Myron Cohen in The Guardian’s “End to Aids in sight as huge study finds drugs stop HIV transmission”

The UK PARTNER study published its findings on May 2 in the Lancet, concluding that the risk of infection between male partners is zero if the virus is fully suppressed by antiretrovirals. In the Guardian’s coverage of the study, they quote UNC CFARs Myron Cohen’s commentary on barriers to care:

“It is not always easy for people to get tested for HIV or find access to care; in addition, fear, stigma, homophobia and other adverse social forces continue to compromise HIV treatment,” he said.

“Diagnosis of HIV infection is difficult in the early stages of infection when transmission is very efficient, and this limitation also compromises the treatment as prevention strategy.”

In an effort to make childbirth safer, $14 million awarded to Jeff Stringer’s research team

Jeff Stringer, director of UNC CFAR’s International Core, is leading two studies to improve pregnancy outcomes in the world’s poorest countries. The Bill and Melinda Gates Foundation has awarded $14 million to Stringer’s interdisciplinary team, composed of researchers from the UNC School of Medicine and UNC Gillings School of Global Health. Read more about this at the UNC Health Care and UNC School of Medicine Newsroom.

Eron Moderates New Video Series

Joseph Eron, MD, division chief of infectious diseases and director of UNC CFAR’s Clinical Core, was recently featured on Contagion‘s latest Peer Exchange panel. The four-part discussion, entitled “HIV Screening, Prevention, and Treatment Advances,” is available to the public here.

From the UNC Health Care and UNC School of Medicine’s Newsroom article,

 “This Contagion “Peer Exchange” panel features five distinguished experts: Joseph J. Eron Jr., MD, professor of medicine and division chief of infectious diseases at the UNC School of Medicine, as moderator; Eric S. Daar, MD, of the Harbor-UCLA Medical Center; Ian D. Frank, MD, of the Perelman School of Medicine of the University of Pennsylvania; W. David Hardy, MD, of the Johns Hopkins University School of Medicine; and Paul E. Sax, MD, of Brigham and Women’s Hospital.

The first segment of this “Peer Exchange” series delves into a discussion on screening and prevention of HIV. In the second segment, the experts provide a brief overview of the current HIV treatment landscape. The third segment focuses on additional considerations for therapy, such as the importance of adherence to treatment and care. In the final segment, our experts discuss upcoming treatment options that are exciting for the HIV community.”

Reducing Stigma and Exploring Resilience Among Young Black Men

In a study published on January 11th, investigators considered of the digital resilience behavior of young, black gay, bisexual, and other men who have sex with men (GBMSM). CFAR investigator and assistant professor of health behavior at the Gillings School Kathryn E. Muessig, PhD, participated as senior author to this study, entitled “Stay strong! keep ya head up! move on! it gets better!!!!’: Resilience processes in the healthMpowerment online intervention of young black gay, bisexual and other men who have sex with men.

The study focused on participants’ forum use of healthMpowerment, an anonymous online intervention system designed by Hightow-Weidman. Investigators analyzed conversations according to the four forms of resilience behaviors: exchanging social support, engaging in health-promoting cognitive processes, enacting healthy behavioral practices and empowering others. Their findings suggest that interventions based on resilience and empowerment may position black GBMSM to better combat negative stereotypes and social institutions that perpetuate HIV-related stigma, racism and blame. This is in contrast to preexisting risk-based frameworks that may reinforce stigma and negative stereotypes associated with this already marginalized group.

Read more about the study’s findings here.

CFAR-Wide Webinar Series: Brian Mustanski

For our January 2019 webinar, Brian Mustanski, PhD, presented “Don’t assume if you build it they will come: Two hybrid effectiveness-implementation trials of eHealth HIV prevention programs for diverse adolescent and young adult MSM.” In case you missed it, a recording can be viewed here.

Next month’s webinar is planned for February 25th at 3:30 ET and will feature Robin Lanzi and Pam Foster from UAB CFAR discussing the Inter-CFAR Faith Initiative Working Group. The 2019 webinar schedule and registration information can be found here.

Brian Mustanksi, PhD, is director of the Institute for Sexual and Gender Minority Health and Wellbeing at Northwestern University, Co-Director of the Center for Prevention Implementation Methodology for Drug Abuse and HIV, and Co-Director of the Third Coast Center for AIDS Research. Additionally, he is a professor of both Medical Social Sciences and Psychiatry and Behavioral Sciences at the Feinberg School of Medicine. Dr. Mustanski’s research focuses on the health and development of LGBT youth and the application of new media and technology to sexual health promotion and HIV prevention with young men.

Cohen Steps Down at Division of Infectious Diseases, Appointed to Fogarty Advisory Board

After 30 years of contribution, UNC CFAR Associate Director Myron “Mike” Cohen, MD will step down from his position as Chief of UNC Division of Infectious Diseases. Learn more about Cohen’s influential career, including his recent appointment to the National Institute of Health Fogarty Advisory Board, where he will join other researchers and policymakers providing oversight to global research projects. Cohen will continue directing the Institute for Global Health and Infectious Diseases (IGHID), serving as Associate Vice Chancellor for Global Health, and working with UNC CFAR.

The incoming Chief of UNC Division of Infectious Diseases is Joseph Eron, MD, who also serves as director of the UNC CFAR Clinical Core, professor of medicine, and adjunct professor of epidemiology.

 

Intervention Improves Adherence, Decreases Mortality

Irving Hoffman

Irving Hoffman, PA, MPH, co-led the HPTN 074 study.

UNC researchers were part of a team that found an integrated intervention increased HIV medication uptake and decreased mortality among people living with HIV who inject drugs at three international sites. Their results were published in The Lancet.

The study, HIV Prevention Trials Network (HPTN) 074, assessed an integrated intervention combining psychosocial counseling and supported referrals for antiretroviral therapy at any CD4 cell count and substance use treatment for people living with HIV who inject drugs compared to the locally available standard of care. The trial was conducted among people who inject drugs in Ukraine, Indonesia and Vietnam. At 52 weeks from enrollment, participants in the intervention arm nearly doubled their antiretroviral therapy usage, viral suppression and substance-use treatment usage compared to the standard of care arm. Mortality was also reduced by more than half with the intervention.

“I believe this very effective, but simple intervention could be applied to populations of people who inject drugs in most settings around the world, and I believe this would result in lives saved and a reduction in HIV transmission,” said Irving Hoffman, PA, MPH, study co-chair and a professor of medicine in the UNC Division of Infectious Diseases.

Overall, 502 people living with HIV and 806 HIV uninfected people with whom they injected drugs entered the study over 15 months and were followed for 12 to 24 months after enrollment. The median age was 35 years. Eighty-five percent of participants enrolled were men; most of the women who participated in the study were enrolled in Ukraine. At week 26, intervention arm participants were twice as likely to report antiretroviral therapy use compared to the standard of care arm participants and twice as likely to achieve an undetectable viral load. The effects persisted at week 52. Among intervention arm participants at week 52, self-reported substance use treatment uptake was higher compared to the standard of care arm participants. Mortality was significantly lower among intervention arm participants and their partners compared to the standard of care arm participants and their partners. Though the study was underpowered to prove the effect of the intervention on HIV transmission no new HIV infections were observed among the partners in the intervention arm, while seven were observed among partners in the standard of care arm.

“The HPTN 074 study assessed the feasibility of an integrated intervention for people living with HIV who inject drugs to reduce HIV transmission to their HIV-uninfected injection partners,” said Myron Cohen, MD, HPTN co-principal investigator and director of the UNC Institute for Global Health and Infectious Diseases. “These study findings related to antiretroviral therapy use and HIV prevention are promising, and this and other interventions are needed to get people living with HIV who inject drugs into care for their own health and to stop transmission of the virus.”

HPTN 074 is funded by the U.S. National Institute of Allergy and Infectious Diseases (NIAID), and the U.S. National Institute on Drug Abuse (NIDA), both part of the U. S. National Institutes of Health (NIH).

 

 

PrEP Open House

NCATEC will be hosting “PrEP Open House: What Doctors Need to Know; What Patients Need to Ask” on Friday June 29 from 2pm to 3:30pm in the first floor auditorium of the Bioinformatics Building (130 Mason Farm Road) on the campus of UNC-Chapel Hill.  Public parking is available across the street.

This training will address clinical PrEP basics for those interested in prescribing this one-pill-a-day regimen for the prevention of HIV.  The presentation will also cover questions that consumers would want to ask themselves about their readiness to take PrEP and whether or not PrEP is right for them.  The training center will review its online PrEP resources for providers and consumers and review PrEP materials available in English and Spanish.

Please register early as we expect a strong interest in this training.

Ryan White Remembered

April 8 marks the 28 year anniversary of Ryan White’s death.

Before HIV transmission was well understood, factor 8, a protein important to blood clotting, was often pooled from hundreds of untested blood donations.  This exposed hemophilia patients like Ryan White to HIV; in an article for PBS Newshour, Dr. Howard Markel recalls that “virtually every hemophiliac [he] treated in the mid-1980s has since died from AIDS.”

Ryan White was a teenager living with hemophilia during this time period.  He was diagnosed with HIV in December, 1984, and became an eloquent spokesperson for people living with HIV.  Among other forms of stigma, Ryan White was initially not permitted to attend school after his HIV diagnosis.  After winning a court case to resume in-person attendance at school, Ryan and his family faced intense hostility from community members, and relocated to Cicero, Indiana.

Photo by L. Cohen/WireImage

Homophobia and misinformation about HIV transmission were rampant sources of prejudice against people living with HIV; Ryan White’s advocacy helped dispel some of the misinformation about the nature and transmission of HIV/AIDS.

Months after Ryan White’s death on April 8, 1990, President George H. W. Bush signed the Ryan White CARE Act to help cities, states, and community organizations to develop comprehensive systems of care; the legislation targeted the poorest people living in the United States with HIV/AIDS.