Collaborators in nursing, public health tackle AIDS in China

Part of international effort to limit spread of disease, improve care of those already infected.

Ann Williams (left) and Roger Detels began to collaborate on AIDS research and treatment in China 15 years ago — around the same time that World AIDS Day, every year on Dec. 1, was established to unite people around the globe in the fight against HIV.

Ann Williams (left) and Roger Detels began to collaborate on AIDS research and treatment in China 15 years ago — around the same time that World AIDS Day, every year on Dec. 1, was established to unite people around the globe in the fight against HIV.

Ann Williams, associate dean for research at the UCLA School of Nursing, has traveled the world for nearly 30 years caring for people with HIV/AIDS and conducting research to improve treatment outcomes. Over that same period, Dr. Roger Detels, professor and chair of epidemiology at the UCLA Fielding School of Public Health has taken a similar route, conducting AIDS research and training epidemiologists.

Fifteen years ago, their paths intersected in China, when Detels was looking to include nursing as part of a training program in HIV research for Chinese health care professionals. A professor, Williams signed on, and they have been collaborating ever since as part of an international effort to limit the spread of HIV-AIDS and improve the care of those already infected.

Recently, each received HIV research training grants from the Fogerty International Center at the National Institutes of Health to help scientists and clinicians in developing countries build much-needed research infrastructure.

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UCSF scientist wins $89M grant to study anal cancer

Study will focus on HIV-infected people.

Joel Palefsky, UC San Francisco

Joel Palefsky, UC San Francisco

A UC San Francisco investigator has won an eight-year grant from the National Cancer Institute for a major investigation into anal cancer, a debilitating and sometimes fatal disease largely concentrated among people with HIV.

The total amount of the award over the life of the grant is projected to be approximately $89 million.

Anal cancer disproportionately affects HIV-infected men and women, but the rate of infection is rising among people who do not have HIV and without active intervention, and the number of cases is expected to continue to grow in the general population.

Like cervical cancer and some oral cancers, most cases of anal cancer are associated with human papillomavirus (HPV). Vaccination has been shown to reduce the risk, but the majority of HIV-infected individuals currently at risk for anal cancer are older than age 26, do not qualify for vaccination, and may already have been exposed to the form of HPV known to cause anal cancer.

“Given these strong biological similarities, it is very possible that biomarkers and treatments identified in the study will be applicable to cervical and HPV-associated oral cancer as well,” said Joel Palefsky, M.D., a UCSF professor of medicine and principal investigator of the anal cancer project.

The study will focus on determining the effectiveness of treating anal high-grade squamous intraepithelial lesions (HSIL), which are caused by chronic HPV infection, in reducing the incidence of anal cancer in HIV-infected men and women.

Combined with the possibility that anal cancer is preventable, the incidence of anal cancer is unacceptably high and calls for urgent intervention, Palefsky said.

“Compared with the general population, the incidence of anal cancer is increased more than 100-fold among some risk groups of HIV-infected persons, including many who are successfully treated with combination antiretroviral therapy,” Palefsky said. “There is evidence that anal HSIL is the precursor to invasive anal cancer, which makes it a great target for prevention.”

Palefsky is founder and president of the International Anal Neoplasia Society, which will hold its inaugural annual meeting Nov. 22- 24 in San Francisco.

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UCLA gets $7M to study links between substance abuse, HIV

Study will focus on minority men who have sex with men.

Pamina Gorbach, UCLA

Pamina Gorbach, UCLA

The National Institute on Drug Abuse has awarded UCLA a $7 million grant to investigate the links between substance abuse and HIV among Latino and African-American men who have sex with men.

Researchers will examine how non-injected drugs and alcohol can directly interact with the virus and other infectious diseases, to damage these men’s health. Enrollment in the study begins in January.

Called MASCULINE (MSM and Substances Cohort at UCLA Linking Infections Noting Effects), the study will be led by Pamina Gorbach, a professor of epidemiology at UCLA’s Fielding School of Public Health and a professor of infectious diseases at the David Geffen School of Medicine at UCLA, and Steven Shoptaw, a professor of family medicine at the Geffen School and director of the UCLA Center for Behavioral and Addiction Medicine.

For the study, researchers will establish and maintain an extensive repository of tissue, blood and fluid samples. This repository will be headed by Dr. Peter Anton, a professor of digestive diseases at the Geffen School. Anton, Gorbach and Shoptaw are also members of the UCLA AIDS Institute.

“Alcohol, non-injection use of cocaine and methamphetamine are linked to HIV sexual risk behaviors and transmission of infectious disease,” Gorbach said. “But little is known about how these substances can affect biology to produce health threats among those living with or at risk for HIV — especially among minority men who have sex with men.”

MASCULINE will be a companion study to the Multisite AIDS Cohort Study, the first and largest study specifically created to examine the natural history of AIDS. It will be conducted through the Fielding School’s Behavioral Epidemiology Research Group.

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Cocaine use can make otherwise resistant immune cells susceptible to HIV

UCLA study shows how drugs can impact the body’s defenses against the virus.

UCLA researchers have found that cocaine can make once-resistant immune cells susceptible to infection with HIV.

UCLA researchers have found that cocaine can make once-resistant immune cells susceptible to infection with HIV.

In many ways, the spread of HIV has been fueled by substance abuse. Shared needles and drug users’ high-risk sexual behaviors are just some of the ways that narcotics such as cocaine have played a key role in the AIDS epidemic in much of the world.

There is, however, relatively little research into how drugs can impact the body’s defenses against the virus. But a new UCLA study published in the October issue of the Journal of Leukocyte Biology examines how cocaine affects a unique population of immune cells called quiescent CD4 T cells, which are resistant to the virus that causes AIDS.

The results: Cocaine makes the cells susceptible to infection with HIV, causing both significant infection and new production of the virus.

“The surprising result was that the changes cocaine induced on these cells were very minimal, yet they were sufficient to fuel infection,” said the study’s senior author, Dimitrios Vatakis, an assistant professor of medicine in the division of hematology–oncology at the David Geffen School of Medicine at UCLA. “We found that cocaine mediates its effects directly, inducing minimal changes in the physiology of these cells and utilizing the same pathways it uses to target the brain.”

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Putting the spotlight on global health

UC Irvine professor Brandon Brown is spreading the word about global health.

UC Irvine professor Brandon Brown (right)

UC Irvine professor Brandon Brown (right)

By Katherine Tam

Every few months, UC Irvine professor Brandon Brown returns to Epicentro Salud, a gay men’s community-based clinic in Lima, Peru, to help the staff brainstorm ways to encourage local men to get tested for HIV.

The stigma around homosexuality often deters the gay community from proactively getting tested in Lima, but Brown and clinic leaders have been working to change that these last three years. With Brown’s help, the clinic landed a USAID grant in October 2011 that provided funds to train HIV counselors and bought vital clinic and laboratory equipment.

“Epicentro staff did a lot of outreach to get started. We recruited on Facebook, on the streets, at bars, and were active in the gay pride parade,” Brown said. “We’re seeing more people visiting the center than ever. It’s a big asset for gay men and transgendered individuals in Peru.”

Whether it’s battling HIV stigma in Peru, finding new tools to diagnose malaria in Thailand, or improving sanitation in Kenya, Brown has made it his mission to spotlight the importance of global health and spread the word about the myriad opportunities here and around the globe that people can make a difference.

“Global health is an exciting field and there are lots of ways to get involved,” said Brown, who teaches global health, public health ethics, honors research, and epidemiology. “It’s easy for people to be comfortable in the bubble they’re in. But even if you’re studying say math, you can still be educated on things outside your area of expertise.”

That’s why two years ago, Brown launched a new initiative to put global health on more people’s radar at UC Irvine.

The initiative, Global Health Research Education and Translation (GHREAT),brings together researchers to collaborate on projects, and encourages students to get involved in global health. GHREAT offers courses students can take to earn a global health certificate. In addition, it also offers a global health mentorship program, seminar series and global health job opportunities.

Brown leads GHREAT on his own time and does not receive a salary for it. Neither do the motivated students and faculty who collaborate with him.

So far, students who have participated in GHREAT have become involved in a variety of projects here and abroad: studying how sanitation interventions can prevent contamination of the water supply in Kenya; investigating mental health issues of Iraqi refugees; identifying perceptions of genital warts in Peru; and producing a photo series chronicling the experiences of people living with HIV.

“I don’t think I could have asked for a better mentor,” said Karen Munoz, who graduated in May with a bachelor’s degree in public health and will seek a master’s degree in the same field this fall. “He’s always willing to help, especially when it’s a student’s passion and has to do with global health.”

Munoz credits Brown with her ability to successfully secure a grant from the Undergraduate Research Opportunities Program for her project, which focuses on access to health care among low-income women in Southern California for early detection of the human papillomavirus and cervical cancer.

“When we were applying for grants for our projects, he helped us revise our papers and showed us examples of his so we learned what to do,” Munoz said. “Many of us had never applied for a grant before.”

UC Irvine professor Brandon Brown (center) works closely with the staff at Epicentro in Lima, Peru to help gay men in the community.

UC Irvine professor Brandon Brown (center) works closely with the staff at Epicentro in Lima, Peru, to help gay men in the community.

When he’s not teaching at UC Irvine or spearheading GHREAT, Brown continues to work on global health projects. In addition to weekly Skype calls, he returns to Peru during the year to continue his collaborations with Epicentro.

Jerome Galea, founder of Epicentro, said the grant Brown helped secure early on was instrumental in getting the clinic off the ground.

“Probably if it weren’t for Brandon, Epicentro would not have a clinic today,” Galea wrote via email. “I’ve worked with Brandon for about 10 years and have found myself looking for projects to do with him – even though we’re on different continents – since he’s one of those people that you know you’ll have a great work experience with.”

Brown is working simultaneously on three research projects, including a study on syphilis among gay men in Peru that could lead to better treatment. And he has partnered with a UC San Diego team to research cervical cancer prevention among female sex workers in Tijuana, Mexico.

He hopes more students will take an interest in global health, whether they choose it as their major or not. Eventually, he plans to ask the university to establish an organized research unit in global health, which would provide more funding for projects, synergize global health efforts, help support student travel, and make researchers less dependent on grants.

“Few know what’s possible in global health and how to get involved,” Brown said. “Making more people aware could mean a big difference for all of us globally.”

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Combo of social media, behavior psychology leads to HIV testing

Technique developed at UCLA may apply to other diseases, prevention efforts.

Sean Young, UCLA

Sean Young, UCLA

Can social media be used to create sustainable changes in health behavior?

A UCLA study published Sept. 3 in the peer-reviewed journal Annals of Internal Medicine demonstrates that an approach that combines behavioral science with social media and online communities can lead to improved health behaviors among men at risk of HIV infection.

The evidence-based approach not only led to increased HIV testing and encouraged significant behavioral change among high-risk groups but also proved to be one of the best HIV-prevention and testing approaches on the Internet, according to the study’s lead investigator, Sean D. Young, an assistant professor of family medicine and director of innovation at the Center for Behavior and Addiction Medicine at the David Geffen School of Medicine at UCLA.

And it’s not only applicable to HIV prevention efforts, he noted.

“We found similar effects for general health and well-being,” said Young, who is also a member of the UCLA AIDS Institute. “Because our approach combines behavioral psychology with social technologies, these methods might be used to change health behaviors across a variety of diseases.”

In an earlier study, published in February and also led by Young, researchers found that social media could be useful in HIV- and STD-prevention efforts by increasing conversations about HIV prevention.

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UC awarded $21M in stem cell grants

Diseases targeted include prostate cancer, autism, ALS and AIDS/HIV.

Alysson Muotri, UC San DIego

Alysson Muotri, UC San DIego

The University of California and its affiliates received seven grants totaling more than $21 million in the latest round of funding from the state’s stem cell agency.

Prostate cancer, autism, ALS and AIDS/HIV are among the diseases targeted by the California Institute for Regenerative Medicine, whose governing board awarded a total of more than $40 million in funding for this round.

Overall, CIRM’s governing board has awarded more than $1.8 billion in stem cell grants, with half of the total going to the University of California or UC-affiliated institutions.

CIRM Early Translation Awards IV:

  • UC Irvine: $4.3 million: Magdalene Seiler
  • UCLA: $13 million: Donald Kohn, Gerald Lipshutz, Robert Reiter, Jerome Zack
  • UC San Diego: $1.8 million: Alysson Muotri
  • UCSF-affiliated J. David Gladstone Institutes: $2.3 million: Steven Finkbeiner

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New intervention reduces risky sex among bisexual African-American men

Holistic approach takes into account cultural considerations.

Nina Harawa, UCLA

Nina Harawa, UCLA

A culturally tailored HIV prevention program developed and tested by investigators at UCLA and the Charles R. Drew University of Medicine and Science has been shown to significantly reduce unprotected sex among bisexual black men.

The innovative approach, called Men of African American Legacy Empowering Self, or MAALES, is described in an article in the peer-reviewed journal AIDS.

The rate of HIV/AIDS among African-Americans is significantly higher than it is among any other ethnic or racial group. (According to the Centers for Disease Control and Prevention, African-Americans accounted for an estimated 44 percent of new U.S. HIV diagnoses in 2010.) Among men who have sex with men, black men account for the largest estimated number of HIV infections. Yet there are few interventions available to reduce those rates, said the study’s principal investigator, Nina Harawa, adjunct assistant professor of epidemiology at UCLA and associate professor of research at the Charles R. Drew University of Science and Medicine.

MAALES takes a holistic approach to minimizing behaviors that could put men at risk for HIV, engaging participants in small-group discussions about popular media, exercises such as negotiating condom use with sexual partners and activities to improve the participants’ knowledge of sexual health. Importantly, the intervention is also culturally relevant, addressing participants’ shared legacies, including social expectations of African-American men, historical discrimination and disenfranchisement, and societal impacts on individual health and sexual decision-making.

“When we first set out in 2004 to develop an intervention for behaviorally bisexual African-American men, the gap between documented need and services was staggering,” Harawa said. “Up to that point, just one prevention intervention tailored for African-American men who had sex with men had been developed and no interventions designed for behaviorally bisexual men of any race or ethnicity had been published.”

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UC Berkeley names public health dean

Gates Foundation senior fellow, AIDS expert Stefano Bertozzi to lead school.

Stefano Bertozzi

Stefano Bertozzi

Dr. Stefano Bertozzi, a prominent global health scientist, AIDS expert and health economist, has been named dean of the School of Public Health at the University of California, Berkeley, effective Sept.1.

Bertozzi, 53, is currently a senior fellow at the Bill & Melinda Gates Foundation, where he has directed the HIV and tuberculosis programs and led a team that manages the foundation’s portfolio of grants in HIV vaccine development, biomedical prevention research, diagnostics, and strategies for introduction and scaling-up of interventions. He oversaw the development of a new initiative in efficiency and effectiveness, and represented the private foundation’s constituency on the board of the Global Fund to Fight AIDS, Tuberculosis and Malaria. He also serves on the scientific advisory boards for the President’s Emergency Plan for AIDS Relief, the National Institute of Health’s Office of AIDS Research and the World Health Organization.

“Stefano Bertozzi’s extensive experience confronting and engaging complex global health challenges, combined with his expert academic credentials, make him uniquely suited to lead UC Berkeley’s School of Public Health,” said UC Berkeley Chancellor Nicholas Dirks, who officially began his tenure on June 3. “His passion, commitment and accomplishments will help ensure that faculty, students and staff have the leadership they need. I look forward to working with him as the school becomes ever more central to the mission of UC Berkeley in the years ahead.”

Prior to joining the Gates Foundation, Bertozzi worked at the Mexican National Institute of Public Health as director of its Center for Evaluation Research and Surveys. He led economics and statistics teams that conducted impact evaluations of large health and social programs in Mexico, as well as in Africa, Asia and Latin America. He also led the institute’s AIDS/Sexually Transmitted Infections research group.

Bertozzi is considered a bold choice to lead the school through a period of great change in public and global health.

“During our nationwide search for the new dean, Dr. Bertozzi emerged early as a clear leader,” said George Breslauer, UC Berkeley’s executive vice chancellor and provost. “We were impressed with his breadth of experience – from teaching to research to program evaluation – as well as his progressive ideas about the role higher education can play in the evolving field of public health. I am confident that he will prove to be a transformative dean.”

Bertozzi has also held positions with UNAIDS and the World Bank. His research has covered a diverse range of projects in health economics and policy, focusing on the economic aspects of HIV/AIDS and on the health impact of large social programs.

He holds a bachelor’s degree in biology and a Ph.D. in health policy and management from the Massachusetts Institute of Technology. He earned his medical degree at UC San Diego, and trained in internal medicine at UC San Francisco. Bertozzi has lived and worked in developing countries in Africa, Asia and Latin America, and speaks English, French, Spanish and Italian.

“This is an extraordinary time,” said Bertozzi. “The world of public health, both in the U.S. and globally, is changing dramatically because of new tools and technologies. We are interconnected like we’ve never been before. It’s hard to think of a school of public health that’s more centrally located than UC Berkeley’s when it comes to innovation. We are well positioned to take advantage of the Bay Area’s leadership in transformations that are happening in technology, as well as those that are happening in the biomedical sciences.”

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Women who suffered severe sexual trauma as kids benefit most from intervention

UCLA-led study suggests that such interventions should be tailored to individuals’ experience.

Semel Institute for Neuroscience and Human Behavior at UCLAA UCLA-led study of HIV-positive women who were sexually abused as children has found that the more severe their past trauma, the greater their improvement in an intervention program designed to ease their psychological suffering.

The study, conducted by researchers at UCLA’s Collaborative Center for Culture, Trauma and Mental Health Disparities, suggests that such interventions should be tailored to individuals’ experience and that a “one size fits all” approach may not be enough to successfully reduce women’s depression, post-traumatic stress and anxiety symptoms.

“This study shows that those who suffer early and severe trauma can improve their psychological symptoms,” said primary investigator Dorothy Chin, an associate research psychologist at the Semel Institute for Neuroscience and Human Behavior at UCLA. ”Indeed, those who improve the most are those who suffered the most trauma.”

The research findings are published in the peer-reviewed journal Psychological Trauma: Theory, Research, Practice and Policy.

For the study, researchers used data on women who had participated in the Healing Our Women program, a clinical trial testing an HIV/trauma intervention for HIV-positive women who had suffered sexual abuse as children. Previous research demonstrated that this program was successful at reducing psychological distress among these women. The question for the current study was: Who benefited the most?

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Marital status reduces risk of death from HIV/AIDS for men

UC Riverside sociologist finds higher mortality rates for women of color.

Augustine Kposowa, UC Riverside

Augustine Kposowa, UC Riverside

At the height of the AIDS epidemic in the 1980s  men who were married were significantly less likely to die of HIV/AIDS than their divorced or otherwise single counterparts, according to a UC Riverside analysis of new mortality data for that era.

For women, marital status had little impact on who was more likely to die of the disease. But race proved to be a significant risk factor, with African-American women nine times more likely to die of HIV/AIDS and Latinas seven times more likely to die of the disease than white women. Those mortality rates were considerably higher than those for men of color compared to white men.

The study by UCR sociology professor Augustine Kposowa — “Marital status and HIV/AIDS mortality: evidence from the U.S. National Longitudinal Mortality Study” — is the first to examine the effects of marital status on deaths of individuals with HIV/AIDS. It appears in the International Journal of Infectious Diseases, the official publication of the International Society for Infectious Diseases.

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Intestinal bacteria may fuel inflammation, worsen HIV disease

HIV-infected people have different gut microbiome than people who are uninfected.

Intestinal bacteriaChanges in intestinal bacteria may help explain why successfully treated HIV patients nonetheless experience life-shortening chronic diseases earlier than those who are uninfected, according to a new study led by UC San Francisco.

These changes in gut bacteria may perpetuate inflammation initially triggered by the body’s immune response to HIV, researchers reported.

Their study was published online today (July 10) in the journal Science Translational Medicine.

The new findings support recent research pointing to such persistent inflammation is a possible cause of the early onset of common chronic diseases found in HIV patients, who now can live for decades without immune system destruction and death due to infection thanks to lifelong treatment with antiretroviral drugs. Likewise, in the general population, ongoing inflammation has been linked in some studies to chronic conditions, such as heart disease, dementia and obesity.

Studies have shown that inflammation is induced by HIV in both treated and untreated patients, and is associated with – and possibly causes – disease in both, according to Joseph M. McCune, M.D., Ph.D., chief of the Division of Experimental Medicine at UCSF and a senior author of the study. McCune has been investigating the causes of chronic inflammation in HIV-infected patients and has treated patients with HIV for more than three decades.

“We want to understand what allows the virus to persist in patients who have HIV disease, even after treatment,” he said. “In this study, we see that bacteria in the gut may play a role.”

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