 Hey everyone, I'm Raif Derrazy and this is our weekly roundup of the latest HIV news for the week of October 2nd to October 8th. Today I'll be going through 14 articles covering topics ranging from the ongoing effects that dormant or latent HIV has on our immune system, a potential path to HIV cure by reactivating the latent HIV reservoir, a new morning after pill for STI's question mark, potential self-injectable long-acting ART coming down the pipeline, the risks of greater weight gain in the first year of HIV treatment, can you get HIV from someone on PrEP and more. I won't be reading the articles per se, but I will give you a brief summary and sometimes throw in my own opinion or commentary as well. If you'd like to access the complete articles, all links will be available in the description box below. I've done my best to quickly pull this together. I'm currently in Bethesda, Maryland attending the annual Martin Delaney Collaboratories meeting to discuss HIV cure research. It is after 1 a.m. at the moment at the time of filming this and by the time I finish editing and uploading it will be closer to 3 a.m. and I will be waking up at approximately 5 30 to 6 a.m. to attend the second and final day here. I want to thank you all for being patient with me as my schedule has been completely overwhelming and I'm doing this work for almost free next to nothing while trying to manage a completely unrelated full-time job as well. On to the news. Number one, AIDS map, greater weight gain in first year of HIV treatment raises risks of diabetes, metabolic syndrome and precursors of heart disease. In a long-term study on individuals starting antiretroviral treatment, researchers found that greater weight gain in the first year was linked to an increased risk of diabetes, metabolic syndrome and potential precursors of heart disease. The study involving over 2,600 participants revealed that substantial weight gain, particularly in men, was associated with a higher incidence of diabetes. However, women who gained more weight did not show an increased risk. The study also noted differences by race with white and black participants experiencing a higher incidence of cardiometabolic events after significant weight gain. While the study provides valuable insights, it couldn't account for factors like diet and physical activity. Further analysis is needed to understand the impact of weight gain on cardiovascular risk in specific groups. Now, I just want to point out that I'm speaking, I'm trying to speak at a relatively low volume because it is past 1 a.m. and there is a lot of people in this hotel that are trying to get some sleep and I don't want to wake people up. Bear with me. Number two, Paws.com. Health insurers must count co-pays as patient costs court rules. A district judge has overturned a Trump-era federal rule allowing health insurers to exclude co-pay assistance from patients out of pocket costs. The ruling benefits individuals relying on expensive prescription drugs, particularly those with HIV, hepatitis, cancer, arthritis, diabetes and multiple sclerosis. The decision is a victory for patient advocacy groups, including the HIV plus hepatitis policy institute, diabetes leadership council and diabetes patient advocacy coalition representing over 42 million people. The rule implemented in 2020 permitted insurers to divert co-pay assistance benefits away from patients, causing them to pay the amount again before meeting their deductible. The judge deemed the rule conflicting with the Affordable Care Act, arbitrary and allowing insurers to define cost sharing. Patient advocates urged the Biden administration to enforce the decision and prevent further undermining of co-pay assistance. Number three, the Body Pro. PEP use increasing among people with commercial insurance. Recent research on commercially insured individuals in the U.S. reveals a substantial increase in the use of non-occupational post-exposure prophylaxis or NPEP between 2010 and 2019. Now this is the first time I've encountered a distinction between two types of PEP, post-exposure prophylaxis. I thought it was just PEP, PEP is PEP is PEP, but occupational PEP or OPEP, and then there's also non-occupational PEP or NPEP. We are talking about the latter or non-occupational PEP and this is exposure to HIV through sex and or injectable drug use. Occupational PEP is something that would it would be HIV exposure while on the job, like a healthcare service worker or something, maybe getting a needle stick or something like that. Analyzing data from a commercial insurance database, the study found a 515 percent overall increase in NPEP usage with the most significant growth seen among 13 and 24 year olds. However, the absolute numbers of NPEP users remained relatively small. Men accounted for 65 percent of NPEP users and there are regional variations with higher usage in the U.S. south and northeast. The study suggests that factors like the Affordable Care Act, awareness of NPEP and pre-exposure prophylaxis use might contribute to the rise. Gender differences in NPEP usage could stem from lower awareness among women and the study emphasizes the need to explore behavioral factors influencing the demand for NPEP. Number four, the guardian. People with HIV offered hope of a self-injected drug at home. Veeve Healthcare, a joint venture controlled by GlaxoSmithKline or GSK, is working on a long-acting HIV treatment that patients can inject at home every two to three months, potentially reducing clinic visits. Cabotegravir, sold as Cabanova, is currently administered by healthcare professionals every two months. The company aims to develop a formulation with an auto-injector device for patient self-administration at home, likely under the skin, with clinical trials expected to begin in 2026 and the launch by 2030. Veeve is also developing an ultra-long-acting treatment and prevention version that can be injected every four months with potential availability in 2026 for prevention and 2027 for treatment. Now I've talked about long-acting ART before and for me my consensus was always, look, if I have to go to the doctor every one or two months to get a long-acting injection, that's honestly too much for me because having to make those appointments and make sure that I have the schedule and the timing and as I'm saying to you my schedule is overwhelming, the idea of having to go to a doctor's office to get an injection every month or two months is stressful for me. It's much far more easy for me to take a pill once a day every day along with all the other pills that I take for supplements and what have you. However, this is kind of a game changer because hey, and especially if this can be delivered potentially to my home, get a delivery of this auto-injecting device that will give me this long-acting injectable, do it myself at home, click, click, get my injection, don't have to worry about it for months at a time and not having needed to see a health care professional, amazing. Now we're talking, now this is something that I could get on board with. We'll keep following that and I want to remind you at this point to please like this video if you're enjoying it. It helps boost YouTube's support of my content. Number five, health policy watch. PEPR limps into uncertain future after failure of US Congress to authorize five-year plan. I remember talking about this previously and it was this like kind of blasé feeling about the struggle to get this authorized and it's kind of expected, it's going to happen, don't worry too much, but I had my doubts and I had my skepticism especially with the current political climate and here we are. The US Congress's failure to reauthorize the five-year budget for the president's emergency plan for AIDS relief also known as PEPR by its September 30 deadline has raised concerns about the future of the world's largest aid program for global health. Although PEPR can continue providing services in the short term, the lack of reauthorization sends a message that the US is backing down from its leadership in ending HIV AIDS as a public health threat. While the Biden administration supports a five-year authorization, reauthorization, certain programs' authorizations have expired prompting uncertainties about the program's future. Anti-abortion campaigning has complicated matters linking PEPR grantees with the promotion of abortion despite legal restrictions. The situation may impact the stability and effectiveness of PEPR's contribution to HIV AIDS prevention and treatment globally. Unfortunate news. Number six, NPR. PEPR prevents HIV infections but it's not reaching black women. Despite being a crucial tool in preventing HIV, pre-exposure prophylaxis or PEPR faces barriers to uptake among cisgender black women in the United States. Systemic factors such as stigma, racism, and a lack of awareness contribute to this issue. Non-inclusive marketing, limited treatment options, and medical professionals' reluctance to prescribe PEPR are key challenges, particularly in the South, which has the highest rates of new HIV diagnoses. The FDA has approved three PEPR drugs, but the newest, Descovy, wasn't tested on people assigned female at birth. Overcoming these barriers requires changes in messaging, marketing, and providing resources to empower black women to take control of their health, overcoming stigma as well. And just as importantly, training or often re-training of those in health care, the article shares the story of Alexis Perkins who went to her OBGYN's office in Atlanta and the medical assistant had never even heard of PrEP and her OBGYN had heard of PrEP but wasn't confident enough to actually prescribe it to her and she's currently still looking for someone to prescribe her PrEP. That's a travesty. Number seven, DNA magazine. Should gay men be taking a, quote, morning after pill to prevent STIs? The CDC thinks so. For sexually active gay and bisexual men and transgender women, the CDC is proposing new guidelines that include a form of post-exposure prophylaxis, PEP, like we discussed, called doxycycline to reduce the risk of sexually transmitted infections. Make note, I've talked about PEP as it relates to HIV, but not in the context of other STIs. So this is a drug for other STIs. The study involved two groups, one taking a dose of doxycycline after sexual activity and the other not. The doxycycline group had an STI rate of 10 percent, while the other group had a rate of 30 percent of getting STI transmission. However, the CDC suggests caution in implementing doxycycline as a preventive measure, recommending it only for groups at high risk of STI transmission due to concerns about potential long-term development of antimicrobial resistance and impacts on the microbiome. Monitoring and evaluation are called for as more data become available. Number eight, gay times. More gay and bisexual men got tested for HIV than ever before in England last year. In England, the UK Health Security Agency reports recorded HIV testing among gay bisexual and other men who have sex with men in 2022 with 192,503 tests up from 156,865 in 2019. The number of heterosexual adults tested for HIV remains below pre-COVID-19 levels. The use of PEP increased from 61,510 to 86,324 between 2021 and 2022, but disparities in uptake persist based on sexual orientation. The data also indicates a decrease in HIV diagnoses among gay bisexual men who have sex with men, but an increase in heterosexual adults, particularly in women outside London and ethnic minority groups. Overall, there were 3,805 diagnoses in England in 2022, reflecting a 22 percent increase from 3,118 in 2021. The report highlights progress in HIV prevention efforts, but underscores the need for targeted interventions to address disparities. Sexual health organizations emphasize the urgency of accelerated action to meet the goal of ending new HIV transmissions by 2030. It's interesting to note in a couple areas now, based on the latest news that I've been covering in the past few weeks, that in particular areas, the incidence rates of HIV transmission has been decreasing for the gay bisexual men who have sex with men, portion of the population, and on the rise for heterosexual folks. It's alarming, it's concerning, it's great to see that messaging, marketing, and our efforts are working for gay bisexual men who have sex with men, but now we really need to make sure that we are including everybody as this continues to underscore the fact that HIV is not a gay disease. Number nine, Medical Express. TB vaccine discovery paves path to end top killer of people living with HIV. Scientists at the University of Pittsburgh School of Medicine have found a potential tuberculosis vaccination strategy that could prevent TB, the leading cause of death among people with HIV worldwide. The commercially available TB vaccine, Basil Calmet-Garon, or also known as BCG, and I'll refer to that from now on, it's been around for over a hundred years, was administered intravenously to monkeys infected with simian HIV or SIV, successfully preventing lung infection, which has been a challenge for TB vaccination in humans. It's currently injected beneath the skin, and the fear is that direct injection into the bloodstream could be harmful to those with weakened immune system due to HIV, since it is a live bacteria vaccine. This is the reason BCG is typically contraindicated for people living with HIV, and contraindicated simply means it should not be used in people living with HIV. Fancy way of saying it's not, it's not recommended, it shouldn't be used. However, about three weeks after the vaccination in monkeys, they were given antibiotics to kill all the live bacteria in the vaccine, preventing unwanted disease in the immunocompromised monkeys, while still having given enough time to stimulate the immune system to then protect against TB. So this is kind of like playing the fire a little bit. You know, we're putting our hand over the flame long enough to burn the tick off the hand, and then removing our hand from the flame just in time so that we're not actually burning our hand, burning our skin to use an analogy. The discovery is significant as one in three people with HIV die from TB, and the existing BCG vaccine offers minimal protection against lung infections. The study suggests the potential for a new TB vaccination strategy for individuals living with HIV. Although further research is needed to make the approach practical for widespread use, and I say this because in parts of the world, an antibiotic dose administered weeks after a TB vaccine, it was maybe impractical for socioeconomic reasons, poor healthcare infrastructure, and so on, but the promise of developing new strategies from these findings is very helpful. And a reminder to please subscribe to my channel and hit that bell so you get a notification every time a new video comes out. Number 10, AJMC, American Journal of Managed Care. Tailoring and health. HIV interventions is key for equity of access in Latinx patients. This study highlights the need for more tailored mobile health interventions to address the health disparities faced by Latinx people living with HIV in the United States. The Conexiones Positivas, or CP, app designed for self-monitoring mood, stress check-ins, and medication reminders aims to bridge this gap. The study involves Spanish-speaking people living with HIV using the CP app with interviews assessing user experiences. Results showed the app was easy to use, with positive effects on medication adherence, mood, stress, and client-provider communication. Challenges included mental health struggles, stigma, and life stressors. Participants suggested improvements such as more information on HIV and interactive elements. The study emphasizes the potential of tailored mHealth solutions for Latinx people living with HIV, but also highlights areas for improvement. Number 11, Courthouse News Service. HIV drugmaker will pay $246 million to settle suit over generic meds delay. A federal judge has granted preliminary approval to a $246.75 million class action settlement between Gilead Sciences and KPH Health Services over allegations of anti-competitive practices. The lawsuit accused Gilead of colluding with Teva Pharmaceuticals to delay the entry of generic versions of HIV drugs to market, a practice known as Pay for Delay. The settlement follows a jury trial where Gilead was initially cleared of violating antitrust laws. The settlement will establish a fund benefiting the class of direct customers who purchase drugs such as Truvada or a Tripla from Gilead. The final approval hearing is scheduled for January 18, 2024. Number 12, ACS Publications. BCL2 Antagonist Obatoclax reactivates latent HIV-1 via the NFKB pathway and induces latent reservoir cell apoptosis in latently infected cells. I'm smiling as I'm reading this because to most of you this is just going to be blah blah blah war jargon. I'll explain those, bear with me. I don't have access to view the full study. I could only read the abstract or the summary. I mentioned this recently about being paywalled out of science articles and how that's a true barrier for community to have access to science and research. I've since mentioned this to the community engagement coordinator for the HOPECAB, Patricia de Feshoreau. Some of you may have seen our interview that we did together earlier this year and we're trying to come up with a solution so I can access these articles on a regular basis for you all. Okay, on to the article. I'm going to give you the summary of the article. It's going to be a little bit confusing and then I'm going to go back and I'm going to define some terms and kind of break down what the summary is saying. Researchers have identified a potential candidate obatoclax as a latent HIV-1 reservoir activator, LRA, for the shock and kill strategy into achieving a functional cure for AIDS. The strategy involves reactivating latent HIV and then eliminating it with the immune system itself or antiretroviral drugs. Obatoclax, a pan-BCL2 antagonist demonstrated effectiveness in inducing HIV-1 reactivation in latently infected cell lines and CD4T cells of people living with HIV induces apoptosis in latently infected cells. Okay, so I'll explain a few things here to the best of my ability. Apoptosis, let's define what that is, it's a natural biological process that allows cells to self-destruct, also known as programmed cell death. Apoptosis, cell death. BCL2 is a protein in cells that regulates apoptosis or cell death. BCL2, when doing its job, prevents cells from self-destructing from dying. By blocking BCL2 in cells, cell death can occur. BCL2 is no longer able to prevent the cell from dying, so cells start dying. And so obatoclax is a BCL2 antagonist. Obatoclax, in other words, prevents BCL2 from doing its job in the cell and therefore those cells start to die in a process known as apoptosis. These properties make obatoclax a promising candidate for further investigation, so the shock and kill. So I've talked from the HOPE Collaboratory, our strategy for achieving HIV cure is block-lock, excise now called block-lock stop. This is another modality, a strategy towards HIV cure called shock and kill. Basically, what they're doing is, when we are under successful ART, we have these latent reservoirs of HIV, they're inactive for the most part, kind of just sitting there not replicating or anything, and those are the HIV, the cells that we have trouble getting to. We're able to get the free-flowing cells that are in our blood, traveling through our body, we're able to kill all that. It's the latent reservoir. That's why we can't cure HIV at this point, because the latent reservoir is hard to get to. So the idea is, if we can somehow turn on those cells in the latent reservoir, reactivate them again. Once they're reactivated, either the immune system can now see them and target them and kill them, or our ART that we take on a daily basis can kill them. So that's the strategy. Shock is just waking up the reservoir so that it's active again and then kill, pretty straight forward. Okay, number 13, the body. Can you get HIV from someone on PrEP? Interesting question. The article discusses the risk of acquiring or transmitting HIV when one partner is on pre-exposure prophylaxis. If a partner is on PrEP, the likelihood of transmitting HIV is extremely low. As PrEP users are not living with HIV, typically, clinicians typically conduct HIV tests before prescribing PrEP to ensure the patient is HIV negative. Although there's a slim chance of undetective HIV or poor adherence, it's rare. PrEP has proven highly effective in preventing HIV, reducing the risk by up to 99% in certain populations. The article emphasizes understanding PrEP's effectiveness, considering condom use as an option, and communication between partners for informed decisions on safer sex practices. One thing that I don't think I noted in the article is that if you have concern about getting HIV from someone who is on PrEP, there's also the consideration that you yourself can seek a prescription to be on PrEP yourself, and that is part of taking your sexual health into your own hands and not relying on someone else to protect you, right? So while someone may have been tested for HIV while they're in the window period where it doesn't show up in the tests, they appear negative, and so their doctor prescribes them PrEP, they start taking PrEP, but it's ineffective because they've already have acquired HIV. That is a possibility. It's extremely rare, but in that rare case, if you yourself also happen to be on PrEP or you've chosen to use condoms, etc., then you are really taking control of that yourself. So I say that because I don't think it's something that's worth stressing and having anxiety over when there are options for you. And last but not least, number 14, AIDS map. Defective HIV particles may drive inflammation despite long-term viral suppression. Those of you who've been following the content, I've been talking about this recently. There's chronic inflammation that happens in the body and it's great to see another article that is covering this topic because it's extremely important for those of us who are living and thriving with HIV as we age. The article explores the connection between persistent low-level inflammation in people with HIV and defective HIV particles shedding light on the potential cause of worsened health outcomes. The study suggests that even when the virus is undetectable due to treatment, defective HIV particles continue to produce viral components contributing to ongoing inflammation. These defective viruses unable to replicate or infect new cells act as triggers for the immune system leading to a constant inflammatory state. The research highlights the significance of these defective particles in understanding the health challenges faced by individuals with HIV, emphasizing the need to explore immune system-focused approaches for improved HIV treatment. I'm continuing to focus attention on this. This is a key for all of us living with HIV. Increased risk for comorbidities come as a result of this chronic inflammation, understanding what those risk factors are, and more importantly, what can we do to help support our immune system and reduce the stress of chronic inflammation on it, right? Because the intention for me of providing you with all this information in this education is not so that we can start worrying more and start feeling more victimized by the HIV that we're living with, but rather to help empower us so that we can make decisions so that we can inform ourselves so we can advocate and take back the control of our life away from HIV and more for ourselves, so that we can live our life meaningfully and with purpose in the way that we want to. Links to all these articles are in the description box below this video. Please share this with anyone who might find value in this content. That is the best way that you can help support me and my channel. Until next time, cheers.