Posts in ‘HIV’ category

Is antiretroviral treatment for HIV increasing the susceptibility to syphilis

Posted on 9th August 2017 by · 1 comment

Recently, the world has experienced a rapidly escalating outbreak of infectious syphilis primarily affecting men who have sex with men (MSM); many are taking highly active antiretroviral therapy (ARV) for HIV-1 infection.

Treatment with ARV reduces risk of infection (because of greatly reduced viral load) and near-normal life expectancy for those on treatment. The currently accepted hypothesis is that these factors result in increased sexual risk-taking, especially unprotected anal intercourse, leading to more non-HIV-1 sexually transmitted infections, including gonorrhoea, chlamydia and syphilis.

However, syphilis incidence has increased more rapidly than other STDs. In a recent open access article in the journal Sexually Transmitted Infections, Reckart and colleagues hypothesise that ART itself  may alter the innate and acquired immune responses to Treponema pallidum, the bacterium causing infectious syphilis, and that this biological explanation plays an important role in the current syphilis epidemic.

In a leading article in the same journal, Susan Tuddenham and colleagues (only available to subscribers), find the hypothesis intriguing despite some flaws. They go on to suggest that further work is necessary to look at the mechanisms underlying the current syphilis epidemic.

In the same issue David Glidden et al point out that in the early double blind trials with pre-exposure prophylaxis (PrEP) no increase in syphilis was found between those taking PrEP and those taking placebo. These findings would suggest that short term exposure to ART has no effect on the acquired immune responses to Treponema pallidum.

Sexually transmitted infections: challenges ahead

Posted on 21st July 2017 by · No comments

A commissioned article in Lancet Infectious Diseases on July 9, 2017 highlights some of the major issues and challenges facing us in the growing global epidemic of sexually transmitted infections (STI). Authors Prof Mabhus Unemo et al summarise the key issues as follows:

WHO estimated that nearly 1 million people become infected every day with any of four curable sexually transmitted infections (STIs): chlamydia, gonorrhoea, syphilis, and trichomoniasis. Despite their high global incidence, STIs remain a neglected area of research.

In this Commission, we have prioritised five areas that represent particular challenges in STI treatment and control.

Chlamydia remains the most commonly diagnosed bacterial STI in high-income countries despite widespread testing recommendations, sensitive and specific non-invasive testing techniques, and cheap effective therapy. We discuss the challenges for chlamydia control and evidence to support a shift from the current focus on infection-based screening to improved management of diagnosed cases and of chlamydial morbidity, such as pelvic inflammatory disease.

The emergence and spread of antimicrobial resistance in Neisseria gonorrhoeae is globally recognised. We review current and potential future control and treatment strategies, with a focus on novel antimicrobials.

Bacterial vaginosis is the most common vaginal disorder in women, but current treatments are associated with frequent recurrence. Recurrence after treatment might relate to evidence that suggests sexual transmission is integral to the pathogenesis of bacterial vaginosis, which has substantial implications for the development of effective management approaches.

STIs disproportionately affect low-income and middle-income countries. We review strategies for case management, focusing on point-of-care tests that hold considerable potential for improving STI control.

Lastly, STIs in men who have sex with men have increased since the late 1990s. We discuss the contribution of new biomedical HIV prevention strategies and risk compensation.

Overall, this Commission aims to enhance the understanding of some of the key challenges facing the field of STIs, and outlines new approaches to improve the clinical management of STIs and public health.

Read full article on Lancet Infectious Diseases

PrEP introduction for adolescent girls and young women

Posted on 23rd August 2016 by · No comments

Pre-exposure prophylaxis PrEP use in the sexually active females prevents HIV acquisition.

The International AIDS Conference in Durban, South Africa, in July 2016, has renewed interest and momentum around HIV prevention. High and sustained HIV incidence rates—about 2 million people acquiring HIV every year for the past 5 years—highlight the need for new prevention technologies for populations at substantial risk of HIV.1 As many as 7000 new infections a week are occurring in the most vulnerable adolescent girls and young women in eastern and southern Africa.1 75% of young people in sub-Saharan Africa living with HIV are adolescent girls and young women age 15–24 years; AIDS is the leading cause of death for girls age 10–19 years in Africa.1 To date, prevention efforts have not had sufficient effect on risk of HIV in adolescent girls and young women.

Oral pre-exposure prophylaxis (PrEP)—the use of antiretroviral medications by HIV-negative people to avoid getting HIV—is a new biomedical intervention that has the potential to substantially reduce HIV acquisition in the people at greatest risk. Recent evidence suggests that PrEP was effective among several populations in reducing the risk of HIV infection by 70%.2 Less is known about the effectiveness of PrEP for young women,2 but the intervention could greatly increase the ability of adolescent girls and young women to protect themselves from HIV if they are able to access and use it effectively.

Read whole article

Invitation to apply for research Funds – 2016 Round

Posted on 20th April 2016 by · No comments

Applications are invited from researchers in various fields related to sexual health, HIV and other sexually transmitted viruses.

Sexually Transmitted Infections Research Foundation (STIRF) was set up to pump prime research projects relating to the epidemiology, pathophysiology, management, and health care delivery of sexually transmitted infections and HIV in the East and West Midland, the North East and North West Regions.

The primary aim is to provide initial funding to allow promising projects from young researchers to obtain preliminary results as a prelude to acquire further funds from larger funding bodies.

We invite applications from researchers in the above regions on projects relating to sexually transmitted diseases and HIV. All projects will be initially screened by the Scientific Committee of STIRF and those considered suitable will be sent for peer review by experts in the field.

The following fields of research will be considered in relation to STIs and HIV

  • Epidemiology of HIV and other sexually transmitted diseases
  • Research on HPV and other sexually transmissible malignancies
  • Health care delivery including views of clients
  • Issues relating to deprived or marginalised communities.
  • Pathophysiology of diseases and syndromes
  • Inter-relationship between diseases
  • Treatment modalities
  • Complications of treatment and co-morbidities

Applications should not exceed £50,000 in the first year. Depending on satisfactory reports a further £25,000 may be available for the second year. Joint funding with other grant giving bodies will be considered.

For further information and guidance on how to apply visit

How to apply for grants

Deadline for applications is 30th June 2016

Applications using the appropriate form downloaded from the STIRF web site should be sent by email to:

Dr Mohsen Shahmanesh,(Hon Secretary STIRF)

Stirfweb@gmail.com

The perils of chemsex

Posted on 3rd December 2015 by · No comments

The term “Chemsex” is used in the United Kingdom to describe intentional sex under the influence of psychoactive drugs, mostly among men who have sex with men. The main drugs are mephedrone, γ-hydroxybutyrate (GHB), γ-butyrolactone (GBL), and crystallised methamphetamine. These drugs are often used in combination to facilitate sexual sessions lasting several hours or days with multiple sexual partners.

Mephedrone and crystal meth are physiological stimulants, increasing heart rate and blood pressure, as well as triggering euphoria and sexual arousal. GHB (and its precursor GBL) is a powerful psychological disinhibitor and also a mild anaesthetic.

Anecdotal reports and some small qualitative studies in the UK find that people engaging in chemsex report better sex, with these drugs reducing inhibitions and increasing pleasure.

Unfortunately use of chemsex can lead to mental health problems which can be permanent. Moreover Casual sex, particularly if under the influence of alcohol or drugs can lead to the acquisition of sexually transmitted infections and even such bugs as shigella, an infection causing severe bacillary dysentery and diarrhoea usually associated with travel to regions such as Indian subcontinent, North and East Africa and South America.

See trailer for Chemsex, a film ChemsexOfficial directed by William Fairman and Max Gogarty (a Peccadillo Pictures)  in the medical journal Lancet.

Daily pri-exposure prophylaxis (PrEP) prevents HIV infection in high risk gay men

Posted on 23rd September 2015 by · No comments

Daily HIV medicine taken by men who have sex with men (MSM) reduces risk of HIV infection by 86% as was reported by Molina J-M, and colleagues in the ANRS Ipergay trial  at the Conference on Retroviruses and Opportunistic Infections held in Seattle, USA in 2015 (23LB.).

Molina et al reported the final results of a three year study which randomised MSM who were negative for HIV to either take daily HIV prophylaxis with two anti-retroviral drugs in a single tablet immediately or deferred for 1 year.

The study showed that those taking the drugs on a daily basis have a 86% reduction in the risk of being infected by HIV than MSM not taking the drug (p=0.0001). The trial was stopped in October of 2014 and all participants in the  deferred group were offered pre-exposure prophylaxis (PrEP)

As a Lancet editorial commented:

The science is now clear: oral pre-exposure prophylaxis (PrEP) with a coformulation of tenofovir disoproxil fumarate and emtricitabine (Truvada) significantly reduces the risk of HIV infection among individuals at high risk of HIV infection.

The news that PrEP has shown consistent efficacy among those who take it as prescribed should be a cause for celebration, and galvanise action to ensure access to PrEP for those who could benefit the most. But almost 3 years since the US Food and Drug Administration approved tenofovir–emtricitabine for PrEP little is being done on implementation.

With more than 2 million new HIV infections every year worldwide, it is time for that to change.

Invitation to workshop: role of stigma and shame in the access to sexual health clinics

Posted on 26th August 2015 by · No comments

A workshop on philosophical aspects of sexual health is being held at

Seminar Room 3.28, New Business School, Manchester Metropolitan University Manchester, United Kingdom

The workshop is run by Dr Phil Hutchinson and was part funded by a research grant from Sexually Transmitted Infections Research Foundation (STIRF). Project STIRF-026

Workshop 1: The Problem of Selection Bias in Biomedical & Public Health Research. Wednesday September 16

Workshop 2: Shame, Stigma and HIV. Thursday September 17

Venue: Seminar Room 3.28, New Business School, Manchester Metropolitan University, Manchester, UK

Mandatory registration: contact: marie.chollier@stu.mmu.ac.uk

Further information can be obtained from Phil Hutchinson p.hutchinson@mmu.ac.uk

 

 

Why don’t the Somali Refugee Community Access Sexual Health Services

Posted on 17th August 2015 by · No comments

A new project funded by STIRF (STIRF-027) has just been completed.  

Background: In the United Kingdom there is an established and growing refugee population from Somalia. Despite this Somalis have remained absent from much of the official statistics largely because ‘Somali’ is rarely recognised as a distinct ethnic category. Little is known about the sexual health needs of this particular community but in terms of their broader health issues, Somalis are known to have a high level of need but low uptake of health care services (Carswell et al.2011).

Aims: Through the use of focus groups and individual interviews this study sought to explore the sexual health needs of the local Somali community by ascertaining from their perspective, what they know about sexual health services, the challenges that may prevent them taking up these services and how services could be adapted to best meet their needs.

Results: The study showed little knowledge of services, especially about sexual health, how to accessing services, issues relating to shame, stigma and taboo, the influence of gender, religious and cultural norms, the perceptions of young people, the language barrier lack of cultural awareness and sensitivity demonstrated by healthcare professionals.

Recommendations:

  • Urgent attention be given to raising awareness, amongst the Somali community, about local sexual health services and how they can be accessed.
  • Information about sexual health services be made available in a format that is accessible to the Somali refugee community, for example, via a CD, DVD or USB stick.
  • That public health professionals and health care practitioners make clear the concept of preventative screening, making explicit the value of screening and early diagnosis for infectious diseases including TB and HIV/AIDS.
  • Health practitioners and public health professionals exercise extreme sensitivity when discussing issues related to sexual health and well-being. Every effort must be made to gain the trust of the individual so that they are able to discuss their fears or concerns.
  • Public health professionals and health care practitioners receive appropriate training and education so that they are equipped with the necessary cultural understanding and skills when working with the Somali community.
  • That a proactive approach be taken to helping Somali refugees to attend a programme of induction that includes language classes.
  • That a register of trained interpreters, who understand medical terminology and who are trained to work with those who may have experienced rape and torture should be available for public health professionals and health practitioners. Telephone interpretation should also be made available during consultations.

The results of the study have been presented in international meetings and published in reputable international journals.

Lesbian and bisexual health facts

Posted on 17th August 2015 by · No comments

The US based Centre for disease control (CDC) has recently updated its factsheet on lesbian and bisexual health. The CDC emphasises the potential risks of acquiring sexually transmitted infections and HIV from certain sexual practices. The article provides advise on how lesbian and bisexual women can protect themselves.

Start HIV treatment regardless of CD4 count

Posted on 26th July 2015 by · No comments

A large international study (INSIGHT START) published in the New England Journal of Medicine has found that starting antiretroviral therapy immediately after human immunodeficiency virus (HIV) diagnosis rather than waiting until a patient’s CD4+ count has declined is of considerable benefit.

The results of the study were also released at the International AIDS Society conference in Vancouver, Canada, on 20 July.

Currently most authorities strongly recommend starting anti-HIV once CD4+ count drops to below 350 cells per cubic millimetre. Until the INSIGHT START study there was no randomized trials  showing the benefits and risks of initiating antiretroviral therapy in patients with asymptomatic HIV infection who have a CD4+ count of more than 350 .

START study conducted in 35 countries randomly assigned 4,685 HIV positive patients to either receive immediate antiretroviral therapy (median CD4+ of 650) or wait until their counts fell to below 350.

After a mean follow up of 3 years the study found that 42 patients in the immediate-initiation group died, as compared with 96 patients in the deferred-initiation group  (95% confidence interval, 0.30 to 0.62; P<0.001). Reduction in deaths were largely from tuberculosis, Kaposi’s sarcoma, and malignant lymphomas – conditions that can occur in HIV-infected individuals with only moderately damaged immune systems.

Currently the WHO requires all patients with HIV to be treated CD4+ of 500 or less. WHO may need to extend that to treating anyone at diagnosis. This would not only benefit the individual but by reducing viral shedding in body secretions reduce transmission and hence have a public health benefit. Moreover some of the costs of starting early would be offset by not needing to perform repeated CD4+ counts.