Young Gay Men At Increased Risk Of HIV Infection

August 25, 2011

Compared with older men who have sex with men (MSM), those aged under 35 years are more likely to have never previously been tested for HIV, more likely to report not knowing the HIV status of regular partners, and more likely to report inconsistent condom use with casual and regular partners, according to a study published in the Medical Journal of Australia.

Ms Carol El-Hayek, Epidemiologist at the Centre for Population Health at the Burnet Institute, Melbourne, and co-authors reviewed the age of HIV diagnoses in MSM in Victoria to determine whether younger MSM are at increasing risk of HIV infection.

Between 2000 and 2009, 1635 MSM were diagnosed with HIV in Victoria. The median age at HIV diagnosis in MSM declined significantly, from 38.8 years in 2007 to 35.3 years in 2008 and 35.9 years in 2009. In 2009, the number of HIV diagnoses among MSM aged 25-29 years was 62 per cent higher than in 2007. The median age of MSM testing for HIV remained constant at 33 years between 2006 and 2009.

Ms El-Hayek said that there were multiple factors thought to be contributing to increased rates of HIV diagnoses in MSM, including increased rates of unprotected anal intercourse, an increase in other sexually transmitted infections that facilitate HIV transmission, and increased numbers of sexually active HIVpositive MSM since the introduction of highly active antiretroviral treatment (HAART).

"Recent focus group data have shown that younger MSM are less likely to discuss HIV and other sexually transmitted infections with peers," Ms El-Hayek said.

"It has also been suggested that younger gay men may be more susceptible to engaging in risky sexual behaviour because they are less aware or less concerned about the implications of HIV since the introduction of HAART.

Ms El-Hayek said that deciding how to respond to increasing HIV diagnoses in younger MSM was difficult.

Any response developed would need to consider more diverse health promotion strategies to ensure that prevention messages reached young MSM.

In an accompanying editorial, Mr William Bowtell, Director of the HIV/AIDS Project at the Lowy Institute for International Policy, Sydney, reviewed the history of the global HIV/AIDS pandemic and the economic and political impact of the emergence of HIV/AIDS.

Mr Bowtell said that since the introduction of effective antiretroviral therapy, deaths from AIDS have declined and HIV has become a more manageable chronic condition. However, although the number of global deaths from AIDS had fallen, the number of those living with HIV had increased.

"There are now some 33.4 million people living with HIV infection," Mr Bowtell said.

The Medical Journal of Australia is a publication of the Australian Medical Association.

Medical Journal of Australia

Making It Harder For HIV To Hide From Drugs

August 01, 2011

The virus that causes AIDS is chameleon-like in its replication. As HIV copies itself in humans, it constantly mutates into forms that can evade even the best cocktail of current therapies. Understanding exactly how HIV cells change as they reproduce is key to developing better tests and treatments for patients.

In the Journal of Biological Chemistry and Nature Structural & Molecular Biology, MU microbiologist and biochemist Stefan Sarafianos, PhD, reveals new findings that shed light on how HIV eludes treatment by mutating. His discoveries provide clues into HIV's mechanisms for resisting two main families of drugs.

"These findings are important because identifying a new mutation that affects HIV drug resistance allows physicians to make better decisions and prescribe the proper drugs," Sarafianos said. "Without that knowledge, therapy can be suboptimal and lead to early failure."

Patients with HIV are routinely tested to track the levels of the virus and immune cells in their body. Results of the tests help physicians gauge the health of their patients and prescribe the right mix of antiviral drugs. The drugs help prevent the spread of HIV in patients by inhibiting the virus' ability to replicate.

Sarafianos' lab determined the biochemical properties that allow strains of HIV with a specific mutation - the N348I mutation - to escape inhibition despite treatment with Nevirapine. The drug is commonly used in combination with other antiviral medications to decrease the amount of HIV in the blood. As a result of Sarafianos' discovery, at least one major company that manufactures HIV mutation-testing kits has modified its test to detect the N348I mutation.

Sarafianos' recent findings resulted from research supported by five National Institutes of Health grants. He recently received another $417,000 award from the NIH to assist him in developing modified antibodies for HIV therapy.

"Our latest efforts to design broadly neutralizing antibodies against HIV will hopefully expand our toolbox against the virus, which remains a constantly moving target," Sarafianos said.

Natalie Fieleke
University of Missouri School of Medicine

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