Search

Introduction Trans masculine people who have sex with cisgender (“cis”) men (“trans MSM”) may be at‐risk for HIV infection when they have cis MSM partners or share needles for hormone or recreational drug injection. Limited data are available characterizing indications and uptake of pre‐exposure prophylaxis (PrEP) in trans MSM. The aim of this study was to assess PrEP indication and uptake as a means of primary HIV prevention for adult trans MSM in the U.S. Methods Between November and December 2017, a national convenience sample of trans MSM in the U.S. (n = 857) was recruited using participatory methodologies and completed an online survey of demographics, HIV risk, PrEP, behavioural and psychosocial factors. Self‐reported receptive anal sex or frontal/vaginal sex (with or without a condom) with a cis male sex partner in past six months was an eligibility criterion. A multivariable logistic regression procedure was used to model PrEP indications (yes/no) per an interpretation of U.S. Centers of Disease Control and Prevention recommendations among those without HIV (n = 843). Results The diverse sample was 4.9% Black; 22.1% Latinx ethnicity; 28.4% non‐binary gender identity; 32.6% gay‐identified; 82.7% on testosterone. Overall, 84.1% had heard of PrEP. Of these, 33.3% reported lifetime PrEP use (21.8% current and 11.5% past). Based on HIV behavioural risk profiles in the last six months, 55.2% of respondents had indications for PrEP. In a multivariable model, factors associated with PrEP indication included where met sex partners, not having sex exclusively with cismen, higher perceived HIV risk, greater number of partners and high cis male partner stigma (all p

Background Treatment of HIV-infected men during early hepatitis C virus (HCV) infection with interferon results in a higher cure rate with a shorter duration of treatment than during chronic HCV infection. We recently demonstrated that this phenomenon applied to interferon-free treatment as well, curing most participants with short-course sofosbuvir and ribavirin. Due to the significantly higher potency of the ledipasvir/sofosbuvir (LDV/SOF) combination, we hypothesized that we would be more successful in curing early HCV infections using a shorter course of LDV/SOF than that used for treating chronic HCV infections. Methods We performed a prospective, open-label, consecutive case series study of 8 weeks of LDV/SOF in HIV-infected men with early genotype 1 HCV infection. The primary end point was aviremia at least 12 weeks after completion of treatment. Results We treated 25 HIV-infected men with early sexually acquired HCV infection with 8 weeks of LDV/SOF, and all 25 (100%) were cured. Twelve (48%) reported sexualized drug use with methamphetamine. Conclusions Eight weeks of LDV/SOF cured all 25 HIV-infected men with early HCV infection, including those who were actively using drugs. Based on these results, we recommend treatment of newly HCV-infected men during early infection, regardless of drug use, to both take advantage of this 8-week treatment and to decrease further HCV transmission among this group of men.

(See the Editorial Commentary by Zeremski et al on pages 880–2.) Hepatitis C virus (HCV) chronically infects an estimated 5.2 million people in the United States and 170 million people worldwide [1]. However, as most initial (“acute”) infections are completely asymptomatic, newly infected people are rarely identified. The importance of finding these newly HCV-infected people during the acute phase was made clear in the seminal paper by Jaeckel et al [2] that showed a nearly 100% sustained virologic response (SVR) rate using just 24 weeks of interferon alone, an SVR rate many times higher than that of chronically infected patients at that time, and with just half the duration of interferon [3]. We are now faced with an entirely new group of patients who are becoming HCV infected in the international epidemic of sexually transmitted HCV infection among human immunodeficiency virus (HIV)–infected men who have sex with men (MSM). Published cure rates after treatment of acute HCV in these men, using pegylated interferon (peg-IFN) plus ribavirin (RBV) for 24–48 weeks’ duration, are not as good as those of Jaeckel et al [2], ranging from 53% to 83% [4–15], but are clearly better than the 27%–40% success rates in treatment of chronic HCV in HIV-infected men [16, 17]. Still, even with 48 weeks of treatment in many of these studies of acute HCV, fewer than two-thirds of patients achieved SVR, leaving a large proportion of these men uncured, with the possibility of experiencing rapidly advancing liver disease [18–21] and of infecting others and further propagating the epidemic. With the commercial availability of telaprevir (TVR) in the United States, we hypothesized that its potent activity against genotype 1 HCV would allow us to further shorten the treatment period while also improving the SVR rate. We therefore undertook a study of a 12-week treatment course with a combination of TVR, peg-IFN, and RBV in HIV-infected MSM with newly acquired genotype 1 HCV.

Men who have sex with men (MSM) represent more than half of all new HIV infections in the United States. Utilizing a collaborative, community based approach, a brief risk reduction intervention was developed and pilot tested among newly HIV-diagnosed MSM receiving HIV care in a primary care setting. Sixty-five men, within 3 months of diagnosis, were randomly assigned to the experimental condition or control condition and assessed at baseline, 3-month, and 6-month follow-up. Effect sizes were calculated to explore differences between conditions and over time. Results demonstrated the potential effectiveness of the intervention in reducing risk behavior, improving mental health, and increasing use of ancillary services. Process evaluation data demonstrated the acceptability of the intervention to patients, clinic staff, and administration. The results provide evidence that a brief intervention can be successfully integrated into HIV care services for newly diagnosed MSM and should be evaluated for efficacy.

Positive choices (PC), a brief sexual risk reduction intervention conducted with newly HIV-diagnosed men who have sex with men (MSM), was evaluated for preliminary efficacy. Participants were enrolled if they reported unprotected anal intercourse (UAI) in the three months prior to HIV diagnosis (n = 102). Three months after diagnosis, participants completed baseline assessments and were randomly assigned to receive the 3-session PC intervention or the comprehensive standard of care (C-SoC) at a community health center. Participants completed assessments at 3- (post intervention), 6-, and 9- months after baseline. Compared to C-SoC participants, PC participants significantly reduced the frequency of UAI with HIV serodiscordant (HIV negative or status unknown) partners over the 9-month follow-up period. No differences by condition were found in the frequency of UAI with all partners. The findings from this trial suggest that brief risk reduction approaches for newly-diagnosed MSM integrated into HIV care can benefit secondary HIV prevention efforts.

Background Evaluation of the diagnostic value of anal cytology versus HRA in detecting anal intraepithelial neoplasia (AIN) and the added value of molecular markers in a multicenter cohort of HIV positive MSM (CoRIS-HRA). Methods: Concomitant anal liquid cytology and HRA with biopsy of acetowhite lugol-negative lesions if observed. Concordance was evaluated by the Kappa index. Dual staining for p16INK4a and Ki-67 (CINtec® PLUS, Roche) was done in cytology samples. Taking biopsy as the ‘gold standard’ for AIN diagnosis, the sensitivity and specificity of anal cytology and p16INK4/Ki-67 dual positivity was calculated. Results: Since November 2012, 172 patients were recruited in five Spanish hospitals. In 56 patients, no biopsies were performed as no lesions were observed. In the remaining 116 patients, 142 biopsies were obtained. Among 172 cytologies, 10.5% were inadequate, 27.9% negative, 1.1% ASCUS, 45.3% LSIL and 15.2% HSIL. Histology showed inadequacy in 3.5% of cases, negativity in 25.3%, LG-AIN in 35.2% and HG-AIN in 35.9%. In 116 patients, cytology and biopsy results were available (the highest lesion grade was used if multiple biopsies existed); the strength of agreement was fair (Kappa 0.351; 95% CI 0.232–0.470). Sensitivity and specificity of anal cytology versus HRA guided biopsy was 88.3% and 66.7%, respectively. In 67 cases, results from dual staining for p16INK4a/Ki-67 were available, rendering a sensitivity of 47.3% and a specificity of 66.7% compared with histology results. Conclusions: Although preliminary, our results show that in our setting dual staining for p16INK4a/Ki-67 did not improve the operational characteristics of anal liquid cytology.