The CTN organizes a National network of researchers around thematic research Cores designed to support scientists in the generation of new concepts and study protocols. Co-led by Dr. Mona Loutfy (Toronto) and Dr. Catherine Worthington (Victoria), the Prevention and Vulnerable Population (PVP) Core research agenda is geared towards working collectively with communities and researchers to understand gaps in health services and to look for and evaluate interventions for decreasing HIV transmissions and mitigating disparity and vulnerabilities. 

“Meaningful HIV health interventions can take many forms beyond randomised drug trials and we want to encourage and support prevention and intervention research for populations that are vulnerable to HIV,” say Dr. Loutfy. Community-based research and cross disciplinary collaboration within the PVP Core provide an excellent opening for meaningful engagement and a solid basis for finding inclusive solutions grounded in community needs. “Our goal,” says Worthington, “is to ensure that the studies that come out of the PVP Core address research questions that communities’ support. We are working hard to forge partnerships beyond basic and clinical sciences to work successfully with vulnerable populations.” 

From the time the PVP was established it was decided to focus CTN resources on Aboriginal Peoples, but not to the exclusion of other vulnerable populations. Aboriginal populations are overly represented within HIV statistics in Canada and also overly represented within statistics highlighting other risk factors, including substance use issues within communities, social inequities resulting from the colonization process and stigma and discrimination. Physicians in some of Canada’s most affected provinces, including Manitoba and Saskatchewan, have argued that there is a huge clinical need in Aboriginal communities across the Prairies. Many of the patients they are diagnosing are presenting with late stage HIV, which results in major challenges for effective health management. In September 2010, the CTN formalized a partnership with the Canadian Aboriginal AIDS Network (CAAN) and this past year the PVP Aboriginal-CTN Working Group was established. The CTN also supported the development of an accredited online course for doctors and health care practitioners focused on community-based and culturally appropriate HIV treatment and care for Aboriginal Peoples. The course is open online at: https://www.mdcme.ca/ 

For the next five years the Core has prioritised research in three main areas. Two of them are within specific vulnerable populations; the first being research with and among Aboriginal peoples, and the second being men who have sex with men. The third priority topic is related to engagement and retention in care for people living with HIV. Retention and engagement is a broad research focus that’s relevant across CTN research Core interests, and encompasses and affects all key HIV populations in Canada.   

As part of a new initiative and in partnership with the University of Saskatchewan, the PVP Core is co-hosting a Rural Engagement and Retention in HIV Care Working Group meeting, taking place in Saskatoon in March 2013. The purpose of this meeting, which is funded by a Canadian Institutes of Health Research Planning Grant, is to bring together as many stakeholders as possible to identify the barriers, challenges and successes in HIV testing strategies, and to discuss how to link HIV patients from rural communities to care, with a focus on the unique issues faced by specific populations. “When we involve service providers, policymakers, communities and advocates in the research process, there is broader investment made in the research, and outcomes and results are hopefully acted upon by all parties involved,” says Worthington.  The goal of the meeting is to form a team to develop a grant proposal for research that would support targeted interventions. 

An inclusive approach to research requires a deep commitment from all parties and when it works well the rewards are significant and meaningful. Both Worthington and Loutfy emphasize that working together in collaboration across disciplines provides a platform for relevant and socially engaged research and an opportunity for deeper levels of understanding and respect. 

Dr Mona Loutfy, MD FRCPC MPH is the CTN Prevention and Vulnerable Populations Core co-Leader. She is currently an Associate Professor in the Department of Medicine at the Women’s College Hospital and heads the Women and HIV Research Program at the Women’s College Research Institute in Canada. She is also the President and Director at Maple Leaf Research adjoined to the Maple Leaf Medical Clinic, Canada’s largest private HIV practice. Focused on the clinical management of HIV infection in women, Loutfy’s work has brought forward innovations such as the Canadian HIV Pregnancy Planning Guidelines. 

Dr Catherine Worthington, PhD is the CTN Prevention and Vulnerable Populations Core co-Leader.

Currently, she is a professor at the School of Public Health and Social Policy at the University of Victoria in British Columbia. Her research focuses on HIV prevention, care and support services development. She has served on the CIHR HIV/AIDS Research Advisory Committee (CHARAC), and also acted as Social Sciences Track co-chair for the Canadian Association for HIV Research (CAHR). Worthington is a principal investigator with the CIHR Social Research Centre in HIV Prevention (SRC), and chairs the Education Committee of the Centre for REACH (Research Evidence in Action for Community Health) in HIV/AIDS.

This article fIrst appeared on aidsmap.com here. 

A study from Amsterdam found that gay men who had used post-exposure prophylaxis (PEP) in the past were four times more likely than non-users to subsequently become infected with HIV.

PEP failure does not appear to be the cause of their HIV infection, but rather ongoing risk behaviour following a course of PEP. Self-reported adherence to the PEP regimen was high, at 94%.

The investigators compared HIV infection rates between 2000 and 2009 in 355 men, who had in total received 385 courses of PEP, with infection rates over the same period in 782 gay men entering the Amsterdam Cohort Study. They measured HIV incidence three and six months after receiving PEP in the former group and after cohort entry in the latter.

HIV incidence, translated into infections per man per year, was 6.4% in men who had taken PEP and 1.6% in the cohort study. Three out of the eleven PEP users who acquired HIV were positive three months after PEP but the other eight were only found to be positive six months later, indicating that few - if any - infections were acquired while actually taking PEP.

“Our study showed a high incidence of HIV among MSM [men who have sex with men] who used PEP, an indication of ongoing risk behaviour,” write the investigators. “This implies that PEP alone for this group is not sufficient to prevent HIV infection, and a combination of other more comprehensive preventative strategies is needed.”

Comment: It is important not to interpret this study as a failure of PEP. Instead, it indicates that gay men who come forward for PEP rightly see themselves as being at high risk of HIV, but find that PEP is not a strategy they can use often enough for it to be protective. Previous studies of PEP have also found that, while it has an efficacy of about 80% for individual infections, its use makes no difference to infection rates on a population level. The high HIV incidence in PEP seekers suggests that they might be ideal candidates to be offered an ongoing course of PrEP (pre-exposure prophylaxis). At present, PrEP is still regarded as an experimental prevention technique and access to it is limited to unlicensed or clinical trial-based use.

One of the issues that often comes up in conversations about the sex trade is that of 'safety.'

When sex work is assumed to be heterosexual – that it takes place between a female sex seller and male sex buyer – conversations about safety tend to revolve around concerns for the security and health – physical, sexual, and emotional – of the woman who sells sex. At the centre of these concerns are worries and assumptions that persons who pay for sex are men who are morally questionable at best, and at worst are imagined as predators, child molesters, as violent or in other ways harmful and dangerous.

These worries and assumptions are reflected in the recent focus placed on targeting and criminalizing 'johns,' or individuals who pay for sex, as a way of dealing with harms experienced by some people involved in prostitution. 

But we know that not all commercial sex transactions take place between men and women, just like not all of the interactions that do take place between men and women are unsafe or violent. We know that there are female and male sellers, just as there are both male and female buyers. We also know that individuals of various gender and sexual identities, and all types of sexualities, sell and buy sex. And they do so for various reasons.                                                         

If we recognize that commercial sex does not only and always take place in a heterosexual context, how do we then continue to have conversations about the 'safety' and 'security' – physical, sexual and emotional health and well-being – within the commercial sex industry? How do we move the conversation about these issues beyond predetermined assumptions about victims and perpetrators of harm and violence that are often based on personal views of the sex industry? 

In Canada and around the world, discussions about whether or not the sex trade should be regulated by law are ongoing, and often hotly debated. If it is to be regulated, the question becomes: how precisely should such legislation look? These policy decisions, which may impact education, outreach, and the regulation of the sex trade, should be informed by the perspectives of everyone involved in the industry.

There is no universal way, no single story behind how individuals experience the sex trade as sellers, managers, loved ones, and others close by. Those who purchase sexual services are, of course, among the most integral of individuals who must be involved in order for the sex trade to exist. However, sex buyers are also among the most understudied of contributors. 

The vast majority of the research on and conversations surrounding the topic of the sex trade focus on sex sellers. Occasionally, some perspectives do consider people who pay for sexual services, but rarely do they recognize that we actually know very little about sex buyers, both as a group or as individuals. We tend not to recognize the diversity of buyers, nor acknowledge their unique experiences.

The more buying of sex is stigmatized, the more we as a society seem to be willing to accept stereotypes of those who purchase sex, without asking for evidence that would support the underlying claims and beliefs. Given the Supreme Court indication that there is a need for something to be done about prostitution in Canada, a more in-depth understanding of all parties involved in the sex trade is needed. Otherwise, we seem likely to end up with the same ineffectual, expensive, and often one-sided policies that have struggled to impact the industry to date. 

In 2009 we conducted "Johns' Voice", a study of individuals from across Canada who purchase sex. The research remains the most successful Canadian study of people who pay for sexual services ever conducted.

One of the many important and previously underemphasized findings that the Johns' Voice study revealed was that people who pay for sex come from diverse backgrounds and have markedly different attitudes and experiences relating to their purchase of sex. While many participants reported having safe, satisfying and unproblematic encounters with sex workers/sellers, several shared stories about experiences that revealed that not all commercial encounters are equally safe, secure and conflict-free.

The study allowed us to begin scratching the surface of the issues that may come up in commercial encounters. It also pointed to the need to examine some of these issues further.

In an effort to continue building on what we already know about the sex trade we are currently doing a study, titled Sex, Safety and Security, which looks at the experiences of people who purchase sexual services in Canada. The research is part of a larger project, funded by the Canadian Institutes of Health Research (CIHR), which is designed to understand the ways that gender, conflict and health collectively impact the experiences of people involved in all aspects of Canada's sex industry. A project of this scale has never been done before. 

We are committed to hearing from all people who are involved in the sex trade and so hope to spread the word about this research as widely as possible. Our goal in doing this research is to provide people who have paid for sex with a safe and secure venue for sharing their attitudes, opinions and experiences without fear of judgment, persecution or prosecution. Bringing these voices and perspectives together will help to better understand the complexities of the sex industry in Canada, and in particular the factors influencing health and safety within, and in relation to, the industry.

Stigmatizing and criminalizing sexual behaviour cannot and will not ensure healthy and safe situations, choices and actions – having a better understanding of people's experiences is a necessary step towards where we need to go next. 

For more information, or to take part in the research, please visit our website. 

 Our Facebook:

Twitter: @SexSafetySecure

Recently, I was in Toronto for my annual “checkup” with Paul, my friendly research coordinator with the Ontario Cohort Study (OCS).  I’ve previously talked about my involvement in this Ontario HIV Treatment Network (OHTN)'s research cohort here. Today I wanted to provide a photo-post with more detail on what the testing process looks like from the ground.

But first some background on OCS for those who are unfamiliar with it. Almost 6,000 Ontario people living with HIV have been voluntarily recruited since the program began in 1996 when it was called HOOD, then HIIP before settling on the name OCS.  I’ve been in it since the beginning, participant number seven I believe, so there may be almost  seventeen years of history in their about me and my clinical progress.

Why the need for a longitudinal data base like OCS?  Well here’s what their website says

“The purpose of the OCS is to collect information on the clinical and health profiles of people living with HIV in care in Ontario to provide a robust information resource for clinical, socio-behavioural, population health, and health services research. Our aims are:

• To understand the pychosocial and health context of people living with HIV
• To understand patterns of health services use
• To understand issues related to mental health and addictions
• To examine HIV infection and its complications
• To examine HIV treatment and its complications, including adverse events and HIV drug resistance
• To examine co-morbid diseases and conditions among people living with HIV
• To examine social, psychological, and other factors related to behaviour that poses risk for secondary HIV transmission.” 

The information to accomplish all this is largely drawn from patient records and charts – particpants' CD4, viral load results and treatment information all go in to here, for instance via various automated or manually driven processes, with your informed consent at the outset, of course. All information collected is both anonymous  - there are complex controls for this – and confidential. 

Back to my visit to St Mike’s.  Besides being the location of the HIV Positive Care Clinic I’ve attended, mostly quarterly, since day one, it is also a collection point for OCS data.  And it is one of the two sites – the other is Sunnybrook Hospital – that engages a subset of OCS participants, a few hundred strong, in tests which additionally measure cognitive ability (often called “neuro-AIDS” work now) and also track a bundle of issues like housing, income, depression, mastery, substance use, impact of stigma and, on occasion, one–off suites of questions soliciting participants’ views on things like the criminalization of people living with HIV. The entire process takes about ninety minutes each year. Participants are compensated $50 for their trouble at each visit. 

So today, I’m going to walk you through that process, starting at the back doors of St Michael’s Hospital in downtown Toronto, a building that has clearly seen better days, and where the elevators don’t always work, including the day of this particular visit.  Now I’m a big fan of St Mikes, don’t get me wrong – they’ve kept me alive for almost twenty years, and I have a profound affection for those who work there - but it’s a classic inner city hospital that is an obvious candidate for a refit. Anyway, to the glamourless second floor I go to see Paul, the Research Coordinator who administers the tests that I’m to take. 

Paul always begins with explaining the parameters for the tests, what they are used for, how I am free not to participate in any of them, how some might be difficult or stressful, how Kleenex is available if there are tears. So far I’ve yet to need that, thankfully, although he’s right about the stressfulness, at least for those of us who dislike our weaknesses being exposed. Which is where the memory tests come in which he launches right in to as the first in the series he will be giving me today. 

Paul recites a series of 15 nouns, so slowly that it seems relatively easy for me to repeat them for him. But I cant, I seldom score more than seven, and last week was no better. I’ve tried various techniques and this time I thought I’d concentrate on just the first five and (literally) forget the rest.  Which I did although I managed to tack on two from the end I somehow remembered also. In any event, Paul then repeats the list, presumably to see if your short-term memory improves through repetition.  Mine does, but only marginally; I think I scored eight the second time around – but not surprisingly, I can’t remember now. 

Given that this is a longitudinal study, i.e. one that tracks people over time, I’m thinking tests like this must provide valuable information about how our memory works, or not, as we get older. With HIV and aging in the spotlight nowadays, this data has the potential, I suspect, to add considerably to our knowledge of what aging, or  HIV treatment, or HIV infection generally – does to our brain power. 

So having failed semi-miserably (I think) on the memory test, but knowing that I’ll likely do better from here on in, Paul moves on to a couple of tests which seem to measure my brain/hand coordination.  I'll be needing to put a series of shaped pegs in to shaped holes with the stopwatch running. Here is the board, with the pegs you need to fit into the holes using just one hand. You’ll note that the pegs have ridges on them which means they fit in to the similarly shaped holes only in one direction. 

Over time I've learned how to perform this test with some semblance of dexterity. I am less nimble-fingered when the requirement is next to repeat the task using only my left hand but again experience has somehow increased my dexterity in this, advancing years or not. 

Next to a timed pencil on paper test – I was not allowed to photograph this – in which you are required to match a series of numbers with symbols, the code for which is provided at the top of the page.  I always fly though this one with flying colours (I think). 

Back to memory tests, this one revolving around a series of blue plastic blocks mounted on a small board.  Paul touches/taps these blocks in seeming random order (I’m sure it’s not) first in a sequence of three, then four, then six taps. I'm asked to repeat his series of taps each time, in the right order.  It’s easy-peasy at three, easy at four but by the time he has gone though a sequence of six taps it’s a challenge. It’s even more challenging when we do things backwards. I have to repeat the taps in the reverse order that he showed me. It’s tricky, to say the least, and I’m stumbling by the end. 

More challenges to my memory come next in a reprise of the fifteen nouns ordeal. Sixty minutes (?) have elapsed since we last visited this list of nouns and now I have to repeat those that I remember.  My strategy of concentrating on remembering the first five has collapsed by this time, although I manage to salvage about five nouns nevertheless. Then one final variation – Paul reads me a list of words and I am asked to say which of those words was included in the original list. I’m hit and miss here – after all I really only listened to the first five first time around.

Then on to a battery of questions - on my mental health and any feelings of anxiety or depression, my ability to perform tasks, my housing situation, my mastery of my circumstances, the supports I’m receiving, the kind of health services I’ve used, my alcohol and substance use, even my smoking history (which data collectively,  I’m thinking, will be highly useful for The Smoking Project which I co-chair.)  

Towards the end – it’s late afternoon by now -  there is series of questions on my meds.  Have I missed any doses in the last week, I’m asked? I’m pretty good at adherence but fess up to  missing my mid-day dose just that day, having forgotten to pack it that morning before I left for Toronto.  (There are those memory issues  again.) Veteran of many regimes, I do poorly in remembering what meds I’m on now too.  Paul reverts to charts that he shows me to help me remember the names. 

A few questions about my recent sexual history  - how many partners I’ve had, their status and what I’ve done with them - which is deemed personal enough for Paul to hand his laptop over for participants to input their responses privately. And then the process is done. I’ve always found it a surprisingly draining ninety minutes, a little bit invasive, a little bit tiresome, which is why I never have any trouble accepting the $50 that Paul proffers at the end. There is, in fact, a deep feeling that I’ve truly earned it. 

But, as I  step out into the cool night air, it’s already dark and I’m feeling content, if not smug. Glad that I have $50 in my pocket which I feel the need to turn into something fast, so I cross the street to Fran’s Restauarant and spend half of it on my dinner – but also content that I feel like I’ve truly contributed to something worthwhile.  I’m tuned in enough to realize that the questions I’ve been asked and tests that have been administered will help in some small way to expand our collective knowledge of how HIV affects us in a myriad of ways. And that feels good. 

So does having the meatloaf dinner and strawberry milkshake at Fran’s the test paid for.  But that’s another story.

My fear of all things anal began when I was an early teen. My older brother David took great delight in bursting into our bathroom to startle me, especially if I was on the john. And, since I was a pubescent redhead, his sudden visits included a lot of laughing and pointing. 

I was mortified beyond belief. To this day, I must be sure no one is in the house, and then close and lock the bedroom and bathroom doors before I can properly relax. And I live alone.

But you can’t avoid everything anal if you’re growing up gay. Not if you want to do the really fun stuff.

Thus my conundrum as a youth: exploring the pleasures of my tush while fighting the terror that something stinky might be going on down there. And I suspect I am not alone in this particular anxiety.

I discovered soon enough that if someone had serious intentions in regard to my backside, I couldn’t simply rely upon a bran muffin and a Hail Mary to be properly prepared. God forbid I would, you know, not be… well, you know. This ongoing fear had a habit of wrecking the mood and the evening.

My exclamations during sex were usually panicked calls to turn the lights up, so I could carefully inspect the situation. Or a plea to stop altogether. “Okay, that’s fine, no wait!” I would cry out. “Am I okay down there? I mean, is it… okay go ahead… no hold on! Are you sure I’m…?” I was usually so involved with my protestations that I would hardly notice my date gathering his things to leave.

There are cleansing products meant to address this situation, but they require a certain comfort level with your own body and a little patience, meaning, they were incomprehensible to me. But I tried my best.

Drugstore enemas always felt too clinical, like something a nurse should be administering so you could “move your bowels,” a phrase I hope I never have to hear again, much less type.

But never fear. Leave it to gay men to popularize the “shower shot,” a long hose which screws into your shower head and ends in a narrow nozzle, just right for sliding up your bum for a thorough internal rinse.

The modulation of this instrument, however — and I cannot stress this enough — is of utmost importance. Too little water pressure and you’ve got a dribble with little cleansing effect. Too much, and you’ve just inserted a pressure washer into your ass that could peel the paint off a building.

I was first introduced to this contraption in my early twenties, when my first-time date invited me to visit the bathroom to “rinse out” while he relaxed in bed and waited. I stepped in the shower and surveyed the dangling metal hose. I turned on the water. I considered how it all might operate, and I made my best guess, standing there for God knows how long, hose inserted and whistling a happy tune.

I must say in my defense that no one had ever explained the device to me, much less how to gauge the input versus the output.

That poor, unfortunate man. He had really pretty designer sheets, covered with a gorgeous blue and white pinstripe blanket that I can still see clear as day. Such a lovely bedroom. That is, until a few passionate moments later, when all of it was soaked with a solid gallon of spoiled water that had been percolating in my poopchute, exploding from me in a streaming rush that looked like the wake of an outboard motor hurtling across Lake Erie. The word “apocalyptic” comes to mind.

Only as I matured did I realize I had options (and I will now introduce cute baseball analogies to illustrate my point). I discovered I did not, in fact, always have to play catcher, and I stepped onto the pitcher’s mound with great enthusiasm. But as much as I enjoyed the view from above, I worried still, that maybe I wasn’t holding up my end of the bargain. It was only after pitching a near-perfect game one day that my partner in the dugout helped me make a simple decision.

“Mark,” he said. “Why don’t you just stick to what you do well?” And it was this generous assessment that gave me the confidence to hang up the hiney hose forever.

Yes, that’s right. I’m now a dedicated top. I’ll allow you a few moments of incredulous wonderment.

What’s even more amazing is my having a boyfriend who is not only loving and adorable, but absolutely expert at the exotic mysteries of booty sex preparation. It really is an impressive talent, if you ask me. Like walking on your hands, or spinning plates on sticks.

This is all to tell you, dear reader, that sometimes you must find solutions to your fears in order to take care of yourself. And sometimes you have to face your damn fears head-on. I was reminded of this recently when, at fifty-two years old, I had my first colonoscopy. I don’t think I have to explain my anxiety level going in to this procedure.

Everything checked out fine, thanks. I had heard the anesthesia they give you can produce some odd behavior, but other than proposing to the physician and asking the recovery nurse if they located my pet hamster, I behaved myself quite admirably.

The only side effect of my colonoscopy was a bloated feeling and a case of the gurgles. Well, and a few hours later I had the longest, most continuous release of gas I have ever experienced in all my days. I’m talking a minute plus, people.

I really wish my older brother David had been here. He loves that kind of thing.

Mark

(Artwork courtesy of Andrews’s Anus, via LifeLube.)

****

My Friends, 

If I can face my deepest fears, so can you. Did you know that studies show people living with HIV have a higher incidence of “colonic neoplasms” (the polyps they are looking for during a colonoscopy), which should be checked out for cancerous cell growth? Anyone aged 50 should get a colonoscopy, and some protocols suggest that people with HIV start this screening at age 45. Please don’t delay. Call your doctor! (At left, a picture of my happy procedure team just prior to my colonoscopy.)

And speaking of rectal douching (and why not? We really should discuss this topic more, considering it is such a common practice among gay men), I cannot say enough about LifeLube, the blog created by the AIDS Foundation of Chicago to help gay men address sexuality and their bodies. They have an entire section devoted to rectal douching (did you know there are new douches that limit the amount of healthy bacteria removed?) and another feature, Andrew’s Anus, that provides engaging answers to the questions you’re afraid to ask. The blog is no longer active – meaning, no new postings – but there is a wealth of information here and you should definitely check it out.

This article first appeared in Mark’s own blog My Fabulous Disease here.

This article by Michael Carter first appeared on aidsmap.com here. 

Co-infection with HIV and hepatitis C is associated with an increased risk of cognitive impairment, according to research published in the online edition of the Journal of Acquired Immune Deficiency Syndromes.

Investigators from the United States Department of Veterans Affairs compared cognitive function between co-infected men, hepatitis C mono-infected men, HIV mono-infected men and a control group. Co-infection was associated with mild cognitive impairment and significantly poorer scores in a number of tests designed to assess cognitive function. The results are especially interesting as all the men who had HIV and hepatitis C co-infection had well-controlled HIV infection.

“We were able to detect a mild, yet significant impairment in the cognition among the coinfected group,” write the investigators. “Coinfected subjects performed poorly on the attention, executive function, fine motor function and visual and verbal learning memory tests, with significantly lower…scores than either controls or monoinfected subjects.”

Infection with HIV has been associated with cognitive impairment. This is also the case with hepatitis C infection. However, it is currently unclear if co-infected people with well-controlled HIV infection and minimal liver damage caused by hepatitis C are at increased risk of impairment.

Investigators from the Veterans Affairs Medical Center, San Francisco, therefore designed a study involving four groups of male patients aged between 45 and 65 years:

• Co-infected with HIV and hepatitis C (n = 19).
• Hepatitis C mono-infected (n= 17).
• HIV mono-infected (n = 14).
• Healthy controls (n = 28). 

All the HIV-positive study participants were taking antiretroviral therapy and had an undetectable viral load. None of the participants had liver cirrhosis or clinical depression. Individuals with drug abuse or alcohol problems were excluded from participation in the study.

“This study represents many American HIV-infected individuals today, who are compliant with their ART [antiretroviral therapy] and live their lives with undetectable viral loads,” comment the investigators.

The participants were evaluated for symptoms of depression. Cognitive function was evaluated in seven domains and an overall global deficit score was also calculated.

People with co-infection had more symptoms of depression than those with hepatitis C mono-infection (p = 0.049) and the control group (p < 0.011).

Moreover, the people with co-infection had worse global deficit scores than individuals with hepatitis C mono-infected (p = 0.015), patients with HIV mono-infection (p = 0.008) and the control group (p < 0.001).

The mean global deficit score for the group with co-infection was 0.77 putting “co-infected patients in the mild cognitive impairment range.”

On the basis of the global deficit score, some 65% of people with co-infection were classified as impaired, compared to 42% of the hepatitis C mono-infected participants, 29% of people with HIV mono-infection and 18% of the control group. The difference between people with co-infection and the control group was significant (p = 0.004).

The people with co-infection also performed more poorly on individual tests.

Compared to the healthy control group, co-infection was associated with worse scores in attention working memory (p = 0.007), executive function (p = 0.011), verbal learning and memory (p < 0.011) and visual learning and memory (p < 0.001).

The investigators suggest that it is the “synergistic effect of HIV and HCV in coinfection that is responsible for neuropsychological deficits in the coinfected population.”

In the hepatitis C mono-infected participants (but not those with co-infection), a higher hepatitis C viral load was negatively associated with attention, executive function and speed of information processing. “These findings imply that HCV viral load may play an important but subtle negative role in cognition, a role which could be better elucidated by experiments specifically designed to assess its impact,” suggest the researchers.

They conclude, “this targeted study indicates that coinfection in males is sufficient to push this group over the threshold into mild impairment and high viral load in HCV monoinfection may impact cognition.”

Reference

Sun B et al. Differential cognitive impairment in HCV coinfected men with controlled HIV compared to HCV monoinfection. J Acquir Immune Defic Syndr, online edition. DOI: 10.1097/QAI.0b013e31827b61f1, 2012.