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University of Pittsburgh Research Assistant and Technical Writer

Online intervention effective in the treatment of depressive symptoms in people with HIV

From aidsmap.com

An online self-help intervention is effective in the treatment of mild to moderate depressive symptoms in people with HIV, according to a randomized clinical trial conducted in the Netherlands and published in the September issue of The Lancet HIV.

The trial compared the outcomes in a group who received the online self-help intervention and a control group. The internet-based intervention, available in Dutch and English, consisted of a cognitive behavioral therapy program called “Living Positive with HIV” and developed from a self-help booklet that had previously proved effective in decreasing depressive symptoms. Participants also received minimal telephone coaching by a Masters student in psychology. The control group received the telephone coaching and could access the online intervention after the trial was completed.

Sanne van Leunen and colleagues randomly assigned 188 eligible participants to the intervention (97) or the control group (91) in 2015. Depression was assessed at baseline, Month 2, Month 5 and Month 8 (the control group did not take the last assessment).

As detailed below, results show that more participants in the intervention group than in the control group demonstrated significant change in their symptoms and that this effect was maintained for six months. Anxiety symptoms were also decreased. No adverse events were reported, the rate of satisfaction with the intervention was high, and most participants reported that they would recommend “Living Positive with HIV” to others.

Optimizing HIV care

A session at the 2018 ID Week Annual Meeting in San Francisco explored various strategies to optimize the delivery of care to those infected with HIV. Globally, almost 37 million people are living with HIV, with close to 2 million newly infected annually; about 22 million are treated using antiretroviral therapy.1

Antiretroviral therapy can be interrupted for various reasons; however, whether this practice is wise is a contentious issue, and a trial that would directly address this is ethically dubious. To approach the issue in an ethically palatable way, investigators from the University Hospital of Cologne, Germany, and the German Center for Infection Research, also in Cologne, conducted a systematic review and meta-analysis of the literature to try to provide some clarity as to the safety and tolerability of treatment interruption.

“The meta-analysis was done to examine current evidence about treatment interruption,” explained presenter Melanie Stecher, MSc during the session attended by MD Magazine®. “These data might help in strategies for safe treatment interruption and in designing future clinical trials aimed at curing HIV infection.”

The end of HIV transmission: A once-unthinkable dream becomes an openly discussed goal

From statnews.com

“We have the science to solve the AIDS epidemic,” Dr. Robert Redfield, the director of the CDC, himself a longtime HIV researcher and clinician, told STAT in a recent interview. “We’ve invested in it. Let’s put it into action.‘’

Other leaders in the HIV field have been musing about the idea, buoyed by the astonishing impact effective HIV medications have wrought, both on the lives of people infected with or at risk of contracting the virus, and on the trajectory of the epidemic.

“It’s certainly doable in the United States,” said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and a researcher whose study focused on HIV from the earliest days of the AIDS epidemic.

Fauci and other health experts are quick to point out that the goal of stopping transmission entirely is largely theoretical. There will always be some new cases, and the barriers to providing treatment to existing cases remain significant. There are still just under 40,000 people in the U.S. each year contracting HIV. As Fauci put it: “We live in a real world, we don’t live in a theoretical world.”

But “if we implement all the tools that we have and if we can theoretically, conceptually, get everybody who’s HIV infected on antiretroviral drug so that they will not transmit the infection to anyone else, theoretically you could end the epidemic tomorrow by doing that,” he added.

Read the full article.

NIH study: combination antibody treatment for HIV

From Medicalxpress.com

A clinical trial testing infusions of combination antibodies in people living with HIV has begun at the National Institutes of Health. The early-phase clinical trial will evaluate whether periodic infusions of two highly potent, HIV-specific, broadly neutralizing antibodies (bNAbs)—3BNC117 and 10-1074—are safe in people living with HIV. The study also will gather preliminary data on how effectively the bNAb infusions, delivered together every two to four weeks, suppress HIV following discontinuation of antiretroviral therapy (ART).

Read the full article.

New study finds 4% of HIV-negative gay/bi men using PrEP

From OUT Magazine online…

A mere 4% of gay and bisexual men reported using Truvada as PrEP in a new study, recently published in PLOS ONE.

Led by Psychology Professor Phillip Hammack of the University of California Santa Cruz, the study examined HIV testing and use, familiarity, and attitudes toward pre-exposure prophylaxis (PrEP) among HIV-negative gay and bisexual men in the United States.

Truvada is a daily pill that reduces the likelihood of acquiring HIV by almost 100%. Currently, it is the only FDA-approved form of pre-exposure prophylaxis, or PrEP, which is recommended by the Centers for Disease Control and Prevention (CDC) for those at high risk of HIV/AIDS.

“The extremely low rate of PrEP use, while not surprising given barriers to access in various parts of the country, is disappointing,” said Hammack.

The study used a national probability sample of 470 men ages 18-59. Participants completed the survey between March, 2016 and March, 2017.

Other key results of the study included:

— The majority of gay/bi men between the ages of 18-25 are not tested for HIV annually, as recommended by the CDC.

— 25% of young men in the same age group have never been tested for HIV.

— Approximately 8% of men over 25 had never been tested for HIV.

— Visiting an LGBT health clinic and searching online for LGBT resources were associated with greater likelihood of PrEP use.

— Bisexual and non-urban men were less familiar with PrEP compared to gay-identified and urban men.

— Attitudes were positive among most men (68.4%) who were familiar with PrEP, despite low usage of the drug.

“I worry especially about younger men who didn’t grow up with the concerns of HIV that men of older generations did,” said Hammack. “The low rate of HIV testing probably reflects a degree of complacency and cultural amnesia about AIDS.”

Principal investigator Ilan H. Meyer said of the study, “Our findings suggest that health education efforts are not adequately reaching sizable groups of men at risk for HIV infection. It is alarming that high-risk populations of men who are sexually active with same-sex partners are not being tested or taking advantage of treatment advances to prevent the spread of HIV.”

Health Alert: Rates of STDs climbed for the fourth consecutive year in the US

Rates of syphilis, gonorrhea and chlamydia have climbed for the fourth consecutive year in the United States, the Centers for Disease Control and Prevention (DCD) announced recently. Last year, nearly 2.3 million US cases of sexually transmitted diseases (STDs) were diagnosed, which is the highest number ever reported.

Chlamydia, which remained the most common, is easily transmitted during any form of sexual activity. If not treated, chlamydia can cause permanent damage to the reproductive system. In men, the infection can spread to the tube that carries sperm from the testicles, causing pain and fever.

If not treated, gonorrhea can cause severe and permanent health issues, including problems with the prostate and testicles in men or problems with pregnancy and infertility in women. Gonorrhea is also typically treated with antibiotics but the threat of antibiotic-resistant gonorrhea persists nationwide. 

Syphilis can affect the heart, nervous system and other organs if left untreated. Syphilis is most often transmitted through sexual contact and is 100 percent curable with antibiotics.

Gonorrhea and chlamydia can infect other sites of the body such as the rectum and the throat and diagnosis requires a swab of each site. A urine test alone is not sufficient to diagnose STDs of the throat and the rectum. Additionally, all of these infections can be transmitted through unprotected oral sex.

It is important to remember that even if you don’t have symptoms, you can still be infected. If you’re sexually active, you should get tested for a full range of STDs, including the ones listed here. Don’t be shy about asking your doctor for a full screening. If you need to find free, confidential testing in your area, you can check the PA Department of Health listing here.

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For more information about Health Alerts, go to the Pitt Men’s Study Website.

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

Today’s HIV meds are not linked to high blood pressure

From Poz Magazine online

The antiretrovirals (ARVs) in common usage today are not associated with an increased risk of high blood pressure, aidsmap reports.

Publishing their findings in HIV Medicine, researchers from the D:A:D study, a large, ongoing multi-cohort observational study of people with HIV, updated their 2005 paper in which they were unable to identify a clear link between ARVs and high blood pressure.

For this new analysis, the researchers analyzed data on 33,278 HIV-positive study participants who were in medical care for the virus in Europe, Australia and the United States between 1999 and 2013. They looked for a relationship between hypertension diagnoses and 18 ARVs as well as various other risk factors.

A high blood pressure diagnosis was defined as developing blood pressure of 140 over 90, receiving a blood pressure medication or both.

Three out of four of the participants were male, and 44 percent of the participants overall were men who likely contracted the virus through sex with another man. The median age upon entry into the study was 38 years old. About half of the study members were white and one in five had received an AIDS diagnosis. The median CD4 count was 429. Almost 40 percent had a fully suppressed viral load and 68 percent had received ARVs.

As for cardiovascular risk factors, 60 percent had a history of smoking, 16 percent had a body mass index (BMI) over 26 (between 25 and 29.5 indicates overweight), 18 percent had lipodystrophy (the irregular distribution of body fat associated with some of the earliest ARVs) 4 percent were on medication to lower their blood lipids and 2 percent had diabetes.

During a cumulative 223,000 years of follow-up, 7,636 members of the study (23 percent) developed high blood pressure, for a rate of 3.42 diagnoses per 100 cumulative years of follow-up.

When the researchers analyzed the data without adjusting for any non-ARV factors associated with high blood pressure, they found that all the HIV medications were linked to the condition except for Norvir (ritonavir)-boosted Prezista (darunavir) and Emtriva (emtricitabine).

Then the study authors adjusted for demographic risk factors for high blood pressure and found that the only ARVs still linked to the condition were Ziagen (abacavir), Viramune (nevirapine), Norvir and Norvir-boosted Crixivan (indinavir).

Finally, after the investigators adjusted the data to account for differences in metabolic risk factors, Ziagen and Norvir were no longer associated with high blood pressure. Each five years of exposure to Norvir-boosted Crixivan was associated with a 12 percent increase in the risk of high blood pressure, and Viramune was associated with an 8 percent increase per five years of exposure.

The most prominent risk factors for high blood pressure included being male, being older, being Black, engaging in injection drug use and having an AIDS diagnosis, diabetes, high blood lipids, lipodystrophy, obesity and impaired kidney function.

To read the aidsmap article, click here.

To read the study abstract, click here.