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.

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 HIV research findings from AIDS 2018 with NIH’s Dr. Carl Dieffenbach

From AIDS.gov

The first full day of sessions at the 22nd International AIDS Conference (AIDS 2018) in Amsterdam was filled with new scientific findings shared by researchers from around the world. In a Facebook Live interview with HIV.gov, Carl Dieffenbach, Ph.D., discussed highlights of three studies presented today at the conference, including:

  • an update on a potential association between the HIV treatment medication dolutegravir and birth defects;
  • additional research on the effectiveness of HIV treatment as prevention among gay male serodifferent couples; and
  • a study on whether there may be drug-drug interactions between PrEP and feminizing hormone therapy for transgender women.

Dr. Dieffenbach is the Director of the Division of AIDS at NIH’s National Institute of Allergy and Infectious Diseases (NIAID).

Watch 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.

The HIV Epidemic Among Black Americans Requires Action

From MD Magazine

A report on the state of HIV/AIDS in the African-American community highlighted an alarming health disparity gap—while Black Americans represent 12% of the population, they now account for close to 50% of the total reported HIV/AIDS cases in the US.

The paper, “HIV/AIDS and the African-American Community 2018: a Decade Call to Action,” was led by Cato T. Laurencin MD, PhD, Chief Executive Officer, Connecticut Institute for Clinical and Translational Science (CICATS), and director of the Institute for Regenerative Engineering.

Cato Laurencin MD, PhD

Laurencin and his co-authors call for a more assertive approach to the HIV/AIDS epidemic in the African-American community, noting that their call to action a decade ago has not successfully addressed the situation. In fact, some aspects have worsened: the number of African-American males diagnosed with HIV increased 29% from 2005 to 2016.

From 2005 to 2016, the number of cases of HIV/AIDS in Black women and female adolescents from heterosexual contact increased 75% from 2,392 to 4,189 and during the same time, there was a 76% increase in diagnoses of heterosexual Black men.

Read the full article.

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.

Social isolation is bad for your health

From thebody.com

No one living with HIV/AIDS is immune from the impact of isolation. Numerous studies find that social isolation is a problem among the aging population in general, and especially among the elderly living with HIV. Younger persons are also affected. One study found that younger people living with HIV/AIDS experience more disconnectedness from family and friends than their older peers do. Researchers believe this is due to a combination of factors, including stigma, feeling blamed by others for their illness and younger people not identifying with the need to battle a chronic illness. It should also be noted that persons affected by HIV/AIDS, especially those who went through the 1980s and 1990s, can experience the same symptoms of trauma and isolation as people who are HIV-positive.

Read the full article.

New Research Provides Clarity on Questions of HIV-Related Accelerated Aging

From AIDS United via thebody.com

It’s long been questioned if living with HIV, or using antiretroviral therapy (ART) to manage the virus, causes accelerated aging, but new research might finally be giving some answers. Journalist Marlene Cimons at the Washington Post spoke with several leading HIV/AIDS researchers who agree: starting treatment as soon as possible after diagnosis can help avoid the age-related diseases that have been seen developing at higher rates and at earlier ages in people living with HIV.

Age-related conditions — including heart, liver and kidney diseases, cancers, and bone fragility — have often been observed more frequently in people living with HIV. However, researchers have long rebuffed that it is more the traditional risk factors, such as lack of access to routine preventative care, poor nutrition, stress and substance use habits, that influences this increase as opposed to the presence of the virus itself or the medication used to treat it.

Researchers surveyed earlier this month by the Washington Post added a critical dimension to the current understanding of accelerated aging: the longer someone living with HIV goes without beginning antiretroviral therapy, the worse these long-term health outcomes are likely to be. HIV targets — and, at the same time, activates — the immune system, the body’s protection against pathogens. Once the immune system recognizes significant levels of the virus in the body, it never really stops fighting against it, even after levels are decreased using ART.

Read the full article.