HIV Infections Attributed to Male-to-Male Sexual Contact — Metropolitan Statistical Areas, United States and Puerto Rico, 2010

 

Weekly

November 30, 2012 / 61(47);962-966

Human immunodeficiency virus (HIV) infections attributed to male-to-male sexual contact comprised 64% of the estimated new HIV infections in the United States in 2009 (1). Assessing the geographic distribution of HIV infection by transmission category can help public health programs target prevention resources to men who have sex with men (MSM) in areas where HIV infection from male-to-male sexual contact is most frequent. In 2004, CDC published data on acquired immunodeficiency syndrome diagnoses among MSM and others by metropolitan statistical area (MSA) (2). To examine geographic differences in the prevalence of HIV infection from male-to-male sexual contact among persons aged ≥13 years in the United States and Puerto Rico, CDC estimated the number of HIV infections in persons newly diagnosed in 2010 and analyzed them by transmission category and location. Results indicated that HIV infections attributed to male-to-male sexual contact made up the largest percentage of HIV infections in MSAs (62.1%), smaller metropolitan areas (56.1%), and nonmetropolitan areas (53.7%). Of the 28,851 infections attributed to male-to-male sexual contact, 23,559 (81.7%) were in MSAs, and 11,410 (48.4%) of those infections were in seven MSAs that represented 31.7% (53,169,004 of 167,919,694) of the overall population aged ≥13 years in the MSAs that were assessed. These data support planning for targeted interventions to prevent HIV acquisition and transmission by male-to-male sexual contact among MSM, particularly in those areas most affected.

HIV infections in persons newly diagnosed in 2010 that were reported to the National HIV Surveillance System through June 2011 were examined from 564 locations, including 103 MSAs, 263 smaller metropolitan areas, and 198 nonmetropolitan areas in the United States and Puerto Rico.* Reported diagnoses of HIV infection for persons aged ≥13 years were tallied, and numbers of diagnoses overall and by transmission category were estimated. Data were adjusted for reporting delays and missing HIV risk factors but not for underreporting (3,4). Because a substantial proportion of persons with diagnosed HIV infection are reported to CDC without an identified risk factor, multiple imputation methods are used to assign transmission categories to those persons whose diagnoses are reported without a risk factor (4). Multiple imputation is a statistical approach in which missing transmission categories for each person are replaced with plausible values that represent the uncertainty regarding the actual, but missing, values (5).

Estimates were calculated for new diagnoses of HIV infection attributed to male-to-male sexual contact, injection-drug use, male-to-male sexual contact and injection-drug use, heterosexual contact, and other HIV risk factors or modes of transmission (e.g., hemophilia, blood transfusion, or perinatal exposure). Transmission categories are assigned, based on the single risk factor (of all identified risk factors) that was most likely responsible for HIV transmission (6,7). An exception is male-to-male sexual contact and injection-drug use, which makes up a separate transmission category. Estimates were not calculated for locations that did not have confidential name-based HIV reporting in place by January 2007 (or had not reported these data to CDC since at least June 2007) to enable the calculation of reporting delays. Excluded were locations in Hawaii, Maryland, Massachusetts, Vermont, and the District of Columbia (6).

Of the estimated 37,934 persons aged ≥13 years with a diagnosis of HIV infection who resided in MSAs in the United States and Puerto Rico during 2010, a total of 23,559 (62.1%) had HIV infection attributed to male-to-male sexual contact; 10,128 (26.7%) had HIV infection attributed to heterosexual contact, 3,070 (8.1%) to injection-drug use, 1,145 (3.0%) to male-to-male sexual contact and injection-drug use, and 33 (0.1%) to other modes of transmission (Table 1). Among smaller metropolitan areas, 3,182 (56.1%) of 5,677 HIV infections were attributed to male-to-male sexual contact, and among nonmetropolitan areas, 1,756 (53.7%) of 3,272 HIV infections were attributed to male-to-male sexual contact (Table 1). Of the 28,851 HIV infections among persons with infection attributed to male-to-male sexual contact overall, 23,559 (81.7%) were among persons living in MSAs. Persons aged ≥13 years living in MSAs comprised 65.5% (167,919,694 of 256,388,562) of the total population† of persons aged ≥13 years for the areas that were assessed (103 MSAs, 263 smaller metropolitan areas, and 198 nonmetropolitan areas).

A total of 11,410 (48.4%) of the 23,559 estimated HIV infections attributed to male-to-male sexual contact were among persons who resided in seven MSAs: New York, New York, New Jersey, Pennsylvania (3,347); Los Angeles, California (2,589); Miami, Florida (1,481); Atlanta-Sandy Springs-Marietta, Georgia (1,059); Chicago, Illinois, Indiana, Wisconsin (1,011); Dallas, Texas (995), and Houston-Baytown-Sugar Land, Texas (928) (Table 2). Persons aged ≥13 years residing in these seven MSAs comprised 31.7% (53,169,004 of 167,919,694) of the total population of persons aged ≥13 years for the MSAs that were assessed. The four largest percentages of HIV infections attributed to male-to-male sexual contact in MSAs were in Los Angeles, California (81.9%), Fresno, California (80.8%), Modesto, California (78.8%), and Oxnard-Thousand Oaks-Ventura, California (78.2%).§

Reported by

Hollie Clark, MPH, H. Irene Hall, PhD, Tian Tang, MS, Shericka Harris, MPH, Anna Satcher Johnson, MPH, Joseph Prejean, PhD, Div of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC. Corresponding contributor: Hollie Clark, hclark@cdc.gov, 404-639-3983.

Editorial Note

The results of this analysis indicate that the majority of HIV infections in newly diagnosed persons aged ≥13 years in 2010 were attributed to male-to-male sexual contact. The percentages of HIV infections attributable to male-to-male sexual contact were higher in MSAs, compared with smaller metropolitan areas and nonmetropolitan areas. Among the MSAs examined, seven accounted for 48.4% of the persons with HIV infection attributable to male-to-male sexual contact. The four MSAs with the largest percentages of HIV infections attributed to male-to-male sexual contact were located in California. These results highlight the disproportionate burden of HIV infection among MSM, who were estimated to comprise approximately 3.9% of the male population aged ≥13 years in 2008 in the United States (8).

The geographic concentration of HIV infection reflects the higher risk for HIV transmission in areas with larger populations, greater prevalence of HIV infection attributed to male-to-male contact (e.g., MSAs compared with smaller areas), and possibly a greater prevalence of MSM living in the community. Effective interventions that could reduce the number of HIV infections in MSAs include HIV testing, HIV care and treatment, and risk-reduction counseling.

The findings in this report are subject to at least three limitations. First, HIV infection surveillance locations in five areas were excluded because they had not had confidential name-based reporting in place by January 2007 or had not reported these data to CDC since at least June 2007. The effect of this limitation is unknown. Second, comparisons were made based on estimated percentages of diagnoses instead of HIV diagnosis rates. To evaluate disparities in HIV risk between groups, HIV diagnosis rates should be calculated by applying population denominators for persons within each transmission category; however, such population estimates currently are unavailable for MSAs, smaller metropolitan areas, and nonmetropolitan areas. Finally, transmission category estimates were adjusted for missing risk factor information. Whether these adjustments introduce any bias in overestimation or underestimation of percentages of HIV infection attributed to specific categories is unknown. Adjusted estimates should be interpreted with caution, particularly when numbers are small (i.e., less than 12).

CDC’s High-Impact HIV Prevention¶ program relies on geographic targeting of resources and proven, cost-effective interventions to achieve the goals of the National HIV/AIDS Strategy, which include reducing the number of persons who become infected with HIV, increasing access to care and optimizing health outcomes for persons living with HIV, and reducing HIV-related health disparities.** The results of this analysis underscore the uneven geographic distribution of the burden of HIV infection in MSAs in the United States and Puerto Rico. The geographic disparity in HIV burden also indicates a need to target MSM who bear a large percentage of the burden of infection in areas where persons are at greatest risk for HIV transmission. Health departments, community-based organizations, and other agencies can use these results in planning interventions in their areas to reduce HIV infection and transmission.

References

  1. Prejean J, Song R, Hernandez A, et al. Estimated HIV incidence in the United States, 2006–2009. PLoS One 2011;6:e17502.
  2. CDC. AIDS cases, by geographic area of residence and metropolitan statistical area of residence, 2004. HIV/AIDS surveillance supplemental report. Vol. 12, No. 2. Atlanta, GA: US Department of Health and Human Services, CDC; 2006. Available at http://www.cdc.gov/hiv/surveillance/resources/reports/2006supp_vol12no2/pdf/cover.pdf . Accessed November 21, 2012.
  3. Song R, Green TA. An improved approach to accounting for reporting delay in case surveillance systems. JP Journal of Biostatistics 2012;7:1–14.
  4. Harrison KM, Kajese T, Hall HI, Song R. Risk factor redistribution of the national HIV/AIDS surveillance data: an alternative approach. Public Health Rep 2008;123:618–27.
  5. Rubin, DB. Multiple imputation for nonresponse in surveys. New York, NY: John Wiley & Sons, Inc.; 1987.
  6. CDC. Diagnoses of HIV infection and AIDS in the United States and dependent areas, 2010. HIV surveillance report, 2010. Vol. 22. Atlanta, GA: US Department of Health and Human Services, CDC; 2012. Available at http://www.cdc.gov/hiv/surveillance/resources/reports/2010report/index.htm. Accessed November 21, 2012.
  7. CDC. Terms, definitions, and calculations used in CDC HIV surveillance publications. Atlanta, GA: US Department of Health and Human Services, CDC; 2012. Available at http://www.cdc.gov/hiv/topics/surveillance/resources/factsheets/pdf/surveillance_terms_definitions.pdf . Accessed November 21, 2012.
  8. Purcell DW, Johnson CH, Lansky A, et al. Estimating the population size of men who have sex with men in the United States to obtain HIV and syphilis rates. Open AIDS J 2012;6:98–107.

* MSAs have populations ≥500,000; smaller metropolitan areas have populations of 50,000–499,999, and nonmetropolitan areas are those with populations <50,000. Additional information available at http://www.whitehouse.gov/sites/default/files/omb/assets/bulletins/b10-02.pdf .

† Includes populations for adults and adolescents living in seven MSAs that were excluded from the total estimated number of HIV infections attributed to male-to-male contact.

§ Only percentages based on estimated numbers ≥12 are presented.

¶ Additional information available at http://www.cdc.gov/hiv/strategy/hihp/pdf/dhap_policy_maker.pdf .

** Additional information available at http://www.whitehouse.gov/administration/eop/onap/nhas.

What is already known on this topic?

In 2009, an estimated 64% of new human immunodeficiency virus (HIV) infections were attributed to male-to-male sexual contact.

What is added by this report?

Of the estimated 28,851 infections in 2010 attributed to male-to-male sexual contact, 23,559 (81.7%) were in metropolitan statistical areas (MSAs) with populations of 500,000 or more in the United States and Puerto Rico, and 11,410 (48.4%) of those infections were in seven of the MSAs assessed. The four MSAs with the greatest percentages of HIV infections attributed to male-to-male sexual contact were in California.

What are the implications for public health practice?

Effective interventions that could reduce the number of HIV infections in areas where men who have sex with men are at greater risk for HIV infection and transmission by male-to-male contact include HIV testing, HIV care and treatment, and risk-reduction counseling.

TABLE 1. Estimated number and percentage* of diagnoses of HIV infectionamong persons aged ≥13 years, by transmission category and size of location of residence — National HIV Surveillance System, United States and Puerto Rico, 2010
Location of residence (population) HIV transmission category Total diagnoses
Male-to-male sexual contact Injection-drug use Male-to-male sexual contact and injection-drug use Heterosexual contact Other transmission§
Reported

no.

Estimated no.** % of total Reported no. Estimated no.** % of total Reported no. Estimated no.** % of total Reported no. Estimated no.** % of total Reported no. Estimated no.** % of total Reported no. Estimated no.**
MSAs (≥500,000) 16,898 23,559 62.1 1,522 3,070 8.1 800 1,145 3.0 5,343 10,128 26.7 10,637 33 0.1 35,200 37,934
Small metropolitan areas (50,000–499,999) 2,153 3,182 56.1 248 502 8.8 114 182 3.2 840 1,802 31.7 1,525 8 0.1 4,880 5,677
Nonmetropolitan areas (<50,000) 1,137 1,756 53.7 161 313 9.6 69 121 3.7 491 1,076 32.9 1,033 5 0.2 2,891 3,272
Total 20,332 28,851 60.8 1,963 3,963 8.3 986 1,463 3.1 6,716 13,153 27.7 13,381 46 0.1 43,378 47,477
Abbreviations: HIV = human immunodeficiency virus; MSAs = metropolitan statistical areas.

* Estimates result from statistical adjustment that accounted for reporting delays, but not for incomplete reporting. Cases without reported risk factors were assigned transmission categories using multiple imputation methods.

† Includes all new diagnoses of HIV infection, regardless of stage of disease at diagnosis.

§ Includes hemophilia, blood transfusion, and perinatal exposure.

¶ Includes reported numbers from 103 MSAs, 263 smaller metropolitan areas, and 198 nonmetropolitan areas.

** Includes estimated numbers only from 96 MSAs, 258 smaller metropolitan areas, and 198 nonmetropolitan areas located in areas that had implemented confidential name-based HIV infection reporting by at least January 2007 and had reported these data to CDC since at least June 2007. Reported and estimated numbers smaller than 12 or percentages based on estimated numbers smaller than 12 are considered unreliable and should be interpreted with caution.

TABLE 2. Estimated number and percentage* of diagnoses of HIV infection attributed to male-to-male sexual contact among persons aged ≥13 years, by location of residence — National HIV Surveillance System, United States and Puerto Rico, 2010
Location of residence HIV infection attributed to male-to-male sexual contact Total diagnoses
Reported no.§ Estimated no. % of total Reported no.§ Estimated no.
Akron, Ohio 13 21 60.2 33 35
Albany–Schenectady–Troy, New York 28 46 46.4 75 99
Albuquerque, New Mexico 43 57 75.0 70 76
Allentown–Bethlehem–Easton, Pennsylvania, New Jersey 25 35 49.7 63 70
Atlanta–Sandy Springs–Marietta, Georgia 387 1,059 64.5 1,182 1,641
Augusta–Richmond County, Georgia, South Carolina 24 67 52.4 89 128
Austin–Round Rock, Texas 144 186 71.1 239 262
Bakersfield, California 28 50 36.0 112 138
Baltimore–Towson, Maryland 96 818
Baton Rouge, Louisiana 88 146 43.2 312 337
Birmingham–Hoover, Alabama 91 145 60.9 217 238
Boise City–Nampa, Idaho 9 17 60.8 25 27
Boston–Cambridge–Quincy, Massachusetts, New Hampshire 156 431
Bradenton–Sarasota–Venice, Florida 44 55 59.1 85 92
Bridgeport–Stamford–Norwalk, Connecticut 33 55 38.5 107 142
Buffalo–Niagara Falls, New York 51 77 45.8 127 169
Cape Coral–Fort Myers, Florida 28 33 34.1 89 97
Charleston–North Charleston, South Carolina 67 85 63.5 123 134
Charlotte–Gastonia–Concord, North Carolina, South Carolina 204 292 63.7 408 459
Chattanooga, Tennessee, Georgia 19 36 55.1 55 65
Chicago, Illinois, Indiana, Wisconsin 604 1,011 68.9 1205 1,468
Cincinnati–Middletown, Ohio, Kentucky, Indiana 113 164 66.7 226 246
Cleveland–Elyria–Mentor, Ohio 104 169 73.4 213 230
Colorado Springs, Colorado 21 28 72.2 35 38
Columbia, South Carolina 104 142 62.5 209 228
Columbus, Ohio 159 258 75.8 316 340
Dallas, Texas 767 995 68.4 1,334 1,455
Dayton, Ohio 62 75 76.2 90 98
Denver–Aurora, Colorado 201 241 68.2 322 353
Des Moines, Iowa 21 29 68.1 39 43
Detroit, Michigan 244 367 67.6 508 544
Durham–Chapel Hill, North Carolina 41 60 50.3 109 119
El Paso, Texas 77 101 76.1 121 132
Fresno, California 75 94 80.8 97 117
Grand Rapids–Wyoming, Michigan 21 29 69.5 39 42
Greensboro–High Point, North Carolina 66 87 62.6 128 139
Greenville, South Carolina 38 47 64.7 67 73
Harrisburg–Carlisle, Pennsylvania 22 31 54.3 53 57
Hartford–West Hartford–East Hartford, Connecticut 67 98 47.1 164 207
Honolulu, Hawaii 32 61
Houston–Baytown–Sugar Land, Texas 616 928 59.7 1,425 1,553
Indianapolis, Indiana 131 177 65.4 247 270
Jackson, Mississippi 62 104 56.7 167 184
Jacksonville, Florida 154 175 45.2 355 388
Kansas City, Missouri, Kansas 156 185 75.4 223 245
Knoxville, Tennessee 29 36 71.9 46 50
Lakeland, Florida 43 56 45.9 112 122
Lancaster, Pennsylvania 16 18 34.9 46 50
Las Vegas–Paradise, Nevada 249 284 73.4 351 387
Little Rock–North Little Rock, Arkansas 35 69 70.3 89 98
Los Angeles, California 1,575 2,589 81.9 2,335 3,161
Louisville, Kentucky, Indiana 68 128 68.6 170 186
Madison, Wisconsin 20 29 75.1 36 39
McAllen–Edinburg–Pharr, Texas 48 64 67.9 85 94
Memphis, Tennessee, Mississippi, Arkansas 108 231 52.8 395 438
Miami, Florida 1,184 1,481 53.9 2,514 2,749
Milwaukee–Waukesha–West Allis, Wisconsin 95 133 73.4 165 180
TABLE 2. (Continued) Estimated number and percentage* of diagnoses of HIV infection attributed to male-to-male sexual contact among persons aged ≥13 years, by location of residence — National HIV Surveillance System, United States and Puerto Rico, 2010
Location of residence HIV infection attributed to male-to-male sexual contact Total diagnoses
Reported no.§ Estimated no. % of total Reported no.§ Estimated no.
Minneapolis-St. Paul–Bloomington, Minnesota, Wisconsin 169 236 69.5 307 340
Modesto, California 12 16 78.8 17 20
Nashville–Davidson–Murfreesboro, Tennessee 158 234 71.5 298 327
New Haven–Milford, Connecticut 34 51 37.7 104 136
New Orleans–Metairie–Kenner, Louisiana 152 244 55.8 404 437
New York, New York, New Jersey, Pennsylvania 2,013 3,347 54.5 4,669 6,140
Ogden–Clearfield, Utah 10 11 83.0 12 13
Oklahoma City, Oklahoma 67 98 62.4 143 157
Omaha–Council Bluffs, Nebraska, Iowa 37 54 60.2 81 90
Orlando, Florida 310 407 59.8 622 682
Oxnard–Thousand Oaks–Ventura, California 25 34 78.2 35 43
Palm Bay–Melbourne–Titusville, Florida 35 44 53.6 75 82
Philadelphia, Pennsylvania, New Jersey, Delaware, Maryland 484 1,192
Phoenix–Mesa–Scottsdale, Arizona 300 361 73.9 453 489
Pittsburgh, Pennsylvania 92 112 67.3 153 166
Portland–South Portland, Maine 16 22 61.9 30 36
Portland–Vancouver–Beaverton, Oregon, Washington 131 158 72.5 198 218
Poughkeepsie–Newburgh–Middletown, New York 20 32 34.4 70 94
Providence–New Bedford–Fall River, Rhode Island, Massachusetts 67 89 60.5 151 147
Provo–Orem, Utah 4 4 66.8 6 7
Raleigh–Cary, North Carolina 114 143 69.3 190 206
Richmond, Virginia 105 147 56.3 217 260
Riverside–San Bernardino–Ontario, California 242 319 71.5 366 447
Rochester, New York 71 105 67.3 118 156
Sacramento–Arden–Arcade–Roseville, California 106 140 59.6 191 234
St. Louis, Missouri, Illinois 202 294 68.3 380 430
Salt Lake City, Utah 32 36 59.0 57 62
San Antonio, Texas 159 207 69.5 273 298
San Diego–Carlsbad–San Marcos, California 372 469 74.5 515 630
San Francisco, California 553 729 70.4 873 1,035
San Jose–Sunnyvale–Santa Clara, California 89 128 70.8 144 180
San Juan–Caguas–Guaynabo, Puerto Rico 138 267 34.3 475 778
Scranton–Wilkes-Barre, Pennsylvania 11 12 34.9 30 34
Seattle, Washington 267 328 74.9 401 438
Springfield, Massachusetts 21 72
Stockton, California 39 51 47.3 87 107
Syracuse, New York 26 38 58.0 49 65
Tampa–St. Petersburg–Clearwater, Florida 317 404 63.6 578 635
Toledo, Ohio 17 24 63.6 35 38
Tucson, Arizona 57 77 73.1 96 105
Tulsa, Oklahoma 46 59 69.8 79 84
Virginia Beach–Norfolk–Newport News, Virginia, North Carolina 131 241 60.4 335 400
Washington, District of Columbia, Virginia, Maryland, West Virginia 589 1,715
Wichita, Kansas 30 35 63.5 49 55
Worcester, Massachusetts 13 61
Youngstown–Warren–Boardman, Ohio, Pennsylvania 9 23 58.7 37 40
Total 16,898 23,559 62.1 35,200 37,934
Abbreviations: HIV = human immunodeficiency virus; MSAs = metropolitan statistical areas.

* Estimates result from statistical adjustment that accounted for reporting delays, but not for incomplete reporting. Cases without reported risk factors were assigned transmission categories using multiple imputation methods.

† Includes all new diagnoses of HIV infection, regardless of stage of disease at diagnosis.

§ Includes reported numbers from 103 MSAs, 263 smaller metropolitan areas, and 198 nonmetropolitan areas.

¶ Includes estimated numbers only from 96 MSAs, 258 smaller metropolitan areas, and 198 nonmetropolitan areas located in states that had implemented confidential name-based HIV infection reporting by at least January 2007 and had reported these data to CDC since at least June 2007. Reported and estimated numbers smaller than 12 or percentages based on estimated numbers smaller than 12 are considered unreliable and should be interpreted with caution.

 

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Study finds increased fractures in first 2 years after starting antiretroviral treatment

 

HIV positive individuals appear to have significantly increased risk of bone fractures during the first 2 years after beginning antiretroviral therapy (ART), but the risk returned to baseline levels thereafter, according to a study published in the November 2012 issue of the journal AIDS.

Several studies and clinical reports have shown that bone mineral density (BMD) decreases significantly upon starting ART. Moreover, HIV positive men have been shown to experience fractures at a younger age than HIV negative men.

Michael Yin of Columbia University and others looked at the incidence of fractures in over 4600 HIV positive individuals in the AIDS Clinical Trials Group (ACTG) Longitudinal-Linked Randomized Trial cohort, made up of participants from 26 HIV treatment studies; most were treatment-naive when they enrolled in these studies.

The average age in the cohort was 39 years, 48% were white, 29% were black, and 83% were men. Participants had relatively advanced HIV disease, with a baseline CD4 T-cell count of 242 cells/mm3 and a nadir or lowest-ever count of 187 cells/mm3. Nearly 40% were smokers, 4% had hepatitis B virus (HBV) coinfection, and 10% had hepatitis C virus (HCV) coinfection.

Results

  • A total of 116 fractures were reported among 106 participants (2.3%), 67 of them among people who were treatment-naive at enrollment.
  • Average time to first fracture was just over 2 years.
  • Baseline incidence of fractures was 0.40 per 100 person-years (PY) among all participants, and 0.38 per 100 PY among those who were treatment-naive.
  • Among treatment-naive people starting therapy, the risk of fractures within the first 2 years after ART initiation was 0.53 per 100 PY.
  • After 2 years, however, the rate decreased to 0.30 per 100 PY.
  • Traditional risk factors like smoking, HBV or HCV coinfection, and corticosteroid use increased the risk of fractures.
  • Current and lowest-ever CD4 count were not significant predictors of fractures.
  • Use of specific antiretroviral drugs was not associated with additional risk.

“Fracture rates were higher within the first 2 years after ART initiation, relative to subsequent years,” the researchers concluded. “However, continuation of ART was not associated with increasing fracture rates in these relatively young HIV-positive individuals.”

This study and others suggest loss of bone mineral density and increased risk of fractures are significant risk factors associated with the start of ART. This risk seems to be highest during the first 2 years after starting antiretrovirals and declines thereafter.

While the biological mechanism for this is not fully understood, the study’s authors suggest 2 possible explanations. First, the decrease in risk over time might be a reflection of overall improvement in health with more time on ART. It is also possible that increased study visits and clinical vigilance in the short term after treatment initiation might have identified more fractures.

Furthermore, several factors known to increase the risk of bone loss and fractures are common among people with HIV. These include smoking, HCV coinfection, alcohol and drug use, and corticosteroid use. There is likely an additive risk for people on antiretrovirals. Of note, only about 20% of participants in this analysis used tenofovir (Viread, also in the Atripla, Complera, and Stribild coformulations), which is now one of the most commonly used HIV drugs and has been linked to bone loss. It is also noteworthy that other studies have found higher rates of fractures among people with HIV in general, not only those on ART.

The study’s authors note that this cohort was generally young, with an average age of 39 years. Risk of fractures increases with age. Therefore, fracture rates would be expected to be higher among older people with HIV, particularly post-menopausal women.

The authors also note that although the bone loss was similar in the near term among those starting antiretrovirals and corticosteroids, the risk of fracture is higher among those initiating corticosteroids. The authors argue that this apparent discrepancy suggests the need for further study of the “micro-architecture” of bones during this acute loss of BMD.

By Paul Dalton

CDC Releases Data on New Cases of HIV

December 19, 2012  •  0 comments • By Jonathan Mermin, MD, MPH, Director, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention

Johnathan MerminToday, the Centers for Disease Control and Prevention released new data on HIV incidence in the United States from 2007 to 2010. There were an estimated 47,500 new HIV infections in 2010, and incidence remains relatively stable at about 50,000. Data from this report also show two noteworthy trends; first, between 2008 and 2010, new HIV infections among African American women declined 21 percent, giving us cause for cautious optimism. Secondly, however, there was an increase in incidence of 22 percent among young gay and bisexual men aged 13 to 24 years.

While we are encouraged to see declines among African American women, they remain one of the most severely affected populations. As for youth, last month’s Vital Signs focused on the issue of HIV among youth aged 13 to 24 years in the United States, among whom 72 percent of all new infections were attributable to male-to-male sex.  In addition, 54 percent of new HIV infections were among African-American and 20% were among Hispanic/Latino gay and bisexual youth.

These new data establish a baseline for the National HIV/AIDS Strategy (NHAS) goal of decreasing new HIV infections by 25 percent by 2015. CDC is using a High Impact Prevention approach to programs, policy, and research, and partnering with state and local health departments, community-based and national organizations, and multiple federal agencies such as the Health Resources and Services Administration (HRSA), the National Institutes of Health (NIH) and the Substance Abuse and Mental Services Health Administration (SAMSHA), to have the greatest effect possible on HIV prevention and care.

To reach this NHAS goal, we need to continue to have national involvement in HIV prevention and care from all parts of society, including lesbian, gay, bisexual, and transgender communities and organizations, African-American and Latino leaders, and everyone who has, or is affected by, HIV. We can’t afford for a new and vibrant generation to lose its health to a preventable disease.

Note from AIDS.gov: On the CDC website you can find a fact sheet on this data.

Sexually Transmitted HCV Rising among HIV+ Gay Men in Europe, but More Are Getting Treated

by Liz Highleyman

Hepatitis C virus (HCV) infection rates continue to rise among HIV positive people in Europe, with the highest incidence among injection drug users and men who have sex with men, researchers reported at the 11th International Congress on Drug Therapy in HIV Infection last month in Glasgow. Another study, however, found that HIV/HCV coinfected people are now more likely to receive hepatitis C treatment.

Over the past decade several outbreaks of presumed sexually transmitted HCV infection have been reported among HIV positive gay and bisexual men, first in cities in the U.K. and Europe, followed by Australia and the U.S. Studies have not seen a similar phenomenon among HIV negative men who have sex with men (MSM), despite similar sex- and drug-related behavior. Ole Kirk from the University of Copenhagen and fellow investigators conducted a study to determine the incidence of acute hepatitis C — indicating recent infection — within the large EuroSIDA cohort, and to explore regional differences throughout Europe and between different HIV transmission risk groups. The analysis included EuroSIDA participants who were HCV antibody negative at baseline (January 1, 2002, or entry into the cohort) and had at least 2 available HCV antibody test results. HCV seroconversion was defined as change from a negative to a positive HCV antibody test within the observation period. Results

  • A total of 150 HCV seroconversions occurred among 4295 EuroSIDA participants during 18,928 person years (PY) of follow-up.
  • The overall incidence was 0.79 acute infections per 100 PY.
  • 95 of these seroconverters (63%) were gay/bisexual men.
  • The incidence of HCV seroconversion increased from 0.47 per 100 PY in 2002 to 2.34 per 100 PY in 2010, with an overall incidence of 0.79 acute infections for the entire period.
  • In a multivariate analysis, injection drug use was associated with a higher incidence rate ratio (IRR) — 4.59, or more than 4-fold higher — than men having sex with men.
  • Southern and Eastern Europe both had higher incidence than Western Europe (IRR 1.98 and 2.41, respectively).
  • Later calendar years were also associated with a higher incidence (IRR 1.29, or 29% increase every 2 years).

“The incidence of acute HCV within EuroSIDA increased over time,” the researchers concluded. “Although the incidence of seroconversion was 54% higher in MSM than in heterosexuals, injection drug users had the highest incidence of HCV seroconversion.” “Rising incidences can be found in all European regions highlighting the need for increased prevention efforts in all European countries,” they advised — a recommendation that could also be appropriate for the U.S. Hepatitis C Treatment A second study presented at the conference found that more HIV people in the same cohort are taking advantage hepatitis C treatment, although some may be waiting for better options. Daniel Grint from Royal Free Hospital in London and fellow EuroSIDA investigators assessed the frequency of hepatitis C treatment — using at least pegylated interferon (Pegasys or PegIntron) plus ribavirin, and possibly the new direct-acting antivirals boceprevir (Victrelis) or Telaprevir (Incivek or Incivo) —among HIV/HCV coinfected study participants. They also estimated the effect of treatment on all-cause mortality and liver-related death. Up to 30% of HIV positive patients in Europe who are tested for HCV are seropositive, the researchers noted as background. “All coinfected patients with chronic HCV and F2 [moderate] fibrosis should be considered for HCV therapy given their increased risk of death from liver disease,” they wrote. This prospective observational analysis included 1947 EuroSIDA participants who tested positive for both HCV antibodies and HCV RNA. Just over 40% had difficult-to-treat HCV genotype 1. About three-quarters had a history of injection drug use. Results

  • Overall, 456 HIV/HCV coinfected patients (23%) received hepatitis C treatment during a median follow-up period of 107 months.
  • The likelihood of hepatitis C treatment rose from 0.29 per 100 PY in 1998 to 5.26 per 100 PY in 2007, fell to 3.73 per 100 PY in 2009, and stabilized at 4.70 in 2010.
  • During the early upswing, treatment uptake increased by approximately 25% per year, followed by a 12% annual decline.
  • Considerable regional differences were observed in treatment uptake; Northern Europe had the highest rate in 2010, though rates in other regions had peaked and fallen previously.
  • Factors that significantly predicted treatment included CD4 T-cell count greater than 350 cell/mm3 (IRR 1.75), HIV RNA < 500 copies/mL (IRR 1.58), and HCV genotype 3 (IRR 1.55 vs genotype 1).
  • A total of 355 deaths from all causes and 95 liver-related deaths occurred during follow-up.
  • In a multivariate model, hepatitis C treatment was not significantly associated with all-cause mortality (IRR 0.81) or liver-related death (IRR 1.0).

“The incidence of treatment for HCV among coinfected patients increased from 1998 until 2007 and was common in those with higher CD4 cell counts and lower HIV RNA, consistent with HCV treatment guidelines,” the researchers concluded. “HCV treatment was not associated with all-cause or liver-related death in this population.” Grint suggested that possible reasons for the recent stabilization in treatment uptake could be that most eligible patients have already been treated, or that people without advanced liver disease may be waiting for new and better therapies currently in development, including interferon-free all-oral regimens. 12/14/12 References J Rockstroh, D Grint, C Boesecke, O Kirk, et al. Increases in acute hepatitis C (HCV) incidence across Europe: which regions and patient groups are affected? 11th International Congress on Drug Therapy in HIV Infection (HIV11). Glasgow, November 11-15, 2012. Abstract O242. D Grint, L Peters, M Vogel, et al. Temporal changes and regional differences in treatment uptake of hepatitis C therapy in EuroSIDA. 11th International Congress on Drug Therapy in HIV Infection (HIV11). Glasgow, November 11-15, 2012. Abstract O243.

AIDS Activist Spencer Cox Dies

BY Sunnivie Brydum

December 18 2012 7:08 PM ET

Spencer Cox, a pivotal AIDS activist who helped spearhead research on lifesaving protease inhibitors, died this morning of AIDS-related causes at Columbia Presbyterian Hospital in New York City. He was 44 years old.

Cox cofounded Treatment Action Group and was a spokesman for ACT UP, and his activism began early. According to an obituary posted on ACT UP’s website, Cox “schooled himself in the basic science of AIDS and became something of an expert, a ‘citizen scientist’ whose ideas were sought by working scientists. In the end, Spencer wrote the drug trial protocol which TAG proposed for testing the promising protease inhibitor drugs in 1995. Adopted by industry, it helped develop rapid and reliable answers about the power of those drugs, and led to their quick approval by the FDA.”

Cox was featured prominently in David France’s recent documentary about the AIDS epidemic, How to Survive A Plague, and in memory of the activist, France released the interview below, an outtake from his powerful documentary. Watch Cox’s heartfelt reflections on a pivotal moment for AIDS patients in the video below.

 

http://youtu.be/unDyouBoo9M

 

Support Group Meeting @ Project Response 12/18/2012

Holiday dinner2012

An AIDS-Free Generation

Created on 07 December 2012 Written by Blog.AIDS.Gov Category: North America HIV News

Despite great strides in treating HIV, and despite effective prevention strategies that have reduced its spread among many populations, about 50,000 new cases of HIV are still diagnosed each year. December 1, World AIDS Day, is a good time to remember not only how far we have come since HIV first appeared three decades ago, but also the obstacles that still stand in the way of creating the “AIDS-free generation” that Secretary of State Hillary Rodham Clinton has called on the world community to achieve.

One of those obstacles is drug abuse, which has been closely intertwined with the epidemic since the start. A third of the 1.2 million Americans living with HIV are current drug users, and most have a history of illicit drug use. One fifth of those with HIV don’t know they have it. All forms of drug and alcohol abuse facilitate the spread of HIV by making risky behaviors such as unsafe sex more likely, and use of injection drugs compounds the risks through the danger of sharing contaminated needles. Injection drug users (IDUs) are at greatly increased risk for contracting HIV compared to the rest of the population, and unfortunately they are also the hardest to reach with testing and treatment.

One of the goals set forth in the National HIV/AIDS Strategy is increasing access to care and improving health outcomes for all Americans living with HIV, and in unveiling the President’s Emergency Plan for AIDS Relief (PEPFAR) Blueprint this week, Clinton emphasized the need to break down barriers to HIV services for key populations worldwide, including IDUs.