Antiretroviral Therapy in Prevention of HIV and TB: Update on Current Research Efforts

Granich, Reuben; Gupta, Somya; Suthar, Amitabh B.; Smyth, Caoimhe; Hui‐Kang, David; Vitória, Marco; Simao, Mariangela Bavicchi; Hankins, Catherine; Schwartländer, Bernard; Ridzon, Renée; Bazin, Brigitte; Williams, Brian G.; Lo, Ying-Ru; McClure, Craig; Montaner, Julio S. G.; Hirnschall, Gottfried

doi:10.2174/157016211798038597

Cited by 92 publications

(90 citation statements)

References 51 publications

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“…160 HPTN 052, 161,162 conducted in 13 sites in nine countries including India and Thailand, demonstrated that earlier ART reduces the risk of heterosexual HIV transmission by 96% 163 in discordant couples and confirmed results of observational and ecological studies. [164][165][166][167][168][169] These results prompted a retrospective study of treated and untreated discordant couples in China, 170 which showed a relative reduction of 26% of HIV-1-linked transmission (Table 2).…”

Section: Treatment As Prevention (Tasp)mentioning

confidence: 99%

HIV Epidemic in Asia: Implications for HIV Vaccine and Other Prevention Trials

Phanuphak

Shao³

et al. 2015

AIDS Research and Human Retroviruses

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An overall decrease of HIV prevalence is now observed in several key Asian countries due to effective prevention programs. The decrease in HIV prevalence and incidence may further improve with the scale-up of combination prevention interventions. The implementation of future prevention trials then faces important challenges. The opportunity to identify heterosexual populations at high risk such as female sex workers may rapidly wane. With unabating HIV epidemics among men who have sex with men (MSM) and transgender (TG) populations, an effective vaccine would likely be the only option to turn the epidemic. It is more likely that efficacy trials will occur among MSM and TG because their higher HIV incidence permits smaller and less costly trials. The constantly evolving patterns of HIV-1 diversity in the region suggest close monitoring of the molecular HIV epidemic in potential target populations for HIV vaccine efficacy trials. CRF01_AE remains predominant in southeast Asian countries and MSM populations in China. This relatively steady pattern is conducive to regional efficacy trials, and as efficacy warrants, to regional licensure. While vaccines inducing nonneutralizing antibodies have promise against HIV acquisition, vaccines designed to induce broadly neutralizing antibodies and cell-mediated immune responses of greater breadth and depth in the mucosal compartments should be considered for testing in MSM and TG. The rationale and design of efficacy trials of combination prevention modalities such as HIV vaccine and preexposure prophylaxis (PrEP) remain hypothetical, require high adherence to PrEP, are more costly, and present new regulatory challenges. The prioritization of prevention interventions should be driven by the HIV epidemic and decided by the country-specific health and regulatory authorities. Modeling the impact and cost-benefit may help this decision process.

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Section: Treatment As Prevention (Tasp)mentioning

confidence: 99%

HIV Epidemic in Asia: Implications for HIV Vaccine and Other Prevention Trials

Phanuphak

Shao³

et al. 2015

AIDS Research and Human Retroviruses

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“…There are relatively few such studies focussing on Asia. 16,17 The HPTN 074 vanguard study for a network-based randomised HIV prevention trial comparing an integrated intervention including supported ART compared with the standard of care for IDUs may consider sites in Asia.…”

Section: Prevention Benefit Of Art Testing and Treatingmentioning

confidence: 99%

Challenges and potential barriers to the uptake of antiretroviral-based prevention in Asia and the Pacific region

Kato²,

Phanuphak

et al. 2014

Sex. Health

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Abstract. Evidence has emerged over the past few years on the effectiveness of antiretroviral-based prevention technologies to prevent (i) HIV transmission while decreasing morbidity and mortality in HIV-infected persons, and (ii) HIV acquisition in HIV-uninfected individuals through pre-exposure prophylaxis (PrEP). Only few of the planned studies on treatment as prevention (TasP) are conducted in Asia. TasP might be more feasible and effective in concentrated rather than in generalised epidemics, as resources for HIV testing and antiretroviral treatment could focus on confined and much smaller populations than in the generalised epidemics observed in sub-Saharan Africa. Several countries such as Cambodia, China, Thailand and Vietnam, are now paving the way to success. Similar challenges arise for both TasP and PrEP. However, the operational issues for PrEP are amplified by the need for frequent retesting and ensuring adherence. This paper describes challenges for the implementation of antiretroviral-based prevention and makes the case that TasP and PrEP implementation research in Asia is much needed to provide insights into the feasibility of these interventions in populations where firm evidence of 'real world' effectiveness is still lacking.

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“…84 Eight different trials of ART for HIV prevention that include TB outcomes are currently underway or planned. 85 …”

Section: Participantsmentioning

confidence: 99%

Tuberculosis screening in high human immunodeficiency virus prevalence settings: turning promise into reality [State of the art series. Active case finding/screening. Number 5 in the series]

Corbett

MacPherson²

2013

int j tuberc lung dis

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SUMMARYTwenty years of sky-high tuberculosis (TB) incidence rates and high TB mortality in high human immunodeficiency virus (HIV) prevalence countries have so far not been matched by the same magnitude or breadth of responses as seen in malaria or HIV programmes. Instead, recommendations have been narrowly focused on people presenting to health facilities for investigation of TB symptoms, or for HIV testing and care. However, despite the recent major investment and scale-up of TB and HIV services, undiagnosed TB remains highly prevalent at community level, implying that diagnosis of TB remains slow and incomplete. This maintains high transmission rates and exposes people living with HIV to high rates of morbidity and mortality.More intensive use of TB screening, with broader definitions of target populations, expanded indications for screening both inside and outside of health facilities, and appropriate selection of new diagnostic tools, offers the prospect of rapidly improving population-level control of TB. Diagnostic accuracy of suitable (high throughput) algorithms remains the major barrier to realising this goal.In the present study, we review the evidence available to guide expanded TB screening in HIVprevalent settings, ideally through combined TB-HIV interventions that provide screening for both TB and HIV, and maximise entry to HIV and TB care and prevention. Ideally, we would systematically test, treat and prevent TB and HIV comprehensively, offering both TB and HIV screening to all health facility attendees, TB households and all adults in the highest risk communities. However, we are still held back by inadequate diagnostics, financing and paucity of population-impact data. Relevant contemporary research showing the high need for potential gains, and pitfalls from expanded and intensified TB screening in high HIV prevalence settings are discussed in this review. In high human immunodeficiency virus (HIV) prevalence settings, population-level tuberculosis (TB) incidence increased in parallel with adult HIV prevalence in the 1990s and remains extremely high, with over 1% of adults diagnosed with TB each year in many Southern African towns. 1 Outbreaks of multi-and extensively drug-resistant TB (XDR-TB) have been generated in HIV care clinics, and then spread into general communities. 2,3 Autopsy studies show that TB is the single biggest killer of people living with HIV (PLHIV), being the cause in 32% to 45% of HIV-related deaths 4 and with a high proportion of fatal cases undiagnosed in life. 4,5 Of the estimated 430 000 TB-related deaths among PLHIV during 2011, 79% were in Africa. These stark facts demonstrate the urgent need to strengthen TB prevention and care services using all available approaches, including more ambitious TB screening strategies.TB screening is the first step in both anti-tuberculosis treatment and TB prevention pathways, and has an integral place in routine HIV care and infection control. Key potential entry points for TB screening are illustrated in Figure 1. TB screening c...

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Antiretroviral Therapy in Prevention of HIV and TB: Update on Current Research Efforts

Cited by 92 publications

References 51 publications

HIV Epidemic in Asia: Implications for HIV Vaccine and Other Prevention Trials

HIV Epidemic in Asia: Implications for HIV Vaccine and Other Prevention Trials

Challenges and potential barriers to the uptake of antiretroviral-based prevention in Asia and the Pacific region

Tuberculosis screening in high human immunodeficiency virus prevalence settings: turning promise into reality [State of the art series. Active case finding/screening. Number 5 in the series]

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