This Week in HIV Research: Erectile Dysfunction in the Modern Age

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On the docket this week in the court of newly published HIV research:

  • Is HIV still guilty by association of reducing erectile function among men who have sex with men?
  • Will Australia and San Francisco realistically achieve UNAIDS 90-90-90 "fast track" targets?
  • Can hepatitis C infection act as a proxy for HIV risk among people who inject drugs?
  • Is the live herpes zoster vaccine safe for people living with HIV?

Follow along for a closer look at the verdicts. To beat HIV, you have to follow the science!

Barbara Jungwirth is a freelance writer and translator based in New York. Follow Barbara on Twitter: @reliabletran.

Myles Helfand is the executive editor and general manager of TheBody.com and TheBodyPRO.com. Follow Myles on Twitter: @MylesatTheBody.


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HIV Associated With Lower Erectile Function Among MSM

Men who have sex with men (MSM) and live with HIV are more likely to suffer from lower erectile function than MSM in the general population, a Dutch study published in AIDS found. The findings offer an updated examination of sexual dysfunction among an aging cohort of HIV-positive MSM in the Netherlands.

The study examined 399 MSM living with HIV and 366 controls age 45 or older who answered questions about sexual functioning as part of a larger questionnaire for the parent study, the AGEhIV Cohort Study. Among those living with HIV, exposure to lopinavir/ritonavir (Kaletra) was associated with lower erectile function. However, study authors cautioned that few participants were taking that antiretroviral in the modern treatment era, leading to a wide confidence interval.

Lower sexual desire and satisfaction among those living with HIV were attributed to the higher rate of depression among that group, rather than their HIV status or prescribed medications. Other psychological factors, such as fear of transmitting the virus, were not assessed and may have confounded the findings, researchers noted. They called for the development of targeted interventions for sexual dysfunction, also in light of reports of higher rates of unprotected sex among MSM with erectile dysfunction.


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Working Towards UNAIDS Targets in Australia and San Francisco

Achieving the UNAIDS 90-90-90 targets by 2020 in Australia would lower HIV incidence there by 10% compared to 2010 levels, a modeling study published in Clinical Infectious Diseases found. As we explained last week, these targets call for 90% of people living with HIV to be diagnosed, 90% of those diagnosed to be on treatment, and 90% of those taking antiretrovirals to be virally suppressed. Even in the best case, however, Australia will fall short of the UNAIDS "fast track" goal to reduce HIV incidence by 90% between 2010 and 2030, the study suggests.

One of the "fast track" cities is San Francisco, California. Another study in the same publication found that new HIV diagnoses in that city dropped substantially between 2009 and 2014. However, they were much higher among African-American men than white men: 140 versus 52 per 100,000 people. While most care indicators improved, retention in care did not. Study authors noted that 11% of 2014 diagnoses were among homeless people and that this population has been shown to be less likely to remain in care. They called for programs focused on vulnerable populations, if the city's HIV goals are to be met.


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Hepatitis C and HIV Seroconversion in People Who Inject Drugs

Hepatitis C (HCV) infection was associated with a greater risk of HIV seroconversion among people using injection drugs, a study published in AIDS showed.

Researchers followed 260 people who attended a harm reduction unit in Madrid, Spain, between 2013-2016 and did not live with HIV at baseline. This resulted in 331 person-years of observation -- a relatively small sample attributed to an unstable cohort due to periods of incarceration, abstinence and relapse. The overall incidence rate for HIV seroconversion was 3.8%; that rate rose to 5% for people living with HCV and dropped to 1.2% for those without that virus.

It is often difficult to assess HIV risk based on behavior, because stigma may prevent people from reporting needle share activities, study authors noted. HCV infection could be used as a proxy for this purpose, they argued. Authors called for implementing pre-exposure prophylaxis in this population as part of a comprehensive harm reduction package.


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Live Herpes Zoster Vaccine Safe for People With Suppressed HIV

A clinical trial published in Clinical Infectious Diseases found that the live attenuated herpes zoster vaccine appeared to be safe for people living with HIV who are virally suppressed.

In younger people with a fully functioning immune system, herpes zoster (shingles) usually clears up within 10-15 days. When the immune system is weakened, for example by HIV, herpes zoster can spread in the body, causing potentially fatal conditions, such as encephalitis.

Researchers randomized 395 people with undetectable viral loads and CD4 cell counts of 200 cells/μL or higher 3:1 to receive two doses of the vaccine six weeks apart or placebos. Participants were followed for another six weeks after the second dose.

The frequency and severity of adverse events was not significantly different, statistically, between the two arms. Antibody levels were higher in those receiving the vaccine compared to the placebo, indicating that the vaccine elicited an immune response. That response was greater among participants with CD4 counts ≥ 350 cells/μL compared to lower counts.

While the study findings support the safety and immunogenicity of the live vaccine, it was insufficiently powered to conclusively assess efficacy of the live vaccine or a recombinant adjuvanted vaccine for an HIV-positive population, study authors concluded.

The findings published in this study are similar to earlier data presented at the 2012 Conference on Retroviruses and Opportunistic Infections by Constance Benson, M.D., who is also the lead author of the newly published research.