Risk among men who have sex with men in the United States: a comparison of an Internet sample and a conventional outreach sample.

This study compared the demographics and risk behaviors of two samples of men who have sex with men (MSM), using cross-sectional data that were collected via the Internet and through conventional bar-based outreach. The Internet sample was significantly older, more likely to identify as "bisexual," and less educated than the bar sample. After controlling for age and education, few differences were observed between the samples. However, three variables that markedly differentiated the samples were history of sexually transmitted disease infection, HIV serostatus, and sources utilized to obtain health information. No difference in Internet use was found. Based on the possible decreased social desirability promoted by the use of electronic data collection methodologies, these findings provide preliminary evidence that Internet and bar respondents are similar and that the Internet may serve as an expedient as well as reliable methodology to increase understanding of risk among MSM

Risk factors for acquisition of hepatitis C virus infection: a case series and potential implications for disease surveillance

BACKGROUND: Transmission of hepatitis C vims (HCV) is strongly associated with use of contaminated blood products and injection drugs. Other "non-parental" modes of transmission including sexual activity have been increasingly recognized. We examined risk factors for acquiring HCV in patients who were referred to two tertiary care centers and enrolled in an antiviral therapy protocol. METHODS: Interviews of 148 patients were conducted apart from their physician evaluation using a structured questionnaire covering demographics and risk factors for HCV acquisition. RESULTS: Risk factors (blood products, injection/intranasal drugs, razor blades/ toothbrushes, body/ear piercing, occupational exposure, sexual activity) were identified in 141 (95.3%) of participants; 23 (15.5%) had one (most frequently blood or drug exposure), 41 (27.7%) had two, and 84 (53.4%) had more than two risk factors. No patient reported sexual activity as a sole risk factor. Body piercing accounted for a high number of exposures in women. Men were more likely to have exposure to street drugs but less exposure to blood products than women. Blood product exposure was less common in younger than older HCV patients. CONCLUSION: One and often multiple risk factors could be identified in nearly all HCV-infected patients seen in a referral practice. None named sexual transmission as the sole risk factor. The development of a more complete profile of factors contributing to transmission of HCV infection may assist in clinical and preventive efforts. The recognition of the potential presence of multiple risk factors may have important implications in the approach to HCV surveillance, and particularly the use of hierarchical algorithms in the study of risk factors

Long-term clinical outcomes in cirrhotic chronic hepatitis B patients treated with tenofovir disoproxil fumarate for up to 5 years

Background: Phase 3 clinical studies have shown that long-term treatment with tenofovir disoproxil fumarate (TDF) can suppress hepatitis B viral load and promote significant fibrosis regression and cirrhosis reversal in a majority of treated chronic hepatitis B (CHB) patients. This retrospective analysis investigated the impact of baseline cirrhosis status on virologic, serologic, and histologic outcomes in patients treated with TDF. Methods: Patients enrolled in studies GS-US-174-0102 and GS-US-174-0103 who had baseline liver biopsy–diagnosed cirrhosis and entered the open-label phase of the studies were included in the virologic and serologic analyses. Patients (both HBeAg positive and negative) with paired liver biopsies at baseline and 5 years (N = 348) were included in a histologic analysis. Results: After 5 years on study, comparing patients with and without baseline cirrhosis, respectively: 99.2 and 98.0 % achieved virologic response (hepatitis B viral load < 69 IU/ml) (p = 0.686); 79.7 and 81.9 % had normal serum levels of alanine aminotransferase (p = 0.586); 4.0 and 1.2 % developed hepatocellular carcinoma (p = 0.044). In HBeAg-positive patients with and without baseline cirrhosis, HBsAg loss occurred in 14.4 and 8.3 % of patients, respectively (p = 0.188). One HBeAg-negative patient had HBsAg loss. Conclusions: This represents the largest analyses to date of CHB patients with sequential liver biopsies demonstrating that treatment with TDF for up to 5 years is associated with favorable virologic, serologic, and histologic outcomes, regardless of baseline cirrhosis status. Notably, histologic improvement was observed in the majority of cirrhotic and noncirrhotic patients

Increasing hepatitis B vaccination among young African-American men who have sex with men: simple answers and difficult solutions.

Using a bar-based sample, we identified factors associated with hepatitis B virus (HBV) vaccination among young African American men who have sex with men (MSM). The mean (+/- standard deviation [SD]) age of the 170 participants was 26 +/- 6.5 years. Nearly 40% reported at least one dose of vaccine; the remainder were completely unvaccinated. Approximately 22% (37) reported having never heard of HBV. Less than 7% of participants reported using condoms the majority of the time during oral intercourse within the past 3 months, and approximately 50% reported using condoms the majority of the time during anal intercourse within the past 3 months. In multivariable analysis, variables associated with vaccination were younger age (odds ratio [OR], 0.44 per 10-year increase in age; 95% confidence interval [CI]: 0.21-0.93, p = 0.032), higher educational attainment (OR, 4.6; 95% CI: 1.17-12.59, p = 0.003), homosexual as opposed to bisexual behavior (OR, 0.15; 95% CI: 0.06-0.41, p = 0.0001), and recent visits to a health care provider (OR, 4.31; 95% CI: 2.08-8.94, p = 0.0001). Our findings underscore the need to reach MSM for HBV vaccination. Innovative approaches are necessary to ensure the prevention of infection, transmission and disease among individuals with limited education, bisexual MSM, and men who have limited access to health care

Association of CTLA4 polymorphisms with sustained response to interferon and ribavirin therapy for chronic hepatitis C virus infection.

Cytotoxic T lymphocyte antigen-4 (CTLA4) suppresses cytotoxic T lymphocyte activity. We examined the associations of CTLA4 single-nucleotide polymorphisms (SNPs) at promoter site -318 and exon-1 site 49 with clearance of hepatitis C virus (HCV) after treatment with combination interferon-alpha plus ribavirin (IFN-alpha+R) therapy in 79 white sustained responders (SRs) and 79 nonresponders (NRs). SRs had higher frequencies of 49G, alone (odds ratio [OR], 2.3; P=.042) and tightly linked with -318C in a haplotype (OR, 2.4; P=.030). Homozygosity for the -318C-49G haplotype was even more frequent among SRs (OR, 5.2; P=.049). Comparably strong associations persisted after multivariable analysis. Relationships were not seen with non-1 genotype viruses (OR, 0.93-1.25; P>.25). Virus load also declined more rapidly in carriers of both 49G (P=.0095) and the -318C-49G haplotype. CTLA4 49G in exon 1 alone and in a haplotype with -318C promoter is associated with sustained IFNalpha+R response in white patients with HCV genotype 1 infection

Hepatitis A vaccination among young African American men who have sex with men in the deep south: psychosocial predictors.

Despite recommendations for vaccination against hepatitis A (HAV) of men who have sex with men (MSM), most remain unvaccinated. This study was designed to identify attitudes and beliefs associated with vaccination against HAV using a conventional outreach sample of African American MSM in Birmingham, Alabama. Of 107 participants, nearly 34% reported being vaccinated against HAV. Over half of the participants reported 10 or more different lifetime male sexual partners, and a third reported having had intercourse with females, as well as, males within the past 5 years. About 10% of the participants reported condom use over half of the time during oral intercourse, and 50% of the participants reported using a condom over half the time during anal intercourse. In multivariable analysis, predictors of HAV vaccination were a decreased perception of the practical barriers to HAV vaccination (odds ratio [OR], 0.05; 95% confidence interval [CI]: 0.01-0.18, P = 0.002); increased health provider communication (OR, 9.89; 95% CI: 2.74-35.65, P = 0.02); and increased perceived personal self-efficacy to complete the two-dose series (OR, 7.31; 95% CI: 2.38-22.45, P = 0.02). Our findings underscore the need to increase vaccination through innovative approaches to reduce perceived barriers to vaccination while increasing provider-patient communication and self-efficacy to complete the vaccine series