Today's HIV Profile

The Conference on Retroviruses and Opportunistic Infections (CROI) annually assembles researchers from around the world to share the latest studies, important developments, and best research methods in the ongoing battle against HIV/AIDS, and related infectious diseases. CROI translates basic, and clinical investigation into clinical practice, and the 2018 CROI, held in March 2018, demonstrated how far our understanding of HIV has come in the last 30 years. It also revealed some cutting-edge science.

The journalTopics in Antiviral Medicinehas published a summary of CROI's key findings. Written by the Clinical Research Director of Bridge HIV at the San Francisco Department of Public Health, the summary reveals several areas of challenge or advancement.

Since 1997, the annual number of new diagnoses fell, from approximately 60,000, to 40,000 in 2016. While this is good news, the bad news is that the proportion of men who have sex with men (MSM) increased from 35% to 70%. Additionally, new diagnoses in the Unites States' southern states increased significantly, from 37% to more than 50%. States with the highest rates of new infections include Florida, Texas, Georgia, and North Carolina, and these states alone account for 62% of new infections.

The author reports that HIV infection is increasing in rural areas, and its epidemiology is significantly different when it moves out of the city and into the country. Public health agencies in rural areas with previously low numbers of HIV infection need to be prepared to respond quickly, especially when outbreaks occur in clusters. Young age is still a serious risk factor for HIV infection, regardless of sex or mode of transmission.

Increasingly, researchers and clinicians who work with people living with HIV are concerned about accidental or intentional drug overdoses. At this convention, experts indicated that overdose deaths increased between 2013 and 2016. In 2013, 35.5 deaths per 100,000 population were recorded. By 2016 that number had increased to 53.8 of 100,000 population. Roughly 7% of overdose deaths were intentional, indicating that the vast majority are accidental.

Phylogenetic analyses (looking at the virus's evolution using genetic markers) took center stage. A compelling study of phylogenetic surveillance activities found a likely source of transmission for 84% of recently infected individuals. They were unable to find many sources locally, making the case for national databases. Remarkably, 47% of likely sources were unaware of their infection at the time of transmission. This means that phylogenetic surveillance activities could allow earlier diagnosis, and prevent further transmission.

Reference

Buchbinder SP, Liu AY. CROI 2018: Epidemic trends and advances in HIV prevention.Top Antivir Med. 2018;26(1):1-16.