HIV updates

December 4, 2023

This human T cell (blue) is under attack by HIV (yellow), the virus that causes AIDS. The virus specifically targets T cells, which play a critical role in the body's immune response against invaders like bacteria and viruses.

This page includes the latest East Bay HIV updates, which include practice-changing studies and developments. Please click here to share feedback.

East Bay HIV updates

Click here to vote on your HIV priorities! It’s time to update our East Bay HIV strategic plan and decide on what efforts we will focus on for the next year. We’d love to include your thoughts, ideas and feedback.
In case you missed the 2023 World AIDS Day (WAD) commemoration event on November 30th, you can read about it and watch the recordings here.

New HIV/STD resources for 2023

updated December 2023

IDWeek 2023: click here to read a rapid review of the HIV studies by Dr. Paul Sax.
Check out our new PIP: HIV PEP-in-Pocket page! PIP is providing a HIV post-exposure prophylaxis (PEP) prescription for HIV-negative people who have 0-4 high risk HIV exposures per year. There are lots of effective HIV medical prevention strategies to choose from now!

The 2023 updates of the HIV Essentials and Quick Clinical Guides are now available for free download! This collection of updated guides now includes injectables and can also be downloaded as separate documents:

2-pager on HIV testing, rapid ART, PEP and PrEP
2-pager on HIV health care maintenance
And more detailed 3-6 page guides and protocols on:

Check out our Injectables webpage! You can find the latest East Bay resources and updates on injectable HIV medication and PrEP on this page.
Injectable Sunlenca (lenacapavir, or LEN) is available on Medi-Cal and ADAP. Sunlenca is a long-acting injectable HIV medication (capsid inhibitor) taken every 6 months for people who have drug-resistance has been a Medi-Cal pharmacy benefit since March 1 and on the CA ADAP formulary starting April 25, 2023. Prior authorization is required for ADAP coverage due to its high cost.

DoxyPEP for sexy peeps! Our new East Bay doxy-PEP resource guide has been posted and will be kept updated as new data, guidance and resources become available.
The East Bay Rapid ART quick guide has been updated with the latest guidelines and practices. Many thanks to Drs. Doug White and Sunny Lai and the Highland ED and HIV teams for collaborating with us on this guide! GTZ-SF has also recently updated the GTZ-SF Rapid ART guide.
Do you have new staff who want HIV training? Check out our Quick start guide for new HIV staff with free trainings and East Bay HIV resources recommended for case managers, clinicians, nurses, pharmacists and HIV all care team members.
Updated national pediatric HIV guidelines released in April include a shorter course of post-partum AZT prophylaxis (2 weeks instead of 4-6 weeks) for infants born to people living with HIV, and recommendations for shared decision-making around breast/chest-feeding with sustained undetectable viral loads.
Updated perinatal HIV data (here and here; data from 2010-2019) found that the U.S. is approaching the goals set in 2012 for a perinatal HIV transmission rate below 1%, though disparities still persist. Infants born to Black parents have higher rates of HIV diagnosis, and infants born to Latinx parents still have HIV transmission rates higher than 1%.
Alameda County released a health advisory on xylazine (“tranq”), a veterinary sedative detected in combination with fentanyl and other substances in a rising number of overdose deaths, particularly in the northeastern United States. Click for: more info on xylazine from CDPH, xylazine info and wound care handouts (PDF) in English and Spanish.
There has been a Penicillin G Benzathine shortage (Bicillin L-A® or “BIC”) since April 2023. ACPHD recommends that Benzathine penicillin G (Bicillin L-A®) is prioritized for treatment of pregnant people infected with or exposed to syphilis and to use alternative treatments for other populations when available. ACPHD also recommends to stick with 2.4 million units of Bicillin L-A® for primary, secondary, and early latent syphilis, since additional doses do not increase efficacy, including among PLWH.
A shigella outbreak has been reported at an LA conference August 21-24, 2023, with cases among Alameda County residents. Alameda County issued a health alert on September 1 and providers are asked to monitor, test and report cases.
Increase in extensively drug-resistant (XDR) shigellosis: Alameda County issued a health alert in March on this enteric bacterial infection, which is transmitted fecal-orally person-to-person, including through sex, as well as through contaminated water and food. A huge increase in recent years have disproportionately impacting MSM, PLWH, international travelers and people experiencing homelessness. Test people with more than 3 days of diarrhea and cramping with a stool culture and susceptibility testing.

Did you miss our mental health workshop on March 30? Click here for our guide to East Bay mental health resources and watch the recording.

New HIV/STD studies

updated October 2023

Current lists of open Bay Area HIV, hepatitis, Mpox and COVID studies are posted here.

Recent COVID-19 is associated with increase in false positive HIV Ag/Ab tests: an observational study found that a positive SARS-CoV-2 PCR result within 2 weeks of HIV combo testing significantly increased the likelihood of a false-positive HIV Ag/Ab test (OR 4.22). The false-positive association was strongest for a positive HIV antigen result, which suggests that there may be cross-reactivity between HIV and SARS-CoV-2 proteins. This strengthens the importance of getting an HIV RNA test to confirm positive HIV Ag/Ab results.

A study on disparities among women living with HIV in the US found that racial/ethnic disparities in viral suppression among women taking ART were substantially reduced after accounting for social determinants of health, such as poverty, transportation needs, health literacy, and gaps in health insurance coverage. The authors conclude that “structural interventions to improve [these determinants] are needed to improve health equity for women with HIV”.

HIV telemedicine visits had better outcomes than in-person visits in a 2022 comparison study at an HIV primary care clinic in Arizona. Patients in the study were given the option for telemedicine or in-person visits. Better performance was seen for those receiving telemedicine visits for visit show rate, medical outcomes (viral load suppression, diagnosis rates), cost-effectiveness, time management, and patient and employee acceptance of the clinics.

The CROI 2023 conference took place on February 19-22, one of the most important international scientific conferences covering HIV, STIs, mpox, hepatitis and COVID. You can read selected highlights below, our complete highlights here, more summaries on Dr. Paul Sax’s CROI 2023 Really Rapid Review and on NATAP’s website.

Doxy-PEP: doxycycline post-exposure prevention for STIs was found again to be effective for MSM and transwomen but not in a group of ciswomen in Kenya. No marked doxycycline resistance has been found yet.
CAB/RPV (Cabenuva) injectable ART: Thigh injections have drug levels equivalent to gluteal injections. CAB/RPV is highly effective even for people with viremia and adherence challenges and is non-inferior to BIK, but baseline viremia and NNRTI or INSTI resistance are associated with CAB/RPV failures so watch those starting with viremia closely and avoid using it alone with baseline resistance.
CAB-LA (Apretude) injectable PrEP: there may be some forgiveness with late injections. Failures are rare and can be hard to detect, so get an HIV RNA and Ag/Ab at each injection and quarterly after stopping. Treat people with breakthrough infections with protease-inhibitor-based regimens, such as Symtuza.