HIV-infected individuals may not mount typical serologic responses to infections including HCV. This group of investigators sets out to determine the prevalence of chronic seronegative HCV infection in a large, multi-center, nationally representative cohort of HIV-infected men and women (The FRAM Cohort). Their results, published in Clinical Infectious Diseases, demonstrate that among the 1,174 anti-HCV-negative study particpants, the prevalence of seronegative HCV infection as determined by HCV RNA testing was 3.2%. Notably, by multivariate logistic regression analysis, the researchers were able to determine factors associated with HCV RNA positivity in anti-HCV-negative subjects. These factors were history of injection drug use (IDU), higher alanine aminotransferase (ALT) levels, and CD4+ cell counts <200 cells/l. Among those HIV-infected individuals with a history of IDU and either an abnormal ALT level or CD4+ cell count <200 cells/l, the prevalence of seronegative HCV infection was 24%. The authors suggest that the low overall prevalence of seronegative HCV infection, while still greater than reported prevalence in HIV-uninfected patients, demonstrates that the HCV EIA 2.0 assay, commonly used in many institutions, is a sufficiently sensitive screening tool to determine antibody status. However, the findings suggest that HCV RNA testing should be performed in anti-HCV-negative HIV-infected patients, especially those with a history of IDU and either a CD4+ cell count <200 cells/l or an abnormal ALT level.

Using two back calculation models, Deuffic-Burban et al. estimated the future disease burden of HCV and HIV infections in the United States. The study, the first of its kind to account for antiviral treatment advances, utilized United States epidemiological data from the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO). Based on past incidence, it appears that the HCV incidence in the peaked in 1984 at 350,000 new infections then fell to 77,000 in 1998, while HIV incidence reached a maximum in 1989 at 142,000 new infections before declining to 79,000 in 1998. Looking forward, the investigators estimate that mortality related to HCV, defined as death from liver failure or hepatocellular carcinoma, will peak at nearly 13,000 in the 2030, having risen from only 3,700 in 1998. The authors assert that predicted HCV mortality will fall only if there is increased access to treatment or more effective antiviral development. In comparison, HIV-related mortality will drop to approximately 4,200 in 2030, down from 14,400 in 1998. These results showcase the decline in HIV-related mortality due to the effectiveness of HAART, but highlight the growing burden HCV-related death over the next twenty-five years.

Researchers from Australia, seeking to address the concerns of politicians, prison staff, and inmates, examined the long-term effects of the introduction of condoms and dental dams into New South Wales' prisons. Their findings, published in Sexually Transmitted Infections, demonstrate that most of the concerns regarding condoms in prisons were not realized. In contrast to the general expectations, the investigators reported an overall decrease in both self-reported consensual male-to-male sex as well as male sexual assaults over the five year period condoms became available to inmates. While there were reported incidents of prisoners using condoms to conceal contraband material, such as tobacco, there was no associated increase in IDU. Additionally, the fear that condoms would be used as weapons was not born out, as there were only three reported incidents of condoms being used in assaults; none of which were serious. The data were derived from Inmate Health Surveys of randomly selected prisoners from all prisons and official New South Wales Department of Corrective Services' reports taken at the beginning of the distribution program in 1996 and then again in 2001. The authors note that the decrease in both consensual sex and sexual assault among male prisoners may be due to other factors, including the introduction of an HIV/AIDS education program in 1996. However, they suggest that the presence of condoms in the prisons may have further raised awareness and reinforced the prevention messages. The investigators conclude that the introduction of condoms did not cause the mayhem that many had feared and note that opposition to the distribution program soon dissipated.

Hypertriglyceridemia is the hallmark dyslipidemia associated with HIV infection. N-3 polyunsaturated fatty acids (PUFAs), such as fish oil, have been found to reduce triglyceride levels in HIV un-infected patients. This double blind, randomized study assessed the evolution of triglyceride levels in HIV-infected patients receiving stable HAART treated with fish oil. One hundred and twenty-two patients with baseline triglyceride levels between 200-1000 mg/dL were randomized for eight weeks to fish oil (2 g of fish oil three times daily) or placebo. At week eight, the median change in triglyceride levels was -25.5% in the fish oil group versus 1% in the placebo group. Triglyceride levels were normalized in 22.4% of the fish oil group, as opposed to only 6.5% of the placebo group. An eight week open label phase, during which all patients received fish oil supplementation, followed the initial eight week randomized period. The decrease in triglyceride levels was sustained in the original group assigned fish oil at week 16, whereas a 21.2% decrease occurred for patients in the placebo group who were switched to active drug at week 8. Significantly, the incidence of adverse events during the randomized double blind study period was not more frequent in the fish oil group; minor gastrointestinal disorders without vomiting being most common. Additionally, CD4+, CD8+ and viral load measurements were stable throughout the study. The authors suggest these results, which are comparable to previous randomized, open-label studies, demonstrate the efficacy and safety of fish oil to reduce some of the risk associated with hypertriglyceridemia in HIV-infected patients on HAART.