Pitt breakthrough may improve HIV treatment

From the Triblive.com

A discovery about how HIV spreads through the human body could help doctors tame the virus in some infected patients, researchers say. Findings at the University of Pittsburgh Graduate School of Public Health show the disease moves slowly in people whose immune cells are low in cholesterol. That suggests HIV patients might live longer if researchers can regulate cholesterol metabolism in those cells, said lead author Giovanna Rappocciolo.

“We think it’s important because it’s a very new approach to the study of the HIV infection. I think it could be significant,” said Rappocciolo, an assistant professor in the Department of Infectious Diseases and Microbiology at Pitt. Her work with department Chairman Charles Rinaldo appears Tuesday in mBio, the journal of the American Society for Microbiology. Funded through the National Institutes of Health, their discovery caps several years of research focused on eight men in the Pittsburgh area.

The men are among 5 percent to 10 percent of the more than 1.1 million people in the United States living with HIV who can stay healthy for seven years — or longer — without conventional therapies, Rappocciolo said. Those patients had low cholesterol levels inside certain cells that spread HIV in the body, Rappocciolo and several Pitt colleagues found. Researchers relied on data assembled over 30 years through the Pitt Men’s Study, part of the NIH-supported Multicenter AIDS Cohort Study spanning four cities.

“Results like ours are the real payoff of the past three decades of meticulous data and specimen collection,” Rinaldo said in a statement. Rappocciolo said their department has received more than $70 million for research related to AIDS, the final stage of the HIV disease that severely inhibits the immune system. Rappocciolo stressed her findings do not mean that HIV patients with low-cholesterol diets are safeguarded.

Read more at triblive.com 

HIV infection increases risk of melanoma

From aidsmap.com

HIV infection is associated with an increased risk of melanoma, according to the results of a meta-analysis published in PLOS ONE. Overall, people living with HIV had a 26% increase in their relative risk of melanoma compared to the general population, the risk increasing by 50% for white-skinned people with HIV. The increased risk was statistically significant in white-skinned people diagnosed with HIV and of borderline statistical significance for all people diagnosed with HIV.

The authors recommend that fair-skinned people living with HIV should be regularly screened for suspicious skin lesions and should also be warned about the dangers of prolonged exposure to the sun.

Melanoma (skin cancer) diagnoses have increased markedly in the UK and many other countries in recent years. There is also evidence suggesting that people living with HIV have a higher risk of developing this skin cancer compared to individuals in the general population. Studies conducted before effective antiretroviral therapy became available in the mid-1990s showed that having HIV increased the relative risk of melanoma by approximately a quarter.

However, it is uncertain whether people living with HIV continue to have an increased risk of melanoma in the era of effective antiretroviral treatment. A team of Australian and UK investigators therefore conducted a systematic review and meta-analysis, looking at the association between HIV and the relative risk of melanoma in the periods before and after potent HIV therapy became available. The investigators’ analysis included cohort studies involving adult patients.

A total of 21 studies met their inclusion criteria. These were conducted between 1999 and 2013. Most (twelve) were conducted in the United States, eight in Europe and one in Australia. Most of the studies reported on cohorts of patients with HIV and those diagnosed with AIDS, but six studies defined their study population as patients with AIDS. The majority of studies (16) were population based, most of the patients being men (76-92%). One study included only men who have sex with men; one study included women only; a single study was restricted to veterans and two studies reported on single-clinic patient cohorts.

Continue reading on aidsmap.com.

Marking a scientific milestone

research pageFrom the Huffington Post
by John-Manuel Andriote
Journalist and author, ‘Victory Deferred: How AIDS Changed Gay Life in America’

Thirty years ago, in an April 23, 1984 press conference in Washington, D.C., the world learned that American microbiologist Robert C. Gallo and his colleagues at the National Cancer Institute had proved that a retrovirus first seen by their counterparts at Institut Pasteur in Paris was the cause of AIDS.

Secretary of Health and Human Services Margaret Heckler also announced that day that the Gallo team had created a blood test to detect antibodies produced by the body to fight infection. With it we finally had the ability to know who was infected, to screen donated blood and to track the spread of the virus.

By the time of the announcement, 4,177 AIDS cases had been reported in the United States across 45 states. New York City alone accounted for more than 1,600 cases. San Francisco, far smaller than the nation’s largest city and the East Coast’s biggest gay mecca, had more than 500 cases. The majority of these cases were among gay men of all skin tones.

Although the HIV test was originally intended to screen the blood supply, it became available to the public in early 1985. After early uncertainty about what, exactly, a positive test meant, it became clear it meant that a microbial time-bomb was ticking inside you, set to explode at some unpredictable time in a nightmare that would eventually lead to your death from the cancers, dementia, brain infections and other horrors that attack a body when HIV has destroyed the immune system.

Continue reading on the Huffington Post.

Combating HIV by zip code

Minority neighborhoods in the U.S. are hit as hard by HIV as gay enclaves

From Healthline.com

HIV rates in some urban American neighborhoods rival those of Haiti and Ethiopia, according to a researcher at Brown University in Providence, R.I.

And while affected communities include big-city gay enclaves, such as New York’s Chelsea district, minority neighborhoods in the Bronx and Harlem make the list, too. The difference is that those in mostly white neighborhoods are more likely to be tested and treated than those in minority neighborhoods.They are also less likely to die of AIDS.

In an era of Internet targeting, Dr. Amy Nunn’s approach of going door-to-door if necessary to reach people with HIV may seem old-fashioned. But in areas with limited access to health care, employment, and education, HIV experts agree that a new model is needed to reach at-risk groups of black and Hispanic Americans.

Of the 50,000 new HIV infections in the U.S. in 2010, gay and bisexual men accounted for two-thirds of them, according to the U.S. Centers for Disease Control and Prevention (CDC). Black men and women are eight times more likely to become infected than whites, based on population size. Of all groups, white men who had sex with men comprised the largest segment of new infections, at 11,200. Black men who had sex with men were second, with 10,600 new infections.

Dr. Nunn, an assistant professor of medicine at Brown, told Healthline that more money must be targeted toward poor and minority neighborhoods. “If this were happening to white people there would be protests,” she said. “It’s so easy to overlook poor people.”

Of the more than 1.1 million people in the U.S. living with HIV, almost 16 percent don’t know they have it, according to the CDC. Powerful antiretroviral medications available to most everyone in the U.S. can suppress viral loads to the point that transmission is unlikely. But they will only work if they are taken regularly.

“We’ve got to get these people into treatment come hell or high water,” Nunn said.

Continue reading on Healthline.com.

Weekly clinic geared toward LGBTQ clients in Pittsburgh

research pageFrom The Pittsburgh Post Gazette… 

The first weekly Community Clinic for lesbian, gay and transgender people will be held Thursday in downtown Pittsburgh. The clinic, with physician Stacy Lane, is the only one targeting LGBTQIA individuals with no age limits or income requirements. It will be held on the eighth floor at 810 Penn Ave. from 2 to 5:30 p.m. During the clinic hours, the Garden of Peace Project will supply testing for sexually transmitted diseases and Project Silk will provide HIV testing.

Charmaine Turner, founder and director of Step Up 2 Step Out, will host a hip-hop dance class at 4 p.m. The Garden of Peace Project and Project Silk, which are the hosts, invite other providers to host their own dance classes or other health-related group activities such as yoga, meditation and self-esteem workshops.

STD prevention is a part of HIV prevention: STD Awareness Month 

A message from Gail Bolan, M.D., Director, Division of STD Prevention, Centers for Disease Control and Prevention (from AIDS.gov)

Gail Bolan, M.D., Director, Division of STD Prevention, Centers for Disease Control and Prevention

Gail Bolan, M.D., Director, Division of STD Prevention, Centers for Disease Control and Prevention

April marks the annual observance of STD Awareness Month. And for this month, I’d like to focus on the link between STD prevention and HIV prevention.

The Centers for Disease Control and Prevention (CDC) has been invested in exploring the intersection of HIV and other STDs. Every year, 20 million new STDs occur including 50,000 new HIV infections. We know that people who have STDs such as gonorrhea, herpes, and syphilis are more likely to get HIV compared to people who do not. In fact, being infected with genital herpes makes you 3 times more likely to get infected with HIV, if exposed. And data collected from several major U.S. cities indicate that nearly 45% of gay and bisexual men with syphilis are also infected with HIV.

So this STD Awareness Month, I encourage the public, health care providers, and community-based organizations to bring a renewed sense of enthusiasm and focus to their STD awareness and prevention efforts. Individuals should know that the same behaviors that put you at risk for acquiring STDs can put you at risk for getting HIV. Physicians should follow recommended screening and treatment guidelines. And community-based organizations should support local STD and HIV prevention efforts.

The link between STDs and HIV is real. By educating yourself on ways to lower your risk, you can take action to protect your health. Not having sex is the most effective way to prevent STDs and HIV, but if you are sexually active, you can lower your risk of STDs and HIV by

  • Choosing one partner and agreeing to be sexually active only with each other. It is still important that you and your partner get tested for STDs and HIV and share your test results with one another.
  • Limiting the number of people you have sex with if you have more than one partner.
  • Using latex condoms or dental dams the right way every time you have sex.

STD and HIV testing is a critical part of preventing the spread of disease. I am urging providers to educate patients on their risk for STDs and HIV, and make taking a sexual history a priority. The behaviors and circumstances that put people at risk for STDs also put them at risk for HIV; take the opportunity to offer HIV testing to all patients who are tested for an STD. With 20% of new HIV cases being detected in STD clinics, it’s clear that a continued merging of STD and HIV prevention efforts is needed. As well, patients diagnosed with HIV at STD clinics have been found to have less-advanced disease.

You can go to the CDC Website to find out more about STD Awareness Month.

New gay epidemic — and what you can do to end it

From the Huffington Post… 

(by Jimmy LaSalvia)

quit-smoking-man-largeThe new gay epidemic is an old one. It’s killing your gay friends and family, and it’s totally preventable. No, it’s not what you may be thinking. It’s not HIV/AIDS. I’m talking about smoking. Last week was LGBT Health Awareness Week, so this is good time to bring up a LGBT health crisis that many ignore or minimize. According to the American Lung Association, gay men are approximately 2.5 times more likely to smoke, and lesbians are about twice as likely as their straight counterparts. Most everyone knows that smoking is the leading preventable cause of death. That’s true for everyone, including LGBT Americans.

There’s not a physical reason why gay people smoke more, but there are some unique factors that contribute to the higher rate of smoking. For decades, the gay community has socialized and interacted in smoking venues such as bars. For a long time, gay bars were the only place for LGBT people to find others like them. It’s still a big part of gay culture and socialization. The American Lung Association also says that stress from social stigma and discrimination because of their sexual orientation is frequently cited as a reason that LGBT people start smoking. That’s especially the case with young people, who have a much higher rate of smoking than their straight peers.

It’s important for all of us, no matter who we are, to combat this epidemic within our own families and circles of friends. Understanding these unique pressures and risk factors can help us to urge our gay friends and family who are still smoking to stop. Quitting smoking is hard. Everyone knows that. While giving it up “cold turkey” (ideally with some advice from a doctor) is the best and most effective way, it’s just not possible for everyone. A wide range of pharmaceutical products — everything from over-the-counter nicotine gum to prescription medicine — can also help some people some of the time but also have very high failure rates particularly over the long term. Nicotine is addictive and quitting it is very, very hard.

For those who simply can’t quit or don’t want to there are products such as e-cigarettes and dissolvable smokeless tobacco that can help people with their addiction to nicotine without carrying the risks of smoking. These products are still addictive and certainly aren’t “safe” overall. But they are still safer than smoking. It’s the smoke that’s the real killer.

Continue reading on the Huffington Post.

HIV-infected men at increased risk for heart disease, large study finds

NIH-Supported Research Also Identifies Predictors of Heart Disease Risk In This Group
Plaque buildup in the arteries that nourish the heart, a condition called coronary atherosclerosis, narrows the arteries and increases the risk for heart attack.

Plaque buildup in the arteries that nourish the heart, a condition called coronary atherosclerosis, narrows the arteries and increases the risk for heart attack.

The buildup of soft plaque in arteries that nourish the heart is more common and extensive in HIV-infected men than HIV-uninfected men, independent of established cardiovascular disease risk factors, according to a new study by National Institutes of Health grantees. The findings suggest that HIV-infected men are at greater risk for a heart attack than their HIV-uninfected peers, the researchers write in Annals of Internal Medicine. In addition, blockage in a coronary artery was most common among HIV-infected men whose immune health had declined the most over the course of their infection and who had taken anti-HIV drugs the longest, the scientists found, placing these men at even higher risk for a heart attack. “These findings from the largest study of its kind tell us that men with HIV infection are at increased risk for the development of coronary artery disease and should discuss with a care provider the potential need for cardiovascular risk factor screening and appropriate risk reduction strategies,” said Gary H. Gibbons, M.D., director of the National Heart, Lung, and Blood Institute (NHLBI), part of NIH. “Thanks to effective treatments, many people with HIV infection are living into their 50s and well beyond and are dying of non-AIDS-related causes¬—frequently, heart disease,” said Anthony S. Fauci, M.D., director of the National Institute of Allergy and Infectious Diseases (NIAID), also part of NIH. “Consequently, the prevention and treatment of non-infectious chronic diseases in people with HIV infection has become an increasingly important focus of our research.”

NIAID and NHLBI funded the study with additional support from the National Center for Advancing Translational Sciences, part of NIH. Past studies of the association between heart disease and HIV infection have reached inconsistent conclusions. To help clarify whether an association exists, the current investigation drew participants from the Multicenter AIDS Cohort Study (MACS), a study of HIV/AIDS in gay and bisexual men established by NIAID nearly 30 years ago. “One advantage of the MACS is that it includes HIV-uninfected men who are similar to the HIV-infected men in the study in their sexual orientation, lifestyle, socioeconomic status and risk behavior, which makes for a good comparison group,” said Wendy S. Post, M.D., who led the study. Dr. Post is a professor of medicine and epidemiology at the Johns Hopkins School of Medicine and the Johns Hopkins Bloomberg School of Public Health in Baltimore.

Another advantage was the MACS’ size, with nearly 7,000 men cumulatively enrolled, 1,001 of whom participated in the new study. The participants included 618 men who were HIV-infected and 383 who were not. All were 40 to 70 years of age, weighed less than 200 pounds, and had had no prior surgery to restore blood flow to the coronary arteries. Dr. Post and colleagues investigated whether the prevalence and extent of plaque buildup in coronary arteries, a condition called coronary atherosclerosis, is greater in HIV-infected men than HIV-uninfected men and whether that plaque is soft or hard. Coronary atherosclerosis, especially soft plaque, is more likely to be a precursor of heart attack than hard plaque.

The scientists found coronary atherosclerosis due to soft plaque in 63 percent of the HIV-infected men and 53 percent of the HIV-uninfected men. After adjusting for cardiovascular disease risk factors, including high blood pressure, diabetes, high cholesterol, high body mass index and smoking, the presence of soft plaque and the cumulative size of individual soft plaques were significantly greater in men with HIV infection.

In addition, by examining a subgroup of HIV-infected men, the scientists discovered two predictors of advanced atherosclerosis in this population. The first predictor deals with white blood cells called CD4+ T cells, which are the primary target of HIV and whose level, or count, is a measure of immune health. The researchers found that for every 100 cells per cubic millimeter decrease in a man’s lowest CD4+ T cell count, his risk of coronary artery blockage rose by 20 percent. The scientists also found that for every year a man had taken anti-HIV drugs, his risk of coronary artery blockage rose by 9 percent.

Because the investigators examined coronary artery plaque at a single point in time, further research is needed to determine whether coronary artery plaque in HIV-infected men is less likely to harden over time, or whether these men simply develop greater amounts of soft plaque, according to Dr. Post. In addition, she said, studies on therapies and behavioral changes to reduce risk for cardiovascular disease in men and women infected with HIV are needed to determine how best to prevent progression of atherosclerosis in this population.