Monthly Archives: May 2014

Low vtamin D is linked to poor HIV treatment outcomes


There is an apparent association between low vitamin D levels and an elevated risk of HIV disease progression among people beginning treatment for the virus, aidsmap reports. Publishing their findings in The Journal of Infectious Diseases, investigators studied members of the PEARL trial in eight low- and middle-income countries, as well as in the United States.

The HIV-positive study participants had progressed to the World Health Organization’s stage 3/4 of HIV disease within 96 weeks of starting on antiretrovirals (ARVs), or they had experienced virologic failure (two consecutive viral loads over 1,000 16 weeks after starting ARVs), or they had experienced immunologic failure (CD4s dropping below 100 after 48 weeks of ARVs). The researchers compared these participants to randomly selected HIV-positive people to determine if their vitamin D levels when they started taking HIV therapy were linked to a raised risk of worse clinical outcomes.

Forty-nine percent of the participants had low vitamin D upon starting HIV treatment. Low vitamin D at this point was linked to a 2.13-fold increased risk of clinical disease progression and a 2.13-fold increased risk of virologic failure. Some evidence suggested that low vitamin D may also be linked to a worse CD4 response to ARVs, although there was not enough evidence to prove the association.

The researchers believe this research supports the need for future study into whether supplementing for vitamin D affects outcomes of HIV treatment. They say that there is a biologic plausibility that low vitamin D would increase the risk of worse clinical outcomes during HIV treatment.

To read the study abstract, click here.

CDC’s Start Talking campaign to fight HIV

The Centers for Disease Control and Prevention (CDC) launched their latest communication campaign under their Act Against AIDS initiative –  This new national HIV prevention campaign is the result of input from more than 500 gay and bisexual men from various racial and ethnic groups, ages, and geographic areas across the United States. The campaign was created by and for gay and bisexual men to promote open communication about a range of HIV prevention strategies for sexual partners.

Start Talking. Stop HIV. features messages that engage, inspire, and spark conversations between sexual partners and provides gay and bisexual men with practical tools and tips for talking about important HIV prevention topics like:

  • HIV testing and their HIV status,
  • Condoms and engaging in lower-risk sexual behaviors,
  • Medicines that prevent and treat HIV, including the use of pre-exposure prophylaxis (PrEP), post-exposure prophylaxis (PEP), and antiretroviral therapy (ART).

More than thirty years after the first diagnosis of AIDS in the United States, gay and bisexual men continue to be the population most severely affected by HIV nationwide, due to a number of complex factors.

Research shows that communication between sexual partners is associated with reduced risk behavior and increased HIV testing and HIV status disclosure; however, many gay and bisexual men may still find it difficult to talk openly with their sexual partners about HIV prevention.

A dedicated campaign website and Facebook Page  provide conversation starters and accurate information to inform these life-saving conversations.

Study supports benefits of beginning HIV therapy early


Starting antiretroviral (ARV) treatment for HIV before CD4 cells drop too low reduces the risk of AIDS and HIV-related illnesses, according to the same large study that proved early ARV treatment reduces the risk of HIV transmission by 96 percent, aidsmap reports. Called HPTN 052, the study was a large multi-site trial conducted in 13 sites in nine countries. Results were published in Lancet Infectious Diseases.

The trial randomized 1,762 HIV-positive participants who had CD4s between 350 and 550 to either begin ARVs immediately or to wait until their CD4 levels had either dropped to 250 or until they developed a symptomatic disease related to HIV. The median CD4 count at the study’s outset was 436. The participants were followed for a median of 2.1 years.

A total of 57 participants (6 percent) who started treatment early and 77 (9 percent) who delayed treatment experienced one or more of the following (considered a “primary outcome”): death, an AIDS diagnosis, tuberculosis (TB), a severe bacterial infection, cardiovascular disease, serious liver or kidney disease, non-AIDS cancers or diabetes. The cumulative two-year probability of such an outcome was 4.8 percent for the early treatment group, compared with 7.9 percent for the delayed treatment cohort. Although there was a 27 percent reduced risk of a primary outcome among those who started early, this difference was not statistically significant, meaning it could have occurred by chance.

Five percent of those in the early treatment group were diagnosed with an AIDS-defining event, compared with 7 percent among those who delayed treatment. The cumulative two-year probability of an AIDS diagnosis was 3.3 percent in the group that started ARVs early and 6 percent in those who delayed. Starting treatment early lowered the risk of an AIDS-defining illness by 36 percent, a difference that was statistically significant.


Official guidelines for pre-exposure prophylaxis (PrEP) released


The U.S. Public Health Service and the Centers for Disease Control and Prevention released guidelines for the use of daily oral antiretroviral pre-exposure prophylaxis, or PrEP, for HIV infection, entitled: Preexposure Prophylaxis for the Prevention of HIV Infection in the United States – 2014 [PDF 867KB].

These guidelines provide health care providers with recommendations on the use of PrEP to prevent HIV, and include a supplement [PDF 690KB] with additional materials and tools for clinicians who prescribe PrEP and their patients. These guidelines replace previous interim guidance released by CDC for the use of PrEP.

CDC recommends PrEP for HIV-uninfected patients at substantial risk for HIV infection, including patients who have any of the following indications:

  • Is in an ongoing relationship with an HIV-infected partner;
  • Is not in a mutually monogamous relationship with a partner who recently tested HIV-negative; and is a
  • gay or bisexual man who has had sex without a condom or been diagnosed with a sexually transmitted infection within the past six months;
  • heterosexual man or woman who does not regularly use condoms when having sex with partners known to be at risk for HIV (e.g., injecting drug users or bisexual male partners of unknown HIV status); or
  • Has, within the past six months, injected illicit drugs and shared equipment or been in a treatment program for injection drug use.

PrEP is a powerful HIV prevention tool. However, for sexually active people, no prevention strategy is 100% effective. Therefore, the guidelines also recommend that physicians encourage patients to use PrEP with other effective strategies—like using condoms, testing for HIV with partners, reducing the number of partners, and having partners who are HIV positive take antiretroviral therapy—to provide even greater protection from HIV.

To achieve the full promise of PrEP, each of us has a critical role to play. Clinicians play a central role in increasing awareness and the delivery of this new prevention method when there are indications for its use. Advocates can help raise PrEP awareness and understanding about PrEP, especially in at-risk populations. Medical associations and professional organizations can help educate providers and share clinicians’ experiences delivering PrEP, and HIV prevention programs can integrate PrEP education into existing activities.

We mark a milestone with the release of these new guidelines—a promising tool for HIV prevention, and one that has the potential to alter the course of the U.S. HIV epidemic.

For more about PrEP and its use. Please visit the CDC PrEP page.

HIV associated with increased risk of melanoma


HIV infection is associated with an increased risk of melanoma (skin cancer), according to the results of a meta-analysis published in PLOS ONE. In short, people living with HIV had a 26% increase in their relative risk of melanoma compared to the general population. The risk increases to 50% for white-skinned people living with HIV.

The authors of the analysis therefore recommend fair-skinned people with HIV should get regular screenings for suspicious skin lesions and should be warned about the dangers of prolonged exposure to the sun.  You can talk to your doctor about finding a specialist who can perform a skin cancer screening.  To help prevent melanoma, it is also important to use sun block with an SPF of at least 15 on exposed skin, when outdoors.

Read the full article on

To find out about how indoor tanning (tanning beds) also increases the risk of melanoma, go to the CDC information page.

For tips on how to spot a melanoma, go to the Skin Cancer Foundation.

To subscribe to Pitt Men’s Study Health Alerts, send an email to with the word “subscribe” in the subject line.



Pitt research shows low cholesterol in immune cells slows HIV progression

by Bill Buchanan, Pitt Men’s Study Clinic Coordinator

For decades we’ve wondered why some people don’t progress to AIDS as quickly as others. Now we’ve discovered at least one of the reasons, and you “non-progressors” out there can thank your parents. As for everyone else, this might turn into a new and innovative way to control HIV.

Pitt Men’s Study researchers looked at 30 years of data and samples provided by Study volunteers and studied dendritic cells and B cells, both important components of our immune systems. Those men who progressed slowly had dendritic cells and B cells that contain less cholesterol than the cells of men who progressed more quickly.

That’s right, low levels of cholesterol in the membranes of these cells is protective against HIV. Why? HIV needs cholesterol to transmit from one cell to another. If the transmission of HIV between cells is slowed down because there’s not enough cholesterol in the immune cells, the virus can’t multiply as quickly; and if the virus is not multiplying quickly, it can’t hurt one’s immune system as quickly. This study also indicated that this could be an inherited trait, since it was also observed using cells that were stored in the Pitt Men’s Study freezers before these volunteers become infected with HIV.

Dendritic cells are particularly crucial for HIV multiplying in our bodies because they pass the virus on to our T cells, the cells that are most responsible for viral replication. For most people today, taking highly active antiretroviral therapy interrupts viral replication and halts progression to AIDS. But now we know why some people progressed to AIDS more slowly than others without using HIV meds.

“We’ve known for two decades that some people don’t have the dramatic loss in their T cells and progression to AIDS that you’d expect without drug therapy,” said lead author Giovanna Rappocciolo, Ph.D., an assistant professor at Pitt’s Graduate School of Public Health. “Instead the disease is much slower to progress, and we believe low cholesterol in dendritic cells may be a reason.”

“We couldn’t have made this discovery without the dedication of our volunteers. Results like ours are the real pay-off of the past three decades of meticulous data and specimen collection,” said senior author Charles Rinaldo, Ph.D., chairman of Pitt’s Department of Infectious Diseases and Microbiology, and principal investigator of the Pitt Men’s Study.

This discovery was featured in the April 29, 2014 edition of mBio, the journal of the American Society for Microbiology.

IMPORTANT DISCLAIMER: The cholesterol discussed above is not the same as the cholesterol measured in routine blood tests. In fact, our study’s non-progressors had similar levels of blood cholesterol as the progressors did. Notably, we used statins to treat dendritic cells and B cells from HIV negative men in the study’s lab (in vitro), and this lowered the cholesterol in their membranes and shut down HIV transmission. However, we do not know if ingesting statins will have the same effect in people (in vivo) and do not endorse anyone relying on their blood cholesterol results or their use of statins to determine their HIV treatment.


Heads Up for PACT Patients

For HIV patients who receive care at Pittsburgh AIDS Center for Treatment (PACT), UPMC, it might be worth noting that impending changes in your healthcare may effect where and how you get treatment. Talking to your HIV clinic social worker might be the best way to prepare. With that said, here are some tips to keep in mind…

If you have health insurance:

  • If Medicare is your primary coverage and you have a Highmark policy, whether a Medicare HMO or Medicare Supplement, you still have access to all UPMC facilities after 1/1/2015. This also includes patients who have medical assistance coverage in addition to Medicare.
  • Currently, the only Highmark plans UPMC does not accept are Community Blue plans.
  • If UPMC refuses Highmark commercial plans beginning 1/1/2015, then patients need to keep this in mind during their employer’s open enrollment period.  Patients who do not have an insurance plan that is accepted by PACT can be referred to AGH Positive Health Clinic.
  • If medical assistance is your primary coverage, UPMC PACT accepts UPMC for You and Gateway Health Plan.   UPMC does not accept the following medical assistance plans:  Coventry Cares, or United Health Care Community Plan for Families.

If you are uninsured:

  • PACT is currently awaiting word from the SPBP program regarding when and how they will begin assisting clients with health insurance premium and/or co-pay assistance. Pennsylvania’s SPBP program is one of only nine states that doesn’t already have a program like this in place.
  • PACT is also awaiting word regarding Governor Corbett’s Healthy PA plan for uninsured individuals with income under $16,105. The Corbet plan is not yet in place so details are unknown for the moment.
  • Open enrollment for health insurance in 2015 through the ACA Marketplace begins November 15, 2014. PACT social workers are available to help and/or answer questions.
  • The Ryan White Program has informed grantees that grant funds cannot be used to pay tax penalties for those who have not signed up for coverage. PACT continues to see patients if they are uninsured.

If you are a PACT patient, and have questions, you can email Pat McGlone at While this information is specific to patients at PACT, all people living with HIV should be speaking with a social worker or case manager about impending health insurance changes.