Caitlyn Fitzpatrick

The majority of new incidences of HIV infections in 2015 were reported in African American males, according to the US Centers for Disease Control and Prevention (CDC), and the trend is predicted to continue. In an ongoing effort to concentrate research on this high-risk group, researchers from New York University (NYU) evaluated the population specifically in incarcerated individuals.

Prisons are breeding grounds for sexually transmitted infections (STIs), including HIV. While most incarcerated people get infected with HIV before going to prison, it’s not uncommon for them to first learn about their diagnosis while being tested in prison. The NYU team aimed to understand how sex partnerships in prison, and the types of partnerships, impact STI and HIV risks in African Americans.

“We identified subgroups of participants with distinct relationship profiles and measured associations between relationship characteristics and multiple partnerships of inmates and their partners in the 6 months before incarceration,” Maria Khan, PhD, MPH, (

) associate professor in the NYU School of Medicine’s Department of Population Health, said in a news release.

The cohort included 207 African American men from the study Project DISRUPT. All of the men were being released from prison in North Carolina and in committed heterosexual partnerships before entering prison.

The average length of the committed relationship was three years and most of them were considered stable, meaning they lived together, helped each other financially, raised children together, had relationship satisfaction, and were together for multiple years. Although in relationships, the majority of participants were not married.

Satisfaction in the relationship was more telling than length of time together or marriage. Factors such as economic deprivation, substance use, violence, and mental disorder symptoms were linked to being dissatisfied or having an unstable relationship.

“Being in a marital or non-marital partnership with high levels of relationship satisfaction — which was a majority of committed partnerships – was associated with protection against non-monogamy for inmates and their partners,” Khan continued.

Satisfied/stable relationships were reported in 58% of the participants and 42% were dissatisfied/unstable.

But how does this translate to STI/HIV risk?

Being in a dissatisfied/unstable relationship was linked to engaging in multiple partnerships in prison (adjusted odds ratio (AOR) 2.93, 95% confidence interval (CI) 1.50, 5.72) and for their partners (AOR 4.95, 95% CI 1.68, 14.58).

Khan said that these findings indicated that there is a need to reduce barriers standing in the way of maintaining healthy relationships while incarcerated, including limited phone time, distance from prison, expense of getting to the prison, and childcare expenses. There is also a need to help inmates strengthen relationship skills while they are in prison and address the factors causing dissatisfaction/instability in the relationship — which could contribute to STI/HIV risk as well as violence.

, “The Committed Intimate Partnerships of Incarcerated African-American Men: Implications for Sexual HIV Transmission Risk and Prevention Opportunities,” was published in the 

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Many physicians would agree that proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors were a game-changer when the first one, alirocumab (Praluent/Sanofi, Regeneron), was approved by the US Food and Drug Administration (FDA) in July 2015.

Clinical trials continue to gather more data on different PCSK9 drugs and some highly anticipated ones were presented at the 66

 Scientific Session of the American College of Cardiology (

, Richard A. Chazal, MD, who was the ACC president at the time of the conference, revealed which studies he believes could change medical practice in the near future.

“I believe there’s been a continuing evolution to look at the lipid lowering effects of the PCSK9 inhibitors,” Chazal said, “and particularly two presentations at the opening late-breaking trial sessions, the FOURIER trial and SPIRE trials are a particular interest.”

The FOURIER trial examined adding evolocumab (Repatha/Amgen) to statin therapy, which resulted in a 

15% risk reduction in major adverse cardiovascular events

“The FOURIER trial showed important outcomes in patients that already on statins had modest control, not tight control, but modest control on modern type of statins and showed a substantial risk reduction,” Chazal continued, “and it appears as though that risk reduction was getting greater year by year, so it may have even greater effects long-term.”

vents) 1 and 2 trials evaluated bococizumab (Pfizer), which was pulled from the market in November 2016 for not showing significant benefit. In the SPIRE trials, outcomes showed that the drug was safe, but had 

“Along with the SPIRE trials, which also looked at lipid-lowering by a different PCSK9 inhibitor, they both showed dramatic improvements,” Chazal said.

But how low should LDL cholesterol guidelines go? Chazal explained that the ACC guideline task forces are working on the lipid section of it. “I believe it will likely in the future at some point to be driving LDL levels much lower than we have in the past,” he said, “and we certainly need to look very carefully at how we approach this with regard to targets.”

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Richard A. Chazal, MD, who was the ACC president at the time of the of the most recent ACC conference, revealed which presented studies he believes could change medical practice in the near future. He also discussed how low LDL cholesterol level guidelines will go.

How Low Will LDL Cholesterol Level Guidelines Go?

New research from The Scripps Research Institute (TSRI) could make it possible to alter HIV-fighting antibodies to become immune cells. The scientists did just that in a lab and were able to create cells that are resistant to the virus long-term.

“This research is possible because of the ability to select specialized antibodies from combinatorial antibody libraries,” Richard Lerner, MD, (

) Lita Annenberg Hazen Professor of Immunochemistry, said in a news release.

The team first used rhinovirus, the most common virus to cause the common cold, to test their system. Lentivirus, a vector, was used to deliver a new gene to cultured human cells. The gene synthesized the antibodies which bind to ICAM-1, a human cell receptor that rhinovirus needs. Since the antibodies were using the site, rhinovirus was unable to enter the cell and spread the virus.

Jia Xie, senior staff scientist at TSRI, explained that this “neighbor effect” is more effective because the antibody was nearby as opposed to floating through the bloodstream. “You don’t need to have so many molecules on one cell to be effective,” Xie said.

The researchers noted that their system can’t reach 100% of cells so both engineered and unengineered cells were used. When rhinovirus was added to those cells, the vast majority died in about two days. The population never recovered when the virus was only in the company of unengineered cells. When the rhinovirus was among a mix of both types of cell, there was an initial die-off but quick bounce back. The cell populations were at similar levels as the undiseased control group after 125 hours.

Positive results were also found using HIV; the resistant cells were able to replace infected cells, and quickly. Using antibodies that could potentially protect the CD4 cell receptor, where HIV binds to infect a person, the team found that the technique worked again.

The technique differs from others in a way that provides “a significant advantage,” according to the team, and could potentially cure HIV. In other therapies, antibodies float freely in the bloodstream at a relatively low concentration; the new technique has the antibodies hanging from a cell’s surface, which blocks viruses from invading cell receptors and spreading the infection.

Lerner described the system as “a form of cellular vaccination.”

The TSRI team is planning to work with City of Hope’s Center for Gene Therapy in order to analyze the therapy’s efficacy and safety profiles. City of Hope already has clinical trials in motion to test gene therapy for AIDS through blood stem cell transplantation.

“The ultimate goal will be the control of HIV in patients with AIDS without the need for other medications,” said John A. Zaia, MD, director of the Center for Gene Therapy in the Hematological Malignancy and Stem Cell Transplantation Institute at City of Hope.

, “Immunochemical engineering of cell surfaces to generate virus resistance,” was published in the 

Proceedings of the National Academy of Sciences of the United States of America

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Researchers are hopeful that their new technique could cure HIV.

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Dementia is even more common than heart failure, making it necessary for physicians in the primary care setting to understand, David Reuben, MD, Archstone professor of medicine at the University of California, Los Angeles (UCLA) told 

“The first telltale [sign that someone may have dementia] is when things aren’t making sense,” Reuben said at the American College of Physicians Internal Medicine Meeting (

) in San Diego, California, “that in fact you’re not getting a coherent story, if people are asking the same questions over and over again, if they don’t seem to be following the conversation. It’s more of an inkling or kind of an index of suspicion that things aren’t quite right.”

Patients with cognitive impairment are usually referred to a specialist for two reasons: to establish the diagnosis and to manage the condition. Managing dementia can be both complicated and time-consuming, Reuben said, so there are times when a neurologist or psychologist can better help the patient.

Dementia is even more common than heart failure, making it necessary for physicians in the primary care setting to understand, David Reuben, MD, Archstone professor of medicine at the University of California, Los Angeles (UCLA) told MD Magazine.

Caitlyn Fitzpatrick

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