August 13, 2010

Highlighted Publications

DHAP authors are bolded.

Expanded HIV Testing and Trends in Diagnoses of HIV Infection

CDC. Expanded HIV testing and trends in diagnoses of HIV infection—District of Columbia, 2004–2008. MMWR 2010;59(24):737-41.

This article describes expanded HIV testing efforts in Washington, DC, since 2006, the same year that CDC revised its recommendations for routine, voluntary HIV screenings in health-care settings. Starting in 2006, the Department of Health in the District of Columbia (DCDOH) engaged multiple community-based and clinical providers throughout DC to perform rapid HIV screening, launched extensive social marketing campaigns to educate DC residents and providers about routine HIV testing, and trained providers to facilitate immediate linkage to care among those testing HIV-positive. This report reviewed DC HIV case surveillance data (using AIDS diagnoses as the best, current marker of the HIV epidemic in DC), HIV testing data, and data from the Behavioral Risk Factor Surveillance System (BRFSS). The trend data from 2004 to 2008 show that increases were noted in DC residents who were tested for HIV within the previous 12 months and fewer AIDS diagnoses occurred over time. Blacks/African Americans remain disproportionately affected by the HIV epidemic in DC. This report analyzes surveillance and population data in an effort to evaluate the expanded HIV testing program in DC and suggests that these expanded efforts may counter the DC HIV epidemic and decrease racial/ethnic HIV disease disparities in DC.

CDC. Diagnoses of HIV infection and AIDS in the United States and Dependent Areas, 2008. [updated 2010 Jun 14; cited 2010 Jul 9].

The annual HIV Surveillance Report provides an overview on the current epidemiology of HIV disease in the United States and dependent areas. CDC funds state and territorial health departments to collect surveillance data on persons diagnosed with HIV infection; all personal identifiers are removed from these data before being transmitted to CDC via a secure data network. Data are analyzed by CDC and then displayed by age, race, sex, transmission category, and jurisdiction (where appropriate). Prior to the 2008 reporting year, the report was referred to as the HIV/AIDS Surveillance Report.

In accord with CDC’s recognition of the changing needs for data and its commitment to meeting those needs, the presentation of 2008 data emphasizes the date of diagnosis of HIV infection or AIDS (diagnosis as of December 31, 2008; reported to CDC as of June 30, 2009). Changes to the 2008 HIV Surveillance Report can be found  here. The report is published annually in late summer or early fall.

Developing HIV Behavioral Interventions for Men Who Have Sex With Men: Comparing Experiences from the United States and Australia

Neumann MS, Herbst JH, Guenther-Grey CA. Developing HIV behavioral interventions for men who have sex with men: Comparing experiences from the United States and Australia. In: Feldman D, editor. AIDS, culture, and gay men Gainesville, FL: University Press of Florida; 2010.

There are approximately 7 million adult gay and bisexual men in the United States and 120 million adult gay and bisexual men globally. This highly readable volume of original essays explores the cultural dimensions of AIDS among men who have sex with men (MSM).

The traditional emphasis in HIV/AIDS research within gay communities has focused on sexual behavior and psychological issues. Yet to better understand the social and cultural dimensions of the disease, and to halt the spread of HIV, it is essential to recognize and understand the culture of MSM. Cultural anthropologists, unquestionably, are in a unique position to achieve this understanding. Douglas Feldman has gathered a diverse group of experts to contribute to this collection, and the volume features a wealth of scholarly data unavailable elsewhere.

According to lead author, Mary Neumann, researchers know the histories of how the U.S. and Australia responded to HIV/AIDS and their approaches to preventing HIV/AIDS among men who have sex with men (MSM). This book chapter synthesizes and compares the U.S. and Australian HIV prevention efforts for MSM and has identified the most frequently noted topics incorporated in their formative and intervention studies and behavioral surveys. The combined topic areas from U.S. and Australian approaches are attitudes, HIV testing, correlates of risk behaviors, risk reduction strategies, risk behaviors, social connectedness, range of sex practices, prevention services, and treatment. We recommend that specific information on these topic areas and the context of behaviors related to MSM be routinely collected. Combining the U.S. and Australian approaches provides a greater breadth and depth of knowledge. If the recommended specific information on these topic areas was routinely collected, it could be used to more fully inform interventions for and to monitor behavioral and epidemiologic trends among MSM.

Supervie V, García-Lerma JG, Heneine W, Blower S. HIV, transmitted drug resistance, and the paradox of pre-exposure prophylaxis. PNAS [Internet]. 2010 [cited 2010 Jul 9];107:12381-6.

The administration of antiretrovirals before HIV exposure to prevent infection (i.e., pre-exposure prophylaxis [PrEP]) is under evaluation in clinical trials. The authors use a mathematical model to predict the effect of PrEP interventions on the HIV epidemic in the men-who-have-sex-with-men community in San Francisco. They predict PrEP interventions could substantially reduce transmission but increase the proportion of new infections caused by resistant strains.

DHAP’s J. Gerardo García-Lerma, one of the paper’s authors, explained that Pre-exposure prophylaxis (PrEP), the use of HIV treatment medications to protect uninfected individuals from HIV infection, is one of the most promising areas of HIV prevention research. As of 2010 several PrEP trials enrolling more than 22,000 participants from high-risk populations are at various stages of completion. Because PrEP is based on antiretroviral drugs, there is some concern that PrEP could lead to an increase in transmission of antiretroviral drug-resistant viruses. The researchers involved in this paper developed a new mathematical model to predict the effect of PrEP interventions on the HIV epidemic in the gay and bisexual community in San Francisco. They found that PrEP is likely to decrease the transmission of both resistant and non-resistant HIV strains but only under certain circumstances. If individuals increase risky sexual practices then it is a valid concern that PrEP could increase transmitted resistance. However, if risk behavior remains stable, the concern is unfounded and PrEP is likely to decrease transmitted resistance. The study also defines a paradox of PrEP: if drug-resistant infections decline, but less than non-resistant infections, the relative proportion of resistance will increase. In this scenario, resistance might appear to be increasing but it is actually decreasing.

Other Publications

Assessing Medication Adherence of Perinatally HIV-Infected Children Using Caregiver Interviews
Allison S, Koenig LJ, Marhefka S, Carter R, Abrams E, Bulterys M, et al. Assessing medication adherence of perinatally HIV-infected children using caregiver interviews [Abstract]. J Assoc Nurses AIDS Care 2010 May 6. Epub 2010.

Medication adherence is critical for children's HIV treatment success, but obtaining accurate assessments is challenging when complex measurement technologies are not feasible. The authors’ goal was to evaluate a multidimensional adherence interview designed to improve on existing adherence measures. Their modified interview appears to successfully identify family struggles with adherence and to have the capacity to help clinicians address medication adherence challenges.

AIDS-Defining Opportunistic Illnesses in U.S. Patients, 1994–2007: A Cohort Study

Buchacz K, Baker RK, Palella FJ Jr, Chmiel, JS, Lichtenstein KA, Novak RM, et al. AIDS-defining opportunistic illnesses in U.S. patients, 1994–2007: A cohort study [Abstract]. AIDS 2010;24(10):1549-59.
This is the first major paper in several years to describe the rates, the risk factors, and types of opportunistic infections that continue to occur among HIV-infected patients seen in the contemporary, highly active antiretroviral therapy era in North America or Europe.

CDC. Routine jail-based HIV testing—Rhode Island, 2000–2007. MMWR 2010;59(24):742­­-5.

This article focuses on HIV testing data in the Rhode Island unified jail system from 2000 to 2007. Since 1991, the jail has routinely offered HIV testing to every person (opt-out) admitted as part of the initial medication evaluation conducted within 24 hours of admission. This report provides data on the number of newly diagnosed positives identified. Significantly, a large percentage of these newly diagnosed positives (43%) would have been released without being tested if testing had been conducted 1 week after admission rather than in the first 24 hours. The article makes a compelling case for the effectiveness of performing routine HIV testing in jails upon entry, given the rapid turnover in jail systems.

Fagan JL, Bertolli J, McNaghten AD. Understanding people who have never received HIV medical care: A population-based approach [Abstract]. Public Health Rep 2010;125(4):520-7.

A substantial number of people living with HIV have never received HIV medical care despite the benefits of early entry to care. This article reviews the context, rationale, and potential contributions of a nationally representative surveillance system to monitor delays in receiving HIV care and provides data from the formative phase of a CDC pilot surveillance project.

Granade TC, Workman S, Wells, SK, Holder AN, Owen SM, Pau CP. Rapid detection and differentiation of antibodies to HIV-1 and HIV-2 using multivalent antigens and magnetic immunochromatography testing [Abstract]. Clin Vaccine Immunol 2010;17(6):1034-9.

Magnetic immunochromatography testing (MICT) uses a standard lateral-flow platform that incorporates magnetic-bead conjugates for quantitative measurement of the magnetic field distortion associated with the bound magnetic conjugate (reported as adjusted relative magnetic units). The results of the optimized MICT assay were compared to standard enzyme immunoassay and Western blotting results. MICT can provide a rapid, low-cost method of determining HIV antibody status requiring no subjective interpretations.

Ham C, Srinivasan P, Thorstensson R, Verschoor E, Fagrouche Z, Sernicola L, et al. International multicenter study to assess a panel of reference materials for quantification of simian immunodeficiency virus RNA in plasma [Abstract]. J Clin Microbiol 2010;48(7):2582-7.

An international multicenter study was conducted to assess the performance of a panel of simian immunodeficiency virus (SIV) RNA reference materials for plasma viral load determinations. Availability of external reference materials will enable independent calibration of SIV plasma viral load assays.

Mansergh G, Charania MR, Purcell D. Developing innovative intervention approaches for methamphetamine-using men who have sex with men not currently in drug treatment. Open AIDS J 2010;4:103-4.

This editorial opens the e-publication of a special issue of The Open AIDS Journal. The papers in this issue were written from the formative data (funded in 2006) used to design four site-specific innovative interventions targeting methamphetamine-using men who have sex with men not currently in drug treatment. Each of these newly developed interventions is currently being preliminarily evaluated using one-group pre-post designs in the Prevention Research Branch. The goal of this project was to simultaneously support the development and pilot testing of several interventions to identify the most promising approaches that could move on to more costly and rigorous evaluations in the future.

Marc L, Patel-Larson A, Hall I, Hughes D, Alegria M, Jeanty G, et al. HIV among Haitian-born persons in the United States,1985–2007 [Abstract]. AIDS 2010 Jun 9. Epub 2010.

Haitian-born persons have been historically stigmatized for introducing HIV to North America; however, no previous study has reported on the national HIV surveillance trends among this foreign-born group. This article concludes that the importance of having accurate denominators to estimate the AIDS rate for the Haitian population is paramount.

Martin M, Vanichseni S, Suntharasamai P, Mock PA, van Griensven F, Pitisuttithum P, et al. Drug use and the risk of HIV infection amongst injection drug users participating in an HIV vaccine trial in Bangkok, 1999–2003 [Abstract]. Int J Drug Policy 2010;21(4):296-301.

HIV spread rapidly amongst injecting drug users (IDUs) in Bangkok in the late 1980s. In recent years, changes in the drugs injected by IDUs have been observed. The authors examined data from an HIV vaccine trial conducted amongst IDUs in Bangkok during 1999–2003 to describe drug injection practices, drugs injected, and determine if drug use choices altered the risk of incident HIV infection.

Martin S, Blanchard K, Manopaiboon C, Chaikummao S, Schaffer K, Friedland B, Kilmarx PH. Carraguard® acceptability among men and women in a couples study in Thailand [Abstract].  J Womens Health 2010 Jun 24. Epub 2010.

This study’s aim was to evaluate the use and acceptability of Carraguard® among men and women enrolled as couples in a microbicide trial. Men and women in this study found the gel acceptable and thought that it should be made available if it is found to be safe and effective. Strategies for marketing a potential microbicide product must take the target population into consideration. For married couples, key considerations may be partner dynamics and trust issues, whereas messages focusing on sexual pleasure or disease prevention may resonate more strongly with sex workers or other populations.

Painter TM, Ngalame P, Lucas B, Lauby JL, Herbst, JH. Strategies used by community-based organizations to evaluate their locally developed HIV prevention interventions: Lessons learned from CDC’s Innovative Interventions Project. AIDS Educ Prev 2010;22: in press.

This article focuses on how community-based organizations evaluate their HIV prevention interventions and shares lessons learned from CDC’s Innovative Interventions Project.

Semaan S, Neumann MS, Hutchins K, D’Anna LH, Kamb ML. Brief counseling for reducing sexual risk and bacterial STIs among drug users—results from Project RESPECT [Abstract].  Drug Alcohol Depend 2010;106(1):7-15.

Project RESPECT's brief risk reduction counseling (BRRC) reduced sexual risk and bacterial sexually transmitted infections (STIs) among at-risk heterosexuals and has been packaged for use with this population. The authors assessed BRRC's efficacy with RESPECT participants who used drugs and examined BRRC's applicability to present-day users of heroin, cocaine, speedball, or crack. Efficacy of BRRC in reducing sexual risk and bacterial STIs in ever-injectors (EIs) and similar profiles for EIs and present-day drug users suggest evaluating BRRC with present-day drug users.

Smith J, Dauner A, Li B, Srinivasan P, Mitchell J, Hendry M, Ellenbarger D, Butera S, Otten R. Generation of a dual RT Env SHIV that is infectious in rhesus macaques. J Med Primatol 2010;39(4):213-223.

The best current animal model for HIV infection and evaluation of antiviral compounds is the simian-human immunodeficiency virus (SHIV)/macaque system. The objective of this study was to develop and characterize a SHIV recombinant virus for evaluating the efficacy of ART and microbicide products that target both HIV reverse transcriptase (RT) and/or Env-mediated entry. RT Env SHIV can productively infect macaques by both the IV and mucosal route, making it a valuable tool for transmission studies.

van Griensven F, Thienkrua W, Sukwicha W, Wimonsate W, Chaikummao S, Varangrat A, et al. Sex frequency and sex planning among men who have sex with men in Bangkok, Thailand: Implications for pre- and post-exposure prophylaxis against HIV infection [Abstract]. J Int AIDS Soc 2010:13(1):13.

Daily HIV antiretroviral pre-exposure prophylaxis (PrEP) is being evaluated in clinical trials among men who have sex with men (MSM). However, daily PrEP may not be congruent with sexual exposure profiles of MSM. In this article, the authors investigate sex frequency and sex planning to identify and inform appropriate PrEP strategies for MSM. They conclude that intermittently dosed PrEP (as opposed to daily) may be a feasible HIV prevention strategy and should be considered for evaluation in clinical trials.

Wiegand RE. Performance of using multiple stepwise algorithms for variable selection [Abstract]. Stat Med 2010;29(15):1647-59.

Some research studies in the medical literature use multiple stepwise variable selection (SVS) algorithms to build multivariable models. The purpose of this study is to determine whether the use of multiple SVS algorithms in tandem (stepwise agreement) is a valid variable selection procedure. The authors conclude that stepwise agreement is often a poor strategy that gives misleading results and researchers should avoid using multiple SVS algorithms to build multivariable models. More research on the relationship between sample size and variable selection is needed.