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

December 2022

New HIV/STD resources and studies

New resources

DoxyPEP interim recommendations: While we await CDC guidelines, the SF Department of Public Health released their doxyPEP recommendations on the use of oral doxycyline 200 mg as post-exposure prophylaxis (PEP) within 72 hours of condomless sex for MSM and transwomen to reduce syphilis, gonorrhea and chlamydia infections.

Pacific AETC has released the Expand Your HIV Toolkit: Cabotegravir and Rilpivirine (CAB/RPV) Essentials and Clinical Guide, including checklists, protocols and resources for patient evaluation, screening, and shared decision making when considering prescribing long-acting CAB/RPV (Cabenuva). You can also register to watch on-demand videos of the PAETC 4-part CA statewide trainings on injectables.

New studies

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

The Fast-Track Cities 2022 conference took place October 11-13 in Sevilla, Spain. The abstract book summarizing results from studies evaluating programs to improve engagement in care can be downloaded here

A CDC study found that in a cohort of MPX cases they were consulted on, most people hospitalized for severe MPX were Black/African American cismen living with HIV and had CD4<200. The people with severe MPX also experienced had delays in diagnosis and treatment. 12 of the 57 in this cohort died. This study underscores the importance of MPX vaccination, rapid diagnosis, testing for HIV/STDs in people with MPX, and rapid treatment with TPOXX for people with severe MPX symptoms and PLWH with CD4<200.

AIDS 2022, the International AIDS Conference, took place July 29 – August 2, 2022 in Montreal, Canada and virtually. Below are three clinical practice-changing highlights and other key studies that inform current clinical practice. For more studies and details, check out NATAP’s AIDS 2022 conference summaries and/or download the AIDS 2022 abstract book (PDF). 

Practice-changing highlights from AIDS 2022:

  1. DoxyPEP to prevent bacterial STIs: doxycycline 200 mg PO x1 within 72 hours of sex was found to reduce bacterial STIs by ~65% among MSM and transwomen living with HIV or on PrEP who’ve had at least one STI in the past 12 months and engage in condomless sex. Risk reduction for STI incidence per quarter was 0.35 overall and by STI and PrEP/PLWH respectively was 0.45/0.43 for gonorrhea, 0.12/0.26 for chlamydia and 0.13/0.23 for syphilis. See slides below. (doxyPEP study; Annie Luetkemeyer et al!)
  2. BIC/FTC/TAF (Biktarvy) for HBV/HIV coinfection: The ALLIANCE study (mostly in Asia and in MSM) found that people with HBV/HIV coinfection treated with BIC/FTC/TAF over DTG+F/TDF had higher rates of HBV viral load suppression, ALT normalization and HBeAg seroconversion. (ALLIANCE HBV/HIV study; Avihingsanon et al.)
  3. CAB/RPV (Cabenuva) for people with viremia and adherence challenges: 15 PLWH on CAB/RPV in Ward 86’s pilot group were not virally suppressed, some had advanced HIV and one had raltegravir resistance, and all achieved viral load suppression or at least 2-log drop. (CID; Kat Christopoulos et al!) Also: CAB/RPV injections in the lateral thigh had similar concentrations to gluteal injections. (Margot et al; abs. EPB240) For East Bay prescribers: Please click here for the updated Cabenuva prescribing info making the oral lead-in optional, which may help you get insurance coverage. CAB is available at specialty pharmacies, such as Community Walgreens, AHF, EBAC and AHS/Highland pharmacies.

AIDS 2022 studies that inform current clinical HIV practices:

  • Cabotegravir long-acting injectable (CAB) PrEP:
    • For transwomen taking hormones, CAB PrEP efficacy was comparable, and hormones don’t appear to impact CAB concentrations. During the median 1.4 years follow-up, transwomen taking CAB had lower incidence of HIV infection compared to those taking TDF/F. (HPTN 083; Grinsztejn et al.).
    • Pregnancy outcomes were comparable between people taking CAB vs. TDF/FTC PrEP (HPTN 084; Delany-Moretlwe et al.). 
  • ART and weight gain: More studies found that TDF suppresses weight while TAF and DTG-containing regimens lead to weight gain.  
    • Weight gain among treatment-naĂŻve PLWH in South Africa was most pronounced for TAF/F+DTG (9 kg) > TDF/F+DTG (6 kg) > TDF/F+EFV (3 kg) and in people who identified as females > males. (ADVANCE trial; Venter et al.)
  • Dolutegravir (DTG) safety and efficacy studies affirmed first-line recommendation for all PLWH, including pregnant PLWH. 
    • The Pediatric HIV/AIDS Cohort study in the US and Europe found that DTG-based ART had higher rates of viral suppression at delivery (97%) compared to regimens containing elvitegravir–cobicistat (90%), raltegravir (89%), and atazanavir–ritonavir (84%). BIC+F/TAF was not studied. (NEJM; Patel et al.)
    • Studies from Brazil and the NAMSAL network in Cameroon found that DTG is superior to efavirenz (EFV), especially in advanced HIV, likely related to higher rates of discontinuation of EFV due to lower tolerability. (Brites et al. and NAMSAL; Mpoudi-Etame et al.)
    • The Tsepamo study in Botswana shared updated data showing that the rate of neural tube defects among babies born to people taking DTG during pregnancy was no longer higher than the rate of the general population. (Zash et al.)
  • Bictegravir (BIC) 5-year follow-up shows high resistance barrier and efficacy: a US study found that pretty much everyone who takes their BIC-containing ART will stay suppressed over time, and those who didn’t did *not* develop resistance. This adds to data that show a very high resistance barrier for BIC and DTG-containing regimens. (Sax et al; abs. EPB150)
  • Lenacapavir (LEN) long-acting injectable updates:
    • Lenacapavir (LEN) is a long-acting injectable taken twice yearly (q6 months) studied for both HIV treatment and prevention and in a new class of HIV drugs called capsid inhibitors. 
    • Gilead resubmitted its LEN application for FDA approval in June 2022 and approval is anticipated by the end of 2022. The EU approved LEN on August 22.
    • LEN in 72 highly treatment-experienced PLWH taking an optimized oral background regimen found that it was well-tolerated and led to high rates of viral suppression (86%) and CD4 increase. Risk factors for the 8 of 72 people who had LEN resistance poor adherence or no active background ART. (Margot et al. and VanderVeen, abs. EPB239)
    • A simplified LEN regimen in which oral LEN (2 x 300mg) is given on the same day as the LEN sub-cutaneous injection (927 mg), followed by oral LEN on Day 2, found that LEN concentrations were comparable with the Phase 2/3 regimen (oral LEN on Days 1,2, 8; then injection on Day 15). (Jogiraju et al.)

Prevention & testing

The FDA has finally authorized a condom for anal sex, in addition to vaginal sex. While many of us have long advised people to use condoms for anal sex, the FDA finally has enough data to allow the ONE Condom to add anal sex to the product label, based on a study showing the failure rate, defined as slippage or breakage, to be less than 1% during anal sex.

Injectable long-acting PrEP (cabotegravir) is now FDA-approved! Cabotegravir PrEP (brand name: Apretude) is given as two initial injections administered one month apart, and then every two months thereafter. Health plans regulated by the California Department of Insurance are required to cover all PrEP drugs and related clinical services without cost sharing – including injectable PrEP. Processes for getting it covered are still getting worked out.

The CDC released its updated PrEP Clinical Practice Guideline on December 10, 2021. The update includes guidance for recommended initial and follow-up STD screening, revised HIV testing strategies, and recommended primary care practices for patients being prescribed oral or injectable PrEP. The Clinical Providers Supplement includes revised checklists, patient information sheets, and billing codes for both oral and injectable PrEP and includes guidance for counseling patients about adherent PrEP use.

Key revisions to the guideline include (from Demetre C. Daskalakis, MD, MPH, Director of the CDC Division of HIV Prevention):

  • A new recommendation for providers to inform all sexually active adults and adolescents about PrEP. This is intended to increase awareness of PrEP more broadly.
  • A recommendation that, in addition to taking a very brief history to identify persons with indications for PrEP, providers prescribe PrEP to anyone who requests it, even if they do not report specific HIV risk behaviors. This recommendation is intended to make PrEP available to people who may be apprehensive about sharing potentially stigmatized HIV risk behaviors with their provider.
  • A recommendation for F/TAF (Descovy) as an FDA-approved PrEP option for sexually active men and transgender women at risk of getting HIV, based on recent data showing its effectiveness for these populations.
  • A new section on prescribing bimonthly intramuscular injections of cabotegravir (CAB) for sexually active men and women who could benefit from PrEP, pending FDA data review and potential regulatory action.

A study of PrEP services at Kaiser Northern California from 2012 to 2019 showed that among those linked to PrEP care, people less likely to receive PrEP prescriptions included young adults ages 18-25, people with substance use disorders, people living in lower income neighborhoods, women, and among African American and Latinx people.

Cabotegravir for HIV Prevention in Cisgender Men and Transgender Women: A study of 4,566 people including 570 (12%) transgender women, participants were randomized to receive TDF-FTC vs. CAB LA for PrEP. The results showed that CAB-LA was superior to daily oral TDF–FTC in preventing HIV infection. The study authors wrist that “strategies are needed to prevent INSTI resistance in cases of CAB-LA PrEP failure.”


A resurgence in STD cases: New CDC data show that during March-April 2020, reported STD cases dramatically decreased compared to the same time in 2019. However, a resurgence in gonorrhea and syphilis cases later in the year suggest overall STDs may have increased during 2020.

The CDC released their updated 2021 Sexually Transmitted Infections Treatment Guidelines. Click on this link to access the full guidelines and visit their provider resource page for copies of a summary wall chart and pocket guide. 

Treatment & cure

Please also see above for the most recent highlights from the AIDS 2022.

An international collaborative group has released the first Global Cure Strategy, which summarizes the priorities and recommendations for the next 5 years. The collaborative group included community members, scientific and industry experts. Key goals include understanding and measuring HIV reservoirs, identifying mechanisms of virus control, targeting the HIV provirus, developing ways to support immune control, cell and gene therapy, pediatric remission and cure, and the social, behavioral and ethical aspects of cure.

A case report has been published of a woman in Argentina who has undetectable HIV viral load after more than 8 years off ART, even with ultra-sensitive testing of multiple organs and reservoirs. It appears that her immune system may have cleared the HIV-1 virus, an extremely rare phenomenon.

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