East Bay Getting to Zero
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.

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East Bay HIV updates

East Bay HIV strategic plan priority activities for 2024

New HIV/STD updates and studies

updated May 2024

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

  • PIP (PEP-in-Pocket): implementing a flexible new option for HIV prevention. Consider offering PIP as backup for people on PrEP who may stop PrEP for a variety of reasons, and also consider PIP as an option for people with ≤4 HIV exposures per year. More PIP info and resources here.
  • Moderate intensity statins are now recommended for most PLWH 40+ yo; the strongest evidence is for ASCVD ≥5%; if <5% decide on a case by case basis. Recommended options include:
    • Pitavastatin 4 mg once daily
    • Atorvastatin 20 mg once daily
    • Rosuvastatin 10 mg once daily
  • Injectable ART for people with HIV viremia: The IAS-USA treatment guidelines have been updated to recommend considering long-acting CAB/RPV injectable ART (Cabenuva) with intensive case management services for people with HIV viremia who are unable to take oral ART, have high risk of HIV progression, and have a virus susceptible to both CAB and RPV. 

  • The CROI 2024 conference covering the latest scientific research in HIV, STIs, mpox, hepatitis and Covid, took place on March 3-6, 2024. Below are some of the highlights, with more details on our CROI 2024 highlights webpage.
    • Injectable ART: more evidence that injectable ART is effective for people with adherence challenges. 
      • More evidence was presented from the LATITUDE trial and the Ward 86 team that CAB/RPV is effective (and superior) for people with adherence challenges and viremia.
      • A LEN+CAB case series of people with adherence challenges and RPV resistance found that viral suppression rates doubled after starting LEN.
      • The CARES trial in Uganda found that for people starting out virally suppressed and adherent on CAB/RPV, longer intervals between viral load monitoring (Q24 weeks) might be sufficient.
    • PrEP: viral loads likely not needed in oral PrEP and may still be useful in CAB-LA injectable PrEP; injectable PrEP uptake is slow but offering options increases PrEP coverage.
      • A CDC study evaluated a large cohort of PrEP users, including 439 people on CAB-LA, and found no conclusive LEVI cases. Meanwhile, the HPTN083 study group found that getting viral loads for people on CAB-LA would have detected some cases earlier. These data combined suggest that viral loads are likely not needed in oral PrEP and may be useful in CAB-LA PrEP if you can get them.
      • A PrEP dynamic choice study in East Africa found that offering multiple options including CAB-LA increased overall PrEP coverage.
      • Another CDC study found that only 0.5% of PrEP users were prescribed CAB-LA as of September 2022, with insurance coverage and staffing major challenges.
    • STI prevention: doxy-PEP works; the 4CMenB vaccine not so much.
      • The DOXY-PEP and DOXYVAC studies continue to show that doxycycline PEP reduced gonorrhea, chlamydia and syphilis infections among men who have sex with men and transgender women.
      • Public health data from SF also showed that community STIs were reduced after doxy-PEP was introduced.
      • The DOXYVAC study conducted further analysis and found that the 4CMenB vaccine did not significantly reduce the cumulative incidence of culture-positive gonorrhea infection, though the data does not rule out small benefit for symptomatic gonorrhea.
  • Cardiometabolic risk reduction for PLWH:
    • MASLD (steatotic/fatty liver) and GLP-1 agonist treatment for PLWH:
      • The SLIM LIVER study found that 53% of PLWH have MASLD and
      • low-dose once-weekly GLP-1 agonist semaglutide for 24 weeks in PLWH with MASLD lowered weight (with an average 17 lbs lost), and had reductions triglycerides, glucose, and HbA1C.
      • 29% had complete resolution of MASLD.
      • MASLD diagnosis in the study was done by liver MRI.
      • MASLD diagnosis in our network: clinicians are using mostly ultrasound-based elastography (such as FibroScan). Other diagnostic options include liver MRI, and if imaging is not available/accessible, serologic tests, such as the FIB-4 index.
    • InSTIs and TAF are associated with significant weight gain, especially in the first year and more likely among women, Black and Latinx people.
      • A study presented at CROI 2024 found that women who switched to INSTI regimens during menopause experienced early increases in waist circumference and BMI.
      • Data from the TANGO and SALSA cohorts so far suggests that switching ART doesn’t seem to help and the benefits of these agents as effective HIV treatment outweigh the metabolic risks for most people.
      • IAS guideline recs: Counsel on weight gain and metabolic changes on InSTIs, TAF.
      • Check weight, BMI and BP every 6 months and screen for diabetes every year.
      • If there’s >5% weight gain, support people to exercise and modify their diet.
  • More CROI 2024 resources:
  • Vaccines to prevent STIs and opportunitistic illnesses:
    • Using the 4CMenB vaccine (Bexsero) for gonorrhea prevention: mixed data on efficacy. Some studies have shown that 2 doses of the 4CMenB vaccine reduces gonorrhea acquisition by about 40%, and the UK JVCI (vaccine committee) now recommends it for people at high risk for gonorrhea. However, the DOXYVAC study presented further analysis at CROI 2024 and found that the 4MenB vaccine did not significantly reduce the risk of gonorrhea infection. This vaccine is covered on the Alameda Alliance and Medi-Cal formularies for ages 19+. Please see page 216 of the 2024 Medi-Cal formulary (PDF) listed as “Meningococcal Group B Vaccine”).
    • Mpox: 2 doses of JYNNEOS will also protect against more virulent Clade I from the Democratic Republic of Congo. CDC data suggests that 25% who need it in the US have gotten vaccinated.
    • Meningococcal disease has been increasing: the MenACWY vaccine primary series and boosters for PLWH reduce the risk for infection and severe disease.
    • Covid vax for long COVID prevention: staying up to date on vaccines (73% for 3+ doses) and avoiding re/infection have the most evidence. Evidence for Paxlovid treatment is mixed.
  • Doxy-PEP for people assigned female at birth: A study in Kenya published in December 2023 did not find efficacy for doxy-PEP among cisgender women at high risk for STIs. However, the analysis found very low levels of adherence (29%), suggesting that low adherence led to the trial not showing efficacy. A doxycycline drug level study found that doxycycline drug levels were at similar inhibitory concentrations for people assigned male vs. female at birth, in rectal and vaginal tissue. This data may lead clinicians to consider offering doxy-PEP for people assigned female at birth with shared decision-making around the risks and benefits.
  • Screen for syphilis! Including cisgender women. Congenital syphilis has exploded over the past 10 years. The FDA is importing powdered benzathine benzylpenicillin (Extencilline®) due to the Bicillin® shortage. There is a new congenital syphilis “hotline” at stdccn.org.
  • Chagas screening: updated DHHS OI guidelines are to screen all PLWH who’ve lived in Mexico, Central or South America for >6 months with a serologic test (T. cruzi antibody (IgG)) and if positive, confirm with PCR send-out to the CDC lab, and evaluate for treatment.
  • Record rates of pulmonary coccidioidomycosis: suspect in a patient with CAP who does not respond to initial antibiotics, who has exposure to dust/dirt, or sxs >1-2 weeks. Check cocci IgM, IgG; consider cx + PCR.

2023 HIV/STD updates

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

  • 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.

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. 

Please click here to read our highlights from the updated IAS-USA HIV guidelines.

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