Author Interviews, CDC, HIV, Race/Ethnic Diversity / 06.02.2015

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. (more…)
Author Interviews, CDC, Cost of Health Care, HIV / 05.02.2015

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. (more…)
Author Interviews, Hepatitis - Liver Disease, HIV, Lancet / 05.02.2015

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. (more…)
Author Interviews, Brigham & Women's - Harvard, Cost of Health Care, HIV, NEJM / 30.01.2015

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. (more…)
Author Interviews, Cognitive Issues, HIV / 27.01.2015

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). (more…)
Author Interviews, Dermatology, HIV / 22.01.2015

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. (more…)
Author Interviews, HIV, Johns Hopkins, Kidney Disease / 06.01.2015

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. (more…)
Author Interviews, Hearing Loss, HIV, JAMA, UCSD / 27.12.2014

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. (more…)
Author Interviews, HIV, JAMA / 26.12.2014

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. (more…)
Author Interviews, HIV, Nature, UCLA / 22.12.2014

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. (more…)
Author Interviews, CDC, HIV / 26.11.2014

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 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. (more…)
Author Interviews, HIV / 15.11.2014

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.  (more…)
Author Interviews, HIV, Occupational Health / 13.11.2014

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. (more…)
Author Interviews, Hepatitis - Liver Disease, HIV / 11.10.2014

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. (more…)
Author Interviews, HIV, Infections, NEJM / 04.09.2014

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 (more…)
Education, HIV, Yale / 24.07.2014

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). (more…)
Author Interviews, HIV / 22.07.2014

Dr. Nelli Westercamp PhD, MPH, MBA University of Illinois at Chicago School of Public Health Kenya, Epidemiology and Public HealthMedicalResearch.com Interview with: Dr. Nelli Westercamp PhD, MPH, MBA University of Illinois at Chicago School of Public Health Kenya, Epidemiology and Public Health Medical Research: What are the main findings of the study? Dr. Westercamp: The three clinical control trials in Kenya, Uganda and South Africa found that male circumcision reduces the risk of female to male transmission by up to 60%, prompting the endorsement of medical male circumcision as an HIV prevention intervention by the WHO and UNAIDS.  However, as medical male circumcision services for HIV prevention are being rolled out in the priority countries, questions remain whether the male circumcision promotion will actually translate into decreases in HIV infections. One factor that could reduce the effectiveness of male circumcision for HIV prevention at the population level is the behavioral risk compensation.  In other words, if men who become circumcised believe that they are fully protected against HIV and engage in higher sexual risk taking behaviors as a result of this belief, this could reduce or even negate the protective effect of male circumcision against HIV. To answer this question, we conducted a large prospective study concurrently with the scale up of male circumcision services in Western Kenya.  We recruited 1,588 men seeking circumcision services as well as 1,598 men who decided to remain uncircumcised  and assessed their sexual behaviors over 2 years, every 6 months.  We then compared the behaviors of circumcised men before and after circumcision and also the behaviors of circumcised and uncircumcised men over time. In the beginning of the study, we found that men choosing to become circumcised believed they were at higher risk of HIV than their uncircumcised counterparts. This perception of HIV risk declined significantly among the circumcised men after circumcision (from 30% at baseline to 14% at 24 months of follow up), while remaining relatively stable among the uncircumcised men (24% to 21%, respectively).  Looking at sexual risk behaviors, we saw that the overall level of sexual activity increased equally in both groups, mostly driven by the youngest age group (18-24 year old). However, despite the decrease in risk perception among circumcised men and the increase in sexual activity among all men, all other risky behaviors decreased in both groups and protective behaviors – such as condom use – increased, particularly among circumcised men. (more…)
Author Interviews, Brigham & Women's - Harvard, HIV, JAMA, Weight Research / 21.07.2014

Steven Grinspoon, MD Professor of Medicine, Harvard Medical School Director, MGH Program in Nutritional Metabolism Co-Director, Nutrition Obesity Research Center at Harvard Massachusetts General Hospital Boston, MA 02114MedicalResearch.com Interview with Steven Grinspoon, MD Professor of Medicine, Harvard Medical School Director, MGH Program in Nutritional Metabolism Co-Director, Nutrition Obesity Research Center at Harvard Massachusetts General Hospital Boston, MA 02114 Medical Research: What are the main findings of the study? Dr. Grinspoon: The primary finding is that tesamorelin, a hypothalamic peptide that increases the endogenous pulsatile secretion of growth hormone, reduced liver fat in HIV-infected patients with increased visceral (abdominal) fat.  Increased visceral fat is very closely linked with increased liver fat in HIV patients, but the effects on liver fat were not known.  Our data show that tesamorelin reduces liver fat in conjunction with decreasing visceral fat, which may be clinically important for patients with HIV-infection who have both increased abdominal fat and fatty liver disease. In addition the study demonstrated that this treatment strategy was neutral to glucose by the end of the 6 month study. (more…)
Author Interviews, CDC, HIV / 21.07.2014

Anna Satcher Johnson MPH Division of HIV/AIDS Prevention Centers for Disease Control and Prevention (CDC) Atlanta, GeorgiaMedicalResearch.com: Interview with: Anna Satcher Johnson MPH Division of HIV/AIDS Prevention Centers for Disease Control and Prevention (CDC) Atlanta, Georgia Medical Research: What are the main findings of the study? Answer: The new analysis confirms historical trends suggesting that we’ve made significant progress in reducing HIV in the U.S. over time – overall and among several key populations, including injection drug users and heterosexuals.  Overall, new HIV diagnoses from 2002 to 2011 declined 33 percent.  However, these findings underscore continued concerns of a surging HIV epidemic among young gay and bisexual men.  We found a significant increase in HIV diagnoses among young men who have sex with men between the ages of 13 and 24. (more…)
Author Interviews, HIV, JAMA / 20.07.2014

Dr Peter MacPherson MBChB PhD Wellcome Trust Clinical Research Fellow Liverpool School of Tropical Medicine Department of Clinical Sciences Liverpool School of Tropical Medicine Pembroke Place, Liverpool L3 5QAMedicalResearch.com Interview with: Dr Peter MacPherson MBChB PhD Wellcome Trust Clinical Research Fellow Liverpool School of Tropical Medicine Department of Clinical Sciences Liverpool School of Tropical Medicine Pembroke Place, Liverpool L3 5QA Medical Research: What are the main findings of the study? Dr. MacPherson: In 2012, an estimated 35 million individuals were infected with the human immunodeficiency virus (HIV) worldwide. Antiretroviral therapy (ART) substantially reduces the risk of HIV transmission as well as greatly reducing illness and death, raising hopes that high uptake of annual HIV testing and early initiation of ART could improve HIV prevention as well as care. Achieving high coverage of HIV testing and treatment is a major challenge however, with low rates of HIV testing and poor linkage into HIV care. Self-testing for HIV infection (defined as individuals performing and interpreting their HIV test in private) is a novel approach that has seen high acceptance in Malawi and the United States, and is a process that could overcome barriers to conventional facility-based and community-based HIV testing, which lack privacy and convenience. However, no studies in high HIV prevalence settings have investigated linkage into HIV care after HIV self-testing. Among 16,6660 adults in Blantyre, Malawi offered HIV self-testing, optional home initiation of HIV care (including two-weeks of ART for those eligible) compared with standard HIV care resulted in a substantial and significant increase in the proportion of adults initiating antiretroviral therapy. HIV self-testing was also extremely popular, with 58% of the adult population self-testing with just 6-months. To our knowledge, this is the first study to investigate a comprehensive home-based HIV testing, eligibility assessment and treatment initiation strategy. (more…)
Author Interviews, HIV, Lancet / 20.07.2014

Dr. Colette SmithMedicalResearch.com Interview with: Dr. Colette Smith: PhD Research Department of Infection and Population Health University College London, London, UK   Medical Research: What are the main findings of the study? Dr. Smith: We followed a group of approximately 45,000 HIV-positive people from Europe, USA and Australia between 1999 to 2011. We found that the death rate approximately halved over the 12-year study period. For every 1,000 people, around 18 died per year in 1999-2001, reducing to 9 deaths per year in 2009-2011. We also studied what people died of. We found that the death rate from AIDS and from liver disease decreased by around two-thirds. Deaths from heart disease approximately halved. However, the rate of cancer deaths (excluding cancers that are classified as AIDS events) remained constant over time. One in three deaths were caused by AIDS in 1999 to 2011, and this decreased to one in five deaths in the last two years of the study. However, even in recent years it was the joint most common cause of death. The proportion of deaths from cancer increased over time. One in ten deaths were from cancer in 1999 to 2001, and this increased to one in five deaths in 2009 to 2011. By the end of the study it was the joint-most common cause of death. (more…)
Author Interviews, HIV, JAMA, OBGYNE / 19.07.2014

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 are the main findings of the study? Dr. Baeten: Among heterosexual African couples in which the male was HIV positive and the female was not, receipt of antiretroviral pre-exposure preventive (PrEP) therapy did not result in significant differences in pregnancy incidence, birth outcomes, and infant growth compared to females who received placebo. (more…)
Author Interviews, Herpes Viruses, HIV, PLoS / 06.07.2014

Dr. Don C. Des Jarlais PhD Director, International Research Core, Center for Drug Use and HIV Research Research Fellow, NDRI Director of Research, Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center Professor of Epidemiology, Department of Epidemiology and Population Health, Albert Einstein College of MedicineMedicalResearch Interview with: Dr. Don C. Des Jarlais PhD Director, International Research Core, Center for Drug Use and HIV Research Research Fellow, NDRI Director of Research, Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center Professor of Epidemiology, Department of Epidemiology and Population Health, Albert Einstein College of Medicine Medical Research: What are the main findings of the study? Dr. Des Jarlais: HIV infection among non-injecting users of heroin and cocaine doubled doubled over the last several decades, from 7% to 14%. Herpes simplex virus type 2 (HSV-2) increases both susceptibility to and transmissibility of HIV. We examined HSV-2 infection among non-injecting heroin and cocaine user over the same time period using stored serum samples. HSV-2 infection was strongly related to HIV infection, and both increased over time. We calculated population attributable risk percentages (PAR%) to estimate the extent to which HSV-2 was driving increased HIV infection. HSV-2 infection was responsible for approximately half of the increase in HIV infection (more…)
Annals Internal Medicine, Author Interviews, Herpes Viruses, HIV / 01.07.2014

Connie Celum, MD, MPH Professor of Global Health and Medicine Director, International Clinical Research Center University of Washington Harborview Medical Center Seattle WA 98104MedicalResearch.com: Interview with Connie Celum, MD, MPH Professor of Global Health and Medicine Director, International Clinical Research Center University of Washington Harborview Medical Center Seattle WA  98104 MedicalResearch: What are the main findings of the study? Dr. Celum: We conducted a randomized, double blind study of daily oral tenofovir and tenofovir combined with emtricitabine (FTC) as oral pre-exposure prophylaxis (PrEP) for HIV among HIV serodiscordant couples (in which onepartner had HIV and the other partner did not) in Kenya and Uganda. Because of recent studies showing that tenofovir gel could reduce the chances of becoming HSV-2 infected, we studied the subset of HIV-uninfected partners who did not have HSV-2 and compared the rates who became HSV-2 infected during follow-up among those  who received oral pre-exposure prophylaxis versus those who received placebo.  We found that oral pre-exposure prophylaxis reduced HSV-2 acquisition by 30%. (more…)
Author Interviews, HIV, Infections, Lancet / 27.05.2014

Dr. Duncan ChandaMedicalResearch.com Interview with: Dr. Duncan M. Chanda MD Institute for Medical Research & Training and UNZA-UCLMS Research and Training Project University Teaching Hospital Lusaka, Zambia MedicalResearch: What are the main findings of the study? Dr. Chanda:  The main findings are that in this cohort of relatively healthy patients, with a median CD4 of 367, ART can be delayed till the end of TB short course chemotherapy without deleterious effects. This differs from studies that looked at cohorts with very low median CD4  ( around 25-150 in most cases) in which early cART was found to reduce mortality and other AIDS defining events.   (more…)
Author Interviews, HIV, Infections, Social Issues / 11.04.2014

Amy Nunn, ScD, MS Assistant professor (research) of Behavioral and Social Sciences Brown University School of Public HealthMedicalResearch.com Interview with: Amy Nunn, ScD, MS Assistant professor (research) of Behavioral and Social Sciences Brown University School of Public Health MedicalResearch.com: What are the main findings of the study? Answer: The main findings are that people living in poor, mostly-minority urban neighborhoods, where health resources such as HIV testing and linkages to care are often lacking, are at a greater risk of contracting HIV and dying of AIDS. This is not because of differences in behavior. It's because they live in medically underserved areas where HIV incidence is very high and fewer people know their status. Fewer people knowing their status means fewer people on treatment. Fewer people on treatment means it's easier for people to come into contact with the virus, even if they don't engage in any higher risk behavior. In the paper, my colleagues and I call for increasing the focus of public health efforts on these neighborhoods where the epidemic is concentrated and contributing heavily to racial and economic disparities in AIDS mortality. (more…)
Author Interviews, HIV, Mental Health Research, University of Pennsylvania / 11.04.2014

Michael B. Blank, PhDMedicalResearch.com Interview with: Michael B. Blank, PhD Associate Professor of Psychology in Psychiatry Perelman School of Medicine University of Pennsylvania Philadelphia, PA 19104-3309 MedicalResearch.com: What are the main findings of the study? Dr. Blank:  We found that people in treatment for mental illnesses in inpatient and outpatient settings in Philadelphia and Baltimore were about times as likely to be infected with HIV as the general population in those cities and about 16 times as likely to be HIV infected as the general population of the US.  We also found that severity of psychiatric symptoms increased the likelihood of infection. (more…)
Author Interviews, HIV, Johns Hopkins / 25.02.2014

Samuel R. Friedman PhD Institute of Infectious Disease Research National Development and Research Institutes, Inc. New York, NY Department of Epidemiology Johns Hopkins Bloomberg School of Public Health, Baltimore, MDMedicalResearch.com Interview with: Samuel R. Friedman PhD Institute of Infectious Disease Research National Development and Research Institutes, Inc. Ny, NY Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore, MD MedicalResearch.com: What are the main findings of the study? Dr. Friedman: The main finding is that programs that helped protect people who inject drugs from HIV and those that helped them to get medical care seem to be associated with less HIV disease and less death related to HIV disease among the heterosexual population of large United States metropolitan areas. This is important.  Drug users in the US are widely despised, and their has been a lot of political opposition to programs like syringe exchange and drug abuse treatment. Our findings show that these programs are associated with better health and less death in the broader population.  It makes more sense to help people--even those you despise--stay uninfected, and to get medical care, than to restrict or attack programs for them. (more…)
Author Interviews, HIV, Kidney Disease / 11.09.2013

MedicalResearch.com Interview with: Magnus G. Rasch MD Faculty of Health Sciences, University of Copenhagen 1455 København K, Denmark Department of Infectious Diseases Copenhagen University Hospital, Rigshospitalet, Denmark MedicalResearch.com: What are the main findings of the study? Dr. Rasch: In the study “Increased risk of dialysis and end-stage renal disease among HIV patients in Denmark compared with the background population” we found that the risk of acute renal replacement therapy (aRRT) and the risk of chronic renal replacement therapy (cRRT) was increased substantially in HIV patients compared with the background population. The risk of aRRT was highest the first year after HIV diagnosis. Factors associated with increased risk of aRRT were intravenous drug use, hypertension and an AIDS-defining illness. Risk factors for cRRT were hypertension and baseline estimated glomerular filtration rate. (more…)