Wednesday, June 21, 2017

🏳️‍🌈✝️Are Mental Issues to Blame For a Decline in Daily Functions?


June 20 2017
 
 
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Despite that one in five HIV-positive people blame cognitive issues like memory loss, poor concentration, and reduced attention span for a decline in everyday functioning, researchers are now concluding these problems might not be the root cause.
 
In fact, researchers say it’s conditions such as depression, anxiety, or worries about being able to afford basic needs that tend to cause a decline in daily functions, and people living with HIV ought to assess for “these problems first before concluding that the underlying problem is a physical decline in cognitive function,” reports AIDS Map. 

Results from the study were reported in the Journal of Acquired Immune Deficiency Syndromes. While prior research shows that HIV-positive people have higher prevalence for cognitive impairment, for most cases it was so low that it had virtually no impact on daily functions. 

Studies have shown that 22 percent of people living with HIV will be diagnosed with major depression, while up to 64 percent might be dealing with Post Traumatic Stress Disorder. As a result of these kinds of mental issues, those living with such co-morbidities often don’t take their medication, which makes the depression even worse.

Researchers in the CIPHER study sought to figure out factors that caused a decline in most daily functions by giving standard tests (which involved 16 separate activities) to 448 participants between 2011 and 2013 — 89 percent were on antiretroviral therapy and 81 percent were undetectable. 

Overall, the most commonly reported daily difficulties had to do with social activities, work, housekeeping and reading or watching TV. The study showed an association of their decline to poorer speed/reaction time, attention span, and memory lapses, which of course are all measurements of cognitive impairments. However, other factors included, “difficulty affording basic needs, being unable to work or unemployed, depression, anxiety and being diagnosed with HIV for at least five years,” reports AIDS Map. 

“All our observed associations may have multiple explanations, and causality could be in either direction,” the authors wrote. “These results imply that patients who report symptoms of cognitive impairment, or declining everyday function, should be assessed for depression, anxiety, concomitant medical conditions and financial difficulties. Failure to recognize these important elements of patients’ lived experiences risks diagnostic delay, failure to address important needs, unnecessary investigations and further anxiety.”

Further studies are needed to decide whether improving one’s mood or anxiety can also improve cognitive tests. 

But given the fact that these causes are super complex, researchers concluded that doctors and physicians ought to be careful crediting cognitive issues to a decline in daily functions, but rather look at the symptoms of other causes — such as depression and anxiety — as a likely cause as well. 

Read more articles from PLUS, here.
  

Tuesday, June 20, 2017

🏳️‍🌈✝️ Gay Men Have Higher Meningitis Risk, Especially if They Have HIV


New York City, Los Angeles and Chicago have had clusters of the potentially fatal, vaccine-preventable meningococcal disease.
June 20, 2017


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Compared with the general population, men who have sex with men (MSM) are at higher risk of meningococcal disease, in particular if they have HIV, aidsmap reports.


The recent reported cases of this potentially fatal bacterial infection are small in number but serious enough to warrant a recommendation for MSM and HIV-positive people to get vaccinated.


Publishing their findings in Clinical Infectious Diseases, researchers analyzed data from the National Notifiable Disease Surveillance System on all reported cases of infection with Neisseria meningitidis among men 18 to 64 years from 2012 to 2015.


Out of 527 identified cases, 74 (14 percent) were among MSM. Sixty-three percent of the cases among MSM occurred in New York City, Los Angeles and Chicago. Of the 64 MSM about whom there were data on their HIV status, 38 (59 percent) were living with the virus.


These figures meant that the annual rate of meningococcal disease among MSM in the United States was an estimated 0.56 cases per 100,000 MSM, compared with 0.14 among the non-MSM male population. The study authors calculated that compared with non-MSM males, MSM are four times more likely and HIV-positive MSM are 10.1 times more likely to contract the infection.


To read the aidsmap article, click here.

To read the study abstract, click here.

Read more articles from POZ, here.

Monday, June 19, 2017

🏳️‍🌈✝️ Low Vitamin D Tied to Statin-Related Muscle Toxicity in People With HIV


June 16, 2017


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Lower levels of 25-hydroxyvitamin D (25OHD) independently predicted statin-related muscle toxicity in a retrospective study of 545 people with HIV infection. Older age and taking statins longer than 24 months independently predicted myalgia in this Italian cohort.
Statins remain the principal anti-lipid agent recommended for people with HIV infection, but as many as 13% of statin-treated patients endure muscle symptoms, including myalgia. Research links vitamin D deficiency to statin-related myalgia in the general population, and low vitamin D is common in people with and without HIV. Researchers in Italy conducted this retrospective cohort study to determine whether low 25OHD is associated with statin-related muscle toxicity in people with HIV infection.

The study involved antiretroviral-treated adults taking 10 mg of rosuvastatin or 20 mg of atorvastatin daily for at least 12 months between 2011 and 2015. They defined muscle toxicity as myalgia, creatine kinase (CK) elevation, or CK elevation and myalgia. The investigators used multivariate logistic regression to identify independent predictors of muscle toxicity.

The study group included 545 patients, 56% taking atorvastatin and 44% rosuvastatin. The group averaged 53.4 years in age, 81% were men, and 91% were white. Participants had taken antiretroviral therapy for an average 4.7 years, CD4 count averaged 549 cells/mm3, and 95% had a viral load below 50 copies/mL.

Muscle toxicity affected 18.3% of study participants, including myalgia in 7.7%, CK elevation in 6.1%, and CK elevation plus myalgia in 4.6%. Muscle toxicity was not significantly more prevalent with atorvastatin than with rosuvastatin (20.7% versus 15.3%, P = 0.082). Sixty-eight of the 100 participants with muscle toxicity stopped their statin for that reason. Rhabdomyolysis developed in no one.

Compared with mean baseline 25OHD levels in people without muscle toxicity (32.1 ng/mL), levels were significantly lower with myalgia (19.4 ng/mL, P = 0.017) or with myalgia and elevated CK (22.8 ng/mL, P = 0.024). Myalgia proved more prevalent in older patients (mean 58.6 versus 52.5 years, P = 0.041) and in patients who took their statin longer (mean 36.7 versus 27.2 months, P = 0.006). Compared with people who had no history of myalgia, those who did had a higher prevalence of statin-related myalgia (69% versus 11%, P = 0.022) or CK elevation and myalgia (44% versus 11%, P = 0.037).

Multivariate logistic regression identified baseline 25OHD below 30 ng/mL as an independent predictor of statin-related myalgia (P = 0.009) and CK elevation with myalgia (P = 0.046) but not CK elevation alone (P = 0.155). History of myalgia also independently predicted statin-related myalgia (P = 0.014) and CK elevation plus myalgia (P = 0.039). Age 60 or older predicted myalgia alone (P = 0.032), as did statin duration longer than 24 months (P = 0.025).

The researchers note that the vitamin D receptor is expressed on skeletal muscle, so muscle pain in statin-treated patients with low vitamin D "could reflect a reversible interaction between vitamin D deficiency and statins on skeletal muscle." If that hypothesis is true, vitamin D2 supplementation could improve or resolve statin-related myalgia. The authors recommend measuring vitamin D in antiretroviral-treated patients with myalgia during statin therapy.

Mark Mascolini writes about HIV infection.


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🏳️‍🌈✝️ Stable Housing Improves Viral Suppression and CD4 Counts




June 16, 2017


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This week, a study finds that stable housing can impact CD4 counts and viral load suppression rates in people living with HIV. Another study finds that treatment initiation is often delayed because of assistance program eligibility and provider inexperience. And a study links interleukin-8 levels to viral load in semen. Finally, a nanoparticle version of lopinavir shows good pharmacokinetics in a rat study. To beat HIV, you have to follow the science!
 


Supportive Housing Improves Viral Suppression Rates and CD4 Counts


After entering a supportive housing program for formerly homeless people with HIV, the percentage of participants who had undetectable viral loads increased from 66% to 79%, a statistically significant improvement (P < .05), according to data from the Shelter Plus Care program in Cincinnati, Ohio. The results were published in AIDS Care.
 
Researchers analyzed data on 86 program participants. At the start of the study, 28% of participants had a healthy CD4 count (greater than 500). That percentage increased to 45% at the end of the study, which was also statistically significant (P < .01). Those who did not have health insurance before entering supportive housing, who had been previously in jail or prison, or who stayed only briefly in the program were less likely to achieve viral suppression than participants without these characteristics. However, other health, mental health, or substance use issues did not influence these outcomes.




"Without stable housing, it's hard to achieve these good health outcomes," noted lead study author Elizabeth Bowen in an associated press release.




HIV Treatment Start Delayed by Assistance Program Eligibility Thresholds, Provider Inexperience

In 2013, almost 30% of HIV care providers did not start patients on antiretroviral therapy independent of CD4 count, a study published in the Journal of Acquired Immune Deficiency Syndrome estimated.
Researchers based this conclusion on surveys returned by 1,234 medical practitioners who care for people living with HIV. Medical providers who saw 20 or fewer patients living with HIV or worked at facilities that did not receive Ryan White HIV/AIDS Program (RWHAP) funds were more likely to defer treatment. Study authors noted that various programs link medical providers with experienced HIV specialists, and recommended that such support be expanded to practitioners at non-RWHAP facilities.

Patients who refuse to go on treatment and providers' concern about their patients' ability to adhere to the medication regimen were the most common reasons cited for not prescribing antiretrovirals. Providers also waited before starting patients on HIV treatment when patient assistance programs did not provide sufficient medications, sometimes because of CD4 count thresholds for program eligibility.
 
 
 
Interleukin-8 Levels Appear to Mediate Viral Load in Semen


Proinflammatory cytokines, especially interleukin-8 (IL-8), appear to be the common pathway for increased viral load in semen, a small study published in Open Forum Infectious Diseases showed.

Researchers analyzed blood and semen samples from 30 men who have sex with men, are living with HIV, and have never taken antiretroviral medications. Thirteen of the participants were observed longitudinally for up to one year. Since current guidelines recommend most people start antiretroviral therapy upon diagnosis, relatively few men were eligible for this trial. A large variation in shedding patterns for HIV and cytomegalovirus was seen both within the group and in individuals over time.

Among the variables studied, only levels of IL-8 in the semen and blood viral loads were consistently associated with semen viral loads. Factors such as T-cell influx, reactivation of the herpes virus, as well as the person's microbiome appear to be mediated through these IL-8 levels, study authors concluded. Understanding these mechanisms may lead to new HIV prevention techniques, they noted.


Nanoparticle Lopinavir Shows Good Pharmacokinetics in Rats


Nanoparticle versions of lopinavir (Kaletra) showed favorable pharmacokinetic profiles in rats, a study published in Nature Communications reports.

The liquid version of ritonavir-boosted lopinavir, which is currently recommended by the World Health Organization for young children living with HIV, contains a high percentage of ethanol in order to dissolve the drugs. This liquid formulation also has a limited shelf life and requires refrigeration. By contrast, the solid drug nanoparticles (SDN) of lopinavir that were produced in this study can be re-dissolved in water and do not need to be kept cold.

SDN technology has already been applied successfully for other medications. This study also developed methods for accelerating the screening of potential nanoparticles, which may speed up development of other nanomedicine-based therapies.

Study authors caution that the results of this animal model may not be directly applicable to humans. However, Andrew Owen, one of the lead authors, is optimistic, stating, "Our approach has the potential to overcome challenges with current antiretroviral therapy, which include administration of high doses needed to achieve efficacious concentrations in the body, and the urgent need for better formulations for children living with HIV," according to a press release about the study.

Warren Tong is the senior science editor for TheBody.com and TheBodyPRO.com. Follow Warren on Twitter: @WarrenAtTheBody.

Barbara Jungwirth is a freelance writer and translator based in New York. Follow Barbara on Twitter: @reliabletran.

Read more articles from theBodyPro, here.
 

Sunday, June 18, 2017

🏳️‍🌈✝️ Inflammation in the Brain Continues Even With Undetectable Plasma Viral Load



June 16, 2017


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A person living with HIV had an undetectable viral load in the blood but detectable virus in the cerebrospinal fluid (CSF). That virus was resistant to every drug in the person's then-current antiretroviral therapy (ART) regimen. Once the regimen was changed to reflect that resistance, the person's neurological symptoms disappeared. Serena S. Spudich, M.D., of the Yale University School of Medicine gave this example in a recent IAS webinar, but conceded that such cases were "exceedingly rare." They show, however, that the virus not only can penetrate the blood-brain barrier but also, once in the central nervous system (CNS), can replicate independently there. Studies have shown that viral strains in the systemic (body) and CNS compartments can differ substantially, indicating separate viral mutation within the CNS.

More commonly, HIV causes macrophages and microglial cells in the brain to be activated at much higher levels than in people who do not live with HIV. Brain autopsies of people who died suddenly (e.g., in car accidents) have shown this to be the case, even if the person's viral load had otherwise been well controlled. Clinical trials among people with acute HIV found that the virus had migrated to the brain as early as five days after the estimated date of seroconversion. Within four months, the virus started to evolve locally within the CNS, and it had compartmentalized by the end of primary infection. Acute infection occurs during the first three months after the virus is contracted, followed by primary infection between three months and one year after acquiring HIV and chronic infection thereafter.

If ART is started during the acute phase, less viral RNA reaches the brain, fewer macrophages are activated and neuronal injury is prevented. However, even then, some virus persists in the CSF and activates macrophages there. "Shock and kill" strategies for a functional cure of HIV may cause that latent virus to become active, which could lead to neurological damage. This line of cure research relies on activating dormant HIV to then "kill" the virus with antiretrovirals. While the initial inflammation and replication of such "shocked" virus in the blood can be controlled with medication, "We don't know if that is true in the CNS compartment," Spudich cautioned. She advocated for neurological exams to be incorporated into clinical trials that test such strategies.



Treatment interruptions, which are needed to see whether a strategy suppresses HIV without ART, may also cause problems in the brain. One study found very high white blood cell counts, indicating inflammation, in the CSF of participants who had stopped therapy. Treatment interruptions may also cause HIV in the CNS to "leak" back into the blood. Spudich cited the case of someone who had unique viral strains in the CSF before starting ART, took antiretrovirals for some time and then stopped treatment. When that person resumed medical care, the viral strains in their blood were mostly related to the strains in the CSF, not the ones in their blood before ART. However, today's cure studies monitor participants very closely and resume treatment immediately when a person's viral load reaches detectable levels, Spudich noted. This seems to prevent the greater brain inflammation seen in earlier studies.

HIV thus seems to breach the blood-brain barrier rather quickly, then evolve independently in the CNS and continue to activate the immune system there. HIV replication in the brain appears to continue even if a person's viral load in the blood is undetectable. However, immediate ART may reduce that ongoing inflammation, as well as the amount of virus that reaches the brain in the first place. Researchers are investigating the addition of anti-inflammatory drugs to medication regimens during acute HIV to counter that persistent inflammation.

Barbara Jungwirth is a freelance writer and translator based in New York.
 
Follow Barbara on Twitter: @reliabletran.


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🏳️‍🌈✝️ U=U: The Evidence Is In


Courtsey of CATIE

June 12, 2017



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How Can I Make This Work for Me?

You can make this HIV prevention strategy work for you by taking your HIV treatment as prescribed and seeing your healthcare provider regularly. Your ongoing healthcare should include blood tests to check your viral load and ensure that it remains undetectable.

Wait until you have had at least two consecutive undetectable viral load test results before depending on this strategy.

To make this strategy keep working for you, adherence is key. If you have trouble taking your HIV medications every day, don't be afraid to ask for help from your doctor, pharmacist and/or peer counsellor.

If your viral load does not become undetectable or if it becomes detectable again, this can increase the risk of transmission. In that case, you may need to use other prevention strategies, such as condoms, until your viral load becomes undetectable.

What About Other STIs?

Maintaining an undetectable viral load can prevent HIV transmission but it does not prevent the transmission of other sexually transmitted infections (STIs), such as chlamydia, gonorrhea and syphilis. However, condoms can reduce the risk of many STIs, so you might want to use HIV treatment and condoms.

What Is an Undetectable Viral Load?

Viral load refers to the amount of HIV in the blood of a person living with HIV. HIV treatment can reduce the amount of HIV in the blood to a level too low to be measured by a viral load test. At that point, a person's viral load is said to be undetectable. For most people, this occurs after taking HIV treatment for three to six months.

Having an undetectable viral load does not mean you are cured of HIV. The virus is still in the body. If you stop taking HIV treatment or miss too many doses, HIV will start replicating again and the viral load will once again become detectable.

What are the Benefits of Having an Undetectable Viral Load?

We now know that it's good for your health: Starting treatment as soon as possible after becoming HIV positive decreases a person's risk of developing serious illnesses and allows people to live long, healthy lives. Having an undetectable viral load can also prevent HIV transmission.

How Do I Know if I'm Undetectable?

The only way to know is to have regular viral load tests. If your viral load becomes detectable again, there may be a risk of HIV transmission. An ongoing detectable viral load may also indicate that your HIV treatment is no longer working properly. If your viral load becomes detectable, talk to your doctor.

How Can I Know That Maintaining an Undetectable Viral Load Prevents the Sexual Transmission of HIV?

A significant body of research has been accumulating over the years. In 2016, the final findings from two large international studies -- PARTNER and HPTN 052 -- were published. These studies showed that not a single HIV transmission occurred between serodiscordant sex partners when the partner living with HIV was on treatment and had an undetectable viral load.


As Dr. Myron Cohen, the principal investigator of HPTN 052, stated: "We now have 10,000 person years (of follow-up) with zero transmissions from people who are suppressed."


As a result, we can confidently say that when a person taking antiretroviral treatment maintains an undetectable viral load, they do not transmit HIV to their sex partners.


The Prevention Access Campaign -- an international coalition of HIV advocates, activists and researchers who are spreading the word that undetectable HIV is untransmittable -- has turned this scientific evidence into a simple message: U=U. Researchers from all the major treatment as prevention studies have endorsed it.

What Does U=U Mean to You?

I spent 21 years stigmatizing myself while trying to provide a positive front in my work with people living with HIV. I feel somewhat hypocritical because while fighting against stigma and discrimination, I perceived HIV as making me damaged goods, dirty and less than. I lived in fear of transmitting HIV and built walls to keep others out.

U=U has impacted me to my very soul. I am now aware that I am much more than a virus. I can look forward to meaningful relationships with others and opening my heart.
      -- Tom, Bonny River, NB


I am an HIV-positive woman. I have known for a long time, through consultations with HIV specialists, that I was not able to transmit the virus. This has given me a sense of relief when having condomless sex. The scientific proof makes me feel optimistic about stigma changing. It is an enormous move forward in normalizing people living with HIV, as we will no longer be marginalized. Through education, the public will respond to HIV in a more supportive manner and the quality of life for me and the HIV community will improve.
      -- Anonymous, Montreal


It took us too long to disseminate the findings of the PARTNER study. We were not simply cautious in our messaging regarding this transformative research, we were silent. Why did it take people with HIV and the organizations that represent us so long to get the U=U message out? Some thoughts: deep-rooted stigma against people with HIV; paternalism in our organizations and the alignment of ASOs with an under-informed government agenda, held in place through diminishing funding; and a disengaged, less scientifically literate national PHA movement that seems prepared to settle for the status quo in HIV.
      -- Darien, Toronto


This research is wonderful but many people are not aware that U=U. We need more education and we need to deal with the social stigma of HIV before the positive impacts of U=U can be widely felt. Despite all the research, the stigma is still there -- not just in serodiscordant relationships but also in society.

I am in a long-term relationship and I've been undetectable for three years, but many women with HIV are fearful of being criminalized for not disclosing their HIV status. We still have lots of work to do before we can fully enjoy the benefits of U=U.
      -- Madhuri, Calgary


[Ed's note: U=U has not yet had an impact on HIV laws in Canada. A person living with HIV in Canada still has a legal duty to disclose their HIV status to a sex partner before: (1) sex (vaginal or anal) without a condom; and (2) sex (vaginal or anal) with a condom unless you have a low viral load (less than 1,500 copies/ml). It is not clear how the law applies to oral sex.]

As an activist and as a person living with HIV who is privileged to have access to life-saving treatments and good healthcare, U=U is something I embrace and celebrate. U=U has presented people with HIV with even more reason to demand universal access to treatment and healthcare. As part of the North American U=U Steering Committee, I have connected with peers and activists across the globe to advance this important message locally and globally. As a member of the Canadian Positive People Network, it is my hope that our network can further explore how we can spread awareness of U=U -- among poz folks, within the HIV sector, and with public health, government and the general public.
      -- Christian Hui, Toronto


All of us here at CATIE, and indeed around the world, are celebrating the most significant development in the HIV world since the advent of effective combination therapy 20 years ago. The "fabulousness" of this news cannot be overstated. With or without a condom, if you're undetectable you won't pass along HIV! This is an absolute game-changer and those who live with HIV can proudly share this information.
      -- Laurie Edmiston, Executive Director of CATIE



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🏳️‍🌈✝️ So the guy you like just told you he’s HIV-positive — Now what?








Jake Myers
Many guys who aren’t HIV-positive can’t get past the stigma surrounding HIV. And many poz guys know too well that fateful text later in the night–“Hey man, it’s just not gonna be a fit.” But without being able to talk through things, it’s easy to let overwhelm, uncertainty, and bias color the chance for love (or hot sex). 

As a Licensed Marriage and Family Therapist who specializes in LGBTQ issues, I work with people on both sides of the issue–newly diagnosed and those concerned about becoming positive–to work through the fears and misunderstandings around HIV so that they can live fully and freely, without fear, judgment, or low self-worth. 
 
Here are some tips on how to talk to that guy after he drops the HIV bombshell…
Be honest and authentic about your feelings. 
 
Your first instinct might be to close up. Don’t. Guys with HIV have most likely had to go through this conversation before, and they can handle it. It’s much worse to pretend you’re not having a reaction and then reject someone later without a real, honest dialogue. It’s okay to be freaked out or have concerns, questions, fears, disappointments, et cetera. Talking about them and being heard can help you move past them. 

Ask Questions. 
 
You don’t have to dance around the details. Although it can seem like a very personal issue, it’s important for you to get out all of your questions and concerns, so that you can move through some of your fears of the unknown. For example, ask him what his health status is. Is he undetectable? What does that mean exactly? How long has he been positive? By not shying away from those topics, you are relaying a message that you are open and willing to learn more, and things will feel less overwhelming. The truth is that he’s really not any different than a negative guy but you should explore the issues with him.
 
Don’t assume he wants to date someone negative
 
Believe it or not, you’re not the only one who gets to decide if he wants to be in a sero-discordant relationship (a relationship where both partners have a different HIV statuses). Many poz guys prefer to only date someone else with the same status, to avoid the fear of transmitting it to someone they love and dealing with those emotional repercussions. Or they may not be up for negotiation around safe sex. Both you and your partner get to decide what works for each of you. 
 
Talk about exactly how protection could look.  
 
There are many ways to still have a healthy, safe sex life when one member of a couple has HIV. Different layers of protection include: the positive partner being undetectable, the negative partner being on PrEP; condoms; not having anal intercourse. A discussion about what each person would be comfortable with is essential. If you’re not on the same page, instead of immediately jumping to judgment or rejection, ask why. It’s important for both you to understand each other. 
 
Be aware of HIV stigma.
 
Pay attention to your reaction and try to be conscious of any pre-conceived negative judgment that you have around HIV. Some people still believe that only a slut or someone who is self-hating would be careless enough to get HIV. That just isn’t true, and comes from a place of prejudice. Having HIV doesn’t define a person, and may not even say anything about them at all. If you feel yourself going into a place of judgment, just acknowledge it as a first step to letting it go.
 
Jake Myers is a Licensed Marriage and Family Therapist in Los Angeles and Queerty’s relationship columnist. He has a Bachelor’s degree in Psychology from Boston College and a Master’s degree in Clinical Psychology from Antioch University Los Angeles, with a specialization in LGBT Affirmative Psychotherapy. Visit him on Facebook @jakemyerstherapy or at jakemyerstherapy.com.
 
Have a burning question for Jake? Write him at Holla@Queerty.com.

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