Denial of Risk Behavior Does Not Exclude Asymptomatic Anorectal Sexually Transmitted Infection in HIV-Infected Men

via PLoS ONE, by Edward R. Cachay, Amy Sitapati, Joseph Caperna, Kellie Freeborn, Joseph T. Lonergan, Edward Jocson, William C. Mathews, for the Owen Clinic Study Group


Background:

The Centers for Disease Control recommend screening for asymptomatic sexually transmitted infection (STI) among HIV-infected men when there is self-report of unprotected anal-receptive exposure. The study goals were: (1) to estimate the validity and usefulness for screening policies of self-reported unprotected anal-receptive exposure as a risk indicator for asymptomatic anorectal infection with Neisseria gonorrhoeae (GC) and/or Chlamydia trachomatis (CT). (2) to estimate the number of infections that would be missed if anal diagnostic assays were not performed among patients who denied unprotected anorectal exposure in the preceding month.

Read the entire article.

High prevalence of anal chlamydia in Swiss HIV-positive gay men

via Aidsmap, by Michael Carter

A large proportion of HIV-positive gay men in Switzerland have anorectal infection with chlamydia, investigators report in the November15th edition of Clinical Infectious Diseases. The researchers suggest that undiagnosed anal chlamydia infections could be contributing to the continued spread of HIV amongst gay men in Switzerland.

Gay and other men who have sex with men remain the group most affected by HIV in many industrialised countries, including Switzerland. Sexually transmitted infections also disproportionately affect gay men. If left untreated these infections, including chlamydia, can significantly increase the risk of acquiring HIV. As reported on aidsmap.com UK investigators found that many chlamydia infections in gay men were in the rectum, and that HIV-positive gay men were disproportionately affected by rectal chlamydia

Investigators from the Swiss HIV cohort therefore postulated that anorectal chlaymdia infection could be contributing to the ongoing HIV epidemic amongst gay men in the country.

They therefore screened 147 HIV-positive men who reported unprotected receptive anal sex in the previous two years for the infection. The aims of their study were to determine the prevalence and symptoms of anorectal chlamydia, and to see if they could identify any risk factors associated with the infection.

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IRMA NIGERIA holds Microbicides Sensitization Forum

SENSITIZATION PROGRAM FOR HIV/AIDS SUPPORT GROUP, SEX WORKERS AND SOME HEALTH WORKERS IN ALIMOSHO LOCAL GOVERNMENT, LAGOS STATE, NIGERIA.

IRMA NIGERIA organized a sensitization program on Microbicides development on the 6th of June, 2009.

Report by Kadiri Audu
IRMA Steering Committee member




Attendance:

HIV/AIDS Support group 32 people

Sex workers 20 people

Health workers 9 people

Total 61 people



Aim: To create awareness about Microbicides Development and to encourage the participants to get involved in the process.

Analysis: Questionaires were administered at the event to estimate the level of awareness of participants about Microbicides Development.

o 57% of the participants have never heard about Microbicides.
o 15% heard about it but require more information
o 15% heard about it but do not know what it is or how it works.
o While 13% are familiar with Microbicides development.

Some of the questions asked at the event were:
o When would Microbicides likely to be available?
o How much would it cost?
o Would it be supplied for free?
o How are trial volunteers recruited?
o What if I want to volunteer?

Outcome: The outcome was quite encouraging because all the participants showed a level of understanding and 38 people joined IRMA NIGERIA.

Presentation: The paper presented at the event is below.


PAPER PRESENTATION: MICROBICIDES SENSITISATION SYMPOSIUM

ORGANISED BY IRMA NIGERIA

WHAT IS MICROBICIDES?
Microbicides are products that could be applied vaginally and that would reduce the transmission of HIV during sexual intercourse. A Microbicides could take the form of a gel, film, suppository, sponge, cream, vaginal ring or other delivery method that releases the active ingredient gradually.

THE NEED FOR MICROBICIDES:
Giving women power over AIDS. The power for women to enjoy safe sex, without negotiating with a sex partner.

KEY ISSUES IN MICROBICIDES DEVELOPMENT:
• Timing – if the handfuls of Microbicides candidates that are currently in advanced clinical trials prove to be effective, a Microbicides could be ready by the end of 2010.

DRUG DEVELOPMENT:
Drug development generally, is a long and complicated process. It takes 10 – 15 years between discovery of a promising lead and its availability on the market.
• Many candidates fail before one ever proves both safe and effective.
• The development stage needs many different candidates which use different mechanisms of action.

MAKING MICROBICIDES AVAILABLE TO PEOPLE LIVING IN THE DEVELOPING WORLD:
• The Microbicides field is committed to making the product available to firstly, those who need them most.
• Public sector developers and advocates are working hard to ensure that innovative vaccines and Microbicides will be accessible and affordable to the people who need them most.
• It is possible that Microbicides would be licensed first in a country where HIV prevalence rate is high rather than countries with low risk.

NATURE OF CLINICAL TRIALS:
• Pre-clinical trials – This is a stage where identified Microbicides candidates pass through a series of rigorous tests in a laboratory and animals before they are allowed to be tested on human beings.

Clinical trials:
• Phase I – phase I trials are conducted to determine whether the product is safe if used by a small number of volunteer participants over a few weeks, usually 1-3 weeks with 20 – 30 participants
• Phase II – phase II also test for safety of the product but over a longer period of time and with a larger number of participants; 6-18 months, 200-400 participants
• Phase III – phase III trials measures effectiveness; that is weather or not Microbicides actually works in the course of normal use to prevent HIV and STIs. 1-2 years, thousands of participants are enrolled at this stage.
NOTE:
• Frequently, clinical trials need to be repeated to confirm their result or to test the findings in different population.
• The product must be reviewed and licensed for use by at least one drug regulatory agency.

RECTAL MICROBICIDES:
These are products that could be applied rectally and that would reduce the transmission of HIV during anal intercourse and prevent infection.

THE NEED FOR RECTALMICROBICIDES:
• Vaginal Microbicides might not be safe for rectal use
• There are people who engage in anal sex world over

ISSUES AROUND RECTALMICROBICIDES:
• Stigmatization
• Human rights
• Rectal safety of vaginal Microbicides

CROI - Sex Gels Show Protection in Women, Monkeys; plus PrEP news

via Bloomberg

A vaginal gel made by Indevus Pharmaceuticals Inc. showed first signs that such a product might protect women from the AIDS virus.

Women who used the gel were 30 percent less likely to become infected with the virus than those using no gel or an unmedicated product, said Salim Abdool Karim, a Columbia University researcher who presented the study today at an AIDS meeting in Montreal (CROI - Conference on Retroviruses and Opportunistic Infections.) While the finding didn’t pass a test for statistical significance, it should spur further examination of Lexington, Massachusetts-based Indevus’s product, he said...

---- snip

...U.S. government research presented at the conference also suggested that Gilead’s Viread and Truvada, used in gels or in oral pills, might prevent the spread of HIV, said scientists studying a monkey equivalent of the disease.

In one test, animals treated with a gel containing Viread were completely protected from SHIV, an animal version of the AIDS virus, U.S. Centers for Disease Control and Prevention scientists said today at the conference in Montreal. The single- drug gel was just as protective as a gel containing two-drug Truvada, said Walid Heneine, laboratory chief of CDC’s division of HIV/AIDS prevention, who led the study.

“This is very promising, although we’re waiting for the results of human trials to see if they correlate with animal studies,” Heneine said in an interview.

The second trial measured how oral doses of Truvada, a combination of two Gilead drugs, would affect monkeys exposed to HIV through the rectum.

Almost all untreated monkeys were quickly infected after being exposed to the virus twice. Two doses of Truvada, one before and another after rectal exposure, protected most monkeys from infection, said Gerardo Garcia-Lerma, a CDC senior scientist in the HIV/AIDS prevention division...

---- snip

Read the complete article on Bloomberg here.

Rectal chlamydia - A reservoir of undiagnosed infection in MSM.

abstract via PubMed

Annan NT, Sullivan A, Nori A, Naydenova P, Alexander S, McKenna A, Azadian B, Mandalia S, Rossi M, Ward H, Nwokolo N.

Chelsea & Westminster Hospital NHS Foundation Trust, United Kingdom.

OBJECTIVE: To determine the prevalence of rectal chlamydia infection in a cohort of men who have sex with men (MSM) and the proportion of infection that would be missed without routine screening.

METHODS: MSM presenting to four HIV/GUM outpatient clinics at the Chelsea & Westminster Hospital NHS Foundation Trust between 1/11/05 and 29/9/06 were offered testing for rectal chlamydia infection in addition to their routine screen for sexually transmitted infections (STIs). Chlamydia trachomatis (CT) tests were performed using the Beckton-Dickinson Probe-Tec Strand Displacement Assay (B-D Probetec SDA). Positive samples were re-tested at the Sexually Transmitted Bacteria Reference Laboratory (STBRL), to confirm the result and identify Lymphogranuloma venereum (LGV) associated serovars.

RESULTS: A total of 3076 men were screened. We found an 8.2% prevalence of infection with CT (LGV and non-LGV serovars) in the rectum and 5.4% in the urethra. The HIV and rectal chlamydia co-infection rate was 38.1%. The majority of rectal infections {69.2%, (171/247)} were asymptomatic and would have been missed if routine screening had not been undertaken. Of the samples re-tested, 94.2% (227/242) rectal and 91.8%, (79/86) urethral specimens were confirmed CT positive and 36 cases of LGV were identified.

CONCLUSION: Our data shows a high rate of rectal chlamydia infection, the majority of which were asymptomatic. We recommend routine screening for rectal chlamydia in men at risk, as this may represent an important reservoir for the onward transmission of infection.