CDC Endorses Truvada For HIV Prevention Purposes

There was important news in the fight against HIV/AIDS this week. The federal government announced they were issuing guidelines that recommend that sexually active HIV-negative gay men take doses of Truvada for "pre-exposure prophylaxis" (PrEP) purposes.

The guidelines say PrEP should be considered for HIV-uninfected patients with any of the following indications:

• Anyone who is in an ongoing sexual relationship with an HIV-infected partner.

• A gay or bisexual man who has had sex without a condom or has been diagnosed with a sexually transmitted infection within the past six months, and is not in a mutually monogamous relationship with a partner who recently tested HIV-negative.

• A heterosexual man or woman who does not always use condoms when having sex with partners known to be at risk for HIV (for example, injecting drug users or bisexual male partners of unknown HIV status), and is not in a mutually-monogamous relationship with a partner who recently tested HIV-negative.

• Anyone who has, within the past six months, injected illicit drugs and shared equipment or been in a treatment program for injection drug use.

“While a vaccine or cure may one day end the HIV epidemic, PrEP is a powerful tool that has the potential to alter the course of the U.S. HIV epidemic today,” said Jonathan Mermin, M.D., M.P.H., director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. “These guidelines represent an important step toward fully realizing the promise of PrEP. We should add to this momentum, working to ensure that PrEP is used by the right people, in the right way, in the right circumstances.”

This is a very important step. California's largest AIDS service providers had endorsed this position a few weeks ago, so it is good that this policy position will adopted nationwide.

Obama Announces $100M Initiative To Find HIV/AIDS Cure

Big news from the Obama administration following the celebration of World AIDS Day. President Obama announced a new $100 million initiative at the National Institutes of Health that will be focussed on finding a cure for AIDS/HIV in pursuit of Obama's goal of an "AIDS-free generation."

The Washington Blade reports:

The event was part of the rollout for a new White House report on confronting HIV/AIDS, titled “Improving Outcomes: Accelerating Progress Along the HIV Care Continuum.” The report describes the state of the epidemic, makes recommendations going forward and highlights local successes as well as public-private partnerships.

In his remarks, Obama said significant progress has made in confronting HIV/AIDS since Congress first allocated funds to fight the disease in 1983, but certain communities continue to be affected more than others, including LGBT people and the D.C. area.

“Here in the United States, we need to keep focusing on investments to communities that are still being hit hardest, including gay and bisexual men, African-Americans and Latinos,” Obama said. “We need to keep up the fight in our cities — including Washington, D.C., which in recent years has reduced diagnosed infections by nearly half.”

As Assistant to the President on Domestic Policy Cecilia Munoz pointed out at the start of the event, the Centers for Disease Control has reported gay and bisexual men account for two-thirds of all new HIV infections in the United States.

Despite the fact that this is not "new money" which is being added to the NIH budget, it is still very encouraging that the focus is shifting towards a cure, although there are concerns about whether this initiative will have a negative impact on HIV prevention efforts.

Hat/tip to Joe.My.God

President Signs HIV Organ Policy Equity (HOPE) Act Into Law

THE WHITE HOUSE

Office of the Press Secretary

FOR IMMEDIATE RELEASE

November 21, 2013

Statement by the President on the HIV Organ Policy Equity (HOPE) Act

Earlier today, I signed into law the HIV Organ Policy Equity (HOPE) Act, a bipartisan piece of legislation that allows scientists to carry out research into organ donations from one person with HIV to another.  For decades, these organ transplants have been illegal. It was even illegal to study whether they could be safe and effective.  But as our understanding of HIV and effective treatments have grown, that policy has become outdated.  The potential for successful organ transplants between people living with HIV has become more of a possibility.  The HOPE Act lifts the research ban, and, in time, it could lead to live-saving organ donations for people living with HIV while ensuring the safety of the organ transplant process and strengthening the national supply of organs for all who need them.

Improving care for people living with HIV is critical to fighting the epidemic, and it’s a key goal of my National HIV/AIDS Strategy.  The HOPE Act marks an important step in the right direction, and I thank Congress for their action. 

###

LA TIMES semi-endorses gay blood ban repeal

The Los Angeles Times editorialized on the topic of modifying the lifetime ban on gay men (who have had sex with another man since 1977) on donating blood, a subject that MadProfessah has been following for quite awhile. They want to change that to a ban on gay men who have had sex with a man since 2005:

Beyond the theories, the reality is that there were only four known cases of transfusion-related HIV infection from 1999 to 2007, out of more than 112 million units of blood. In all four cases, the donors had denied having any risk factors. In addition to sexually active gay men, the high-risk groups banned from donating include anyone who was ever an intravenous drug user, people with a history or family history of certain illnesses and anyone who has ever accepted payment for sex. Other groups cannot donate for up to a year -- people who have had acupuncture or body piercings, for instance, or heterosexuals who have engaged in high-risk sexual practices.

[...]

A 2008 report by the American Medical Assn., which reviewed a host of pertinent studies, concluded that there was a very small but statistically significant increase in risk of transmission of AIDS and other diseases if men who had abstained from sex for one year were allowed to give blood. That risk, small as it might be, is nonetheless too big. The FDA should reject a shift to a one-year abstention policy.

But the agency should seriously consider allowing donations from gay men who have abstained from sexual contact for at least five years. Under that scenario, the AMA found, the risk would be indistinguishable from current levels. The figures are theoretical, of course, based on statistical probabilities. If anything, they are probably conservative. The four transfusion-related HIV cases in recent years were a tiny fraction of what the statistical models predicted. Because not all donors remember exactly how long they have abstained from sex, the FDA should consider adding a buffer of several more years. If it does ease the restrictions, it should require.

No one should be deceived about how meaningful such a change would be. Mostly, it would give a symbolic victory to the gay and lesbian community. The number of gay men who have abstained completely from sex for at least five years is considered to be quite small. Fewer yet would be interested in donating blood. The AMA report predicts that even though changes in risk would be unnoticeable, the number of blood donors would not increase appreciably.

But that's not a valid defense for clinging to what might be outdated guidelines. The country has more effective tests and other safety measures than when these rules were devised. If there is no reason to think the country would see a rise in transfusion- related illness with a five- to 10-year rule, refusal to relax the restriction would indeed be unfairly discriminatory.

So, they think the lifetime ban should be lifted, but want to replace it with a 5-10 year ban if you have had sex with another man, as opposed to a year for all other "high risk groups." Still sounds discriminatory to me.

What I find bizarre is that there is no mention of safer sex in their analysis. I'd like to see statistical analyses of the difference in probabilities between a gay man who has had sex with a condom a year ago and straight man who has had sex without a condom a year ago. Plus, it must be remembered that all donated blood is tested for HIV antibodies. The very low probability scenario that everyone is trying to avoid is the case of someone who has HIV (and doesn't know it) because they are in a one-month window of when they haven't developed detectable antibodies to the virus but they have donated blood.

Is it really reasonable to tar all gay men with the broad brush of medical hazard to avoid this infinitesimally small event? As the editorial mentions, there were 4 known cases of transmission out of 122 million units of blood donated between 1999 and 2007. Even if the rate were to DOUBLE this would still be a vanishingly small probability, on the order of being struck by lightning.

VIDEO: HIV Infecting T-Cells Caught On Tape

Hat/tip to Joe.My.God