... I. Makadon, Harvey J., 1947-II. ... Illinois Hilary Goldhammer, MS The Fenway Institute, Fenw... more ... I. Makadon, Harvey J., 1947-II. ... Illinois Hilary Goldhammer, MS The Fenway Institute, Fenway Community Health Boston, Massachusetts Joanne Greenfield, PhD Private clinical practice Lexington, Massachusetts Robert Guzman, MPH San Francisco Department of Public Health ...
2 Men who have sex with men (MSM) represent more than half of all new HIV infections in the U.S. ... more 2 Men who have sex with men (MSM) represent more than half of all new HIV infections in the U.S. Utilizing a collaborative, community based approach, a brief risk reduction intervention was developed and pilot tested among newly HIV diagnosed MSM receiving HIV care in a primary care setting. Sixty five men, within three months of diagnosis, were randomly assigned to the experimental condition or control condition and assessed at baseline, 3- and 6- month follow up. Effect sizes were calculated to explore differences between conditions and over time. Results demonstrated the potential effectiveness of the intervention in reducing risk behavior, improving mental health, and increasing use of ancillary services. Process evaluation data demonstrated the acceptability of the intervention to patients, clinic staff and administration. The results provide evidence that a brief intervention can be successfully integrated into HIV care services for newly diagnosed MSM and should be evaluated ...
Background Human immunodeficiency virus (HIV)-infected men who have sex with men (MSM) are at inc... more Background Human immunodeficiency virus (HIV)-infected men who have sex with men (MSM) are at increased risk of anorectal infection with high-risk human papillomavirus and subsequent high-grade squamous intraepithelial lesions (HSIL), the putative precursor to anal cancer. Recently, an epidemic of sexually transmitted hepatitis C virus (HCV) has emerged that shares this anorectal route of transmission. We hypothesized that the prevalence of anal HSIL would be high in HIV-infected MSM with sexually acquired early HCV infection. Methods High-resolution anoscopy (HRA) findings from a cohort of HIV-infected MSM with sexually acquired early HCV infection were compared with HRA findings from a contemporary cohort of HIV-infected MSM without HCV infection who underwent HRA due to abnormal anal cytology found during routine screening. Results Sixty HIV-infected MSM with sexually acquired early HCV infection and the comparator group of 1150 HIV-infected MSM with abnormal anal cytology but wi...
Treatment of HIV-infected men during early hepatitis C virus (HCV) infection with interferon resu... more Treatment of HIV-infected men during early hepatitis C virus (HCV) infection with interferon results in a higher cure rate with a shorter duration of treatment than during chronic HCV infection. We recently demonstrated that this phenomenon applied to interferon-free treatment as well, curing most participants with short-course sofosbuvir and ribavirin. Due to the significantly higher potency of the ledipasvir/sofosbuvir (LDV/SOF) combination, we hypothesized that we would be more successful in curing early HCV infections using a shorter course of LDV/SOF than that used for treating chronic HCV infections. We performed a prospective, open-label, consecutive case series study of 8 weeks of LDV/SOF in HIV-infected men with early genotype 1 HCV infection. The primary end point was aviremia at least 12 weeks after completion of treatment. We treated 25 HIV-infected men with early sexually acquired HCV infection with 8 weeks of LDV/SOF, and all 25 (100%) were cured. Twelve (48%) reported...
Positive choices (PC), a brief sexual risk reduction intervention conducted with newly HIV-diagno... more Positive choices (PC), a brief sexual risk reduction intervention conducted with newly HIV-diagnosed men who have sex with men (MSM), was evaluated for preliminary efficacy. Participants were enrolled if they reported unprotected anal intercourse (UAI) in the three months prior to HIV diagnosis (n = 102). Three months after diagnosis, participants completed baseline assessments and were randomly assigned to receive the 3-session PC intervention or the comprehensive standard of care (C-SoC) at a community health center. Participants completed assessments at 3- (post intervention), 6-, and 9- months after baseline. Compared to C-SoC participants, PC participants significantly reduced the frequency of UAI with HIV serodiscordant (HIV negative or status unknown) partners over the 9-month follow-up period. No differences by condition were found in the frequency of UAI with all partners. The findings from this trial suggest that brief risk reduction approaches for newly-diagnosed MSM integrated into HIV care can benefit secondary HIV prevention efforts.
ABSTRACT Background Evaluation of the diagnostic value of anal cytology versus HRA in detecting a... more ABSTRACT Background Evaluation of the diagnostic value of anal cytology versus HRA in detecting anal intraepithelial neoplasia (AIN) and the added value of molecular markers in a multicenter cohort of HIV positive MSM (CoRIS-HRA). Methods: Concomitant anal liquid cytology and HRA with biopsy of acetowhite lugol-negative lesions if observed. Concordance was evaluated by the Kappa index. Dual staining for p16INK4a and Ki-67 (CINtec(®) PLUS, Roche) was done in cytology samples. Taking biopsy as the 'gold standard' for AIN diagnosis, the sensitivity and specificity of anal cytology and p16INK4/Ki-67 dual positivity was calculated. Results: Since November 2012, 172 patients were recruited in five Spanish hospitals. In 56 patients, no biopsies were performed as no lesions were observed. In the remaining 116 patients, 142 biopsies were obtained. Among 172 cytologies, 10.5% were inadequate, 27.9% negative, 1.1% ASCUS, 45.3% LSIL and 15.2% HSIL. Histology showed inadequacy in 3.5% of cases, negativity in 25.3%, LG-AIN in 35.2% and HG-AIN in 35.9%. In 116 patients, cytology and biopsy results were available (the highest lesion grade was used if multiple biopsies existed); the strength of agreement was fair (Kappa 0.351; 95% CI 0.232-0.470). Sensitivity and specificity of anal cytology versus HRA guided biopsy was 88.3% and 66.7%, respectively. In 67 cases, results from dual staining for p16INK4a/Ki-67 were available, rendering a sensitivity of 47.3% and a specificity of 66.7% compared with histology results. Conclusions: Although preliminary, our results show that in our setting dual staining for p16INK4a/Ki-67 did not improve the operational characteristics of anal liquid cytology.
Men who have sex with men (MSM) are at high risk for contracting and transmitting HIV. They are i... more Men who have sex with men (MSM) are at high risk for contracting and transmitting HIV. They are increasingly encouraged to get tested, but understanding of the interplay between HIV testing and risk behavior is limited. One hundred fifty newly HIV-diagnosed (within past 3 months) MSM were recruited from a community clinic in New York City. Participants completed an interview assessing sexual behavior and substance use during the 3 months pre-diagnosis, current depressive symptoms, and prior HIV testing. HIV-related health characteristics at diagnosis were abstracted from medical records. Analyses examined factors associated with unprotected anal intercourse (UAI) in the 3 months pre-diagnosis, and with a negative HIV test in the 12 months pre-diagnosis. The sample was young (mean age=32.5, SD=8.8), ethnically diverse (62% racial/ethnic minority), low-income (71%≤$30,000/year), and educated (48% college/advanced degree). Most (95%) had a prior negative HIV test, 55% within the last 12 months. Significant risk behavior was reported, with 79% reporting UAI. UAI was associated with recent testing and use of substances during sexual behavior. Recent testing was associated with being employed/a student, having had UAI, and higher CD4 count. Implications for future research addressing perceived HIV risk, HIV testing utilization, and risk behavior are discussed.
... I. Makadon, Harvey J., 1947-II. ... Illinois Hilary Goldhammer, MS The Fenway Institute, Fenw... more ... I. Makadon, Harvey J., 1947-II. ... Illinois Hilary Goldhammer, MS The Fenway Institute, Fenway Community Health Boston, Massachusetts Joanne Greenfield, PhD Private clinical practice Lexington, Massachusetts Robert Guzman, MPH San Francisco Department of Public Health ...
2 Men who have sex with men (MSM) represent more than half of all new HIV infections in the U.S. ... more 2 Men who have sex with men (MSM) represent more than half of all new HIV infections in the U.S. Utilizing a collaborative, community based approach, a brief risk reduction intervention was developed and pilot tested among newly HIV diagnosed MSM receiving HIV care in a primary care setting. Sixty five men, within three months of diagnosis, were randomly assigned to the experimental condition or control condition and assessed at baseline, 3- and 6- month follow up. Effect sizes were calculated to explore differences between conditions and over time. Results demonstrated the potential effectiveness of the intervention in reducing risk behavior, improving mental health, and increasing use of ancillary services. Process evaluation data demonstrated the acceptability of the intervention to patients, clinic staff and administration. The results provide evidence that a brief intervention can be successfully integrated into HIV care services for newly diagnosed MSM and should be evaluated ...
Background Human immunodeficiency virus (HIV)-infected men who have sex with men (MSM) are at inc... more Background Human immunodeficiency virus (HIV)-infected men who have sex with men (MSM) are at increased risk of anorectal infection with high-risk human papillomavirus and subsequent high-grade squamous intraepithelial lesions (HSIL), the putative precursor to anal cancer. Recently, an epidemic of sexually transmitted hepatitis C virus (HCV) has emerged that shares this anorectal route of transmission. We hypothesized that the prevalence of anal HSIL would be high in HIV-infected MSM with sexually acquired early HCV infection. Methods High-resolution anoscopy (HRA) findings from a cohort of HIV-infected MSM with sexually acquired early HCV infection were compared with HRA findings from a contemporary cohort of HIV-infected MSM without HCV infection who underwent HRA due to abnormal anal cytology found during routine screening. Results Sixty HIV-infected MSM with sexually acquired early HCV infection and the comparator group of 1150 HIV-infected MSM with abnormal anal cytology but wi...
Treatment of HIV-infected men during early hepatitis C virus (HCV) infection with interferon resu... more Treatment of HIV-infected men during early hepatitis C virus (HCV) infection with interferon results in a higher cure rate with a shorter duration of treatment than during chronic HCV infection. We recently demonstrated that this phenomenon applied to interferon-free treatment as well, curing most participants with short-course sofosbuvir and ribavirin. Due to the significantly higher potency of the ledipasvir/sofosbuvir (LDV/SOF) combination, we hypothesized that we would be more successful in curing early HCV infections using a shorter course of LDV/SOF than that used for treating chronic HCV infections. We performed a prospective, open-label, consecutive case series study of 8 weeks of LDV/SOF in HIV-infected men with early genotype 1 HCV infection. The primary end point was aviremia at least 12 weeks after completion of treatment. We treated 25 HIV-infected men with early sexually acquired HCV infection with 8 weeks of LDV/SOF, and all 25 (100%) were cured. Twelve (48%) reported...
Positive choices (PC), a brief sexual risk reduction intervention conducted with newly HIV-diagno... more Positive choices (PC), a brief sexual risk reduction intervention conducted with newly HIV-diagnosed men who have sex with men (MSM), was evaluated for preliminary efficacy. Participants were enrolled if they reported unprotected anal intercourse (UAI) in the three months prior to HIV diagnosis (n = 102). Three months after diagnosis, participants completed baseline assessments and were randomly assigned to receive the 3-session PC intervention or the comprehensive standard of care (C-SoC) at a community health center. Participants completed assessments at 3- (post intervention), 6-, and 9- months after baseline. Compared to C-SoC participants, PC participants significantly reduced the frequency of UAI with HIV serodiscordant (HIV negative or status unknown) partners over the 9-month follow-up period. No differences by condition were found in the frequency of UAI with all partners. The findings from this trial suggest that brief risk reduction approaches for newly-diagnosed MSM integrated into HIV care can benefit secondary HIV prevention efforts.
ABSTRACT Background Evaluation of the diagnostic value of anal cytology versus HRA in detecting a... more ABSTRACT Background Evaluation of the diagnostic value of anal cytology versus HRA in detecting anal intraepithelial neoplasia (AIN) and the added value of molecular markers in a multicenter cohort of HIV positive MSM (CoRIS-HRA). Methods: Concomitant anal liquid cytology and HRA with biopsy of acetowhite lugol-negative lesions if observed. Concordance was evaluated by the Kappa index. Dual staining for p16INK4a and Ki-67 (CINtec(®) PLUS, Roche) was done in cytology samples. Taking biopsy as the 'gold standard' for AIN diagnosis, the sensitivity and specificity of anal cytology and p16INK4/Ki-67 dual positivity was calculated. Results: Since November 2012, 172 patients were recruited in five Spanish hospitals. In 56 patients, no biopsies were performed as no lesions were observed. In the remaining 116 patients, 142 biopsies were obtained. Among 172 cytologies, 10.5% were inadequate, 27.9% negative, 1.1% ASCUS, 45.3% LSIL and 15.2% HSIL. Histology showed inadequacy in 3.5% of cases, negativity in 25.3%, LG-AIN in 35.2% and HG-AIN in 35.9%. In 116 patients, cytology and biopsy results were available (the highest lesion grade was used if multiple biopsies existed); the strength of agreement was fair (Kappa 0.351; 95% CI 0.232-0.470). Sensitivity and specificity of anal cytology versus HRA guided biopsy was 88.3% and 66.7%, respectively. In 67 cases, results from dual staining for p16INK4a/Ki-67 were available, rendering a sensitivity of 47.3% and a specificity of 66.7% compared with histology results. Conclusions: Although preliminary, our results show that in our setting dual staining for p16INK4a/Ki-67 did not improve the operational characteristics of anal liquid cytology.
Men who have sex with men (MSM) are at high risk for contracting and transmitting HIV. They are i... more Men who have sex with men (MSM) are at high risk for contracting and transmitting HIV. They are increasingly encouraged to get tested, but understanding of the interplay between HIV testing and risk behavior is limited. One hundred fifty newly HIV-diagnosed (within past 3 months) MSM were recruited from a community clinic in New York City. Participants completed an interview assessing sexual behavior and substance use during the 3 months pre-diagnosis, current depressive symptoms, and prior HIV testing. HIV-related health characteristics at diagnosis were abstracted from medical records. Analyses examined factors associated with unprotected anal intercourse (UAI) in the 3 months pre-diagnosis, and with a negative HIV test in the 12 months pre-diagnosis. The sample was young (mean age=32.5, SD=8.8), ethnically diverse (62% racial/ethnic minority), low-income (71%≤$30,000/year), and educated (48% college/advanced degree). Most (95%) had a prior negative HIV test, 55% within the last 12 months. Significant risk behavior was reported, with 79% reporting UAI. UAI was associated with recent testing and use of substances during sexual behavior. Recent testing was associated with being employed/a student, having had UAI, and higher CD4 count. Implications for future research addressing perceived HIV risk, HIV testing utilization, and risk behavior are discussed.
Uploads
Papers