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.
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.
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
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).
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.
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.
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.
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.
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.
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.
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
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%.
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.  
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.
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.
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.
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.
Author Interviews, HIV, Social Issues, UCLA / 03.09.2013

Sean D. Young, PhD, MS Assistant Professor In-Residence Center for Behavioral and Addiction Medicine Department of Family Medicine University of California, Los AngelesMedicalResearch.com Interview with: Sean D. Young, PhD, MS Assistant Professor In-Residence Center for Behavioral and Addiction Medicine Department of Family Medicine University of California, Los Angeles Dr. Young: Here's the main take-home point: There is a lot of excitement about the possibility of using technologies, big data, and mHealth to improve health outcomes and change behavior. However, 1) little work has been done on this topic using sound research methods (for example, studies have asked people to report whether a technology changed behavior rather than objectively measuring whether it actually changed behavior.
Author Interviews, Hepatitis - Liver Disease, HIV, McGill / 16.08.2013

Marina Klein, MD, MSc, FRCP(C) Associate Professor of Medicine McGill University Health Centre Division of Infectious Diseases and Chronic Viral Illness Service 3650 Saint Urbain Montreal, Quebec H2X 2P4MedicalResearch.com Interview with: Marina Klein, MD, MSc, FRCP(C) Associate Professor of Medicine McGill University Health Centre Division of Infectious Diseases and Chronic Viral Illness Service 3650 Saint Urbain Montreal, Quebec H2X 2P4 Disease in HIV–Hepatitis C Coinfection: A Longitudinal Cohort Analysis                MedicalResearch.com: What are the main findings of the study? Dr. Klein: We showed that people with HIV and hepatitis C infection who smoked marijuana did not tend to progress more rapidly to liver fibrosis, liver cirrhosis or end-stage liver disease, even with increasing numbers of joints smoked per week. Previous studies that reported that marijuana was harmful to the liver were likely biased because they did not ensure that marijuana smoking occurred before the development of liver problems.
Author Interviews, HIV, Infections, JNCI, Lymphoma / 08.08.2013

MedicalResearch.com Interview with: Satish Gopal, MD, MPH Program in Global Oncology, Lineberger Comprehensive Cancer Center UNC Project-Malawi, Tidziwe Center, Private Bag A-104, Lilongwe, Malawi MedicalResearch.com: What is the primary message our physician readers should take away from the piece?” Answer: Lymphoma is one of the leading causes of HIV-associated death in the modern ART era. In our analyses of a large multicenter US cohort, survival for HIV-associated lymphoma patients receiving routine care has not clearly improved since the modern ART era began, and remains significantly worse than SEER outcomes for the same lymphoma subtypes in the general population. This was somewhat surprising in an era of normalizing life expectancy for HIV-infected patients on ART, and quite different from the outstanding results achieved for this population in recent clinical trials conducted by AMC and NCI.
HIV, Infections, JAMA, Race/Ethnic Diversity / 21.06.2013

MedicalResearch.com Interview with Dr. H. Irene Hall, PhD Division of HIV/AIDS Prevention National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC 1600 Clifton Road, MS E-47, Atlanta, GA 30333 MedicalResearch.com: What are the main findings of the study? Dr. Hall: Our research finds that, across all populations, far too few Americans with HIV receive the care they need to stay healthy and reduce risk of transmission. According to our research, gaps in care are the largest among African Americans and young people. Moving forward, improving care for all HIV-infected people will be critical to achieving the goal of an AIDS-free generation in America. More specifically, some of the key findings of the study include:
  • Overall, only a quarter of all Americans with HIV have a suppressed viral load – meaning the level of HIV in their bodies is low enough to stay healthy and dramatically reduce the chance of transmitting to others.
  • By race/ethnicity, African-Americans and Hispanics or Latinos are less likely to be aware of their infection compared to whites.
  •  By age, younger Americans are less likely to be in ongoing care and have a suppressed viral load; HIV care and viral suppression generally improved with age. For example:
  • Fifteen percent of those aged 25-34 were virally suppressed, compared to 36 percent of those aged 55-64.
  • In terms of ongoing care, 28 percent of those 25-34 years old were retained in care, compared to 46 percent of those aged 55-64.
Author Interviews, HIV / 27.04.2013

MedicalResearch.com eInterview with Dr. Sara Gianella Weibel, M.D. Center For Aids Research (CFAR) University of California San Diego La Jolla CA, 92093-0679 Email: gianella@ucsd.edu MedicalResearch.com: What are the main findings of the study? Answer: In this study we evaluated a large number of seminal samples from HIV-infected sexually active gay men treated with antiretroviral therapy (ART) using an extensive battery of tests for viral and bacterial co-infections. Around 10% of enrolled subjects presented detectable levels of HIV RNA in semen despite being on suppressive ART.