This blog is adapted and cross-posted from HIV.gov.

The AIDS 2024 conference is taking place in Munich, Germany. HIV.gov is providing daily coverage. Here are four updates:

NIH

Louis Shackelford, M.P.H. of the HIV Vaccine Trials Network spoke with Carl Dieffenbach, Ph.D., director of NIAID’s Division of AIDS. They discussed the case report of the “Next Berlin patient,” a person living with HIV who is now in remission off of antiretroviral therapy following a stem cell transplant. Dr. Dieffenbach explained that this transplant was unique because both the donor and the recipient had a genetic makeup not previously seen in similar HIV cure case reports. They also discussed how this approach is only possible in unique circumstances when someone has a condition such as a cancer that requires a stem cell transplant, and discussed other approaches being explored for scalable HIV cure. Among them, he discussed the use of HIV broadly neutralizing antibodies—antibodies that bind to parts of HIV that remain relatively stable even when it mutates—in cure research. Finally, they discussed a new analysis from a large study of long-acting injectable cabotegravir (CAB-LA) for HIV pre-exposure prophylaxis (PrEP). Learn more about their conversation below:

Dismantling Inequities

Earlier in the day, Office of Infectious Disease and HIV/AIDS Policy's Kaye Hayes, M.P.A, talked with White House Office of National AIDS Policy Director Francisco Ruiz, M.S., about a panel he participated in about dismantling inequities that influence the HIV epidemic. Francisco said it is important to tailor interventions and approaches to regions and be intentional about including people with lived experience to help inform policies and programs. Learn more about their conversation below:

U=U University

HIV.gov director Miguel Gomez spoke with CDC’s Monique Carry, Ph.D., Deondre Moore and Jesse Milan, J.D., of the Presidential Advisory Council on HIV/AIDS (PACHA), about the Centers for Disease Control’s U=U University and toolkit developed in partnership with the Prevention Access Campaign and released during the pre-conference. The U=U toolkit is a community-led health message and global campaign to communicate the science behind the message of U=U, or undetectable equals untransmittable. Our colleagues also highlighted the important impact U=U is having globally and for individuals with HIV. Learn more about their conversation below:

Doxy PrEP

On Monday, Kaye Hayes spoke with Troy Grennan, M.D., physician lead for the Provincial HIV/STI Program, British Columbia Centre for Disease Control and Clinical Associate Professor, University of British Columbia, about research findings he shared on the potential of doxycycline as pre-exposure prophylaxis for STIs, or Doxy PrEP. While Doxy PrEP is not yet available, the work builds on previous studies. In a small pilot study of men living with HIV, researchers looked at the efficacy, tolerability, and use patterns of Doxy PrEP. They found that doxycycline was well tolerated overall, and observed 79%, 92%, and 68% reductions in syphilis, chlamydia, and gonorrhea respectively in the group who took doxycycline compared to those who took a placebo. Learn more about their conversation below:

About AIDS 2024

The International AIDS Conference is the world’s largest conference on HIV and AIDS. Held July 22-26 in Munich, Germany, AIDS 2024 brings together an estimated 15,000 scientists, policymakers, healthcare professionals, people living with HIV, and others at the intersection of science, advocacy, and human rights. The conference features more than 200 sessions, including plenaries, symposia, oral abstracts, workshops, Global Village activities, pre-conferences, and satellites. Visit the conference website for more information.

Follow, watch, and share coverage of the conference on HIV.gov’s Facebook page, Twitter/X, YouTube, and the LinkedIn page for the HHS Office of Infectious Disease and HIV/AIDS Policy.

As syphilis rates continue to rise in the United States, emergency departments may be a way for people with limited healthcare access to get screening and treatment. A NIAID study derived an emergency department syphilis screening strategy to help people get diagnosed before their infection reaches an advanced stage. This approach could reduce disease burden and prevent cases of congenital syphilis, in which the bacteria are passed from a birth parent to their infant. The findings were published today in Open Forum Infectious Diseases. 

Syphilis, caused by the bacteria Treponema pallidum, is a common sexually transmitted infection (STI). Untreated syphilis can cause nervous system and organ damage, as well as pregnancy complications for birth parents and their infants. In the United States, adult and congenital syphilis cases have increased by 78.9% since 2018, with a drastic 17% increase in 2022 alone. The syphilis surge has disproportionately burdened historically and medically underserved populations. These health disparities underscore the need for greater access to syphilis testing and treatment resources. 

Researchers analyzed blood samples retrospectively from 1,951 adults who presented to a Baltimore emergency department over the course of a month in early 2022. They found 103 people (5.3%) had detectable treponemal antibodies to syphilis, which are indicative of a previous or active syphilis infection. Of them, 23 people (22%, 1.1% overall) had high non-treponemal antibody levels, which indicate active syphilis. The study investigators prioritized identifying people with active syphilis and performed statistical analyses to determine the associated risk factors to inform a potential screening strategy.  

The proportion of samples with active syphilis was highest among people with HIV and people without a primary care provider. Among women with active syphilis, eight out of nine (88%) were between the ages of 18 and 49 years, which is defined as the window of reproductive age. Statistical analyses demonstrated that screening people living with HIV, without a primary care physician, and women aged 18 to 49 years would have identified 21 of the 23 people (91%) with active syphilis in the participating emergency department.

Typically, emergency departments only screen people for syphilis if they present with symptoms consistent with primary or secondary syphilis. According to the authors, the findings demonstrate the advantages of conducting focused syphilis screening during routine emergency department visits, particularly for communities who may have limited access to health care. They suggest that implementing a screening strategy informed by this study could help address the underdiagnosis of syphilis while expanding the reach of effective prevention and treatment, reducing the burden of adult and congenital syphilis. Finally, the continued syndemic of HIV and syphilis—two epidemics that interact with each other, with adverse effects on the health of communities—highlights the opportunity to provide comprehensive HIV and STI prevention and care in the emergency department, where people with high incidence frequently seek care. 

Reference: 

J Hunt, et al. A Potential Screening Strategy to Identify Probable Syphilis Infections in the Urban Emergency Department Setting. Open Forum Infectious Diseases. DOI: https://doi.org/10.1093/ofid/ofae207 (2024).