H.I.V. treatment should start at diagnosis, U.S. health officials say

From the New York Times

People with H.I.V. should be put on antiretroviral drugs as soon as they learn they are infected, federal health officials said Wednesday as they announced that they were halting the largest ever clinical trial of early treatment because its benefits were already so clear.

The study was stopped more than a year early because preliminary data already showed that those who got treatment immediately were 53 percent less likely to die during the trial or develop AIDS or a serious illness than those who waited.

The study is strong evidence that early treatment saves more lives, the officials said. Fewer than 14 million of the estimated 35 million people infected with H.I.V. around the world are on treatment now, according to U.N.AIDS, the United Nations AIDS-fighting agency. In the United States, only about 450,000 of the estimated 1.2 million with H.I.V. are on treatment, according to the Centers for Disease Control and Prevention.

“This is another incentive to seek out testing and start therapy early, because you will benefit,” said Dr. Anthony S. Fauci, director of the National Institute for Allergy and Infectious Disease, which sponsored the trial. “The sooner, the better.”

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Backlash to New York City’s fear-based HIV prevention campaign

From aidsmeds.com

The New York City Department of Health and Mental Hygiene’s recent fear-based HIV prevention campaign may have led to unintended consequences by stigmatizing young black and Latino men who have sex with men (MSM). Publishing their findings in Health Affairs, researchers analyzed the 2010 “It’s Never Just HIV” campaign, which used fearful, horror-movie-like imagery and messaging to highlight health problems tied to HIV or its treatment, such as osteoporosis, dementia and anal cancer.

“Relying on fear is risky business,” the authors write in the paper. The health department came to appreciate that its analysis of the campaign’s success could not be governed simply by HIV rates among the target population. Rather, the department needed to consider the campaign’s social and political impact. Not only was there a huge amount of controversy among people in the HIV community, but according to certain criticisms, people at risk of HIV and those living with the virus may have suffered stigma as a result of the campaign.

New York City has since moved away from fear-based HIV prevention campaigns. For example, “Be HIV Sure,” which launched on World AIDS Day 2014, encourages HIV testing as part of sexual intimacy.

To read a press release on the study, click here.

People who don’t tell anyone else their HIV status have as good health outcomes as other people living with HIV

From aidsmap.com

[D]oes non-disclosure matter? Is it associated with poorer health outcomes? While a quantitative survey, completed on a single occasion by respondents, has some limitations in terms of the insight it can give into the quality of people’s lives and relationships, these data are reassuring.

Mental health difficulties and adherence problems were quite common among survey respondents. But they weren’t more frequently reported by people who hadn’t disclosed to anyone. After statistical adjustment for other factors that could skew the results, rates of the following were very similar in people who disclosed and people who did not:

  • Low social support.
  • Symptoms of depression.
  • Symptoms of anxiety.
  • Problems with adherence to HIV treatment.
  • A detectable viral load.

In fact, some of the data suggested that having disclosed to most or all friends and family was actually associated with poorer outcomes in gay men. A more selective disclosure strategy was associated with better outcomes.

Read the full article on aidsmap.com.

Can HIV accelerate age-related conditions?

From MedicalExpress.com

To answer that question, researchers at the UCLA AIDS Institute and Center for AIDS Research and the Multicenter AIDS Cohort Study investigated whether the virus induces age-associatedepigenetic changes—that is, changes to the DNA that in turn lead to changes in expression of gene levels without changing the inherited genetic code. These changes affect biological processes and can be brought on by environmental factors or by the aging process itself.

In a study published online in the peer-reviewed journal PLOS ONE, the researchers suggest that HIV itself accelerates these aging related changes by more than 14 years.

“While we were surprised by the number of epigenetic changes that were significantly associated with both aging and HIV-infection, we were most surprised that the data suggests HIV-infection can accelerate aging-related epigenetic changes by 13.7 to 14.7 years,” said Beth Jamieson, professor of medicine in the division of hematology/oncology at the David Geffen School of Medicine at UCLA and one of the study’s senior authors. “This number is in line with both anecdotal and published data suggesting that treated HIV-infected adults can develop the diseases of aging mentioned above, approximately a decade earlier than their uninfected peers.”

Read the full article.

New study shows gay and bi men twice as likely to get skin cancer

From USA Today

Tanning-x400Gay and bisexual men in the United States are twice as likely as heterosexual men to get skin cancer, a new study shows.

One likely reason: Gay and bisexual men are three times more likely to engage in indoor tanning, according to the study to be presented Friday in San Francisco at a meeting of the American Academy of Dermatology.

The study suggests that anti-tanning messages, most often aimed at young women, need to be broader, says researcher Sarah Arron, an associate professor of dermatology at the University of California, San Francisco. “The primary reason that men and women engage in indoor tanning is because of the cultural association of tanning with a healthy look and overall attractiveness,” Arron says. “We need to dispel the myth of the healthy tan.”

Tanning, whether in the sun or in a tanning bed, can cause skin cancer, including melanoma, the most dangerous kind, according to the U.S. Surgeon General’s office.

Most HIV infections from those not treated

From the Washington Blade

protection-from-HIV-1-infection-in-human-CD4+-T-cellsA new study from the Centers for Disease Control (CDC) found that more than 90 percent of new HIV infections in the U.S. are passed on from HIV-positive people who are not in medical care or treatment, the Journal of the American Medical Association reports.

The study, published Feb. 23, “estimates that 91.5 percent of new HIV infections in 2009 were attributable to people with HIV who were not in medical care, including those who didn’t know they were infected. In comparison, less than six percent of new infections could be attributed to people with HIV who were in care and receiving antiretroviral therapy,” the Journal reports.

“We were shocked to see that the number was as high as it is — nine out of 10 new HIV infections in 2009 occurred this way — over 91.5 percent” said Michael Weinstein, AIDS Healthcare Foundation President. “Such off-the-charts numbers suggest that HIV/AIDS resources, funding and energies must be directed toward far more aggressive and proactive HIV testing, linkage to medical care and antiretroviral treatment for those already infected rather than to the more expensive and esoteric HIV prevention methods such as PrEP. We’ve known for over four years that ‘treatment as prevention’ works. Until this study, we just didn’t know how great the need was for us to fully deploy ‘treatment as prevention’ to get as many HIV-positive individuals in care and on treatment as possible in order to break the chain of infection.”

New study: AIDS drug cuts risk of infection by 86 percent

prep-400x210(Reuters) – Gay men at high risk of HIV who took a daily dose of a Gilead AIDS drug as a preventative measure cut their risk of infection by 86 percent, according to results of a British trial released on Tuesday. Researchers who conducted the trial of so-called pre-exposure prophylaxis (PrEP) said the results offer real hope of reversing the HIV epidemic among men who have sex with men, one of the highest risk groups.

“These results … show PrEP is highly effective at preventing HIV infection in the real world,” said Sheena McCormack, a professor of clinical epidemiology at University College London and the study’s lead investigator.

PrEP involves people who do not have HIV but who are at high risk of becoming infected and seek to protect themselves by taking a single pill, usually a combination of two antiretrovirals, every day.

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