This Week in HIV Research: Many Black MSM on PrEP Are Already Positive

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Welcome! Thanks for stopping by to browse our latest selection of HIV-related research published in peer-reviewed journals. We span a wide range of topics in this week's collection of study summaries, including:

  • Surprisingly high HIV prevalence rates among black men who have sex with men (MSM) who are currently using pre-exposure prophylaxis (PrEP).
  • A link between substance use reduction and a lessening of depressive symptoms among people with HIV.
  • A glimpse into just how common pain symptoms are among people with HIV, even younger people.
  • A longitudinal look at the impact of seroconversion and antiretroviral therapy on risk behaviors.

Feel free to keep reading to peruse our wares more closely. 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 and TheBodyPRO. Follow Myles on Twitter: @MylesatTheBody.

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High HIV Prevalence Rates Found Among African-American MSM Using PrEP

One in three African-American MSM who reported that they currently use PrEP was found to be living with HIV, a study published in the Journal of Acquired Immune Deficiency Syndromes showed.

Participants -- who were recruited at Black Gay Pride events in the U.S. between 2014 and 2017 -- filled out a questionnaire and were offered on-site HIV testing. Of the 3,512 men who accepted, 32% of current PrEP users turned out to be HIV positive; by comparison, HIV prevalence was found to be 20% among men who reported no current PrEP use.

Inability to afford health care coverage was reported more frequently among PrEP users who tested positive. In addition, among a subset of participants who were asked questions about PrEP access, only 76% reported getting their PrEP from a health care provider; this suggests many PrEP users may not be getting routinely tested for HIV and sexually transmitted infections, and that side effects are not monitored, study authors wrote. They stressed that the relatively high rate of seroconversions was likely due to inadequate adherence rather than medication failure.

"The current findings, in sum, should be interpreted as a call-to-action for public health and medical officials to carefully monitor the rollout and impact of PrEP," they concluded.

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Reducing Substance Use Also Lowers Depressive Symptoms in People With HIV

Among people living with HIV (PLWH), less use of illicit substances is associated with improvements in depressive symptoms, even among people who do not stop using substances altogether, a study published in the Journal of Acquired Immune Deficiency Syndromes showed. This was especially true for amphetamine-type substances (ATS), mainly methamphetamine.

At baseline, 40% of 9,905 PLWH enrolled in the Centers for AIDS Research Network of Integrated Clinical Sites cohort reported using one or more substances. Most (3,277) used marijuana, followed by ATS (1,016), crack/cocaine (728) and illicit opioids (290). Depressive symptoms were measured using the self-administered PHQ-9 questionnaire -- higher scores mean more severe depression, with a maximum score of 27. PHQ-9 scores dropped by a mean of 2.2 points for those who stopped ATS and by 1.7 points for those who used ATS less frequently. Improvements were also seen in those who stopped or reduced marijuana use or stopped using cocaine/crack.

"These results suggest that there may also be a role for treating depression in parallel with efforts to treat substance use disorders," study authors concluded.

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Study Explores Pain Rates Among People With and Without HIV

Younger (< 50 years) PLWH reported pain at similar rates as older (≥ 50 years) people not living with the virus (62.7% versus 63.7%), a British study published in AIDS showed. The highest rates of pain in the study (70%) were reported by older PLWH.

In the study, 882 of 1,325 participants reported pain during the last month, and 580 said they were currently in pain. Fifty-nine percent of the 882 people reporting pain said they had consulted a doctor about it, and 15.3% used analgesics to manage it. In all three arms, current pain was associated with lower likelihood of full-time employment, and 13.6% had missed work or study because of pain. PLWH who experienced pain were more likely to have depressive symptoms and a poorer quality of life than those without pain.

"Interventions are required to assist clinicians to proactively manage pain in their patients, and to assist PLWH to communicate their pain to clinicians and to self-manage pain and related symptoms," study authors concluded.

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Risk Behaviors Drop After Seroconversion, Especially in More Recent HIV Treatment Era

Historically, MSM engaged in fewer risk behaviors after HIV seroconversion, and the rate of such behaviors dropped even further after highly active antiretroviral therapy (HAART) became available, according to data from a large prospective cohort study published in AIDS.

Researchers compared the self-reported behaviors of 558 MSM who enrolled at various time points between 1984 and 2008 in the Multicenter AIDS Cohort Study. After acquiring HIV, participants were less likely to have ≥2 partners (adjusted odds ratio [aOR] for any sex was 0.371, and for insertive anal sex was 0.360), or to drink heavily (aOR: 0.704). After the advent of HAART, a term commonly used in the late 1990s and 2000s to describe HIV treatment regimens consisting of multiple drug classes, the aOR for multiple partners declined further, to 0.219.

The fixed-effects model used in the study controlled for individual levels of propensity for risk but did not account for changes in such propensity over the course of a person's life. Nonetheless, results imply a need for continuing investment in the HIV care continuum to expand on positive behavioral changes after HIV testing, study authors concluded.