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Attitudes towards men who ‘bareback’ are a barrier to wider use of PrEP

National Aids Manual (UK) - 15/01/2018
Two new qualitative studies from Toronto shed light on how stigma affects the uptake of pre-exposure prophylaxis (PrEP) and the experience of taking it. In the first, young gay men acknowledged that they did not always use condoms but did not see themselves as the kind of ‘barebacker’ for whom they thought PrEP was

Faster action on adherence is needed after viral load becomes detectable, researchers warn global treatment programmes

National Aids Manual (UK) - 12/01/2018
Low-level HIV viral load, above the limit of detection, is an important warning signal for future treatment failure and World Health Organization guidelines on spotting treatment failure need to be revised to encourage greater vigilance and swifter action by healthcare providers in lower- and middle-income settings, investigators report in The Lancet Infectious Diseases. The study,

Withdrawing Depo-Provera contraceptives would result in more lives lost than HIV infections prevented

National Aids Manual (UK) - 11/01/2018
Even if Depo-Provera and other contraceptive injections raise the risk of HIV infection, withdrawing them from use in African countries would greatly increase maternal mortality, a modelling study has shown. The loss of life due to pregnancy complications and unsafe abortions would far outweigh the number of HIV infections prevented, according to the study published in

New 'mini-pillbox' device could deliver three HIV drugs in a single once-weekly dose

National Aids Manual (UK) - 09/01/2018
A new oral device that is taken once a week in a capsule could deliver two or three antiretroviral drugs and significantly reduce the risk of missing does or of developing drug resistance, according to research published today in Nature Communications. The investigators describe their device as a 'mini-pillbox' – no

Twice the rate of bone loss among ART-treated women than men

National Aids Manual (UK) - 09/01/2018
Bone mineral density declines twice as quickly among HIV-positive women than HIV-positive men, according to Italian research published in the online edition of the Journal of Acquired Immune Deficiency Syndromes. The study is the largest ever analysis of long-term changes in bone mineral density (BMD) in HIV-positive people, over three-quarters

High prevalence of emphysema in middle-aged HIV-positive smokers

National Aids Manual (UK) - 08/01/2018
HIV infection is associated with airway obstruction, French investigators report in AIDS. Middle-aged HIV-positive smokers were matched with HIV-negative smokers of the same sex and age. After controlling for potential confounders, the investigators found a significant association between HIV and airway obstruction, an association that persisted after controlling for history

High cholesterol and diabetes common among people on HIV treatment in Malawi

National Aids Manual (UK) - 04/01/2018
High LDL cholesterol levels and diabetes are much more common in people living with HIV on long-term antiretroviral treatment in Malawi compared to people of a similar age without HIV, especially in people over 60, a study conducted in Chiradzulu, Malawi, has found. The findings, published in the journal AIDS,

Diabetes in people with HIV over 50 overwhelmingly linked to old antiretrovirals, not age or body weight

National Aids Manual (UK) - 03/01/2018
People with HIV over the age of 50 are more likely to have developed type 2 diabetes if they started antiretroviral treatment before 1999 or had a longer exposure to older antiretroviral drugs such as stavudine (d4T) or first-generation protease inhibitors such as nelfinavir or indinavir, according to a study

Middle-aged HIV-positive people have increased risk of 'silent' cerebral vascular disease linked to more severe health problems

National Aids Manual (UK) - 02/01/2018
Prevalence of silent cerebral small-vessel disease (CSVD) – an important precursor to more serious neurocognitive conditions – is significantly higher among middle-aged HIV-positive people compared to controls in the general population, according to French research published in Clinical Infectious Diseases. After controlling for age, blood pressure and other traditional risk factors,

Dolutegravir and lamivudine potent and safe in people starting HIV therapy for the first time

National Aids Manual (UK) - 28/12/2017
The two-drug antiretroviral combination dolutegravir and lamivudine is virologically effective and safe in people starting HIV therapy for the first time, according to US research published in the online edition of Clinical Infectious Diseases. The phase 2 pilot study recruited 120 antiretroviral-naïve adults. After 24 weeks of treatment, 90% of participants had viral suppression and none

People with high viral load most likely to report sex that could pass on HIV

National Aids Manual (UK) - 18/12/2017
People with HIV who had high viral load were more likely to report vaginal or anal sex without a condom with a partner of unknown or different HIV status, a US study of people with detectable viral load has found.Viral loads tended to be lower among those people with a

Baseline CD4 count biggest factor in long-term immune system improvements after starting HIV therapy

National Aids Manual (UK) - 14/12/2017
Pre-treatment CD4 cell count is the most important factor in immune recovery following the initiation of combination antiretroviral therapy (cART), according to the results of a large observational and modelling study published in HIV Medicine. The 7600 people included in the analysis all had an estimated date of seroconversion. The average CD4 cell count

Progress on the 'Third 90' target is not a reliable guide to HIV transmission potential, South African study shows

National Aids Manual (UK) - 13/12/2017
Measuring the proportion of people with an undetectable viral load may be lulling health policymakers into a false sense of security in their efforts to control HIV transmission through comprehensive treatment, according to a new study from South Africa. Undetectable viral load has been adopted “as a proxy for ART [antiretroviral

People with HIV less likely to be prescribed key drugs to reduce cardiovascular risk

National Aids Manual (UK) - 12/12/2017
Physicians in the United States are less likely to prescribe key recommended medications for the prevention of cardiovascular disease to people with HIV compared to HIV-negative individuals, according to research published in the Journal of the American Heart Association. Prescription rates for aspirin, antiplatelet medications and statins were markedly lower

People with HIV who are undiagnosed and those with detectable viral load less likely to use condoms, South African study finds

National Aids Manual (UK) - 07/12/2017
People with HIV who don't use condoms consistently are more likely to be unaware they are HIV-positive or to have a detectable viral load when their HIV infection has been diagnosed, according to research conducted in South Africa and published in Nature Scientific Reports. “We found that those unaware of their

HIV-positive transgender men in US have significant unmet medical and social needs

National Aids Manual (UK) - 06/12/2017
HIV-positive transgender men in the United States have significant unmet social and healthcare needs, according to a study published in Research and Practice. Approximately half were living in poverty and only 60% had sustained viral suppression. “Many transgender men receiving HIV medical care in the United States face socioeconomic challenges and suboptimal health outcomes,” write the

HIV drug resistance now high enough to trigger a change in first-line treatment in eastern and southern Africa

National Aids Manual (UK) - 04/12/2017
HIV drug resistance is increasing rapidly in southern and eastern Africa and Latin America and, as a result, it may soon be necessary to change the recommended first-line antiretroviral drug regimen in many countries to integrase inhibitor-based treatment, according to an analysis published in The Lancet Infectious Diseases on 30 November. The

ART reduces prevalence of cervical infection with high-risk HPV, pre-cancerous cell changes and cervical cancer

National Aids Manual (UK) - 04/12/2017
Antiretroviral therapy (ART) is associated with a lower prevalence of high-risk cervical human papillomavirus (HPV) infection in women with HIV, according to the results of a meta-analysis published in The Lancet HIV. Prevalence of high-grade pre-cancerous HPV-related cervical lesions and invasive cervical cancer was also lower among ART users. “This is the first meta-analysis to investigate

Many Americans still get their HIV diagnosis years after infection

National Aids Manual (UK) - 30/11/2017
Many people with HIV in the United States are still being diagnosed with HIV late, and therefore not getting the full therapeutic and prevention benefits of starting antiretroviral therapy (ART) early, according to the latest Vital Signs report from the US Centers for Disease Control and Prevention (CDC), released in advance of World AIDS Day. People at

HIV testing rate among children and adolescents boosted after caregivers receive a cash incentive

National Aids Manual (UK) - 29/11/2017
Children and adolescents are more likely to be tested for HIV if their parents or caregivers are offered a cash incentive, according to the results of a study conducted in Zimbabwe and published in The Lancet HIV. Offering the small cash incentive more than doubled the proportion of children undergoing