Some lubricants damage cells – but may not increase HIV risk
However, as far as can be told from test-tube studies, this damage does not increase susceptibility to HIV infection.
The tests, of 14 lubricants ordered online, were done after initial reports three years ago suggested that some lubricants might increase people’s susceptibility to sexually transmitted infections, especially in rectal use.
The researchers tested whether the lubricants killed off beneficial bacteria; whether they damaged the cells that line the vagina and rectum (epithelial cells); and whether their use increased the likelihood of HIV infection or replication.
They found that while a number of the lubricants certainly caused damage to the mucous membranes, this did not – in test-tube conditions at least – lead to a higher rate of HIV infection of those cells.
The lubricants that were toxic to cells were mainly water-based ones that were hyper-osmolar: this means that they had a higher concentration of dissolved salts in them than human body fluids, including the fluid in cells. Because of this they drew water out of epithelial cells, making them dry out and detach from their base. The least toxic lubricants were ones that were iso-osmolar, meaning they most resembled human body fluids.
Lead researcher Charlene Dezzutti said that these are preliminary studies and that “much more work needs to be done to explore the safety of lubes,” especially as they are actually used during sex.
Young gay men with HIV worry about disclosure, transmission and prosecution – older ones about confidence
The What do you need? survey of the needs of people living with HIV in the UK found that the gay men consistently worried about disclosing their HIV status to potential partners, being rejected by partners if they did, and being prosecuted for HIV transmission if they did not disclose.
Although these concerns were common in all the gay men surveyed, it was young, recently diagnosed men for whom these were the most pressing issues, as well as men not on HIV treatment. Although many older gay men also worried about these issues, concerns about poor self-image, loss of self-confidence, low libido and lack of sexual opportunity were of more concern to this age group.
Seventy per cent of respondents reported at least one problem with sex during the last year. Over a third of men said their problem(s) had become worse over the last year. When asked what might help improve their problems, over a third said that some kind of one-to-one or group therapeutic support might help them address low self-esteem. One said: “Feeling better about myself and not seeing myself as a dirty, infected bastard would help things.” A quarter said that better public awareness about HIV would help them with disclosure, while a sixth said that clarity about the criminalisation of transmission would help: “Currently, all the pressure and responsibility is on me,” remarked one.
Study confirms HIV is largely transmitted by recently infected people
A study from Denmark, looking at 1515 people diagnosed with HIV since 2001, has found more evidence that HIV is largely passed on by people who are themselves newly infected and have a high viral load. Using a technique called phylogenetic analysis to examine the genetic code of individual strains of HIV, the researchers were able to sort a third of people in the study into transmission clusters – groups of two or more people who had identical or very similar viruses and were clearly linked by transmission or by a chain of infection.
Only 20% of people diagnosed late – in other words, with a CD4 count below 200 – were members of a transmission cluster, compared with 50% of people with recent HIV infection.
A large proportion – more than one in six – of the group studied were in primary HIV infection, defined by the researchers as being infected no more than six months ago. The two largest clusters of connected infections contained half of the people with primary infection.
This does not mean that a large number of infections all happened at once; half of the genetically connected clusters contained people diagnosed over the whole ten-year time span of the study, showing that infection ‘chains’ may be sustained for a very long time.
While it has been known for some time that individuals in early infection contribute disproportionately to HIV transmissions, it is hypothesised that people diagnosed very late might also contribute significantly to transmissions, as they tend to have high viral loads. This study appears to show that this is not the case, and that people are at most risk of transmitting HIV when they have recently been infected themselves.
Drug users starting HIV therapy take fewer sexual and needle-sharing risks
Starting antiretroviral therapy (ART) is associated with reductions in sexual risk-taking and injecting among HIV-positive drug users, according to US research. When injecting drug users started ART, the study found, there was a 75% reduction in the likelihood of their having unprotected sex, and a 38% fall in the likelihood of injecting drugs.
In the year before starting HIV therapy, two-thirds of participants reported some sort of sexual activity and 60% injected drugs; half engaged in unprotected sex and a quarter reported sharing injecting equipment.
In the year after starting ART, half of participants reported sexual activity and a third injecting drugs; and only one in six reported unprotected sex or sharing injecting equipment.
However, for the 16% of participants who continued to share needles after starting ART, the frequency of sharing injecting equipment almost doubled
The reductions in risk behaviour were sustained for up to five years after HIV treatment was started – but so was the increase in needle-sharing among the minority who did so.
Overall, the investigators were encouraged by their findings, writing: “Our data do not support the premise that HAART [highly active antiretroviral therapy] is associated with generally increased risky behavior among IDUs [injecting drug users].”
“Our results support the optimistic view that for most IDUs, risk compensation following HAART initiation is unlikely, albeit with the worrisome caveat that a small minority of active injectors may be more likely to share needles after initiating treatment,” conclude the authors. “Based on our findings, targeting risk-reduction interventions for persons with high-risk behaviors in the time-period shortly before HAART initiation should be considered.”
Over-the-counter HIV tests may be feasible
As well as getting people to do the test, the study also tested their ability to correctly recognise positive, negative and invalid test results when shown photos of typical tests. Ninety-five per cent of people correctly identified a negative result and 96.4% a positive result, with only 1.1% interpreting a positive result as negative.
Nine out of 519 participants (1.7%) turned out to have HIV. Of these, eight correctly interpreted a picture similar to their own test result, while the ninth was uncertain whether the picture closest to his own test result was positive or invalid.
The test sites were in tents; the researchers note that the trial period was particularly cold and rainy, and suggest that tests taken in people’s homes might produce more reliable results.
After self-testing, 84% of participants said they were more motivated to self-test for HIV again.
When asked how much they might be prepared to pay for such a test, a third said ten to 19 euros, a quarter said 20 to 29 euros and one in five said €30.00 or more. (OraQuick, the HIV test using oral fluid sampling that has been approved for home-testing use in the US, is now on sale over the counter for $40.00 in the US, which at today’s exchange rate is about €31.00.)
This study is important partly because the ‘window period’ for the Determine HIV Combo (the blood test used in this study) is likely to be somewhat shorter than that for OraQuick.
The researchers say: “This is the first published study showing that a high percentage of HIV-negative people are able to perform a blood-based point-of-care test and read the results correctly.” They urge further research into self-testing in different populations and with different kits.
More gay men than ever diagnosed in the UK
The total number of HIV diagnoses attributed to sex between men was 3010 in 2011, while 2990 were attributed to heterosexual contact. This is the first time since 1999 that new HIV diagnoses in gay and bisexual men have exceeded the number attributed to heterosexual contact. The total number of new diagnoses in 2011 (6280) represented a decline of 20% compared to the 2005 peak (7914), but the number of new diagnoses linked to sex between men was higher than any previous year.
The HPA continues to report that approximately one-in-five infections diagnosed in the UK among men who have sex with men had been acquired outside the UK (a consistent trend over the past decade). Among heterosexual people, an improved method of pinpointing the approximate year of infection has revealed that almost half (48%) of infections diagnosed in heterosexuals born abroad were acquired in the UK.
This change has been driven largely by a very substantial decline in HIV diagnoses among people of East African origin, whereas in contrast there has been a steady increase in HIV diagnoses among people from the European region (up from 258 in 2003 to 639 in 2011).
There has also been a shift in the age at which gay and bisexual men are being diagnosed with HIV. Whereas in 2003 almost half of new diagnoses occurred in men aged 30 to 39, and less than a quarter in men aged 20 to 29, an almost equal number of men in each of these age groups were diagnosed with HIV in 2011.
Other recent news headlines
Only half of US black gay men on HIV treatment are non-infectious
A study of people with HIV in the USA, most of whom were black and with very low incomes, has found that only 51% fit the criteria of the ‘Swiss statement’ for being non-infectious. The other half either had detectable viral loads, despite taking antiretrovirals, or recent sexually transmitted infections. Three-quarters of this group had been in prison and this was the biggest risk for having unsuppressed HIV.
Low awareness of PEP in Spain
A Spanish study has found low levels of awareness and almost no use of post-exposure prophylaxis (PEP). Of the people polled, only a third of gay men and a sixth of heterosexual people knew about PEP; only 2% had ever used it. This compares with 56% of UK gay men knowing about PEP and the vast majority of gay men in Australia. The researchers urge that the availability of PEP be promoted.
Role preference is a better guide to HIV risk in Chinese gay men than reported behaviour
A study among gay men in China has found that the role gay men say they prefer to take in anal sex is a better guide to their HIV risk than asking them what they have actually done sexually. HIV prevalence in men who said they preferred to be ‘bottom’ or ‘versatile’ was 2.5 times higher than in men who said they preferred to be ‘top’ (18 versus 7%). On the other hand, when men were asked what they’d actually done with the last three partners, HIV prevalence was about 15% in men who had been bottom or versatile and 10% in men who said they had been top, and this was not a statistically significant difference.
Testing scale-up does not violate confidentiality
Efforts to scale up HIV testing in sub-Saharan Africa have not resulted in breaches of patient rights or the provision of poorer services, a study suggests. Some human rights campaigners had expressed fears that moves to large-scale opt-out testing would violate people’s right to refuse a test or their confidentiality if they tested positive. A high proportion of people (83%) met with a counsellor before testing; 90% reported they had given consent; 99% were provided with their test results and 74% received an appropriate onward referral.
Editors’ picks from other sources
Disagreement over PrEP trial in France
French HIV prevention activist group The Warning has issued a press release saying that the placebo arm of the IPERGAY randomised controlled study of intermittent PrEP should be dropped. This is in response to a press release by the French national HIV research agency, ANRS, which said it should continue (see the October edition of this bulletin). The Warning's position differs from those of other French community organisations, which range from support for IPERGAY as it is, to demanding PrEP be made available alongside the trial, to total rejection of it. See here for a summary of community reports to the trial co-ordinators (in French).
Novel approaches to testing for sexually transmitted infections, including HIV and hepatitis B and C in Europe
The European Centre for Disease Prevention and Control has launched a new report evaluating novel approaches to testing for HIV and hepatitis B and C in Europe.
Risky sex not unusual for kids born with HIV
In a cohort of teenagers infected with HIV at birth, nearly two-thirds of those who were sexually active reported unprotected sex, and 40% of them had viral loads over 5000 copies/ml.
Condoms treated with silver nanoparticles could ‘completely inactivate’ HIV, other STDs
Condoms have a 15% failure rate, so a University of Manitoba team tried soaking condoms in a solution packed with “remarkable” microscopic silver nanoparticles. The treated devices appeared to kill all HIV and herpes in lab experiments, the scientists report.
"I'm on antivirals and undetectable: what about safe sex?"
In a wide-ranging interview that poses difficult questions, Bob Leahy asks Toronto-based clinician/scientist Dr Rupert Kaul about how we can interpret risk of HIV transmission in the age of undetectable viral load.