Despite similar rates of enrollment into medical care, youth with HIV have much lower rates of viral suppression — reducing HIV to undetectable levels — compared to adults, according to an analysis funded by the National Institutes of Health. Among more than 1,000 youth, most of whom were newly enrolled in care at treatment centers throughout the United States, 12% had attained viral suppression, far lower than the 32% to 63% observed in studies of adults over age 24. The findings suggest that after they enroll in an HIV treatment program, a low proportion of youth adhere to care regimens. The study appears in the Journal of Acquired Immune Deficiency Syndromes.
“Our findings indicate an urgency for research on how best to tailor HIV intervention services to the needs of youth,” said the study’s first author, Bill G. Kapogiannis, M.D., of the Maternal and Pediatric Infectious Diseases Branch at NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). The analysis was funded by NICHD, the National Institute on Drug Abuse and the National Institute of Mental Health.
In 2018, 37,832 people received an HIV diagnosisa in the United States (US) and dependent areas.b From 2010 to 2017, HIV diagnoses decreased 11% among adults and adolescents in the 50 states and District of Columbia. However, annual diagnoses have increased among some groups.
New HIV Diagnoses in the US and Dependent Areas for the Most-Affected Subpopulations, 2018 (click image to enlarge).
Today’s powerful antiretroviral therapy (ART) helps fight back HIV infection and restore normal immune function. However, clinical evidence suggests that people with HIV who are virologically suppressed still have higher rates of comorbid viral infections than the general population.
Now, a new study in the Journal of Infectious Diseases suggests that ART does not restore the immune system completely back to normal. Instead, people with HIV may experience “immune amnesia,” in which the immune system slowly loses its capacity to recognize and fight off viral infections introduced during childhood or through a vaccine.
“Even with therapy, there’s something not quite fixed about the immune system,” said lead author Michael Augenbraun, M.D., FACP, FIDSA, who is vice chair of the Department of Medicine and director of the Division of Infectious Diseases at SUNY Downstate Health Sciences University and Kings County Hospital Center.
In the study, Augenbraun and his colleagues compared immune response among a group of 50 HIV-negative women and a group of 50 HIV-positive women on ART with low viral load. Each of these women had been vaccinated against smallpox during childhood, so they should all theoretically have similar levels of lingering protection against the smallpox virus.
Both relationship-specific and structural factors influence whether coupled gay men living in New York City choose to use pre- and post-exposure prophylaxis (PrEP/PEP) for HIV prevention. Some men – particularly those in monogamous relationships – felt that discussing PrEP and PEP in the context of a relationship could threaten the relationship by raising issues of trust, while others felt that it had the potential to enhance sexual health and satisfaction.
Stigma from the gay community and healthcare providers around promiscuity also presented barriers to PrEP uptake. This qualitative research was conducted by Stephen Bosco, Dr Tyrel Starks and colleagues at City University New York and published in the Journal of Homosexuality.
Gay and bisexual men accounted for 66% of all new HIV diagnoses in the US in 2017. It is estimated that 35-68% of these infections happen within the context of a long-term relationship. This indicates that coupled gay men have the potential to benefit significantly from biomedical prevention strategies, such as PrEP (taken on an ongoing basis) and PEP (taken shortly after a suspected infection). However, only 7% of the potential 1.1 million gay and bisexual men who could benefit from PrEP were prescribed it in 2016. Black and minority men in the US remain most at-risk for HIV infection, while also having the lowest rates of PrEP uptake.
Extensive evidence from HIV prevention research studies has firmly established that “Undetectable Equals Untransmittable,” or U=U. This means that people living with HIV who achieve and maintain an undetectable viral load — the amount of virus in their blood — by taking antiretroviral therapy (ART) as prescribed do not sexually transmit HIV to others. The U.S. Centers for Disease Control and Prevention estimates this strategy is 100% effective against the sexual transmission of HIV.
Now, a new study of nearly 112,000 men who have sex with men in the United States has found increasing acceptance of the U=U message in this population. Overall, 54% of HIV-negative participants and 84% of participants with HIV correctly identified U=U as accurate. The study was supported by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health. Study results were published online in the Journal of Acquired Immune Deficiency Syndromes.
“U=U has been validated repeatedly by numerous studies as a safe and effective means of preventing the sexual transmission of HIV,” said Anthony S. Fauci, M.D., NIAID Director. “The increased understanding and acceptance of U=U is encouraging because HIV treatment as prevention is a foundation of efforts to end the epidemic in the United States and around the world. This public health message has the power to reduce stigma, protect the health of people living with HIV and prevent sexual transmission of HIV to others.”
Also, according to CDC research, cases of gonorrhea, chlamydia and syphilis have risen for the fifth consecutive year.Some STIs (including HIV) can go unnoticed since symptoms can be mistaken for minor health problems like a cold or sore throat. Some may have no symptoms at all. The only way to know for sure if you’re infected is to get tested.
If you send us your zip code, we can help find local testing near you. Most are free. You can also ask us questions about basic sexual health, including PrEP. Send a message to m4mInformation@pitt.edu. We’re here to help.
HIV prevalence is as high as 12% in young people experiencing homelessness. This population is also 6 to 12 times more likely to become infected with HIV than housed youth. Obstacles to HIV prevention and care among youth experiencing homelessness are compounded by substance use, housing instability, and mental illness. These obstacles present a need to develop targeted interventions for this population.
Few HIV prevention programs prioritize the prevention needs of youth experiencing homelessness, but an oral abstract session at the Association of Nurses in AIDS Care Conference (ANAC 2019) discussed the development of a protocol for nurse care management for HIV prevention called NCM4HIV.
NCM4HIV integrates a theoretical framework, methodology for behavioral change, and practical strategies designed to engage youth experiencing homelessness, with an outcome evaluation plan. The program builds on past nurse care management using the Comprehensive Health Seeking and Coping Framework. NCM4HIV also incorporates the psychological modality known as motivational interviewing. Results of behavioral interventions will then be accounted for through behavioral feedback technology, allowing case management specialists to further tailor the intervention through goal setting and patient response.
For the first time in 19 years, a team of scientists has detected a new strain of HIV.
The strain is a part of the Group M version of HIV-1, the same family of virus subtypes to blame for the global HIV pandemic, according to Abbott Laboratories, which conducted the research along with the University of Missouri, Kansas City. The findings were published Wednesday in the Journal of Acquired Immune Deficiency Syndromes.
HIV has several different subtypes or strains, and like other viruses, it has the ability to change and mutate over time. This is the first new Group M HIV strain identified since guidelines for classifying subtypes were established in 2000. It is important to know what strains of the virus are circulating to ensure that tests used to detect the disease are effective.
“It can be a real challenge for diagnostic tests,” Mary Rodgers, a co-author of the report and a principal scientist at Abbott, said. Her company tests more than 60% of the world’s blood supply, she said, and they have to look for new strains and track those in circulation so “we can accurately detect it, no matter where it happens to be in the world.”
As countries across the globe continue the fight against HIV, treatments that are quickly initiated and effective are crucial for getting patients with HIV virally suppressed both to improve their clinical outcomes and to stop the transmission of infection.
Addressing both of these issues, Mary Montgomery, MD, associate physician in the Division of Infectious Diseases at Brigham and Women’s Hospital, and an instructor of medicine at Harvard Medical School, discussed emerging treatment strategies for managing HIV during a session at the National Association of Managed Care Physicians 2019 Fall Managed Care Forum, held October 10-11 in Las Vegas, Nevada.
More and more, clinicians are understanding the benefit of prescribing antiretroviral therapy (ART) to patients the day they are diagnosed with HIV, otherwise known as rapid ART initiation.
The literature has shown that rapid ART initiation is associated with a more favorable mortality profile, as well as quicker viral suppression. In one study,1 the median time to viral suppression was 56 days for those who initiated treatment at diagnosis, compared with 126 days for those who began treatment consistent with prior recommendations for universal ART and 219 days for those who received CD4-guided ART.
Research says that men who have sex with other men make up 67% of new HIV infections. Then on top of that, 25 percent of Latino men who have sex with other men (MSM) will be infected with HIV in their lifetime. And, 50 percent of Black MSM will experience the same. That’s compared to 12.5 percent of white men. That said, men of color are less likely to use the HIV preventive drug pre-exposure prophylaxis or PrEP. Why is this?
As NBC writes, researchers believe the problem lies in accessibility issues to health care. Studies show health care providers are not prescribing Black and Latino men to PrEP. In addition, men of color are less aware of PrEP’s very existence. The CDC’s study found that 95% of white men, 87% of Latino men, and 43% of Black men are knowledgeable about PrEP. Then even worse, only 58% of white, 44% of Latino, and 43% of Black men said they discussed the preventative medication with a physician.
As Kanny told Reuters Health,“This type of research is critical to finding—and correcting — missed opportunities to offer PrEP to people at risk of HIV, particularly among African American and Latin gay and bisexual men.”
He said further: “It’s important for providers to take sexual histories of gay and bisexual men and to discuss PrEP as an option for HIV prevention with those who could potentially benefit from it,” said Kanny. “These discussions also help to destigmatize PrEP use, which is particularly important for increasing PrEP use among African American and bisexual men.”