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.

‘Double discrimination,’ loneliness contribute to bisexual health disparities, study says

From NBC News online

“Double discrimination” and loneliness put bisexual individuals at “higher risk for poor mental health outcomes,” according to a recent study out of American University. The study compared the mental health of bisexual men and women to that of gay men, lesbians and heterosexuals.

“Bisexual people face double discrimination in multiple settings — bisexual people are often invisible, rejected, invalidated [and] stigmatized in the heterosexual community as well as the traditional LGBTQ communities,” Ethan Mereish, an assistant professor at American University and the study’s lead author, told NBC News. “Given that isolation and discrimination, bi people might be experiencing increase factors that might make them more lonely or isolated.”

Previous research has shown that lesbian, gay and bisexual individuals broadly face higher rates of mental health issues than their straight counterparts. Yet there are mental health disparities that the bisexual community faces at higher rates than even gays and lesbians. That said, the American University study surveyed 503 bisexual adults ranging in age from 18 to 64 to hone in on their unique minority stressors and the effects they have on mental health.

“This study adds to the growing body of research confirming that bisexual people face unique mental health disparities [that are] closely related to stigma and discrimination [they face] from straight, gay and lesbian communities,” Heron Greenesmith, a senior policy analyst at LGBTQ advocacy organization Movement Advancement Project, said. “Internal stigma adds another barrier to bisexual people.”

Greenesmith, whose organization has compiled a number of studies and reports that point to the relatively poor health of the bisexual community, said this latest study makes it “even more clear that the bisexual community needs tailored mental health services.”

Read the full article.

PATF changes name to reflect exapanded services

From the Pittsburgh AIDS Task Force

As of September 26, 2017, Pittsburgh AIDS Task Force will be Allies for Health + Wellbeing! The name change follows a period of significant expansion for the agency and is in keeping with feedback given by current and potential clients. The new name also pays homage to the agency’s founders.

In 1985, the volunteers who formed the Pittsburgh AIDS Task Force were truly allies fighting against HIV/AIDS on a number of fronts. They fought for the dignity, rights and humanity of those were dying of AIDS. They fought against rampant discrimination and fear. These allies fought to prevent HIV transmission by disseminating accurate information to the community and by offering free anonymous screenings.

Today, we continue to be on the side of people living with HIV, working with them to maximize their health and quality of life. From primary medical care to housing, to a food pantry and, soon, onsite mental health services, Allies for Health + Wellbeing delivers integrated services with a holistic approach. We have also expanded services for those at risk of HIV, including Pre-exposure Prophylaxis (PrEP), treatment for sexually transmitted infections and viral hepatitis, as well as primary medical care.

With a new name comes a new logo and a whole new brand image. Our new brand image will be unveiled at a launch party on September 26th.

Panel creates health care standards for men who have sex with men

From the Washington Blade

The absence of a national standard of care for gay and bi men is partially to blame for higher rates of STDs and other health disparities a national panel of health professionals said this week according to the Clarion Ledger.

The panel, co-chaired by a University of Mississippi Medical Center professor, has created a standard of care for men who have sex with men to address STD prevention programs and other issues, the Ledger reports.

The panel’s sexual health standard of care for MSM includes:

  • A comprehensive sexual history; mental health assessments and referrals; counseling about condoms, lubrication, enemas and douches; and discussions about sexual satisfaction and pleasure.
  • A visual exam to check for signs of HPV, syphilis or other STDs.
  • Urethral swab or urine-based chlamydia and gonorrhea screening; rectal and pharyngeal chlamydia and gonorrheal screening.
  • Syphilis, HIV and hepatitis C screening every three to six months for sexually active MSM with multiple partners, and at least annually for other MSM.
  • Vaccines for human papillomavirus, or HPV, and Hepatitis A and B.
  • Pre- and post-exposure prophylaxis as indicated; expedited partner therapy for chlamydia or gonorrhea infection.

The panel’s recommendations go beyond federal guidelines and instead incorporate the collective experiences of the panel’s experts in sexual health. Their work took into consideration the social landscape for many MSM that can impact whether or not they walk into a clinic, the Ledger reports.

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.