In this edition:
- Partner Notification Uncovers
- HIV Rate in
- One in Six Americans with HIV is Incarcerated
- Five Percent of HIV Carriers May Have “Superinfection”
- Diabetes Risk Increases With HIV Infection and Antiretroviral Therapy
- Syphilis Outbreak Triggers Detective Work
Partner Notification Uncovers
A new strategy of HIV testing along with partner notification allowed public health officials in
The investigation uncovered an invisible network of sexual liaisons involving 61 male students at 21 colleges who became infected with HIV within the past four years. Nearly all were infected through homosexual activity.
The investigation began in late 2002 when a new surveillance program run by the state health department identified two men attending different colleges in the same city who had just become infected. Health officials knew the infections were recent because both men had the virus in their blood but no antibodies-- a condition that lasts for only about two weeks after infection.
“When we saw that, we knew that something was going on,” said Lisa Hightow, an infectious-diseases physician at the
Following the chain of transmission led to 69 linked cases of HIV infection, 61 involving college students and 8 involving men outside college. The interviews revealed that the “network” was not something the infected people consciously belonged to or joined intentionally, but was a population of shared race, age, interests and geography in which the members found most of their sex partners.
No place, person or mode of contact appears to be driving the outbreak, the researchers said. It may be that HIV was introduced by chance into the small, closed population of gay black
The outbreak was described in detail at the 11th Conference on Retroviruses and Opportunistic Infections, the annual midwinter AIDS meeting held in the
“We believe that this may not be unique to college students or to
The outbreak became “amplified” not only because the pool of partners was small, but also because many people had sex soon after they became infected-- a time when the amount of virus in their bloodstream is often 10 times higher than it would be years later. The higher a person’s “viral load,” the more likely it is for that person to pass on the virus.
The investigators believe the cases represent an outbreak with a distinct beginning and not simply a steady state of HIV transmission. That is because they found the number of new HIV infections in college men has risen rapidly in just a few years. In 2000, there were six; in 2001, 19; in 2002, 29; and in 2003, 30.
Of that total of 84 new infections, 73 were in blacks and 11 in whites. (Not all became infected through the web of transmission that was the “network.”) About 60 percent of them reported having sex with men only; one third with both men and women; and 4 percent with women only. They attended 33 colleges in
The outbreak was identified in time for the authorities to ask
The testing that uncovered the cases is one done by the state health department, which processes 120,000 blood samples a year. Samples that test negative for antibodies to HIV are pooled in batches, and the batches are then tested for HIV genetic material with the highly sensitive polymerase chain reaction (PCR) method.
If a pool turns up positive, technicians can test the individual samples. This eventually leads to the single sample that contains HIV but not antibodies -- and, therefore, represents a brand-new infection. Doing this extra step adds about $2 to the cost of a standard HIV test, which is about $3.50, Leone said.
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HIV Rate in
Close to 4 percent of men living in
This statistic “quite overwhelming,” as is the finding that 2.8 percent of all men living in
Although data have been available for the number of AIDS cases, the reporting of HIV infections by
A substantial percentage (27 percent) of the individuals diagnosed with HIV infection since HIV infection reporting began also had AIDS. This represents a “missed opportunity” to provide early treatment and to prevent the further spread of infection, he said.
Lead investigator Dr. Denis Nash of the New York City Department of Health and colleagues reported the results of data collected on HIV infection as of
During this period there were 6,478 incident HIV diagnoses in
HIV infection rates were 5-times higher among non-Hispanic blacks and 2.5-times higher among Hispanics, compared with non-Hispanic whites.
Overall, as of the end of 2001, there were 75,550 people diagnosed with HIV/AIDS, including 3.9 percent of all men between the ages of 40 and 49 years, 2.8 percent of men living in
Dr. Nash’s group also found that the population of those diagnosed with HIV infection in 2001 differed from that of the rest of the HIV/AIDS population. Of the HIV cases diagnosed in 2001, there was a higher percentage of women (35 percent versus 30 percent), non-Hispanic blacks (53 percent versus 44 percent) and individuals between the ages of 39 and 39 years old (36 percent versus 29 percent).
These findings provide a more accurate picture of the HIV/AIDS epidemic in
New HIV infections among gay men have held at a steady rate of about 1,100 cases a year, according to Dr. Lucia Torian, director of the city Health Department’s HIV Epidemiology Program. But she said recent health department surveys show that more than half of the HIV-infected men in the city routinely have anal intercourse without using a protective condom.
“This is a prescription for a resurgent, explosive HIV epidemic,” Torian warned. “Have we seen it yet? No. Could we? Definitely.”
“Everybody should get an HIV test,” Torian said. “And every doctor should offer it routinely. It should be just like cholesterol screening.”
Since 1985, HIV has taken a larger toll in
[Reuters Health,
A recent rise in HIV in certain populations in
A new HIV test that can more accurately determine exactly when an individual became infected with the virus could soon be available in
STARHS - serologic testing algorithm for recent HIV sero-conversion - would be done after an HIV-positive test and reveal whether the person was infected within the last six to 12 months.
Knowing how long an individual has been infected could make it easier for doctors to decide on treatment options, said Kathy Thornson, HIV/STD prevention director for the Fort Wayne-Allen County Department of Health.
The test also will help researchers evaluate if “the people who are being reported for the first time have been living with HIV for a while or are ... newly infected,” said Michael Butler, director of the state’s division of HIV and STD. “Part of the program involves interviewing them to find out what types of risky behaviors they’ve engaged in, and to find out more about what may have led them to become HIV-infected,” he said.
Individuals who are HIV-positive are not required by law to inform the health department or a physician who their sexual contacts are. The spousal law - requiring anyone testing HIV-positive to inform any spouse they might have had in the past 10 years - is the only requirement.
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The Arkansas Health Department plans to limit enrollment in the state’s AIDS Drug Assistance Program (ADAP) at 500 because the entire state appropriation of $660,000 was cut last year by the Legislature and federal funding is expected to be about $900,000 short of the need. The program currently has almost 450 participants.
In 2002, 1,700 Arkansans were diagnosed with HIV, the virus that causes AIDS. More than 300 Arkansans test positive for the virus each year.
Medications can cost from $14,000 to $30,000 per patient a year.
The ADAP program serves Arkansans without Medicaid or private insurance.
[Associated Press,
One in Six Americans with HIV is Incarcerated
One in six Americans infected with HIV is behind bars, making jails and prisons important places to stop the spread of AIDS and big providers of health care to people who have it, researchers report.
Studies on HIV among prisoners were presented Tuesday at the 11th annual Retrovirus Conference, the chief
Prison populations are at an all-time high, and more than half the inmates are drug offenders, a group with a high prevalence of AIDS. The most recent U.S. Department of Justice report says that more than 2 million Americans are in jails or prisons and that more than 10 million pass through the system each day.
HIV infection is a risk not just when inmates are incarcerated but also when they’re released. About 11 million Americans are released each year and studies show that most have sex within a day of leaving, making it critically important to counsel them about “safer” sex, Joe Bick, a California Department of Corrections official, told the conference. “Theoretically, we can reduce the spread of disease in the community once inmates are released,” he said.
But first, officials have to find the prisoners who have the virus. Many don’t know they do, and those who are aware they’re infected often don’t disclose it because they fear repercussions in prison, Bick said.
In some states confidential testing is offered to all inmates, but many refuse because they think a blood or urine sample will be tested for drugs or DNA evidence, Bick said. All inmates in federal prisoners are required to be tested for HIV.
[The
Gonorrhea cases in
Efforts to get treatment for infected patients -- and to test their partners for infection -- have paid off in a continued decline in gonorrhea, Beilenson said. He also credited increased condom use among teen-agers and young adults.
At the same time, the city met a snag in its campaign to reduce and eliminate syphilis. The disease, Beilenson said, is rising among two hard-to-reach demographic groups: teen-age girls who have sex with older men, and men, often married, who identify themselves as heterosexual but have relations with men. Such men are particularly elusive because they don’t frequent places where public health appeals are made, Beilenson said.
Gonorrhea cases dropped 16 percent over the previous year and were 33 percent lower than they were in 1999, when
Last year, there were about 4,000 cases of gonorrhea. In the 1970s, Beilenson noted, it was common for
Syphilis cases rose from 121 cases in 2002 to about 135 cases last year, roughly a 10 percent increase. In the 1990s, syphilis cases typically topped 600.
In 2002, the city had the nation’s fifth-highest syphilis rate, 18.6 cases per 100,000 people. It also had the third-highest gonorrhea rate, 748 cases per 100,000. The federal government has not compiled national rankings for last year.
[The
An
Musser showed no reaction when the verdict was announced. He also faces two more trials, in March and April, on the same charge but involving different victims. The woman who accused Musser in the latest case testified that she tested positive for HIV a year after her last sexual encounter with Musser.
Musser testified that he told the woman of his HIV status and that he used a condom in all of their sexual encounters. The woman said protection was used only half the time. She said she asked him about his HIV status, but when he denied he had the virus, she believed him.
The woman said she and Musser had an off-and-on relationship for about six months. In February 2003, after seeing media reports of charges against Musser for criminal transmission of HIV, she called the
The jury deliberated for an hour before reaching a verdict.
[The Associated Press,
Five Percent of HIV Carriers May Have “Superinfection”
Researchers in
The Web site AIDSmap.com reported a San Diego researcher studied 78 HIV-positive people (90 percent were gay men) between 1997 and 2003, and found that superinfection took place anywhere from five months to a little over a year after initial HIV infection.
Three superinfected individuals-- all gay men-- were identified; but since the three all had multiple sex partners, researchers were not able to figure out when and where the men got infected. All three men also saw their viral loads increase and CD4 cell counts decrease after superinfection.
For years superinfection, which is the reinfection of someone who is already HIV-positive with another version of HIV, was a controversial issue, since many medical experts weren’t sure if it was possible.
In July 2002 a researcher at the international AIDS conference in
In April 2003 the medical journal AIDS reported on a man in
The study noted that it was possible that the men were infected with both strains of the virus at the same time, but that either way the 5 percent superinfection rate may be a conservative underestimate of current infection rates.
Superinfection is of great interest to vaccine researchers, since rising rates of superinfection could make the creation of a viable vaccine more difficult.
[Gay.com/PlanetOut.com Network,
Diabetes Risk Increases With HIV Infection and Antiretroviral Therapy
HIV-infected men have more than three times the risk of developing diabetes over a 3-year period than do those without HIV infection, according to the results of a prospective trial. And the use of highly active antiretroviral therapies (HAART) that include a protease inhibitor, d4T, or efavirenz, doubles the risk of hyperglycemia.
Dr. T. T. Brown of
Dr. Brown and colleagues used data from the Multicenter AIDS Cohort Study collected data between April 1999 and September 2002 to estimate the prevalence and incidence of pre-diabetes and diabetes.
The study included 563 HIV-negative and 544 HIV-positive men, 423 of whom were receiving HAART. The incidence rates of hyperglycemia and diabetes were determined in 618 men with a fasting plasma glucose of 105 mg/dL or lower and no history of diabetes mellitus or use of diabetes medications.
At baseline, 14 percent of the HIV-infected men had diabetes, compared with 5 percent of the HIV-negative men.
After controlling for age and body mass index, Dr. Brown’s group found that HIV-infected men on HAART had 1.8 times the risk of development diabetes or pre-diabetes of HIV-negative men. The risk of diabetes was 3.1 times greater in the HIV-infected men on HAART than in the HIV-negative men.
Exposure to a protease inhibitor, d4T, or efavirenz was associated with a 1.9-, 2.1-, and 3.9-times increased risk, respectively, of pre-diabetes or diabetes.
These findings provide a more quantitative estimate of diabetes mellitus risk in HIV-infected patients, the authors note. Furthermore, the results suggest that health care providers should be aware of diabetes as potential co-morbid condition among HIV- infected patients.
[Reuters Health,
Syphilis Outbreak Triggers Detective Work
For years, syphilis had been nonexistent in
When the outbreak first appeared in October 2001, Alan McNamara of the Pennsylvania Department of Health went to interview a man supposedly at his home address - a crack bar. The man was so indifferent to the women who had traded him sex for drugs that he refused to provide names. To learn who might be at risk, McNamara, a 52-year-old white man, had to instead become an insider in the man’s network.
At the same time, Dr. Jonathan Han started seeing syphilis cases at the
McNamara walks around city streets to see who is coming and going and to hear from the old ladies who know everything about a block. If the conversation suggests he is talking to someone at risk for syphilis infection, he then talks about the outbreak, trying to instill a sense of urgency about testing and treatment.
By January 2002, 12 people had tested positive, and McNamara focused on several pregnant prostitutes and crack cocaine users. But he was discreet: If people hear that a Health Department worker is looking for Jane Doe, they will assume Jane has AIDS, he said. During the outbreak, McNamara’s efforts have prevented four congenital syphilis cases.
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Preliminary figures from the state Health Department show a record number of chlamydia cases in
Kirby Kruger, manager of the state Health Department’s sexually transmitted diseases program, said 90 percent of the chlamydia cases are among people ages 15 to 29. “It definitely is a young person’s disease,” Kruger said.
He attributed the increase to more reliable tests as well as more cases. “Even though we are testing more people and we have better tests - we also think we have more prevalence of the disease,” he said.
Health officials also report 101 cases of gonorrhea in the state last year, compared with 72 the previous year and the most since 1999.
[Associated Press,
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The HIV Update is a weekly report of articles, studies and other information related to HIV/AIDS, sexually transmitted diseases and related risk behaviors compiled from various news sources by the Children’s AIDS Fund.
The Children’s AIDS Fund is a non-profit, non-partisan organization dedicated to helping limit the suffering of HIV-impacted children through direct assistance and resources, as well as through technical assistance for their parents and care-givers. For additional information, call (703) 471-7350. Previous editions of the HIV Update are available on-line at http://www.childrensaidsfund.org/news.asp
