In serodiscordant heterosexual couples, undetectable viral load (VL) is associated with a substantially reduced HIV transmission risk. No studies in gay male serodiscordant couples (SDCs) have been reported. ‘Opposites Attract’ is an ongoing cohort study of gay SDCs recruited via clinics and community-based advertising. HIV-Positive Partners (HPPs) have VL tested at baseline; HIV- Negative Partners (HNPs) have HIV antibody tests and report sexual behaviour and partner’s perceived VL. Associations between unprotected anal intercourse (UAI) and VL were examined with logistic regression and Wilcoxon rank-sum test.
As of April 2013, 64 couples were enrolled. At baseline, 84.4% (n=54) of HPPs were taking ART and 76.6% (n=49) had undetectable VL. Overall, 68.8% (n=44) of HNPs reported any UAI with their partners: 59.4% of HNPs reported any insertive UAI, 37.5% reported receptive UAI without ejaculation, and 21.9% reported receptive UAI with ejaculation. 78.1% of HNPs believed their HPP’s last VL test result to be undetectable. The HNP’s perception of his partner’s VL was mostly in accord with the baseline test results. In the couples with perceived undetectable VL, 78.0% reported UAI in the last three months. In comparison, only 35.7% of couples in which the HPP’s VL was perceived to be detectable (n=8) or where the VL result was not known (n=3) reported UAI (OR=0.16, 95%CI=0.04-0.56, p=0.005). Overall, the median number of UAI acts in the last three months was 4 (range=0-183, mean=18.5, SD=34.0). The median number of UAI acts was 6.5 in couples where the HNP believed his partner’s VL was undetectable. This compared to 0 in couples where the perceived VL was detectable or was not known (p=0.007).
Among Australian gay male SDCs, perceived undetectable VL is strongly related to increased practice of UAI. Studies of HIV transmission risk in this population are an urgent research priority.
Adherence to combination antiretroviral therapy (cART ) plays an important role on treatment outcomes. The TREAT Asia Studies to Evaluate Resistance – Monitoring Cohort Study (TASER-M) collects patients’ adherence based on a Visual Analogue Scale. The aim of this analysis was to assess the rates of, and factors associated with, suboptimal adherence in the first 24 months of initial cART in Asian patients.
REACH was a collaborative research and practice initiative to develop evidence building frameworks, capacity, tools and resources with the Victorian HIV community partnership.
HIV disease is associated with chronic inflammation and activation of the innate immune system. This state, as measured using plasma markers of inflammation, persists following suppression of HIV viremia using antiretroviral therapy, and may increase risk of non-AIDS co-morbidities. The causes of innate immune activation in the setting of virological suppression are unclear. Natural killer (NK) cells are innate immune cells that kill virus-infected and transformed cells without prior sensitization. We have shown that NK cells are activated both phenotypically (elevated expression of HLA-DR) and functionally (increased spontaneous degranulation measured by CD107a surface expression) in virologically suppressed (VS) HIV+ individuals. NK cells also lose expression of CD16, the receptor which mediates antibody-dependent cellular cytotoxicity.
Regular HIV testing is recommended in men who take sexual risks. We assessed the relationship between perceived barriers to HIV testing, and frequency of testing among men who engaged in unprotected anal intercourse with casual partners (UAIC), to inform HIV testing strategies.
The majority of HIV diagnoses including delayed diagnoses in Australia occur among men who report homosexual contact – hereafter called gay and bisexual men (GBM). Delayed diagnosis is strongly associated with increased HIV-related mortality and morbidity. People who are unaware of their HIV-positive status may also be unwittingly transmitting HIV. We assessed trends in delayed HIV diagnoses among GBM in Australia.
HIV-associated leishmaniasis, endemic in the Mediterranean basin is a growing problem in India, Brazil and East Africa. Despite surviving for than 20 years, the clinical course of our visceral-leishmania (VL)-HIV co-infected patient illustrates several management challenges including diagnosis, speciation and drug resistance; monitoring burden of disease; access to and use of VL-treatments; end-organ toxicity and the combined immunosuppressive effects of HIV-VL.
Early first sexual intercourse has been proposed as an important marker of later sexual and reproductive health. Discussions of what constitutes early sexual debut in this context, however, have been limited.