World AIDS Day 2007
On December 1st PLoS Medicine is publishing a collection of research articles and commentary, as well as an editorial to mark World AIDS Day 2007.
Like all PLoS Medicine papers they are open access: freely available for anyone to read, download, redistribute and otherwise use, as long as the authorship is properly attributed
Details of the papers can be found below:
Please mention PLoS Medicine in your report and use the links below to take your readers straight to the online articles:
Men who have sex with men face high AIDS risk in developing countries
New research published in PLoS Medicine shows the high risk of acquiring HIV infection faced by men who have sex with men in developing countries. The findings make clear that it is vital for HIV prevention programs to try to reach these men.
In most developed countries men who have sex with men (MSM - a term that includes gay and bisexual men and others who sometimes have sex with men) are now a 'visible' part of society and there has already been a great deal of research into the health issues they face. In contrast, MSM are not visible in the majority of low and middle-income countries - in particular this is due to laws against homosexuality. Information about them has seldom been collected.
Chris Beyrer and colleagues at Johns Hopkins University, Baltimore, USA, conducted a systematic review to trace what studies had been done in these countries. They found 83 published studies that had reported levels of HIV prevalence in 38 low and middle-income countries in Asia, Africa, the Americas and Eastern Europe. An increased level of risk in MSM was found regardless of the income level of the countries in question or the frequency of illicit drug use. The exact level of risk varied between different regions of the world but, overall, MSM are nearly 20 times more likely to be HIV infected than the general population. The difference between MSM and others was greatest in those countries where overall HIV prevalence is relatively low.
The authors of the PLoS Medicine article believe that there is a need for more research but that it is already clear that every effort should be made by national AIDS prevention programs to try to include MSM. They argue that by increasing surveillance, research and prevention among MSM in low-to-middle income countries, it should be possible to curb HIV transmission in this marginalized population and reduce the global burden of HIV.
Citation: Citation: Baral S, Sifakis F, Cleghorn F, Beyrer C (2007) Elevated risk for HIV infection among men who have sex with men in low- and middle- income countries 2000–2006: A systematic review. PLoS Med 4(12): e339.
PLEASE ADD THE LINK TO THE PUBLISHED ARTICLE IN ONLINE VERSIONS OF YOUR REPORT: http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0040339
PRESS-ONLY PREVIEW OF THE ARTICLE: http://www.plos.org/press/plme-04-12-beyrer.pdf
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Women disclose their HIV status at three key times around childbirth
A study published this week in PLoS Medicine identifies three key times when African women who have had an HIV test during pregnancy are likely to disclose their HIV status to their male partner. Targeting counseling to these key moments could help reduce the sexual transmission of HIV within stable relationships in sub-Saharan Africa.
The study, conducted by Annabel Desgrées-du-Loû and colleagues within a program for prevention of mother-to-child transmission of HIV in Abidjan, Côte d'Ivoire, suggests that the end of pregnancy, the early stage of weaning and the resumption of a woman’s sexual activity with her partner are the moments at which specific counseling should be targeted to support women to disclose their status and to encourage their partner to take an HIV test.
The program provided support and testing to more than 900 women, both HIV infected and uninfected, during and following pregnancy. Fewer than half of the women infected with HIV told their partners about their status two years after childbirth. Of those did tell their partners, two-thirds did so before delivery, and many others disclosed at the time of early weaning at 4 months. These times were related to the mother’s decision on how to feed the child: HIV can be transmitted by breast feeding, and the women needed considerable support from their partners in order to formula feed from birth or to wean early. The third peak time for disclosure, around the resumption of sexual relations, may reflect the women’s desire to protect their partners through the use of condoms.
The study also found that the partners of the HIV-positive women who had disclosed their status were about three times more likely to take an HIV test that those who had not been told. Although the women in the program are encouraged to communicate their status to their partner, the fear of rejection (which could lead to accusations of infidelity and loss of housing or food and) can make this disclosure difficult.
Citation: Brou H, Djohan G, Becquet R, Allou G, Ekouevi DK, et al. (2007) When do HIV-infected women disclose their HIV status to their male partner and why" A study in a PMTCT programme, Abidjan. PLoS Med 4(12): e342.
PLEASE ADD THE LINK TO THE PUBLISHED ARTICLE IN ONLINE VERSIONS OF YOUR REPORT: http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0040342
PRESS-ONLY PREVIEW OF THE ARTICLE: http://www.plos.org/press/plme-04-12-desgrees-du-lou.pdf
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Unnoticed mutation in AIDS virus can cause drug resistance
A mutation in a little-studied structural region of the AIDS virus can cause resistance to several HIV drugs, according to a study published in PLoS Medicine by Gilda Tachedjian and colleagues from Australia, Canada, and the United States.
Several mutations in reverse transcriptase (RT), the viral enzyme that copies the genes of HIV, are already known to cause drug resistance and are routinely detected in blood tests used by physicians to individualize HIV treatment. The mutation in this study, designated N348I, is located not in the active part of RT, but rather in the so-called connection domain, which falls outside the region of the virus normally included in resistance tests.
The researchers analyzed the first two-thirds of the RT gene in viruses isolated from more than 1,000 patients in Canada, and found that virus carrying the N348I mutation developed in more than 10% of treatment-experienced patients. Patients treated with the HIV drugs zidovudine and nevirapine were 2.6-times more likely to have the N348I mutation than patients not treated with these drugs. The mutation appeared early in therapy, often in viruses that had other resistance mutations. Furthermore, the appearance of the N348I mutation often coincided with an increase in the amount of HIV present in blood. When the researchers introduced the N348I mutation into HIV growing in the laboratory, they found that it decreased the susceptibility of the virus to drugs.
Because the N348I mutation confers resistance to two classes of RT inhibitor drugs and can emerge early during therapy, it could have a large impact on patient responses to antiviral regimens that contain zidovudine and nevirapine. It might now be worth investigating whether looking for the N348I mutation (and for other mutations outside the region of RT included in current tests) could improve the ability of resistance tests to predict treatment outcomes.
The study is discussed in a perspective by Mattias Götte.
Citation: Yap SH, Sheen CW, Fahey J, Zanin M, Tyssen D, et al. (2007) N348I in the connection domain of HIV-1 reverse transcriptase confers zidovudine and nevirapine resistance. PLoS Med 4(12): e335
PLEASE ADD THE LINK TO THE PUBLISHED ARTICLE IN ONLINE VERSIONS OF YOUR REPORT: http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0040335
PRESS-ONLY PREVIEW OF THE ARTICLE: http://www.plos.org/press/plme-04-12-tachedjian.pdf
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Related PLoS Medicine Perspective:
Citation: Götte M (2007) Should we include connection domain mutations of HIV reverse transcriptase in HIV resistance testing" PLoS Med 4(12): e346.
IN YOUR ARTICLE, PLEASE LINK TO THIS URL, WHICH WILL PROVIDE ACCESS TO THE PUBLISHED PAPER: http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0040346
PRESS-ONLY PREVIEW OF THE ARTICLE: http://www.plos.org/press/plme-04-12-gotte.pdf
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HIV confirmatory test can also estimate recent infections
A test commonly used to confirm HIV infection can also be used to calculate how many recent infections have occurred in a population, according to a study by University of Zurich researcher Jörg Schüpbach and colleagues, published in PLoS Medicine.
Diagnosing recent HIV infection usually involves special testing to detect antibodies produced early on in the course of infection. The researchers showed that analyzing data already available from an antibody test routinely used to confirm HIV infection in Switzerland can accurately estimate the proportion of people who became infected within the previous 12 months.
The antibody test (INNO-LIA HIV I/II Score, produced by the Belgium-based company Innogenetics) is not currently approved for HIV screening in the United States and is not generally used in developing countries. The test could, however, provide a cost-effective means to improve HIV surveillance in countries that already use it for confirming HIV infection.
Citation: Schupbach J, Gebhardt MD, Tomasik Z, Niederhauser C, Yerly S, et al. (2007) Assessment of recent HIV-1 infection by a line immunoassay for HIV-1/2 confirmation. PLoS Med 4(12): e343
PLEASE ADD THE LINK TO THE PUBLISHED ARTICLE IN ONLINE VERSIONS OF YOUR REPORT: http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0040343
PRESS-ONLY PREVIEW OF THE ARTICLE: http://www.plos.org/press/plme-04-12-schupbach.pdf
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