Contrary to some hysterically hyped headlines this past week, HIV is not on the verge of being cured in the next three months, nor have scientists found an effective vaccine.

The truth is that a hopeful compound to force HIV out of hiding is under study, and the results should be known in the near future. Unfortunately, however, even if researchers hit a home run with this drug, it won't likely be a cure by itself and we will still be waiting for the day that we have a vaccine or other types of immune therapy to help the body kill any remaining infected cells. 

Let's unpack the hype. Last week the London Daily Telegraph ran a story on this new compound, but claimed that a cure was just around the corner. The reporter apparently misquoted the researcher and overly hyped what he'd been told. The reporter has since toned down his piece and changed the headline due to pressure from a prominent activist in England and likely due in part to a piece the researchers themselves felt compelled to post to refute the article's claims. Unfortunately, the press outside of London grabbed hold and has been retreading the original uncorrected story since then.

Here is the real story. First, contrary to some reports there is no actual vaccine involved at this point. That's probably the most mystifying and frustrating thing. Instead, there is a class of drugs that helps cause HIV that is bound up inside the DNA of resting immune cells to begin reproducing. If we want to cure HIV, then that's the first thing we'll have to do -- to unmask the hidden HIV. The class of drugs is called HDAC inhibitors.

Thus far, there have been four studies of this class of drug. Two were conducted with a very weak form called valproic acid that ultimately had no effect. Two more recent studies were with a drug called vorinostat and showed at least transient increases in HIV RNA production from latent cells, indicating activity, but the effect was also somewhat weak and didn't have the ultimate effect we'd want to see, which is to reduce the amount of HIV DNA there. That would tell us that we are actually reducing the size of the HIV reservoir.

The researchers in Denmark are using a more potent HDAC inhibitor called panobinostat. All of us in the cure advocacy arena have good hopes about the drug, but it is a very, very long way from being a cure all by itself and the very small Phase I study being run by the Danish researchers has yet to publicly report any results. Panobinostat may turn out to be a potent way to kick start HIV replication, but we'll probably have to pair it with a vaccine in order to kill those latent cells that panobinostat has woken up. Unfortunately, we're quite a ways away from having such a vaccine.

It says something quite sad about the state of science journalism in general that articles like this make it out the door. The hype that never pans out ultimately makes people so skeptical about the kind of work Project Inform advocates for and reports on. It's also sadly the case that stories like this, where the reporter, or the researcher -- or both -- hypes a study and claims a cure is just around the corner are all too common. We'll do our best to set the record straight when these arise.

This article original appeared in TheBody.com here.

PositiveLite.com editor's note: we have published this article even though it contains an inaccuracy - see our note below.

From aidsmap.com

About 10% of gay men taking antiretroviral treatment have low levels of HIV detectable in their semen, according to new research. 

In the study, a low but detectable viral load (between 50 and 500 copies/ml) was associated with the presence of HIV in semen.

There is currently a lot of discussion about the effect of HIV treatment on infectiousness and the use of HIV treatment as prevention. Research conducted in heterosexual couples has shown that antiretroviral therapy that reduces viral load in the blood to undetectable levels (below 50 copies/ml) reduces the risk of sexual transmission by 96%. (PositiveLite.com editor's note: the research to which this refers - HPTN 052  - measured the impact of early treatment, not undetectable viiral load, two entirely different concepts..  We have questioned aidsmap.com about the accuracy of their statement.  UPDATE May 20: we have since heard from aidsmap who have admitted their statement is incorrect; they will be issuing a clarification.)

But there have been rare case reports of HIV transmissions in the presence of an undetectable viral load.

Untreated bacterial sexually transmitted infections (STIs) such as chlamydia and gonorrhoea may cause viral load to increase in genital fluids, even if a person is taking effective antiretroviral treatment.

Doctors in the United States wanted to see if infection with human herpes viruses also had an impact on viral load in genital fluids.

They monitored blood and semen samples taken from 114 gay men. All were taking HIV treatment and had a blood viral load below 500 copies/ml (88% had a viral load below 50 copies/ml).

HIV was detected in the semen of 10% of the men. The average viral load in semen was low – 126 copies/ml. Whether or not this level of HIV in semen is associated with transmission is unknown.

Detection of HIV in semen was associated with the presence of two viruses of the herpes family – high semen levels of CMV (cytomegalovirus) and detectable EBV (Epstein Barr virus) in semen.

“The association between isolated HIV shedding and high-level CMV replication and EBV replication in the genital tract suggests that the presence of these viruses could play a role in HIV transmission…these findings have important implications for the development of strategies to reduce HIV transmission,” comment the researchers.

They also found that 36% of study participants with a detectable viral load were shedding HIV in semen compared to 6% of participants with an undetectable viral load.

A urethral bacterial STI was diagnosed in 4% of men, but these untreated infections were not associated with the presence of HIV in semen.

For more detailed information on HIV transmission, visit our online resource HIV transmission and testing.

This article originally appeared in aidsmap news, May 2013. Read the full article here.

This article by Gus Cairns first appeared on aidsmap.com here.  

Data from two national sex surveys in the United States show that gay and bisexual men (men who have sex with men, MSM) reported significantly fewer sexual partners in the previous year in a survey conducted between 2006 and 2010 than they did in one conducted in 2002. This decline was consistent across most ethnicities and age groups, but was particularly marked, and statistically significant, in younger men aged under 24.

In contrast, the proportion who reported having condomless anal sex at least once in the previous year did not change between surveys. In the minority of men who also had sex with women, condom use fell markedly, but on the other hand the proportion of MSM who also had sex with women fell too.  

The proportion of men who tested for HIV or for sexually transmitted infections (STIs) in the last year did not change, although the proportion who had never tested for HIV fell.

The survey

The data come from the last two National Surveys of Family Growth (NSFGs). The NSFG is a survey of 15 to 44-year-olds; participants are contacted at random by phone but due to lower contact/response rates, people under 24, black people and Hispanic people are ‘oversampled’, i.e. a higher proportion are initially contacted than are in the general population.

NSFGs used to be conducted every three to seven years, but in 2006 a decision was taken to conduct interviews (by voice-assisted automated computer interview) continuously. This study therefore compared figures from interviews conducted in 2002 with ones conducted in 2006 to 2010.

NSFG interviewed 4928 and 10403 men in 2002 and 2006 to 2010, respectively. Of these, 197 and 272 reported having a male sexual partner in the last year – 2.7 and 2.1% respectively (this difference was not statistically significant, p = 0.1).

The results

The mean number of male sexual partners MSM reported in the previous year fell significantly from 2.9 to 2.3 between the two surveys (p = 0.035) and was more marked in men under 24 years old (mean 2.9 to 2.1 partners, p = 0.027). The number of partners also fell in men aged 35 to 44 from 3.0 to 2.2, though this was not quite statistically significant (p = 0.07).

The fall in the number of partners was statistically significant in men with incomes under 150% of the US federal poverty level (3.0 to 2.1) and in men living in suburban metropolitan areas (3.2 to 2.1) but not in city-centre areas (2.6 in both surveys). There were declines in partner numbers in white (3.0 to 2.5) and black (2.4 to 1.9) men, though these did not reach statistical significance. In general though, there was a consistent picture of fewer partners among most groups.

There were no changes in condom use for anal sex. In 2002, 57% of men had not used a condom the last time they had sex and in 2006 to 2010 the proportion was 58%. In the minority of men who also had sex with women, the proportion who had not used a condom the last time they had vaginal sex was 46% in 2002 but had become 67% by 2006 tp 2010, and this difference was statistically significant (p = 0.04). However, the proportion of MSM who had had female partners also decreased from 38 to 25% (p = 0.03).

One other notable difference was that fewer men reported transactional sex (sex for money or drugs) in the last year (down from 15 to 3%) and fewer men said they had injected drugs or had had sex with someone who had injected drugs (from 12 to 5%).

HIV and STI testing in the last year did not increase. In 2002 and 2006 to 2010, 41% of men said they had had an HIV test in the last year and in the case of STI check-ups 38% reported having one in 2002 and 39% in 2006 to 2010. The proportion of men who had never had an HIV test, however, fell from 25 to 15%.

Conclusions and comments

The researchers comment on the fact that HIV prevalence and the incidence of STIs increased in gay men during a period when numbers of partners and some other sexual risk behaviours were falling. They note that there have been previous studies in Seattle and Peru where STI incidence and/or HIV diagnoses have remained high even though sexual risk indicators in gay men have fallen. Studies of young black gay men in the US, including one recently presented at the 20th Conference on Retroviruses and Opportunistic Infections (CROI), have consistently shown that they tend to have fewer partners despite considerably higher HIV incidence.

The researchers speculate that this may be due to ‘network factors’: factors about partners that are not captured by the individual risk behaviour focus of most studies. For instance, some studies have found that black gay men tend to restrict sex to partners of their own ethnicity and are also more likely to have sex with men a number of years older or younger than themselves. Both of these would tend to concentrate HIV infection within the black gay community.  

Whether these are the main drivers of US black men’s greater vulnerability to HIV infection, another interesting aspect of this study is that gay men appear to have taken steps that could reduce their HIV risk by using a method that has received little emphasis in HIV prevention programmes for gay men – reducing their number of partners – while not increasing condom use, which has received the most emphasis.

Leichliter JS et al. Temporal trends in sexual behaviour among men who have sex with men in the United States, 2002 to 2006-10. J Acquir Immun Defic Syndr, early online publication, DOI: 10.1097/QAI.0b013e31828e0cfc, 2013. 

This article by Gus Cairns first appeared on aidsmap.com here.  

About 40% of men who answered a community survey for HIV-positive gay men in the Netherlands said they took their viral load into consideration in deciding whether or not to use condoms. This represents about two-thirds of those who actually did have unprotected sex.

This published paper adds new data to this study’s original conference presentation at the AIDS Impact conference in 2011.

The survey found that consideration of viral load was almost as common when having sex with partners who also had HIV as when having sex with partners of negative or unknown status. Disclosure and discussion of viral load was far more common with HIV-positive partners, whereas viral load was rarely discussed with partners assumed to be HIV negative, remaining purely part of a unilateral decision.

The study also found that this group of HIV-positive men, who, as part of a community consultation panel providing advice to the Netherlands HIV Association (NHA), might be assumed to be well informed on HIV prevention matters, were as a group by no means convinced that undetectable viral load protected them from transmitting HIV to partners. Not surprisingly, the more confident individuals were that this was the case, the more likely they were to take it into account as part of a decision to have condomless sex.

The study

The NHA’s Open Online Panel consists of 517 women and men living with HIV who are contacted on a regular basis by email to ask their opinion on important topics in HIV. In this case just the 212 gay men on the panel were asked to complete an online survey about unprotected sex and consideration of viral load.  

This paper only looked at the answers from the 177 men (85%) who said they had an undetectable viral load. Of these, all but two were on antiretroviral therapy.

Results: unprotected sex

One hundred and twenty (68%) of the 177 had ever had unprotected anal sex since their HIV diagnosis and of these 73 (61%, or 41% of the whole group) did it without a condom the last time they had anal sex. 

The researchers asked respondents if their last sex had been with a casual or a regular partner and of the 73 who’d had unprotected sex last time,  43 (59%) said it was with a casual partner and 30 (41%) with a regular one.

The 73 were also asked the HIV status of the most recent partner and 38 (52%) said they were HIV negative or status unknown and 35 (48%) that they were HIV positive. Unprotected sex partners were more likely to be ‘buddies’ if they were HIV positive (15 casual, 20 buddies) and more likely to be casual meets if they were HIV negative or status unknown (28 casual, 10 buddies); this is what one would expect, as HIV status is usually not discussed until people have reached  a level of trust.

Results: considering viral load

Of the 120 who had ever had unprotected sex since diagnosis, 75 (63%) said that their viral load was something they had taken into account when deciding to use condoms.

Interestingly, more said they had taken viral load into consideration with HIV positive partners (44% of the 120) than with men who were HIV negative or of unknown status (38% – some men considered it with both positive and negative partners).

Participants were asked to estimate the perceived protective value of having an undetectable viral load on a scale of one (“absolutely no risk”) to seven (“absolute risk”).  The average score was three (low-to-moderate risk) when considering sex with HIV-negative partners and two (no-to-low risk) when considering sex with HIV-positive partners (where the perceived risk was presumably superinfection). Not surprisingly, men who thought the risk was lower were more likely to have unprotected sex and to consider viral load as one of the reasons involved in doing so.

When having unprotected sex with HIV-positive partners, men said they were more likely to consider viral load with buddies (over half the partners) than with casual partners (only one in five). Conversely, when having unprotected sex with HIV-negative partners, nearly 60% said they considered their viral load with a casual partner but only 40% with a buddy.

With positive partners, all but one of the 14 men who said they had considered viral load had explicitly discussed it with their partner before sex. Conversely, only three of the 20 men who had considered viral load when having unprotected sex with an HIV negative partner had discussed the subject.

Conclusions

It looks as if there are two different phenomena going on. With HIV-negative partners, men who considered their viral load are doing so in the main as part of a unilateral process of considering how liable they are to transmit HIV. In the case of HIV-positive partners, the researchers comment that “further qualitative studies are needed to shed light on the perceived added value of considering viral load”, but speculate that it may take place within the context of broader discussions about HIV superinfection and STIs.

This is a small study of quite a specific group: HIV-positive gay men who were already engaged and informed enough to join a community consultation group. They could therefore be ‘early adopters’ of viral load as a factor to take into account when considering sexual risk.

As the researchers comment, “future investigations should include the perspectives of HIV-negative MSM in the communication around undetectable viral load and unprotected anal intercourse”, and a wider consultation with less-engaged HIV-positive men would be interesting too. 

They also comment that further investigations are needed to establish the risk of transmitting HIV via anal sex with an undetectable plasma viral load.

They comment: “HIV prevention campaigners need such evidence to take an informed stance in the debate around viral load considerations and urgently so, in light of their already frequent use by MSM.”

Reference

Van den Boom W et al. Undetectable viral load and the decision to engage in unprotected anal intercourse among HIV-positive MSM. AIDS and Behavior, e-publication ahead of print: DOI 10.1007/s10461-013-0453-9, 2013.