Each month in Boyz the team from NAM aidsmapreport the latest news on HIV and sexual health. Keep up to date and read more on their website at aidsmap.com
The consequences of local authorities and the NHS failing to provide PrEP to people who need it have been starkly revealed by doctors in Manchester. At least nine gay men have been diagnosed with HIV while on a waiting list to take part in a research study towards PrEP, Dr Sally Jewsbury of the Hathersage Centre in Manchester discovered.
In November 2017, just before recruitment to the PrEP Impact study began, the clinic’s doctors began to keep a list of patients who wanted to go on PrEP and who the doctors had assessed as being suitable. Some people were also added to the waiting list after they contacted the clinic asking for PrEP.
Although the clinic was able to enrol some men into PrEP Impact and other research studies, there was more demand than places. Many men never came off the waiting list.
Dr Jewsbury compared the 493 names still on the waiting list with those of people recently diagnosed at the Hathersage Centre. She found nine cases – people who wanted to take PrEP, couldn’t get it and subsequently became HIV positive. They were all gay and bisexual men, mostly in their twenties or thirties, and they had been on the waiting list for six months on average.
These cases are likely to be the tip of the iceberg – some men who wanted PrEP were probably never added to the list in the first place and some men on the list could have been diagnosed at other clinics. And there are probably many other cases across the country, in other towns and cities where it has been hard to get on the PrEP Impact study.
Dr Jewsbury described access to PrEP in the UK as a postcode lottery – Scotland, Wales and Northern Ireland do not have the same restrictions as England. Although the number of trial places was meant to be doubled recently, full roll-out of this has been blocked by the local authorities in London. They pay for the HIV testing and sexual health check-ups that PrEP users need, whereas the NHS pays for the drugs.
If you can’t get a place on the PrEP Impact trial, NAM aidsmap’s factsheet ‘How to get PrEP in the UK’ explains your options. You could buy PrEP online, buy it through 56 Dean Street’s PrEP Shop (for as little as £17.50 a month) or, if you are on a low income, apply to the Mags Portman PrEP Access Fund for a free supply. Whatever you do, you should go into a sexual health clinic for the tests you need and advice on the best way to take it.
The man who no longer has HIV
Australian researchers have identified a patient who appears to have spontaneously cleared his own HIV infection without any medication, many years after he was first infected.
However, the patient appears to have a unique combination of fortunate circumstances that only serve to show how difficult it is to eliminate HIV infection once it is established.
Dr John Zaunders of the University of New South Wales said that he was an ‘elite controller’, in other words one of the rare individuals who could maintain an undetectable viral load without medication. More specifically: The virus he was infected with lacked a piece of DNA that encodes a viral gene called nef; he had only one copy of the gene that peppers the surfaces of CD4 cells with the co-receptor molecule CCR5, making it harder for new CD4 cells to be infected with HIV; his CD4 cells had a very potent and specific response to a particular signal of viral infection; he had two cellular immune genes that ensured his response to HIV was particularly efficient, HLA-B57 and HLA-DR13; he had a strong and broad CD8 cell response to HIV-infected cells.
So a very specific chain of characteristics had to come together in the right order to ensure that the immune response to what was already a weakened virus in one person’s system was strong, specific and fast enough to do what has never been seen before: enable someone to spontaneously clear all the HIV from his body, without the need for medicine.
It may be impossible for scientists to recreate the same circumstances in other people with HIV by artificial means such as genetic engineering. But the case is a ‘proof of concept’. It shows that spontaneous cure or profound remission of HIV can happen and this will spur researchers on to try to make it happen again.
Read more at aidsmap.com/page/3511496
Rectal douching raises the risk of infection
Rectal douching may put gay men at increased risk of HIV, hepatitis B, hepatitis C, chlamydia, gonorrhoea and other sexually transmitted infections, researchers report. Pooling the results of 28 separate studies, involving 21,570 men, they found that the risks of HIV infection were increased almost threefold in men who douched.
Douching could increase the risk of infections in three ways. Firstly, it may damage the delicate lining of the rectum, especially when soap or anything apart from plain water is used. It might also lead to the removal of naturally occurring protective bacteria inside the rectum. Finally, if douching bulbs or shower attachments are shared between people, an infection could be passed on that way.
Read more at aidsmap.com/page/3484935
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