium.