ABSTRACT
OBJECTIVES: To test the hypothesis that in comparison with those with shorter risk duration, individuals with longer HIV risk duration would have reduced susceptibility to HIV-1 infection as measured by CCR5 expression, and to evaluate whether variation in CCR5 expression could be explained by known genetic polymorphisms. DESIGN AND METHODS: A cross-sectional study of HIV-1 exposed but uninfected men who have sex with men. The risk duration was estimated from self-reported years since first receptive anal intercourse. CCR5 expression on peripheral blood CD4+ monocytes and T cells was determined by flow cytometry. The CCR5-Delta32 mutation and polymorphisms in the CCR5 promoter and CCR2 as well as the copy number of CCL3L1 were analyzed by polymerase chain reaction. Plasma levels of MIP-1alpha (CCL3), MIP-1beta (CCL4) and RANTES (CCL5) were also measured. As risk duration varied with age, analyses were restricted to 67 individuals aged 30-49 years. RESULTS: Multiple linear regression analyses, adjusted for age and race, showed a significant negative association between HIV risk duration and CCR5 expression on monocytes (P = 0.01), and in a separate model, a similar negative association with CCR5 expression on T cells (P = 0.03). Low CCR5 expression was attributable mainly to CCR5-Delta32 heterozygosity and the CCR5-59029G allele. CONCLUSIONS: We confirmed a role for reduced CCR5 expression in HIV-1 resistance. CCR5-Delta32 heterozygosity and the CCR5-59029G allele were significant predictors of low CCR5 expression. Individuals with high CCR5 expression who resisted infection despite long HIV risk duration form an interesting group within which to search for additional mechanisms of resistance to HIV infection.
Subject(s)
HIV Seronegativity/physiology , Homosexuality, Male , Receptors, CCR5/analysis , Sexual Behavior , Adult , CD4-Positive T-Lymphocytes/chemistry , Cross-Sectional Studies , Genotype , HIV-1 , Homosexuality, Male/psychology , Humans , Male , Middle Aged , Monocytes/chemistry , Receptors, CCR5/genetics , Risk-Taking , Time FactorsABSTRACT
The purpose of this qualitative study was to understand the impact of HAART on the lives of HIV seropositive men and women. The data demonstrate that the demands of these treatments are substantial, but that renewed health and hope for the future due to the implementation of HAART often overshadows the stress of the treatments on the physical, emotional and social well-being of the individuals. Practitioners should be keenly aware of the struggles faced by those on HAART, and provide multidimensional support to assure maximum effectiveness of these treatments in light of the realities of their clients' lives.
Subject(s)
Antiretroviral Therapy, Highly Active/psychology , HIV Seropositivity/psychology , Adult , Antiretroviral Therapy, Highly Active/adverse effects , Attitude to Death , Female , Focus Groups , HIV Protease Inhibitors/therapeutic use , HIV Seropositivity/drug therapy , Homosexuality, Male/psychology , Humans , Interpersonal Relations , Male , Sexual Behavior/psychologyABSTRACT
As part of a larger investigation examining genetic immunity to HIV, we undertook a cross-sectional investigation of 97 HIV-seronegative men who have sex with men (MSM). Our aim was to better understand the factors to which these men attributed their HIV serostatus and to relate these attributions to sexual risk taking. Three beliefs were related to sexual risk taking with HIV-negative/status unknown casual partners: (a) medication treatment advances, (b) the low probability related to HIV transmission, and (c) a healthy immune system, capable of resisting infection. A multivariate regression model suggested that use of recreational drugs, in combination with the belief that treatment advances reduce the risk of HIV seroconversion, in part, may explain the frequency with which individuals engage in unprotected anal receptive intercourse. Our findings suggest that MSM who intentionally engage in unprotected anal sex may be influenced by perceptions that medical advances have mitigated the threat of HIV and corroborate previous studies depicting an intimate relationship between illicit drug use and sexual risk taking.
