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TREE Featured at Annual Conference on Retroviruses and Opportunistic Infections
Over 4,200 basic, translational, and clinical HIV researchers from 90 countries assembled in Seattle from February 13-17, 2017 for the annual Conference on Retroviruses and Opportunistic Infections (CROI). Attendees shared the latest studies, important developments, and best research methods in the ongoing battle against HIV/AIDS and related infectious diseases.
CROI is the place where important new advances in HIV research are often presented for the first time. The meeting covers a wide range of research about HIV, AIDS, and related infections, including cervical cancer. This year, Treatment, Research, and Expert Education researchers were featured
Sharon Greene presented the results of a randomized trial conducted in Kenya among 400 HIV-infected women with high grade cervical pre-cancer. In resource-limited settings where HIV is endemic, treatment for high grade cervical pre-cancer usually takes the form of cryotherapy (freezing cells with nitrous oxide); this technique is cost-effective and feasible. There is indirect evidence that cryotherapy may be less effective for HIV-infected women than treatment with LEEP (loop electrosurgical excision procedure), which removes abnormal cells by cutting them away with a thin wire loop, heated with an electrical current. Greene reported that HIV-infected women treated with cryotherapy had a 64% higher risk of recurrent lesions compared to those treated with LEEP at 24-months follow-up.
TREE is also investigating better ways to test for pre-treatment HIV-drug resistance (PDR) to 1st-line antiretroviral treatment (ART) which is correlated with virologic failure. The risk with virologic failure is HIV disease progression and higher risk of HIV transmission to uninfected partners. Therefore, understanding methods to detect PDR can lower the risk of virologic failure and keep patients healthier and decrease the risk of HIV for their sexual partners. Ingrid Beck reported that PDR among Kenyans initiating 1st-line treatment at the Coptic Hope Center in Nairobi in a comparison of 3 studies conducted in 2006, 2010 and 2014. When patients are on nevirapine based drugs, a single mutation may confer resistance to the drug whereas patients on efavirenz based treatment may also have a single mutation, but the treatment is still effective against HIV. Therefore, a lower risk of virologic failure conferred by single mutations during EFV-ART suggests that use of sensitive assays to detect and manage PDR could maximize viral suppression and extend the use of efavirenz based treatment in low-resource settings.
Testing for PDR prior to ART initiation with an oligonucleotide ligation assay (OLA), a low-cost point mutation assay, is a potential strategy to address the PDR in resource-poor settings. Horatio Duarte developed a cost-effectiveness model to simulate the emergence of PDR and the cost of testing for PDR prior to treatment initiation. Coupling pre-treatment testing using OLA with a test for virologic failure at 12 months was reported to be a cost-effective strategy and would help to reduce the prevalence of PDR.