Articles tagged as "Issue #01 - May 16, 2006"

May
16
2006

HIV This Week - Issue #01

Welcome to the maiden issue of HIV this week, our regular weekly update on HIV coverage in the scientific literature. Since 2002 we have collated and circulated tables of contents from scientific journals weekly and then retrieved the articles that UNAIDS staff members in the former Strategic Information Unit were keen to read. After consultation with a number of you, we have decided to expand this service to all staff and to make it more user friendly by selecting a few relevant scientific abstracts each week. The thematic areas covered in this week’s HIV scientific literature cover universal access, behaviour change, condom use, costing and resource needs, epidemiological estimates and projections, male circumcision, men who have sex with men, microbicides, treatment, reproductive health, and vaccines.

We want to be as helpful to you as we can, so please let us know what your interests are and what you think of HIV This Week by posting a comment on the blog (click on the Add Your Comments tab above) or by sending one to hivthisweek@unaids.org. If you would like to recommend an article for inclusion in HIV This Week, please let us know.

Don’t forget that you can find a wealth of information on the HIV epidemic and responses to it at http://www.unaids.org.

Cate Hankins

Charles Shey Wiysonge
Chief Scientific AdviserResearch Officer

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May
16
2006

4 for everyone?

Okie S. Fighting HIV — Lessons from Brazil. N Engl J Med 2006;354:1977-81

Okie x-rays Brazil’s experience in providing access to HIV prevention, treatment, care and support to those in need of these services. The government-funded treatment programme, which has improved the health system and extended the survival of tens of thousands of Brazilians, has saved the country an estimated US$2.2 billion in hospital costs between 1996 and 2004, and inspired similar efforts elsewhere — including PEPFAR. In addition, Brazil’s persistent and aggressive efforts to prevent new HIV infections have probably played an equal or greater role in slowing the spread of the virus and containing the country’s epidemic. At the beginning of the 1990s, the epidemics in Brazil and South Africa, both middle income countries, were at a similar stage, with a prevalence of HIV infection of about 1.5 percent among adults of reproductive age. But by 1995, the year before Brazil’s treatment program was established, the HIV epidemic in South Africa had begun to explode; with a prevalence already greater than 10 percent, whereas the infection rate in Brazil had declined by half.

National responses
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May
16
2006

Behaviour Change

Zablotska I, Gray RH, Serwadda D, et al. Alcohol use before sex and HIV acquisition: a longitudinal study in Rakai, Uganda. AIDS 2006;20: 1191-96

The authors examined the association between alcohol use before sex and incident HIV in a population-based cohort in Rakai, Uganda, between 1994 and 2002. In 6791 men and 8084 women they found that HIV incidence was 1.4/100 person-years and 1.5/100 person-years, respectively. After controlling for sociodemographic and behavioural factors, the relative risks for HIV when one partner consumed alcohol before sex were 1.67 (95% CI 1.17–2.40) among men, and 1.40 (95% CI 1.02–1.92) among women. When both partners consumed alcohol, the relative risks were 1.58 (95% CI 1.13–2.21) among men, and 1.81 (95% CI 1.34–2.45) among women. Alcohol use was significantly associated with inconsistent condom use and multiple sexual partners in both sexes. The authors conclude that alcohol use before sex increases HIV acquisition, and a reduction of alcohol use should be incorporated into HIV prevention programmes.

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May
16
2006

Costing

Soorapanth S, Sansom S, Bulterys M, et al. Cost-effectiveness of HIV Rescreening During Late Pregnancy to Prevent Mother-to-child HIV Transmission in South Africa and Other Resource-limited Settings. J Acquir Immune Defic Syndr 2006 Apr 24; [Epub ahead of print]

The authors used a decision analysis model, from a health care system perspective, to assess the cost-effectiveness of HIV re-screening during late pregnancy to prevent perinatal HIV transmission in South Africa, a country with high HIV prevalence and incidence among pregnant women. Because new HIV prenatal prophylactic and pediatric ART regimens are becoming more widely available, the study was carried out with different combinations of the two. With an estimated HIV incidence during pregnancy of 2.3/100 person-years, HIV re-screening would prevent additional infant infections and result in net savings when zidovudine plus single-dose nevirapine or single-dose nevirapine is used for perinatal HIV prevention, and ART was available to treat perinatally HIV-infected children. The cost savings were robust over a wide range of parameter values when ART was available to treat perinatally HIV-infected children but were more sensitive to variations around the baseline when ART was not available. The minimum time interval between the initial and repeat screens would be from 3 to 18 weeks, depending on prophylactic and treatment regimens, for HIV re-screening to be cost saving. Overall, HIV re-screening late in pregnancy in high-prevalence, resource-limited settings such as South Africa would be a cost-effective strategy for reducing mother-to-child transmission.

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May
16
2006

Estimates and Projections, Epidemiology

Lewden C, Jougla E, et al. Number of deaths among HIV-infected adults in France in 2000, three-source capture-recapture estimation. Epidemiol Infect 2006;11:1-8

Lewden et al estimated the number of HIV-related adult deaths in France in 2000 from three sources, namely, (1) the 'Mortalite 2000' survey (M2000) which documented 964 deaths in 185 hospital wards involved in HIV management; (2) 1288 death certificates which mentioned HIV infection as cause of death (CepiDc); and (3) the French hospital database on HIV infection (FHDH) which identified 654 deaths; using the capture-recapture method with log-linear modelling. Overall 1559 deaths were observed. Estimation of the total number of deaths in France was 1699 (95% CI 1671-1727). The completeness of M2000, CepiDc and FHDH were 55%, 76% and 38% respectively. Theauthors conclude that the diversity of diseases and causes of death in HIV-infected adults may explain: (1) the diversity of physicians involved in their management and the incompleteness of M2000 and FHDH, and (2) why HIV infection was not mentioned in all death certificates.

Epidemiology
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May
16
2006

Condom Use

Agha S, Hutchinson P, Kusanthan T. The effects of religious affiliation on sexual initiation and condom use in Zambia. Does religious affiliation reduce HIV risk among young women in Zambia? J Adolescent Health 2006;38:550-55.

Agha et al analyzed data from a representative probability sample of 5,534 women aged 13-20. The women were questioned about their sexual initiation, condom use during first sex, religious affiliation and sociodemographic characteristics. These young women were found to be more likely to delay sexual initiation but less likely to use condoms during first sex. The authors conclude that denominations which are not only strongly opposed to premarital sex and condom use, but are able to exercise control over adolescents through socialization or the threat of social exclusion, are likely to create conflicting behaviors among adolescents that cancel each other in terms of HIV risk. Overall, these findings suggest that affiliation with conservative religious groups is unlikely to reduce the risk of HIV infection.

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May
16
2006

Male Circumcision

Atashili J. Adult male circumcision to prevent HIV? Int J Infect Dis 2006;10:202-5.

The author summarizes and discusses the main findings of studies of the evidence underlying adult male circumcision to prevent HIV, explores its feasibility and the implication for policy and future research. While the existing biological and epidemiological evidence suggest potential reduction of the risk of HIV acquisition in circumcised men, additional evidence from randomized trials are needed to confirm this. Even if the findings are confirmed, the practical aspects of implementing adult circumcision would have to be carefully considered. The feasibility of such an intervention, particularly with respect to its cost-effectiveness, safety and acceptability, is still to be demonstrated.

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May
16
2006

Men who have sex with men

Mao L, Crawford JM, Hospers HJ, et al. Serosorting' in casual anal sex of HIV-negative gay men is noteworthy and is increasing in Sydney, Australia. AIDS 2006;20: 1204-06.

The authors found that ‘serosorting’ (defined as engaging in unprotected anal intercourse with casual partners who claim to be HIV negative) has been increasing among HIV-negative gay men in Sydney. They conclude that prevention and intervention programmes are urgently needed to alert HIV-negative gay men to the risks associated with ‘serosorting’, and remind them of the need for correct and consistent condom use.

Wolitski RJ, Jones KT, Wasserman JL, Smith JC. Self-Identification as "Down Low" Among Men Who Have Sex with Men (MSM) from 12 US Cities. AIDS Behav 2006 May 12 [Epub ahead of print].

Wolitski compared MSM who considered themselves to be on the "down low" (DL) with MSM who did not (non-DL MSM). 20% of the 455 MSM self-identified as DL. Blacks and Hispanics were more likely than Whites to self identify as DL. MSM who did not identify as gay were more likely than gay-identified MSM to describe themselves as DL. DL-identified MSM were less likely to have had seven or more male partners in the prior 30 days, but were more likely to have had a female sex partner and to have had unprotected vaginal sex. DL-identified MSM were less likely to have ever been tested for HIV than were non-DL MSM. The authors conclude that prevention agencies should expand existing programs for MSM to include specific efforts to reach DL MSM.

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May
16
2006

Microbicides

Cohen JA, Steele MS, Urena FI, Beksinska ME. Microbicide Applicators: Understanding Design Preferences Among Women in the Dominican Republic and South Africa. Sex Transm Dis 2006 May 9; [Epub ahead of print].

Cohen et al aimed to identify acceptable microbicide applicator designs in 2 low-resource settings. They surveyed 895 women, randomly sampled from clinics in the Dominican Republic (n = 449) and South Africa (n = 446), with questions on sociodemographics, applicator attribute preferences, and price/design tradeoffs. They found that single-use design was the most valued attribute, and reusable design and low price were the least valued attributes in both populations. Preference for single-use design was associated with concern about reusable applicators spreading germs, secondary or higher education, older age, having children, and perception of moderate to high HIV risk. They conclude that acceptability factors related to microbicide delivery mechanisms should continue to be evaluated among potential microbicide users to directly inform product development and introduction of microbicides.

El-Sadr WM, Mayer KH, Maslankowski L, et al. Safety and acceptability of cellulose sulfate as a vaginal microbicide in HIV-infected women. AIDS 2006;20:1109-116.

El-Sadr et al conducted a randomized placebo-controlled trial to evaluate the safety and acceptability of 6% cellulose sulfate (CS) gel as a vaginal microbicide in sexually abstinent and active HIV-infected women. Sexually abstinent women applied the gel once or twice daily and sexually active women used gel once daily for 14 days. The authors found the CS gel to be safe with no reported severe or life-threatening adverse events (AE). 39 of 59 (66%) participants experienced urogenital AE probably or possibly related to gel, with no significant difference noted between the CS and placebo arms in the prevalence. There was no increase in AE by frequency of gel use or sexual activity with the exception of abdominal/pelvic pain which was noted more frequently with twice daily use among sexually abstinent women. Women and men found the gel highly acceptable. The authors conclude that they have demonstrated the vaginal gel was safe, well tolerated and acceptable by HIV-infected women and their male partners, and recommend further development of the gel as a potential method to prevent HIV transmission and acquisition.

Holt BY, Morwitz VG, Ngo L, et al. Microbicide preference among young women in California. J Womens Health 2006;15:281-94.

Holt et al integrated conjoint analysis with more traditional epidemiological and behavioural research to examine potential users' preferences for different microbicide formulations. Focus group discussions (n = 67) were held with a diverse population of young men and women (aged 18-32 years) from Northern California. Then young women participated in structured surveys (n = 321) that included a conjoint study, a methodology not yet used in microbicide acceptability. Participants' responses suggested that the ideal microbicide would (1) offer protection from pregnancy, HIV, STIs, and vaginal infections, (2) offer as much protection as condoms, (3) allow insertion up to 8 hours prior to sexual activity, (4) be available over the counter, (5) be inserted with an applicator, and (6) have only slight leakage not requiring a panty liner. The average predicted purchase probability for this ideal microbicide was 69%. The authors conclude that their findings help illustrate microbicide product preferences and demand among young women in California, and that the methodological approach should lend itself to other populations as well as during clinical trials when understanding product use and non-use is critical.

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May
16
2006

Treatment

Sanchez R, Portilla J, Gimeno A, Boix V, et al. Immunovirologic consequences and safety of short, non-structured interruptions of successful antiretroviral treatment. J Infect 2006 May 8; [Epub ahead of print].

Sanchez et al evaluated the safety of short ART interruptions and their virologic and immunologic consequences in HIV-infected adults in Spain on HAART with suppressed viral replication. They prospectively followed 20 patients with undetectable viral load while on HAART to detect any treatment interruption, and analysed viral and cellular kinetics, incidence of resistance mutations, clinical outcome and results after therapy resumption. The mean time since HIV diagnosis was 95 months and time with undetectable viral load 16 months. Treatment was interrupted because of adverse effects, cancer, tuberculosis or patient will, and reintroduced after 4 weeks using, if possible, the same combination. HIV viral load was detectable on day 28 after interruption in 18 (90%) patients. There was a non-significant decrease in median CD4 count from 478/mm3 to 257/mm3. Resistance mutations were found in 9 (45%) patients after interruptions, and treatment was reintroduced in 14 patients; all of whom achieved viral suppression. The authors conclude that in patients on HAART who have undetectable viral load, an interruption no longer than 4 weeks due to any intercurrent problem seems to be safe. However, due to the frequent development of resistance, a genotypic test during interruption might be helpful.

Etard JF, Ndiaye I, Thierry-Mieg M, et al. Mortality and causes of death in adults receiving highly active antiretroviral therapy in Senegal: a 7-year cohort study. AIDS 2006;20: 1181-89

The authors evaluated survival and ascertained causes of death among the first HIV-1 infected adults patients of the Senegalese Antiretroviral Drug Access Initiative (enrolled between 08/1998 and 04/2002). The first-line regimen for these patients consisted of two NRTI and either a NNRTI or PI. Cause of death was ascertained through medical records or verbal autopsy. A total of 404 patients (54.7% women; median age 37 years, CD4 128 cells/μl, viral load 5.2 log cp/ml) were enrolled and followed for a median of 46 months after initiating HAART. At baseline, 5% were ART-experienced, and 39% and 55% were respectively at CDC stage B and C. 93 patients died during follow-up giving an overall death rate of 6.3/100 person-years. The death rate, which was highest during the first year after HAART initiation, decreased with time yielding a cumulative probability of dying of 17.4% at 2 years and 24.6% 5 years. The most frequent causes of death were mycobacterial infections, neurotropic infections and septicaemia.

Crabb C. Testing a CCR5 drug? Avoid mosquito bites. AIDS 2006; 28:N3-N4.

‘Sleep under netting, wear long sleeves and pants, and use mosquito repellent’, may be sage advice for HIV patients taking experimental CCR5-blocking drugs. Researchers at theNational Institutes of Allergy and Infectious Diseases in Bethesda, Maryland, have discovered that the genetic mutation of the CCR5 surface protein that makes individuals highly resistant to HIV infection also leaves them more susceptible to potentially fatal infection of the mosquito-borne West Nile virus.

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