Strong Link Between HPV and HIV Infection in MSM

MedicalResearch.com Interview with:

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

Dr. Brown

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

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

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

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

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

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

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

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

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

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

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

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

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Syphilis Skyrockets Among MSM

MedicalResearch.com Interview with:

Alex de Voux, PhD, Epidemiologist Centers for Disease Control Division of STD Prevention

Dr. Alex de Voux

Alex de Voux, PhD, Epidemiologist
Centers for Disease Control
Division of STD Prevention

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

Response: Reported cases of primary and secondary syphilis have been increasing steadily in the United States since 2001, with men-who-have-sex-with-men (MSM) accounting for 83% of male primary and secondary syphilis cases with information on sex of sex partner in 2014.

However calculating the true disparity of primary and secondary syphilis cases relative to the MSM population size has been difficult because census data does not routinely collect information on sexual orientation or same-sex behavior. Through a recent collaboration with Emory University and CDC, Grey and colleagues developed refined estimates of the population size of MSM by state allowing us to calculate state-specific rates of primary and secondary syphilis for the first time. Looking at data from 44 states that had information on sex of sex partner for at least 70% of their male primary and secondary syphilis cases, the overall rate of syphilis was 309 per 100,000.

The state level data found syphilis rates among gay and bisexual men ranged widely among the 44 states, from 73.1 per 100,000 in Alaska to 748.3 per 100,000 in North Carolina. Some of the highest rates among MSM were in states in the Southeast and the West.

Comparing rates of syphilis among MSM to men reporting sex with women only (MSW), the overall rate for MSM was 107 times the rate for MSW. By state, the rate among MSM was at least 40 times the rate among MSW – and at most, 340 times the rate among MSW.

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Meta-analysis finds that pre-exposure chemoprophylaxis for prevention of HIV infection may be associated with an increase in STDs among MSM

MedicalResearch.com Interview with:
Noah Kojima

David Geffen School of Medicine
University of California
Los Angeles, California

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

Response: One of the most exciting new methods to prevent human immunodeficiency virus (HIV) type 1 infection is through the use of chemical pre-exposure prophylaxis (PrEP), which has been shown to be safe and effective in randomized-controlled trials and “real world” studies among men who have sex with men (MSM). However, reports of high incidence of sexually transmitted infections (STIs) and condomless sex in PrEP trials has led clinicians and public health advocates to be concerned that the use of PrEP for HIV might lead to higher STI incidence due to increased sexual risk behavior. We found that PrEP for HIV infection is associated with increased risk of STI acquisition among MSM in a meta-analysis of prior studies.

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Young Black MSM Account For Largest Number of New HIV Cases

MedicalResearch.com Interview with:

Laura Kann, PhD Chief of the School-Based Surveillance Branch (SBSB) Division of Adolescent and School Health (DASH). CDC

Dr. Laura Kann

Laura Kann, PhD
Chief of the School-Based Surveillance Branch (SBSB)
Division of Adolescent and School Health (DASH).
CDC 

Medical Research: What is the background for this study?

Dr. Kann:  Young persons aged 13–24 years accounted for an estimated 22% of all new diagnoses of human immunodeficiency virus (HIV) infection in the United States in 2014. Most new HIV diagnoses among youths occur among males who have sex with males (MSM). Among all MSM, young black MSM accounted for the largest number of new HIV diagnoses in 2014 (4,398 among blacks, 1,834 among Hispanics, and 1,366 among whites).  Although other studies have examined HIV-related risk behaviors among MSM, less is known about MSM aged <18 years.

Medical Research: What are the main findings?

Dr. Kann:  Among male students who had sexual contact with males, black students had a significantly lower prevalence than white students of drinking five or more drinks of alcohol in a row; ever using inhalants, heroin, ecstasy, or prescription drugs without a doctor’s prescription; and drinking alcohol or using drugs before last sexual intercourse. Black students also had a significantly lower prevalence than Hispanic students of drinking five or more drinks of alcohol in a row and ever using cocaine, inhalants, methamphetamines, ecstasy, or steroids without a doctor’s prescription.  However, among male students who had sexual contact with males, black students had a significantly higher prevalence than white students of ever having had sexual intercourse and using a condom during last sexual intercourse; black students also had a higher prevalence than Hispanic students of ever having sexual intercourse.

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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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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 

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

CDC Recommends Routine Annual HIV Testing for Sexually Active MSM

MedicalResearch.com: Interview withDr. Sonia Singh Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA Dr. Sonia Singh
Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA

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

Dr. Singh: While there is a great deal of information about the epidemiology of HIV among MSM (men who have sex with men), there is much less information about a subset of MSM who also have sex with women – MSMW.  In this article, CDC researchers examined HIV diagnoses among MSMW and MSM only (MSMO) from 2008 to 2011 to obtain a better understanding of the characteristics of men diagnosed with HIV who have ever had sex with both men and women.  Of all MSM diagnosed with HIV during 2011, 26% also had sex with women with women in the past.  From 2008 to 2011, HIV diagnoses among MSMW were relatively stable while there was an increase among young MSMO aged 13 to 29 years.

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