LATEST NEWS REGARDING HIV/AIDS

Top Stories on TheBodyPRO.com: November 21, 2017

TheBodyPro.com
Top Stories on TheBodyPRO.com: November 21, 2017
Top 10 HIV Clinical Developments of 2017

These major stories changed the way we think about HIV patient care and treatment in 2017. David A. Wohl, M.D., walks us through what happened — and why it matters.

TheBodyPRO.com on Twitter
For even more of the latest HIV updates and news stories, or to share comments and questions, follow us @BodyPROHIV.

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In Their Words: Burdens of HIV Nursing Include Lack of Respect and Resources

At the 2017 Association of Nurses in AIDS Care (ANAC) conference, nurses gathered in Dallas to talk about juggling the medical complexities of HIV infection, managing their patients’ additional comorbid conditions, and providing emotional support.

Read More →

This Week in HIV Research: Repeat Diagnoses Reveal Gaps in Care

Sobering data regarding linkage to HIV care among women in the U.S.; Latinx HIV incidence inequalities; efficacy of hepatitis C treatment among people with HIV; and a call for frequent STI testing among at-risk people with HIV.

Read More →

In a Large HIV Group, Only 36% of Those Needing Statins Received Statins

The majority of HIV-positive people with a statin indication by current guidelines are not receiving a statin, according to an analysis at a St. Louis HIV clinic.

Read More →


D/C/F/TAF Noninferior to Continued Protease Inhibitor at Week 48 of Phase 3 Trial

No Transmissions From Breastfeeding in Tanzania Cohort From Mothers With Undetectable Viral Load

Eliminating Viral Hepatitis Is Possible: Four Lessons From the World Hepatitis Summit
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NAM AIDSMAP UPDATE NOVEMBER 22, 2017

22 November 2017

You may have an undetectable viral load, but your partner may still need PrEP or PEP

New HIV infections among the HIV-negative gay men in the PARTNER study, due to sex with partners outside the main relationship, was high, a recent conference heard.

PARTNER made headlines by demonstrating that there were no transmissions from an HIV-positive partner who was on antiretroviral therapy and virally suppressed in almost 60,000 acts of condomless sex. These data allowed the researchers to establish the maximum possible likelihood of transmission, and to announce that, most likely, the chance of an HIV-positive partner with a fully suppressed viral load of below 200 copies/ml passing on HIV was zero. PARTNER provides crucial evidence for the U=U (Undetectable = Untransmittable) campaign.

However, there were HIV infections in PARTNER: eleven of them by 2016, ten in gay men. In all cases, however, phylogenetic testing showed that the infecting virus came from someone other than the primary partner.

Each year, 2% of HIV-negative gay male partners acquired HIV. Looking only at those men who reported having condomless anal sex with non-primary partners, each year 7% acquired HIV.

In short, men whose main partner is undetectable are not safe from HIV if they are also having condomless sex with other people. In this situation, it would make sense for the HIV-negative man to use post-exposure prophylaxis (PEP) or pre-exposure prophylaxis (PrEP).

But very few of those taking part in the PARTNER study did so, resulting in these high levels of infection.

To find out more, read NAM’s factsheets on PrEP, PEP and viral load.

HPV and anal cancer

HPV (human papillomavirus) is a sexually transmitted virus that causes genital warts, and in some forms, leads to the development of cervical, anal, mouth and throat cancers. Anal cancer, rare in the general population, is becoming more common in people living with HIV, especially men who have sex with men.

The European AIDS Clinical Society has strengthened its advice on vaccination against HPV. All people living with HIV under the age of 26 and all gay men living with HIV under the age of 40 should be vaccinated, it says. These recommendations are in line with the guidance of the British HIV Association (BHIVA).

The reason why these guidelines include upper age limits is that the older you are, the more likely it is that you have already been exposed to several types of HPV, making the vaccine less effective. The younger you are, the more likely you are to benefit from vaccination.

Recently, Dutch clinicians reported on their experience of screening gay men living with HIV for pre-cancerous anal lesions. This is not the same as anal cancer, but having these pre-cancerous cell changes is associated with a small risk of developing cancer in the future. The lesions might go away on their own, but in case they don’t, many doctors would recommend treatment.

Of just under 1700 men who were screened, they found that 30% had high-grade lesions. Given this high rate, the clinicians believe that screening all gay men living with HIV would be a good idea.

Nonetheless, screening for pre-cancerous anal cell changes in people who don’t have symptoms is not currently recommended in guidelines. This is because we don’t yet know whether the available treatments are good enough to make screening worthwhile in people who haven’t got symptoms. The treatments can be uncomfortable, have side-effects and don’t always stop high-grade lesions from recurring. It could be worrying to find out that you have pre-cancerous lesions, but if you didn’t know you had them, it’s possible that they would go away on their own or cause you no harm.

On the other hand, some experts believe that finding and treating high-grade lesions promptly will prevent cases of anal cancer that would be much harder to treat later on, so they think it is worth getting tested regularly.

These doctors also point to high rates of anal cancer in gay men living with HIV, for example a recent analysis from Austria – in men under 50 years, 8 in 1000 had ever had anal cancer; in men over 50 years, 26 in 1000 had ever had it. As the risk of cancer increases the older we get and more people with HIV are going to live longer in future years, these rates could increase further as time goes on.

For more information, read NAM’s factsheet ‘Anal cancer and HIV’.

Does U=U apply to breastfeeding?

Taking effective HIV treatment and having an undetectable viral load massively reduces the risk of onward transmission during breastfeeding, but it does not appear that the risk is zero, a leading paediatrician from St Mary’s Hospital, London said last week. Dr Hermione Lyall said that she often needed to advise women who were doing well on HIV treatment, with an undetectable viral load, who wished to breastfeed.

Studies from African countries suggest that for women with HIV taking treatment (not necessarily undetectable), around 1 to 2 in 100 may pass on HIV to their baby. More reassuringly, a recent Tanzanian study found that among 177 mothers, there were no transmissions from mothers with undetectable viral loads. This suggests that there is a very low risk of breastfeeding transmission when viral load is suppressed, but these are not enough data to say that the statement “undetectable = untransmittable” (U=U) applies to breastfeeding as well as to sexual transmission.

Dr Lyall says that women with HIV should be advised that formula feeding has a zero risk of HIV transmission and is the safest thing to do. Nonetheless, some women will choose to breastfeed and healthcare professionals should support them to do so as safely as possible.

Mothers should be advised that having an undetectable viral load, taking all their doses of their treatment and limiting the duration of breastfeeding will help lower the risk of passing HIV on. They should attend monthly check-ups with their clinical teams.

Dr Lyall also presented three key safety points that women should remember while they breastfeed:

  • No virus: Only breastfeed if your HIV is undetectable.
  • Happy tums: Only breastfeed if both you and your baby are free from tummy problems.
  • Healthy breasts for mums: Only breastfeed if your breasts and nipples are healthy with no signs of injury or infection.

For more information, read ‘After your baby is born’ in NAM’s booklet ‘HIV & women’.

Healthcare workers living with HIV

Nurses and other healthcare workers who are living with HIV have mixed reactions when they mention their HIV status to colleagues, according to a small Dutch study. Some healthcare workers disclosed because they were confident they would have a positive reaction or because concealment was stressful. Very often, those disclosed to saw the participant’s HIV status as a non-issue, as one interviewee explained:

“In the beginning, it was talked about and thought about a lot but that was, at a given moment, gone and nobody gave it anymore thought.”

Other interviewees concealed because they did not believe that disclosure was relevant or necessary. Some people did not discuss their HIV status because they expected negative reactions or stigma, often because they had previously experienced this themselves or had seen it occur in relation to other people.

“I’m not going to tell them anymore because I’m, yeah, I’m scared of how my colleagues will react. And where does this come from? It comes from, for example, the fact that whenever a patient is admitted and he has HIV, then they immediately say, ‘You need to be careful, eh? He has HIV so be extra careful’.”

The researchers say that it’s important to emphasise that disclosure is a choice. Before disclosing at work, people should think carefully about their motivations for disclosure and the potential reactions they might have. The authors comment that while disclosure can be a good idea if it results in social support or less stress, it may sometimes be better to conceal at work, especially when the risks are great and social support is available elsewhere.

For more information, read ‘Deciding whether to tell people that you have HIV’ in NAM’s booklet ‘HIV, stigma & discrimination’.

Heart disease and kidney disease

Cardiovascular disease (angina, heart failure, stroke, blocked arteries etc) goes hand in hand with chronic kidney disease, according to an analysis of over 27,000 people living with HIV.

People who were assessed as being at high risk of cardiovascular disease were also more likely to go on to have kidney disease. Similarly, being at high risk of kidney disease increased people’s risk of having cardiovascular disease. Rates of subsequent disease were especially high in people who had been assessed as being at risk of both.

The researchers say that doctors should assess the risk of these conditions together. They should also focus on encouraging people with HIV to make lifestyle changes which lower the risk of both conditions – eat a healthy, balanced diet; exercise regularly; lose weight if you’re overweight; don’t smoke; and limit your intake of drugs and alcohol.

To find out more, read NAM’s factsheets ‘The heart’ and ‘Chronic kidney disease and HIV’.

Editors’ picks from other sources

Avon and Somerset police branded ‘disgusting’ for HIV ‘misinformation’ over spit hoods

from Bristol Post

People living with HIV say Avon and Somerset police are “disgusting” for suggesting the immunodeficiency virus can be contracted through spitting. One HIV-positive man, who has asked not to be named, claims the language used around the police’s announcement that its officers would be allowed to put ‘spit hoods’ over the heads of people who have been arrested only furthered “misconceptions and lies” about HIV.

12 gay men living with HIV explain what it means to be undetectable

from HuffPost

A British LGBTQ advocacy group is hoping to clarify some misconceptions about what it means to be HIV undetectable in a quirky new video. The Undetectables, released earlier this month, features testimony from 12 gay men who are living with HIV.

This is what it’s like to be one of the men infected by HIV in Britain’s first case of deliberate transmission

from Buzzfeed

Despite the nature of Daryll Rowe’s crimes, and the multiple tabloid headlines surrounding this case screaming about an already highly stigmatised condition, this is not really a story about HIV. The virus was merely Rowe’s weapon of choice. This is a story about abuse.

Prince Harry hands out HIV self-testing kits to end stigma

from PEOPLE.com

The royal visited the Terrence Higgins Trust (THT) HIV testing center in Hackney, north London, on Wednesday last week to launch this year’s National HIV Testing Week. During his visit he watched a live demonstration and met some the shop’s volunteers.

A reduction in new HIV diagnoses is no reason to reduce effort

from The King’s Fund

The drop in new diagnoses among gay and bisexual men must be seen as an indicator of the reductions that are possible, rather than meaning that the job is done or that a downwards trajectory in new diagnoses will continue in the future. Importantly, so far these reductions have only been seen in one population group.

The S word

from Alex Sparrowhawk (blog)

Misuse of the term ‘stigma’ continues to control the behaviours of people living with HIV. It is all too common to blame this monster in the dark, a beast lurking on the streets than it is to blame our own family and friends, the people we love for their fear or ignorance. And we also need to stop telling people living with HIV that they will be stigmatised.Y

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Top Stories on TheBodyPRO.com: November 21, 2017

TheBodyPro.com
Top Stories on TheBodyPRO.com: November 21, 2017
Top 10 HIV Clinical Developments of 2017

These major stories changed the way we think about HIV patient care and treatment in 2017. David A. Wohl, M.D., walks us through what happened — and why it matters.

TheBodyPRO.com on Twitter
For even more of the latest HIV updates and news stories, or to share comments and questions, follow us @BodyPROHIV.

Advertisement
In Their Words: Burdens of HIV Nursing Include Lack of Respect and Resources

At the 2017 Association of Nurses in AIDS Care (ANAC) conference, nurses gathered in Dallas to talk about juggling the medical complexities of HIV infection, managing their patients’ additional comorbid conditions, and providing emotional support.

Read More →

This Week in HIV Research: Repeat Diagnoses Reveal Gaps in Care

Sobering data regarding linkage to HIV care among women in the U.S.; Latinx HIV incidence inequalities; efficacy of hepatitis C treatment among people with HIV; and a call for frequent STI testing among at-risk people with HIV.

Read More →

In a Large HIV Group, Only 36% of Those Needing Statins Received Statins

The majority of HIV-positive people with a statin indication by current guidelines are not receiving a statin, according to an analysis at a St. Louis HIV clinic.

Read More →


D/C/F/TAF Noninferior to Continued Protease Inhibitor at Week 48 of Phase 3 Trial

No Transmissions From Breastfeeding in Tanzania Cohort From Mothers With Undetectable Viral Load

Eliminating Viral Hepatitis Is Possible: Four Lessons From the World Hepatitis Summit

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News from EACS 2017 NOV. 2017

News from EACS 2017

How a London clinic reduced new HIV infections by 90% and why more European cities can do the same

Scaling up HIV testing to reduce undiagnosed HIV infection requires a fundamental re-ordering of HIV testing services to make them more attractive to people at risk, and doing so can bring about enormous changes in HIV incidence and treatment uptake, delegates heard on the opening day of the 16th European AIDS Conference (EACS 2017) in Milan.

Read more >>

Up to a quarter of HIV-negative gay men attending three English clinics used PrEP in the last year

A prospective cohort study of gay men attending three clinics in southern England – 56 Dean Street and Mortimer Market Centre in London and the Brighton & Hove SHAC (Sexual Health & Contraception) service – have found that 23% of HIV-negative service users who responded to a follow-up questionnaire had used PrEP (pre-exposure prophylaxis) in the last year.

Read more >>

HIV diagnoses in English gay men have been falling since 2014

A new analysis by Public Health England of testing rates and HIV diagnoses from all of England’s sexual health clinics shows that the decline in diagnoses is England-wide, started at least a year before the decline was first noticed at London’s 56 Dean Street clinic, and is not restricted to gay men who test frequently.

Read more >>

High HIV incidence from non-primary partners and low PEP and PrEP use seen in PARTNER study

HIV incidence among the HIV-negative gay men in the PARTNER 1 and 2 studies, due to sex with partners outside the main relationship, was high, and very high in partners who admitted having condomless anal sex with non-primary partners, the conference heard.

Read more >>

European AIDS Clinical Society strengthens HPV vaccination advice

The European AIDS Clinical Society (EACS) has recommended HPV (human papillomavirus) vaccination for everyone living with HIV aged under 26 and men who have sex with men up to the age of 40.

Read more >>

Swiss study examines which years gay men decided to stop consistent condom use

An innovative study presented at the conference used a machine-learning algorithm (originally developed to help astronomers classify galaxies) to tease out whether there were specific groups of gay men within a large national cohort whose sexual risk behaviours followed similar trajectories over time, and if so, whether they were influenced by external factors such as new scientific data.

Read more >>

Survey of dating app users finds that PrEP usage has not increased in Europe in the last year

A study of men who have sex with men (MSM) conducted by the European Centre for Disease Prevention and Control (ECDC) in collaboration with the gay contact site Hornet has found that pre-exposure prophylaxis (PrEP) usage has not increased, on average, among its respondents over the proportion reported last year, when a similar survey was carried out.

Read more >>

Hepatitis C test-and-treat programme reduces HCV by two-thirds among men who have sex with men in Swiss HIV Cohort

A systematic policy of test-and-treat cured 99% of men who have sex with men with hepatitis C in the Swiss HIV Cohort in an 8-month period and reduced the prevalence of hepatitis C by almost two-thirds, Dominique Braun of the University Hospital, Zurich, reported at the conference.

Read more >>

High rate of hepatitis C reinfection in German men who have sex with men

Around one in seven gay and bisexual men cured of hepatitis C at major treatment centres in Germany has become reinfected since 2014, according to findings from the German Hepatitis C Cohort presented at the conference.

Read more >>

Symtuza as effective as multi-pill combination in previously untreated people with HIV

The single-pill combination of darunavir, cobicistat, tenofovir alafenamide and emtricitabine (Symtuza) is just as effective as a multi-pill combination of darunavir, cobicistat, emtricitabine and the older formulation of tenofovir (tenofovir disoproxil) in previously untreated people with HIV, Professor Chloe Orkin of the Royal London Hospital reported at the conference.

Read more >>

Fostemsavir controls viral load in half of people with highly drug-resistant HIV

Fostemsavir, a new experimental attachment inhibitor, suppressed viral load in over half of participants with extensive drug resistance when added to a background regimen selected by resistance testing, Max Lataillade of ViiV Healthcare reported at the conference.

Read more >>

Hepatitis C halved in Spanish people living with HIV in one year due to treatment

Spain is making dramatic progress towards eliminating hepatitis C in people living with HIV because of widespread use of direct-acting antivirals, Juan Berenguer of Hospital Gregorio Marañón, Madrid, reported at the conference.

Read more >>

People with HIV still expect a lower quality of life than their negative peers, European survey finds

A study commissioned by the drug company Gilead Sciences and conducted in five European countries has found that, compared with their HIV-negative peers, people with HIV still expect to die sooner and think they are less likely to achieve a long-term relationship.

Read more >>

New EACS treatment guidelines

Everyone with HIV and hepatitis C virus (HCV) co-infection should receive direct-acting antiviral treatment for hepatitis C and should receive the same treatment for hepatitis C as people with hepatitis C monoinfection, new European guidelines issued at the conference recommend.

Read more >>

ABX464 reduces HIV reservoir but doesn’t delay viral rebound

ABX464, a new drug that stimulates the clearance of HIV from infected cells, reduces the reservoir of HIV DNA in the body but does not delay the rebound in viral load when antiretroviral treatment is interrupted, Linos Vandekerckhove of the University of Ghent reported at the conference.

Read more >>

Boosted protease inhibitor and lamivudine provides effective maintenance treatment

HIV maintenance treatment with two drugs, a boosted protease inhibitor and lamivudine, is just as effective as three-drug treatment with a boosted protease inhibitor in people who already have fully suppressed viral load, a meta-analysis of clinical trials presented at the conference shows.

Read more >>

News from The Liver Meeting 2017

Curing hepatitis C with DAAs linked to 71% reduction in liver cancer

People who achieved a sustained response to hepatitis C treatment lowered their risk of hepatocellular carcinoma by around 70%, regardless of whether they were treated with new direct-acting antivirals (DAAs) or older interferon-based therapy, according to study results presented at The Liver Meeting 2017, the annual conference organised by the American Association for the Study of Liver Diseases (AASLD), in Washington, DC.

Read more >>

Daily aspirin therapy linked to lower liver cancer risk

People with hepatitis B virus who took an aspirin a day – often recommended to help prevent cardiovascular disease – had a lower risk of developing liver cancer, according to a study from Taiwan presented at the conference.

Read more >>

Hepatitis C testing linked to reduced opioid use among people who inject drugs

Getting tested for hepatitis C virus was associated with reduced drug use, especially among those who tested positive, but even people who tested negative saw some reduction, according to study results presented at the conference.

Read more >>

Maviret cures most people with HCV genotype 3 and those with cirrhosis

Glecaprevir and pibrentasvir, the two drugs in the recently approved Maviret co-formulation, demonstrated high sustained response rates for people with chronic hepatitis C virus (HCV) genotype 3 and for people with liver cirrhosis, according to a pair of reports presented at the conference.

Read more >>

HCV infection is rising among HIV-positive gay men in San Diego

Hepatitis C incidence is increasing among gay and bisexual men living with HIV in San Diego, according to the largest analysis of its kind done in the United States. Study results were presented at the conference.

Read more >>

Other aidsmap news

Healthcare workers living with HIV have different motivations for disclosing or concealing their HIV status

Nurses and other healthcare workers who are living with HIV have mixed reactions when they mention their HIV status to colleagues, according to a small Dutch study reported in the November/December issue of the Journal of the Association of Nurses in AIDS Care. Some healthcare workers disclosed because they expected a positive reaction or they felt the need to share a secret. Others concealed their HIV status because they feared a negative reaction or did not believe that disclosure was relevant or necessary.

Read more >>

People with HIV more likely to adhere to their antiretroviral therapy than treatment for other chronic health problems

Ageing HIV-positive people have significantly higher levels of adherence to their antiretroviral therapy than to medication taken for other chronic health problems, Swiss investigators report in HIV Medicine. The research also revealed that people living with HIV rated the necessity of their HIV treatment more highly than therapy for other illness and also had lower levels of concern about their antiretroviral treatment compared to therapy for co-morbid conditions.

Read more >>

Starting ART immediately after HIV diagnosis cuts mortality risk by two-thirds for people with high CD4 cell counts

People with a high CD4 cell count who start antiretroviral therapy (ART) immediately after diagnosis with HIV cut their 12-month mortality risk by two-thirds, according to research conducted in China and published in Clinical Infectious Diseases.

Read more >>

Global progress towards hepatitis C elimination still blocked by cost of treatment, lack of diagnosis

Nine countries – Australia, Brazil, Egypt, Georgia, Germany, Iceland, Japan, the Netherlands and Qatar – are on course to eliminate hepatitis C by 2030, according to data released at the World Hepatitis Summit in São Paulo, Brazil.

Read more >>

UK elimination of hepatitis C in jeopardy unless more patients found

Just one in three people with hepatitis C in the United Kingdom has been diagnosed according to the latest estimates released at this year’s World Hepatitis Summit in São Paulo, Brazil.

Read more >>

Editors’ picks from other sources

Vital microbicides may soon be out of reach

from Rewire

Whether, when, and how microbicide development proceeds depends on the US government, and the federal Division of AIDS has suggested this development may no longer be a priority. It’s wrong.

US: Trump policy harming Kenya, Uganda health services

from Human Rights Watch Health

Early effects of United States restrictions to global health aid include cuts to essential health services in Kenya and Uganda, Human Rights Watch said in a letter to US Secretary of State Rex Tillerson that was released in October. The changes have resulted in a loss of training and equipment from nongovernmental groups for government health clinics, and widespread confusion about implementation. Human Rights Watch sent its findings in advance of a six-month review by the State Department of these funding restrictions.

Canada: Debate over drug consumption sites might be coming to end

from CBC

In the space of two years, the number of supervised consumption sites approved to operate in Canada has gone from one to 22. “Whereas it took many, many years of advocacy and civil disobedience to establish a supervised injecting site in Vancouver, it’s become a lot less politicized, a lot less controversial and I think there are no really sane actors who are sitting around questioning whether there is a role for these initiatives anymore,” says Dr Thomas Kerr, a researcher at the University of British Columbia.

U=U taking off in 2017

from The Lancet HIV

U=U is a simple but hugely important campaign based on a solid foundation of scientific evidence. The clarity of the message will make it easier to promote the undeniable benefits of treatment.

GSK and Gilead go head to head as HIV drugs enter new phase

from Reuters

Gilead Sciences and GlaxoSmithKline (GSK) are heading for an HIV showdown, pushing rival treatment visions and competing products that are expected to hit the market in the next few months. Gilead is likely to secure the bigger near-term win, as it builds on a 20-year-old strategy of combining three drugs to control the virus, while GSK is placing a longer bet that its core drug is potent enough to work with just one other.

MSF secures deals for key hepatitis C medicines, price a fraction of branded drug

from Intellectual Property Watch

Médecins Sans Frontières (MSF, Doctors Without Borders) has announced that it has secured deals for two key generic hepatitis C medicines, sofosbuvir and daclatasvir, for as low as US$1.40 per day, or US$120 per 12-week treatment course.

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In HIV News: Keeping PWHIV in Care; Nurses’ Pivotal Moments; Advice on Entering the HIV Workforce; and More

TheBodyPro.com
Top Stories on TheBodyPRO.com: November 14, 2017
How Can We Keep People With HIV in Care? New Research Offers Insights

Two recent studies looked at patient and provider issues that impact retention in care, and offered new insights that might help end disparities in the HIV care continuum.

TheBodyPRO.com on Twitter
For even more of the latest HIV updates and news stories, or to share comments and questions, follow us @BodyPROHIV.

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“Caring at Its Essence”: HIV Nurses Recall Pivotal Moments With Patients

At the 2017 Association of Nurses in AIDS Care (ANAC) conference, HIV nurses shared their memory of a moment in which their unique perspective made a big difference in the care of a particular patient.

Read More →

Starting in the HIV Field? Here’s Advice From People Who’ve Been There

What’s the best way to begin working in HIV without feeling lost or alone? We asked several community leaders to give advice to people who are newly entering the field.

Read More →

This Week in HIV Research: Quality of Life Is About More Than Viral Suppression

This week, we get an important reminder that an HIV-positive person’s sense of wellbeing doesn’t start and end with an undetectable viral load.

Read More →


Low Dietary Calcium Tied to Low BMD With HCV but Not HIV

New HIV Rate Similar Above and Below Age 45 in 86,836-Person U.S. Study

HIV Remission: The Quest to Turn Lessons From Exceptional Cases Into Solutions

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NAM AIDSMAP UPDATE NOVE 8TH 2017

Wednesday 8 November 2017

Contents

HIV diagnoses fall sharply in England: why?

Noel Gill presenting at EACS 2017. Image credit: @caryjameslondon

HIV testing behaviour and treatment uptake are changing rapidly among men who have sex with men in some European countries, leading to new opportunities to reduce HIV incidence, the 16th European AIDS Conference (EACS 2017) heard last month in Milan.

Changes are occurring as a result of greater promotion of HIV testing, greater use of new technologies for HIV testing such as self-sampling, earlier treatment and a more widespread awareness that undetectable viral load makes a person uninfectious.

One of the earliest documented shifts has taken place in England, where surveillance has shown a dramatic reduction in HIV infections in men who have sex with men since 2014.

Dr Noel Gill of Public Health England told the conference that HIV diagnoses have fallen by 65% in London and by 48% outside London from their peak in 2014.

Dr Gill said the three most important factors contributing to the observed decline were:

  • A 50% increase in STI clinic attendance in gay men since 2011
  • An increase in the frequency of gay men’s HIV testing, with the average now 2.5 tests a year
  • 90% of those diagnosed with HIV start treatment within a year of diagnosis.

He said that a new 90-90 target could drive down the number of new infections even further, if 90% of people diagnosed with HIV started treatment within 90 days of diagnosis.

The conference also heard about how London’s busiest sexual health clinic has transformed its services in recent years to greatly increase HIV testing capacity and encourage a culture of regular sexual health screening.

A shift away from consistent condom use in Swiss men who have sex with men appears to correlate with the emergence of new information about HIV transmission risk, undetectable viral load and the effectiveness of pre-exposure prophylaxis (PrEP).

Switzerland was the first country to translate scientific evidence about the impact of undetectable viral load on sexual transmission risk into advice for doctors and people with HIV. Swiss experts said in January 2008 that HIV could not be passed on during sex by people with undetectable viral load who have no sexually transmitted infections.

A study of condom use in men who have sex with men in the Swiss HIV Cohort shows changes in condom use after 2008, with further changes after the first results of the PARTNER study and the PROUD and Ipergay studies became known.

Just because a partner has undetectable viral load, it doesn’t rule out the need for PrEP or PEP

HIV incidence among the HIV-negative gay men in the PARTNER 1 and 2 studies, due to sex with partners outside the main relationship, was high, and very high in partners who reported having condomless anal sex with non-primary partners, the conference heard.

PARTNER made headlines when in 2014, and again in 2016, the researchers confirmed that there had been no transmissions from an HIV-positive partner who was on antiretroviral therapy and virally suppressed in, by 2016, an estimated 58,213 condomless sex acts. These data allowed the researchers to establish the maximum possible likelihood of transmission, and to announce that, most likely, the chance of an HIV-positive partner with a fully suppressed viral load of below 200 copies/ml passing on HIV was zero, or statistically indistinguishable from it.

PARTNER, and other studies like Opposites Attract and HPTN 052, have provided the evidence base for the success of ‘Treatment as prevention’ and for the U=U (Undetectable = Untransmittable) campaign.

However, there were HIV infections in PARTNER: eleven of them by 2016, ten in gay men. In all cases, however, phylogenetic testing showed that the infecting virus came from someone other than the primary partner.

Levels of post-exposure prophylaxis (PEP) and pre-exposure prophylaxis (PrEP) use in HIV-negative study participants were very low despite the fact that around one-third reported condomless anal intercourse with someone other than their main partner.

Presenting the results, Valentina Cambiano of University College London commented that the low level of PEP and PrEP use and the high HIV incidence seen from sex outside the main relationship were of concern.

“PrEP eligibility discussions with HIV-negative MSM [men who have sex with men] should ensure that risks from all sexual contacts are taken into consideration, and routes to securing PrEP discussed,” she added.

HPV vaccination advice from EACS

The European AIDS Clinical Society (EACS) has recommended HPV (human papillomavirus) vaccination for everyone living with HIV aged under 26 and all men who have sex with men up to the age of 40.

HPV is a sexually transmitted virus that causes genital warts, and in some forms, leads to the development of cervical, anal and oropharyngeal cancers. Anal cancer, rare in the general population, is becoming more common in people living with HIV, especially men who have sex with men.

Deborah Konopnicki of St Pierre University Hospital, Brussels presented a review of the evidence supporting vaccination against HPV in people living with HIV at the conference.

Screening for HPV-related cancers is inconsistent and for anal cancer, the choice of screening technique is still a matter of debate, she said. As for oropharyngeal cancers caused by HPV, whether to screen for these conditions is still unclear.

EACS considered several questions specific to HIV when developing its guidance:

  • Does vaccination provide protection in older people with HIV, who are more likely to have been exposed to HPV already?
  • Does vaccination provide any protection for people already exposed to HPV?
  • What vaccination schedule should be followed and which vaccine is preferred?

Only one study, the ACTG 5298 study, has looked at the effect of vaccination on protection against HPV infection in HIV-positive adults. That study found that in a predominantly male population with a median age of 47 years vaccination did not reduce persistent infection with HPV.

This finding led EACS to recommend that HPV vaccination should be offered to people with HIV aged 26 and under. EACS has also followed the British HIV Association in recommending vaccination for all men who have sex with men with HIV under the age of 40. Previous guidance issued in 2015 recommended that doctors should follow national guidance on HPV vaccination.

Although EACS states that the efficacy of the vaccine is questionable in people who have already been exposed to HPV, Deborah Konopnicki said it is still plausible that vaccination could improve protection against HPV-associated disease.

The ACTG A5240 study showed that in women already seropositive for any of the HPV types included in the quadrivalent vaccine, vaccination resulted in a substantial increase in HPV antibody titres (levels) (+1.5 log10 IU/ml).

There is also some evidence from studies in HIV-negative women and men who have sex with men that vaccination after the treatment of HPV-associated cervical or anal lesions is associated with reductions in recurrence of lesions. Two ongoing studies are likely to provide further information on vaccination’s role in the prevention of recurrence in people living with HIV.

Vaccination results in greater antibody responses in women living with HIV who already have undetectable HIV viral load at the time of the first vaccination, probably because viral suppression permits immune restoration.

EACS recommends the 9-valent HPV vaccine if available (active against nine common types of HPV). Dr Konopnicki noted that there is no evidence in people living with HIV to support anything less than a 3-dose vaccination schedule, although several studies in young women have shown that a single vaccination is just as immunogenic as multiple vaccinations.

Lack of increase in PrEP usage in Europe over the past year

Teymur Noori presenting at EACS 2017. Image credit: @caryjameslondon

A study of men who have sex with men conducted by the European Centre for Disease Prevention and Control (ECDC) in collaboration with the gay contact site Hornet has found that pre-exposure prophylaxis (PrEP) usage has not increased, on average, among its respondents since a survey last year.

The survey found that 10% of its respondents were currently taking PrEP, though this varied from hardly any in some countries to 17% in the case of Ukraine.

Participants were generally young; 75% were under 40 and 28% under 25. Approximately half were being prescribed PrEP by a doctor, the remainder were buying PrEP drugs online or obtaining them from friends or by requesting post-exposure prophylaxis (PEP).

Although PrEP was slowly being introduced in more countries, progress was slow, Teymur Noori of ECDC said. The cost of PrEP was overwhelmingly cited as the main barrier to adopting it, with two-thirds of 36 nations in the EU/EEA mentioning cost as a principal barrier. In the face of national health systems’ unwillingness to spend on PrEP, the survey provided evidence that men who have sex with men throughout the European region were attempting to access it in other ways.

Hepatitis C test-and-treat in Switzerland

A systematic policy of test-and-treat cured 99% of men who have sex with men with hepatitis C in the Swiss HIV Cohort in an 8-month period and reduced the prevalence of hepatitis C by almost two-thirds, Dominique Braun of the University Hospital, Zurich, reported at the conference.

Reducing onward transmission and prevalence of hepatitis C virus (HCV) requires a reduction in the number of people with chronic HCV infection and a reduction in risk behaviours. Chemsex – especially the use of drugs and sharing of injecting equipment during sex – and group sex are strongly implicated in the increase in hepatitis C in men who have sex with men.

The Swiss HIV Cohort has seen a 20-fold increase in the prevalence of HCV in men who have sex with men since 1996, with the greatest increase occurring since 2008, in common with other western European countries.

Swiss researchers designed an intervention study in which they sought to diagnose all men who have sex with men with HIV and HCV co-infection already in HIV care in Switzerland, treat all those with genotype 1 or 4 infection and prevent onward transmission and reinfection through behavioural intervention.

All men with genotype 1 or 4 infection were offered immediate treatment with a course of grazoprevir/elbasvir (Zepatier), with or without ribavirin, for varying durations of treatment depending on genotype, previous treatment history and baseline resistance profile.

Of the 177 people diagnosed with chronic HCV infection, 122 took part in the study (34 received treatment elsewhere, 11 had a genotype other than 1 or 4, 6 had contraindications for treatment and the remainder were either lost to follow-up or unwilling to take part in the study).

All participants except one were cured and no serious drug-related adverse events were reported.

Sixty-eight men recruited to the study reported condomless sex with non-regular partners. Of these men, 51 agreed to take part in a four-session behavioural intervention devised by Professor Dunja Nicca of Zurich University that accompanied the treatment phase of the study.

The first session focused on emotional responses to safe sex problems, the second on individualised solutions, the third on developing a personal risk reduction plan and the fourth session a reflection on the post-treatment achievement of hepatitis C cure and how to maintain it.

The overall completion rate of the behavioural intervention was 90%. No cases of reinfection have been identified to date.

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Top Stories on TheBodyPRO.com: November 7, 2017

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Top Stories on TheBodyPRO.com: November 7, 2017
Each One, Teach One: HIV Community Leaders Share Their Mentorship Stories

Mentorship is a key component helping us challenge stigma, live with HIV, and commit to a life of service. We asked some community leaders to tell us about their mentors and what they’ve gained from these relationships.

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This Week in HIV Research: Test-and-Treat Ain’t Just for HIV

Our four brief summaries this week include new data on hepatitis C coinfection treatment; a late-stage fixed-dose combination drug for HIV; HIV incidence among gay men in London; and HIV’s ability to hijack effector memory T-cells.

Read More →

Estimating the Total Size of the HIV Reservoir

Researchers estimated a total body burden of as many as seven million cells expressing HIV RNA at any given time in tissues, despite viral load suppression to undetectable levels in the blood.

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One on One With Sharon Lewin, Ph.D.

The noted HIV researcher talks to Positively Aware about recent advances, the search for a cure, and the long road ahead.

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Italian and U.S. Researchers Look to the Future and Explore Aging-Related Issues

Dolutegravir/Lamivudine Dual Therapy as Switch Option in Multiple Studies

New York City Finds Gaps in the HIV Cascade of Care Linked to Reduced Survival

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NAM AIDSMAP UPDATE NOV 8TH 2017

Hepatitis C and quality of life

A recent conference heard that Spain is making dramatic progress towards eliminating hepatitis C in people living with HIV because of widespread use of direct-acting antivirals – the proportion of people living with HIV who have chronic hepatitis C has fallen dramatically from 22% in 2015 to 12% in 2016. Treatment cures people of infection and stops the virus from being passed on.

And curing hepatitis C also results in significant improvements in people’s quality of life, a study of over 3000 people shows. Every six months, participants completed questionnaires to assess their health-related quality of life, answering questions about energy levels, pain, emotional wellbeing, mental health and whether their health had impacted their ability to do things. All participants had been cured of hepatitis C during clinical trials of treatment that included the drug sofosbuvir.

After starting treatment participants saw significant improvements in all aspects of health-related quality of life, especially scores for ‘vitality’ and ‘general health’. The greatest improvements were seen in people who had co-morbidities (such as depression or type 2 diabetes), sleep problems, tiredness or liver cirrhosis before starting treatment.

Scores began rising at the end of treatment and continued to increase after achieving a sustained virological response (cure) until they were around the normal levels for people in the general population. The improvements were maintained through three years of follow-up.

For more information, read NAM’s booklet ‘HIV and hepatitis’.

Adherence to treatment for other health conditions

People living with HIV who take medication for other health conditions are less likely to miss doses of their HIV treatment than the other medication, according to a small study. Thanks to effective HIV treatment, people living with HIV can expect to survive well into old age and often need treatment for other health problems such as cardiovascular disease and depression.

Swiss doctors ran a survey with patients who were taking treatments for other conditions. Of the 105 people who took part, the average age was 56, three-quarters were men and almost all had an undetectable viral load.

Whereas 87% said that they had not missed any doses of their HIV treatment in the past four weeks, only 75% said that they had been fully adherent to the other treatments they took.

This might be because people did not always think that their good health depended on the other medicines that they took, whereas they did think this about their HIV treatment. The necessity of antiretroviral therapy was rated much higher (4.5 out of 5) than treatment for other long-term health problems (2.9 out of 5).

And participants had more concerns about the other drugs they took (4.1 out of 5) than they had for HIV treatment (2.9 out of 5). The researchers say this might be because people are often given less information and support about their other conditions than they get for HIV.

Immediate HIV treatment lowers the risk of death

An analysis from China adds to the evidence of the benefits of HIV treatment.People who start HIV treatment early and do so very soon after being diagnosed with HIV have a lower risk of death in the year following HIV diagnosis than people who don’t take treatment.

The study followed over 35,000 people who were diagnosed with HIV between 2012 and 2014. All of those included in the study had a CD4 cell count of over 500, which means they were diagnosed in good time and had a well-preserved immune system.

Around 5% started HIV treatment within 30 days of being diagnosed, while 16% started treatment later, and 79% did not start HIV treatment.

Deaths were uncommon, and were not generally due to HIV-related disease. The most common cause of death was heart disease.

Whereas 2.4% of those who did not start HIV treatment died within a year of diagnosis, this was the case for 1.0% of those who took treatment immediately. This amounts to a 63% reduction in the risk of death.

This is likely to be due both to the direct benefits of HIV treatment for the immune system and because people taking treatment had regular medical appointments, allowing other health problems to be identified and treated.

News from the 16th European AIDS Conference (EACS 2017)

This recent conference included several interesting studies which are relevant to people living with HIV in the UK. As a subscriber to HIV update, you should receive our email conference bulletins automatically.

You can also read the bulletins online. They include analyses of how the 56 Dean Street clinic has reduced HIV diagnoses in gay men, a European study showing that many people with HIV still expect to die prematurely and a survey of pre-exposure prophylaxis (PrEP) use in Europe.

The conference heard about a new drug for people with highly drug-resistant HIV (fostemsavir) and HIV maintenance treatment with two drugs, a boosted protease inhibitor and lamivudine. There was a lot of news on hepatitis C, including the success of Spain and Switzerland in treating large numbers of people and preventing onward transmission.

Editors’ picks from other sources

U=U taking off in 2017

from The Lancet HIV

U=U is a simple but hugely important campaign based on a solid foundation of scientific evidence. The clarity of the message will make it easier to promote the undeniable benefits of treatment.

Uganda: ARVs stock-out sparks fear of mass drug resistance

from AllAfrica

Civil society organisations and people living with HIV have warned that almost a million Ugandans could develop resistance to first-line antiretroviral therapy if nothing is done about the nation-wide stock-out of drugs.

Top gay sexual health clinic forced to turn away four out of five people a day

from Gay Star News

Around 1500 people are trying to get just 300 appointments at the most popular sexual health clinic for gay and bisexual men in the UK, after other clinics closed. Now experts are warning the cuts could lead to sexual infections rising in the UK capital.

Why AIDS film BPM has so many love scenes – and so much dancing

from Poz

The film’s director and stars also discuss how ACT UP Paris differed from US activism and what young viewers find exciting about BPM.

This HIV survivor quit smoking to vape. Don’t judge.

from My Fabulous Disease

My years of smoking are much more likely to kill me than HIV. I suppose that’s progress, and testament to how far we have come in my 32 years living with the virus. So why am I so defensive about my switch to vaping?

Consent: the unspoken problem on the chemsex scene

from GMFA

“It’s hard because you totally blame yourself, you totally think that it’s your fault. You think that you shouldn’t have gone home with this guy, you shouldn’t have been in that club, you shouldn’t have taken something. It all seems valid in your own head but at the end of the day, it’s not your fault.”

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Top Stories on TheBodyPRO.com: October 24, 2017

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Top Stories on TheBodyPRO.com: October 24, 2017
Betty Price’s “Quarantine” Comment a Startling Example of Remaining HIV Stigma and Ignorance

“The stigma, fear and ignorance associated with HIV are still very strong; those of us who do this work on a daily basis might forget this sad fact,” Paul Sax, M.D., writes.

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Highlights From TheBodyPRO.com’s Coverage of IDWeek 2017:

Hepatitis C Drug Uptake and Efficacy Jump After Arrival of Newer Direct-Acting Drugs

According to a new Swiss study, uptake of anti-hepatitis C therapy by people coinfected with HIV rose dramatically with the advent of direct-acting antivirals (DAAs), especially second-generation DAAs.

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Ten-Year Mortality High With on-ART Viral Load of 400-999 Copies/mL

Researchers aimed to see whether they could define a clinically meaningful threshold of detectable viral load below 1,000 copies/mL with a single viral load measure at six months after initiation of antiretroviral therapy.

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Lung Cancer Screening Results Similar in HIV Group and General Population

Screening HIV-positive people for lung cancer with low-dose computed tomography (LDCT) yielded a positive-image rate similar to that in the general population, according to the results of a recent study.

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Anti-Inflammatory Antibody Canakinumab: Implications for Heart Disease, Cancer and HIV

Thank You, Paul Kawata: Reflections on USCA and Being a Gay Man of a Certain Age

U.S. Simulation Explores Intersection of PrEP and Some Sexually Transmitted Infections

 

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NAM AIDSMAP UPDATE OCT. 30, 2017

Monday 30 October 2017

Contents

Spain making good progress towards elimination of HCV in people with HIV

Juan Berenguer and Juan González from GeSIDA at EACS 2017. Image credit: @GeSIDA

Widespread use of direct-acting antivirals (DAAs) has achieved an almost 50% reduction in hepatitis C virus (HCV) prevalence among people with HIV in Spain, according to data presented to the 16th European AIDS Conference (EACS 2017), held last week in Milan, Italy.

The research involved 43 HIV treatment centres across Spain. The proportion of people with chronic HCV fell from 22% in late 2015 to 11.6% in late 2016. After taking into account people currently undergoing treatment, the real figure could be as low as 9%.

Since early 2016, DAA therapy has been available for all people with HCV in Spain with F2 fibrosis and above, and also for individuals at risk of transmitting HCV, regardless of fibrosis status.

The proportion of HIV-positive people in Spain who have co-infection with HCV has been falling since 2002. Part of this can be explained by a decline in people who were infected with HIV through injecting drug use: from 55% in 2002 to 30% in 2016.

But it’s clear that HCV treatment is also a major contributory factor. The proportion of people receiving treatment increased from 23% in 2002, to 59% in 2015 and to 74% in 2016.

The results of the analysis suggest that use of DAAs is helping Spain make excellent progress towards the elimination of HCV among people with HIV.

HCV care continuum across Europe

Sarah Amele presenting at EACS 2017. Image credit: @ProfJLundgren

A study conducted by EuroSIDA involving people with HIV and hepatitis C virus (HCV) co-infection in Western, Southern and Eastern Europe showed that people are being lost at each stage of the HCV care continuum. The findings were presented at the conference.

The research involved approximately 7000 people who tested positive for HCV antibodies before January 2015. A fifth of these people never had a confirmatory test for HCV RNA – an essential first step to determine the presence of active HCV infection.

Only 46% of people in Eastern Europe had an RNA test compared to 94% of people in Western Europe. People from migrant communities were less likely to receive an HCV RNA test but people who inject drugs were more likely to receive an HCV RNA test than the population as a whole.

A total of 5027 people had a positive RNA result and 57% of the entire study sample were RNA-positive as of January 2015.

Only 45% of these people underwent genotype testing. Less than half of all people with chronic HCV underwent a course of treatment, and only 9% received interferon-free DAA therapy.

Overall, substantial numbers of people were being lost at each stage of the HCV care continuum.

High rate of HCV reinfection among gay and bisexual men

About one in seven gay and bisexual men cured of hepatitis C virus (HCV) at major treatment centres in Germany has been reinfected with the virus since 2014, the conference heard.

All the reinfections occurred within 18 months of completing curative therapy.

The risk of reinfection was highest for men who shared drug-injecting equipment during sex – chemsex.

But injecting drug use only explained about a quarter of the cases of reinfection. There’s uncertainty about the exact roles of injecting drug use and unprotected sex and sexual activities such as fisting in the HCV epidemic among gay men. Research suggests that hepatitis C can be passed on during sex between men that involves contact with semen, rectal mucus or blood.

Previous research has shown that between 7 and 10% of gay men cured of HCV are rapidly reinfected with the virus.

Experimental treatment for extensively drug-resistant HIV does well in trial

Fostemsavir presentation by Max Lataillade at EACS 2017. Image credit: @chloe_orkin

Half of patients with extensive resistance to existing anti-HIV drugs achieved viral suppression when treated with fostemsavir, an experimental attachment inhibitor in combination with other antiretrovirals selected after resistance testing.

The study – designed to lead to the eventual approval of the drug – recruited people with very limited existing treatment options.

Participants were randomised to take fostemsavir or a placebo, which was taken with the pre-existing failing regimen for seven days. All participants then switched to fostemsavir plus a combination of drugs selected after resistance testing. A separate group of people with no fully active treatment options received open-label fostemsavir plus optimised therapy.

The main aim of the study was to measure changes in viral load during the first week of treatment. By day 8, people receiving fostemsavir had much bigger falls in viral load compared to those taking the placebo.

After six months of treatment with fostemsavir/optimised regimen, 54% of people had an undetectable viral load and a further 32% had a viral load above 40 copies/ml but were still taking the drug.

The most common side-effects were headache, vomiting, diarrhoea, tiredness and weakness, and 6% of people stopped therapy because of an adverse event.

The drug is expected to be approved in the US in early 2018.

Symtuza combination pill safe and effective in people starting HIV treatment

Chloe Orkin presenting at EACS 2017. Image credit: Francesc Martínez, gTt-VIH.org

The single-pill combination of darunavir, cobicistat, tenofovir alafenamide and emtricitabine (Symtuza) is as safe and effective as a pre-existing multi-drug single-pill therapy for people taking HIV therapy for the first time, the conference heard.

Symtuza is already approved for treating people with HIV.

The latest study compared Symtuza to a multi-pill combination of darunavir, cobicistat, emtricitabine and the older formulation of tenofovir (tenofovir disoproxil). All the participants were starting HIV therapy for the first time.

Individuals were equally randomised to take Symtuza or the control therapy.

After 48 weeks, 91% of people taking Symtuza had an undetectable viral load compared to 88% of those taking the comparison treatment.

The most common side-effects were diarrhoea, rash and nausea. People taking Symtuza were less likely to stop therapy than those taking the other regimen (2 vs 4%), though the adverse events rate was similar between the two study arms (5 vs 6%).

Symtuza had advantages in terms of kidney function and bone density. However, the therapy was associated with slightly higher cholesterol than the control treatment.

Quality of life survey shows that many people with HIV still pessimistic about their prospects

Image from the ‘HIV is: Expectations from Life’ website: http://campaigns.visit-gbu.eu/expectations-from-life

A Europe-wide study has shown that many people with HIV still expect to die prematurely and are also fearful of HIV-related stigma.

The study was commissioned by the drug company Gilead Sciences and was conducted in late 2016.

A total of 522 HIV-positive individuals were recruited and were matched with 2723 HIV-negative individuals in the general population.

The life expectancy of people doing well on HIV treatment is now excellent. Nevertheless, it’s clear that many people with HIV are still pessimistic about their prognosis. A third of people with HIV, compared to 10% of the controls, said they expected to die earlier than their friends, peers and older siblings.

People with HIV were also less likely than individuals in the general population to rate their health as excellent or good (44 vs 69%).

People with HIV were more likely than the controls to prioritise love and a healthy sex life over financial stability.

Over half of people with HIV thought that the virus was a potential barrier to meeting a partner, with disclosure widely cited as a reason. Just under a half (47%) of all people with HIV and 38% of those with an undetectable viral load feared transmitting the virus to others.

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