Strong Link Between HPV and HIV Infection in MSM

MedicalResearch.com Interview with:

Brandon Brown, MPH, PhD Associate Professor Center for Healthy Communities Department of Social Medicine, Population and Public Health UCR School of Medicine Riverside, CA 

Dr. Brown

Brandon Brown, MPH, PhD
Associate Professor
Center for Healthy Communities
Department of Social Medicine, Population and Public Health
UCR School of Medicine
Riverside, CA

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: The authors have been working in Lima, Peru on HIV-related projects for over 17 years. This particular study arose out of interest from our main community collaborator and the only gay men’s health NGO in Lima, Epicentro Salud (http://epicentro.org.pe/index.php/en/). The NGO noticed that one of the main health issues among their clients was genital warts. When we learned this, we applied for funding through the Merck Investigator Initiated Studies Program to conduct a study examining the link between genital warts and incident HIV infection.

The relationship between anogenital HPV types and incident HIV infection among men who have sex with men and transgender women in Lima, Peru

The relationship between anogenital HPV types and incident HIV infection among men who have sex with men and transgender women in Lima, Peru

Although most studies have shown a general link between HPV and HIV co-infection, our findings illustrate the strong relationship between individual HPV types and HIV infection. Specifically, individuals in our study with any HPV type, more than one HPV type, or high-risk HPV were more likely to acquire HIV.

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Single Dose of Ibalizumab Boosts Immunity in Resistant HIV

MedicalResearch.com Interview with:

Brinda Emu, MD Assistant Professor of Medicine (Infectious Diseases) Yale School of Medicine

Dr. Emu

Brinda Emu, MD
Assistant Professor of Medicine (Infectious Diseases)
Yale School of Medicine

MedicalResearch.com: What is the background for this study?

Response: This was a Phase 3 study of a new antiretroviral agent, ibalizumab, for the treatment of HIV-1 infection.  Ibalizumab is a monoclonal antibody that targets the CD4 receptor on host cells.  CD4 is the receptor that HIV uses to infect CD4+ T cells.  By binding to the CD4 receptor, ibalizumab prevents viral entry.  This study recruited patients that harbor multi-drug resistant HIV and were failing their current regimen of antiretroviral agents, and thus had limited options for treatment of their HIV-1 infection using approved medications.

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For Resistant HIV: Phase III Trial of Trogarzo Demonstrates Safety and Efficacy

MedicalResearch.com Interview with:
TaiMed BiologicsStanley Lewis, M.D.

TaiMed Biologics
Irvine, CA 92614


MedicalResearch.com: What is the background for this study?

Response: The phase III clinical trial was conducted to assess the efficacy and safety of Trogarzo™ (ibalizumab-uiyk) injection in patients with multidrug resistant HIV-1. The study design was approved by the FDA. Results obtained were included in the New Drug Application submitted to the FDA which approved Trogarzo™ on March 6, 2018.

The phase III, open-label study, enrolled 40 patients with multidrug-resistant (MDR) HIV-1 in whom multiple antiretroviral therapies had failed. All patients at baseline were experiencing viral failure. After a seven-day control period, patients received an intravenous 2000 mg loading dose of Trogarzo™ which was the only change made to their antiretroviral regimen. Through the 24-week treatment period of the study, patients were given a maintenance dose of 800 mg of Trogarzo™ every two weeks along with an optimized background regimen that included at least one additional fully active agent.

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HPV Status Influences Survival in Esophageal Cancer

MedicalResearch.com Interview with:

Barrett's Esophagus -wikipedia

Barrett’s Esophagus -wikipedia

Shan Rajendra MBBCh, MSc , MD, FRCP, FRACP
Professor of Medicine
University of New South Wales
Director of Medicine & Clinical Executive Director
Bankstown-Lidcombe Hospital
Director Gastro-Intestinal Viral Oncology Group
Ingham Institute for Applied Medical Research
Sydney 

MedicalResearch.com: What is the background for this study?  

Response: High-risk human papillomavirus(HPV)  infection has been strongly associated with a subset of Barrett’s dysplasia and oesophageal adenocarcinoma.

The research question was; Does HPV status of Barrett’s high-grade dysplasia and esophageal adenocarcinoma influence survival as in viral positive head and neck cancers?

We therefore sought to determine the prognostic significance of esophageal tumor HPV status and associated viral transcriptional markers (E6/E7 mRNA and p16INK4A) and TP53.

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HIV: Hopeful Results of Doravirine vs Ritonavir-Boosted Darunavir at 96 Weeks

MedicalResearch.com Interview with:
merck

Kathleen Squires MD
Director, Division of Infectious Diseases
Jefferson University Hospitals and
Ming-Tai Lai, PhD
Senior Principal Scientist, Biology Discover
Merck

 

MedicalResearch.com: What is the background for this study? What are the main findings? 

Dr. Squires: The DRIVE-FORWARD study is a pivotal, randomized, double-blind, Phase 3 study that evaluated the safety and efficacy of doravirine (DOR), a non-nucleoside reverse transcriptase inhibitor (NNRTI) in treatment-naïve adults with HIV-1 infection. Data from week 48 of this trial have previously been presented demonstrating that doravirine met its primary endpoint of non-inferior efficacy compared to ritonavir-boosted darunavir (DRV+r). In addition, at 48 weeks, a secondary endpoint showed that the doravirine-treated group had statistically significant lower levels of fasting LDL-C and non-HDL-C versus the DRV+r group.

The data presented at AIDS 2018 are week 96 data from the DRIVE-FORWARD trial.
At week 96, the doravirine group demonstrated efficacy of 73.1% compared with 66.0% in the DRV+r group, a treatment difference of 7.1% (95% CI: 0.5, 13.7)  Two participants in the DOR treatment group developed genotypic and phenotypic resistance to DOR through 96 weeks of treatment. The rate of discontinuation of therapy due to adverse events was 1.6 percent in the DOR group and 3.4 percent in the DRV+r group.

Doravirine is a late-stage investigational NNRTI for the treatment of HIV-1 infection in treatment-naïve adults and is being evaluated both as a once-daily single-entity tablet in combination with other antiretroviral agents, and as a once-daily fixed-dose combination regimen with lamivudine (3TC) and tenofovir disoproxil fumarate (TDF). Earlier this year, Merck announced that the FDA accepted for review two New Drug Applications (NDAs) for doravirine for the treatment of HIV-1 infection in treatment-naïve adults. The NDAs are based upon the findings at week 48 of two ongoing Phase 3 trials, DRIVE-FORWARD and DRIVE-AHEAD, evaluating the efficacy and safety of doravirine and the fixed-dose combination regimen of DOR/3TC/TDF, respectively. The FDA has set a target action date of October 23, 2018 for both applications.

Dr. Lai: This study aimed to characterize the mutant viruses selected in treatment-naïve participants through week 48 from DRIVE-FORWARD and DRIVE-AHEAD, and to assess the impact of selected mutations on non-nucleoside reverse transcriptase inhibitor (NNRTI) susceptibility and viral fitness. All of the seven doravirine (DOR)-resistant mutants are either partially susceptible or susceptible to etravirine. Mutants containing the F227C substitution were shown to be hypersusceptible to some nucleoside reverse transcriptase inhibitors (NRTIs) such as azidothymidine (AZT), tenofovir (TFV), lamivudine (3TC), and MK-8591. Among the 12 participants who developed efavirenz (EFV) resistance, 9 of the EFV-resistant clinical mutants were susceptible to DOR with fold-change <2.5.

The majority of DOR-selected viruses identified in the treatment-naïve participants in clinical trials to date retain susceptibility to etravirine and hypersensitivity to some NRTIs, with low replication capacity. In addition, the majority of EFV-selected viruses retain susceptibility to DOR.  Continue reading

Treatment and Prevention of HIV Infection Recommendations Updated

MedicalResearch.com Interview with:

Michael S. Saag, MD Professor,Division of Infectious Diseases UAB

Dr. Saag

Michael S. Saag, MD
Professor,Division of Infectious Diseases
UAB

MedicalResearch.com: What is the background for this study? What are the main findings? 

  • An update of prior recommendations made by the IAS-USA, which have been updated every 2 years since 1996
  • Cover ARVs for prevention and treatment of HIV infection
  • Developed by an international panel of 16 volunteer experts in HIV research and patient care appointed by the IAS–USA
    • Members receive no compensation and do not participate in industry promotional activities while on the panel
  • Primarily for clinicians in highly resourced settings; however, principles are universally applicable
  • Reviewed data published or presented from September 2016 through June 2018
  • Rated on strength of recommendation and quality of evidence

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Did Billions in US AIDS Prevention Money Save Babies’ Lives in Kenya?

MedicalResearch.com Interview with:

Professor Donna Spiegelman ScD Susan Dwight Bliss Professor of Biostatistics Director, Center for Methods in Implementation and Prevention Science (CMIPS)­­­­­­, Yale School of Public Health Professor, Department of Statistics and Data Science, Yale University Director, Interdisciplinary Methods Core, Center for Interdisciplinary Research on AIDS Yale School of Medicine

Dr. Spiegelman

Professor Donna Spiegelman ScD
Susan Dwight Bliss Professor of Biostatistics
Director, Center for Methods in Implementation and Prevention Science (CMIPS)­­­­­­,
Yale School of Public Health
Professor, Department of Statistics and Data Science, Yale University
Director, Interdisciplinary Methods Core, Center for Interdisciplinary Research on AIDS
Yale School of Medicine

MedicalResearch.com: What is the background for this study?

Response: HIV infections can be transmitted from mothers to their infants during pregnancy, childbirth, and  breastfeeding.  Without access to a package of health services that includes antiretroviral medicines and counseling on best breastfeeding practices, it is estimated that 25% of children born to HIV-positive mothers become infected with HIV.In low-resource settings, 50% of these children die before their second birthday.

A 32% increase in under-five mortality between 1988 and 2003 prompted the Kenyan government to establish Prevention of Mother to Child Transmission of HIV (PMTCT) programs
in over 10,000 health facilities.
This achievement was supported by U.S.President’s Emergency Fund for AIDS Relief
(PEPFAR), the which contributed over $248 million to PMTCT programs in Kenya between 2004 and 2014.

Although this investments in PMTCT coincided with a remarkable halving of Kenya’s under-five mortality rate, it is unknown whether this improvement can be causally attributed to PEPFAR funding for PMTCT. During the 2000s, child mortality decreased across most of sub-Saharan African countries.  These regional trends, rather than PEPFAR funding, may explain all or part of Kenya’s reduction in over 10,000 in child mortality. To help identify whether PEPFAR’s investments in PMTCT made a causal contribution to this reduction in child mortality, we used statistical methods to assess whether the amount or “dose” of PEPFAR funding provided to different provinces in Kenya was associated with increased HIV testing among pregnant women, which is a critical first step in identifying which women need PMTCT, and reduced infant mortality in Kenya.

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Girls with PID Underscreened For Syphilis and HIV in ERs

MedicalResearch.com Interview with:

Monika K. Goyal, M.D., M.S.C.E., senior study author Assistant professor of Pediatrics and Emergency Medicine Children’s National Health System Washington, DC

Dr. Goyal

Monika K. Goyal, M.D., M.S.C.E., senior study author
Assistant professor of Pediatrics and Emergency Medicine
Children’s National Health System
Washington, DC 

MedicalResearch.com: What is the background for this study?

Response: Patients with pelvic inflammatory disease (PID) are at an increased risk for syphilis and HIV. We know that adolescents account for 20 percent of the 1 million cases of PID that are diagnosed each year. We also know that an estimated one in four sexually active adolescent females has a sexually transmitted infection (STI). While screening for syphilis and HIV is recommended when diagnosing PID, actual screening rates among adolescents have been understudied.

This multi-center study aimed to quantify rates of HIV and syphilis screening in young women diagnosed with . pelvic inflammatory disease in pediatric emergency departments and to explore patient- and hospital-specific characteristics associated with screening for these two sexually transmitted infections.

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New HIV Vaccine Advances in Phase 2 Studies

MedicalResearch.com Interview with:

Dan Barouch, M.D., Ph.D. Professor of Medicine Harvard Medical School Ragon Institute of MGH, MIT, and Harvard Director, Center for Virology and Vaccine Research Beth Israel Deaconess Medical Center Boston, MA 02215

Dr. Barouch

Dan Barouch, M.D., Ph.D.
Professor of Medicine
Harvard Medical School
Ragon Institute of MGH, MIT, and Harvard
Director, Center for Virology and Vaccine Research
Beth Israel Deaconess Medical Center
Boston, MA 02215

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: This study demonstrates that the mosaic Ad26/Env HIV vaccine candidate induced robust and comparable immune responses in humans and monkeys.

Moreover, the vaccine provided 67% protection against viral challenge in monkeys.   

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CDC’s Change in HIV Policy Impacted Providers’ Role in Prevention

MedicalResearch.com Interview with:

Rogério M. Pinto, LCSW, Ph.D. Associate Professor Associate Dean for Research School of Social Work University of Michigan Ann Arbor, USA

Dr. Pinto

Rogério M. Pinto, LCSW, Ph.D.
Associate Professor
Associate Dean for Research
School of Social Work
University of Michigan
Ann Arbor, Michigan

MedicalResearch.com: What is the background for this study?

Response: This research, published in Health Education & Behavior (https://doi.org/10.1177/1090198118760681),highlights the crucial role of providers of social and public health services in helping patients to access lifesaving HIV services. Before 2012, providers were encouraged and trained to link patients to behavioral interventions to help patients modify their behaviors to protect themselves against HIV transmission and infection. A shift in policy from targeting anyone at risk to those at highest risk (called “High Impact Prevention”) made these interventions less available (they were actually discontinued) and new policy dictated that providers should have as many people as possible access HIV testing and link them to HIV primary care in order to receive antiretroviral medication.

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Why So Many New HIV Infections in US, Despite PrEP Availability?

MedicalResearch.com Interview with:

Rogério M. Pinto, LCSW, Ph.D. Associate Professor Associate Dean for Research School of Social Work University of Michigan Ann Arbor, USA

Dr. Pinto

Rogério M. Pinto, LCSW, Ph.D.
Associate Professor
Associate Dean for Research
School of Social Work
University of Michigan
Ann Arbor, USA

MedicalResearch.com: What is the background for this study?

Response: This integrative review, published in the journal AIDS and Behavior, includes content from 47 peer-reviewed scholarly articles reporting multiple barriers to high-risk individuals trying to access pre-exposure prophylaxis (PrEP), the HIV drugs that reduce subsequent risk of infection. We found 31 potential solutions to 30 barriers at the patient, provider and health-system levels. In synthesizing this research from a multi-level perspective, based upon a socioecological model, our report contributes much-needed analysis to the rapidly expanding field of PrEP implementation research.

At this stage in the scale-up of U.S. PrEP programs, it is important to systematically and comprehensively analyze and integrate knowledge about the successes of and the barriers to PrEP implementation. Our review provides a comprehensive analysis and informs the direction of PrEP implementation across a variety of settings.

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Long Term HIV Viral Suppression Reduces But Does Not Eliminate Elevated Cancer Risk

MedicalResearch.com Interview with:

Lesley S. Park, PhD, MPH Instructor, Medicine- Primary Care and Population Health BioStanford Center for Population Health Sciences (PHS) Associate Director, Research and Data Strategy; Director, PHS Postdoctoral Fellowship Veterans Aging Cohort Study (VACS) Cancer Core Co-Director

Dr. Lesley Park

Lesley S. Park, PhD, MPH
Instructor, Medicine- Primary Care and Population Health
BioStanford Center for Population Health Sciences (PHS) Associate Director, Research and Data Strategy; Director, PHS Postdoctoral Fellowship
Veterans Aging Cohort Study (VACS) Cancer Core Co-Director

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: As the population of persons living with HIV/AIDS is aging, the overall burden of cancer is substantial and increasing; however, we have much to learn about the potential cancer prevention benefits of antiretroviral treatment (ART).

Our study is the first to examine the effects of prolonged periods of viral suppression and potential cancer prevention benefits. While prior randomized clinical trials (RCTs) and observational studies have examined viral suppression and cancer risk, they mostly were limited to small numbers of cancer outcomes or were only focused on few specific cancer types.

Our study demonstrated a benefit of the prevention of cancer development in AIDS-defining cancers (non-Hodgkin lymphoma, Kaposi sarcoma), which was expected, but also in some non-AIDS-defining cancer types (lung, larynx, melanoma, leukemia).  Continue reading

Unique Vaginal Cells Facilitate HIV Infection and Persistence

MedicalResearch.com Interview with:

Manish Sagar, MD Assistant Professor of Medicine, Boston University School of Medicine Boston MA 

Dr. Sagar

Manish Sagar, MD
Infectious Disease Physician at Boston Medical Center
Boston MA 

MedicalResearch.com: What is the background for this study?

Response: Women compromise the majority of new infections in the world and most of them acquire the virus after sexual exposure.  The goal of the study was to understand how HIV establishes initial infection in the female genital tract. We obtained discarded vaginal tissue and isolated cells present in the outermost layer that contact the virus during exposure.

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HIV Incidence Decreasing But Not Among Latino and AA Gay and Bisexual Men

MedicalResearch.com Interview with:
Sonia Singh, PhD, Epidemiologist
Division of HIV/AIDS Prevention
CDC 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: HIV infection is a persistent health concern in the United States, particularly for people at high risk of infection such as gay and bisexual men. We used data from the National HIV Surveillance System to estimate HIV incidence and prevalence and the percentage of undiagnosed HIV infections overall and among gay and bisexual men.

Estimated HIV incidence declined nearly 15% overall in the U.S. from an estimated 45,200 infections in 2008 to 38,500 in 2015. Estimated HIV incidence declined for both males (9%) and females (33%) over this period. Estimated HIV incidence declined 32% among heterosexuals, 42% among people who inject drugs and 20% among gay and bisexual men who also inject drugs. Estimated HIV incidence remained relatively stable among gay and bisexual men; however, it increased over 25% among Latino gay and bisexual men, almost 45% among gay and bisexual men ages 25 to 34 and 30% among gay and bisexual men ages 55 and older.

The percentage of undiagnosed HIV infections decreased nearly 20%, from 18.1% in 2008 to 14.5% in 2015. The percentage of undiagnosed HIV infections among gay and bisexual men declined 21.6%, from 21.3% in 2008 to 16.7% in 2015. In 2015, the percentage of undiagnosed HIV infections was highest among gay and bisexual males ages 13-24 (52.2%) compared to other age groups and higher among Latino (20.1%) and African American (19.6%) gay and bisexual men, as well as Asian gay and bisexual men (20.5%), compared to white gay and bisexual men (11.9%).

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Salivary Assay Developed for HIV Can Be Used To Detect Zika

MedicalResearch.com Interview with:

Researchers at NYU College of Dentistry are developing a test for Zika virus that uses saliva to identify diagnostic markers of the virus in a fraction of the time of current tests. NYU/Sapna Parikh

Researchers at NYU College of Dentistry are developing a test for Zika virus that uses saliva to identify diagnostic markers of the virus in a fraction of the time of current tests.
NYU/Sapna Parikh

Maite Sabalza Ph.D
Post Doctoral Associate
Department of Basic Science and Craniofacial Biology
College of Dentistry, New York University
New York, NY 10010

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: With previous NIH funding we were able to develop an automated “dual assay” (able to detect both host antibodies and viral RNA) for HIV.

In relatively short time, we were able to migrate those findings into the new assay for ZIKA Virus. Continue reading

Brief Interruption of HIV Treatment Did Not Lead To Irreversible Expansion of Viral Reservoir

MedicalResearch.com Interview with:

“HIV-infected T cell” by NIAID is licensed under CC BY 2.0

HIV-infected T-cell
NIAID image

Tae-Wook Chun, Ph.D.
National Institutes of Health
Bethesda, MD 20892 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: While antiretroviral therapy (ART) has improved the clinical outcome for people living with HIV, persistence of viral reservoirs in the peripheral blood and lymphoid tissues remains a hurdle to complete eradication of virus and cure of the infection. We know the vast majority of people living with HIV will experience plasma viral rebound within weeks of cessation of therapy. Considering that current research on the treatment of people living with HIV has been heavily focused on developing strategies aimed at achieving sustained virologic remission in the absence of ART, it is of great interest to investigate whether treatment interruption results in expansion of the viral reservoir and/or damage to the immune system. Using data from a recently concluded trial that employed short-term analytical treatment interruption (ATI), we found that, as expected, HIV DNA increased in the CD4+ T cells of individuals living with HIV during the treatment interruption phase. However, the size of the HIV reservoirs as well as immune parameters returned to baseline 6–12 months after the participants resumed ART.  Continue reading

Post Exposure Doxycycline in PReP Users May Reduce Risk of Syphilis and Chlamydiae

MedicalResearch.com Interview with:

Professor Jean-Michel Molina MD Head of Department of Infectious Diseases, Hôpital Saint-Louis Paris France 

Prof. Molina

Professor Jean-Michel Molina MD
Head of Department of Infectious Diseases, Hôpital Saint-Louis
Paris France 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: There is a high rate of sexually transmitted infections (STIs) among Pre-exposure prophylaxis users and we wished to assess whether post-exposure prophylaxis (PEP) with doxycycline could reduce the incidence of sexually transmitted infections in this population.

We have found indeed a high rate of STIs most of them (71%) being asymptomatic and warranting therefore systematic testing. Also PEP reduced the incidence of syphilis and chlamydiae infection by 70%, not for gonorrhea due to the high rate of detection in throat swabs without any impact of PEP.

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Adherence to HIV Treatment May Protect Brain From Further Injury

MedicalResearch.com Interview with:

Ryan Sanford

Ryan Sanford

Ryan Sanford, MEng
Department of Neurology and Neurosurgery
Montreal Neurological Institute
McGill University, Montréal, Québec, Canada
 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: With the introduction of combination antiretroviral therapy (cART) the outlook for HIV+ individuals has dramatically shifted from a fatal disease to a chronic manageable condition. However, HIV-associated neurocognitive disorders are still prevalent. The etiology of this dysfunction remains unknown. Previous work has reported progressive brain atrophy in HIV+ individuals with advanced disease and poor viral suppression, but it is unclear whether stable treatment and effective viral suppression can mitigate the progression of brain atrophy. To examine this issue, we followed well-treated HIV+ individuals with good viral suppression and well-matched controls, and assessed whether ongoing brain atrophy occurs over time.

The main finding in this study was the HIV+ participants had reduced brain volumes and poorer cognitive performance compared to the control group, but the changes in brain volumes and cognitive performance were similar between the groups.

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HIV PreExposure Prophylaxis -PrEP- For MSM Found To Be Effective and Cost Saving

MedicalResearch.com Interview with:

Dr Valentina Cambiano PhD Institute for Global Health University College London London UK

Dr. Cambiano

Dr Valentina Cambiano PhD
Institute for Global Health
University College London
London UK

MedicalResearch.com: What is the background for this study?

Response: Pre-Exposure Prophylaxis (PrEP) which involves the use of drugs, which are used to treat HIV, in people without HIV to prevent them from getting is a critical new advance in HIV prevention. It has been shown to reduce the risk of HIV infection by 86% and the benefits heavily out-weigh any concerns. However, introducing this intervention has a cost.

When we started working on this study the National Health Services was discussing whether to introduce PrEP and if so for which populations. Unfortunately, at the moment NHS England is not providing Pre-exposure prophylaxis. However, a large study, the PrEP impact trial, funded by the NHS, has just started and this will provide PrEP to 10,000 people.

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Urban Transgender Females Likely To Get HIV Testing

MedicalResearch.com Interview with:

Adrian Juarez, PhD, RN Assistant Professor The State University of New York School of Nursing  Department of Family, Community and Health Systems Sciences Buffalo, New York 14214

Dr. Juarez

Adrian Juarez, PhD, RN
Assistant Professor
The State University of New York
School of Nursing
Department of Family, Community and Health Systems Sciences
Buffalo, New York 14214

 

 

MedicalResearch.com: What is the background for this study?

Response: HIV testing is considered the initial component of HIV eradication strategies such as “seek, test, treat, and retain.” This study examines the characteristics of an urban, transgender population in western New York when volunteering for an HIV test. The use of an intersectional lens was observed in order to determine the level of influence of sexual partnership types, previous HIV and STD testing, substance use, housing status referral source and racial/gender identification on HIV testing.

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Even Treated, HIV-Positive Children Have Ongoing White Matter Brain Damage

MedicalResearch.com Interview with:
Marcin Jankiewicz  University of Cape Town Cape Town, South Africa
Marcin Jankiewicz 
University of Cape Town
Cape Town, South Africa 

MedicalResearch.com: What is the background for this study?

Response: The Children with HIV Early Antiretroviral (CHER) trial, conducted in Cape Town and Soweto, was designed when there was uncertainty whether to start antiretroviral therapy (ART) as soon as HIV was diagnosed (below 12 weeks of age) or to wait until there was evidence of immuno-compromise and disease progression. Also, there were concerns about maintaining adherence, long-term toxicity and also resistance in the setting of few antiretroviral options. Early outcomes showed a decreased risk in childhood mortality in the early treatment arms compared to deferred treatment, becoming standard of care globally.

The CHER cohort is one of the largest and best documented of children receiving ART within the first year of life. Also, age- and community-matched HIV exposed uninfected (HEU) and HIV unexposed (HU) uninfected infants were enrolled in parallel for a linked vaccine study.

We therefore had an amazing opportunity to link with a neurodevelopmental sub-study in participants from Cape Town and apply sophisticated neuroimaging modalities that could link with clinical, virological and immunological characteristics.

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Marijuana Use Linked To Cognitive Impairment In HIV Patients

MedicalResearch.com Interview with:

Richard Saitz, MD, MPH, FACP, DFASAM Department of Community Health Sciences Boston University School of Public Health Clinical Addiction Research and Education (CARE) Unit Section of General Internal Medicine, Department of Medicin Boston University School of Medicine and Boston Medical Center Boston , Massachusetts

Dr. Saitz

Richard Saitz, MD, MPH, FACP, DFASAM
Department of Community Health Sciences
Boston University School of Public Health
Clinical Addiction Research and Education (CARE) Unit
Section of General Internal Medicine, Department of Medicin
Boston University School of Medicine and Boston Medical Center
Boston , Massachusetts

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Many people living with HIV infection use alcohol and other drugs including marijuana. People with HIV infection are also susceptible to cognitive dysfunction from many causes from HIV infection itself to aging.

The main findings were that among people with HIV and substance use disorder, lifetime marijuana and alcohol use were not associated with cognitive dysfunction, likely due to competing risks.  But current marijuana use was associated with cognitive dysfunction.

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Data From NY City Suggest PReP Use Is Increasing

MedicalResearch.com Interview with:
Paul M. Salcuni, MPH

Department of Health and Mental Hygiene
New York City

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: NYC Health Department is committed to ensuring equitable access to HIV pre-exposure prophylaxis (PrEP) for all New Yorkers who are HIV-negative and may be exposed to HIV. We examined trends in PrEP prescribing by 602 ambulatory care practices in New York City from 2014 to 2016, as well as associated patient and practice factors, to inform our comprehensive scale-up efforts. For every 100,000 medical visits in the first three months of 2014, roughly 39 involved a patient being prescribed PrEP. In the second quarter of 2016, 419 of every 100,000 medical visits at those same practices involved a PrEP prescription.

Despite this nine-fold increase overall, some groups of patients among these practices were less likely to be prescribed PrEP. Those groups include men of color, women, and people getting health care at smaller private practices or practices outside of the city center.

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In the Age of Antiretrovirals for HIV, New Secondary Tumors Have Emerged

MedicalResearch.com Interview with:

Fahad Mukhtar MD MPH Department of Epidemiology and Biostatistics College of Public Health University of South Florida, Tampa

Dr. Mukhtar

Fahad Mukhtar MD MPH
Department of Epidemiology and Biostatistics
College of Public Health
University of South Florida, Tampa

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Studies done in the 80s and 90s showed that patients with Kaposi sarcoma may be at risk of having secondary tumors. As a result of changes that have taken place in the demographics of patients affected with HIV/AIDS as well as Kaposi’s sarcoma, we hypothesized that tumors that follow Kaposi sarcoma might have also changed. We analyzed the incidence of second tumors developing after Kaposi sarcoma using the Surveillance Epidemiology and End Result (SEER) data.

Our result indicated that the incidence of secondary tumors following Kaposi sarcoma have decreased after the emergence of antiretroviral therapy. However, we observed a significantly higher than expected number of cancer of the anus, liver, tongue, penis lymphomas, and acute lymphocytic leukemia developing in patients with Kaposi sarcoma in the era of antiretroviral therapy.

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Single Measurement May Underestimate HIV Viral Suppression

MedicalResearch.com Interview with:
Dr. Nicole Crepaz PhD
Behavioral Scientist
Division of HIV/AIDS Prevention
CDC

MedicalResearch.com: What is the background for this study?

Response: The most common measure of viral suppression in clinical and surveillance studies is the most recent viral load in past 12 months. This single-value measure does not capture the viral load dynamics over time. We examined durable viral suppression, never virally suppressed, and cumulative HIV burden (measured in the viremia copy-year) to help us better understand viral suppression and transmission risk potential.

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