Category Archives: Research

Neurological manifestations of HIV

Dr Faktorovich, Department of Neurology, Icahn School of Medicine, Mt Sinai, New York, NY

From Neurologytimes.com

Human immunodeficiency virus (HIV) is responsible for a wide spectrum of neurological manifestations, with etiologies ranging from inflammatory, infectious, neoplastic. and more. The development of antiretroviral therapy (ART) has dramatically increased life expectancy, however neurological complications remain a significant cause of long-term disability. Understanding and recognizing these conditions is crucial in effectively managing HIV.

Dr Svetlana Faktorovich, Department of Neurology, Icahn School of Medicine, explains the various forms of neurological manifestations of HIV in this Neurologytimes.com article.

Why STDs are on the rise in America

From the Economist online

Much of the increase in STDs has come from gay and bisexual men. Although a relatively small share of the population, they accounted for 81% of male syphilis cases in 2016, according to the Centres for Disease Control. As with heterosexuals, this seems to be because sex is now seen as less risky. That is due to the advent of PrEP, a prophylactic drug cocktail which gay men can take to nearly inoculate themselves from HIV. The reduced chances of catching HIV—along with the fact that a positive diagnosis is no longer a death sentence—seems to encourage men to drop their guard. A recent study of gay and bisexual men, published in the Lancet, a medical journal, found that as more began taking PrEP, rates of consistent condom usage dropped from 46% to 31%. Recent studies have shown that uptake of PrEP is strongly associated with increased rates of STD infection.

All this shows that changing sexual mores, and a reduced fear of the risks of unprotected sex, seem to be at fault—especially since the problem is not just limited to America. England experienced a 20% increase in syphilis diagnoses in 2017 and a 22% increase in those of gonorrhoea. Other countries in western Europe have seen ever worse outbreaks, sometimes exceeding 50%. Dwindling public spending on STD prevention—which in America has fallen by 40% in real terms since 2003—is not helping matters. Yet the chief methods of prevention, abstinence and condoms, are tried and true. Should these options seem too chaste or chaffing, then prospective partners ought to get an STD test (especially since most infections can be cleared up with a simple course of antibiotics). Verified testing is vital since verbal assurances, especially on the cusp of a liaison, can be misleading.

Read the full article.

New report from UN warns we have ‘miles to go’ in fight against HIV

From ABC News

Rates of HIV infection are on the rise in 50 countries with more than 1.8 million people becoming infected in 2017, a far cry from goals established for the near future, according to a new United Nations report.

The report, entitled “Miles to Go,” published earlier this week by the Joint United Nations Program on HIV/AIDS, says the pace of progress in saving lives and preventing new infections is “not matching the global ambition” of cutting the infection rate to 500,000 a year by 2020.

While the death rate from AIDS-related illnesses — 940,000 in 2017 — is the lowest this century, it is still nearly double the goal of reducing AIDS-related deaths to 500,000 or fewer by 2020, according to the report.

”New HIV infections are not falling fast enough,” Michel Sidibé, UNAIDS Executive Director, wrote in the report. “HIV prevention services are not being provided on an adequate scale and with sufficient intensity and are not reaching the people who need them the most.”

Read the full article and see the video here.

High numbers of HIV-positive MSM not being tested for syphilis

From healio.com

Nearly one-third of sexually active HIV-positive men who have sex with men are not tested for syphilis at least annually, researchers reported in a recent study, calling the finding “concerning.”

Alex de Voux, PhDan Epidemiologist in the CDC’s Division of STD Prevention, and colleagues sought to examine the proportion of sexually active HIV-positive men who have sex with men (MSM) currently in care who were tested for syphilis in the past 3, 6 and 12 months by their HIV care provider.

A 2017 study showed that MSM accounted for more than 60% of syphilis cases nationwide in 2015. In that study, researchers determined that the rate of primary and secondary syphilis in the United States among MSM was 106 times that of men who have sex with women only.

In the current study, the authors noted that guidelines recommend that sexually active MSM, including HIV-positive MSM, be tested at least annually for syphilis, with testing every 3 to 6 months for MSM at elevated risk, and used this timeline to evaluate the group.

De Voux and colleagues used the most recent medical record and interview data collected by the Medical Monitoring Project, a population-based HIV surveillance system, from 2013 to 2014. The data showed that 71% of all sexually active HIV-positive MSM had at least one test for syphilis in the past 12 months. In the past 6 months, only 43% had been tested, and the number dropped to 22% in the past 3 months.

Researchers also examined the frequency of testing in MSM who reported risk factors, including having condomless sex and having sex with two or more partners.

Read the full article.

To find free syphilis testing near you, search by zip code on the CDC testing Website: gettested.cdc.gov

For more information about syphilis, its symptoms and treatment, click here.

By 2030, top cancers among people with HIV expected to be prostate and lung

From POZ Magazine online

By 2030, the most common cancers among people with HIV are projected to be prostate and lung cancer.

Publishing their findings in the Annals of Internal Medicine, researchers analyzed data from the National Cancer Institute’s HIV/AIDS Cancer Match study, modeling cancer diagnosis rates during 2000 to 2012 to make projections about how rates will change from 2013 to 2030.

The U.S. HIV population is steadily aging, thanks to effective antiretroviral treatment. In 2006, an estimated 27 percent of the population was age 50 or older, a proportion that increased to 45 percent in 2014. Between 2010 and 2030, the proportion of the population age 65 and older is expected to increase from 8.5 percent to 21.4 percent, while the proportion that is age 45 to 64 is expected to increase from 39.4 percent to 47.7 percent.

Between 2000 and 2012, the 463,300 HIV-positive adults in the HIV/AIDS Cancer Match Study were diagnosed with 23,907 cancers. During this period, the annual diagnosis rates (known as incidence) declined for Kaposi sarcoma (KS), non–Hodgkin lymphoma (NHL), cervical cancer, anal cancer (among men who have sex with men), lung cancer, Hodgkin lymphoma and other cancers among all age types. Colon cancer incidence decreased among those age 65 and older. Meanwhile, prostate cancer incidence increased among men ages 35 to 64.

Overall, cancer incidence among the U.S. HIV population is expected to decline through the next decade.

Among three AIDS-defining cancers, the estimated numbers of diagnoses seen in the U.S. HIV population in 2010 and projected to occur in 2020 and 2030, respectively, according to the study authors’ analysis were: 8,150, 7,490 and 6,690 diagnoses of NHL; 1,490, 750 and 450 diagnoses of KS; and 120, 50 and 30 diagnoses of cervical cancer.

As for non-AIDS-defining cancers, the respective numbers of diagnoses seen in 2010 and projected to occur in 2020 and 2030 were: 5,420, 6,150 and 5,980 diagnoses of lung cancer; 830, 910 and 1,030 diagnoses of prostate cancer; 750, 1,340, 1,590 diagnoses of anal cancer; 360, 460 and 480 diagnoses of liver cancer; 300, 200 and 120 diagnoses of Hodgkin lymphoma; 250, 320 and 340 diagnoses of oral cavity/pharyngeal cancer; 220, 260 and 260 diagnoses of breast cancer; 220, 230 and 200 diagnoses of colon cancer; and 1,910, 1,880 and 1,510 diagnoses of other types of cancers.

The study authors concluded that their findings stress the importance of expanding access to HIV treatment and cancer prevention, screening and treatment.

To read a press release about the study, click here.

To read the study abstract, click here.

HIV damages the Brain, but treatment halts progression

From Poz Magazine

Not long after an individual contracts HIV, the virus penetrates the brain and begins to cause progressive damage to the volume of the organ as well as cortical thickness. Antiretroviral (ARV) treatment apparently halts this progression and is able to dial back some of the damage.

Publishing their findings in Clinical Infectious Diseases, researchers studied 65 people who entered the study soon after they contracted HIV, in a period known as primary HIV infection. These participants, 30 of whom started ARV treatment during the study, received multiple MRIs of their brains over time.

The researchers compared the brain scans of the participants with scans of 16 people with long-term, or chronic, HIV infection as well as 19 HIV-negative individuals.

The study authors found that before participants began ARV treatment, a longer time spent with untreated HIV was associated with loss in volume in various parts of the brain, including the thalamus, caudate and cerebellum. More time living with untreated HIV was also linked with cortical thinning in the frontal and temporal lobes and the cingulate cortex.

After individuals started ARVs, the progression of such brain damage stopped, and there were some small increases in cortical thickness measures.

“We knew HIV could cause neurological damage, but we did not know it happened so early in the infection,” Serena Spudich, MD, MA, a professor of neurology at Yale and a co–senior author of the paper, said in a press release. “The findings emphasize the importance of identifying infected people early and treating them so we can halt its progression.”

To read a press release about the study, click here.

To read the study abstract, click here.

HIV-infected people are living for years, but age-related diseases set in early

From the Washington Post

David Hardy has been treating HIV-infected patients since the early 1980s, when the epidemic began. In those days, people newly diagnosed with AIDS lived for only about six months. Hardy, an infectious-disease specialist and internist, was ecstatic when powerful new drug combinations came into widespread use in 1996, enabling HIV-infected people to measure their lives in decades rather than months. But in recent years, his euphoria has turned bittersweet.

“Most people assume that the medicines have worked and that everything has gone back to normal, and that’s not really true,” says Hardy, who directs research for Whitman-Walker Health in Washington and who still sees patients weekly. “While we have suppressed HIV very well, we’ve now discovered that the medicines only treat part of the problem.”

Many HIV-infected people, now in their 50s and 60s, who have lived for years with HIV under control, are developing aging-related conditions — heart, liver and kidney disease, certain cancers and frailty, for example — at a rate significantly higher than uninfected people of the same age. “These are things that people develop all the time as they get old, but they are occurring at an earlier age in HIV-positive people,” Hardy says.

Read the full article.