Video games, social networks, chat rooms, may help prevent HIV

Despite decades of outreach and education efforts that have stabilized human immunodeficiency (HIV) infection rates in the U.S., the pace of new infections among men who have sex with men has been steadily increasing, particularly among young adults and racial and ethnic minorities.

"This is a population that is very used to technology, and there is built-in privacy and immediacy with digital communication that may be especially appealing to men who aren't comfortable disclosing their sexual orientation or their HIV status in a face-to-face encounter," says lead study author Rebecca Schnall, PhD, RN, an assistant professor at Columbia Nursing. "If we want to reduce HIV infection rates, particularly among younger men, we need to explore the use of technology to meet them where they live -- online and on their phones."

A team of researchers led by Schnall conducted a systematic literature review to determine the effectiveness of eHealth interventions for HIV prevention among men who have sex with men. Included studies had to be focused exclusively on eHealth, limited to HIV prevention and testing rather than treatment, targeted only to adult men who have sex with men, written in English, designed as experimental or randomized controlled trials.

One interactive website, Sexpulse, designed by health professionals and computer scientists to target men who seek sexual partners online, successfully reduced high-risk sexual behaviors. Another site, Keep It Up! (KIU), used video games to help reduce rates of unprotected anal sex. A third initiative, a downloadable video game, helped mitigate shame felt by some young men who have sex with men, though the reduction in risky sexual behavior wasn't statistically significant.

Chat rooms may also help prevent HIV, the study found. When a sexual health expert entered a popular chat room to regularly post information about HIV testing and respond to instant messages seeking information on HIV, self-reported HIV testing among participants in the chat room significantly increased.

On social networks such as Facebook and Twitter, popular individuals can spread HIV-prevention messages to their friends and followers. The sharing of information about HIV testing via trusted sources on a social network appeared to increase requests for HIV testing kits, one study found. Another study found that using opinion leaders to disseminate HIV-prevention information via social networks may increase testing rates and bolster condom use during anal sex with partners found online.

"Taken together, the findings from all of these relatively small studies demonstrate the enormous potential of eHealth as a tool to prevent HIV," says Schnall. The task is urgent, she adds. Although men who have sex with men represent about 7 percent of the male population in the U.S., they account for about 78 percent of new HIV infections among males, reinforcing the need for new approaches to prevention. "What we now have is a road map to follow for larger, longer trials that may definitely confirm the effectiveness of eHealth in fighting the spread of HIV."

Antibody-producing cells in people infected with HIV found

By analyzing the blood of almost 100 treated and untreated HIV-infected volunteers, a team of scientists has identified previously unknown characteristics of B cells in the context of HIV infection. B cells are the immune system cells that make antibodies to HIV and other pathogens. The findings augment the current understanding of how HIV disease develops and have implications for the timing of treatment. Researchers at the National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health, led the study.

Using advanced tools to probe B-cell responses to HIV and other pathogens in the laboratory, the researchers found that the B cells that make antibodies to HIV in infected, untreated people are abnormal in that they are more activated, unstable and unresponsive to further stimulation than normal B cells, and also are infrequently observed in healthy people. This finding may help explain why HIV-specific antibodies naturally produced by HIV-infected people do not clear the infection, according to the scientists.

The researchers also observed that when HIV-infected people start antiretroviral therapy, their B-cell response to HIV diminishes quantitatively but improves qualitatively, with normal B cells dominating. However, the earlier a person starts treatment for HIV, the greater their capacity to maintain their pre-treatment level of B-cell response to the virus. An HIV antibody response from primarily normal B cells correlated with both a low amount of virus in the blood (viral load) and a low level of immune activation. According to the scientists, more research is needed to determine whether normal B cells lead to a more effective antibody response than abnormal B cells, and whether HIV-infected people who maintain a low viral load and low immune activation generate a better B-cell response than people who have a higher viral load and a higher degree of immune activation.
Finally, the scientists observed that the B-cell response to HIV is unlike the B-cell responses to other pathogens in the same people. For instance, when researchers exposed the volunteers' blood cells to a tetanus probe, they observed a relatively normal B-cell response. This was likely, they say, because the volunteers had been vaccinated for tetanus before they became infected with HIV, had a normal B-cell response then, and maintained the normal response for years. However, the volunteers' B-cell response to influenza was less normal than their response to tetanus, probably because they had been exposed to certain strains of influenza after acquiring HIV, but more normal than their response to HIV.

Taken together, the study findings add to the growing body of evidence indicating that starting HIV treatment early benefits the health of infected individuals, according to the scientists.

HIV can cut and paste in human genome

A technology that uses the HIV virus as a tool in the fight against hereditary diseases - and in the long term, against HIV infection as well - has been developed in a first of its kind study. The technology repairs the genome in a new and safer manner. "Now we can simultaneously cut out the part of the genome that is broken in sick cells, and patch the gap that arises in the genetic information which we have removed from the genome. The new aspect here is that we can bring the scissors and the patch together in the HIV particles in a fashion that no one else has done before," says one researcher.

For the first time researchers have succeeded in altering HIV virus particles so that they can simultaneously, as it were, 'cut and paste' in our genome via biological processes. Developed at the Department of Biomedicine at Aarhus University, the technology makes it possible to repair genomes in a new way. It also offers good perspectives for individual treatment of both hereditary diseases and certain viral infections: "Now we can simultaneously cut out the part of the genome that is broken in sick cells, and patch the gap that arises in the genetic information which we have removed from the genome. The new aspect here is that we can bring the scissors and the patch together in the HIV particles in a fashion that no one else has done before," says associate professor in genetics Jacob Giehm Mikkelsen from Aarhus University. 'Hit-and-run' technique leaves no traces.

At the same time, the team of researchers from Aarhus have developed a technique that increases the safety of the cutting process, the so-called "gene editing": "In the past, the gene for the scissors has been transferred to the cells, which is dangerous because the cell keeps on producing scissors which can start cutting uncontrollably. But because we make the scissors in the form of a protein, they only cut for a few hours, after which they are broken down. And we ensure that the virus particle also brings along a small piece of genetic material to patch the hole," says Jacob Giehm Mikkelsen. "We call this a 'hit-and-run' technique because the process is fast and leaves no traces."

The researchers have benefited from many years of intense research into HIV as this has e.g. shown that HIV particles can be converted into transporters of genetic information. But when they also become transporters of proteins that are not normally found in the cells, as is the case now, the particles are altered. Virus particles are converted into nanoparticles which carry the substances that can have a direct effect on the treated cells.

HIV infection is one of the areas where the researchers want to make use of the technique, and here the goal is to stop a specific gene from functioning - something that the protein scissors can do. "By altering relevant cells in the immune system (T cells) we can make them resistant to HIV infection and perhaps even at the same time also equip them with genes that help fight HIV. "So in this way HIV can in time become a tool in the fight against HIV," says postdoc and PhD Yujia Cai of the research team.