Category Archives: HIV

Study Reveals High Rate of Anal Cancer in HIV-Positive Women

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Newswise — NEW YORK CITY (April 12, 2012) – Anal cancer is on the rise among HIV-positive women, according to a Montefiore Medical Center study entitled, “High Prevalence of High Grade Anal Intraepithelial Neoplasia in HIV-Infected Women Screened for Anal Cancer,” to be published in the Journal of Aids on May 1.

“Anal cancer was widely associated with HIV-infected men who have sex with men,” said Mark H. Einstein, MD, MS, Director of Clinical Research, Division of Gynecologic Oncology at Montefiore Medical Center and Professor at Albert Einstein College of Medicine. “But now, this study reveals anal precancerous disease in a high proportion of women with HIV.”

Out of 715 asymptomatic HIV-infected women studied, 10.5% exhibited some form of anal disease and approximately one third of them were found to be true pre-cancerous disease. The researchers determined that this is likely due to the fact that HIV promotes human papillomavirus (HPV) persistence and consequently, which is known to cause nearly all anal cancers. HIV-infected individuals are also at increased risk for the development of many other HPV-associated neoplasms.

The incidence of anal carcinoma (AC) has been increasing despite the implementation of antiretroviral therapy (ART), which has not been shown to consistently alter the course of HPV–associated anogenital disease.

The women studied were Montefiore patients in the Bronx, which has one of the highest HIV prevalence rates in the United States. Data indicates that 1.8% of the Bronx population is known to be HIV infected, representing 3% of the total number of HIV patients in the entire country. Montefiore is the largest provider of medical services for people with HIV in the Bronx and has adopted routine screening for AC with annual anal cytology in all HIV-infected patients.

As a result of these findings, Dr. Einstein and his colleagues recommend that all HIV+ women who have any abnormal anal cytology be referred for high resolution anoscopy, particularly those with poorly controlled HIV who are significantly at even higher risk for harboring a high-grade AIN than women who are well controlled. Also, all HIV infected men and women should be considered for anal cancer screening. Given the lower high-grade anal disease prevalence in women with well-controlled HIV, other strategies to improve disease ascertainment, such as inclusion of HPV testing might be found to be useful for AC screening. This risk stratification might prove to be different for women than it is for men, where prevalence rates seem to be considerably higher. Given the high rate of high-grade anal precancerous lesions in screened HIV-infected women and an aging population of HIV-infected patients, measures to increase routine AC screening should be strongly considered. Depending on the size of the pre-cancerous legion, it can be removed long before it becomes cancer, thus being able to save lives.

HIV Rates for Black Women in Parts of the US Much Higher than Previously Estimated

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Newswise — 3/09/2012 – Newark is one of six locations in the United States that are the focus of a new study whose findings indicate that the HIV incidence rate for US women living in areas hardest hit by the epidemic is much higher than the overall estimated incidence rate in the US for black women. The study was designed, and the national research team chaired, by Sally Hodder, MD, professor and vice chair of the Department of Medicine at the University of Medicine and Dentistry of New Jersey-New Jersey Medical School.

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.

Bacterial STD Linked to Increased Risk of HIV

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Newswise — 3/9/2012  — A common sexually transmitted bacterial infection more than doubles the risk of HIV infection in African women, according to a study by researchers at RTI International.

The study, published in the March 13 issue of AIDS, found that women with the “emerging” sexually transmitted disease Mycoplasma genitalium are more likely to acquire HIV infection.

“Further research will be required to confirm a causal relationship and to identify risk factors for M. genitaliuminfection in African populations,” said Sue Napierala Mavedzenge, Ph.D., a research investigator with theWomen’s Global Health Imperative at RTI International and the study’s lead author. “If findings from this research are confirmed, M. genitalium screening and treatment among women at high risk for HIV-1 infection may be warranted as part of an HIV-1 prevention strategy.”

First discovered in 1980, M. genitalium is a bacterial STD that causes inflammatory conditions of the genitals and reproductive tract (urethritis, cervicitis and pelvic inflammatory disease). The infection, which may be present for years without causing any symptoms, can be eliminated with appropriate antibiotics.

This study used data from a larger study of HIV acquisition among young women in Zimbabwe and Uganda to assess the effects of M. genitalium on HIV risk. In the study, 190 women who became infected with HIV during follow-up were matched to women of similar age and risk who did not acquire HIV. Both groups were tested for the presence of M. genitalium, which was evaluated as a risk factor for HIV infection.

In initial samples, when all women were HIV free, infection with M. genitalium was present in about 15 percent of women who later developed HIV versus 6.5 percent in women who remained HIV free. Mycoplasma genitalium was more frequent than other bacterial STDs, including gonorrhea and chlamydia.

The researchers found that after adjustment for other factors, women who initially had M. genitalium were more than twice as likely to become infected with HIV. Certain other STDs were also risk factors for HIV.

The researchers estimated that about 9 percent of all HIV infections occurring in the study were attributable to M. genitalium. However, other factors were more strongly associated with HIV risk, especially the presence of herpes simplex virus 2 (the virus that causes genital herpes) and having a partner with HIV risk factors.

 

HIV Virus Infection Rates Are on the Rise

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Since HIV infection rates began to rise again around 2000, researchers have been grasping for answers on what could be causing this change, especially in the homosexual community. The rising numbers are a stark contrast to the 1990′s, when infection rates dropped due to increased awareness of the virus. A new study in Israel reveals that the number of new HIV cases diagnosed each year in the last decade saw a startling increase of almost 500% compared to the previous decade, and similar trends have been reported in a number of other developed nations, including the U.S.

According to Prof. Zehava Grossman of Tel Aviv University‘s School of Public Health at the Sackler Faculty of Medicine and the Central Virology Laboratory of the Ministry of Health, a new approach to studying HIV transmission within a community has yielded a disturbing result. By cross-referencing several databases and performing a molecular analysis of the virus found in patients, an astonishingly high number of newly-diagnosed men with male sexual partners were found to have contracted the virus from infected, medicated partners who are already aware of their HIV-positive status.

Reported in the journal Clinical Infectious Diseases, these findings indicate that the public health approach towards HIV counselling and education needs to be reconsidered, Prof. Grossman says.

Researchers had begun to suspect that the rise in infection rates was due to a change in social behavior, but hard evidence was lacking. The answers, Prof. Grossman says, were not easy to find by asking the patients themselves. Questionnaires and similar methods to gather information are hard to interpret because, in addition to the difficulty of recruiting an accurate cross-section of the population, people are often unwilling to be frank about risky sexual behavior.

To unravel the mystery, Prof. Grossman and her colleagues at the Central Virology Laboratory directed by Prof. Ella Mendelson and Israel’s leading AIDS clinicians turned to the virus itself. Working with senior epidemiologists of the Public Health Services of Israel’s Ministry of Health, they conducted a comprehensive analysis of laboratory, clinical, and epidemiological data, including information about patients’ diagnosis and treatment, sexually transmitted diseases contracted along with HIV, and the molecular characteristics of the virus in different patients.

Prof. Grossman and her colleagues found that an overwhelming number of new cases were infected with HIV strains that had already developed resistance to existing HIV drug therapies. Because the virus can only become resistant if previously exposed to medication, this result indicates that new patients are often infected by an HIV-positive partner already receiving the therapies. More often than in the past, HIV found in different patients could be traced back to a common source.

Changing the educational approach

While people are now more knowledgeable about the virus and aware of the risks of unprotected sex, it appears that an increasing number of homosexual men, including those who are infected and treated for HIV, are likely to engage in risky sexual behaviour. Public health authorities, educators, and activists should be encouraged to find new ways of changing this attitude and of better imprinting the message about the risk and consequences of HIV transmission, particularly within the gay community.

Clearly, Prof. Grossman warns, the need to establish the values of safe sex within at-risk populations is as imperative as it has ever been.

Hepatitis C is transmitted by unprotected sex between HIV-infected men

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Sexual transmission of hepatitis C virus (HCV) is considered rare. But a new study by researchers at Mount Sinai School of Medicine, working with the Centers for Disease Control and Prevention (CDC), provides substantial evidence that men with HIV who have sex with other men (MSM) are at increased risk for contracting HCV through sex.

The results of the study are published in today’s edition of the CDC’s Morbidity and Mortality Weekly Report.

HCV transmission primarily occurs through exposure to blood, and persons who inject drugs at greatest risk. But when Mount Sinai researchers observed a large increase in the number of new cases of HCV transmission among HIV-infected men who did not inject drugs, they took a closer look to examine the role of sexual transmission among these men.

The researchers identified 74 HIV-infected men between October 2005 and December 2010 who had documented new HCV infection and yet reported no other risk factor for HCV infection, including injection drug use. When they compared 22 of these men with a control group of 53 closely matched HIV-infected MSM who did not have HCV infection, they found that the men who had recently contracted HCV were 23 times more likely to have had unprotected anal sex with men. In addition, HCV genetic analysis suggested that HCV was transmitted within social networks of these men, consistent with the presence of a city-wide epidemic.

“While hepatitis C is rarely transmitted among stable heterosexual couples, this is clearly not the case among HIV-infected MSM in New York City,” said Dr. Daniel Fierer, Assistant Professor of Medicine and Infectious Diseases at Mount Sinai School of Medicine. “MSM, and to some extent their health care providers are generally not aware that having unprotected receptive sex can result in HCV infection. The good news is that the cure rate for new HCV infections is very high with early treatment, but without regular testing of the men at risk, these largely asymptomatic infections may be missed and this opportunity lost.”

“Our study suggests that HIV-infected MSM should take steps to protect themselves and others by using condoms. Also, health care providers should be screening these men for hepatitis C, and public education and outreach programs should include information about these risks,” Dr. Fierer concluded.
For more information, visit http://www.mountsinai.org/