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NIH research network finds many youth have high levels of HIV
Study succeeds at early diagnosis but suggests high risk of HIV infection for youth
January 23, 2014 - More than 30 percent of young males who had sex with other males and who
were subsequently enrolled in a government treatment and research network were found to have high levels of
HIV, reported researchers from the National Institutes of Health and other institutions.
The health status of the study participants, who ranged in age from 12 to 24 years, was monitored as part of
their participation in the Adolescent
Medicine Trials Network for HIV/AIDS Interventions (ATN). The ATN provides medical care to youth
with HIV and offers counseling and, medications, and other preventive measures to youth who are at
risk of acquiring HIV. As part of their participation in the network, the youth have the option
of taking part in research studies of the latest methods to prevent people from acquiring HIV
and to treat those who have become infected.
To conduct the current study, researchers analyzed the health records of youth with HIV, soon after they
enrolled in the ATN. The study authors noted that the high blood levels of the virus seen in the majority
of study participants indicated that they were diagnosed early in the course of HIV infection, when the
chances for minimizing the health consequences of HIV are greatest. The researchers added, however,
that the study results suggest that HIV is highly likely to be transmitted among members of this group.
"This is not a time for complacency,'' said study author Bill G. Kapogiannis, M.D., scientific director of
the ATN. "Our results suggest that all health care providers who work with young people - particularly those
who work with males who have sex with other males - should stress the urgency of getting tested, and, if
infected, into treatment, which benefits their own health as well as reduces transmission to others."
According to the U.S. Centers for Disease Control and Prevention, 1 in 4 new HIV infections occur
in young people from 13 to 24 years of age. About 60 percent of all youth with HIV do not know they are infected, are not getting treated,
and can unknowingly pass the virus on to others. Among the groups that the CDC
recommends get tested for HIV are those:
Who have injected drugs and shared needles and other equipment with others
Who have had unprotected sex with men who have sex with men, had multiple partners or anonymous partners
Have been diagnosed with hepatitis, tuberculosis, or a sexually transmitted disease
Had unprotected sex with someone in the above groups
The network is funded by three institutes at the National Institutes of Health: The Eunice Kennedy Shriver National Institute of Child
Health and Human Development (NICHD), the National Institute on Drug Abuse and the National Institute of Mental Health.
The study was published online in the journal AIDS. The study's principal investigator was Jonathan M. Ellen, M.D., of All Children's
Hospital Johns Hopkins Medicine, St. Petersburg, Fla. The study also included researchers from Indiana University School of Medicine
in Indianapolis; Westat, in Rockville, Md., and the Johns Hopkins University School of Medicine in Baltimore.
To conduct the study, the researchers measured the viral load and CD4 counts of 852 youth in 14 cities in the United States and Puerto
Rico. Viral load
is the amount of HIV in the blood. Dr. Kapogiannis explained that viral levels are highest very early in the course of an HIV
infection. CD4 counts
measure infection-fighting white blood cells known as T-cells.
"In the first few weeks, the viral load can be millions of copies, or higher," he said. "Then, over the
ensuing months, it stabilizes at about 30,000 to 50,000 copies. Normal CD4 counts range from 500 to 1,000,
but drop substantially during the infection."
Among the study participants, 34 percent had CD4+ counts of 350 or less, 27 percent had counts from 351
to 500, and 39 percent had counts greater than 500. Male youth who had reported sexual contact with
another male had the highest average viral load, in excess of 115,000. Among all males, regardless
of sexual orientation, the viral load averaged more than 106,000. For females, the average viral
load count was roughly 48,000. Most of those diagnosed with HIV had been referred for medical
care during the course of the study (79 percent.)
"Men with HIV tend to have higher viral loads than do women," Dr. Kapogiannis said. "But I think there
is a timing issue here as well. It's possible that the young men who have sex with men are being
diagnosed earlier than are the women, because of greater awareness of the risks and more frequent testing."
Because of the high viral loads they detected in their study, the researchers concluded that efforts to
diagnose and treat people with HIV should focus a large share of their efforts on youth, particularly
young men who have sex with men.
"It's important to get these individuals into treatment early, not only for the sake of their own health,
but also for that of others, because many youth don't even know they are infected and may risk
unknowingly transmitting the virus during this time," Dr. Kapogiannis said.
About the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD): The
NICHD sponsors research on development, before and after birth; maternal, child, and family health;
reproductive biology and population issues; and medical rehabilitation. For more information,
visit the Institute's website at http://www.nichd.nih.gov .
About the National Institutes of Health (NIH): NIH, the nation's medical research agency,
includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services.
NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical
research, and is investigating the causes, treatments, and cures for both common and rare diseases.
For more information about NIH and its programs, visit www.nih.gov .
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