New research was presented virtually at CROI 2022, the annual Conference on Retroviruses and Opportunistic Infections, from February 12-16. The features below highlight some of the studies that emerged from the conference.
No Detectable Virus at 2 Years in Babies Born With HIV
Current evidence indicates that starting infants who are at high risk for HIV on presumptive treatment may not only prevent transmission of the virus, but also allow children to attain the lowest possible viral reservoir, a first step toward HIV remission. Therefore, Deborah Persaud, MD, and colleagues administered first doses of a three-drug pre-emptive treatment within 24 hours of birth to a cohort of 54 infants. They measured viral suppression at 24 weeks, 48 weeks, and 2 years, at which point antibody and PCR tests were used to evaluate children for treatment interruption. Among 34 infants in cohort one, 24 passed testing at 24 weeks and six had PCR tests that found no cell-associated HIV DNA. In cohort two, 15 passed testing at 24 weeks and four had no detectable HIV DNA via PCR. More than 2 years after the study started, the researchers determined which children met the criteria for treatment interruption and found that as many as 30% (N=16) were candidates. If even one child was able to stop treatment, it would be the first step toward a functional cure for HIV for the youngest patients, Dr. Persaud and team noted.
Third Person ‘Cured’ of HIV After Transplant
A woman in the United States has remained in HIV remission and off antiretroviral therapy for 14 months following receipt of closely matched blood from a relative and HIV-resistant umbilical cord blood, according to Yvonne Bryson, MD, who reported the news at CROI 2022. The patient developed acute myeloid leukemia while taking antiretroviral therapy and has now been cancer-free for more than 4 years. The case is the third known incidence of HIV remission and the first to occur in a woman of mixed race, as well as the first known case with haplo-cord CCR5-∆32∆32 stem cell transplant, according to the researchers. While the study team acknowledged that a bone marrow transplant is not a feasible strategy for the widespread cure of HIV, the results do provide proof-ofconcept findings that HIV can be cured.
Universal HCV Screening in Pregnancy Boosts Detection
With the American College of Obstetrics and Gynecology recommending universal hepatitis C virus (HCV) screening for all pregnant women, Catherine Chappell, MD, and colleagues examined screening for, and detection of, HCV during risk-based versus universal screening. Universal screening began in June 2020, using EMRs to issue reminders if HCV testing was not ordered in a new OB panel and reflex testing for HCV RNA if IgG positive. The investigators assessed results for two 12- month periods—January 1-December 31, 2019 (risk-based screening; N=12,142) and July 1, 2020-June 30, 2021 (universal screening; N=12,588)—although data from January-June 2020 were omitted because of healthcare utilization concerns related to COVID-19. Universal HCV screening increased IgG screening from 23% of women entering obstetrical care to 81% (P<0.001), and the HCV IgG positivity rate was higher with risk-based versus universal screening (5.4% vs 2.3%; P<0.001), but the prevalence of HCV IgG-positive women was lower overall with risk-based versus universal screening (1.2% vs 1.9%; P<0.001). Reflex HCV testing increased active HCV identification from 0.091% to 0.68% (P<0.001), and an additional four infants with perinatal HCV were identified with universal screening that was undetected with risk-based screening.
Strategy Reduces Vertical HBV Transmission Without Immunoglobulin
For a study, Olivier Segeral, MD, and colleagues examined the efficacy of a strategy for preventing mother-to-child transmission (MTCT) of HBV using hepatitis B surface antigen (HBsAg)/ hepatitis B e antigen (HBeAg) algorithms to screen pregnant women and determine tenofovir (TDF) eligibility; TDF treatment from 24 weeks of amenorrhea for those deemed eligible; and HBV vaccination for all infants less than 2 hours after birth. Among participants, 94% started TDF and 14.5% were treated less than 4 weeks before delivery. The proportion of women with HBV DNA at delivery of less than 5.3 (log)10 IU/mL was 90% for those treated more than 4 weeks compared with 50% for those treated less than 4 weeks (P<0.001). Most infants (86%) received the first vaccine dose within 2 hours of life; 95% received it within 24 hours and 15% received hepatitis B immune globulin (HBIg). Overall, the MTCT rates were 1.26% and, without HBIg, 1.48% for TDF-eligible women: 0% for those treated more than 4 weeks before delivery and 8.33% for those treated less than 4 weeks. Among TDF-ineligible women, the transmission rates were 0.98% and 1.06% without HBIg.
Lifetime HIV Risk Declines for US Men & Women
Estimates of lifetime risk may be useful in easily explaining the burden of HIV to the public. Thus, Sonia Singh, MD, and colleagues conducted a study to estimate lifetime risk for HIV diagnosis by sex, race/ethnicity, and residence using diagnosis, mortality, and census population data. HIV diagnoses and non-HIV deaths from 2017-2019 were used to determine probabilities of an HIV diagnosis at a given age, as long as no HIV diagnosis had been made prior to that age, and comparisons were made to findings from a 2010-2014 analysis. During the latter period, the overall lifetime risk for HIV diagnosis was one in 120, one in 76 for males, and one in 309 for females; at every age, males had a higher estimated lifetime risk than females. Lifetime risk among males was one in 27 for Black persons, one in 50 for Hispanic/Latino persons, and one in 171 for White persons; respective risk rates in females were one in 75, one in 287, and one in 874. Lifetime risk improved, compared with 2010-2014 rates, for all groups except for men who were American Indian/ Alaska Native, Hispanic/Latino, and Native Hawaiian/other Pacific Islander and women who were White.