【新知】CDC Officially Admits People With HIV Who Are Undetectable Can't Transmit HIV

After hundreds of other experts and HIV organizations have already signed on to a pledge that recognizes that people living with HIV whose treatment has brought their viral load to an undetectable level — which is nearly half of all HIV-positive people in the U.S. — do not transmit HIV to any other person, the Centers for Disease Control and Prevention has come out with the definitive statement on the subject.

In recognition of National Gay Men’s HIV/AIDS Awareness Day, the CDC memo stated, "On this day, we join together in taking actions to prevent HIV among gay and bisexual men and ensure that all gay and bisexual men living with HIV get the care they need to stay healthy." Gay and bisexual men, the CDC noted, continue to be disproportionately affected by HIV, with, "more than 26,000 gay and bisexual men received an HIV diagnosis in 2015, representing two-thirds of all new diagnoses in the United States, and diagnoses increased among Hispanic/Latino gay and bisexual men from 2010 to 2014."

【新知轉載】HIV and Diabetes

Last Reviewed: October 6, 2017

Key Points

• Diabetes is a disease in which levels of blood glucose (also called blood sugar) are too high. Glucose comes from the breakdown of the foods we eat and is our main source of energy. There are two main types of diabetes: type 1 diabetes and type 2 diabetes.
• Use of some HIV medicines may increase blood glucose levels and lead to type 2 diabetes. Other risk factors for type 2 diabetes include a family history of diabetes, being overweight, and lack of physical activity.
• People with HIV should have their blood glucose levels checked before they start taking HIV medicines. People with higher-than-normal glucose levels may need to avoid taking some HIV medicines and use other HIV medicines instead.
• Blood glucose testing is also important after starting HIV medicines. If testing shows high glucose levels, a change in HIV medicines may be necessary.
• Type 2 diabetes can often be controlled with a healthy diet and regular exercise. A healthy diet includes vegetables, fruits, beans, whole grains, and lean meats and is low in processed foods high in sugar and salt. Regular exercise means being active for 30 minutes on most days of the week. Sometimes, in addition to a healthy diet and regular physical activity, some people may need to take medicines to control type 2 diabetes.

【新知】Is PrEP making a difference? Top HIV researchers provide answers

July 23, 2017, by Emily Newman

BETA is attending and reporting from the 2017 International AIDS Society conference on HIV Science this week in Paris, France from July 23 to 26—bringing you the latest news, updates, and research on HIV treatment and prevention.

As countries, cities and agencies worldwide ramp up their investment in pre-exposure prophylaxis (PrEP) services for people at risk for HIV, many are wondering: Is this strategy working in the “real world”—outside the safe parameters of clinical trials?

At the International AIDS Society conference this week, three researchers offered evidence to this point. Here’s what we learned about how the scale-up of PrEP health services (along with other PrEP awareness and educational campaigns) is helping to reduce the number of new HIV infections in communities and countries around the world.

Extensively Drug-Resistant HIV Yields to a New Drug: Ibalizumab

原文網址：Extensively Drug-Resistant HIV Yields to a New Drug: Ibalizumab

Extensively Drug-Resistant HIV Yields to a New Drug: Ibalizumab
By Myles Helfand
From TheBodyPRO.com
October 31, 2016

HIV clinicians who have patients in declining health due to extensive HIV drug resistance may soon have a new lifesaving option: ibalizumab. The HIV entry inhibitor in development shows highly encouraging antiretroviral activity in the days after it is first administered, according to early Phase 3 study results presented at IDWeek 2016 by Jacob Lalezari, M.D. Lalezari discussed the results at a press conference on Oct. 28 and during an oral abstract presentation on Oct. 29.
Ibalizumab is "not the most potent drug we've seen for HIV, but it's ... very good," Lalezari said. More to the point, he said, it is "maybe all we have right now" for people who have few to no HIV treatment options remaining due to the development of multidrug resistance. He described the drug as being aimed at people with HIV who have been "left behind by an otherwise amazing evolution in HIV treatment."

Second case of HIV infection on PrEP

原文網址：Second case of HIV infection on PrEP

Second case of HIV infection on PrEP

October 18, 2016, by Emily Newman

At the HIV Research for Prevention conference in Chicago today, the HIV community received news of the second well-documented PrEP failure case. Howard Grossman, from Cleveland Clinic in Florida, shared information about a male client on Truvada PrEP since January 1, 2016 who seroconverted. Here’s what we know about what happened.
The man on PrEP who seroconverted was a man in his 20s who has sex with other men. He was in a relationship with a man who has been living with HIV since 2012 and who has maintained an undetectable viral load.
The man on PrEP did not acquire HIV from his primary male partner. This was confirmed by genetic comparisons of the strain of HIV acquired by the man on PrEP and the strain of the partner, which revealed they were “unrelated viral populations.”
The man on PrEP had two other sex partners on two separate occasions 5.5 and 11 weeks before testing positive for HIV. Both times, the man on PrEP was the “top,” or insertive sex partner. Grossman concluded that the man’s history was “consistent with transmission during condomless insertive anal intercourse.”
The man on PrEP was adherent to PrEP. “Excellent adherence” was confirmed by measures of tenofovir in blood spots and hair taken from the client.
The man on PrEP acquired a multi-drug resistant form of HIV, with high-level resistance to lamivudine, abacavir, didanosine, emtricitabine, tenofovir, efavirenz, nevirapine, and rilpivirine. Because the type of HIV he was exposed to was resistant to the drugs in Truvada PrEP (tenofovir and emtricitabine), PrEP was not able to prevent HIV infection.
Read more about PrEP and drug resistant HIV on BETA.

amfAR Publishes Recommendations for Health Plans and Health Care Purchasers to Support Efforts to Curb the HIV Epidemic in the U.S.

原文網址：amfAR Publishes Recommendations for Health Plans and Health Care Purchasers to Support Efforts to Curb the HIV Epidemic in the U.S.

amfAR Publishes Recommendations for Health Plans and Health Care Purchasers to Support Efforts to Curb the HIV Epidemic in the U.S.

amfAR Publishes Recommendations for Health Plans and Health Care Purchasers to Support Efforts to Curb the HIV Epidemic in the U.S.
From amfAR, The Foundation for AIDS Research
October 13, 2016
New York -- Today, amfAR, The Foundation for AIDS Research released a new report, Curbing the HIV Epidemic by Supporting Effective Engagement in HIV Care: Recommendations for Health Plans and Health Care Purchasers, which highlights the critical role of health plans and health care purchasers, including Medicaid and Medicare programs, marketplaces, and employers, in moving the nation toward ending the domestic HIV epidemic.
According to the report, there are a relatively small number of actionable and meaningful steps that these entities can take that will improve health outcomes, reduce preventable HIV-related health spending, and contribute to the development of more tightly integrated systems of care.
"While we have the science and the tools to stop HIV transmissions and support all people with HIV to lead long and healthy lives, the HIV community cannot achieve this vision alone," said Greg Millett, amfAR Vice President and Director, Public Policy. "We hope that this report shows health plans and major health care purchasers that they can take a small number of strategic steps to provide better care to their members that will help us achieve critical national goals."
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amfAR worked in partnership with a group of leading researchers in HIV/AIDS policy to identify changes in policy and practice in clinics, communities, and health care programs to reduce unnecessary health spending, increase the effectiveness of services, and increase the integration of services.

2016.09.10 疾管署防疫醫師 黃士澤 醫師 講課講義【認識茲卡病毒感染症】

2016.09.10 疾管署防疫醫師 黃士澤 醫師 講課講義
【認識茲卡病毒感染症】

Evidence that “on-demand” PrEP taken before and after sex can prevent HIV

原文網址：Evidence that “on-demand” PrEP taken before and after sex can prevent HIV

Evidence that “on-demand” PrEP taken before and after sex can prevent HIV

September 8, 2016, by Emily Newman

How many doses of Truvada-based PrEP (pre-exposure prophylaxis) are needed to provide adequate protection against HIV? Might it be possible to take PrEP only before and after sex—instead of every day?
In the U.S., once-daily dosing with Truvada is the only approved method of PrEP by the FDA—since continuous therapy provides the most complete protection against HIV. Researchers are now investigating, however, if other dosing schedules may also be effective—to reduce cost and also provide the most flexibility to PrEP users.
A recent article published in The Lancet HIV provides insight into this very question. The researchers report the results from a very small pharmacokinetic study with 21 HIV-negative participants. The participants, who took Truvada daily for a total of 30 days, had the level of drug measured in their blood at day 1 (after their first dose), 3, 7, 20, and 30. Based on drug concentration modelling, the researchers were able to estimate the proportion of people who achieved protective levels of drug with each different dose level.

Sex 58,000 Times With Undetectable Partners = Zero HIV Transmission: Learn More

原文網址：Sex 58,000 Times With Undetectable Partners = Zero HIV Transmission: Learn More

Sex 58,000 Times With Undetectable Partners = Zero HIV Transmission: Learn More

By JD Davids
From TheBody.com
July 14, 2016

The PARTNER study looks at HIV transmission risk in couples -- both gay and straight -- where one person is on HIV treatment and has an undetectable viral load and the other is HIV negative. On July 12, the Journal of the American Medical Association (JAMA) published the striking finding that, even after 58,000 sex acts by 1166 couples not using condoms, there were no cases of HIV transmission between them. Zero. None.

After so many years of fear and loss during the HIV epidemic, it can be hard to believe even extremely good and well-proven news. Throw in a hefty dose of persistent and pernicious HIV stigma, and it's not surprising to see a lot of resistance to spreading the word about this revolution.

TheBody.com offers these tools for sharing the news about the new era of HIV prevention that includes treatment as prevention (TasP) and pre-exposure prophylaxis (PrEP).

It's Official: Zika Is a Sexually Transmitted Infection

原文網址：It's Official: Zika Is a Sexually Transmitted Infection

It's Official: Zika Is a Sexually Transmitted Infection

As more local cases are announced in Florida, the CDC confirms that Zika can be spread sexually from men or women.

By Maryn McKenna
PUBLISHED AUGUST 1, 2016
Fourteen Miami-area residents who have caught Zika virus in the city are the first believed to have been infected by U.S. mosquitoes. The news confirms what public health experts have been predicting for months: At some point this summer in the United States, Zika would cease to be only an imported illness and become a locally transmitted one.

But reaction to the Florida discoveries—four cases announced Friday and ten today—obscures another development. The Centers for Disease Control and Prevention has confirmed something that’s been implicit in discussions of the virus for a while: Zika is effectively a sexually transmitted disease.

Public health experts now know that Zika can be passed in bodily fluids between one man and another, between a man and a woman, and from a woman to a man—and though no case has been made public, they assume it can be transmitted between female partners as well.

So far, in the continental United States, 15 cases of Zika are confirmed to have been transmitted by sexual contact. That’s out of 1,657 cases of infection. (In Puerto Rico, where Zika is spreading very rapidly—4,684 cases as of July 29—analysis for sexual transmission hasn’t been done.)

What we’re learning about new PrEP drugs and delivery methods at AIDS 2016

原文網址：What we’re learning about new PrEP drugs and delivery methods at AIDS 2016

What we’re learning about new PrEP drugs and delivery methods at AIDS 2016

July 21, 2016, by Emily Newman

BETA is reporting from the 21st International AIDS Conference this week in Durban, South Africa—bringing you the latest news, updates, and research on HIV treatment and prevention.

The drug maraviroc is safe and well-tolerated as pre-exposure prophylaxis for women

Maraviroc, a drug that is already on the market to treat HIV (brand name, Selzentry), is a CCR5 antagonist that concentrates in the genital tract and rectum, and selects for drug resistance uncommonly—making it a desirable product for PrEP, if it works.

(影片) 事前預防性投藥 (PrEP) -- 預防愛滋的新選擇

版權所有：台灣愛滋病學會

臺灣暴露前口服預防性投藥使用指引-臺灣愛滋病學會

(轉載) GLOBAL HIV TARGETS

原文網址：GLOBAL HIV TARGETS

Those working in the field of HIV, from policy makers to programmers, and national governments to community-based organisations, operate within the framework of global HIV targets.

In the post-2015 era, targets are geared to ending the HIV epidemic by 2030.

Role of international HIV organisations


International organisations working in the HIV response play a key role in advocating for strong HIV and AIDS targets and indicators by which to measure progress. For example, those focussing on human rights and equal access to HIV services for all, call for global indicators to properly include key affected populations.

2015 Sexually Transmitted Diseases Treatment Guidelines

Summary

These guidelines for the treatment of persons who have or are at risk for sexually transmitted diseases (STDs) were updated by CDC after consultation with a group of professionals knowledgeable in the field of STDs who met in Atlanta on April 30–May 2, 2013. The information in this report updates theSexually Transmitted Diseases Treatment Guidelines, 2010 (MMWR Recomm Rep 2010;59 [No. RR–12]). These updated guidelines discuss 1) alternative treatment regimens for Neisseria gonorrhoeae; 2) the use of nucleic acid amplification tests for the diagnosis of trichomoniasis; 3) alternative treatment options for genital warts; 4) the role of Mycoplasma genitalium in urethritis/cervicitis and treatment-related implications; 5) updated HPV vaccine recommendations and counseling messages; 6) the management of persons who are transgender; 7) annual testing for hepatitis C in persons with HIV infection; 8) updated recommendations for diagnostic evaluation of urethritis; and 9) retesting to detect repeat infection. Physicians and other health-care providers can use these guidelines to assist in the prevention and treatment of STDs.
附件下載：2015 STD Treatment Guidelines.pdf

原文轉自：2015 STD Treatment Guidelines

2014 Top Stories in HIV Medicine

December 14th, 2014

2014 Top Stories in HIV Medicine

性病、HIV大哉問 (交流版面)

有任何問題請在下方順序提出，由友善性病醫師團隊或護理師、個管師等回應。在您提問前請先注意是否有他人已先提出並有回覆，本版經審核訊息後才會發佈。

C型肝炎合倂HIV治療大哉問 (北榮顧文瑋醫師)

隨「雞尾酒療法」的問世，愛滋病友們的平均壽命和生活品質日漸提升；然而近年來，相同傳染途徑的C型肝炎感染人數卻逐年上升。在同時感染愛滋病毒(HIV)與C肝病毒(HCV)的病友身上，肝臟慢性發炎及肝硬化的進程更加快速。治療C肝的傳統藥物效果不好，但隨著皮下注射「長效型干擾素」的發明，合併口服「雷巴威林」連續治療半年到一年後，有將近五成到七成的病患得以根治，也讓這「不治之症」出現了治療的曙光。

◎長效型干擾素（Pegylated Interferon）
國內的長效型干擾素有alfa-2a（Pegasys 珮格西施）及alfa-2b（Peg-intron 派樂能）兩種藥品，兩者都是予以一週一次的皮下注射。藥品必須冷藏在冰箱，在注射前30分鐘再把針劑取出回溫。注射方式如同打胰島素針，需挑選皮下脂肪較厚的區域，例如腰線以下的兩側小腹、兩側上臂及大腿，輪流挑選不同地方注射，避免刺激皮膚反應。以下是常見的副作用：

流行性感冒般的症狀：包括肌肉痠痛、發燒、頭痛及疲勞，通常是注射一、兩天後最不舒服，然後慢慢改善。如擔心副作用會影響工作，病友可以選擇在週末注射，並在家休息，或服用類似普拿疼成分（acetaminophen）的止痛解熱藥，隨著治療的時間越久，這樣的不適感也會越趨緩和。

噁心、食慾不振：可採取清淡的飲食，少量多餐，多休息，避免刺激及油膩的食物以減低腸胃道的不適；當體重有明顯下降時，醫師可能會重新調整干擾素或雷巴威林的劑量。

貧血、血小板及白血球低下：這是使用干擾素常見的副作用，合併雷巴威林時易發生溶血性貧血。可能的症狀包括疲累、牙齦流血、皮膚出現小出血點、走路運動易喘、頭暈；除可靠不定期輸血、保持休息與營養外，需要時建議使用促進紅血球及顆粒球生長激素，幫助緩解症狀。當情況惡化時，醫師可能會減少干擾素或雷巴威林的劑量，甚至停止治療。

情緒低落及憂鬱症：使用干擾素所帶來的身體不適可能會造成情緒波動，甚至在原有情緒疾患的病友身上加重病情。建議在每次回診的時候主動與主治醫師討論情緒及睡眠的問題，亦可及早轉介精神科醫師評估、治療。

掉髮、甲狀腺功能異常、血糖控制難、自體免疫疾病惡化：在少部分、通常是在接受治療前，已有糖尿病或是自體免疫疾病的病友會有上述的問題。在開始治療前與治療中，主治醫師會定期追蹤甲狀腺功能與血糖，而病友應該規律維持原本糖尿病與甲狀腺疾病的藥物治療；且當症狀嚴重時，建議須停止干擾素的治療。

◎雷巴威林（ribavirin）
除了上面所提到造成溶血性貧血的副作用之外，雷巴威林也有造成畸胎的風險。除了女性病友在接受治療的期間應避免懷孕之外，男性病友在接受治療時精子也會受到藥物作用，所以其女性伴侶暫時也不應懷孕，要記得避孕。

我什麼時候適合接受C型肝炎的治療？
根據國內外的治療指引，只要是肝功能指數ALT（或稱GPT，麩丙酮酸轉胺脢）異常，血液中同時能測得C肝病毒的抗體和病毒量（亦即代表曾經感染過C肝病毒，而病毒持續在體內複製），就符合慢性C型肝炎的定義，並透過全民健保接受健保給付的藥物治療。不過如果肝硬化進展到肝功能代償不全的病友，或是有上述使用干擾素或是雷巴威林的禁忌症者（例如打算懷孕的女性），則不適合治療。

還沒有使用抗愛滋病毒藥物(HAART)的病友，也可以治療C型肝炎嗎？
目前國內外的治療指引多建議在愛滋病毒量控制良好、CD4高於200的病人身上才考慮治療C肝，也就是已規則服用抗愛滋病毒藥物的病友們。不過如果是急性C型肝炎，或慢性C肝的肝硬化程度進展快速、需提前接治療的病友則需與主治醫師考量治療的利弊得失後，再進行治療。

使用治療C型肝炎的藥物會不會影響我的抗愛滋病毒藥物？
目前的長效型干擾素和口服雷巴威林，均未有報導表示會與抗愛滋病毒藥物產生交互作用，但是由於抗愛滋病毒藥物中的zidovudine成分（立妥威、卡貝滋）較易造成骨髓抑制與貧血，故服用此成份藥物時，則不建議與干擾素合併使用。

如果治療C型肝炎的藥物副作用太大，我應該要停藥嗎？
如在治療的過程中有任何不適，務必與個管師聯絡，甚至提早回診，由主治醫師評估調整藥物劑量或是中止治療。病友不應擅自停藥，或是單用干擾素或是雷巴威林，這樣不但治療效果差，對副作用的減少亦無幫助。

展望：雖目前治療C肝的藥物副作用較多，但從國內的研究統計看來，在合併用於愛滋病友的治療效果，並不亞於單一感染C肝的病患；因此我們期待隨著更多抗C肝病毒藥物的問世，使病友們有副作用更少、使用更便利的治療出現。

台北榮民總醫院感染科／顧文瑋醫師

資料來源：http://www.lourdes.org.tw

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