Research: Lung cancer deaths higher among HIV+ smokers

According to the U.S. National AIDS Strategy report, about 1 in 5 American adults smoke. Among adults living with HIV, the number of people who smoke is 2 to 3 times greater. The report also states that smoking can cause health risks specifically for people who are living with HIV. For example, smokers with HIV are at higher risk (as compared to nonsmokers with HIV) of developing smoking-related cancers, bacterial pneumonia, COPD, heart disease, and oral candidiasis (thrush).

Furthermore, previous research found that HIV-positive smokers lose years of life to cigarettes as compared to nonsmokers with HIV.

If all of that wasn’t enough to convince gay and bi men with HIV to kick the habit, a new study published in The Journal of the American Medical Association narrows the range of research, focusing specifically on projected lung cancer deaths.

The researchers found that nearly 25 percent of people who adhere well to anti-HIV medications but continue to smoke will die from lung cancer. Among smokers who quit at age 40, only about 6 percent will die of lung cancer. The authors also found that people with HIV who take antiviral medicines but who also smoke are from 6 to 13 times more likely to die from lung cancer than from HIV/AIDS.

“Quitting smoking is one of the most important things that people with HIV can do to improve their health and live longer,” Travis Baggett, MD, MPH, of the MGH Division of General Internal Medicine and coauthor of the study, said in a recent press release. “Quitting will not only reduce their risk of lung cancer but also decrease their risk of many other diseases, such as heart attack, stroke and emphysema.”

To read a press release about the study, click here. To find out more about how you can quit smoking, click here and here.  For more information about Health Alerts, go to the Pitt Men’s Study Website at https://pittmensstudy.com/health-alerts/. To subscribe to the Pitt Men’s Study Health Alerts, send an email to rgy2@Pitt.edu, with the word subscribe in the subject line.

Health Alerts are presented by the HIV Prevention and Care Project and the Pitt Men’s Study at the University of Pittsburgh Graduate School of Public Health, with funding from the Pennsylvania Department of Health.

Does PrEP use lead to higher STI rates among gay and bi men?

From POZ.com

Rates of new sexually transmitted infections (STIs) are much higher among men who have sex with men (MSM) taking Truvada (tenofovir disoproxil fumarate/emtricitabine) as pre-exposure prophylaxis (PrEP) than among other MSM. More research is needed, however, to determine whether starting PrEP leads to higher STI rates among MSM.

Publishing their findings in the journal AIDS, researchers conducted a meta-analysis of 18 studies of MSM in which new STI diagnoses were reported. Five of the studies included MSM given PrEP, and 14 were conducted with MSM who were not given PrEP. (One study, the PROUD study, included both a group given PrEP immediately and a group given PrEP on a deferred basis and thus fell into both the PrEP and the non-PrEP categories of studies.)

The researchers found that the rates of new diagnoses of STIs among MSM given PrEP were 25.3 times greater for gonorrhea, 11.2 times greater for chlamydia and 44.6 times greater for syphilis, compared with the rates among MSM not given PrEP. After repeating the analysis but excluding studies conducted before 1999, the researchers found that the results were similar.

Looking to parse apart the contributing factors to the higher rate of STI diagnoses among MSM given PrEP, the meta-analysis’s authors theorized that the regular STI testing that is part of taking PrEP might have led to a higher rate of STI detection. A greater number of sex partners and a higher rate of condomless sex among those given PrEP might also have contributed to their higher STI diagnosis rate.

The study is limited by the fact that, except in the case of PROUD, the researchers compared different populations of MSM from study to study. They also compared groups that tested for STIs at different frequencies and used different variations of STI tests. Additionally, the PrEP studies specifically sought out participants engaging in high-risk sexual behaviors, while the other studies might have had different criteria with regard to sexual risk taking. However, participants in many of the non-PrEP studies were indeed recruited based on some level of reported sexual risk taking.

 

Read the full article.

 

Anti-HIV pill safe among gay, bisexual adolescent boys

From Reuters Health

A pill that protects against the human immunodeficiency virus (HIV) can be safely used by young men who have sex with men, according to a new study.

In a diverse group of teen boys at high risk for HIV infection, pre-exposure prophylaxis (PrEP) in the form of a pill that combines the drugs emtricitabine and tenofovir disoproxil fumarate was well tolerated, researchers found.

“I do hope clinicians increase their comfort with being able to provide PrEP to adolescents,” said lead author Sybil Hosek, a clinical psychologist and HIV researcher at Cook County Health and Hospitals System’s Stroger Hospital in Chicago.

She hopes the new data will be submitted to the U.S. Food and Drug Administration (FDA) and will encourage the agency to approve the pill for use by younger people. The pill is currently approved for HIV prevention in adults.

The drug was first approved by the FDA in 2012 as Truvada, which was marketed by Gilead. Trials found that the drug reduced the risk of HIV infection by over 90 percent.

But little evidence was collected on its use among gay and bisexual adolescent males, who are among those most at risk for HIV infection.

For the study, researchers enrolled 78 gay and bisexual young men, ages 15 to 17, from six U.S. cities. The participants all tested negative for HIV at the start of the study, but were at high risk for an infection.

Participants received a counseling session about HIV risk, plus access to daily doses of PrEP for the next 48 weeks.

Overall, 47 participants completed the study.

Only three adverse events occurred that were possibly related to PrEP, the researchers found.

“I think the safety piece is important,” Hosek told Reuters Health. “It was well tolerated. We didn’t see many complaints about side effects. We did not see many adverse events.”

The researchers also didn’t find an increase in sexually risky behaviors over the study period.

Three young men did become infected with HIV, however. Blood samples suggest they were taking less than two doses of PrEP each week at the time of infection.

The rate of HIV infection in the study was 6.4 cases per 100 people per year, which is about twice as high as the rate seen among men ages 18 to 22 years enrolled in a similar trial, the researchers write in JAMA Pediatrics.

“I shudder to think what the (HIV infection) rate would be if we didn’t offer PrEP,” said Hosek.

She said the high rate of HIV infections is likely due to poor adherence. While more than 95 percent of the young men had evidence of the preventive medication in their blood during the first 12 weeks of the study, by week 48 only about 15 percent of participants had detectible levels of the drug.

Low adherence to medications is a common problem with adolescents, said Hosek.

Dr. Renata Arrington-Sanders writes in an editorial accompanying the new study that making PrEP a success among gay and bisexual adolescents will require effort.

“This work suggests that adolescents may require additional visits than what is currently recommended by national guidelines and suggests a need for multiple team members to address structural barriers to accessing PrEP, assist with youths’ interpretation of HIV risk, and support self-efficacy to swallow and adhere to medications,” writes Arrington-Sanders, of Johns Hopkins University in Baltimore.

Hosek agreed, calling for doctors to be more connected to their young patients on PrEP.

“Clinicians should not be afraid to see adolescents more frequently, maintain a connection with the adolescents and keep them engaged,” she said.

SOURCE: bit.ly/2wDAUi5 and bit.ly/2wCTF5i JAMA Pediatrics, online September 5, 2017.

Can new ‘Smart PrEP Pills’ increase adherence for HIV-prevention medication among young people?

From the Daily Herald online…

How does the smart PrEP work?

“The pill Truvada — the only PrEP drug approved by the Food and Drug Administration — has a sensor tablet encapsulated over it, so that when the pill is swallowed, the sensor tablet comes in contact with gastric fluid in the stomach and creates an electrical signal,” explained Dr. Gregory Huhn, CCHHS’ Associate Professor of Infectious Diseases and principal investigator of the trial. “The electrical signal is less than the frequency of a heartbeat, so nobody is going to feel it. But it transmits a signal in real-time that the pill has been ingested.”

By having a record of when the pill has been taken that goes to both the patient and his or her doctors or providers, the providers can reach out to patients who haven’t been taking the pills as directed and find out if there are any issues they can help resolve-like medication side effects a patient might be having or that they’ve run out of medication, Brothers said.

PrEP is supposed to be taken once a day.

Read the full article.

New injectable antiretroviral treatment proved to be as effective as standard oral therapy

From Science Daily

Antiretroviral therapy (ART) intramuscularly administered may have the same effectiveness as current oral treatments. This is the main conclusion of the Phase II clinical trial carried out by 50 centers around the world — 9 in Spain — to which the team of Dr. Daniel Podzamczer, principal investigator of the Bellvitge Biomedical Research Institute (IDIBELL) and Chief of the HIV and STD Unit of the Infectious Diseases Service of Bellvitge University hospital (HUB) has contributed. The results of the trial, published by the journal The Lancet, pave the way to the implantation of all-injectable antiretroviral therapies with a lower frequency of administration, which would imply a significant improvement of the quality of life of HIV patients.

Read the full article.

Undetectable viral load “completely effective” at stopping HIV transmission, study finds

From Buzzfeed

A groundbreaking new study found zero transmissions occurred between HIV-positive men with an “undetectable viral load” due to treatment, and their HIV-negative partners, across thousands of instances of anal sex without a condom.

The Opposites Attract study, led by professor Andrew Grulich from the Kirby Institute, followed a cohort of 358 gay male couples – one partner HIV-positive, the other HIV-negative – in Australia, Thailand and Brazil.

The HIV-positive partners in the study had an “undetectable viral load”, meaning they are on treatment to suppress the virus so it is undetectable in the blood.

Not a single HIV transmission occurred across the almost 17,000 times participants reported having anal sex without a condom.

12,000 of those sexual encounters were protected solely by the HIV-positive partner’s undetectable viral load, and in the other 5,000, the HIV-negative partner was also taking a drug to protect against contracting HIV, known as PrEP.

“It really does confirm that undetectable viral load is completely effective at preventing transmissions in gay couples,” Grulich told BuzzFeed News from Paris, where he is presenting the research to the International Aids Society (IAS) Conference on HIV Science.

“Essentially, we’re documenting that this is a form of safe sex for couples in this situation.”

Read the full article.

Smoking rampant in LGBTQ community, UIC researcher finds

From dnainfo.com

LGBTQ people smoke at twice the rate of straight people, a University of Illinois at Chicago researcher notes in a paper that offers five ideas to reduce the trend.

UIC clinical psychologist Phoenix Matthews

The paper, produced by a team led by UIC clinical psychologist Phoenix Matthews, said LGBTQ people are “at an elevated risk for tobacco related health disparities due to disproportionately high rates of tobacco use.”

Around 46 percent of gay men and 48 percent of adult lesbians smoke, according to the National Institutes for Health.

Many anti-smoking programs target specific ages, ethnicities and gender — but not sexual orientation, Matthews said in a press release about the paper, published in June by the Society of Behavioral Medicine. Cessation services, such as tobacco quit lines, “are underused by LGBT smokers,” Matthews added.

Matthews recommends that smoking surveys include gays and lesbians specifically and that anti-smoking media campaigns include messages that target them. In addition, the paper urges reducing menthol-flavored cigarettes, which are favored by young smokers, and creating a national clean air act aimed reducing second hand smoke.

Read the full article.