They are slowly getting closer to a vaccine and each of these little discoveries brings us one day closer ...

MedlinePlus: Scientists Break Into HIV 'Hideout'

The Sydney Symphony conducted by Sir Charles McKerras playing Richard Strauss' Thus Sprach Zarathustra. And the second half of the program is Mozart's C minor Mass.

It may seem remarkable that, 23 years after the identification of the human immunodeficiency virus (HIV), there is still denial that the virus is the cause of acquired immune deficiency syndrome (AIDS). ...

HIV denial has taken root in the general population and has shown its potential to frustrate public education efforts and adversely affect public funding for AIDS research and prevention programs.

PLoS Medicine - HIV Denial in the Internet Era

Part of the reason that these stupid opinions get any airplay is that people like Act-Up San Francisco and the Foo Fighters (!) actively promote the idea among gullible people. In Australia, a prominent court case in 2006 was forced to weigh the evidence when a man charged with the reckless endangerment of his sexual partners used AIDS denial as a key plank in his defense. The court came down on the side of mainstream science, and he was finally jailed last month after an appeal failed.

Man jailed for spreading HIV

Although I'm no fan of jailing people for diseases (were his sex partners jailed for taking part in unprotected sex as well? No.), I'm glad that the court, with no vested interest in the scientific status quo, found in favour of HIV as the cause of AIDS.

Surprise, surprise. Valproic acid makes no difference to latent viral reservoirs, and moreover, seems to have some incredibly toxic side effects. So NOT a cure ....

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Entrez PubMed

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PLoS Medicine: Modelling the Impact of Antiretroviral Use in Resource-Poor Settings

 

There is no doubt that ARV is really important as a part of the control of the impact of HIV, but for too long now, we have been looking to treatments to somehow take the brunt of prevention. This study hopefully puts a nail in the coffin of the arguments that drugs can do what behaviour change can't. As the authors say, "Our analysis found that ART cannot be seen as a direct transmission prevention measure, regardless of the degree of coverage. Counselling of patients to promote safe sexual practices is essential and must aim to effect long-term change."

Treatment IS NOT prevention.

But neither is counselling positive people to achieve bevaiour change enough either. Putting the onus onto positive people means that newly infected people, who have not yet been diagnosed, can carry on as if they are not infected. Given the infeciousness of the newly positive, this is a serious flaw in any prevention strategy.

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Potential new way to fight HIV

Pardon my cynicism, but why do they always announce these things prior to a stock float, rather than prior to the release of the actual miracle cure.

 With no apologies to catholics anywhere, is there any doubt that Ratzinger is a Kunt with a capital c. We should listen even less to the Catholic church on moral or health issues even less than we take the advice of the us senate on these issues.. 

Pope faces controversy on gay priests and HIV/AIDS - news from ekklesia

I think it has been clear to most of us in Australia, and to thoughtful people in the rest of the world that in general people with HIV behave better in relation to spreading their infection if they know they're infected. Some Americans have now proved it with a meta analysis.

"The analysis integrating all 11 findings indicated that the prevalence of UAV with any partner was on average 53 percent lower (95 percent confidence interval [CI]: 45 percent-60 percent) in HIV+ aware patients compared to HIV+ unaware patients. After adjusting the data to focus on UAV with partners who were not already HIV+, the researchers found a 68 percent reduction (95 percent CI: 59 percent-76 percent). ?

Again, it seems that a really effective contribution to prevention efforts is encouraging testing - letting people know their status so they can behave appropriately.

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UNITED STATES: Meta-Analysis of High-Risk Sexual Behavior in Persons Aware and Unaware They Are Infected with HIV

 Here's one I missed from last week's Lancet - a new treatment (vaproic acid) that attacks latent T-cells, and has shown promising results in a (huge!) trial of 4 patients, one of whom developed serious anaemia in less than four weeks on the treatment. Cynical aside: this reminds me of the kind of claims that were being made in the mid-90s about HAART - some period - say 2 years - on HAART + vaproic acid and HIV might be wiped out. At least these guys aren't peddling mathematical models this time. They are about to start a somewhat larger trial.

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New HIV Therapy Clears Out Hidden Virus - HIV: health and medical information about HIV and AIDS

Another view of the same material is at: http://www.wired.com/news/medtech/0,1286,68521,00.html?tw=rss.TEK

Another great idea from the UK - maps that show STD hotspots in London - soon to be published in the International Journal of Health Geographics. I don't think we pay enough attention to space as a dimension in STD surveillance - it is certainly an idea that might shed some light on what is happening with syphilis in Melbourne and Sydney (although maybe it's a technique that needs a few more incident cases to be useful). Maybe chlamydia in Victoria might provide a better case for testing the usefullness of it. Worth cheking out anyway...  

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STD "hotspot map" to improve treatment? | Headlines | News | Gay.com UK

Update: It was actually already published when I wrote this.

See: http://www.ij-healthgeographics.com/content/4/1/4

More news about HPV and anal cancer in gay men ... 

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New trial focuses on HPV protection for gay men | Headlines | News | Gay.com UK

 

Trials of a new vaccine intended to protect gay men from human papillomavirus (HPV) - and subsequently reduce the rates of anal cancer - are being undertaken in Australia.

The clinical trials will include gay men aged between 18-23, according to the country's Associated Press, with a view to eventually designing a vaccine that could be available for gay men at risk of the virus.

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http://www.docguide.com/news/content.nsf/news/8525697700573E188525705B0049EE38

The ongoing uproar about syphilis in gay Australia (a storm in an epidemiologist's teacup if you ask me) should perhaps look to the success factors in California's recent decline in syphilis cases in an equivalent population (http://www.aegis.org/channel/s/AD051641.html). Although the scattergun approach may be what is yielding results, I'm curious about how this decline fits into the model Nature recently presented on syphilis as a geographically periodic disease - is it declining because of the public health measures as Klausner claims, or because this periodic bump in syphilis is over?

Dr. Jeffrey Klausner, director of San Francisco's department of STD prevention and control, cited as reasons for the declines more people testing for syphilis; the launch of Magnet, a gay health center in Castro; medical care providers' awareness of the need to screen patients for STDs; increased partner testing and treatment; and Inspot, an online system for informing partners they may have an STD.

Though HIV cases have also recently declined, HIV-positive men accounted for nearly 60 percent of syphilis cases. Gay HIV- positive men may be serosorting, but also eschewing condom use, which can lead to STD transmission, health officials hypothesized. In the meantime, HIV-negative men who comprised the majority of rectal infections at City Clinic are not serosorters, but an unrepresentative higher-risk population, said Klausner.

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UNITED STATES: Cultural Challenge; Conference Addresses Meth, HIV Among Gay Latinos

 

Nice to see an American quote on HIV that mentions culture:

 

Understanding the impact of culture and family on sexual behaviors and attitudes is key to forming effective HIV/AIDS prevention messages to Latinos. "Gender scripts can impact on how you promote HIV testing and prevention," said deLeon. "Family scripts impact a whole range of drug use and sexual behaviors. For Latino men who have sex with men [MSM], sexual silence imposed by the family is an important factor in HIV. The silence built of fear of disclosure leads drug-using Latino men and women and Latino [MSM] to engage in more risky sexual behavior in unsafe venues."

 "Anal" cancer precursors common in "homosexual" men 

By Will Boggs, MD

NEW YORK (Reuters Health) - As many as one in five "homosexual" men have "anal" squamous intraepithelial lesions (ASILs), precursors of "anal" cancer, according to a report in the June 15th issue of the Journal of the National Cancer Institute.

"There is a high prevalence of "anal" cancer precursor lesions and "anal"  human papillomavirus (HPV) in this population across all "sexually" active age groups, confirming early studies of disease prevalence," lead author Dr. Peter V. Chin-Hong, from University of California San Francisco, told Reuters Health.

Dr. Chin-Hong and colleagues investigated the age-related prevalence and risk factors for ASILs in 1262 HIV-negative men who have "sex" with men (MSM) in four U.S. cities.

The overall prevalence of ASILs was 20%, the authors report, including 15% of men with low-grade SILs and 5% with high-grade SILs. The prevalence was similar for all age groups.

ASILs were significantly more common among men with more than five receptive "anal" "sex" partners (compared with fewer than two) during the previous 6 months. Other risk factors included older age at first receptive "anal" intercourse, injection drug use two or more times per month in the previous 6 months, PCR evidence of an "anal" HPV infection, and "anal" HPV infection with increasing numbers of HPV types, the report indicates.

Low-grade and high-grade SILs individually showed similar risk patterns, the researchers note. High-grade SILs were additionally associated with infection with high-risk HPV types alone or in combination with other HPV types. Residence in San Francisco also seemed to confer an increased risk of high-grade SILs.

"Our group for a long time has advocated for systematic screening of individuals at risk for "anal" cancer including, but not limited to, MSM," Dr. Chin-Hong said. Other at-risk groups include women with other HPV disease, transplant recipients and all HIV-positive men and women.

"More providers need to be trained to do high resolution anoscopy and treatment of "anal" precancer lesions once detected and confirmed by biopsy," he said.

"One promising strategy will be the HPV prophylactic vaccine," Dr. Chin-Hong added. "Studies of polyvalent vaccines and trials in MSM (for anal disease) are ongoing."

J Natl Cancer Inst 2005;97:896-905.

 

This one is a bit different from (my other blog ). That one is for my academic writing about life with HIV - this one is a kind of ongoing commentary about the stuff about HIV that is circulating all the time on the internet. Some of it will be just direct quotes of things I find interesting, and some of it will include some discussion from me.