Category Archives: Research

Implementing rapid ART initiation to successfully manage HIV

As countries across the globe continue the fight against HIV, treatments that are quickly initiated and effective are crucial for getting patients with HIV virally suppressed both to improve their clinical outcomes and to stop the transmission of infection.

Addressing both of these issues, Mary Montgomery, MD, associate physician in the Division of Infectious Diseases at Brigham and Women’s Hospital, and an instructor of medicine at Harvard Medical School, discussed emerging treatment strategies for managing HIV during a session at the National Association of Managed Care Physicians 2019 Fall Managed Care Forum, held October 10-11 in Las Vegas, Nevada.

More and more, clinicians are understanding the benefit of prescribing antiretroviral therapy (ART) to patients the day they are diagnosed with HIV, otherwise known as rapid ART initiation.

The literature has shown that rapid ART initiation is associated with a more favorable mortality profile, as well as quicker viral suppression. In one study,1 the median time to viral suppression was 56 days for those who initiated treatment at diagnosis, compared with 126 days for those who began treatment consistent with prior recommendations for universal ART and 219 days for those who received CD4-guided ART.

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FDA approves second PrEP medication

From HIV.gov

PrEP, or pre-exposure prophylaxis, is an HIV prevention method in which people who do not have HIV take medicine on a daily basis to reduce their risk of getting HIV if they are exposed to the virus. Descovy for PrEP should be used as part of a comprehensive strategy, including adherence to daily administration and safer sex practices, including condoms, to reduce the risk of sexually acquired infections.

The safety and efficacy of Descovy for PrEP were evaluated in a randomized, double-blind multinational trial in 5,387 HIV-negative men and transgender women who have sex with men and were at risk of HIV-1 infection. The trial compared once daily Descovy to Truvada (emtricitabine, tenofovir disoproxil fumarate, 200 mg/300 mg), a daily fixed dose combination of two drugs approved in 2012 to prevent the sexual acquisition of HIV; participants were followed for 48 to 96 weeks. The primary endpoint was the rate of HIV-1 infection in each group. The trial showed that Descovy was similar to Truvada in reducing the risk of acquiring HIV-1 infection.

Read the full article on HIV.gov.

New survey examines health, HIV and human rights of gay men worldwide

From qnotes

OAKLAND, Calif. — MPact Global Action for Gay Men’s Health and Rights has announced the launch of its fourth global survey on the health and human rights of gay men, bisexual men and other men who have sex with men.

The 2019 Global Men’s Health and Rights Survey (GMHR 2019) focuses on factors that impact the health of gay and bisexual men around the world including discrimination, access to services, and the criminalization of homosexuality. The survey also addresses issues of mental health, freedom of gender identity and expression, and social connection and wellbeing which have all shown to be indicators of broader sexual health.

“We are very excited to launch the GMHR 2019 and to continue to collect information that allows us to advocate for the needs of community members,” said Sonya Arreola, Senior Research Advisor at MPact. “It is critical that we are amplifying the voices of those most marginalized in the global response to sexual health and human rights. We anticipate that this survey will provide insight into the lived realities of key populations locally and globally, including gay and bisexual men, transgender people, people living with HIV, sex workers, and people who use drugs.”

Last launched in 2014, the previous iterations of the GMHR survey yielded more than 10,000 responses from around the world, revealing vital information about the state of homophobia, human rights and access to health services worldwide. As in the past, this year’s survey is designed to support knowledge generation, policy development, program implementation, and advocacy linked to the issues that matter most to community members at the local and global level.

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University of Pittsburgh: Scarcity of LGBTQ youth health research

From HealthNewsDigest.com

There is a dearth of scientifically investigated, evidence-based interventions to address substance use, mental health conditions and violence victimization in sexual and gender minority youth, according to a research review led by the University of Pittsburgh Graduate School of Public Health, recently published in the journal Pediatrics.

After poring over thousands of research publications spanning nearly two decades, the scientists identified only nine studies that evaluated such interventions, and most of these used suboptimal study designs, thereby limiting the validity of the findings. None of the programs would be sufficient to mitigate the substantial inequities faced by lesbian, gay, bisexual, transgender and queer (LGBTQ) youth, the scientists concluded.

“While this knowledge gap is distressing, I think we can look at it as an opportunity,” said lead author Robert W.S. Coulter, Ph.D., M.P.H., assistant professor in Pitt Public Health’s Department of Behavioral and Community Health Sciences. “Promising programs are being created by community-based organizations that are ripe for rigorous evaluation by scientists to determine if they are successfully improving health among LGBTQ youth and, if so, whether they can be replicated in other communities.”

Compared with their heterosexual peers, sexual minority youth have up to 623% higher odds of substance use in their lifetimes; up to 317% higher odds of mental health conditions, such as suicidality and depression; and up to 280% higher odds of violence victimization, such as being bullied at school, or sexually or physically abused. Due to these health inequities, the federal government has designated LGBTQ youth as a priority population for research focused on preventing, reducing and treating these health issues.

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Use of HIV prevention pill rising among men who have sex with men

From Reuters Health

A growing proportion of American men who have sex with men know they can take a daily pill to avoid infection with HIV and more of them are using it, a U.S. study suggests.

HIV pre-exposure prophylaxis (PrEP) is highly protective against the virus that causes AIDS, but many people worldwide don’t get this pill because they aren’t aware of it, don’t think they need it, or because it’s unavailable or unaffordable. Efforts to raise awareness among one high-risk group – men who have sex with men – have been complicated because some of these men don’t identify as gay or bisexual and mistakenly think heterosexual people don’t need PrEP.

In 2014, the U.S. Centers for Disease Control and Prevention (CDC) launched an effort to get PrEP to all men who have sex with men who might benefit from the pill, not just gay and bisexual individuals. The current study looked at national health survey data to track changes in awareness and use of PrEP from 2014 to 2017 in 20 American cities.

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Connection to care is effective in achieving viral suppression in at-risk populations

NIH press release

Gay, bisexual and other men who have sex with men and transgender women with HIV, who are not in care, can be engaged in care when reached and connected with HIV treatment services, according to findings from a clinical trial supported by the National Institutes of Health. Nearly half of the study participants achieved and maintained viral suppression by one year, researchers reported today at the 10th IAS Conference on HIV Science (IAS 2019) in Mexico City.

Effective HIV treatment resulting in sustained viral suppression benefits the health of the person with HIV and also prevents sexual transmission of the virus to others. The clinical trial, called HPTN 078, assessed an HIV prevention strategy involving a peer-to-peer recruitment method to identify, recruit and link to HIV care men and transgender women with unsuppressed HIV in the United States. It also evaluated whether a case management intervention could help them achieve and maintain viral suppression.

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Quest for elusive HIV vaccine is poised for major test

From Bloomberg.com

Johnson & Johnson is preparing to test an experimental HIV vaccine in the U.S. and Europe in a move toward developing the first immunization against the deadly disease after decades of frustration.

Some 3,800 men who have sex with men will receive a regimen of shots in a study that’s planned to be launched later this year, Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases, said in an interview. The agency and the HIV Vaccine Trials Network of testing sites will collaborate with J&J’s Janssen unit on the effort.

Since cases first began to gain notice in the early 1980s, scientists have been searching fruitlessly for a vaccine against the virus that causes AIDS and kills close to 1 million people worldwide annually. Efforts are continuing with at least two other promising candidates in late-stage studies.