National Men’s HIV/AIDS Awareness Day

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Viral load as low as 400 copies/ml six months after starting ART is associated with a significant ten-year mortality risk

Michael Carter
Published: 05 July 2017

A viral load as low as 400 copies/ml six months after starting HIV therapy is associated with a substantial ten-year mortality risk, investigators from the United States report in the online edition ofAIDS. People with a viral load between 400 and 999 copies/ml had a 20% mortality risk, similar to the 23% risk observed in people with a viral load between 1000 and 4 million copies/ml. In contrast, the mortality risk was only 14% for individuals who rapidly achieved complete viral suppression – a viral load below 20 copies/ml.

“A single viral load measurement collected six months after initiating ART [antiretroviral therapy] remains highly informative regarding the risk of death over 10 years,” write the authors.

The aim of ART is rapid and sustained suppression of viral load to below the limit of detection (between 50 to 20 copies/ml depending on testing assay). Treatment guidelines suggest that viral load should be undetectable six months after the initiation of treatment. Newer antiretroviral drug combinations, especially those containing an integrase inhibitor, suppress viral load more rapidly.

Ongoing low-level viral replication despite therapy is associated with the emergence of drug-resistant virus, causing treatment failure and an increase in the risk of HIV- and non-HIV-related illnesses. Small increases in viral load once complete suppression has been achieved, above the limit of detection on occasional tests, so-called viral load `blips`, do not predict treatment failure and are not problematic. This study looked at the failure of treatment to achieve viral suppression after six months.

Analysing viral load measurements taken six months after ART initiation, a team of US investigators sought to determine the level of low-level viraemia (up to 1000 copies/ml) which was associated with an increased risk of all-cause mortality over ten years.

Their study population consisted of approximately 8000 adults who initiated ART between 1998 and 2014. Study participants were followed until death or for up to ten years.

Median age at baseline was 40 years; 83% of participants were male; 62% were in the men who have sex with men risk group; 45% were white and 12% reported ever injecting drugs. The median pre-ART viral load was 75,000 copies/ml and the median year of ART initiation was 2007. Approximately a third of people had been diagnosed with AIDS before starting treatment.

The median period of follow-up was 6.2 years, during which time there were 863 deaths.

Over half (57%) of viral load measurements six months after starting therapy were below 20 copies/ml, with 15% measured at 1000 copies/ml or higher.

As expected, compared to a viral load below 20 copies/ml, a viral load above 999 copies/ml was strongly associated with an increased risk of all-cause mortality over ten years (HR = 1.96; 95% CI, 1.56-2.46). A slightly increased risk of mortality was discernible at a viral load as low as 130 copies/ml (HR = 1.39; 95% CI, 1.02-1.88).

“While we observed an increased hazard of death with low-level viral loads, discernible at 130 copies/ml,” write the authors, “this association was largely driven by the elevated mortality risk experienced by patients with viral load between 400 and 999 copies/ml.”

The average ten-year mortality risk for people with a viral load below 20 copies/ml was 13%, similar to the 14% risk observed in individuals with a viral load between 20 and 400 copies/ml. The ten-year mortality risk was 20% for people with a viral load between 400 and 999 copies/ml, comparable to the 23% risk for people with a viral load of 1000 copies/ml or higher.

“Low-level viral loads between 400 and 999 copies/ml shortly after starting ART appear to place patients at a significantly higher 10-year risk of death than patients with viral loads under 20 copies/ml, and occurrences of viral loads in this range may need to be treated similarly as viral load that exceed 1000 copies/ml,” conclude the authors. “Given the importance of rapidly achieving virologic suppression after initiating treatment, further investigation of the causes of unsuppressed viral loads between 400 and 999 copies/ml is warranted.”

The authors suggest that incomplete viral suppression six months after starting treatment may be a marker for several problems. Apart from lack of adherence to treatment or poor retention in care, incomplete viral suppression might be a consequence of undetected drug resistance, or of drug-drug interactions that lead to low levels of antiretroviral drugs. Planning in advance to prevent these problems from undermining treatment, and prompt investigation of any problems, are likely to improve the chances of viral suppression

 

  • September 27, 2016: National Gay Men’s HIV/AIDS Awareness Day (NGMHAAD), a national campaign highlighting the disproportionate impact HIV/AIDS has had on gay men. Despite only making up 2% of the population, 55% of people living with HIV in the U.S. identified as gay, bisexual, or other MSM. Learn more about services and ways to get involved.

 

https://www.aids.gov/news-and-events/awareness-days/gay-mens/

Global Female Condom Day!!

 

GFCD Logo

Get excited! Global Female Condom Day is quickly approaching!

 

In less than a month, we will celebrate the 5th annual Global Female Condom Day! In years past, we shared stories through the “Female Condoms Are …” film festival and showed the need for female condoms by Dancing for Demand. Now in 2016, even as the prevention landscape evolves to include the HIV prevention pill PrEP, the need for multi-purpose technology continues. We want you to share your vision for the future of female condoms.

What is the next step for female condoms? Where can this tool fit in the future of HIV and pregnancy prevention? On September 16, advocates across the globe will tweet and text responses to these questions. Stay tuned for specifics about how to take part in our worldwide vision for the future on September 16. In the meantime, here’s what you can do right now to prepare:

  • Sign on to officially endorse GFCD as an organization or an individual
  • Lend your support to a campaign to make female condoms easier to access to the United states
  • Tell us how you promote FCs all year long
  • Let your networks on social media know that GFCD 2016 is coming September 16 by using the hashtags #FemaleCondoms and #GFCD2016
  • Become inspired by fellow advocates who champion female condoms as a prevention option in their communities

Watch your inbox next week for more ways to participate in our online day of action on September 16 and for a full social media toolkit. We can’t wait to hear your vision for the future!

 

“License to Discriminate” Legislation Angers LGBTQ Community

On July 12th, exactly one month after the horrifying massacre at the Pulse nightclub in Orlando, Florida the Committee on Oversight and Government Reform held a hearing on H.R. 2802, the First Amendment Defense Act (FADA). I attended this hearing on behalf of AIDS United.

Although its proponents will not say so, the purpose of FADA is to allow individuals, nonprofits, and federal employees to discriminate against LGBTQ people on the basis of their religious beliefs and/or moral convictions without federal intervention. The act would prohibit the federal government from taking any action, such as revoking tax-exempt status, against entities who discriminate against others based on their beliefs that marriage should be between one man and one woman or that sex should be confined to marriage. Opponents of the bill are calling it a “license to discriminate” because it legalizes discrimination against the LGBTQ community. This act not only negatively affects the LGBTQ community, it also would place undue burden on single mothers and unmarried couples.

The hearing hosted a comprehensive panel including Senator Mike Lee (R-UT) and pro-LGBTQ advocates such as Jim Obergefell, the lead plaintiff in the Supreme Court case Obergefell v. Hodges that nationally legalized same sex marriage, former Congressman Barney Frank, and Katherine Franke, the Isidor and Seville Sulzbacher professor of law and the director of the Center for Gender and Sexuality Law at Columbia Law School.

Many members of the committee and panel criticized the inopportune timing of the hearing. Representative Elijah Cummings (D-MD) remarked, “To say this meeting is tone deaf is the understatement of the year.” According to Representative Cummings, 80 letters were submitted and disregarded asking the committee to postpone the meeting to a different day.

Obergefell noted, “Today, exactly one month after this horrifying event, I am appearing before this Congressional committee to discuss a bill that would authorize sweeping, taxpayer-funded discrimination against LGBT people. I think that is profoundly sad.”

I and others in the LGBTQ community found this hearing insulting not just because of its poorly planned date, but also because of the detrimental effects the bill would have on our community. In his opening remarks, Rep. Frank explained how this bill is very personal to him and described a scenario in which the bill would allow discrimination against same-sex couples; if nonprofit developers wanted to use government funding to build housing and chose to exclude same-sex couples from that housing because same-sex marriage goes against the religious beliefs of the organization, the government would be prohibited from denying the organization federal funds due to this bill.

Meanwhile, Senator Lee, argued its purpose is to ensure no American is forced to choose between their religious beliefs and being eligible for nonprofit tax-exempt status and access to federal grants. Ms. Franke repeatedly reminded the committee that these religious protections already exist through the First Amendment. Obergefell added that no church or clergy in this country have ever been forced to marry a couple that would violate their religious beliefs. Further, various religious-affiliated organizations across the nation voiced their opposition to the FADA bill. Franke concluded, “FADA is a solution looking for a problem.”

Not only is this legislation unnecessary, but it also prohibits the federal government from protecting same-sex couples from discrimination by entities such as nonprofits and foster care agencies. If passed, this legislation would start a dangerous precedent of federally-sanctioned discrimination against marginalized groups of people in the name of religious freedom. The First Amendment already guarantees religious freedom in this country, but there is currently no federal legislation protecting members of the LGBTQ community from discrimination. While this bill is unlikely to pass during the Congress, Republican Presidential Nominee Donald Trump recently said he would sign FADA into law if he were president. During a time where there is increased violence against the transgender community and on the anniversary of the tragic Orlando shooting targeting LGBTQ people, it is disgraceful that elected officials are even considering such legislation.

 

Enough is Enough!! We need to stop violence against LGBTQ. To many years of seeing how discrimination has hurt so many. I lived most of my life in New York City and saw how the Gay community was treated, “Horrible”! The only time I saw and heard some form of peace was when I used to dj at dance a teria, Palladium, 54 and my hangouts in soho area. I used to work on gay night, not to many dj’s where available on certain nights. I must say it was a privilege and honor to spin my music and give so many the freedom & happiness, even though it was for a couple of hours.

Thank you, LGBT for allowing me to learn so much about your world and learn how discrimination can hurt so many!!!

I will always fight for your cause!!!

 

Peace, Love, Happiness to all!!

 

Documentary About HIV/AIDS in the 1980s to Debut on CNN

 

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Michael S. Gottlieb, M.D., Immunologist, UCLA Medical Center

CNN will present “The Fight Against AIDS” on Thursday, May 12, 2016, at 9 p.m. as part of its documentary series The Eighties. The seven-part series focuses on the events that shaped the ’80s—a decade that included President Ronald Reagan, the end of the Cold War, Wall Street corruption, the tech boom, the expansion of television and the beginning of the AIDS crisis.

“The Fight Against AIDS” chronicles the history of HIV/AIDS through archival footage and interviews with journalists, historians, doctors, researchers, celebrities and activists. It traces the AIDS crisis from the epidemic’s beginning—when young, sexually active gay men, Haitian refugees, drug users and hemophiliacs were among the first known cases—to the panic and hysteria that resulted from the uncertainty, misinformation and ignorance surrounding the virus; and on to Hollywood’s involvement and gay-rights activists’ struggles to pressure the government to find a treatment and cure.

Highlights include the development of test kits, the impact of Rock Hudson’s AIDS diagnosis upon public awareness, the harassment of Ryan White and his subsequent activism, the Reagan controversy, and the mobilization of the LGBT community. The documentary, however, touches only briefly upon the epidemic in Black America, which the media and many other mainstream organizations largely ignored.

Gay-rights activists Cleve Jones and Larry Kramer; immunologist Dr. Anthony S. Fauci, who has been director of the National Institute of Allergy and Infectious Diseases since 1984; immunologist and HIV researcher Dr. Michael Gottlieb; and Black AIDS Institute founder, president and CEO Phill Wilson are among the pioneers in fighting the epidemic who are featured in the episode, which is definitely worth watching.

April Eugene is a Philadelphia-based writer.

 

 

 

United States Conference On AIDS 2015

http://www.2015usca.org/

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