HIV begins to yield secrets of how it hides in cells

Credit: CC0 Public Domain


UC San Francisco scientists have uncovered new mechanisms by which HIV hides in infected cells, resting in a latent state that evades the body’s immune system and prevents antiviral drugs from flushing it out.

The findings, published online February 28, 2018, in Science Translational Medicine, could help scientists design and test new therapies aimed at curing a virus that still affects more than 1 million Americans.

Typically, HIV commandeers called CD4 T cells and turns them into factories that can produce more virus. But for reasons that remain mysterious, a tiny fraction of these become dormant and do not make virus. Finding these “silent” HIV-infected cells is extremely challenging.

“We can’t even separate out uninfected from infected cells, let alone latently infected cells,” said Steven A. Yukl, MD, associate professor of medicine at UCSF and a staff physician at the San Francisco Veterans Affairs Medical Center. “Latently infected cells are extremely rare—one in 1 million CD4 T cells—and we don’t know how to identify them.”

Latently infected cells can remain dormant for decades—perhaps indefinitely—before encountering certain natural stimuli that cause them to start producing viral particles. Current antiretroviral therapies (ARTs) cannot kill latently infected cells, nor can they prevent them from reactivating. At best, ARTs can keep the virus at bay, but it usually rebounds as soon as patients stop taking the drugs.

“Knowing what mechanisms keep these latently infected cells silent would help us develop a therapy to either wake them up and kill them or silence them permanently,” Yukl said. “Until we figure out what keeps them latent, we can’t cure HIV.”

Scientists at the UCSF-affiliated Gladstone Institutes had previously developed a device that could track HIV inside cloned laboratory CD4 cells, allowing them to scrutinize the entire course of an HIV infection, including the latency stage. But, since laboratory systems do not necessarily show what is really happening inside a human body, Yukl’s team set out to examine cells taken from 18 HIV-infected patients.

Previously, researchers thought that latency stemmed from CD4 cells’ inability to convert HIV DNA into viral RNA. It was thought that some unknown cellular mechanism was blocking the start of this DNA-to-RNA conversion process, called transcription, which meant that while the viral DNA persisted, it was never translated into viral proteins that would trigger a response from the body’s immune system.

Yukl and his colleagues discovered that this wasn’t the case. Using a panel of tests for different regions of the viral RNA (based on an amplification and quantification method called droplet digital PCR), the team detected multiple fragments of viral RNA, meaning that the process of converting the viral DNA to RNA was at least starting in latently infected cells.

These RNA fragments were almost all short or incomplete, however, which meant that the transcription process was stalling out at various stages. Infected cells were unable to make longer, full-length, or spliced viral RNAs, and the transcription process was never completed. These problems with transcription were reversed, however, when researchers activated the infected T cells.

“It’s not that the cells aren’t making viral RNA, but that the RNA isn’t finished,” Yukl said. To wake up latent cells, he added, the full viral transcription process needs to take place, and none of the currently available drugs can effectively complete this process. “Now we can start developing drugs that will make them finish the viral RNA, which can then be made into viral proteins so that the body can recognize and kill the infected cells.”

Researchers have experimented with various ‘latency-reversing’ agents, although they are not yet used in the clinic. In the new study, the researchers discovered that each of these agents helped the cells at different steps along the process of making viral RNA, so a combination of them may be needed to completely activate the CD4 from their latent state.

“One of the nice things about knowing all these mechanisms is that we can look for new drugs or combinations and test how well they can overcome these transcription blocks,” Yukl said. “It provides a roadmap to design and evaluate new therapies.”

Author: Laura Kurtzman


Get Comfortable With HIV PrEP in Primary Care

A Highly Effective Primary Prevention Strategy

The Medical Care Criteria Committee (MCCC) of the New York State Department of Health (NYSDOH) AIDS Institute recently released guidelines on preexposure prophylaxis (PrEP), PrEP to Prevent HIV Acquisition. This clinically focused guideline for the administration and management of PrEP for prevention of HIV infection supports New York State’s End the Epidemic (ETE) initiative, a three-point plan set forth by Governor Cuomo in 2014 to end the AIDS epidemic in New York State. ETE aims to decrease the number of new HIV infections to 750 (from an estimated 3000) by 2020, and HIV prevalence will be reduced for the first time ever in New York State. The plan focuses on three key actions:

  • Identifying people with HIV infection who have not received a diagnosis and linking them to HIV care;
  • Linking and retaining people diagnosed with HIV to healthcare to maximize virus suppression so that they remain healthy and do not transmit the virus; and
  • Facilitating access to PrEP for people at high risk of acquiring HIV to prevent infections.

PrEP is a highly effective primary prevention strategy for individuals at increased risk for HIV acquisition. The NYSDOH AIDS Institute guideline committee recommends PrEP as part of a comprehensive HIV prevention strategy that includes counseling on safer sex and safer injection practices. PrEP consists of a daily tablet of combined tenofovir disoproxil fumarate/emtricitabine (TDF/FTC; Truvada for PrEP™). The significant effectiveness of PrEP in reducing HIV acquisition has been demonstrated in clinical trials and through implementation in the clinical setting.

Guideline-Based Approach to Implementing PrEP in Clinical Practice

The NYSDOH AIDS Institute PrEP guideline takes a step-by-step approach to implementing PrEP in clinical practice, starting with guidance on screening to identify candidates for PrEP. Several checklists are provided for clinicians; these include pre-prescription evaluation, patient education, and PrEP management, all of which are available in printable pocket guides as well. The guideline is written for a broad range of clinicians, including primary care practitioners and specialists in infectious diseases, general internal medicine, pediatrics/adolescent medicine, family medicine, and gynecology/obstetrics. In short, it is designed for use by all care providers who have the opportunity to address sexual health and HIV prevention with their patients. The PrEP Guideline is a tool for all clinicians to understand the benefits, use, and management of PrEP; to educate their patients; and to help their patients protect themselves from HIV infection.

Candidates for PrEP

When used as prescribed, PrEP is > 90% effective in reducing risk acquired through sexual activity, and > 70% effective in reducing risk acquired through injection drug use.[1,3,6] PrEP use has been rising steadily over the past 4 years, but PrEP awareness and uptake are not aligned with need. In the United States, 44% of new HIV infections occur among black people, but 70% of PrEP users are white and only 10% are black.[8] There is a critical need to increase the use of PrEP among individuals who stand to benefit from it the most. Early adopters and those willing to seek out PrEP providers are likely to obtain PrEP from HIV care providers and to be adherent with PrEP. Expanding the use of PrEP beyond early adopters will challenge clinicians to identify those who are more reluctant, may not recognize their risk, may have barriers to considering and obtaining PrEP, or may not know about this HIV prevention method.

Author: Joseph P. McGowan, MD


Guidelines aim to reduce treatment disparities for people with HIV diagnosed with cancer

People living with HIV who are diagnosed with cancer should be offered the same treatment as those without HIV; however, considerations should be made for potential interactions and toxicities, according to new practice guidelines from the National Comprehensive Cancer Network.

“The disparity in cancer care is large and significant. For most cancers, people living with HIV are two-to-three times more likely to receive no cancer treatment compared [with] uninfected people,” Gita Suneja, MD, associate professor of radiation oncology and global health at Duke Cancer Institute, said in a press release. “Although we don’t yet know all the reasons for these large differences in cancer treatment, the lack of clinical management guidelines available to clinicians has been shown to be one contributing factor.”

The most common types of cancer occurring among people with HIV include non-Hodgkin lymphoma, Kaposi sarcoma, lung cancer, anal cancer, prostate cancer, liver cancer, colorectal cancer, Hodgkin lymphoma, oral/pharyngeal cancer, female breast cancer and cervical cancer

The NCCN guidelines offered the main takeaway that people with HIV who develop cancer should be offered the same treatment as people who are HIV negative.

“The ultimate goal is to improve cancer survival among people living with HIV,” Suneja said in the release. “With modern antiretroviral therapy, people with HIV are living longer and, therefore, getting more cancers related to both HIV infection and aging. The bottom line is that the cancer burden is growing — in fact, cancer is quickly becoming the leading cause of death in people living with HIV — so we urgently need to improve cancer treatment in this population.”

Treatment considerations

Cancer treatment modifications for people with HIV should not be made based solely on the basis of a patient’s HIV status, according to the recommendations.

The guideline authors further recommended that an HIV specialist be included in the cancer-care team for patients with HIV.

An HIV specialist along with oncology and HIV pharmacists should review proposed cancer therapy to look for possible drug-to-drug interactions or overlapping toxicities.

“One of the most important points we want providers to be aware of surrounds the potential for drug interactions and overlapping toxicities between cancer therapeutics and [antiretroviral therapy],” Erin Reid, MD, clinical professor at UC San Diego Moores Cancer Center, said in the release. “Some antiretroviral-cancer therapeutic combinations have serious risk for increased toxicity, whereas others may reduce levels of either cancer therapeutics or the antiretroviral. The good news is that with the expansion of antiretroviral combinations available, there is opportunity to minimize these risks by modifying antiretroviral therapy during cancer treatment.”


HIV patients with depression face serious risks

(Reuters Health) – The proportion of time patients with HIV spend depressed is directly related to their likelihood of missing doctor appointments, how well their infection is suppressed and their risk of death from any cause, according to a multi-site U. S. study.

In a large analysis of records for nearly 6,000 patients receiving HIV primary care across the country, the researchers found that for patients depressed during the entire study period, the risk of death was double that of patients with no depression.

Even shorter periods of time spent with depression were tied to increases in viral load, missed appointments and increased mortality, researchers report in JAMA Psychiatry.

“If we can shorten an HIV patient’s exposure to depression by picking it up early and treating it well using evidence based protocols, we can make a difference in their outcomes,” said lead author Brian W. Pence, an associate professor of epidemiology at the Gillings School of Global Public Health at the University of North Carolina, Chapel Hill.

This is the first time that the impact of cumulative depression has been studied across the whole HIV care continuum, Pence told Reuters Health in a telephone interview.

The results suggest that even short-term, mild depression can have “meaningful negative outcomes on HIV treatment and survival,” Pence and colleagues write.

An estimated 1.1 million people in the U. S. were living with HIV at the end of 2015, according to the latest statistics from the Centers for Disease Control and Prevention. Between 20 percent and 40 percent of people living with HIV also have depression, Pence noted.

“We need to find better ways to integrate mental health care into chronic disease care . . . There’s good evidence that primary care providers and non-specialists can be as effective as psychiatrists using assertive dosing schedules.”

For the analysis, the researchers studied data from 5,927 patients, 5,000 of whom were men, who were receiving HIV care at six medical centers across the U.S. that were participating in the Center for AIDS Research Network of Integrated Clinical Systems (CNICS). The patients’ median age was 44 years, and each was followed for one to six years between September 2005 and August 2015.

All participants had two or more consecutive screenings for depression separated by less than year.

Of the entire study group, half of the patients spent less than 14 percent of their time in the study with depression, while 32 percent experienced no depression and 3.6 percent were depressed during the whole follow-up period.

Overall, researchers found that each increase in “percentage of days with depression” was tied to a corresponding increase in risk of missing appointments for HIV primary care, of having detectable virus in blood tests – meaning the virus was no longer suppressed, and of death from any cause.

For every 25 percent rise in percentage of days with depression, there was an 8 percent increase in missed appointments, a 5 percent increase in likelihood of having detectable viral load and a 19 percent rise in mortality risk. For the patients who were depressed 100 percent of the time, that translated to a 37 percent higher risk of missing appointments and 23 percent risk of treatment failure.

A limitation of the study is that all of the participants came through the CNICS, so the results may not represent what would happen among other groups of HIV patients.

“What’s useful and important about this study is the fact that caring for people with HIV requires more than getting drugs into their bodies to control their disease,” said Judith D. Auerbach, a researcher with the Center for AIDS Prevention Studies/Division of Prevention Sciences in University of California, San Francisco School of Medicine, who was not involved in the research. “I think this problem is transferable to other chronic diseases and disorders,” she said in a telephone interview.

“You have to keep checking for depression regularly, every three to six months, otherwise you may not catch depression until it has already done damage,” she said.

Author: Cheryl Platzman Weinstock


Creating Criminals: The Misguided Crackdown on HIV/AIDS

A vindictive, unscientific campaign against people with HIV fueled mass incarceration and racial injustice, Trevor Hoppe says in ‘Punishing Disease.’

California has long been at the vanguard of public health initiatives that were once derided as wrongheaded but are now considered mainstream: auto emissions tests, clean air and anti-smoking laws, bike helmet regulations, medical marijuana. But there’s at least one policy the state has had great cause to regret.

California’s anti-HIV law was harsh: Exposing an unknowing person to the virus was made a felony, punishable by up to eight years in prison.

BOOK REVIEW —  “Punishing Disease: HIV and the Criminalization of Sickness,” by Trevor Hoppe (University of California Press, 275 pages).

In the mid-1980s, the HIV/AIDS epidemic was sweeping through major cities like a scythe, with no end or cure in sight. An HIV diagnosis was considered a death sentence. As Trevor Hoppe recounts in the new book “Punishing Disease,” the public mood was both fearful and vengeful:

In the face [of] failed prosecutions, media outlets demanded that legislators introduce HIV-specific laws. An Orlando Sentinel editorial specifically argued that stiff penalties were necessary to discourage “case by case experimenting” in which authorities “dream up novel ways to prosecute today’s version of Typhoid Mary.” But nowhere in the country was the discussion as heated as in California, where conservative extremist Lyndon LaRouche had stoked the fears of Americans through repeated ballot initiatives aimed at restricting the civil rights of all people living with HIV. In a 1987 editorial entitled “There Ought to Be a Law,” [the] Daily News of Los Angeles staff wrote that “it is time for Sacramento to exercise the political will needed to prevent unstable AIDS victims from passing a death sentence to others.”

California was hardly alone in responding to the epidemic with punitive statutes. At least 30 other states eventually passed laws criminalizing the potential exposure to HIV. (Most of these laws, including California’s, did not require actual transmission of the virus.) California’s law was particularly harsh. Exposing an unknowing person to the virus was made a felony, punishable by up to eight years in prison. People living with HIV could “be subject to a longer potential sentence than for certain types of manslaughter,” according to Lambda Legal, the civil rights and legal advocacy group.

“Punishing Disease” is a meticulously researched history of how punishment came to be perceived as a “legitimate disease control strategy” in response to the HIV epidemic. Neatly organized in two sections — one on public health, one on criminal justice — the book is further divided into six chapters, each about a different social problem. It begins with the outbreaks of tuberculosis and typhoid in early-20th-century urban America, quoting firsthand accounts of the heavy-handed quarantine tactics used to fight them. The book ends with a pioneering demographic analysis showing which communities are most affected by HIV criminalization laws.

Hoppe, a sociologist at the University at Albany, State University of New York, has already established himself as a scholar of sexuality, medicine, and the law. In addition to “Punishing Disease,” he was co-editor of the 2017 essay collection “The War on Sex,” with David M. Halperin, the well-known theorist of sexuality, gender theory, literature, and critical studies at the University of Michigan (and formerly at MIT). Hoppe completed his doctorate at Michigan, where his research found that heterosexual African-American men are disproportionately convicted under that state’s HIV disclosure law.

“Punishing Disease” argues that HIV presents a unique experience in our history because “no disease has been met with a singularly systemic campaign to criminalize people living with infectious disease.” HIV was so feared in the 1980s, Hoppe writes, because no one knew what it was or how to treat it. The first cases were reported in June 1981. Researchers eventually discovered the human immunodeficiency virus in 1983. Isolating the virus led to developing a diagnostic test two years later. During those years, cases were largely untreatable and often terminal.

New Jersey became the first state to criminalize HIV exposure in 1985. More than a dozen states, including California, followed suit by 1988 with laws to punish exposure or transmission, according to Hoppe’s research. These laws were introduced after several high-profile failures to convict people living with HIV under traditional felony statutes such as attempted murder or assault; police, prosecutors, and media outlets were frustrated and demanding harsher, HIV-specific laws.

The criminalization of HIV was accompanied by the rise of mass incarceration, an escalating “war on drugs” that began during the Nixon administration, and the racialized backlash against gains made by African-Americans during the civil rights era. Hoppe, like many other scholars, calls attention to the racialization of the Reagan-era drug war, its “focus on a drug that was disproportionately used by poor black Americans: crack cocaine,” the harsher sentencing guidelines that targeted those users, and the resulting significant racial disparities in policing, courts, and corrections. All played into the injustices wrought by state HIV criminalization laws.

The book’s sixth and final chapter examines racial and gender disparities in HIV-specific convictions and sentencing, presenting a first-of-its-kind dataset that includes convictions under HIV-specific criminal laws in six states — Arkansas, Florida, Louisiana, Michigan, Missouri, and Tennessee. The findings are striking: Heterosexual male defendants are disproportionately convicted; African-American men receive longer and harsher prison sentences; Men accused of not disclosing to women “were sentenced to prison terms roughly a year longer than their [gay] counterparts,” in the three states — Michigan, Missouri, and Tennessee — where data was available. (One of these data sets, on racial disparities in sentencing, was reported in Undark last August in my Convictions column about Hoppe’s presentation at the 2016 AIDS conference in Durban, South Africa.)

Racial and gender disparities persist in the application of HIV-specific criminal laws.

Much has changed, of course, since the nightmarish 1980s. Powerful antiretroviral therapies (ARVs), introduced in 1996, have revolutionized treatment outcomes, saving millions of lives. These treatments mean that people living with HIV have a chronic but manageable condition — like asthma or diabetes — and can live long, healthy, and productive lives. Daily adherence to an ARV regimen makes it extremely unlikely, if not virtually impossible, to transmit HIV to a sexual partner, studies have demonstrated.

Last fall, California finally repealed the misguided felony provision of its HIV law. The new law, SB 239, signed by Gov. Jerry Brown in October, makes deliberate intent to expose — which very rarely happens, according to most experts — a misdemeanor. It incorporates the current evidence-based science concerning the virus and notes that “use of a condom, barrier protection of prophylactic device, or good faith compliance with a medical treatment regimen for the infectious or communicable disease prescribed by a health officer or physician” demonstrates a “practical means to prevent transmission.” The legislation was supported by Republicans and Democrats, public health officials, medical professionals, legal scholars, civil rights advocates, and leading newspapers such as The San Francisco Chronicle. It’s an encouraging development, though as Jessica Wapner reported in detail for Undark in August 2016, there is still much to be done in other states.

“Punishing Disease” — engagingly written and accessible to non-scientific and non-academic audiences — impressively deploys the tools of sociology, criminology, and epidemiology to help us understand the baleful consequences of reacting to a public health emergency with punishment instead of compassion.


The Criminalization of HIV Non-Disclosure and Poz Youth Responses Towards it


Webinar: The Criminalization of HIV Non-Disclosure and Poz Youth Responses Towards it.
Date: Thursday, March 22nd, 2018
Time: 11am PST / 2pm EST

To Register for this webinar, click this link:

In Canada, those of us living with HIV have the duty to disclose our HIV status to our partners before engaging in sexual activities that have a “realistic possibility” of passing HIV. This webinar aims to explain how this law impacts our community, and to discuss how this law contributes to and is influenced by HIV stigma. As well, we will highlight the on-going work of an ambitious group of local youth advocating for the much necessary changes we hope to see regarding this law.

Neil Self, from Positive Living BC, will be speaking on the work of the Canadian Coalition to reform HIV Criminalization.
William Flett, from YouthCO HIV and Hep C Society, will be speaking on the youth responses towards the non-disclosure law.
There will be an opportunity for questions and further dialogue for both presenters, at the end of the presentation.

March 22, 2018 at 11am – 12pm

Can Pot Prevent Fatty Liver Disease in Those With Hep C and HIV?

A recent study found that daily cannabis use was associated with a reduced risk of the liver condition in this population.

Among people living with HIV and hepatitis C virus (HCV), fatty liver disease, also known as steatosis, is a serious health concern. Hep C is a liver-based virus that raises the risk of steatosis, and coinfection with HIV is known to exacerbate liver-related health problems in those living with HCV.

A French research team has published a study in the Journal of Viral Hepatology that found that regular pot use is associated with a lower risk of fatty liver disease among those with HIV and HCV, even when the investigators controlled for body weight and other major risk factors for the liver condition.

So does this mean everyone with HIV and HCV should fire up the bong or bake a bunch of brownies? Like any prudent scientist, the new study’s research director, Patrizia Carrieri, PhD, a researcher at the French National Institute of Health and Medical Research (INSERM) who is based in Marseille, says the results of her study should be interpreted with caution. Much more research is needed to determine whether there is in fact a causal relationship between using pot and a mitigated risk of fatty liver.

Carrieri’s paper also stresses that addressing lifestyle factors such as diet, exercise and alcohol consumption are vitally important when it comes to modulating the risk of fatty liver among HIV/HCV-positive individuals.

Then there is the often-overlooked fact that cosuming pot is, in fact, a form of smoking (provided, of course, that individuals consume it through lighting up). “Smoking, whatever the product,” Carrieri notes, “is not good for your health. This is particularly true for people living with HIV and HCV.”

An estimated 40 to 67 percent of those living with HIV and HCV have fatty liver disease. The accumulation of fat in liver cells is a potential risk factor for the progression of fibrosis (scarring) of the organ and for liver cancer and may lessen the chance of successfully curing hep C with direct-acting antiviral treatment.

Risk factors for fatty liver particular to those coinfected with HIV and HCV include antiretroviral (ARV) treatment for HIV, especially nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs). Research has indicated that this class of HIV medications is associated with metabolic disorders, including fatty liver. Additionally, alcohol abuse is common in the HIV/HCV-positive population.

Hep C is also associated with a higher risk of insulin resistance and type 2 diabetes. Researchers have firmly established that insulin resistance plays a key role in the development of fatty liver disease.

As for pot’s role as a potential mitigating risk factor for fatty liver, a study published in Clinical Infectious Diseases in 2015 found that those with HIV and HCV who used cannabis had a lower risk of developing insulin resistance and steatosis.

Looking to further explore this association, the French group conducted what is known as a cross-sectional study (meaning data was collected at one specific point rather than over time, providing a snapshot effect) among 838 people with HIV and HCV who were members of ANRS CO13-HEPAVIH, an ongoing study of HIV/HCV-coinfected individuals conducted in various French clinics since 2005.

The participants included in the analysis all had data in their medical records about their cannabis use, or lack thereof, as well as results from an ultrasound examination for steatosis. Forty percent of them had fatty liver disease.

Seventy percent of the participants were men.

The participants were asked whether, during the previous month, they used cannabis “never” (53 percent gave this answer), “sometimes” (21.7 percent), “regularly” (11.7 percent) or “every day” (14 percent).

The study authors adjusted their data to account for various risk factors for fatty liver disease, including body mass index (BMI), current or past exposure to the ARV combination tablet Combivir (zidovudine/lamivudine) and hazardous alcohol consumption. After this adjustment, the investigators found that daily cannabis use, compared with never or sometimes using the substance, was associated with a 36 percent reduced likelihood of having steatosis.

Otherwise, being overweight or obese (having a BMI above 20 and 25, respectively), compared with being underweight (a BMI under 18), was associated with a 93 percent increased risk of fatty liver disease. Any exposure to Combivir, compared with no exposure, was linked to a 51 percent increased risk of the liver condition. And hazardous consumption of alcohol, compared with a lack of hazardous usage, was linked to 73 percent increased risk of steatosis.

The study authors acknowledged that their findings about pot’s link with a reduced steatosis risk stood in contrast to a cross-sectional study, published in the journal Gastroenterology in 2008, that found that daily use of cannabis was actually associated with an increased risk of the liver condition among those with HCV.

“The inconsistency is perhaps due to the difference in the study populations,” says Carrieri. “That study included individuals living with HCV only, who did not use drugs other than cannabis and who were never treated for HCV. Our study group was coinfected with HIV, and we did not exclude individuals who used drugs or those who had been treated, whether cured or not, for HCV.”

Carrieri and her colleagues’ new paper is limited by its cross-sectional design. Because they did not follow the study cohort over time, they could not analyze how cannabis may be associated with the development or evolution of fatty liver disease. Additionally, the study cannot rule out that steatosis led to greater use of cannabis. The study could also not parse its data to determine how short- versus long-term use of pot may be differently associated with steatosis risk.

“It would be interesting,” Carrieri says, “to conduct experimental research, such as randomized trials, to study the effect of specific cannabinoids contained in cannabis on specific medical conditions, including steatosis, diabetes and obesity.”

By Benjamin Ryan


HIV rates continue to rise in Manitoba: new report

Province experienced 23% increase in new HIV cases in 2016

A new report by Manitoba Health shows the number of HIV patients in Manitoba rose in 2016 by 23 per cent compared with the year previous.

A new report by Manitoba Health shows the number of HIV patients in Manitoba rose in 2016 by 23 per cent compared with the year previous. (AFP/Getty Images)

Manitoba has the second highest rate of new HIV cases in the country, behind Saskatchewan, according to the province’s latest figures.

In its recently released annual statistical update for 2016 Manitoba Health found 128 new cases of HIV, the human immunodeficiency virus that can lead to acquired immunodeficiency syndrome (AIDS) the potentially life-threatening condition.

Cases of HIV are up 47 per cent compared with 2014.

“That’s quite a concern,” said Keith Fowke, head of medical microbiology and infectious diseases at the University of Manitoba. “These numbers are too high. It’s unacceptable.”

While Manitoba’s HIV rates continue to rise, only one case of AIDS was reported in 2016 — the lowest level since 2006 apart from in 2014 when not a single case was reported.

According to the report, a third of the new HIV cases in 2016 were found in people arriving from countries where rates of the illness are already high. Unprotected sex between men and women and between just men follow as risk factors for the spread of HIV.

Better testing possible factor in HIV rates

The bulk of new cases — almost 40 per cent — had no identifiable risk factor, meaning there was no information provided on how the person might have contracted the virus. The province says this could be because patients did not wish to disclose how they may have acquired the virus, or did not know a behaviour they were engaged could spread the disease.

Along with unprotected sex, sharing needles and sex toys, breast feeding and child birth can all put a person at risk of contracting HIV, according to Health Canada.

Dr. Joss Reimer, medical officer of health for sexually transmitted and blood-borne infections in Manitoba, says Manitoba’s relatively low population makes it harder to draw concrete conclusions from fluctuations in HIV rates.

“Certainly there is the worry that this means that we have more HIV and that things are getting worse but it could also mean that we’re testing more and that we’re being successful in reaching people who already had HIV and we didn’t know about them,” she said.

More than half of HIV patients who self-reported their ethnicity identified as either black or Indigenous (55 per cent), which Reimer says means Manitoba needs to consider a wide range of factors that can lead people to developing the disease. Those of Caucasian descent comprised 20 per cent.

Poverty, racism, colonization and historical trauma all contribute to these higher rates, Reimer says.

“Instead of just focusing on the infection itself, we need to look even further back than that and make sure that we are providing safe and healthy environments for people,” Reimer said.

“How do we change things so if you’re on reserve you get the same access to safe and healthy housing and good education as if you were off reserve? We know that those are not equal right now.”

Fowke says Manitoba has a “fairly good” program finding and identifying HIV cases, but there are likely cases that aren’t being caught.


With treatment, patients with HIV can expect to live out a normal length life, says provincial health officer Dr. Joss Reimer. The disease is now considered chronic, like diabetes. (CBC)

Stigma continues

HIV rates have risen and fallen over the last decade, though new cases have steadily increased since 2014, provincial records show.

“I think as a province we need to pay more attention to this because it’s the tip of the iceberg,” Fowke said. “There’s probably many other cases that have yet to be identified.”

Stigma surrounding an HIV and AIDS diagnosis continues to be a factor blocking patients from seeking out treatment and getting tested, Reimer says.

“It comes from this fear that was set up when AIDS first appeared on the scene and people were dying, but now we know that hepatitis C is a more dangerous infection,” she said.

“Most people with HIV are going to live are going to have the same life expectancy as people who don’t have HIV.”

Fowke says Manitoba needs to watch whether an increase in injection drug use causes HIV rates to rise as well, as has happened in Saskatchewan.

Data from 2017 and the start of 2018 is not yet available, but Reimer says the 2016 data is encouraging, showing a decrease in the number of people infected with HIV who use dirty needles to inject drugs.


DTES at risk of losing only Indigenous-run HIV treatment centre, advocates warn

Vancouver Coastal Health says services won’t be disrupted but could be moved to a different space

Elder Dalannah Gail Bowen says the Vancouver Native Health Society is a special place, and if certain services move, she says patients likely won't know where to find them.

Elder Dalannah Gail Bowen says the Vancouver Native Health Society is a special place, and if certain services move, she says patients likely won’t know where to find them. (Jon Hernandez/CBC)

An Indigenous-run health centre on the Downtown Eastside will soon have to make a bid to Vancouver Coastal Health if it wants retain funding for its unique HIV treatment program.

For two decades, the Vancouver Native Health Society has offered unique culturally sensitive treatment for HIV patients in the DTES by combining spiritual healing, western medicine, and Indigenous staff through the Positive Outlook Program.

But Lou Demerais, the organization’s executive director, says POP’s funding contract with Vancouver Coastal Health ends March 31, and this time around, the health authority is letting other health centres bid to take over the service, rather than renew the contract.

“They’ve told us there’s no guarantee that we’d be the winning bid, even though we have the expertise,” Demerais told CBC News. “We wonder why, after 20 years, they’re doing this, when they haven’t given us real reason for doing it.”

Demerais says staff at VNHS met with representatives from VCH on Thursday to discuss the possibility of a replacement program that could land in a different, potentially non-Indigenous facility.

Blood sample

Vancouver Coastal Health maintains treatment for HIV patients will not be disrupted following the expiration of the contract. (Associated Press)


Following guidelines

According to VCH, the health authority, in putting POP services up for bid, is following organizational guidelines. It says the VNHS is welcome to bid on the service.

A spokesperson said there will be no disruptions in services for HIV clients that frequent the program.

But Demerais says the service will likely be halted following the expiration of the contract, and he’s unsure if VNHS will be submitting a bid.

“We haven’t seen the specs yet, and we don’t know whether the new specs will require us to either alter direction, [or go in a] totally different direction,” he said. “Over 20 years, we’ve come to know [what our patients] needs are.”

“Quite a number of people who have been reliant upon the program for a number of years now will have to find similar kinds of services either elsewhere or wait and hope that similar services  are recreated under another agency.”

Lou Demerais

Lou Demerais, the executive director of the Vancouver Native Health Society, says he’s unsure of the Positive Outlook Program’s fate. (Twitter)


Open to non-Indigenous facilities

According to the First Nations Health Authority, the VNHS is the only Indigenous primary care facility of its kind in the DTES and any disruption to the services it offershould be minimized.

But community advocates fear that if a non-Indigenous health centre acquires the services, it won’t be able to provide the same level of culturally-sensitive care.

“VNHS is the only place where you can experience traditional healing practices in a cultural way,” said Dalannah Gail Bowen, an elder who was asked on Thursday to facilitate a rally to save the service.

“Nobody can replace an Indigenous health practice by being non-Indigenous and believing you can deliver the service,” she added.

“It’s not the same.”

Author: Jon Hernandez


Significant increase in HIV PrEP awareness does not correspond with use

Researchers in Canada have tracked a significant increase in awareness of HIV pre-exposure prophylaxis, or PrEP, although low rates of actual use were reported in the Momentum Health Study.

Nathan Lachowsky, PhD, assistant professor at the University of Victoria School of Public Health and Social Policy in British Columbia, and colleagues evaluated responses to a computer-assisted survey of 732 HIV-negative and HIV-positive men who have sex with men (MSM) regarding PrEP between 2012 and 2016.

Awareness of PrEP among HIV-negative men increased from 18% to 80%, and awareness among HIV-positive men increased from 36% to 77%. Lachowsky and colleagues, however, determined that the higher levels of awareness were not impacting the levels of use, with only 2% of MSM surveyed using PrEP.

Researchers concluded that affordability and access were two factors that could explain the low use of PrEP, despite increased awareness. “Indigenous, Latino, bisexual and single men are less likely to be aware of the newly publicly funded HIV prevention medication,” the BC Centre for Excellence in HIV/AIDS stated in their press release. Funded by the Ministry of Health through the BC PharmaCare program, the BC Centre for Excellence in HIV/AIDS now allows free access to PrEP for people who need the medication.

“Our team and colleagues are engaged in trying to build capacity in health care providers and within health care systems to ensure services meet the demand from the community for PrEP,” Lachowsky told Infectious Disease News. “We also need to increase health promotion to ensure that men know PrEP is funded and to ensure those men who would benefit from PrEP pursue getting it. This includes needing to address and reduce stigma associated with taking PrEP and with HIV generally.” – by Marley Ghizzone