Synthetic Growth Hormone Releaser May Reduce Excess Abdominal Fat in HIV Patients

Julian Falutz, MD Director, HIV Metabolic Clinic MUHC,  Coordinator of Chronic Viral Illness Service, HIV and Aging Clinic McGill University Health Center

Dr. Julian Falutz

MedicalResearch.com Interview with:
Julian Falutz, MD

Director, HIV Metabolic Clinic MUHC,
Coordinator of Chronic Viral Illness Service, HIV and Aging Clinic
McGill University Health Center

Medical Research: What is the background for this study? What are the main findings?

Dr. Falutz: The long-term use of antiretroviral therapy (ART) in HIV-infected patients is associated with body composition changes, including visceral adipose tissue (VAT) accumulation. HIV-infected patients with excess VAT may be at increased risk of type 2 diabetes, cardiovascular diseases, and mortality.

Tesamorelin is a synthetic analog of human growth hormone-releasing factor, also known as growth hormone-releasing hormone (GHRH), which is indicated for the treatment of excess abdominal fat in HIV-infected patients with lipodystrophy.

The objectives of our paper were to

1) evaluate the utility of patient characteristics and validated disease-risk scores, including indicator variables for the metabolic syndrome and the Framingham Risk Score (FRS), as predictors of  visceral adipose tissue reduction during tesamorelin therapy, and

2) to explore the characteristics of patients who reached a threshold of VAT <140 cm2, a level associated with lower risk of adverse health outcomes, after 6 months of treatment with tesamorelin.

The basis of the report was a pooled analysis of the two pivotal, randomized Phase 3 trials of tesamorelin in 806 HIV-infected patients with excess abdominal fat. Our results indicate that presence of metabolic syndrome, high triglycerides, and white race are associated with a greater likelihood of responding to 6 months of tesamorelin treatment. The most robust response appears to be in subjects with VAT above 140 cm2, as well as those in the overweight range for body mass index (BMI) measures.

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Cotrimoxazole Discontinuation in Malaria Endemic Areas Increases Rate of Malaria

 

Dr. Christina Polyak MD MPH Acting Instructor with the University of Washington Clinical research physician at the U.S. Military HIV Research Program Walter Reed Army Institute of Research at WRAIR Bethesda, MD 20817 Medical Research: What is the background for this study? What are the main findings? Dr. Polyak: Today, 35 million people are infected with HIV, the virus that causes AIDS. Cotrimoxazole (CTX) is low-cost and widely utilized broad spectrum antibiotic used to prevent opportunistic infections in patients with HIV. CTX prophylaxis is recommended by the World Health Organization (WHO) for HIV infected adults in settings with high infectious disease prevalence. In these settings, the threshold for CTX discontinuation is undefined. We designed a study to determine whether CTX discontinuation was non-inferior to continued CTX-prophylaxis in decreasing morbidity in adults with evidence of immune reconstitution (CD4 >350 and 18 months on ART). Our findings show that combined morbidity/mortality was significantly higher in the CTX discontinuation arm (RR=2.27, 95% CI 1.52-3.38;p<0.001), driven by malaria morbidity. This suggests that CTX discontinuation among ART-treated, immune-reconstituted adults in malaria-endemic regions resulted in increased incidence of malaria but not pneumonia or diarrhea. These data helped inform and support the 2014 WHO CTX guidelines. Medical Research: What should clinicians and patients take away from your report? Dr. Polyak: CTX discontinuation among ART-treated adults in a region with endemic malaria resulted in increased incidence of clinical malaria but not pneumonia or diarrhea. The implications are broad and our results suggest that CTX prophylaxis should continue in regions with endemic malaria. Medical Research: What recommendations do you have for future research as a result of this study? Dr. Polyak: Understanding the burden of malaria, pneumonia and diarrhea in the HIV-uninfected community would be prudent to compare background rates of disease. Citation: Cotrimoxazole Prophylaxis Discontinuation among Antiretroviral-Treated HIV-1-Infected Adults in Kenya: A Randomized Non-inferiority Trial Christina S. Polyak ,Krista Yuhas, Benson Singa, Monica Khaemba, Judd Walson, Barbra A. Richardson,Grace John-Stewart Published: January 5, 2016 DOI: 10.1371/journal.pmed.1001934

Dr. Christina Polyak

MedicalResearch.com Interview with:
Dr. Christina Polyak MD MPH
Acting Instructor with the University of Washington
Clinical research physician at the U.S. Military HIV Research Program
Walter Reed Army Institute of Research at WRAIR
Bethesda, MD  20817

Medical Research: What is the background for this study? What are the main findings?

Dr. Polyak:    Today, 35 million people are infected with HIV, the virus that causes AIDS.   (CTX)  is low-cost and widely utilized broad spectrum antibiotic used to prevent opportunistic infections in patients with HIV.  CTX prophylaxis is recommended by the World Health Organization (WHO) for HIV infected adults in settings with high infectious disease prevalence.   In these settings, the threshold for CTX discontinuation is undefined.  We designed a study to determine whether CTX discontinuation was non-inferior to continued CTX-prophylaxis in decreasing morbidity in adults with evidence of immune reconstitution (CD4 >350 and 18 months on ART).  Our findings show that combined morbidity/mortality was significantly higher in the CTX discontinuation arm (RR=2.27, 95% CI 1.52-3.38;p<0.001), driven by malaria morbidity.   This suggests that CTX discontinuation among ART-treated, immune-reconstituted adults in malaria-endemic regions resulted in increased incidence of malaria but not pneumonia or diarrhea.  These data helped inform and support the 2014 WHO CTX guidelines.

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How Does PD-L1 Blockade Impact HIV Immune Response?

Andreas Meyerhans, PhD ICREA Research Professor at the University Pompeu Fabra Infection Biology Group Department of Experimental and Health Sciences Universitat Pompeu Fabra Barcelona Spain

Dr. Meyerhans

MedicalResearch.com Interview with:
Andreas Meyerhans, PhD
ICREA Research Professor at the University Pompeu Fabra
Infection Biology Group
Department of Experimental and Health Sciences
Universitat Pompeu Fabra
Barcelona Spain

Medical Research: What is the background for this study? What are the main findings?

Dr. Meyerhans: In brief, chronic HIV infections lead to a dampening of HIV-specific killer cells. This phenomenon is named exhaustion and is mediated by inhibitory proteins, such as PD-1, on the cell surface. A consequence of exhaustion is a reduction of the immune control over virus expansion.

We have studied the effect of blocking the negative signaling from the inhibitory proteins by means of PD-1/PD-L1 pathway inhibition on effector and regulatory T cells (Treg). We found that one can augment antiviral immune control only when the virus load was well controlled in the HIV-infected individuals i.e. by antiviral drugs. In that case, PD-1/PD-L1 pathway blockage led to an expansion of anti-HIV killer cells over Treg cells. This latter are suppressive white blood cells also subject to the same inhibitory pathway regulation. In contrast, when blood cells from viremic HIV-infected individuals were analyzed, Treg cells expanded efficiently and thus reduced the effector to regulatory T cell ratio that controls HIV. Taken together, our data point to Treg cells as an important component in the outcome of PD-1/PD-L1 pathway inhibitor therapies and suggest a net gain in anti-HIV immune responses only when the HIV loads are well controlled during the administration of these novel compounds.

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Women With HIV Far More Likely To Be Treated Than Men

Dr. Andrew Auld MD, MSc Medical Epidemiologis Division of Global HIV & TB CDC

Dr. Andrew Auld

MedicalResearch.com Interview with:
Dr. Andrew Auld 
MD, MSc
Medical Epidemiologist
Division of Global HIV & TB
CDC

MedicalResearch: What is the background for this study?

Dr. Auld: Equitable access to antiretroviral therapy for men and women living with HIV is a principle endorsed by most countries and funding bodies, including the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). This analysis, including more than 765,000 adult patients starting antiretroviral therapy in 12 countries (10 African countries, Haiti, and Vietnam), is the most up-to-date and comprehensive assessment of differences in HIV treatment access among men and women with HIV in developing countries.

MedicalResearch: What are the main findings?

Dr. Auld: Investigators showed that in all 10 African countries and Haiti, women with HIV were far more likely to be on treatment than men. In these 11 countries, women were 23%–83% more likely to access antiretroviral therapy than men with HIV. In addition, in six African countries and Haiti, gender imbalance in HIV treatment access appears to be getting worse over time.
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Sexual Activity Based Antiretrovirals Reduce HIV in MSM

MedicalResearch.com Interview with: Prof Jean-Michel Molina Maladies Infectieuses et Tropicales, Hôpital Saint-Louis, Paris France

Prof. Molina

MedicalResearch.com Interview with:
Dr Jean-Michel Molina
Department of Infectious Diseases
Saint-Louis Hospital and University of Paris Diderot
Paris France

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

Dr. Molina: Men who have sex with men (MSM) are disproportionately affected by HIV worldwide and represent the today in Europe the largest group in which new HIV infections are diagnosed with no decrease over the last 8 years.

The first study assessing preexposure prophylaxis (PrEP) efficacy among MSM was published in 2010 (the Iprex study) which reported for the first time a 44% reduced incidence of HIV in those randomized to receive daily tenofovir/emtricitabine  TDF/FTC (one pill per day) as compared to placebo. Adherence to a daily pill regimen was found to be challenging however since only half of the participants (according to drug detection in blood) were taking their daily regimen. Post-hoc analyses suggested that among those with drugs detectable in plasma, PrEP efficacy could be as high as 92%. However, long term adherence to a daily regimen represents the Achille’s heel of daily PrEP, as shown later in other large PrEP trials among women in Africa (VOICE and Fem-PrEP).

Based on data from animal models we wished to assess whether PrEP with TDF/FTC taken on demand, at the time of sexual activity, could improve adherence, thereby efficacy and also improve safety and cost.

In this randomized double blind placebo controlled trial, on demand PrEP with TDF/FTC reduced the incidence of HIV by 86% in the intent to treat analysis as compared to placebo, and the only 2 participants who became infected in the TDF/FTC arm after more than a year of follow-up, had discontinued the use of PrEP months before infection.

The ANRS Ipergay study reports therefore a very high efficacy of PrEP, similar to that also reported in another PrEP study carried out in the UK among MSM with daily TDF/FTC (PROUD), which results were disclosed at the same time. Both studies have increased awareness about the real potential of PrEP and have had a strong impact on WHO and European guidelines.

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Two Treatment Options Achieve Control in HIV Infected Children

Dr. Louise Kuhn PhD Professor, Epidemiology Sergievsky Center Columbia University

Dr. Kuhn

MedicalResearch.com Interview with:
Dr. Louise Kuhn PhD
Professor, Epidemiology
Sergievsky Center
Columbia University 

Medical Research: What is the background for this study? What are the main findings?

Dr. Kuhn: Ritonavir-boosted lopinavir-based antiretroviral therapy is recommended as first-line treatment for HIV-infected infants and young children while efavirenz is recommended for adults and older children. There are several advantages of transitioning HIV-infected children to efavirenz-based treatment as they get older.  These advantages include the possibility of once-daily dosing, simplification of co-treatment for tuberculosis, avoidance of some metabolic toxicities, preservation of ritonavir-boosted lopinavir for second-line treatment, and alignment of adult and pediatric treatment regimens. However, there have been concerns about possible reduced viral efficacy of efavirenz-based treatment in children exposed to nevirapine for prevention of mother-to-child transmission.  This is because efavirenz and nevirapine are in the same drug class and the majority of children who become infected despite exposure to nevirapine used for prevention have mutations in their virus that usually predict resistance to this drug class.

In this study, we randomized HIV-infected children to two different treatment strategies: In the control strategy they remained on their initial ritonavir-boosted lopinavir regimen; in the alternative strategy they transitioned to an efavirenz-based regimen.  All children had been exposed to nevirapine used (unsuccessfully) to prevent mother to child HIV transmission and were virologically-suppressed (HIV in blood < 50 copies/ml) at the time of enrollment into the study.  We observed excellent virological control in both groups with fewer than 3% of children having levels of HIV in their blood greater than 1000 copies/ml.  Sustained suppression of virus in blood below 50 copies/ml throughout follow-up was achieved in 82% of the children transitioned to efavirenz-based treatment compared to 72% of children remaining on the control treatment.

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Newly Diagnosed HIV+ Men Underreport Male Sexual Encounters

Philip J. Peters MD DTM&H (Diploma in Tropical Medicine & Hygiene) Medical Officer, Division of HIV/AIDS Prevention US Centers for Disease Control and Preventio Atlanta GeorgiaMedicalResearch.com Interview with:
Philip J. Peters MD DTM&H
(Diploma in Tropical Medicine & Hygiene)
Medical Officer,
Division of HIV/AIDS Prevention
US Centers for Disease Control and Prevention
Atlanta Georgia

Medical Research: What is the background for this study? What are the main findings?

Dr. Peters: We recruited participants from the STOP project, an existing multi-site study in North Carolina, New York City, and San Francisco, to analyze self-reported HIV-related risk behaviors among men who have sex with men (MSM). We found that newly diagnosed HIV-positive gay and bisexual men in North Carolina (predominately young and African American) did not always report male sex partners at the time of HIV testing.

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Fat Tissue Identified As Important Reservoir of HIV Infection

MedicalResearch.com Interview with:
Christine Bourgeois
Unité UMR 1184 / Centre IMVA
CR1 INSERM, Coordinatrice site Bicêtre
Le Kremlin-Bicêtre Cedex

Medical Research: What is the background for this study? What are the main findings?

Response: Antiretroviral therapy (ART)  treatment in HIV infected patients had successfully reduced the development of AIDS (acquired immune deficiency syndrome). However, chronic HIV infection in ART treated patients exhibit rapid uprising of viral load following ART interruption indicating that the virus is not eradicated and persist in some cellular or anatomical sites that are called “reservoir”.

Secondly, ART controlled HIV-infected patients exhibit low grade inflammation developing despite efficient viral control. This low grade inflammation has been associated with non AIDS related pathologies. The aim of our work was to identify site that may combine viral persistence and inflammatory potential. We believed that adipose tissue was a very promising candidate because it included the major targets of HIV infection (CD4 T cells, and macrophages) and exhibited a highly pro-inflammatory potential. Although adipose tissue has been extensively studied as a target of antiretroviral toxicity, we readdress the role of adipose tissue as a reservoir and a site of inflammation. We demonstrated that indeed, adipose tissue from  Antiretroviral therapy controlled HIV-infected patients contained infected CD4 T cells that upon in vitro reactivation were able to produce HIV RNA. These results are extremely important because adipose tissue represents 15%-20% of body weight and is diffusely located. We thus identify a large new reservoir.

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Death Rate of HIV-Infected Youth Increased Thirty Fold

MedicalResearch.com Interview with:
Gayatri Mirani MD and
Tulane University School of Medicine
New Orleans, Louisiana

Paige L. Williams, PhD
Department of Biostatistics
Harvard T. H. Chan School of Public Health
Boston, MA 02115

Medical Research: What is the background for this study

Response: Combination antiretroviral therapy (cART) has resulted in a dramatic decrease in HIV-related opportunistic infections and deaths in US youth, but both continue to occur. IMPAACT P1074, a long-term US-based prospective multicenter cohort study funded through NIH was conducted from April 2008 to June 2014. We reviewed complications and mortality rates in HIV-infected US youth enrolled in this study. Comparisons were made with a previous observational cohort study, P219C. While P219C was conducted from 2000 to 2007, we restricted our analysis to 2004-2007 in order to evaluate changes over the past decade.

A total of 1201 HIV-infected youth were enrolled in the IMPAACT P1074 study, with most (1040, or 90%) infected with HIV at birth. The overall study population was 52% female, 58% black non-Hispanic and 28% Hispanic. Their mean age at the first chart abstraction was 17.4 (±5.4 Std. Dev.) years. The majority were on cART, had a stable CD4 count (baseline mean > 500 cells/mm3) and a suppressed viral load over a median follow-up of 3.7 years. The P219C group was younger, with a mean age of 11.9 (±5.0 Std. Dev.) years at the start of the 2004-2007 follow-up period.

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Investigating cellular HIV resistance to understand “Elite controllers”?

Yong-Hui Zheng, Ph.D. Associate Professor Biomedical Physical Science Building Department of Microbiology and Molecular Genetics Michigan State University East Lansing, MI 48824-4320MedicalResearch.com Interview with:
Yong-Hui Zheng, Ph.D.
Associate Professor
Biomedical Physical Science Building
Department of Microbiology and Molecular Genetics
Michigan State University
East Lansing, MI 48824-4320 

Medical Research: What is the background for this study? What are the main findings?

 Dr. Zheng: Although HIV-1 has caused one of the most devastating pandemics by inducing AIDS, this virus failed to induce the disease in a small cohort of patients, who are known as “Elite controllers”. The secrete of the viral resistance in these individuals may point the direction of a cure for AIDS, which is still not available in the current antiretroviral therapies.   We started to study HIV resistance using human CD4+ T cells as a model system, because these cells are primary targets for HIV-1 infection. We successfully identified a highly HIV-resistant cell line CEM.NKR, where HIV-1 replication is decreased by almost 1,000-fold. Understanding of the resistant mechanism has been the primary interest in our laboratory, and we have published a series of papers to elucidate how the HIV-1 replication is inhibited in these cells.

Our initial findings uncovered that HIV-1 is able to enter these cells, but fails to regenerate infectious virions. Further investigation showed that although the virus could make the other viral proteins, it fails to express the viral envelope (Env) glycoprotein. Most viruses have an envelope to cover their protein capsids, where viral spikes are anchored. These spikes are made from the Env glycoproteins, which are required for the virus to penetrate into cells and start infection. Thus, identifying the pathway that specifically inhibits the Env expression will open a new avenue for antiretroviral therapies.

In the present paper, we found that the endoplasmic reticulum class I α-mannosidase (ERManI) initiates the Env inhibition process. ERManI is a host enzyme that is involved in protein N-glycosylation. When the ERManI expression is up-regulated, it targets Env to the ER-associated protein degradation (ERAD) pathway, resulting in Env degradation and inhibition of HIV-1 replication.

Medical Research: What should clinicians and patients take away from your report?

Dr. Zheng: These findings suggested that ERManI could contribute to the natural host resistance to HIV-1 infection. It would be interesting to further investigate the correlation between the ERManI expression levels and viral loads in HIV patients. An inverse correlation would further confirm its important role in the natural resistance.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Zheng: ERManI is an unstable protein and expressed at low levels in mammalian cells. We are planning to develop a technology to boost the ERMani expression, and test whether HIV-1 replication could be eradicated by this technology.

Citation:

Tao Zhou, Dylan A. Frabutt, Kelley W. Moremen, Yong-Hui Zheng.ERManI (Endoplasmic Reticulum Class I α-Mannosidase) Is Required for HIV-1 Envelope Glycoprotein Degradation via Endoplasmic Reticulum-associated Protein Degradation Pathway. Journal of Biological Chemistry, 2015; 290 (36): 22184 DOI:10.1074/jbc.M115.675207

Related links:

http://msutoday.msu.edu/news/2010/msu-professor-probes-hiv-immunity/

http://msutoday.msu.edu/news/2015/international-team-discovers-natural-defense-against-hiv/

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Yong-Hui Zheng, Ph.D. (2015). Investigating “Elite controllers” To Understand HIV Resistance 

HIV Self-Testing Found Safe and Acceptable in Community Setting

MedicalResearch.com Interview with:
Augustine T. Choko MSc
Malawi–Liverpool–Wellcome Trust Clinical Research Programme
Blantyre, Malawi

Medical Research: What is the background for this study?

Response: Despite rapid scale up of HIV testing in the sub Saharan African region, half of people living with HIV are unware of their status. We investigated a novel approach of HIV self testing as an additional strategy to existing HIV testing options.

Medical Research: What are the main findings?

Response: Population uptake of HIV self testing was high at the first offer and remained high at the second offer 12 months later. The approach saw high numbers of adolescents and men testing.

Community participants with 8% illiterate were able to do the test and correctly interpret it on their own with minimal training.

People who self-tested positive were able to link into the clinic for antiretroviral therapy eligibility assessment.

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HIV Meds Given to HIV Negative MSM Reduced New Infections Over 80%

Prof-Sheena-McCormack.jpgMedicalResearch.com Interview with:
Professor Sheena McCormack
Clinical Epidemiology
Medical Research Council Clinical Trials Unit
University College London

Medical Research: What is the background for this study? What are the main findings?

Prof. McCormack: PROUD is the first study of pre-exposure prophylaxis (PrEP) to prevent HIV carried out in the UK. The results show that PrEP could play a major role in reducing the number of new infections among men who have sex with men who are at risk of catching HIV.

Pre-exposure prophylaxis (PrEP) is a HIV prevention strategy that involves HIV-negative people taking some of the drugs we use for treatment of HIV to reduce the risk of becoming infected. The PROUD study (www.proud.mrc.ac.uk) looked at whether offering daily PrEP to men who have sex with men was an effective way to prevent HIV infection. The results show that pre-exposure prophylaxis is highly protective, reducing the risk of infection for this group by 86%.

The drug used in the trial – the antiretroviral Truvada – was already known to reduce the incidence of HIV infection compared to placebo (a dummy pill).  The PROUD study was designed to see how good Truvada would be found as pre-exposure prophylaxis in a real world situation when participants knew they were taking an active drug.  It aimed to address outstanding questions such as whether taking PrEP would change sexual risk behaviour – for example increasing the number of partners they did not use condoms with and increasing the rate of other sexually transmitted infections (STIs) – and whether or not it would be cost-effective to make it available on the NHS.
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Poor Patients Receiving Care Through Ryan White Programs Achieve Better HIV Control

Dr. John Weiser MD MPH Medical epidemiologist Division of HIV/AIDS Prevention CDC MedicalResearch.com Interview with:
Dr. John Weiser MD MPH
Medical epidemiologist
Division of HIV/AIDS Prevention
CDC 

Medical Research: What is the background for this study? What are the main findings?

Dr. Weiser: Ryan White was an Indiana teenager diagnosed with AIDS in the late 1980s. As a result of fear and stigma, he was barred from school and went on to become a national advocate for HIV education and acceptance. This year marks the 25th anniversary of his death and passage of the Ryan White CARE Act creating The Ryan White HIV/AIDS Program (RWHAP) which provides funding for healthcare facilities to deliver needed medical care and support services for hundreds of thousands of poor, uninsured, and underinsured Americans. While increased access to Medicaid and private insurance under the Affordable Care Act will provide coverage for medical care, it might not provide coverage for support services so it is likely that the RWHAP will continue to play a key role in providing these crucial services.

Overall, 34.4 percent of facilities received Ryan White HIV/AIDS Program funding and 72.8 percent of patients received care at RWHAP-funded facilities. Many of the patients at Ryan White HIV/AIDS Program -funded facilities had multiple social determinants of poor health, with patients at RWHAP-funded facilities more likely to be ages 18 to 29; female; black or Hispanic; have less than a high school education; income at or below the poverty level; and lack health care coverage.

Despite the greater likelihood of poverty, unstable housing and lack of health care coverage, nearly 75 percent of patients receiving care at RWHAP-funded facilities achieved viral suppression. The percentage of ART (antiretroviral therapy) prescribing was similar for patients at RWHAP-funded compared with non-funded facilities. Patients at RWHAP-funded facilities were less likely to be virally suppressed. However, individuals at or below the poverty level and those ages 30 to 39 who received care at a RWHAP-funded facility compared with those who received care at a non-RWHAP-funded facility were more likely to achieve viral suppression.

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MMR Vaccination May Not Be Reliable in HIV+ Children

George K Siberry, MD, MPH, Medical Officer Maternal and Pediatric Infectious Disease (MPID) Branch Eunice Kennedy Shriver National Institute of Child Health and Human Development National Institutes of Health Bethesda, MDMedicalResearch.com Interview with:
George K Siberry, MD, MPH, Medical Officer
Maternal and Pediatric Infectious Disease (MPID) Branch
Eunice Kennedy Shriver National Institute of Child Health and Human Development
National Institutes of Health
Bethesda, MD

Medical Research: What is the background for this study?

Dr. Siberry:  Vaccines may not work as reliably in children with HIV infection, especially when their HIV is not under effective treatment. Today, most children in the United States who were born with HIV infection are receiving effective HIV treatment and have reached school age or even young adulthood. However, many received their childhood vaccines before they got started on their HIV treatment (because modern HIV treatments weren’t available when they were very young or their HIV infection was diagnosed late). So we wanted to see if these older children still had immunity from the vaccines they received when they were much younger.

Medical Research:  What are the main findings?

Dr. Siberry: We looked specifically at whether older children with HIV since birth were protected against measles, mumps, and rubella, the three viral infections covered by the measles-mumps-rubella (or MMR) vaccine. We found that 1/3 up to almost 1/2 of these children were not protected against these viruses, even though nearly all of the children had received at least 2 MMR doses, as recommended. And even if their HIV was currently under excellent control.  When we analyzed factors that were linked to being protected, we found that one of the most important factors was whether you got your MMR vaccine doses after you got on good treatment for your HIV infection.  For instance, over 85% of children who had gotten at least 2 MMR vaccine doses after being on effective HIV treatment were protected against measles compared to less than half of those who didn’t get both of their MMR vaccine doses while on effective HIV treatment.
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Methadone For IV Drug Addiction Reduces HIV Infections

MedicalResearch.com Interview with:

Dr. Keith Ahamad, a clinician scientist at the BC Centre for Excellence in HIV/AIDS and a Family Doctor trained and certified in Addiction Medicine.  He is Division Lead for Addiction Medicine in the department of Family and Community Medicine at Providence Health Care, and is also an addiction physician at the St. Paul’s Addiction Medicine Consult Service, the Immunodeficiency Clinic and Vancouver Detox. He is also Lead Study Clinician for CHOICES, a US National Institutes of Drug Abuse (NIDA) funded clinical trial looking at an opioid receptor blocker (Vivitrol) to treat opioid or alcohol addiction in HIV positive patients.Dr. Keith Ahamad, a clinician scientist at the BC Centre for Excellence in HIV/AIDS and a Family Doctor trained and certified in Addiction Medicine.

He is Division Lead for Addiction Medicine in the department of Family and Community Medicine at Providence Health Care, and is also an addiction physician at the St. Paul’s Addiction Medicine Consult Service, the Immunodeficiency Clinic and Vancouver Detox. He is also Lead Study Clinician for CHOICES, a US National Institutes of Drug Abuse (NIDA) funded clinical trial looking at an opioid receptor blocker (Vivitrol) to treat opioid or alcohol addiction in HIV positive patients.

MedicalResearch: What is the background for this study?

Dr. Ahamad: Previous methadone research has mostly been done in restrictive settings, such as the USA, where methadone can only be dispensed through restrictive methadone programs and cannot be prescribed through primary care physician’s offices. Since a systematic review in 2012, randomised controlled trials have compared methadone treatment provided at restrictive specialty clinics with primary care clinics, which have shown the benefits of primary care models of methadone delivery on heroin treatment outcomes, but not on HIV incidence.

MedicalResearch: What are the main findings?

Dr. Ahamad: After adjusting for factors commonly associated with HIV, methadone remained independently associated in protecting against HIV in this group of injection drug users. Those study participants who were not prescribed methadone at baseline were almost four times more likely to contract HIV during study follow up.

MedicalResearch: What should clinicians and patients take away from your report?

Dr. Ahamad: Methadone is an effective medication in treating opioid addiction. Through international randomized control trials, we already know that when prescribed though primary care offices, access to this life-saving medication is increased, effective, and increases patient satisfaction. Now, through our study, we have evidence that when delivered in this manner, it also decreases the spread of HIV.

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Majority of New HIV Infections Occur in Men Who Have Sex With Men

Adaora Adimora, MD, MPH Chair of the HIV Medicine Association Professor of Medicine School of Medicine University of North Carolina, Chapel Hill.MedicalResearch.com Interview with:
Adaora Adimora, MD, MPH

Chair of the HIV Medicine Association
Professor of Medicine School of Medicine
University of North Carolina, Chapel Hill.

MedicalResearch: What is the current scope of the HIV epidemic?

Dr. Adimora: The Centers for Diseases Control and Prevention (CDC) estimates that there are 1.2 million people living with HIV in the U.S. Nearly 13% are undiagnosed and unaware of their status. Men who have sex with men represented 54% of all people living with HIV in 2011. While new infection rates are stable, a majority of new infections (63%) are occurring among men who have sex with men. We have seen alarming increases among young black men who have sex with men who account for 55% of new infections among men who have sex with men. New infections among women have decreased slightly but black and Hispanic/Latina women represent 62% and 17% of new infections respectively among women.[i] While there have been decreases in new HIV infections among people who inject drugs in recent years, the serious outbreak largely among injection drug users in Scott County, Indiana identified this past spring[ii] puts us on high alert to improve access to preventive services and substance use treatment, including access to sterile syringes and equipment.

My responses will generally focus on the U.S. epidemic but want to acknowledge that globally an estimated 36.9 million people were living with HIV at the end of 2014 with just 51% of them being diagnosed and more than 34 million deaths were attributed to HIV-related causes.[iii]

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Tenovir Gel May Reduce Risk of Both HIV and Herpes Simplex

Dr. Salim Abdool Karim at CAPRISA Doris Duke Medical Research Institute South AfricaMedicalResearch.com Interview with:
Dr. Salim Abdool Karim at CAPRISA
Doris Duke Medical Research Institute
South Africa

Medical Research: What is the background for this study? What are the main findings?

Response: Globally, Herpes simplex virus type-2 (HSV-2) is among the most common sexually transmitted infections and is the leading cause of genital ulcers. Available global estimates indicate that approximately 417 million sexually active adults between the ages of 15 and 49 years had an existing prevalent HSV-2 infection in 2012. Current interventions to prevent HSV-2 infection, including condoms, circumcision, and antiviral treatment among heterosexual, HSV-2-discordant couples, have demonstrated protection levels ranging from 6% to 48%. This study showed that peri-coital tenofovir gel reduced HSV-2 acquisition in women by 51%, rising to 71% in high gel-users.

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Cancer Drug Can Activate HIV Reservoirs To Target For Eradication

Dr. Satya Dandekar PhD Professor and Chair Department of Medical Microbiology and Immunology UC DavisMedicalResearch.com Interview with:
Dr. Satya Dandekar PhD
Professor and Chair
Department of Medical Microbiology and Immunology
UC Davis

Medical Research: What is the background for this study? What are the main findings?

Dr. Dandekar: Current anti-retroviral therapy is effective in suppressing HIV replication and enhancing immune functions in HIV infected individuals. However, it fails to eradicate the latent HIV reservoirs. Therapy interruption leads to a rapid viral rebound in these patients.  Eradication of latent HIV reservoirs is essential to achieve HIV cure. A “shock and kill” strategy for HIV cure has been proposed that involves reactivation of latent viral reservoirs using latency reversal agents (LRA) and eradication by the immune response. This highlights the need to identify potent LRAs to optimally activate latent HIV reservoirs so that immune surveillance and clearance mechanisms can be effectively engaged in the process of viral eradication. We have found that ingenol-3-angelate (PEP005), an anti-cancer drug can effectively reactivate latent HIV. It is a protein kinase C agonist that activates NF-kB and stimulates HIV expression. In combination with another compound, JQ1, a previously known p-TEFb agonist, the efficacy of PEP005 for HIV reactivation is markedly increased. In addition, ingenol-3-angelate decreases the expression of HIV co-receptors on immune cells, which potentially will help preventing further spread of the virus. The use of ingenol-3-angelate in combination with other latency reversal agents provides an excellent opportunity to optimally activate latent HIV reservoirs and target them for eradication.

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Risk Score May Help Identify MSM Most In Need Of HIV Prevention Resources

MedicalResearch.com Interview with:
Dr. Martin Hoenigl
Center for AIDS Research
University of California, San Diego

Medical Research: What is the background for this study? What are the main findings?

Dr. Hoenigl: Although men who have sex with men (MSM) represent a dominant risk group for human immunodeficiency Virus, the risk of HIV infection within this population is not uniform. Characterizing and identifying the MSM at greatest risk for incident HIV infection might permit more focused delivery of both prevention resources and selection of appropriate interventions, such as intensive counseling, regular HIV screening with methods that detect acute infection (ie, nucleic acid amplification test), and antiretroviral preexposure prophylaxis (PrEP).

By using data collected at a single HIV testing encounter from 8326 unique MSM were analyzed, including 200 with AEH (2.4%), we were able to create the San Diego Early Test (SDET) risk score. The SDET score consist of four risk behavior variables which were significantly associated with an AEH diagnosis (ie, incident infection) in multivariable: condomless receptive anal intercourse (CRAI) with an HIV-positive MSM (3 points), the combination of CRAI plus 5 or more male partners (3 points), 10 or more male partners (2 points), and diagnosis of bacterial sexually transmitted infection (2 points), all as reported for the prior 12 months. The SDET risk score is deployed as a freely available tool at http://sdet.ucsd.edu.

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Over 1/3 HIV Patients Who Develop Opportunistic Infection Die Within Five Years

MedicalResearch.com Interview with:
Sandra Schwarcz, MD
Senior HIV epidemiologist
San Francisco Department of Public Health

Medical Research: What is the background for this study? What are the main findings?

Dr. Schwarcz: AIDS opportunistic illnesses continue to occur despite effective antiretroviral therapy. Although previous studies examined survival following a diagnosis of an opportunistic illness, there are few recent reports that are population-based. The San Francisco Department of Public Health has the only population-level data on the occurrence of and survival following opportunistic illnesses and use of antiretroviral therapy among persons reported with HIV in the United States. By measuring survival following the occurrence of opportunistic illnesses, we were able to document that survival following opportunistic illnesses has improved with better HIV treatment. However, opportunistic illnesses continue to occur and carry substantial mortality risk. Even in this era of effective HIV therapy, we found that 35% of persons who developed an opportunistic illness died within five years of their diagnosis and some opportunistic illnesses such as brain lymphoma and  progressive multifocal leukoencephalopathy remain highly lethal.
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Black Young Gay Men From Poor Neighborhoods More Likely To Contract HIV

Perry N Halkitis, Ph.D., M.S., MPH Professor of Applied Psychology Global Public Health, and Population Health/Medicine New York University.MedicalResearch.com Interview with:
Perry N Halkitis, Ph.D., M.S., MPH
Professor of Applied Psychology
Global Public Health, and Population Health/Medicine
New York University.

Medical Research: What is the background for this study?

Dr. Halkitis: The P18 Cohort Study is a prospective cohort study of gay, bisexual and other young men who have sex with men (YMSM) which seeks to examine the development of health behaviors as these young men transition from adolescent to adulthood. Officially named “Syndemic Production among Emergent Adult Men”, this study was funded by the National Institute on Drug Abuse from 2009-2014 and renewed on March 1, 2014 for an additional five years.

The original aims of the study were as follows:

  • 1) to develop and test theoretically informed measurement models of the covariance of illicit drug use, unprotected sexual behavior and mental health burden (multiple overlapping epidemics known as a syndemic) among emergent adult HIV-negative YMSM within and across time;
  • 2) to delineate the risk and protective bases- physical factors (e.g., pubertal onset, HIV status, etc.), relational and structural factors (e.g., family history of psychopathology, current romantic relationships, peer support, neighborhood factors, etc.), and psychosocial factors (e.g., sexual identity, internalized homophobia, hyper-masculine conceptions, etc.) that predict the development of syndemics; and
  • 3) to determine the extent to which the development of a syndemic varies by race/ethnicity, social class, and homelessness/housing instability.
  • In this current five year continuation we also seek
    • 1) to describe the social and sexual networks of YMSM, and to examine the relationship between social and sexual network-level structural characteristics, social support and normative influences on syndemic production (illicit drug use, unprotected sexual behaviors, and mental health burden) in YMSM, singly and in combination with the physical, psychosocial, and relational predictors, both within and across time;
    • 2) to describe the acquisition of sexually transmitted infections (STIs) in YMSM, specifically, urethral and rectal gonorrhea and chlamydia, pharyngeal gonorrhea as well as syphilis serology; and to determine the extent to which physical, relational, and psychosocial factors explain STI acquisition as part of the syndemic model within and across time.
    • A third exploratory aim was also added: 3) to describe HIV clinical treatment markers (i.e., HIV viral load, ART uptake and adherence, HIV care) among HIV+ YMSM, and to assess the extent to which physical, relational, and psychosocial factors are associated with differences in these clinical markers among HIV+ YMSM, both within and across time. The study is led by Drs. Perry N Halkitis and Farzana Kapadia at New York University’s Center for Health, Identity, Behavior & Prevention Studies.

Potential participants were recruited through both active (e.g., approaching individuals to solicit study participation) and passive (e.g., flyer posting, website advertisements) methods from June 2009 to May 2011. Eligibility criteria included being 18-19 years old, biologically male, residing in the NYC metropolitan area, having sex (any physical contact that could lead to orgasm) with a man in the last 6 months, and reporting a seronegative or unknown HIV status at baseline. We ensured the diversity of our sample by setting a fixed recruitment quota for participants in each targeted racial/ethnic group, such that African Americans, Latino (across race), Asian-Pacific Islander (API), and mixed race men comprised the majority of the sample. All participants provided written, informed consent before data was collected and were compensated for their time and effort upon completing the baseline assessment. The New York University’s Institutional Review Board (IRB) approved all study protocols and a federal Certificate of Confidentiality protects these data.

A total of 2,068 participants were screened for eligibility to participate in the study, and 600 participants completed the baseline assessment in the first wave of the study. In 2014, we began the second wave and opened to cohort to recruit a baseline sample of 650 YMSM who will now be between the ages of 22-23; recruitment of participants is still underway.

Medical Research: What are the main findings?

Dr. Halkitis: Numerous publications have been generated from the P18 Cohort Study and can be accessed at www.chibps.org.  A recent publication, “Incidence of HIV infection in Young Gay, Bisexual, and other YMSM: The P18 Cohort Study” became available in the May 2015 of JAIDS, the Journal of Acquired Immune Deficiency Syndromes. This paper reports that over a 36 month follow-up period, during the first wave of the study, 7.2% of study participants seroconverted, with Black and Hispanic men much more likely to seroconvert over this time frame than White men. This finding aligns with epidemiological trends for HIV infection at the national and local, NYC, levels. Also, men reporting a lower familial socioeconomic status were more likely to seroconvert than men reporting high familial socioeconomic status, and Black men were more likely to report a lower socioeconomic status.  Moreover, the Black young men who seroconverted were more likely to reside in neighborhoods with higher area-level poverty and higher area-level HIV prevalence. Additionally we found that men who reported anal sex without a condom in the 30 days prior to assessment were no more likely to seroconvert than those who reported sex with a condom.  However, an earlier age of sexual debut was a predictor of HIV seroconversion.

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Diabetes Medication May Improve Cardiac Profile Of HIV Patients on Antiretroviral Therapy

Kevin Yarasheski, PhD Assistant Director, Biomedical Mass Spectrometry Research Facility Professor of Medicine, Cell Biology & Physiology, Physical Therapy Washington University School of MedicineMedicalResearch.com Interview with:
Kevin Yarasheski, PhD
Assistant Director, Biomedical Mass Spectrometry Research Facility
Professor of Medicine, Cell Biology & Physiology, Physical Therapy
Washington University School of Medicine

Medical Research: What is the background for this study?

Dr. Yarasheski:   People living with HIV and taking combination antiretroviral therapy (cART) have successfully reduced the amount of HIV virus in their blood and have partially reconstituted their immune system (CD4+ T-cell count >250 cells/µL).  Despite this, many still experience residual immune cell activation and inflammation that is believed to increase HIV morbidity (non-AIDS conditions e.g., CVD, T2DM, obesity, liver fat, bone loss, dementia) and mortality.  Scientists are seeking safe and effective interventions for residual immune cell activation and inflammation, that have the potential to reduce non-AIDS complications that threaten quality and quantity of life among HIV infected adults.

We have been testing the safety and efficacy of sitagliptin in people living with HIV; a dipeptidyl peptidase 4 inhibitor that is FDA approved for treating T2DM, and appears to have favorable anti-inflammatory and immune modulatory properties that might specifically benefit people living with HIV and experiencing cardiometabolic complications associated with residual immune cell activation and inflammation.

Medical Research: What are the main findings?

Dr. Yarasheski:   In a randomized, double-blinded, placebo controlled 8-wk trial, we found that sitagliptin had beneficial anti-inflammatory, immune regulatory, hematopoietic progenitor cell mobilizing, and glucose lowering effects in cART-treated virally suppressed HIV adults with impaired glucose tolerance.  Sitagliptin improved glucose tolerance (a risk factor for CVD), reduced circulating and adipose-specific inflammatory markers (risk factors for obesity, T2DM, liver fat accumulation, and CVD), and increased the number of blood stem cells that can repair damage and inflammation in the vascular walls.

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‘Heart To Heart’ Aims To Improve Adherence to HIV Medications

Marya Viorst Gwadz, Ph.D Senior Research Scientist Director, Transdisciplinary Methods Core Center for Drug Use and HIV Research (CDUHR) New York University College of Nursing New York, NY 10010 MedicalResearch.com Interview with:
Marya Viorst Gwadz, Ph.D

Senior Research Scientist Director,
Transdisciplinary Methods Core
Center for Drug Use and HIV Research (CDUHR)
New York University College of Nursing
New York, NY 10010

Medical Research: What is the background for this study?

Dr. Gwadz: HIV is a major success story in that the tolerability, convenience, and efficacy of antiretroviral medications have improved dramatically over the last decade. A number of years ago in the course of another research study with vulnerable individuals infected with HIV in New York City, and we noticed that a substantial proportion of study participants were medically eligible for HIV medications, and had access to medications, but had declined or stopped taking them. We then turned our attention to understanding why this is the case, that is, to identify the individual, social, and structural barriers that persons living with HIV/AIDS (PLHA) experience to antiretroviral therapy. We focused in particular on African American/Black and Latino/Hispanic PLHA, because the overall emphasis of our research group at the NYU College of Nursing is the development and evaluation of culturally targeted intervention approaches to address health disparities. Around 2011, studies of the “HIV cascade of care” began to emerge, which highlighted the problem of poor engagement in HIV care and antiretroviral therapy nationally. The ultimate goal of HIV treatment is viral suppression, but at present, the Centers for Disease Control and Prevention (CDC) estimates that we have achieved that goal with only 30% of PLHA.

Medical Research: What kind of intervention approach that emerged from these background findings?

Dr. Gwadz: We found that barriers to HIV medication are complex and multi-faceted for PLHA from African American/Black and Latino/Hispanic backgrounds. In particular, PLHA experience serious emotional barriers to the uptake of HIV medications, such as fear of side effects, stigma, and disclosure of HIV status. Further, high rates of substance use and mental health distress, and barriers to accessing services for these concerns, impede medication uptake. Moreover, PLHA who are wary of HIV medication tend to avoid HIV primary care, often because they do not want to feel pressured to take medications, or explain to their providers why they are not taking them. So poor engagement in HIV care, which is very common among PLHA, and low uptake of HIV medication are actually related problems.

With funding from the National Institute of Mental Health (grant #R34MH093352), and in collaboration with Mount Sinai Beth Israel and Mount Sinai St. Luke’s-Roosevelt Hospital Center, we developed a multi-component culturally targeted intervention grounded in the Motivational Interviewing approach that included three individual sessions, 12-24 weeks of patient navigation (as needed), up to five support groups with other PLHA who had declined medication, which were co-led by a “successful” peer who was engaged in HIV care and were taking HIV medication with good adherence. One novel aspect of the intervention was its focus on emotional barriers to HIV medication, and the program’s “no pressure, no judgment” stance, congruent with the Motivational Interviewing approach, was key to engaging participants into the study to talk about these difficult issues.

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Adolescents Risk Failing HIV Treatment If No Parent Attends Clinic Visits

Elizabeth Lowenthal, MD MSCE Assistant Professor of Pediatrics Children's Hospital of PhiladelphiaMedicalResearch.com Interview with:
Elizabeth Lowenthal, MD MSCE

Assistant Professor of Pediatrics
Children’s Hospital of Philadelphia

Medical Research: What is the background for this study? What are the main findings?

Dr. Lowenthal: Between 2005 and 2012, HIV related deaths declined by 30% worldwide. However, during the same time period, HIV related deaths increased 50% among adolescents. Over 90% of HIV-infected children and adolescents live in sub-Saharan Africa and HIV is the leading cause of death among adolescents in Africa. Treatment is available that can allow babies born with HIV to live to be healthy adults. However, strict adherence to these medicines is necessary and often becomes a great challenge during adolescence. In our study of 300 adolescents (ages 10-19) in Botswana, my team found that adolescents who come to clinic without a parent or guardian have a 4.5X greater odds of failing their HIV treatment.

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Black HIV+ Patients Have Increased Mortality Even When Treated

MedicalResearch.com Interview with:
Catherine R. Lesko, MPH

Department of Epidemiology
UNC School of Global Public Health
Chapel Hill, NC

Medical Research: What is the background for this study? What are the main findings?

Response: There is a lot of evidence out there that HIV-infected minorities, and in particular, African Americans, experience higher morbidity and mortality than do their white, HIV-infected counterparts. This study looked at whether there were still differences in mortality among treated, HIV-infected adults, which was a crude attempt to control for differences in access to HIV-testing, HIV-care, and antiretroviral therapy – all things previously shown to contribute to racial disparities among people infected with HIV. Even among people who had initiated HIV therapy, we still found that black patients had a 10-year risk of mortality that was 8 percentage points greater than white patients. Hispanic patients did marginally better than white patients, but not as much better as their non-HIV-infected counterparts.

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Troubling Increase In HIV Infections In MSM

MedicalResearch.com Interview with:
Lorena Espinoza
Center for Disease Control

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

Response: Men who have sex with men remain the risk group most severely affected by HIV in the United States, accounting for approximately two-thirds of new infections each year. Understanding trends in HIV diagnosis by metropolitan statistical area (MSA) provides valuable insight into developing and evaluating effective prevention strategies. Using data from CDC’s National HIV Surveillance System (NHSS), we measured changes between 2003 and 2012 in the annual rate of HIV diagnoses by metropolitan statistical area (MSA).

o   Overall, the HIV diagnosis rate decreased by an average of 3.7 percent per year.

o   Among MSM, the number of diagnoses increased from 2003 to 2007 by a total of 11 percent before leveling and declining by 2 percent from 2008 to 2012.

  • The number of diagnoses among Men who have sex with men in the later period significantly increased in 10 MSAs, decreased in 9 MSAs, and remain unchanged in all others.

o   Among young MSM, the number of diagnoses continued to increase (by 15 percent overall) from 2008 to 2012.

o   The number of diagnoses among older MSM 55-64 and 65+ years of age remained unchanged from 2008 to 2012.

MedicalResearch: What should clinicians and patients take away from your report?

Response: This analysis suggests that while HIV diagnosis rates in the MSAs declined overall from 2003 to 2012, the number of diagnoses from 2008 to 2012 increased in particular MSAs, especially among Men who have sex with men and among young MSM.  It is important to note that the data represent new HIV diagnoses – not necessarily new infections.  But, these data are consistent with other data, include past estimates on new HIV infections, finding troubling signs of recent increasing infections among young men who have sex with men. The wide variation by geography points to the need for targeted, tailored prevention efforts.

MedicalResearch: What recommendations do you have for future research as a result of this study?

Response: In addition to continuing to monitor trends, we need to investigate correlates to burden of HIV and determine strategies for implementation that are effective in individual MSAs.

Citation:

Increases in HIV diagnoses among MSM in Metropolitan Statistical Areas, United States

MedicalResearch.com Interview with: Lorena Espinoza, & Center for Disease Control (2015). Troubling Increase In HIV Infections In MSM 

Black MSM More Likely To Be HIV Positive

MedicalResearch.com Interview with:
Cyprian Wejnert

Center For Disease Control

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

Cyprian Wejnert: Men who have sex with men (MSM) remain the risk group most severely affected by HIV in the United States, accounting for approximately two-thirds of new infections each year.  Understanding racial and age disparities among MSM is critical to tailor effective prevention efforts. Our study examined data from CDC’s National HIV Behavioral Surveillance system (NHBS) from 20 U.S. cities. We assessed changes in HIV prevalence, awareness of infection, and risk behavior among MSM, by age and race, from 2008 to 2011, finding that:

o   Among black Men who have sex with men, 30 percent were HIV-infected overall, and 1 in 5 black MSM aged 18-24 were infected with HIV. Compared to 14 percent and 4 percent among white MSM.

o   In all age groups younger than 40 years, black Men who have sex with men were significantly more likely to be HIV-positive compared to all other racial/ethnic groups.

o   Disparities in HIV prevalence between black and white MSM were greatest among the youngest MSM, and increased between 2008 and 2011.

o   Black MSM were less likely to be aware of their infection than their white counterparts (54 vs. 86 percent).

o   Black Men who have sex with men did not report higher levels of condomless sex overall or condomless sex with partners of discordant or unknown HIV status. Continue reading

African American Women Less Likely To Achieve HIV Viral Suppression

MedicalResearch.com Interview with:
Dr. Ndidi Nwangwu-Ike
Center Disease Control

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

Response: CDC data has shown encouraging signs of a decrease in new HIV infections among black women in recent years.  However, African American women continue to be far more affected by HIV than women of any other race or ethnicity, with a rate of new infection 20 times that of white women and nearly five times that of Hispanic women.  Ensuring people with HIV are diagnosed and remain in care is key to controlling HIV in the nation. When used consistently, antiretroviral medication can keep HIV controlled at very low levels in the body (known as viral suppression), allowing people with HIV to live longer, healthier lives and reducing the likelihood they will transmit HIV to others. Our study finds that viral suppression among women diagnosed with HIV is low, with young women and black women the least likely to achieve viral suppression. Specifically, we found that:

o   Of women newly diagnosed with HIV in 2012, 83 percent were linked to care within three months of diagnosis.

o   Retention in care varied by age and race/ethnicity; overall, just over half of women (52 percent) diagnosed and living with HIV in 2011 received ongoing HIV care.

o   Overall, only 44 percent of women diagnosed and living with HIV in 2011 had a suppressed viral load.

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Protein Delivered By Gene Vector May Protect Against HIV-Like Viruses

Dr. Michael Farzan PhD Vice Chairman Department of Immunology and Microbial Science Florida Campus The Scripps Research InstituteMedicalResearch.com Interview with:
Dr. Michael Farzan PhD
Vice Chairman
Department of Immunology and Microbial Science
Florida Campus
The Scripps Research Institute

Medical Research: What is the background for this study?

Dr. Farzan: The key points are that HIV-1 needs two receptors – CD4 and CCR5 – to infect cells.  CD4’s primary job is to initially bind the viral entry protein, which upon CD4 binding, uncloaks its CCR5 binding site.   A number of years ago we observed that CCR5 had an unusual modification that was really important to HIV-1.  We later showed that antibodies – protein your body makes to protect from pathogens – mimics CCR5 by incorporating this modification.  We develop a peptide from one of these antibodies that mimics CCR5.

Medical Research: What are the main findings?

Dr. Farzan: By combined a soluble form of CD4 with this CCR5-mimicking peptide, we created a protein that neutralizes all HIV-1 isolates tested, including the hardest-to-stop viruses, as well as distantly related viruses found in monkeys.  It does so better than the best HIV-1 antibodies.  We expressed this protein using a commonly used gene-therapy vector, and showed that after a one-time inoculation we could protect from doses much higher than most humans are likely to see, and we did so 34 weeks after the inoculation.
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Oral Medication For Hepatitis C- HIV Combined Infection

Shyamasundaran Kottilil MBBS, PhD University of MarylandMedicalResearch.com Interview with:
Shyamasundaran Kottilil MBBS, PhD
Division of Infectious Diseases, Institute of Human Virology, University of Maryland, Baltimore
Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland

Medical Research: What is the background for this study? What are the main findings?

Dr. Kottilil:  Due to shared routes of transmission, almost half of all HIV-infected patients also have HCV infection. Traditionally, interferon based therapies have resulted in lower cure rates of HCV in HIV-infected subjects. Treatment for HCV is rapidly changing from an injection (interferon) based therapy to oral well tolerated pill based therapy for a shorter duration.Our intention was to test whether a treatment regimen without the use of interferon and ribavirin can be effective in HIV/HCV infected patients.

Our study demonstrated that HIV/HCV connected patients without cirrhosis can be effectively treated with ledipasvir and sofosbuvir in 12 weeks. Overall 98% of patients were cured.

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HIV Diagnosis and Care Critical To Preventing Spread Of Virus To Others

Jacek Skarbinski, MDMedicalResearch.com Interview With
Jacek Skarbinski, MD

Medical officer
Centers for Disease Control and Prevention

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

Dr. Skarbinski: Previous research has indicated that HIV diagnosis and viral suppression are important prevention tools that can help reduce continued transmission. However, this analysis is the first to estimate precisely what proportion of transmission can be attributed to individuals engaged in 5 stages of HIV care – including those who are unaware of their infection, those who are retained in care, and those who have their virus under control through treatment.

Our analysis shows that more than 90 percent of new HIV infections in the United States could be averted by diagnosing people living with HIV and ensuring they receive prompt, ongoing care and treatment. It also shows that the further people progress in HIV care, the less likely they are to transmit their virus.

More specifically, the analysis shows that 30 percent of new HIV infections were transmitted from people who did know they were infected, highlighting the importance of getting tested. People who had been diagnosed were less likely to transmit their infection, in part because people who know they have HIV are more likely to take steps to protect their partners from infection.

Finally, the model suggests that simply being in care can help people living with HIV avoid transmission of their virus. According to the model, people who were engaged in ongoing HIV care, but not prescribed antiretroviral treatment, were half as likely (51.8 percent) as those who are diagnosed but not in care to transmit their virus. Being prescribed HIV treatment further lowers the risk that a person will pass the virus to others. People who were successfully keeping the virus under control through treatment were 94 percent less likely than those who did not know they were infected to transmit their virus. But, previous national estimates have indicated that just 30 percent of people with HIV have reached this critical step in care.

In short, this analysis validates the nation’s current prevention efforts, reminding us that HIV diagnosis and care improves the lives of people living with HIV and that it is also critical for reducing the chances of transmitting the virus to others.

MedicalResearch: What should clinicians and patients take away from your report?

Dr. Skarbinski: Both patients and clinicians should know that this is the latest in a growing body of evidence that prevention of new infections depends on reaching people who are HIV-positive with testing, care and treatment.

Once people know they have HIV, they take steps to prevent transmission to their partners. In fact, our study shows a 19 percent drop in the transmission rate after diagnosis – largely because people who found out they had HIV decreased the number of times they had sex without a condom with a negative partner.

After diagnosis, simply being in care can help prevent transmission by giving people living with HIV tools and information they can use to protect themselves and their partners. In addition to treatment, HIV care should include risk reduction counseling, STI screening and treatment, treatment for mental health and substance use disorders, and other prevention services.

The ultimate goal is to provide ongoing care and treatment so all people living with HIV can achieve viral suppression. U.S. guidelines now recommend that everyone diagnosed with HIV should get treatment, regardless of their viral load count. According to our model, people who are virally suppression are 94 percent less likely to transmit their virus than people who are unaware of their infections.

Bottom line: improving the health of people living with HIV is critical for both those with HIV and for those at risk for HIV.

MedicalResearch: What recommendations do you have for future research as a result of this study?

Dr. Skarbinski: The study published today is the just the first in a series. Our next step is to expand the current model and assess the potential impact and costs of different interventions that target different steps of the HIV care continuum. The ability to compare the impact and associated cost of combinations of interventions, such as expanded HIV testing and improved retention in care, on prevention will be critical to guiding public health programs and improve HIV prevention. Moreover, we are also expanding the model to better understand patterns of transmission among particular sub-groups, such as men who have sex with men, to help guide prevention efforts.

You may also view the brief, 60-second video the CDC has put together highlighting the key data from the manuscript and putting them into the context of the nation’s prevention efforts here:  http://www.cdc.gov/nchhstp/newsroom/2015/HIV-Testing-infographic.html?s_cid=nchhstp-hcso-nwsrm-hiv-care-004.

Jacek Skarbinski, Eli Rosenberg, Gabriela Paz-Bailey, H. Irene Hall, Charles E. Rose, Abigail H. Viall, Jennifer L. Fagan, Amy Lansky, Jonathan H. Mermin. Human Immunodeficiency Virus Transmission at Each Step of the Care Continuum in the United States. JAMA Internal Medicine, 2015; DOI: 10.1001/jamainternmed.2014.8180

 

Binge Drinking Linked To Risky Sexual Behavior in MSM

MedicalResearch.com Interview with:
Kristen Hess  ORISE Fellow
Division of HIV/AIDS Prevention,
National Center for HIV, Viral Hepatitis, STD and TB Prevention
Centers for Disease Control and Prevention Atlanta, GA

MedicalResearch: What is the background for this study?

Response: Men who have sex with men (MSM) of all races continue to be the risk group most severely affected by HIV in the United States. CDC’s most recent HIV incidence data show that the number of new infections among MSM increased 12 percent between 2008 and 2010, with an even steeper increase among the youngest MSM. These data clearly show the urgent need to better understand the factors that affect their risk and to develop effective prevention interventions.

One specific factor is excessive alcohol use, which is responsible for 88,000 deaths in this nation each year, and cost the U.S. about $224 billion in 2006. Binge drinking (consuming ≥5 drinks for men on an occasion; ≥4 drinks for women) is the most common form of excessive alcohol consumption. The association between excessive alcohol consumption, including binge drinking, and risky sexual behaviors among MSM has had mixed results in the literature with some studies finding an association and others not. One limitation of previous work is that the definition of excessive alcohol consumption varies between studies, so results are not easily compared between studies and populations.

Our study examines the relationship between binge drinking and sexual risk behaviors among MSM who are current drinkers and who were either HIV-negative or unaware of their HIV status.

MedicalResearch: What are the main findings?

Response: We assessed the prevalence of binge drinking, using a standard definition, among a sample of MSM recruited from 20 cities across the U.S. We also examined the association between binge drinking and several risky sexual behaviors.

The findings show that 6 in 10 MSM reported binge drinking. Those who binge drank, in comparison to non-binge drinkers, were more likely to engage in risky sexual behaviors such as sex with an HIV-positive or unknown status partner and exchange sex for money or drugs at last sex, as well as more likely to have concurrent partners and more condomless sex partners in the past year.

We also found that the likelihood of risky sexual behaviors went up with increased frequency of binge drinking. In fact, MSM who reported 10 or more binge-drinking episodes in the past month were more likely to report risky behaviors. This is a critical point, especially given that, among those who binged, 22 percent reported 10 or more binge drinking episodes in the past month. Continue reading

HIV+ Donors Might Add To Available Kidney Donor Pool

Elmi Muller, M.B., Ch.B., M.Med. University of Cape Town–Surgery Groote Schuur Hospital Observatory Cape Town Cape Town, South Africa MedicalResearch.com Interview with:
Elmi Muller, M.B., Ch.B., M.Med.
University of Cape Town–Surgery
Groote Schuur Hospital Observatory Cape Town
Cape Town, South Africa

Medical Research: What is the background for this study?

Dr. Muller: South Africa currently offers dialysis and transplantation as a treatment option for patients with End Stage Renal Disease (ESRD). However, dialysis is not freely available to everyone, but severely limited and only available to a selected group of patients. This means that patients get assessed when they present with ESRD and they only get accepted onto a dialysis programme if they fulfill certain criteria. These criteria are criteria to assess the patient’s medical fitness in general as well as social criteria to assess whether the patient will be compliant with follow-up.  In most state hospitals, patients will only be accepted onto a dialysis program if they are also fit to receive a transplant in the long run.  The idea is that dialysis programs should naturally feed into transplant programs. Therefore a patient who is not a suitable transplant candidate will normally be turned down for dialysis.

In 2008, when the HIV positive-to-positive program started, patients with ESRD and HIV would be turned down for dialysis. The reason was that they were seen as unfit for transplantation and therefore not suitable dialysis patients. This meant that anybody with HIV and ESRD was doomed to die. This situation remained unchallenged for a number of years, especially as the rollout of antiretroviral therapy was quite slow in the state sector.

Because of very high HIV rates in the country, more and more HIV positive brain-dead donors presented to the Groote Schuur Hospital Transplant team. These donors were mostly braindead people who were worked up for organ donation (after consent was obtained from the family) and who then turned out to be HIV positive. In 2008 it made sense to try and marry this supply of donors with the group of HIV positive patients without any treatment options in the country.

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Black Mortality from HIV Declines But Still Higher Than Whites, Hispanics

MedicalResearch.com Interview with:
Azfar-e-Alam Siddiqi, MD, PhD
Associate Chief of Science (Acting)
HIV Incidence and Case Surveillance Branch
Division of HIV/AIDS Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Centers for Disease Control and Prevention

Medical Research: What is the background for this study? What are the main findings?

Dr. Sidiqqi: African Americans remain the population most affected by HIV in the United States — accounting for almost half (44 percent) of all new infections and more than a third (41 percent) of people living with HIV, despite representing just 12 percent of the U.S. population. We also know that far too many African Americans living with HIV do not get the medical care and treatment they need to stay healthy and protect themselves and others. In fact, less than half (40 percent) of African Americans living with HIV are engaged in care and only one-quarter (28 percent) have the virus under control through treatment.

To better understand mortality among African Americans with HIV, our team analyzed data from the National HIV Surveillance System for 2008 through 2012. Because immune suppression caused by HIV infection can result in fatal co-illnesses, our analysis estimated deaths due to all causes, rather than limiting their analysis to deaths resulting directly from HIV infection. This method allowed us to capture the fullest picture of mortality among African Americans with HIV.

According to our new analysis, from 2008-2012, the death rate per 1,000 blacks living with HIV decreased 28 percent, more than the overall decline (22 percent) observed among all persons living with HIV and more than declines observed among other races/ethnicities (13 percent for whites and 25 percent for Hispanics). Despite substantial declines in mortality, the death rate per 1,000 blacks living with HIV in 2012 was 13 percent higher than the rate for whites and 47 percent higher than the rate for Hispanics.

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Cost-Effectiveness of CDC Recommended HIV Prevention Strategies

MedicalResearch.com Interview with:
Ya-lin (Aileen) Huang, PhD.
Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention
Atlanta, GA, 30329

Medical Research: What is the background for this study? What are the main findings?

Dr. Huang: With an estimated 50,000 new HIV infections each year in this country, and no vaccine or cure available yet, prevention is critical. Maximizing the impact of all available prevention strategies could significantly reduce new infections in this country. The purpose of this study is to provide evidence for the cost effectiveness of the interventions recommended under the funding announcement and to highlight where more cost-effectiveness studies may be needed. We limited our scope to the four interventions required under the health department funding announcement, including HIV testing, prevention with HIV-positives and their partners, condom distribution and efforts to align policies with optimal HIV prevention, care and treatment.

Our review provides an updated summary of the published evidence of cost-effectiveness of four key HIV prevention interventions recommended by CDC: HIV testing, prevention with HIV-positives and their partners, condom distribution and policy initiatives. Models suggest that more than 350,000 HIV infections have been avoided because of the nation’s HIV prevention efforts. In addition to lives saved, HIV prevention has also generated substantial economic benefits. For every HIV infection that is prevented, an estimated $402,000 (http://www.ncbi.nlm.nih.gov/pubmed/23615000) is saved in the cost of providing lifetime HIV treatment. It is estimated that HIV prevention efforts have averted more than $125 billion in medical costs since the beginning of the epidemic. Continue reading

PHOTON-2 Study Addresses Combination Hepatitis C Pill For HIV+ Patients

MedicalResearch.com Interview with: Prof Jean-Michel Molina Maladies Infectieuses et Tropicales, Hôpital Saint-Louis, Paris France MedicalResearch.com Interview with:
Prof Jean-Michel Molina
Maladies Infectieuses et Tropicales, Hôpital
Saint-Louis, Paris France

Medical Research: What is the background for this study? What are the main findings?

Prof. Molina: Treatment of co-infected patients is complicated by drug drug interactions with HIV drugs, and the news DAAs are not very potent on HCV G2 and 3 infections.

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Some Prescription Formularies Discourage HIV Patient Enrollment

Douglas B. Jacobs B.S., MD/MPH Candidate Harvard T.H. Chan School of Public HealthMedicalResearch.com Interview with:
Douglas B. Jacobs B.S., MD/MPH Candidate

Harvard T.H. Chan School of Public Health

Medical Research: What is the background for this study?

Response: In May 2014, a formal complaint submitted to the Department of Health and Human Services contended that four Florida insurers were structuring their formularies in a way that discouraged enrollment from HIV positive beneficiaries. These insurers placed all HIV drugs, including generics, on the highest cost-sharing tiers.

This formal complaint served as the impetus for this research. We wanted to discover if this was a phenomenon that was isolated to Florida, or if it was national in scope, and what the implications would be for HIV positive beneficiaries. As such, we analyzed what we called “adverse tiering”—in which all drugs for certain conditions are placed in the highest cost sharing tiers—in 12 states in the federal marketplace. We compared cost-sharing for a commonly prescribed class of HIV medication, called Nucleoside Reverse Transcriptase Inhibitors, or NRTIs.

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Despite Treatment HIV Infected Children Continue To Have Diminished Cognitive Skills

Sophie Cohen MD, PhD Student Department of Pediatric Haematology, Immunology and Infectious Diseases, Emma Children's Hospital, Academic Medical Center, Amsterdam, the Netherlands Cairns Base Hospital Australia MedicalResearch.com Interview with:
Sophie Cohen MD, PhD Student

Department of Pediatric Haematology, Immunology and Infectious Diseases,
Emma Children’s Hospital, Academic Medical Center, Amsterdam, the Netherlands
Cairns Base Hospital Australia

Medical Research: What is the background for this study? What are the main findings?

Response: Since combination antiretroviral therapy (cART) has become widely available for HIV-infected children, the incidence of severe neurological complications has decreased drastically from 30-50% to less than 2%. Unfortunately, even in cART-treated HIV-infected children a range of cognitive problems have been found, such as a lower intelligence quotient (IQ) and poorer visual-motor integration. Importantly, while most HIV-infected children in industrialized countries are immigrants with a relatively low socioeconomic status (SES), cognitive studies comparing HIV-infected children to SES-matched controls are very scarce.  Understanding the prevalence and etiology of cognitive deficits in HIV-infected children is essential because they may result in more pronounced problems, and influence future intellectual performance, job opportunities and community participation. Also, early detection of cognitive impairment might trigger the development of early intervention strategies.

In this study we aimed to compare the neuropsychological profile of HIV-infected children to that of healthy controls, matched for age, gender, ethnicity and SES. Also, we aimed to determine the prevalence of cognitive impairment in the HIV-infected group and detect associations between HIV/cART parameters and cognitive performance.

We found that the HIV-infected group had a poorer cognitive performance compared with the healthy children on all tested domains (including intelligence, information processing speed, attention, memory, executive- and visual-motor functioning). Using a novel statistical method called Multivariate normative comparison (MNC), we detected a prevalence of 17% with cognitive impairment in the HIV-infected group. Lastly, we found that the center for disease control (CDC) clinical category at HIV diagnosis was inversely associated with verbal IQ (CDC C: coefficient -22.98, P=0.010).

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HIV: Zoster Risk May Rise Slightly In First 6 months of Treatment, Declines Overall

MedicalResearch.com Interview with:
Dr Sophie Grabar, MD, PhD
Unité de Biostatistique et Epidémiologie (Aile B2-5ieme étage)
Groupe Hospitalier Cochin Broca Hôtel-Dieu PARIS

Medical Research: What is the background for this study?

Dr. Grabar: We took advantage of a large cohort, the French Hospital on HIV-ANRS CO4 cohort, of more than 100 000 HIV-infected patients to study the incidence trends and risk factors of Herpes Zoster since the advent of cART (combination antiretroviral medications)that have been discrepantly reported in the literature. Also, because Herpes Zoster has been associated with Immune Reconstitution Inflammatory Syndrome, we studied the early impact of cART initiation on the risk of Herpes Zoster and finally evaluated the risk with regards to the risk in the general population that has never been reevaluated in recent years.

Medical Research: What are the main findings?

Dr. Grabar: We found that the incidence of Herpes Zoster has significantly declined with the arrival of cART and continue to decline probably owing to the immune recovery induced by cART. The risk in HIV-infected patients is globally 3-times higher to that of the general population, and 6-times higher between 15-45 years. Among cART naive patients, we found that the risk of Herpes Zoster increases in the first months of cART initiation but only moderately while it sharply decreases after 6 months of cART.
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Study Finds No Increased Heart Attack Risk in HIV Patients

Dr. Daniel Klein, MD Kaiser Permanente Northern California San Leandro Medical Center San Leandro, CA MedicalResearch.com Interview with:
Dr. Daniel Klein, MD
Kaiser Permanente Northern California
San Leandro Medical Center
San Leandro, CA

Medical Research: What is the background for this study?

Dr. Klein: The prognosis for individuals living with HIV infection has dramatically improved with the availability of potent, well-tolerated and convenient antiretroviral therapies. HIV infection can now be viewed as a chronic, manageable condition with the life expectancy of successfully treated patients approaching that of uninfected individuals. As the focus of long-term HIV care has shifted from the managing opportunistic infections and cancers that were the hallmark of the early years of the HIV epidemic, increased attention is being directed at the consequences of treatment, immunodeficiency and chronic inflammation. One such complication is a reported increased risk of coronary artery disease. A recent report from Kaiser Permanente researchers in California offers some good news on this topic. For more than a decade, these investigators, led by Dr Daniel Klein, Chief of Infectious Diseases at Kaiser Hospital in San Leandro, CA, have been comparing rates of hospitalizations for Acute Myocardial infarctions and other forms of coronary artery disease between a group of HIV infected individuals and a large comparison group of uninfected health plan members. In the early years of their study, they noted an increased risk of coronary disease among HIV infected individuals. However in a recently published report, researchers found that there was no longer an excess risk.

Kaiser Permanente is a large, not-for-profit health care provider based in California. For more than 20 years, researchers have been collecting information on their HIV infected members. By matching the HIV patients to other uninfected health plan members who were of comparable age, sex and race, these investigators have been comparing the rates of a number of medical problems between the groups. Their first report on an excess risk of coronary artery disease was published in 2002. The original observation of an excess risk for heart disease was attributed to higher rates of certain conventional risk factors among the HIV group such as smoking as well as exposure to protease inhibitor class drugs.

Medical Research: What was the findings of this study?

Dr. Klein: By comparing the relative rates over time in the most recent study interval, there was no longer an increased risk for a Myocardial infarction among the HIV group as compared to the uninfected group when matched by age, sex and presence.

Medical Research: To what do the authors ascribe this recent finding?

Dr. Klein: A number of factors may have contributed to the results including increased attention to conventional risk factor reduction with greater use of lipid lowering therapies and smoking cessation programs. Also, newer HIV medications may have less association with premature coronary artery disease. In keeping with national guidelines, Kaiser patients are initiating HIV treatment at higher CD4 cell counts and of those on therapy, more than 85 percent have undetectable viral loads. In an earlier report, these researchers observed that patients who maintained CD4 cell counts over 500 had no excess risk of an MI confirming the role of immunodeficiency in premature coronary artery disease among HIV individuals.

Medical Research: What are the main take away messages from this study?

Dr. Klein: For patients, knowing whether you are HIV positive is key to entering care and preserving your immune function. Also if you are a smoker, quitting is the best thing you can do for your own health in conjunction with regular exercise and a healthy diet.  For providers, aggressive conventional risk factor reduction efforts are clearly warranted, coupled with early initiation of antiretroviral treatments to preserve immune function, can translate into reduced heart disease in your patients.

What are the limitations of this study?

Dr. Klein: The majority of our HIV positive members were men so more information about outcomes among HIV infected women is needed. Also, the findings of no increased risk for MIs was over a two year period and further long-term follow up is warranted to ensure that this finding is sustained.

Citation:

Declining Relative Risk for Myocardial Infarction Among HIV-Positive Compared with HIV-Negative Individuals with Access to Care

Clin Infect Dis. first published online January 16, 2015 doi:10.1093/cid/civ014
Daniel B. Klein, Wendy A. Leyden, Lanfang Xu, Chun R. Chao, Michael A. Horberg, William J. Towner, Leo B. Hurley, Julia L. Marcus, Charles P. Quesenberry, Jr., and Michael J. Silverberg

 

 

 

Black HIV Patients Have Greater Risk of Kidney Disease

Alison G Abraham PhD Associate Scientist Department of Epidemiology Johns Hopkins Bloomberg School of Public HealthMedicalResearch.com Interview with:
Alison G Abraham PhD

Associate Scientist
Department of Epidemiology
Johns Hopkins Bloomberg School of Public Health

Medical Research: What was the motivation for this study?

Dr. Abraham: HIV-infected individuals are at higher risk for kidney dysfunction compared to the general population.  Prior to effective antiretroviral therapy, very aggressive forms of kidney disease were described primarily among black HIV-infected individuals.  While effective therapy and increasing viral suppression rates have made HIV-associated nephropathy rare, some of these same drugs have nephrotoxic effects.  In addition, the reduction in AIDS and mortality has led to HIV-infected individuals living long enough to experience age-related chronic diseases, which are also risk factors for kidney disease and end-stage renal disease.  Thus we wanted to know how these competing forces were affecting end-stage renal disease risk in the well-treated HIV-infected North American population over time.  Are we seeing more ESRD as a result of nephrotoxic drugs and chronic disease, or less ESRD as a result of better viral suppression and large reductions in HIV-associated nephropathy?

Medical Research: What are the main findings?

Dr. Abraham: We found that end stage renal disease rates have been steadily falling over the past 10 years coincident with notable improvements in viral suppression prevalence.  However a large racial discrepancy in ESRD risk has persisted even though HIV-associated nephropathy cases are now rare.  While ESRD cases among blacks in our study tended to have higher viral loads and lower CD4 counts compared to non-black ESRD cases, suggesting less effective HIV treatment, we found that the racial discrepancy in ESRD risk persisted even among the well-suppressed subset, i.e. those who had undetectable viral loads for 90% of their follow-up time.

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HIV+ Adults May Have Poorer Hearing

dr-peter-torre Dr. Peter Torre III PhD Associate Professor, Audiology Director, Recreational Noise Exposure and Hearing Lab San Diego State UniversityMedicalResearch.com Interview with:
Dr. Peter Torre III PhD
Associate Professor, Audiology
Director, Recreational Noise Exposure and Hearing Lab
San Diego State University


Medical Research: What is the background for this study? What are the main findings?

Dr. Torre: The primary purpose of our study was to evaluate hearing sensitivity in HIV+ and HIV- adults. And subsequently, in HIV+ adults only, to examine whether HIV disease variables or treatment was associated with hearing sensitivity.

The main findings were that HIV+ adult had poorer hearing for both the lower and higher frequencies compared with HIV- adults, although we did not find any significant associations between HIV variables and treatment variables with hearing loss.
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Safety of Tenofovir for HIV Prophylaxis Supported

Jared Baeten, MD PhD Professor, Departments of Global Health and Medicine Adjunct Professor, Department of Epidemiology University of Washington Seattle, WA 98104MedicalResearch.com Interview with:
Jared Baeten, MD PhD
Professor, Departments of Global Health and Medicine
Adjunct Professor, Department of Epidemiology
University of Washington Seattle, WA 98104

Medical Research: What is the background for this study? What are the main findings?

Dr. Baeten: The medication tenofovir disoproxil fumarate is used widely for the treatment of HIV-1 infection and, more recently, as pre-exposure prophylaxis (PrEP) to protect against HIV-1 infection for at-risk HIV-1 uninfected persons.  Its use has been associated with declines in the estimated glomerular filtration rate (eGFR) when used as part of antiretroviral treatment by HIV-1 infected persons, but limited data are available for risk when used as PrEP for HIV-1 prevention.

Using data from the largest randomized, placebo-controlled trial of PrEP, among heterosexual women and men in Africa, eGFR changes were assessed during prospective follow-up in those receiving pre-exposure prophylaxis and compared to those receiving placebo.  PrEP use resulted in a small (-1.59 mL/min/1.73m2, 95% CI -2.44, -0.74) but statistically significant decline in eGFR that was non-progressive over a median of 18 months and a maximum of 36 months of follow-up.  PrEP use was not accompanied by a substantial increase in the risk of clinically relevant (≥25%) eGFR decline.

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Targeting HIV Hot Zones May Lead To Better Prevention Strategies

David Gerberry PhD Center for Biomedical Modeling, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CaliforniaMedicalResearch.com Interview with:
David Gerberry PhD
Assistant Professor
Department of Mathematics and Computer Science
Xavier University, Cincinnati, Ohio
 

Medical Research: What is the background for this study? What are the main findings?

Response: In an attempt to control the spread of HIV, governments in sub-Saharan Africa are considering providing antiretroviral drugs to people who do not have the virus but are at risk for becoming infected. Such drugs are known as pre-exposure prophylaxis, or PrEP.  Given the cost of PrEP, an important question is how to maximize the impact of interventions given a fixed level of prevention resources.

A common strategy is to target resources to the individuals that are at the highest risk for infection.  This group of people is often referred to as the “core group” and can be thought of as sex workers, clients of sex workers and other individuals that are at very high risk for infection.  While targeting this core group is ideal and would result in the most cost-effectiveness interventions, being able to identify these individuals is difficult in practice and they are often unwilling to participate in the intervention; take pre-exposure prophylaxis or change their behavior for example.  From a mathematical perspective it is also very difficult to quantify their increased level of risk.  For example, is a sex worker at 5 times, 25 times, 100 times or 1000 times the risk for HIV infection?  Without this quantification, it is impossible to estimate the cost-effectiveness of a targeted strategy.

In our work, we build an intervention strategy based on geographical targeting.  This takes advantage of the fact that HIV incidence is much higher in certain geographical locations than others.  Therefore, individuals in these areas are at increased risk for HIV infection.  Most importantly, such an intervention is feasible because reliable data exists across much of sub-Saharan Africa for the severity of the HIV epidemic in different regions.  To illustrate our ideas we used mathematical modeling to consider resource allocation in South Africa and found that targeting the provinces with highest HIV incidence would prevent 40% more infections than a plan that ignored geographic variation while using the same amount of resources.
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Most US Patients With HIV Do Not Have Virus Under Control

MedicalResearch.com Interview with:
Heather Bradley, PhD
Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC

Medical Research: What is the background for this study? What are the main findings?

Dr. Bradley: The key to controlling the HIV epidemic is controlling the virus.  When used consistently, antiretroviral medication can keep HIV controlled at very low levels in the body (known as viral suppression), allowing people with HIV to live longer, healthier lives and reducing the likelihood they will transmit HIV to others. Yet, only one-third of the 1.2 million people with HIV in the U.S. have the virus under control.  Among those who did not have the virus under control, approximately two-thirds had been diagnosed but were not in HIV medical care.

Young people were least likely to have the virus under control.  Only 13 percent of 18 – 24 year olds were virally suppressed, primarily because half don’t know they are infected.  To close this gap among young people, increased HIV testing is critical.

The study did not find statistically significant differences in viral suppression by race or ethnicity, sex, or risk group.

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Semen Impairs Efficacy of HIV Microbicides

Prof. Dr. Jan Münch Institute of Molecular Virology Ulm University Medical Center Ulm, GermanyMedicalResearch.com Interview with
Prof. Dr. Jan Münch
Institute of Molecular Virology
Ulm University Medical Center
Ulm, Germany


Medical Research: What is the background for this study?

Dr. Münch: Most anti-HIV microbicides have potent antiviral activity in vitro but were largely inactive in clinical trials. Here we set out to explore whether the HIV infection enhancing activity of amyloid fibrils in human semen interferes with the antiviral efficacy of microbicides and antiviral drugs

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HIV Transmitted To Woman Via Manicure Tools

MedicalResearch.com Interview with:
Luís Fernando de Macedo Brígido M.D. Ph.D.
Núcleo de Doenças de Vinculação Sanguínea e Sexual
Centro de Virologia  Instituto Adolfo Lutz
São Paulo Brasil

Medical Research: What is the background for this study? What are the main findings?

Response: Fomite transmission of HIV, especially in occupational exposure, have been reported, but the use of manicure utensils has not been previously associated to HIV transmission.  We report a case where none of the classical modes of transmission were identified, and a detailed review of clinical history and phylogenetic analysis allowed the association of the case’s infection to manicure care episodes at home with an HIV infected women many years ago.

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Hepatitis C May Be Spread Through Semen, Especially in HIV+ Men

Dr Daniel Bradshaw Chelsea and Westminster Hospital, LondonMedicalResearch.com Interview with:
Dr Daniel Bradshaw
Chelsea and Westminster Hospital, London

Medical Research: What are the main findings of the study?

Dr. Bradshaw: Over 40% of men with hepatitis C (HCV) infection have HCV RNA in their semen, although the level of RNA was much lower than blood (usually 4 log less than blood).
Neither HIV nor acute hepatitis C led to increased shedding of HCV RNA in semen. Interestingly, however, in acute HCV, HIV-positive men with higher blood levels of HCV RNA were more likely to shed RNA in their semen.
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How Does Prednisone Affect TB Infections in Patients With and Without HIV?

Bongani M. Mayosi, M.B., Ch.B., D.Phil. Department of Medicine, Old Groote Schuur Hospital Cape Town, South AfricaMedicalResearch.com Interview with:
Bongani M. Mayosi, M.B., Ch.B., D.Phil.
Department of Medicine, Old Groote Schuur Hospital
Cape Town, South Africa

Medical Research: What are the main findings of this study?

Dr. Mayosi: In those with definite or probable tuberculous pericardial effusion:

(1)       Prednisolone for 6 weeks and Mycibacterium indicus pranii  for three months had no significant effect on the combined outcome of death from all causes, cardiac tamponade requiring pericardiocentesis or constrictive pericarditis.
(2)      Both therapies were associated with an increased risk of HIV-associated malignancy.
(3)       However, use of prednisolone reduced the incidence of constrictive pericarditis and hospitalization.
(4)       The beneficial effects of prednisolone on constriction and hospitalization were similar in HIV-positive and HIV-negative patients

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Can A Video Game Help Your Teenagers Understand HIV Risks?

Lynn E. Fiellin, M.D. Associate Professor of Medicine Director, play2PREVENT Lab Yale University School of Medicine New Haven, CT 06510MedicalResearch.com Interview with
Lynn E. Fiellin, M.D.
Associate Professor of Medicine
Director, play2PREVENT Lab
Yale University School of Medicine
New Haven, CT 06510

Medical Research: What are the main findings of the study?

Dr. Fiellin: The current findings are part of a larger study evaluating an interactive evidence-based video game, PlayForward: Elm City Stories, developed on the iPad and targeting risk reduction and HIV prevention in 333 young teens (ages 11-14). The larger study is examining a range of outcomes including knowledge, intentions, self-efficacy and actual behaviors and we are collecting at baseline, 6 weeks, 3, 6, 12, and 24 months. We are examining these outcomes in our experimental group compared with a control group playing a set of off-the-shelf games on the iPad. The current findings of the 196 teens who have completed the 6 weeks of gameplay and for whom we have baseline and 3 month data, reveal that, while the two groups had no differences in their baseline HIV risk knowledge, the PlayForward group had statistically significant gains in knowledge at 6 weeks (p<0.0001), sustained at 3 months (p<0.01). In addition, examining the association between exposure to the game and performance on the standardized assessments revealed that the number of game levels completed (a measure of exposure to the intervention) was positively correlated with knowledge gains measured at 3 months (r=0.42; p<0.001).

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