Discussing parenthood with gay men diagnosed with HIV: a qualitative study of patient and healthcare practitioner perspectives.

BACKGROUND: Research on HIV and reproduction has focused largely on women and heterosexual men. This article examines whether it is relevant to address parenthood in HIV care with gay men and what ways of doing so are most appropriate. METHODS: Qualitative interviews were conducted at four London clinics with 25 men living with HIV, aged 20-45, who did not have children, and 16 HIV clinicians. A thematic analysis identified potential reasons why parenthood was rarely discussed with gay men in HIV care. RESULTS: Two sets of ideas contributed to a lack of conversations about parenthood: clinicians' ideas about what matters to gay men and men's ideas about what it means to be HIV-positive. Both sets of ideas largely excluded having children, with patients and practitioners similarly unlikely to raise the topic of parenthood in the clinic. Contrary to what clinician commonly assumed, many men expressed interest in receiving more information, highlighting the importance of reassuring people upon diagnosis that it is possible to become parents while living with HIV. CONCLUSIONS: Parenting desires and intentions were rarely discussed with men in HIV care. Our findings illuminate the potentially beneficial effects of emphasising that having children is a possibility at diagnosis, regardless of patients' gender or sexuality. Conveying this information seems meaningful, not only to men who want to become parents in the future but also to others, as it appears to alleviate fears about mortality and ill health.British HIV Association Isaac Newton Trust Leverhulme Trust (ECF-2018-146) Wellcome Trust (100606/Z/12/Z

Highlights from the 9th IAS conference on HIV science, 23-26 July 2017, Paris, France

The 9th International AIDS Society Conference on HIV Science (IAS 2017) took place at the Palais des Congrès, in Paris, France, from 23 to 26 July 2017, chaired by Linda-Gail Bekker and Jean-François Delfraissy. It was organised by the International AIDS Society (IAS) in partnership with ANRS (the French national agency for research on AIDS and viral hepatitis), bringing together more than 6000 leading scientists, researchers and HIV professionals from around the world. The Conference featured more than 1800 abstracts selected for oral and poster presentations out of over 4300 submissions, in addition to plenary sessions and satellite symposia. Prevention was high on the agenda of this year's Conference. Data relevant to children, adolescents and adults with HIV on recent advances in the understanding of viral–host interactions, targeting of the HIV reservoir, new oral and long-acting antiretroviral drugs, strategies for simplification of treatment regimens, immune-based therapies, pre-exposure prophylaxis (PrEP) to HIV, prevention of mother-to-child transmission, prophylactic and therapeutic vaccines, as well as comorbidities including hepatitis, were presented with an emphasis on translating science into practice and policies

Can HIV‐positive gay men become parents? How men living with HIV and HIV clinicians talk about the possibility of having children

Funder: Isaac Newton TrustFunder: British HIV AssociationAbstract: It is now established that people living with HIV who have an undetectable viral load and adhere to antiretroviral treatment cannot transmit HIV to their sexual partners. Previous research has shown that ‘being undetectable’ changes how HIV‐positive gay men experience their sex lives. But how does it affect gay men’s reproductive behaviours? And what influence does it have on views about parenthood at a time when gay fatherhood has become more socially accepted and publicly visible? Drawing on qualitative interviews with patients and clinicians at four HIV clinics in London, we identify differences in how interviewees talked about the possibility of having children for HIV‐positive men. Both groups, unprompted, frequently referred to sperm washing as a method enabling safe conception. However, whereas clinicians talked about sperm washing as an historical technique, which is no longer necessary, patients spoke of it as a current tool. The men rarely mentioned being undetectable as relevant to parenthood and, when prompted, some said that they did not fully understand the mechanics of HIV transmission. Our findings offer new insights into how biomedical knowledge is incorporated into people’s understandings of living with HIV, raising important questions about how the meanings of being undetectable are communicated

Can HIV‐positive gay men become parents? How men living with HIV and HIV clinicians talk about the possibility of having children

Funder: Isaac Newton TrustFunder: British HIV AssociationAbstract: It is now established that people living with HIV who have an undetectable viral load and adhere to antiretroviral treatment cannot transmit HIV to their sexual partners. Previous research has shown that ‘being undetectable’ changes how HIV‐positive gay men experience their sex lives. But how does it affect gay men’s reproductive behaviours? And what influence does it have on views about parenthood at a time when gay fatherhood has become more socially accepted and publicly visible? Drawing on qualitative interviews with patients and clinicians at four HIV clinics in London, we identify differences in how interviewees talked about the possibility of having children for HIV‐positive men. Both groups, unprompted, frequently referred to sperm washing as a method enabling safe conception. However, whereas clinicians talked about sperm washing as an historical technique, which is no longer necessary, patients spoke of it as a current tool. The men rarely mentioned being undetectable as relevant to parenthood and, when prompted, some said that they did not fully understand the mechanics of HIV transmission. Our findings offer new insights into how biomedical knowledge is incorporated into people’s understandings of living with HIV, raising important questions about how the meanings of being undetectable are communicated

Having children outside a heterosexual relationship: options for persons living with HIV

The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link.This article presents information about the social, legal and medical issues that medical and non-medical practitioners in the UK should consider in order to signpost options for people living with HIV (PLWH) who are not in a heterosexual relationship and want to become parents. Despite significant medical advances, increased medical awareness amongst HIV practitioners, and the ability to live a full life with HIV, stigma still exists around PLWH wanting to have children. There is a lack of awareness amongst the general public and the non-specialist medical community, about the realities of living with HIV, and the options available to become a parent. Vertical transmission rates in the UK are very low (<0.5%) [1]. Despite this, even amongst PLWH it is evident that stigma surrounding parenting with HIV is real, with almost 50% of HIV-positive respondents in a European study saying that having HIV would be a barrier to them deciding to have a family [2]. Irrespective of their sexual orientation, HIV-positive parents and prospective parents may bear not only the brunt of an historical HIV stigma, but also the negative discourses that surround lesbian, gay, bisexual or transgendered/gender diverse (LGBT) parenting, despite the legal advances over the past decade. First steps to breaking down this stigma are to increase public awareness around the realities of living with HIV, and awareness among PLWH that being a parent is an option for them. In 2016 in London, the UNAIDS 90-90-90 target was achieved for the first time. England came close to meeting that target, with 88% of those living with HIV being diagnosed, 96% of those on HIV treatment and 97% of them having an undetectable viral load [3]. Most PLWH taking antiretroviral medication therefore have undetectable levels of HIV in blood, meaning they cannot transmit HIV via sexual fluids [4]. Despite this, parenting is not always routinely discussed with PLWH. A recent study in London HIV clinics found that very few clinicians spoke with HIV-positive gay men about the possibility of having children [5]. Misconceptions about HIV transmission risk and medico-legal issues concerning reproduction may, thus, be rarely addressed. Education is also key to challenging stigma, and supporting the medical profession to better advise HIV-positive patients is critical, as a medical appointment is often the first opportunity that people who are newly diagnosed have to think about future options

Changes in Inflammatory and Atherogenesis Biomarkers With the 2-Drug Regimen Dolutegravir Plus Lamivudine in Antiretroviral Therapy-Experienced, Virologically Suppressed People With HIV-1: A Systematic Literature Review

Background: The 2-drug regimen dolutegravir plus lamivudine has demonstrated long-term noninferior efficacy vs 3-/4-drug regimens (3/4DRs) in phase 3 trials. This systematic literature review summarizes clinical trial and real-world evidence evaluating impact of dolutegravir plus lamivudine on inflammatory and atherogenesis biomarkers in people with human immunodeficiency virus type 1 (PWH). Methods: Using Ovid MEDLINE, Embase, PubMed, and Cochrane library databases and conference proceedings, we searched for studies published from 1 January 2013 to 14 July 2021, reporting changes in inflammatory and atherogenesis biomarkers with dolutegravir plus lamivudine in antiretroviral therapy-experienced, virologically suppressed PWH aged 6518 years. Results: Four records representing 2 randomized controlled trials (RCTs) and 6 records of real-world evidence met eligibility criteria. All real-world studies evaluated CD4+/CD8+\u2005ratio, while only 1 assessed inflammatory biomarkers. Across both RCTs, no consistent pattern of change in biomarkers was observed between dolutegravir/lamivudine and 3/4DR comparators. There were significant changes in soluble CD14 favoring dolutegravir/lamivudine in TANGO at weeks 48 and 144 and SALSA at week 48, and in interleukin-6 favoring the control group in TANGO at weeks 48 and 144. In the real-world study evaluating inflammatory biomarkers, median soluble CD14 significantly decreased 48 weeks postswitch to dolutegravir plus lamivudine (P\u2005&lt;\u2005.001), while other biomarkers remained stable. In all 6 real-world studies, increases in CD4+/CD8+\u2005ratio were reported after switch to dolutegravir plus lamivudine (follow-up, 12-60 months). Conclusions: Results show that dolutegravir plus lamivudine has a comparable impact on inflammatory and atherogenesis biomarkers vs 3/4DRs, with no consistent pattern of change after switch in virologically suppressed PWH

Natural killer cell responses during SARS-CoV-2 infection and vaccination in people living with HIV-1

Natural killer (NK) cell subsets with adaptive properties are emerging as regulators of vaccine-induced T and B cell responses and are specialized towards antibody-dependent functions contributing to SARS-CoV-2 control. Although HIV-1 infection is known to affect the NK cell pool, the additional impact of SARS-CoV-2 infection and/or vaccination on NK cell responses in people living with HIV (PLWH) has remained unexplored. Our data show that SARS-CoV-2 infection skews NK cells towards a more differentiated/adaptive CD57+FcεRIγ- phenotype in PLWH. A similar subset was induced following vaccination in SARS-CoV-2 naïve PLWH in addition to a CD56bright population with cytotoxic potential. Antibody-dependent NK cell function showed robust and durable responses to Spike up to 148 days post-infection, with responses enriched in adaptive NK cells. NK cell responses were further boosted by the first vaccine dose in SARS-CoV-2 exposed individuals and peaked after the second dose in SARS-CoV-2 naïve PLWH. The presence of adaptive NK cells associated with the magnitude of cellular and humoral responses. These data suggest that features of adaptive NK cells can be effectively engaged to complement and boost vaccine-induced adaptive immunity in potentially more vulnerable groups such as PLWH

TESS Hunt for Young and Maturing Exoplanets (THYME). X. A Two-planet System in the 210 Myr MELANGE-5 Association

Young (&lt;500 Myr) planets are critical to studying how planets form and evolve. Among these young planetary systems, multiplanet configurations are particularly useful, as they provide a means to control for variables within a system. Here, we report the discovery and characterization of a young planetary system, TOI-1224. We show that the planet host resides within a young population we denote as MELANGE-5. By employing a range of age-dating methods-isochrone fitting, lithium abundance analysis, gyrochronology, and Gaia excess variability-we estimate the age of MELANGE-5 to be 210 ± 27 Myr. MELANGE-5 is situated in close proximity to previously identified younger (80-110 Myr) associations, Crius 221 and Theia 424/Volans-Carina, motivating further work to map out the group boundaries. In addition to a planet candidate detected by the TESS pipeline and alerted as a TESS object of interest, TOI-1224 b, we identify a second planet, TOI-1224 c, using custom search tools optimized for young stars (Notch and LOCoR). We find that the planets are 2.10 ± 0.09 R⊕ and 2.88 ± 0.10 R⊕ and orbit their host star every 4.18 and 17.95 days, respectively. With their bright (K = 9.1 mag), small (R * = 0.44 R⊙), and cool (T eff = 3326 K) host star, these planets represent excellent candidates for atmospheric characterization with JWST

TESS Hunt for Young and Maturing Exoplanets (THYME). X. A Two-planet System in the 210 Myr MELANGE-5 Association

Young (&lt;500 Myr) planets are critical to studying how planets form and evolve. Among these young planetary systems, multiplanet configurations are particularly useful, as they provide a means to control for variables within a system. Here, we report the discovery and characterization of a young planetary system, TOI-1224. We show that the planet host resides within a young population we denote as MELANGE-5. By employing a range of age-dating methods—isochrone fitting, lithium abundance analysis, gyrochronology, and Gaia excess variability—we estimate the age of MELANGE-5 to be 210 ± 27 Myr. MELANGE-5 is situated in close proximity to previously identified younger (80–110 Myr) associations, Crius 221 and Theia 424/Volans-Carina, motivating further work to map out the group boundaries. In addition to a planet candidate detected by the TESS pipeline and alerted as a TESS object of interest, TOI-1224 b, we identify a second planet, TOI-1224 c, using custom search tools optimized for young stars (Notch and LOCoR). We find that the planets are 2.10 ± 0.09 R⊕ and 2.88 ± 0.10 R⊕ and orbit their host star every 4.18 and 17.95 days, respectively. With their bright (K = 9.1 mag), small (R* = 0.44 R⊙), and cool (Teff = 3326 K) host star, these planets represent excellent candidates for atmospheric characterization with JWST

TESS hunt for young and maturing exoplanets (THYME). X. A two-planet system in the 210 Myr MELANGE-5 association

Funding: P.C.T. was supported by an NSF Graduate Research Fellowship (DGE-1650116), the NC Space Grant Graduate Research Fellowship, the Zonta International Amelia Earhart Fellowship, and the Jack Kent Cooke Foundation Graduate Scholarship. A.W.M. was supported by grants from the NSF CAREER program (AST-2143763) and NASA’s exoplanet research program (XRP 80NSSC21K0393). M.G.B. was supported by an NSF Graduate Research Fellowship (DGE2040435) and the NC Space Grant Graduate Research Fellowship. F.J.P. acknowledges financial support from the grant CEX2021-001131-S funded by MCIN/AEI/ 10.13039/ 501100011033 and through projects PID2019-109522GB-C52 and PID2022-137241NB-C43. This research also received funding from the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation program (grant agreement No. 803193/BEBOP) and from the Science and Technology Facilities Council (STFC; grant No. ST/S00193X/1). The postdoctoral fellowship of K.B. is funded by F.R.S.-FNRS grant T.0109.20 and by the Francqui Foundation. K.A.C. acknowledges support from the TESS mission via subaward s3449 from MIT. M.K. acknowledges support from the MIT Kavli Institute as a Juan Carlos Torres Fellow. This publication benefits from the support of the French Community of Belgium in the context of the FRIA Doctoral Grant awarded to M.T.Young (<500 Myr) planets are critical to studying how planets form and evolve. Among these young planetary systems, multiplanet configurations are particularly useful, as they provide a means to control for variables within a system. Here, we report the discovery and characterization of a young planetary system, TOI-1224. We show that the planet host resides within a young population we denote as MELANGE-5. By employing a range of age-dating methods—isochrone fitting, lithium abundance analysis, gyrochronology, and Gaia excess variability—we estimate the age of MELANGE-5 to be 210 ± 27 Myr. MELANGE-5 is situated in close proximity to previously identified younger (80–110 Myr) associations, Crius 221 and Theia 424/Volans-Carina, motivating further work to map out the group boundaries. In addition to a planet candidate detected by the TESS pipeline and alerted as a TESS object of interest, TOI-1224 b, we identify a second planet, TOI-1224 c, using custom search tools optimized for young stars (Notch and LOCoR). We find that the planets are 2.10 ± 0.09 R⊕ and 2.88 ± 0.10 R⊕ and orbit their host star every 4.18 and 17.95 days, respectively. With their bright (K = 9.1 mag), small (R* = 0.44 R⊙), and cool (Teff = 3326 K) host star, these planets represent excellent candidates for atmospheric characterization with JWST.Peer reviewe