Infectiousness
In the study, a low but detectable viral load (between 50 and 500 copies/ml) was associated with the presence of HIV in semen.
There is currently a lot of discussion about the effect of HIV treatment on infectiousness and the use of HIV treatment as prevention. Research conducted in heterosexual couples has shown that antiretroviral therapy that reduces viral load in the blood to undetectable levels (below 50 copies/ml) reduces the risk of sexual transmission by 96%.
But there have been rare case reports of HIV transmissions in the presence of an undetectable viral load.
Untreated bacterial sexually transmitted infections (STIs) such as chlamydia and gonorrhoea may cause viral load to increase in genital fluids, even if a person is taking effective antiretroviral treatment.
Doctors in the United States wanted to see if infection with human herpes viruses also had an impact on viral load in genital fluids.
They monitored blood and semen samples taken from 114 gay men. All were taking HIV treatment and had a blood viral load below 500 copies/ml (88% had a viral load below 50 copies/ml).
HIV was detected in the semen of 10% of the men. The average viral load in semen was low – 126 copies/ml. Whether or not this level of HIV in semen is associated with transmission is unknown.
Detection of HIV in semen was associated with the presence of two viruses of the herpes family – high semen levels of CMV (cytomegalovirus) and detectable EBV (Epstein Barr virus) in semen.
“The association between isolated HIV shedding and high-level CMV replication and EBV replication in the genital tract suggests that the presence of these viruses could play a role in HIV transmission…these findings have important implications for the development of strategies to reduce HIV transmission,” comment the researchers.
They also found that 36% of study participants with a detectable viral load were shedding HIV in semen compared to 6% of participants with an undetectable viral load.
A urethral bacterial STI was diagnosed in 4% of men, but these untreated infections were not associated with the presence of HIV in semen.
For more detailed information on HIV transmission, visit our online resource HIV transmission and testing.
Oral infection with HPV
Over half of HIV-positive men in a Dutch study had oral infection with human papillomavirus (HPV).
HPV is very common and most people will have it at some point in their lives. For most people, infection with HPV will cause no symptoms or problems and will go away on its own.
There are many different strains of HPV and persistent infection with high-risk strains of HPV can lead to the development of abnormal cells in the cervix or anus. These cells are not cancerous, but they have the potential to develop into cancer if not identified and, if necessary, treated.
Rates of anal and cervical cancer are especially high in people living with HIV.
Infection with high-risk HPV subtypes has also been linked to an increased risk of developing cancers of the head and neck.
Dutch investigators therefore wanted to see how many gay men had oral infection with HPV and to see if the prevalence of infection was higher among men with HIV.
Their research involved 767 men (41% living with HIV).
Overall, 40% of men had oral HPV infection. But prevalence was much higher in HIV-positive men compared to HIV-negative men (57 vs 27%).
The men with HIV also had a higher prevalence of infection with HPV strains associated with cell changes that can lead to cancer (25 vs 9%).
“HIV infection was strongly and independently associated with oral HPV infection,” the investigators comment. They suggest this could be because of “higher HPV exposure due to more sexual high-risk behaviour…an increased susceptibility for HPV infection in the oral cavity, and an increased HPV persistence due to immunosuppression.”
A vaccine that provides very high levels of protection against high-risk strains of HPV is available. The researchers suggest that it could be of value “particularly for HIV-infected men and others at increased risk of HPV-related head and neck cancer”.
HIV care
They found that patients were especially likely to keep an appointment if they believed their care provider knew them as a person.
Large numbers of HIV-positive patients in the United States drop out of care. This is a big concern, increasing their risk of illness and death and undermining HIV prevention efforts.
Investigators wanted to see if the quality of care provided by clinics was associated with keeping appointments.
The study involved 1363 people attending routine clinic appointments. Each person was asked to rate the quality of communication and relationship with their care providers in five key areas:
- Being treated with dignity and respect.
- Being involved in decisions about care.
- Feeling listened to.
- Having information explained in a way that could be understood.
- Feeling known as a person.
The study participants rated their care very highly. People who gave the highest possible ratings to their care provider as regards being treated with dignity and respect, explanations and listening were especially likely to keep their appointments.
But the factor most associated with clinic attendance was feeling known as a person.
Preparing for your next appointment with your HIV clinic? Try our online tool Talking points before you go: www.aidsmap.com/talking-points
Hepatitis C in the UK
The report highlighted a 300% increase in HCV-related deaths since 1996.
Serious concerns were also expressed about the future of HCV services, given recent changes in the NHS.
There are currently an estimated 214,000 people living with chronic HCV. But this figure is expected to increase to 370,000 by 2035.
Unless current treatment rates increase, by 2020 almost 16,000 people will be developing HCV-related cirrhosis each year.
However, UK diagnosis and treatment rates for HCV are far behind those seen in other European countries.
The report also showed that local authorities were unprepared for their new public health responsibilities related to HCV.
Approximately 3% of injecting drug users with HCV in Edinburgh receive HCV therapy each year. The latest research showed that doubling treatment rates could reduce the scale of the epidemic in this population by 50% over the next 15 years.
Editors' picks from other sources
The sound of stigma
from Poz
An essay by Mark S King – an AIDS advocate, an author and a blogger living with HIV since 1985 – on why HIV stigma among gay men persists.
No, HIV is NOT about to be cured in three months
from thebody.com
David Evans of Project Inform dissects the hype around the Sunday Telegraph story that HIV would be cured "within months". Contrary to some hysterically hyped headlines this past week, HIV is not on the verge of being cured in the next three months, nor have scientists found an effective vaccine. The truth is that a hopeful compound to force HIV out of hiding is under study, and the results should be known in the near future.
Queen's Speech signals a new Immigration Bill is on its way
from Migrants' Rights Network
Today we learned that Government is preparing a new Immigration Bill – despite ministers' acknowledgement that much of the detail behind the headlines is still missing. One aspect may be further restrictions on migrants' use of the NHS.