HIV confab highlights SF research

by Liz Highleyman

The recent Conference on Retroviruses and Opportunistic Infections featured the work of San Francisco experts, including studies of long-acting injectable HIV treatment and antibiotics to prevent sexually transmitted infections. Highlights from CROI were discussed at the March 9 meeting of the San Francisco Getting to Zero consortium.

Though primarily an HIV meeting, CROI, which took place last month in Seattle, also includes breaking research on new infectious diseases, which this year included COVID-19 and mpox. Mpox has declined dramatically in the Bay Area and across the country, but it still poses a threat to vulnerable people, including those with untreated HIV.

At the conference, Dr. Chloe Orkin of Queen Mary University of London presented results from an analysis of nearly 400 HIV-positive mpox patients in 19 countries, mostly gay men, who had a CD4 T-cell count below 350. Many developed severe manifestations, including extensive lesions, tissue death, and lung involvement. No one with a CD4 count above 200 died, but mortality reached 27% for those with a count below 100.

The presentation of mpox is “very starkly different” among HIV-positive people with advanced immune suppression, Orkin said at a CROI press briefing. She and her colleagues argue that mpox should be considered an AIDS-defining opportunistic infection.

In San Francisco, “we saw some really extreme mpox cases, mainly in people with low T-cell counts,” Getting to Zero co-chair Dr. Diane Havlir of UCSF said at the recap meeting.

“People did not get [severe mpox] if they were taking HIV treatment and had viral suppression. We absolutely can’t let our guard down.”

Dr. Susan Buchbinder of UCSF and the San Francisco Department of Public Health presented further details about the latest HIV vaccine failure at CROI.

As the Bay Area Reporter previously reported, the Mosaico trial, which included 30 participants in San Francisco, was halted ahead of schedule in January after interim results showed that a combination vaccine regimen did not provide protection. The HIV incidence rate was 4.1 cases per 100 person-years in both the vaccine and placebo groups. Researchers are now focusing on broadly neutralizing antibodies and more sophisticated vaccine approaches, some of which use the same mRNA technology as COVID vaccines. “There’s a really robust pipeline” of new prevention strategies, Buchbinder said.

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