AIDSmeds - Top Stories : Undetectable Viral Load? Not Necessarily in Semen - by Tim Horn

AIDSmeds - Top Stories : Undetectable Viral Load? Not Necessarily in Semen - by Tim Horn

Undetectable Viral Load? Not Necessarily in Semen

by Tim Horn

Undetectable viral loads in blood is not a guarantee that HIV is also undetectable in semen, according to a new study involving 101 HIV-positive men who have sex with men (MSM) conducted in Boston and published online ahead of print by the journal AIDS. Of the 83 men with undetectable virus in blood samples, roughly a quarter of them—21 MSM in total—had semen with detectable HIV.

Though the study conducted by Joseph Politch, PhD, of Boston University School of Medicine and his colleagues didn’t look at whether those with low-but-detectable levels of HIV in their semen were necessarily more likely to transmit the virus than those with undetectable seminal viral loads, the authors nevertheless caution that a risk of ongoing HIV transmission potentially remains in the absence of barrier protection during sexual activity. “Until more information on transmission risk in MSM is available,” they write, “it would be prudent to advise sexually active HIV-infected MSM to use condoms and other risk-reduction strategies throughout all stages of HIV disease regardless of HIV treatment status.”

Politch and his colleagues note that antiretroviral therapy is undoubtedly associated with a reduced risk of HIV transmission during sexual activity. In prefacing their own data, the authors reiterate the results of HPTN 052, which demonstrated that ARV therapy led to a 96 percent reduction in HIV transmission risk among HIV-discordant heterosexual couples, along with a study among MSM conducted over a decade ago concluding that HIV treatment decreases the transmission risk by roughly 60 percent.

Yet, according to the authors, “MSM have experienced a resurgent HIV epidemic in the [ARV treatment] era. Many HIV-infected MSM continue to engage in unsafe sex, and sexually transmitted infections (STIs) or other factors may promote genital HIV shedding and transmission in this population despite [ARV therapy].”

Though the “resurgent HIV epidemic” is undoubtedly multifactorial—roughly 20 percent of those living with HIV, including many MSM, are not aware they are infected and have thus not received personalized care and counseling—Politch’s group set out to explore an important factor associated with HIV transmission: the prevalence of seminal HIV shedding among HIV-positive MSM receiving ARV therapy, and how it relates to a number of clinical, behavioral and biological variables.

The study recruited HIV-positive participants from Fenway Health, a clinic catering to the health care needs of the lesbian, gay, bisexual and transgender community in Boston. Paired blood and semen samples were collected from the 101 study volunteers. Clinical and behavioral data were obtained from medical records and questionnaires. Evidence of genital herpes and genital inflammation were also assessed using laboratory tests.

The men were predominately white (74 percent), and virtually all (97 percent) identified themselves as MSM. The average age of the study volunteers was 43. Eighty percent had been on ARV therapy for more than a year; all had been on HIV treatment for at least three months.

Twenty-seven percent reported only engaging in protected sexual intercourse within the three months before study enrollment and were thus classified as low risk for acquiring a sexually transmitted infection (STI). Seventy-three percent were classified as high risk for having an STI, based on self reports of unprotected sexual intercourse in the past three months.

Nine men, all belonging to the high-risk group, tested positive for an STI within seven days before their official start in the study. Sixty-three percent of the men were positive for genital herpes, or herpes simplex virus-2, HSV-2, antibodies.

Eighteen of the 101 MSMs enrolled in the study had detectable HIV in their blood samples. The average viral load among these men was 560, but it ranged from 80 to more than 600,000. Nine (50 percent) of the men with detectable blood-based viral loads also had detectable HIV levels in their semen.

Eighty-three of the 101 MSM had undetectable levels of HIV in their blood samples. Though most also had undetectable HIV in their semen samples, 21 (25 percent) had detectable seminal viral loads.

Politch and his team note, however, that HIV levels—free-floating HIV-RNA and both HIV-RNA and HIV-DNA in cells—were significantly higher among those with detectable blood-based viral loads, compared with those with undetectable blood-based viral loads. For example, whereas the average free-floating viral load was 4,438 copies among those with detectable blood-based HIV levels, it was 51 copies among those with undetectable blood-based HIV levels.

Still, the authors explained, the prevalence of HIV shedding among those with undetectable blood-based viral loads documented in this study proved higher than has been reported in other studies. “This is likely due to the high prevalence of STIs and genital inflammation in our sexually active MSM cohort.”

Indeed, among the three factors associated with having detectable seminal viral loads among those with undetectable blood-based levels, having an STI was associated with a 29-fold increase in the risk, compared with those who didn’t have an STI. Being positive for HSV-2 was not associated with have a detectable seminal viral load.

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Dance For Life Sparks Reflections on His First Anniversary

This week marks the one-year anniversary of my infection with HIV. I have given some thought and prayer on how I should mark this anniversary.  

Should I even celebrate the anniversary?

Should I not think the marking of it as a celebration at all – especially since it includes feelings of sadness, loss, anger, but then there are also feelings of much gratitude and hope…?

Should I celebrate alone or with others?

Saturday night I attended the 20th Anniversary Performance of Chicago's “Dance for Life” event. It was a beautiful and powerful performance by committed artists and dancers who believe in and support our fight to end AIDS. As the celebration began, the CEO of the AIDS Foundation of Chicago announced that it was not only the 20th anniversary of the “Dance for Life”, but also the 6-month anniversary of his becoming the CEO and more importantly the 17th year of being infected and living with the virus. People applauded wildly after he announced the 20th year for the event; but it came obvious that many did not know how to respond to the announcement of the anniversary of his infection 17 years ago. A few in the large audience applauded but many remained silent with most of them, I am sure, pondering how to respond to such an announcement – the anniversary of someone’s infection with HIV/AIDS.

How should I mark MY one-year anniversary and should I identify it as a celebration? Should I mark it alone or with others, at least with one or two who know and offer me much support in my life with HIV? As I lay awake on my bed at 4am Sunday morning, those questions entered the deeper part of my heart, mind and spirit.

I certainly experience much, much gratitude for the medication and medical attention I have been able to receive over the past year. I take daily medication that is keeping my viral load undetectable and CD4 count at a very normal and healthy level. It is very expensive medication and medical treatment, yet my work health insurance plan makes it possible. I am also especially grateful that our health insurance companies in this country can no longer deny me coverage for having a “pre-existing” illness in case I were to switch employment.

The gratitude, however, is mixed with much sorrow, sadness and often anger since there are so many of my fellow life travelers living with HIV/AIDS who do not have this access to medication and healthcare. In our country, which is the wealthiest in the world, many go without medications or easy access to care, and in the world many are still dying of a disease that is no longer fatal if one is provided with medications and medical attention.

My anger especially flares up when I hear so many people, mostly out of ignorance and close-mindedness, oppose expanding health insurance for infected individuals living with the virus (and all others who need it) through our recently adopted health care reform. I am glad “Obama cares” enough for us and millions others in our country who need to know they will now be able see a doctor and get needed medications, especially when they are in pain or worried about their health.

I have always tried to take good care of my body through a healthy diet, sufficient exercise and adequate sleep. During the past year this approach to taking care of my body took special significance. The medications and treatment cannot on their own keep me healthy as my body fights the virus on a daily basis. And so this week I am also grateful for the opportunities I have to keep my body fit and healthy. I have access to a gym, nutritious food, and a decent and safe house where I can rest and take care of myself. I have them because I have a good job that allows me such opportunities.

But again anger flares up in my heart and gut when I consider the many who do not have these opportunities today, especially a home or a job that allows them to take care of themselves and their chronic illnesses. As the rich keep getting richer in our nation and the poor and middle class lose more and more income on a yearly basis, homes and jobs seem to become much less available to many among us.

Finally, should I celebrate the experience that I nowadays have of having somewhat befriended the virus that lives within my body? I wish with all my heart it did not live there or in the bodies of any human being in this world. Yet it is there. And until researchers find the cure for HIV/AIDS, it will continue to be an intimate part of my body and life. I am reminded of that every day as I take my $50-a-day pill to keep the virus undetectable in my blood stream.

In a year’s time I have learned how to accept that I am HIV positive and to see opportunities for growth as a person, especially in hospitality and compassion. 

I have worked for a number of years in the field that fights against AIDS and supports those living with the virus. But nowadays I have much more solidarity in heart and mind with them. I am one of them and with them today.

I have always tried to practice hospitality and compassion because of my spiritual faith. When persons are hospitable, they “makes room” in their lives for others. And there are so many ways to do so with persons living with the virus: by sharing our resources for the fight against AIDS like so many did last night at the 2011 Dance for Life event; or supporting directly infected individuals and families with much personal care and love; or not judging or stigmatizing them out of ignorance; or by working actively and politically for the resources and opportunities sick people need to remain healthy. I have always tried to practice hospitality in my life; but now that the virus lives within me, I am all the more committed to “making room” in my life for those who travel through this life with the virus in their bodies.

I learned a long time ago that truly compassionate persons are those that know how to suffer with others. The very word compassion comes from the Latin words to “suffer” (passus) and “with” (cum).

My spiritual faith has allowed and supported me to suffer with others in my life over the years. But now that the virus lives within me, I can accompany those infected by HIV/AIDS in a much stronger and closer way. I have and I am dealing with the fear, the anxiety, and the worries that this virus could one day compromise my immune system that keeps us humans alive and healthy. But I also share much more closely the hope and the dreams with other persons living with HIV/AIDS. Nowadays we may be able to live until an old age and enjoy life to its fullest. After the one year, I am all the more compassionate since I can suffer and hope much more closely with my fellow HIV positive life travelers.

Maybe one day before I die, the virus will leave my body through some type of cure. But until it does, I am learning to live with it. It is an unwelcomed friend. But it is a friend since it is making me a more hospitable and compassionate person in this life.

I guess I can celebrate the one year anniversary of my infection.

 
-- Thoughts from a Chicagoan living with HIV


[pics by ed negron. check out the rest on the lifelube facebook page]

Debt deal could jeopardize HIV/AIDS funds

via Washington Blade, By Chris Johnson

The resolution of the debt ceiling negotiations between the White House and congressional leaders has HIV/AIDS advocates concerned that federal funds for prevention and drug initiatives could be on the chopping block as a result of the agreement.

The agreement — which enables President Obama to raise the debt ceiling by $2.1 trillion and eliminates the need for another increase until 2013 — also requires a total of nearly $2.5 trillion in spending cuts to reduce the federal deficit, which could affect federally funded HIV/AIDS programs.

Carl Schmid, deputy executive director of the AIDS Institute, said any cuts to federal spending as a result of the deal will likely “impact HIV programs in a negative way.”

“There will be less money to go around and it will be more competition over that smaller amount of funding,” Schmid said. “And there can be direct cuts to our programs particularly if they are taken across the board. Not going in the right direction if we are going to end AIDS let alone prevent new infections and provide care and treatment to people with HIV/AIDS.”

All federal funding of discretionary HIV/AIDS programs could see an impact as a result of the decision, Schmid said, including the Centers for Disease Control & Prevention, the Ryan White HIV/AIDS Program and AIDS research programs. Additionally, Schmid said AIDS Drug Assistance Programs could be cut and already lengthy wait lists to receive medication through this program could be extended.

“It’s going to be harder and harder to make the case for our programs, but, hopefully, Congress will be receptive to our voices and concerns about the importance of preventing HIV in our country and to provide care and treatment for people who are HIV positive,” Schmid said.


Read more. 

Study Finds Early Initiation of ARVs Reduces HIV Transmission. What Does This Mean for Youth?

via Half the World


The findings of HPTN 052, that “men and women infected with HIV reduced the risk of transmitting the virus to their sexual partners by 96 percent through early initiation of oral antiretroviral therapy”, give the HIV prevention community a new and potentially highly effective tool in its efforts to reduce the spread of HIV.

Simply put, starting antiretroviral therapy (ART) before it’s required for one’s own health can substantially decrease the risk that a person living with HIV will pass the virus on to his or her sexual partners—a discovery that could be an incredible boon for young people, the group that has the most new HIV infections per capita. (Every day, some 2,500 young people acquire HIV, and young people accounted for 41% of new infections in those over 15 in 2009.)

However, there are two clear prerequisites to realizing the promise of this approach for youth, and neither one of them is all that likely to be met.

First and foremost, in order to start ART, a young person has to know his or her status—most young people infected with HIV don’t. (After all, if a young person can’t admit that she’s sexually active, she certainly doesn’t want to go seeking evidence, in the form of a positive HIV test, that this is the case.)

Second, it’s often an older person who infects a younger one—especially older men having sex with young women—so young people knowing their status isn’t enough.

Read more.