HPTN at CROI 2016

The HIV Prevention Trials Network (HPTN) research agenda remains focused on optimizing and developing new agents for pre-exposure prophylaxis (PrEP) and integrating the use of various interventions to prevent HIV infection. During the 23rd Conference on Retroviruses and Opportunistic Infections (CROI) in Boston, HPTN researchers presented findings from several key studies including HPTN 069, HPTN 071 and HPTN 073. 

Optimization of FTC/TDF 
PrEP remained a topic of intense discussion during this year’s conference as results from several HPTN studies were presented. HPTN 073, one of the first studies to evaluate the optimization of TDF/FTC for PrEP among U.S. Black men who have sex with men, demonstrated the benefit of a novel coordinated counseling model (C4) in enhancing the uptake of FTC/TDF in this population. According to HPTN 073 Protocol Chair Darrell Wheeler, PhD, MPH, “Black men who have sex with men remain at disproportionate risk of HIV acquisition, comprising less than 0.4 percent of the U.S. population, yet they accounted for more than 20 percent of all new infections in 2013. It is heartening that use of coordinated counseling intervention with the offer of emtricitabine/tenofovir for PrEP resulted in high uptake of PrEP and offers the possibility for its use in future efforts.” For more information, please read: HPTN 073 Fact Sheet 

New Agents for PrEP 
Findings from the HPTN 069/ACTG 5305 study were presented by Protocol Chair Roy Gulick, MD, MPH. The study evaluated the safety and tolerability of maraviroc-containing drug combinations in HIV uninfected men who have sex with men and women. The study findings indicate maraviroc-containing regimens were comparably safe and well-tolerated when compared to FTC/TDF. Of five seroconversions out of the 406 enrolled in the men’s cohort, all were associated with low, variable, or undetectable drug levels. It should be noted that the study was not powered for efficacy. Ian McGowan, MD, PhD delivered a second oral presentation of the men’s cohort tissue sub-study results that concluded, in an explant model, maraviroc alone may be less effective at preventing HIV than combination antiretroviral drugs. These findings need to be correlated with pharmacokinetic and pharmacodynamic adherence data.

Integrated Strategies for HIV Prevention 
HPTN continues to evaluate integrated strategies that include effective interventions for HIV prevention. HPTN 071 (PopART) is a study being conducted in South Africa and Zambia to assess whether a combination prevention package centered on house-to-house voluntary HIV testing and immediate initiation of antiretroviral therapy, can substantially reduce the number of new HIV infections in communities. 

Presentations from HPTN 071 (PopART) demonstrated progress in the implementation of the intervention and lessons learned to date. An oral presentation by Michael Pickles, PhD, concluded traditional male circumcision, as practiced by various ethnic groups in South Africa and Zambia was associated with higher HIV prevalence than voluntary medical male circumcision. An oral presentation by Sarah Fidler, PhD, concluded the delivery of a home-based combination HIV intervention package resulted in a substantial increase in population level ART coverage by the end of round one of home visits by the study community workers. ART coverage may continue to increase in later rounds of the study intervention as more adults link to HIV care and as health messages of universal HIV treatment become more widely understood and accepted. An oral presentation by Comfort Phiri concluded screening for tuberculosis (TB) using a simple screening tool as part of a community-wide household HIV intervention was feasible and can contribute to active case finding and linkage to TB care. Finally, Helen Ayles, MD, Zambia PI for the study gave a symposium talk on how to engage men in HIV programs. She shared some of the data from HPTN 071 (PopART) study as well as findings from other studies. 

Electronic posters are available on the CROI and HPTN websites. 

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