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Issue No. 31 | July 29, 2011

News and Features

Study Evaluates Sexual Transmission of Hepatitis C Virus Among HIV-Infected Men Who Have Sex with Men

“In the United States, an estimated 3.2 million persons are living with hepatitis C virus (HCV) infection … . HCV transmission occurs primarily through percutaneous exposure to blood, and persons who inject drugs are at greatest risk for infection. The role of sexual transmission of HCV has not been well defined. However, reports over the past decade, mainly from Europe, have implicated sexual transmission of HCV among human immunodeficiency virus (HIV)--infected men who have sex with men (MSM). In late 2005, two HIV-infected MSM, each with acute HCV infection that was suspected to have been acquired sexually, were evaluated at Mount Sinai Medical Center in New York City, prompting Mount Sinai to request referrals of similar patients … . During 2005--2010, a total of 74 HIV-infected MSM with recently acquired HCV infection and no reported history of injection-drug use were evaluated. To examine the role of sexual transmission, a matched case-control study and viral analysis were conducted. Results from the case-control study showed that high-risk sexual behavior was the most likely mode of transmission among these men. Phylogenetic analyses revealed five clusters of closely related HCV variants, suggesting networks of transmission among these men. The findings underscore the importance of screening HIV-infected MSM for HCV, particularly those engaged in high-risk sexual behavior. …

“Sexual transmission of HCV is considered to be an inefficient and rare mode of transmission … . However, concurrent HIV infection results in increased HCV RNA levels (viral load) … , which are thought to increase infectiousness of HCV acquired through sexual contact. Of further concern among persons who are coinfected is that HIV accelerates HCV disease progression, even in its early stages … . End-stage liver disease and hepatocellular carcinoma, both usually resulting from chronic HCV infection, are now leading causes of death not attributable to acquired immunodeficiency syndrome (AIDS) among HIV-infected persons in the United States … .”

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Study Suggests an Increased Risk of HIV-1 Transmission During Pregnancy Among African HIV-1 Serodiscordant Couples

“Physiologic and behavioral changes during pregnancy may alter HIV-1 susceptibility and infectiousness. Prospective studies exploring pregnancy and HIV-1 acquisition risk in women have found inconsistent results. No study has explored the effect of pregnancy on HIV-1 transmission risk from HIV-1 infected women to male partners. …

“In a prospective study of African HIV-1 serodiscordant couples, we evaluated the relationship between pregnancy and the risk of 1) HIV-1 acquisition among women and 2) HIV-1 transmission from women to men. ...

“3321 HIV-1 serodiscordant couples were enrolled, 1085 (32.7%) with HIV-1 susceptible female partners and 2236 (67.3%) with susceptible male partners. HIV-1 incidence in women was 7.35 versus 3.01 per 100 person-years during pregnant and nonpregnant periods (hazard ratio [HR] 2.34, 95% confidence interval [CI] 1.33-4.09). This effect was attenuated and not statistically significant after adjusting for sexual behavior and other confounding factors (adjusted HR 1.71, 95% CI 0.93-3.12). HIV-1 incidence in male partners of infected women was 3.46 versus 1.58 per 100 person-years when their partners were pregnant versus not pregnant (HR 2.31, 95% CI 1.22-4.39). This effect was not attenuated in adjusted analysis (adjusted HR 2.47, 95% CI 1.26-4.85). …

“HIV-1 risk increased two-fold during pregnancy. Elevated risk of HIV-1 acquisition in pregnant women appeared in part to be explained by behavioral and other factors. This is the first study to show pregnancy increased the risk of female-to-male HIV-1 transmission, which may reflect biological changes of pregnancy that could increase HIV-1 infectiousness.”

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CDC Updates Slide Sets on “HIV Surveillance in Adolescents and Young Adults” and “AIDS Trends”

The Centers for Disease Control and Prevention (CDC) recently updated two slide sets with information from the 2009 HIV Surveillance Report. The “HIV Surveillance in Adolescents and Young Adults” slide set provides information on diagnoses of HIV infection and AIDS in adolescents and young adults in the United States and dependent areas, including breakdowns of diagnoses by race/ethnicity, age group, transmission category, and geographic region. The “AIDS Trends” slide set provides information on overall diagnoses of AIDS in the United States and dependent areas and also includes detailed breakdowns of diagnoses by race/ethnicity and transmission category.