Drug resistant HIV: Behaviors and characteristics among Los Angeles men who have sex with men with new HIV diagnosis.

Epidemiology of drug resistant HIV has focused on trends and less attention has been given to identification of factors, especially behaviors including substance use, in acquisition of drug-resistant HIV. From 2009 to 2012 The Metromates Study enrolled and followed for one year men who have sex with men (MSM) seeking testing for HIV in a community clinic in Los Angeles assessing those testing positive for acute and recent HIV infection. Behavioral data were collected via Computer-Assisted Self-Interview from 125 classified as newly HIV infected and 91 as chronically infected (newly HIV-diagnosed); specimens were available and viable for resistance testing for 154 of the 216 HIV positives with new diagnoses. In this community clinic we found prevalence of resistance among MSM with new HIV-diagnosis was 19.5% (n = 30/154) with no difference by recency of HIV infection. Sexual partnership characteristics were associated with resistance; those who reported transgendered sex partners had a higher prevalence of resistance as compared to those who did not report transgendered sex partners (40% vs. 17%; p value = 0.04), while those who reported having a main partner had a lower prevalence of drug resistance (12% vs. 24%; p value = 0.07). In multivariable analyses adjusting for HIV recency and antiviral use, reporting a main partner decreased odds [adjusted odds ratio (AOR) 0.34; 95% confidence interval (CI) 0.13-0.87], reporting a transgendered partnered increased odds (AOR = 3.37; 95% CI 0.95-12.43); and being African American increased odds of drug resistance (AOR = 5.63, 95%CI 1.41-22.38). This suggests African American MSM and TG individuals in Los Angeles represent pockets of exceptional risk that will require special approaches to prevention and care to enhance their own health and reduce their likelihood to support transmission of drug resistance in the US

Joint effects of alcohol consumption and high-risk sexual behavior on HIV seroconversion among men who have sex with men

OBJECTIVE: To estimate the effects of alcohol consumption and number of unprotected receptive anal intercourse partners on HIV seroconversion while appropriately accounting for time-varying confounding. DESIGN: Prospective cohort of 3725 HIV-seronegative men in the Multicenter AIDS Cohort Study between 1984 and 2008. METHODS: Marginal structural models were used to estimate the joint effects of alcohol consumption and number of unprotected receptive anal intercourse partners on HIV seroconversion. RESULTS: Baseline self-reported alcohol consumption was a median 8  drinks/week (quartiles: 2, 16), and 30% of participants reported multiple unprotected receptive anal intercourse partners in the prior 2 years. Five hundred and twenty-nine HIV seroconversions occurred over 35 ,870 person-years of follow-up. After accounting for several measured confounders using a joint marginal structural Cox proportional hazards model, the hazard ratio for seroconversion associated with moderate drinking (1-14 drinks/week) compared with abstention was 1.10 [95% confidence limits: 0.78, 1.54] and for heavy drinking (>14 drinks/week) was 1.61 (95% confidence limits: 1.12, 2.29) (P for trend <0.001). The hazard ratios for heavy drinking compared with abstention for participants with 0-1 or more than 1 unprotected receptive anal intercourse partner were 1.37 (95% confidence limits: 0.88, 2.16) and 1.96 (95% confidence limits: 1.03, 3.72), respectively (P for interaction = 0.42). CONCLUSION: These findings suggest that alcohol interventions to reduce heavy drinking among men who have sex with men should be integrated into existing HIV prevention activities

Methodological consensus on clinical proton MRS of the brain: Review and recommendations

© 2019 International Society for Magnetic Resonance in Medicine Proton MRS (1H MRS) provides noninvasive, quantitative metabolite profiles of tissue and has been shown to aid the clinical management of several brain diseases. Although most modern clinical MR scanners support MRS capabilities, routine use is largely restricted to specialized centers with good access to MR research support. Widespread adoption has been slow for several reasons, and technical challenges toward obtaining reliable good-quality results have been identified as a contributing factor. Considerable progress has been made by the research community to address many of these challenges, and in this paper a consensus is presented on deficiencies in widely available MRS methodology and validated improvements that are currently in routine use at several clinical research institutions. In particular, the localization error for the PRESS localization sequence was found to be unacceptably high at 3 T, and use of the semi-adiabatic localization by adiabatic selective refocusing sequence is a recommended solution. Incorporation of simulated metabolite basis sets into analysis routines is recommended for reliably capturing the full spectral detail available from short TE acquisitions. In addition, the importance of achieving a highly homogenous static magnetic field (B0) in the acquisition region is emphasized, and the limitations of current methods and hardware are discussed. Most recommendations require only software improvements, greatly enhancing the capabilities of clinical MRS on existing hardware. Implementation of these recommendations should strengthen current clinical applications and advance progress toward developing and validating new MRS biomarkers for clinical use

Cost-Effectiveness of Pooled Nucleic Acid Amplification Testing for Acute HIV Infection after Third-Generation HIV Antibody Screening and Rapid Testing in the United States: A Comparison of Three Public Health Settings

Angela Hutchinson and colleagues conducted a cost-effectiveness analysis of pooled nucleic acid amplification testing following HIV testing and show that it is not cost-effective at recommended antibody testing intervals for high-risk persons except in very high-incidence settings

Behavior change following HIV diagnosis: findings from a Cohort of Los Angeles MSM.

The effect of an HIV diagnosis on subsequent behavior of men who have sex with men (MSM) remains unclear. From 2009 to 2012 the NIDA funded Metromates Study enrolled and followed for one year MSM seeking testing for HIV in Los Angeles, assessing those with new HIV diagnoses for acute/recent HIV infection. Behavioral data were collected via Computer-Assisted Self-Interview from 321 men of whom 125 were classified as recently HIV infected, 91 as not recently HIV infected, and 105 as HIV-negative. Differences over time between those with recent HIV infection, not recent HIV infection, and no HIV were evaluated using bivariate and multivariable analyses for repeat measures to assess associations between HIV group, behaviors and condomless receptive (CRAI), intersertive (CIAI), or any condomless anal intercourse (CAI). Participants were mostly young (59% &lt; 30 years of age) and minority. Median number of partners reported in past year dropped significantly over time among recently infected MSM (10 to 5) and HIV negative men (5 to 3) but not for not recently HIV infected. No changes comparing baseline to follow-up were noted in reports of CAI within each HIV-group. Based on GEE multivariable analyses adjusting for age, and race/ethnicity after HIV testing recently HIV infected and not recently HIV infected men practiced more CAI within serodiscordant partnerships than HIV negative MSM: more CRAI than the HIV negatives (AOR =  4.90; 95% CI 1.80-13.29 and AOR = 5.01; 95% CI 1.77-14.16 among recently infected and not recently infected, respectively) but only more CIAI among not recently infected (AOR 3.48; 95% CI 1.31-9.24) when compared to HIV negatives. For MSM seeking HIV testing in Los Angeles at that time, there was little indication of behavior change following HIV diagnosis and continued CAI, suggesting that without rapid linkage to care and viral suppression significant transmissions may have been ongoing

Assessing willingness to test for HIV among men who have sex with men using conjoint analysis, evidence for uptake of the FDA-approved at-home HIV test.

Men who have sex with men (MSM) in the USA, represent a vulnerable population with lower rates of HIV testing. There are various specific attributes of HIV testing that may impact willingness to test (WTT) for HIV. Identifying specific attributes influencing patients' decisions around WTT for HIV is critical to ensure improved HIV testing uptake. This study examined WTT for HIV by using conjoint analysis, an innovative method for systematically estimating consumer preferences across discrete attributes. WTT for HIV was assessed across eight hypothetical HIV testing scenarios varying across seven dichotomous attributes: location (home vs. clinic), price (free vs. $50), sample collection (finger prick vs. blood), timeliness of results (immediate vs. 1-2 weeks), privacy (anonymous vs. confidential), results given (by phone vs. in-person), and type of counseling (brochure vs. in-person). Seventy-five MSM were recruited from a community-based organization providing HIV testing services in Los Angeles to participate in conjoint analysis. WTT for HIV score was based on a 100-point scale. Scores ranged from 32.2 to 80.3 for eight hypothetical HIV testing scenarios. Price of HIV testing (free vs.$50) had the highest impact on WTT (impact score = 31.4, SD = 29.2, p&lt;0.0001), followed by timeliness of results (immediate vs. 1-2 weeks) (impact score = 13.9, SD = 19.9, p≤0.0001) and testing location (home vs. clinic) (impact score = 10.3, SD = 22.8, p=0.0002). Impacts of other HIV testing attributes were not significant. Conjoint analysis method enabled direct assessment of HIV testing preferences and identified specific attributes that significantly impact WTT for HIV among MSM. This method provided empirical evidence to support the potential uptake of the newly FDA-approved over-the-counter HIV home test kit with immediate results, with cautionary note on the cost of the kit

Assessing willingness to test for HIV among men who have sex with men using conjoint analysis, evidence for uptake of the FDA-approved at-home HIV test.

Men who have sex with men (MSM) in the USA, represent a vulnerable population with lower rates of HIV testing. There are various specific attributes of HIV testing that may impact willingness to test (WTT) for HIV. Identifying specific attributes influencing patients' decisions around WTT for HIV is critical to ensure improved HIV testing uptake. This study examined WTT for HIV by using conjoint analysis, an innovative method for systematically estimating consumer preferences across discrete attributes. WTT for HIV was assessed across eight hypothetical HIV testing scenarios varying across seven dichotomous attributes: location (home vs. clinic), price (free vs. $50), sample collection (finger prick vs. blood), timeliness of results (immediate vs. 1-2 weeks), privacy (anonymous vs. confidential), results given (by phone vs. in-person), and type of counseling (brochure vs. in-person). Seventy-five MSM were recruited from a community-based organization providing HIV testing services in Los Angeles to participate in conjoint analysis. WTT for HIV score was based on a 100-point scale. Scores ranged from 32.2 to 80.3 for eight hypothetical HIV testing scenarios. Price of HIV testing (free vs.$50) had the highest impact on WTT (impact score = 31.4, SD = 29.2, p&lt;0.0001), followed by timeliness of results (immediate vs. 1-2 weeks) (impact score = 13.9, SD = 19.9, p≤0.0001) and testing location (home vs. clinic) (impact score = 10.3, SD = 22.8, p=0.0002). Impacts of other HIV testing attributes were not significant. Conjoint analysis method enabled direct assessment of HIV testing preferences and identified specific attributes that significantly impact WTT for HIV among MSM. This method provided empirical evidence to support the potential uptake of the newly FDA-approved over-the-counter HIV home test kit with immediate results, with cautionary note on the cost of the kit

App-Based Sexual Partner Seeking and Sexually Transmitted Infection Outcomes

BACKGROUND:Gay, bisexual, and other men who have sex with men (MSM) face higher rates of sexually transmitted infections (STIs) compared with the general population. The association between venues where sexual partners are met and STI transmission is dynamic and poorly understood, especially among those who use geosocial networking (GSN) apps. This study aimed to determine whether there is a difference in STI incidence between MSM who met their last sexual partner through a GSN app and MSM who met their last partner via other venues. METHODS:Data were analyzed from HIV-negative MSM attending the Los Angeles LBGT Center between August 2015 and July 2016 (n = 9499). Logistic regression models were used to investigate the relationship between STI incidence and whether or not an individual met his last partner through a GSN app. RESULTS:No relationship was detected between STI incidence and whether one's last sexual partner was met via GSN app. However, an association was detected between STI incidence and having used GSN apps to meet sexual partners in the past 3 months. A dose-response relationship was observed between the number of venues used to meet partners and testing positive for any STI (adjusted odds ratio, 1.08; 95% confidence interval, 1.02-1.14). CONCLUSIONS:The relationship between how people meet sexual partners and STI acquisition is much more nuanced than previously thought. Geosocial networking apps do not inherently expose users to high-risk reservoirs of STIs, but further understanding of the complexity of sexual networks and networking methods is warranted, given increasing rates of STIs

Drug resistant HIV: Behaviors and characteristics among Los Angeles men who have sex with men with new HIV diagnosis.

Epidemiology of drug resistant HIV has focused on trends and less attention has been given to identification of factors, especially behaviors including substance use, in acquisition of drug-resistant HIV. From 2009 to 2012 The Metromates Study enrolled and followed for one year men who have sex with men (MSM) seeking testing for HIV in a community clinic in Los Angeles assessing those testing positive for acute and recent HIV infection. Behavioral data were collected via Computer-Assisted Self-Interview from 125 classified as newly HIV infected and 91 as chronically infected (newly HIV-diagnosed); specimens were available and viable for resistance testing for 154 of the 216 HIV positives with new diagnoses. In this community clinic we found prevalence of resistance among MSM with new HIV-diagnosis was 19.5% (n = 30/154) with no difference by recency of HIV infection. Sexual partnership characteristics were associated with resistance; those who reported transgendered sex partners had a higher prevalence of resistance as compared to those who did not report transgendered sex partners (40% vs. 17%; p value = 0.04), while those who reported having a main partner had a lower prevalence of drug resistance (12% vs. 24%; p value = 0.07). In multivariable analyses adjusting for HIV recency and antiviral use, reporting a main partner decreased odds [adjusted odds ratio (AOR) 0.34; 95% confidence interval (CI) 0.13-0.87], reporting a transgendered partnered increased odds (AOR = 3.37; 95% CI 0.95-12.43); and being African American increased odds of drug resistance (AOR = 5.63, 95%CI 1.41-22.38). This suggests African American MSM and TG individuals in Los Angeles represent pockets of exceptional risk that will require special approaches to prevention and care to enhance their own health and reduce their likelihood to support transmission of drug resistance in the US