The spring HIV/ARV Update brought expert presentations about scientific findings on hepatitis B and HIV co-infection, breastfeeding policies, HIV cure strategies, and more.
China’s chief epidemiologist addresses the country’s HIV epidemic
Dr. Zunyou Wu-Chief Epidemiologist, China Centre for Disease Control and Prevention (China CDC), and Director of Division of HIV Prevention, the National Centre for AIDS/STD Control/China CDC-was a featured speaker at the BC-CfE Spring HIV/ARV Update. He shared China’s unique experiences in addressing the HIV and AIDS epidemic, presenting that an estimated 30% of people living with HIV in the country remain undiagnosed today despite a boost in testing efforts. China has ramped up testing efforts: over 240 million HIV tests were completed last year alone.
“While the seek and treat approach does work, the population size of China makes it more challenging to control the epidemic,” said Dr. Wu. “China needs to do everything possible: education, condom promotion, destigmatizing those infected, among other measures.”
China began collaborating with BC in 2009 to tackle its rising rates of HIV and was the first nation to formally announce its adoption of the BC-CfE-pioneered Treatment as Prevention¨ (TasP¨) strategy in 2011.
Importance of addressing syndemics of HIV and hepatitis B
Recent studies show that 35% of patients are not receiving curative hepatitis B treatment in cases where they are co-infected with HIV.
Dr. Mark Hull, a researcher at the AIDS Research Program (a collaboration between St Paul’s Hospital and University of British Columbia) spoke of his experience treating an estimated 7-10% of HIV patients who are co-infected with HIV and hepatitis B. Dr. Hull stressed the importance of addressing these syndemic infectious diseases, particularly as HIV has the effect of increased risk of cirrhosis among individuals co-infected with hepatitis B.
HIV and hepatitis B both require treatment over a patient’s lifetime. Dr. Hull said we need “a system in place to ensure individuals are being appropriately treated for both viral infections, particularly as co-infection increases the risk of progressive liver disease and liver-related mortality.”
Providing infant feeding support for pregnant women living with HIV
Dr. Chelsea Elwood, Clinical Assistant Professor in the Department of Obstetrics and Gynecology at UBC, and health care provider at Oak Tree Clinic, spoke about the challenges faced by her pregnant patients living with HIV when deciding whether to breastfeed their infants.
While HIV treatment can make the viral load undetectable and, therefore, untransmittable in blood and sexual fluids, breast milk can remain a vehicle for HIV transmission. Breastfeeding results in about 50% of new HIV perinatal transmissions worldwide, but little research is done in high-income countries where antiretroviral therapy is more accessible. In high-income countries where access to clean water and formula is available, Dr. Elwood recommends formula feeding to eliminate the risk of breastfeeding transmission, with close prenatal and postnatal support to the mother and the family.
“What we have found is that every woman really wants the best outcome for her baby,” said Dr. Elwood.
“We believe that the risk of perinatal transmission of HIV should be zero in the province of BC,” continued Dr. Elwood. “We believe that hep B should be the same and we are working really hard to make HCV (hepatitis C virus) the same.”
Target is now long-term HIV remission
Currently, an individual who is on sustained HIV treatment can achieve an undetectable viral load allowing their health and longevity to improve. However, when treatment is interrupted the virus can rebound-which is a barrier to an HIV cure or remission. Dr. Mark Brockman, BC-CfE Associate Researcher and Associate Professor in the SFU Faculty of Health Sciences explained scientists now know that HIV develops a latent (or dormant) viral reservoir.
Research continues to build on our knowledge of how the virus diversifies in the body and persists within this reservoir. The question remaining for achieving HIV cure or long-term remission is: “How can we disrupt this latent reservoir?” Dr. Brockman provided an update on potential therapies that could target and eliminate the viral reservoir, saying in vivo and in vitro studies have been promising.
Dr. Zabrina Brumme, Director of the BC-CfE Laboratory, spoke to the use of the CRISPR-Cas9 targeted genome editing system as a tool in HIV research, including research towards an HIV cure.
Research into the use of gene editing technologies in HIV eradication is supported by a historic case of an HIV cure. A second and more recent possible case of HIV cure achieved through a bone marrow transplant from a donor with a naturally occurring mutation in the human CCR5 gene, rendered the resulting protein non-functional. CCR5 is necessary for HIV to enter cells in the body.
The HIV virus uses human proteins at every stage of its life cycle. Dr. Brumme explained how CRISPR-Cas9’s research use, knocking out certain proteins, could help identify which ones may be essential to the replication of HIV. Equipped with this knowledge, potential therapies and strategies could be developed to enhance host proteins, knock them out, or even excise the viral genome.
“There are many challenges to the CRISPR-Cas9 technology”, said Dr. Brumme, “However, it is a powerful technology and easy to use…It is possible, one day in the future, we may see these technologies in the clinic. But we need to be careful, as it raises important ethical questions that will need to be addressed.”
Look for the next upcoming HIV/ARV update, coming up in the fall on October 21.
Watch the videos of the full HIV/ARV lectures online. Here’s a quick peek at what was covered at the health care education event: