At the 19th Conference on Retroviruses and Opportunistic Infections (CROI) in Seattle, the HIV Prevention Trials Network (HPTN) announced results from its HPTN 064 Women’s HIV Seroincidence Study (ISIS) which found an HIV incidence of 0.24% in the study cohort of 2,099 women (88% black), a rate that is fivefold higher than that estimated for black women overall by the Centers for Disease Control and Prevention (CDC). The rate noted in the HPTN 064 (ISIS) study is comparable to estimated HIV incidence rates in the general population in several countries in sub-Saharan Africa including the Congo (0.28 %) and Kenya (0.53%), underscoring the substantial ongoing HIV transmission within specific US populations, including women at risk as defined in this study. The six geographical areas in the US chosen for the study are locations where HIV and poverty are known to be more common.
Hodder, who also is director of the HIV/AIDS Program in the Division of Infectious Diseases of New Jersey Medical School, said about the findings, “We have known that black women in the US are disproportionately impacted by HIV, however, the magnitude of this disparity in areas hardest hit by the HIV epidemic underscores the gravity of the problem.”
Women constitute roughly one-quarter of new HIV infections in the US with 66 percent of these infections occurring among black women, although black women constitute only 14 percent of the US female population. In the US, the age-adjusted death rate of black women with HIV is roughly 15 times higher than that observed for HIV-infected white women. “Despite prevention efforts in the last 30 years, the reality is that we still have ongoing HIV transmission in the US that requires focusing prevention efforts,” said Hodder.
While at CROI, Hodder also described additional research that is focused specifically on Newark. Using data on the HIV-positive population in Newark collected from 2002-09, Hodder and a team of researchers created a model to predict which interventions might be most effective in controlling the epidemic. The four interventions tested were 1) increased HIV testing coverage, 2) decreased time from infection to testing, 3) decreased dropout of patients from treatment programs, and 4) improved use of therapies to suppress viral load in people who are infected. The model suggests that the best approach by far would be a combination of all four of those interventions, leading to a projected reduction the incidence of infection by 39% and in the number of deaths by 45.8%. No single approach among the four is projected to achieve results that are even half as positive as combining all of the interventions within the affected population.
HPTN 064 (ISIS) Study Background:
The HPTN 064 (ISIS) study, funded by the National Institute of Allergy and Infectious Diseases (NIAID) of the National Institute of Health, enrolled a total of 2,099 women, ages 18 to 44 years, between May 2009 and July 2010. Eighty-eight percent of women were black, 12% Hispanic/Latina. Women were enrolled from 10 communities in six distinct geographical areas in the northeast and southeast regions of the US; Atlanta, GA, Raleigh-Durham, NC, Washington D.C., Baltimore, MD, Newark, NJ, New York City, NY.
The study used a novel approach to recruit participants, focusing on geographic areas of the US with the highest HIV prevalence rates in women, i.e. ‘hot spots’. Women without a prior positive HIV test living in areas with high HIV prevalence and poverty were eligible for enrollment and were interviewed about many key aspects of their lives including mental health, sexual behavior, history of sexually transmitted infections (STIs), domestic violence, social support, financial insecurity and health care utilization.
Another significant finding from the study is the high number of women who were found to have HIV infection at the time of enrollment (32 women or 1.5%). These women were previously unaware of their HIV status. This finding highlights the need to increase awareness of HIV risk and expand novel HIV testing and prevention efforts in high prevalence areas of the US.
“The study provides convincing evidence that more effort is needed to develop effective prevention strategies for high risk populations in order to stem the HIV epidemic in the US,” said Sten Vermund from Vanderbilt University, Principal Investigator of the HPTN.
The University of Medicine and Dentistry of New Jersey (UMDNJ) is New Jersey’s only health sciences university with more than 6,000 students on five campuses attending the state’s three medical schools, its only dental school, a graduate school of biomedical sciences, a school of health related professions, a school of nursing and New Jersey’s only school of public health. UMDNJ operates University Hospital, a Level I Trauma Center in Newark, and University Behavioral HealthCare, which provides a continuum of healthcare services with multiple locations throughout the state.