Thursday, April 16, 2009
[NOTE: Jim Pickett of LifeLube attended this CDC consultation, held Dec 2 - 3, 2008. He is delighted to finally see this summary published, and will be active in pushing this important conversation forward.]
- "Serosorting is most often defined as a person choosing a sexual partner known to be of the same HIV serostatus, often to engage in unprotected sex, in order to reduce the risk of acquiring or transmitting HIV."
- "The consultants perceived seroadaptation to be a broader and more inclusive term than serosorting and, more consistent with the broader goal of improving the sexual health of gay and bisexual men in the United States. Discussions also focused on possible ways to frame prevention messages, including breadth and content of the messages as well as specific messages for partnerships in which both members are infected with HIV, partnerships in which both partners are not infected with HIV, and partnerships in which the members are serodiscordant or serostatus is unknown."
- "Regarding superinfection, the consultant noted that few cases have been reported in the literature and that the risk appears highest soon after seroconversion and may decline over the course of infection. Some data discussed by the consultants also indicate limited clinical consequences of superinfection. However, the consultants noted the lack of research among African American and Latino men and on superinfection in general."
- "The consultation highlighted the need to clearly define seroadaptation practices, and particularly serosorting, among MSM, and to understand the differing risks based on a variety of contextual factors. Several areas for future research were recommended. The information obtained in this consultation will inform potential future CDC activities, the development of prevention messages or guidance documents, and the creation of future funding announcements. As follow-up to this consultation, CDC will develop a fact sheet on serosorting among MSM that will include definitions of various seroadaptation practices, the state of the science with regard to behavioral patterns and their potential HIV risk under different situations and with different types of partners, and recommendations for future research. The fact sheet will be released later this year."
Read the whole thing.
Tuesday, October 28, 2008
Study results showed that individuals who had regular unprotected receptive anal intercourse with partners with significant levels of HIV in their blood showed a stronger anti-HIV immune response. In addition, the magnitude of anti-HIV specific immune response correlated with their exposure to HIV through sex.
Published in the October 24th, 2008 issue of PLoS Pathogens, "Immunity to HIV-1 Is Influenced by Continued Natural Exposure to Exogenous Virus," is authored by a research team from UCSF and the Gladstone Institute for Virology and Immunology.
The researchers found no evidence of systemic superinfection (re-infection with another strain of HIV) in the receptive partners, whose virus had been successfully suppressed through antiretroviral therapy for at least five months. In a comparison group of HIV-infected couples in which both partners' viruses had been suppressed by therapy, researchers did not find the same strength of immune responses correlations or the same correlations with sexual exposure.
"We found HIV-specific immune responses in the treatment-suppressed partners that correlated with the level and route of exposure. The individuals with no detectable virus who were on antiretroviral
therapy and who were exposed to HIV through receptive intercourse with a partner with detectable virus, had the stronger anti-HIV immune responses in comparison to individuals exposed to partners whose virus was also suppressed by antiretroviral therapy, where no effect was seen," said study lead author, Christian B. Willberg, PhD, post- doctoral fellow in the UCSF Division of Experimental Medicine.
Notwithstanding the intriguing HIV specific findings, the findings also reveal an important general mechanism occurring in infectious diseases.
"We found that immune responses to chronic viral infections are influenced not only by the chronic infection existing in an individual or host, but also by exposures to exogenous virus from outside the individual or host," said study co-senior author, Douglas F. Nixon, MD, PhD, professor of medicine in the UCSF Division of Experimental Medicine.
The investigators were unable to determine from these findings whether there is any benefit from this type of repeated exposure to HIV—i.e., a type of therapeutic vaccination for HIV-infected patients with suppressed virus. Some HIV patients on antiretroviral regimens lose many of their HIV-specific immune responses over time due to the successful suppression of viral replication by therapy.
"Indeed, our hypothesis had been that in the context of these waning anti-HIV responses among the suppressed partners and the expected level of exposure from repeated unprotected receptive intercourse, we would find evidence of superinfection. While we did not find systemic super-infection, we cannot exclude limited or localized superinfections in the gut. And, antiretroviral therapy may have been the factor that prevented superinfection in these patients," said study co-senior author Robert M. Grant, MD, MPH, senior investigator at the Gladstone Institute of Virology and Immunology and associate professor of medicine at UCSF.
The study involved 49 HIV-infected gay men from the San Francisco Positive Partners Program study—a cohort of couples in which both partners are HIV-positive that began enrolling participants in 2000. Viral suppression in this study meant viral loads less than 50 copies. Among those participants whose virus had not been suppressed, the lowest viral load was 9,420 copies.
The team that designed this study benefited from its unique multidisciplinary composition. Immunologists working with social researchers were able to design a study that managed to distinguish between different levels of viral suppression and different patterns of sexual contacts and correlate the immunological aspects with the behavioral variables.
"We call the interaction between these two scientific communities together: 'social immunology'. It may be true that patterns of social activities shape immune responses generally, as we observed for people with HIV having contact with other HIV infected persons. Obviously more study is needed and we would like to see whether social immunology will continue to offer important insights," said Grant.
"While we have not found a case of superinfection in our cohort of chronically infected HIV couples, a handful of cases of superinfection verified by linkage to a known partner's virus have been reported in chronically infected HIV patients. It is also important to stress, these findings do not address the negative consequences of acquiring other sexually transmitted diseases through engaging in unprotected sex or the potentially positive consequences that unprotected sex may have in partnerships where both individuals are HIV-positive," said study co-author, J. Jeff McConnell, MA, director of the Positive Partners study at the Gladstone Institute for Virology and Immunology.
Read the paper here.
Wednesday, October 1, 2008
...All these seven patients, as well as the two treatment-experienced patients, were gay men aged in their 20s – 40s. They all reported the use of methamphetamine and sex with multiple, mostly anonymous partners. Many of the men also reported the use of other recreational drugs as well as treatments for erectile dysfunction. At the time of HIV infection, many of the men were also infected with a bacterial sexually transmitted infection.
Investigators in Seattle have reported a cluster of nine HIV infections involving resistance to multiple drugs from all the three main classes of antiretrovirals. The report is published in the October 1st edition of the Journal of Acquired Immune Deficiency Syndromes.
Seven of the nine men were newly diagnosed with HIV, the other two men had chronic HIV infection and were receiving antiretroviral therapy. One of these cases appears to involve superinfection during antiretroviral therapy that had been suppressing viral load to undetectable levels.
All nine cases involved gay men with high risk sexual activity. None of the men experienced rapid HIV disease progression and one patient initiated a carefully selected antiretroviral regimen that suppressed his viral load to undetectable levels. Nevertheless, the investigators note that the strain of drug-resistant HIV infecting the men was very “fit” and highly transmissible.
Read the rest.
Thursday, May 8, 2008
Below is an essay, an AMAZING and MUST-READ essay, by LifeLube's very smart, very articulate and very fabulous pal Tony Valenzuela (remember him from the cover above?)
Just published in POZ, it centers on the controversy from a few years back regarding the New York man with the so-called HIV "supervirus." With it, he hopes to be a part of, as well as encourage, a dialog concerning the pathologizing of gay sex and the extraordinary need for an assets-based, holistic approach to gay men's lives and health.
Why do we, members of the LGBT community, continue to stigmatize one another, point fingers and shriek at "bad gays?"
Why do we continue to allow public health authorities, the media and others outside our community to whip up hysteria and terror at our expense?
by Tony Valenzuela
The clueless tabloid and public health hysteria over man-on-man sex may be hindering HIV prevention efforts. From an imaginary "super strain" of HIV to the sci-fi MRSA superbug: What is it about gay sex that makes U.S. health officials want to play Chicken Little with AIDS prevention and public safety?
In February 2005, a New York man with a multidrug-resistant strain of HIV and a crystal meth dependency became the source of the most reported AIDS story of the decade, but he had never, until now, spoken about his trying ordeal. A slew of chilling claims was made about this man – that he carried a new, more virulent strain of HIV dubbed a "supervirus" that progressed from infection to AIDS in as little as two months; that his meth-induced promiscuity would instigate a deadly epidemic potentially undoing a quarter century of progress against HIV; that he signified what many in the gay community had been dreading would occur, given that gay men —stubbornly, recklessly— refused to give up their uniquely nefarious brand of promiscuity. It is, then, no less remarkable that these allegations that gripped the world with renewed fears of gay plague proved comprehensively false, yet the cycle of alarm that equates gay men with disease—as seen once again this past January in San Francisco with a drug-resistant "gay staph" scare—continues unabated to this day. By the time the man with the "supervirus" disappeared from the headlines, those still paying attention would learn he did not have a never-before-seen strain of HIV nor did he set off a new epidemic. Instead, he carried a very rare and difficult-to-treat multidrug-resistant virus that is today fully suppressed as he adheres to a complicated regimen of antiviral medications.
In Paris, the same year the "supervirus" story broke, the late gay-rights pioneer and scholar Eric Rofes declared to an audience of international activists, "The pathologizing of gay men's communities and cultures and spaces is the most powerful challenge we face to promoting gay men's health." Three years later, this man's story lays bare how far too many who work and report on gay health narrowly imagine the sex lives of gay and bisexual men inside a realm of disease and dysfunction.
Read the rest on POZ.
Tuesday, May 6, 2008
what is dual infection, co-infection, superinfection?
why does superinfection matter?
does superinfection occur?
who is at highest risk?
is it bad to have more than one virus?
click here for answers to these important questions, courtesy of the center for aids prevention studies (caps).
Tuesday, February 19, 2008
LOS ANGELES, Feb. 18 (UPI) -- A mathematical model predicts a new wave of drug-resistant HIV infections in San Francisco, researchers at the University of California, Los Angeles said.
However, paradoxically at same time, the evolution of drug-resistant HIV may have actually reduced the severity of the city's epidemic, saving many men from becoming infected, the study said.
UCLA biomathematics professor Sally Blower said the model enabled the researchers to reconstruct the epidemic's past and predict its future by calculating the evolution of several classes of drug-resistant HIV strains in San Francisco.
The researchers examined the rise of HIV strains resistant to the three major classes of drugs -- nucleosides, non-nucleosides and protease inhibitors from 1987 to 2007.
Researchers found complex waves of rising and falling single-, dual- and triple-class drug-resistant HIV strains over 20 years. The model predicts that resistance to nucleosides will decline substantially and protease resistance will fall slightly through 2012, and that resistance to non-nucleosides will rise over the next five years and then begin falling.
The findings are presented at the annual American Association for the Advancement of Science conference in Boston.
Friday, January 11, 2008
The natural evolution of HIV rather than superinfection with a drug-resistant strain of HIV is usually the explanation of antiretroviral treatment failure, according to a Dutch study published in the January 11th edition of AIDS.
Transmitted drug resistance can severely limit the antiretroviral treatment choices for HIV-positive individuals. A significant proportion of new HIV infections (approximately 10% in the UK and 6% in the Netherlands) involve a strain of HIV that is resistant to one or more anti-HIV drugs. In addition, about 30 cases of superinfection with a second or drug-resistant strain of HIV have been reported worldwide.
Many gay men choose to have unprotected sex with other HIV-infected men (often called serosorting), and Dutch investigators therefore wished to see if superinfection was contributing to the virological failure of previously effective antiretroviral therapy.
Read the rest on aidsmap.
Wednesday, August 15, 2007
Doctors from the Multicenter AIDS Cohort (MACs) study have reported a retrospective case of HIV superinfection. The case report is published in the August 15th edition of Clinical Infectious Diseases. The investigators note that their patient became superinfected with dual-tropic HIV between eight and 15 months after his initial HIV seroconversion. This lead to a rapid increase in the patient’s viral load, although there was no significant impact on the individual’s already falling CD4 cell count.
The investigators believe that the patient’s immunological and genetic characteristics may have been important factors in his superinfection. Like all but one of the cases of superinfection reported so far, this patient’s superinfection occurred soon after his initial infection with HIV.
The frequency of HIV superinfection (or reinfection) and its consequences are largely unknown. There have been several case reports of superinfection, but such reports have been rare, and careful laboratory tests are needed to verify if superinfection has indeed occurred.
Read the rest on aidsmap.