The Centers for Disease Control and Prevention (CDC) has recommended a new HIV testing protocol for laboratories that will take advantage of advances in testing technology and will better identify acute cases of the virus. The announcement was made to coincide with National HIV Testing Day on June 27.
New “fourth generation” HIV tests not only screen for antibodies to the virus in blood samples but also for what’s known as the HIV-1 p-24 antigen, which shows up in the body much sooner than antibodies. By recommending the fourth generation tests as the first step in the new testing protocol, the CDC will effectively reduce the “window period” during which false negatives are likely. The new tests will detect an infection by about three weeks following exposure to the virus; with the older HIV tests, the window period could be as long as three months. Correctly identifying acute cases of HIV is crucial for HIV prevention because viral loads are typically very high during that period of infection, making someone much more likely to pass on the virus.
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A clinical review published in the peer-reviewed journal LGBT Health in early June by Jaclyn M. White, M.P.H., Janna R. Gordon, and Matthew J. Mimiaga, Sc.D., M.P.H., from Harvard and the Fenway Institute in Massachusetts, indicates that there may be relief at hand for HIV-positive gay men struggling with added mental health and substance abuse issues that can add difficulty to sticking to an HIV medication regimen. White et al concluded that interventions that combine both adherence counseling with standard cognitive behavioral therapy have made some headway with participants in several recent intervention trials.
Mental health issues, as well as substance use, can lend comorbidity to HIV — that is, an additional condition that compounds the effect of a primary disease. These factors can make adherence to medication more difficult than normal, though this connection is not yet well established.
White et al pointed out that concentration problems and feelings of worthlessness and hopelessness behave as barriers to self-care behavior patterns that are required for optimal outcomes on antiretroviral therapy (ART). Optimal outcomes are measured by self-efficacy efforts; those who believe in their ability to manage their own condition are more likely to approach the 80%-plus adherence level required to thrive while living with HIV, according to White et al.
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NEW YORK (Reuters Health) – Many gay, bisexual and queer men who are good candidates for a drug that prevents HIV don’t believe their risk of being infected with the virus is high enough to warrant the drug’s use, suggests a new study. The poor perception of HIV risk suggests people need to be educated about how to lower the chance of being infected, according to the researchers, who do HIV testing and other research in commercial sex venues in New York City.
“Our testers and counselors were always amazed that a lot of these guys underestimated their risk for HIV – anecdotally,” said Dr. Demetre Daskalakis, the study’s senior author and medical director of ambulatory HIV services at Mount Sinai Hospital in New York City. “It seemed as if it would be an opportune time to ask the population where they were in accessing their own risk given that PrEP was recently approved,” he said. PrEP, which stands for pre-exposure prophylaxis, is a way for people who are at risk of HIV but not infected to prevent infection by taking a pill every day. The pill currently approved by the U.S. Food and Drug Administration for PrEP is Truvada, which is manufactured by Gilead.
The risk of contracting HIV is up to 92 percent lower among people who take PrEP consistently, compared to those who don’t take the medicine, according to the U.S. Centers for Disease Control and Prevention.
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American gay men who have chosen to take pre-exposure prophylaxis (PrEP) are aware of their own risk of being exposed to HIV and see PrEP as providing ‘an extra layer of protection’ on top of their efforts to use condoms, some or all of the time. The use of PrEP can help reduce anxiety and provide greater ‘peace of mind’, men reported in in-depth interviews.
The study also sheds light on the motivations of men who stopped taking PrEP or who chose not to take it at all. Most frequently this was because their sexual relationships or behaviour had changed, but concern about potential side-effects also deterred a number of men.
The findings were presented to the 9th International Conference on HIV Treatment and Prevention Adherence in Miami earlier this week. Hailey Gilmore and colleagues interviewed 87 American men who have sex with men who were enrolled in iPrEx OLE – a programme which offered men who had participated in a clinical trial of PrEP the possibility to take, or continue to take, PrEP after the randomised study had ended. Whereas the effectiveness of PrEP had previously been unknown, by this stage men had learnt that it could help prevent HIV infection.
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Truvada (emtricitabine/tenofovir) as pre-exposure prophylaxis (PrEP) against HIV takes an estimated seven days to reach full efficacy and may protect for nearly a week afterward, the National AIDS Treatment Advocacy Project (NATAP) reports. But those taking PrEP should not assume these are hard facts at this time. Presenting their findings at the 15th International Workshop on Clinical Pharmacology of HIV and Hepatitis Therapy in Washington, DC, researchers conducted an analysis of 11 men and 10 women who took daily Truvada as PrEP for 30 days and then, after stopping the drug, remained in an additional 30 days of follow-up.
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