Expanding recreational use of Viagra and crystal methamphetamine is apparently behind a rise in HIV, syphilis, and other STDs among gay and bisexual men in the United States, according to new studies reported at the 2004 National STD Prevention Conference.
Dr. Samuel J. Mitchell of the San Francisco Health Department (SFHD) said a study found that 17.4 percent of 1,263 gay men who had gone to the city's STD clinic reported using crystal in the four weeks prior to their visit. Crystal users were more than twice as likely as nonusers to have HIV, 4.9 times as likely to receive a diagnosis of syphilis, and 1.7 times as likely to test positive for gonorrhea.
In a study of 388 gay men, Dr. Gordon Mansergh reported his CDC team and the SFHD found that 16 percent had used crystal the last time they had anal sex. The study found that crystal users were twice as likely as nonusers to have engaged in unprotected receptive anal intercourse. In the men's last anal sex encounter, 6 percent had used Viagra, and the Viagra users were 6.5 times more likely to report having had unprotected insertive anal sex during that encounter. Viagra was not linked to receptive anal risk behavior.
Another study found that gay men who used both Viagra and crystal together were 6.1 times as likely to be diagnosed with syphilis as those who did not use either drug, reported SFHD's Dr. William Wong.
For three consecutive years through 2003, syphilis rates fell by 50 percent among women, but increased by 65 percent among men. "We are very, very concerned" about the trend, said Dr. Ronald O. Valdiserri, deputy director of CDC's National Center for HIV, STD and TB Prevention, at a news conference at the meeting.
Seattle health officials also reported a sharp spike among gay men in cases of gonorrhea resistant to the commonly prescribed antibiotic ciprofloxacin. From October-December 2003, ciprofloxacin-resistant gonorrhea accounted for 22 of 133 cases (16.5 percent) compared with 6 of 159 cases (3.8 percent) from July-September 2003; the overwhelming majority of cases were among gay men. Such drug-resistant gonorrhea has also been reported in New York and Boston. (New York Times, 03.11.04, Lawrence K. Altman)
About 6,000-7,000 HIV-positive women give birth each year in the United States, resulting in more than 300 infected infants, according to CDC estimates. Early detection of HIV is crucial. With HIV drugs, infected people can suppress the virus, which is essential to reducing mother-to-child transmission. Although typically only federally funded clinics make HIV testing routine for expectant women, CDC recommends that HIV screening be part of the standard set of tests for all pregnant women.
"Women are feeling well. They're living longer with the disease; they have confidence that they're going to be alive to see this child grow," said Dr. Judy Aberg, director of HIV services for Washington University's Department of Medicine in St. Louis, Mo. Aberg said the risk of transmitting the virus from mother to child can be as low as 1 percent if the mother is on medication during pregnancy. Without prenatal treatment, the risk increases from 25 to 40 percent. But research has shown that even women who forgo treatment can receive intravenous medicine during labor that can significantly reduce the chance of transmitting the virus.
Catherine Williamson, a nurse practitioner at a St. Louis private practice that sees many HIV/AIDS cases, calls it a "wonderful trend" that women are living longer and having healthy babies. She cautions, however, against HIV patients being unrealistic about their condition. "The truth is," she said, "in the real world, people are still getting advanced AIDS and still dying." (Chicago Tribune, 03.10.04, Eun-Kyung Kim)
Under a partner notification program run by the New York City Health Department, scores of people have been identified for HIV testing. "One way we can stop the spread of HIV is to contact partners of infected people who may be afraid or ashamed to do it themselves," said Susan Blank, assistant commissioner of the Health Department's STD control program, according to Sunday's New York Post. The department diagnosed 485 people as HIV-positive in 2002, and those patients gave the names of 241 sex partners. Of the sex partners, 99 consented to testing, and 25 partners were HIV-positive, the department said. A department survey last year reported that while some 80,000 city residents have HIV/AIDS, as many as 20,000 others may be infected but not know it. (Associated Press, 03.14.04)
Researchers reported Monday that HIV patients have a sharply higher risk of atherosclerosis -- clogging and hardening of arteries -- and the disease appears to progress quickly. "In the HIV patients, the extent of atherosclerosis was associated with classic cardiac risk factors such as age, cholesterol levels, cigarette smoking and high blood pressure," said Dr. Priscilla Hsue, assistant professor of medicine at University of California-San Francisco.
Hsue and colleagues studied 148 HIV patients, who were on average 45 years old, infected for 11 years, and undergoing treatment with drug cocktails including protease inhibitors for 3.3 years. Researchers used ultrasound to measure the thickness of the carotid arteries. Thickness of this artery is an indication of atherosclerosis.
The average carotid was significantly thicker in HIV patients than among the 63 age- and gender-matched healthy HIV-negative patients. Buildup of fatty plaque was found in 45 percent of HIV patients compared with 24 percent of non-infected patients. A year later, the arteries of some HIV patients had grown thicker, and the rate of thickening was more rapid than in HIV-negative patients.
Drug cocktails used to treat HIV can have side effects including raised cholesterol and changes to metabolism. HIV infection itself could be a cause, said Hsue, because those patients with the most damaged immune systems had the worst atherosclerosis.
"Our finding suggests that it would be reasonable to consider HIV infection a cardiac risk factor," Hsue said. "Other risk factors, such as high cholesterol and high blood pressure, need to be aggressively treated in HIV patients -- even if it means changes in their HIV medications to control cholesterol levels," she said. (Reuters, 03.15.04)
New York state's refusal to treat hepatitis C-infected inmates serving short sentences does not jeopardize their chances of ultimately beating the virus, the prison system's top doctor told skeptical state Assembly committee chairs Tuesday. "We just don't feel it's wise to start something we can't finish," said Dr. Lester Wright, chief medical officer for the state Department of Correctional Services, adding that hepatitis C is unlike other diseases in state prisons -- such as HIV or TB -- that compel immediate treatment upon detection.
The Assembly's health committee chair, Richard Gottfried (D-Manhattan), and Jeffrion Aubry (D-Queens), chair of the Assembly's corrections committee, remained critical of the prison's policy of treating HCV-infected inmates only if they are incarcerated for the year needed to complete the drug regimen. Consequently, just a few hundred of the estimated 9,200 inmates who show signs of HCV infection are treated while incarcerated.
According to Wright, released inmates do not have particularly good histories of follow-up with doctors and sticking to health care routines. Prison officials have also had difficulty in lining up HCV-treatment programs outside of prisons for inmates released unexpectedly, prior to treatment conclusion. "Treatment ends up with large gaps in it, which is not good health care," said Wright. Discontinuing the treatment schedule could make later attempts to treat HCV impossible, added Wright.
Gottfried said treatment for inmates is often delayed because they cannot become immediately eligible for Medicaid upon their release, and he urged for a plan allowing the paperwork for Medicaid to be started well in advance of the end of inmates' sentences. Dr. Guthrie Birkhead, director of New York's AIDS Institute, said social service officials are hesitant to accept Medicaid applications for people who do not apply in person and who are not currently living in the local district. (Associated Press, 03.15.04, Joel Stashenko)
According to new US study of 1,132 HIV-infected women, women with advanced-stage HIV can benefit greatly from highly-active antiretroviral therapy (HAART) treatment. "Prior to this study, it was believed that many patients with advanced-stage HIV would not do very well with HAART," noted Dr. Kathryn Anastos, principal investigator in the 6-year, National Institutes of Health-sponsored study, and an attending physician and associate professor of medicine and epidemiology at Montefiore Medical Center. "Our study shows that is not the case. It is tremendously exciting news for patients who, for a variety of reasons, do not start HIV therapy early."
To assess the effectiveness of HAART, the researchers measured HIV markers in the blood of patients. "We found that low CD4+ counts and high viral load prior to treatment do not matter in determining the outcome for HIV-infected patients, as long as those numbers improved," Anastos said. "Only post-HAART treatment levels of these markers matter in determining a patient's chances of survival."
Anastos and colleagues found that, "Even in women with advanced immunologic abnormalities, HAART that raises the CD4+ cell count to greater than 200 cells/µL and reduces HIV-1 RNA levels to less than 10,000 copies/mL effectively mitigates the negative prognosis associated with low CD4+ cell counts and high HIV-1 RNA prior to therapy."
However, "There are still some patients who do not respond to therapy with improved laboratory values of CD4+ count and viral load, and thus may not do well clinically," the authors wrote.
The importance of the study was underscored by an accompanying editorial that noted that many HIV-infected patients in the United States are not receiving treatment until after they become sick with AIDS. For these patients, the editorial states, the study is "encouraging because it shows them that most patients with very late-stage illness benefit from antiretroviral therapy." The researchers used data from the Women's Interagency HIV study, the nation's largest ongoing study of women and AIDS, now in its 11th year.
The study, "The Prognostic Importance of Changes in CD4+ Cell Count and HIV-1 RNA Level in Women After Initiating Highly Active Antiretroviral Therapy," was published in the Annals of Internal Medicine (2004;140(4):256-264). (Women's Health Weekly, 03.11.04)
This article was provided by Body Positive. It is a part of the publication Body Positive.