Conference UPDATE: IAS/VIENNA reported by enid VÁzquez & Jeff Berry
IAS/Vienna For more summaries of reports from the International AIDS Society Conference held in Vienna in July, see the September/October issue, or visit www.aids2010.org.
Retroviruses and Opportunistic Infections (CROI) that Gardasil was safe and immunogenic (producing an immune response) in a study with 112 HIV-positive men. The report recommended further efficacy studies for HIV-positive men and women over age 26 and for younger positive men as well (as allowed in the CROI data).
Gardasil in men In a large international study, the Gardasil vaccine was found to be highly effective in reducing the risk of disease from human papilloma virus (HPV) in men, including precursors to anal cancer, in a sub-group of men who have sex with men (MSM). Gardasil is known to protect both sexes against genital warts, but goes further for girls and women, protecting them against cervical cancer. Might protection against cancer extend to men as well? Gardasil was compared to placebo in more than 4,000 men. In three years of follow up, vaccination was associated with an 86% decrease in incidence of persistent HPV infection, as well as a 90% drop in the incidence of genital warts and other HPVassociated external genital lesions. Two-thirds of the 602 MSM participants underwent anoscopy (micropscopic examination of the anal cavity). The study found a 78% increased risk of pre-cancerous changes in the placebo group (11.5%) compared to the vaccinated men (2.6%). 40
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November/December 2010
Men allowed into the study had had five or fewer sexual partners and no history of genital warts or lesions. While vaccination works best before exposure to HPV, it may still work for individuals who have not been exposed to the HPV types from which Gardasil provides protection. In addition, most of the men in this study were quite young (between 16 and 26), making it less likely that they would have been exposed to multiple strains of HIV. Whether these results can be applied to older men isn’t clear. According to the Anal Cancer Info website (www.analcancerinfo.ucsf.edu), “It is clear that patients who are HIV-positive are at increased risk to develop anal cancer, as are HIV-negative MSM and women with a history of anal intercourse (although the association is less for women).” Continuing data, as with this study, helps drive recommendations for Gardasil use and with those recommendations, reimbursement by insurance companies and other payers. Earlier this year, a team of U.S. researchers reported at the Conference on
The U.S. Centers for Disease Control and Prevention (CDC) issued an analysis showing that 2.1% of straight people living in poor urban areas in this country are infected with HIV. This is more than four times the overall U.S. incidence of infection of less than half of 1%. “This analysis suggests that many lowincome cities across the United States now have generalized HIV epidemics as defined by the United Nations Joint Program on HIV/AIDS (UNAIDS),” the CDC reported in a press release. The UNAIDS definition of a generalized epidemic is greater than 1% of a general population. The CDC reported that although injection drug users and men who have sex with men (MSM), two groups at particularly high risk of infection, contribute to the spread of HIV in poor areas, heterosexual transmission alone can sustain an epidemic in these communities. “The analysis also shows that poverty is the single most important demographic factor associated with HIV infection among inner-city heterosexuals,” explained the release. “Contrary to severe racial disparities that characterize the overall U.S. epidemic, researchers found no differences in HIV prevalence by race/ethnicity in this population.” HIV prevalence in low income urban areas was 2.1% among blacks, 2.1% among Latinos, and 1.7% among whites. Among the problems contributing to HIV risk mentioned by the CDC report are limited access to health care, which can reduce the level of HIV testing and prevention services; substance abuse, which can increase sexual risk behavior; and high rates of incarceration. P os i t i v e lyAwar e .co m
PhotO © IAS/Marcus Rose/Workers’ Photos
Poverty Linked to HIV