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Top 10 HIV Clinical Developments of 2012

December 2012

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Black MSM and HIV: The News Is Not Good

A review of:

Kenneth Mayer, et al. An evolving concentrated epidemic: comparison of socioeconomic, behavioural and biological factors among newly diagnosed, previously diagnosed and HIV-negative black men who have sex with men in six U.S. cities (HPTN 061). 19th International AIDS Conference; Washington, DC; July 22-27, 2012; Abstract MOAC0105.

Beryl Koblin, et al. Correlates of HIV incidence among black men who have sex with men in 6 U.S. cities (HPTN 061). 19th International AIDS Conference; Washington, DC; July 22-27, 2012; Abstract MOAC0106.

One of the most striking, if not horrifying, stories of 2012 comes from HIV Prevention Trials Network (HPTN) 061, a.k.a. the BROTHERS study. This is a longitudinal study of black MSM (BMSM) recruited in Atlanta, Boston, Los Angeles, New York City, San Francisco and Washington, D.C., to determine the feasibility of a risk reduction intervention. More than 1,500 men were enrolled, a third of whom under the age of 30. The findings of this study starkly reveal where HIV is and where it is heading.

An incredible 11% of the men recruited were known to be HIV infected at entry. Another 10% were newly diagnosed with HIV on study entry (including 3 with acute infection).

So, let's stop there: Over 20% of BMSM in recruited in these cities were HIV infected. It should be acknowledged that, to get into the study, a man must have had unprotected anal intercourse with a man in the prior 6 months. But still, this is an incredibly high number.

It gets worse.


Of the 1,009 men who were uninfected at baseline and had follow-up data over a year, 26 became HIV infected during the study (annual incidence of 2.8%). Your jaws should be dropping.

Of these 26 young men, 20 were between the ages of 18 and 30 years, 19 had sex exclusively with men and 20 had an income less than $20,000 per year. In addition, those who self-identified as gay or homosexual were at greater risk of seroconversion -- and, not surprising, so were men reporting unprotected sex and those with a sexually transmitted infection at baseline. A separate report found that 60% of the HPTN 061 cohort had been incarcerated and that 24% were locked up during the study, providing another potential opportunity to intervene.

These are extremely concerning results. The prevalence and incidence of HIV among the men studied was astounding, about an order of magnitude greater than that seen in a similar HPTN study of women living in areas where poverty and HIV prevalence were common.

Our reflexive demands for action need to be accompanied by realistic and scalable interventions that can meaningfully reduce the transmission of HIV by and to BMSM. The HPTN study provides a roadmap. The correlates of infection (youth, poverty, gay identity) reveal points to leverage. The fires are burning. Will we respond?

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Reader Comments:

Comment by: Ashley (QMsiijnYJx) Thu., Jan. 10, 2013 at 10:18 am UTC
the HIV virus is very fragile once it is oudtsie of the human body. when it is exposed to the air, it dies in about 2 hours. so, dried semen will only have dead HIV cells. you are safe.
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Comment by: Mani (UubwaSyASLWZnBAlN) Thu., Jan. 10, 2013 at 9:29 am UTC
I've talked to both my patrens about it at differnt times. My mom thinks it nessasary. She knows that teens r going to have sex and they need to be educated.My dad thinks its better to be educated then to not know anythingI think sex-ed is needed for everyone. I never though my dad (the republican who was in the army) Would be so libral
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Comment by: harleymc Tue., Dec. 25, 2012 at 11:02 pm UTC
I was very happy to read this article.
I'm someone who's been on combinations containing boosted PIs and suffer badly with them. When my current script runs out in a few days I'll be switching to TDF/FTC/rilpivirine + raltegravir (already on the raltegravir). It was reassurring to read of an improvement in outcomes.

It's one thing to have a fabulous viral load but when side effects are both vile and life threatening, a change sounds brilliant.
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Comment by: Anonymous Mon., Dec. 17, 2012 at 10:48 am UTC
good message of hope
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Comment by: Sean (Dublin, Ireland) Fri., Dec. 14, 2012 at 6:38 am UTC
Thanks for the section called "The Cure Agenda". If YOU are feeling optimistic, that makes me feel optimistic.

Happy Yule!
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Comment by: Patrick D (South Deerfield, MA) Thu., Dec. 13, 2012 at 3:56 pm UTC
Dr. Wohl writes "In the past, I have played with the HIV therapies of patients doing well, and on more than a few occasions I have been burned," then describes some of the benefits that may come from switching from a more complex drug regime to a more simplified one. Dr. Wohl clearly has his patients best interests in mind, but I want to remind him that when a switch in meds fails (temporarily or permanently) for patients who had been doing well on an older regime, it isn't the doctor who gets burned, it's the patient. I have had occasion to remind my own doctors of this, when they seem to want to fiddle with a regime that is working perfectly well, with negligible side effects, for no other reason than to put their signature on my treatment.

It can indeed be a benefit to simplify a drug regime, especially for patients who have trouble taking their meds in the first place. But as I've reminded several doctors, for many HIV patients, HIV drugs are not the only drugs we're taking (and that's not taking supplements into account), so simplifying the HIV drug regime alone doesn't result in not taking other drugs at other times of the day, and thus may not be a strong reason for changing a regime that's working.
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