Dr. Wolfe,

Here’s my bio!  I am a bisexual man, part-time student and full-time waiter.  A table of customers where talking about a local men’s study in Pittsburgh.  Is this an HIV study?  Is it confidential?  I’m HIV negative, but I wondered if I could participate in this study.

Curious

Dear Curious,

Great questions!  Initially I planned to interview folks at the Pitt Men’s Study, the study that you were referring to in your letter.  However, I thought it would be better to give you (and others) an initial description of the study, their website and phone number to call with inquiries.  I hope you find this helpful!

The Pitt Men’s Study (PMS) is a confidential research study of the natural history of HIV/AIDS, funded by the National Institutes of Health (NIH) that has been ongoing in Pittsburgh since 1984.  The Study has followed a group of approximately 3000 men to gather information on the distribution, characteristics and evolving science behind HIV.

The Pitt Men’s Study is part of a national study, the Multicenter AIDS Cohort Study (MACS) with sites in Los Angeles, Chicago, Baltimore as well as Pittsburgh, and is led by medical and social scientists. It is part of the Department of Infectious Diseases and Microbiology in the Graduate School of Public Health of the University of Pittsburgh.  Participants are seen in a free standing clinic dedicated to this research project.

Over the past 28 years the Pitt Men's Study and the MACS have been in the forefront of many aspects of HIV/AIDS research, supporting work that has led to over 1,700 scientific publications. Some of the most significant findings of the Pitt Men's Study and the MACs have been identifying a link between sexual behaviors and HIV transmission in 1987, and finding a relationship between HIV viral load and progression to AIDS in 1996.

New sub-studies are always being introduced into the MACS.  Recently the Study received funding from the NIH to conduct research to better comprehend fracture risk in older men in the MACS.  HIV-infected men may be at particularly high risk of fracture compared to their HIV-uninfected peers.  Four hundred men will be recruited from the four sites, including the PMS, to undergo state-of-the-art testing of bone health.

Innovation is important aspect of The Pitt Men’s Study arsenal against HIV too.  They have created a program called Text for Texting, which is designed to make free HIV testing more accessible to residents of Pennsylvania.  By texting 'PAtest' to 41411, smart phone users can connect to the Centers for Disease Control and Prevention database that lists free testing clinics throughout the state.  You can then search by zip code to find the location nearest you.  The Study also offer email alerts on health issues faced by men who have sex with men, which you can subscribe to by sending an email to This e-mail address is being protected from spambots. You need JavaScript enabled to view it .  More information about these services and more can be found on their website pittmensstudy.com, or by linking through glccpgh.org.

If you have any questions about the study, please feel free to call and speak confidentially with one of our clinic staff at 412-624-2008 or 1-800-987-1963. Their website is regularly updated with health information and news.

Dr. Wolfe

Dear Dr. Wolfe,

I’m a 23-year-old gay man. This morning on my way to work, I overheard two men talking on the bus about getting either an HIV or HPV vaccine. It was too loud to hear, so I’m not sure which.

Is this true? Is there really an HIV vaccine? And the HPV vaccine? Is that anything I should be concerned about, given that I’m a gay man? That only affects women, right?

Curious

Great questions, Curious!

While no effective HIV vaccines exist at this time, discussion of two hopeful HIV research trials looking into vaccine safety were released recently.

The first clinical trial studied the safety of a new HIV vaccine in 24 people in Barcelona, Spain. HIV genes were used to adapt the already-successful smallpox vaccine.  The study participants ages 18-55, who did not have HIV and were low-risk for infection, received three injections of the new HIV vaccine and were followed for four years.

The study looked at serious side effects and how well the body developed an immune response. The vaccine appeared to be well-tolerated and there were no serious side effects. Approximately three-quarters of the volunteers had a detectable immune response to the vaccine, though it is not known if the response is sufficient to protect against HIV infection or to lower HIV levels in people who are already HIV-positive. This study warrants further investigation into this vaccine.

A similar trial will begin early this year in Ontario, Canada. Forty HIV-positive participants will be followed for a year looking at the safety of a whole, genetically-modified HIV virus that was killed similar to the process that makes the influenza vaccination.  It will likely take 5 to 10 years of many research phases studying thousands of participants to understand the vaccine’s effectiveness.

As for the HPV vaccine, I have better news to share with you, Curious. And yes, this is something you should be concerned about. HPV affects men too, even men who don’t have sex with women.

Human papillomavirus (HPV) infection is the most common sexually transmitted disease in the U.S.  Four types of HPV are responsible for a majority of disease related to HPV—two causing 70% of cervical cancers and two causing 90% of genital and anal warts.

The HPV vaccine, Gardasil, prevents these four types. The Food and Drug Administration (FDA) approved Gardasil in June 2006 for women ages 9-26.

After further study, the FDA approved Gardasil in October 2009 for men ages 9 to 26 to prevent genital warts. The Advisory Committee on Immunization Practices (ACIP), a group of experts in the Department of Health and Human Services that advise the Center of Disease Control, reviewed additional data showing efficacy in preventing anal cancer, then further updated their recommendation to routinely vaccinate men ages 11 to 12  with Gardasil, with the three-dose vaccination series.  In addition, ACIP suggests catch-up vaccination for unvaccinated men ages 13 to 26 (e.g., YOU…Curious). The most adverse effects related to vaccination involved mild or moderate pain or tenderness at the injection site.

Early administration maximizes the chance that children will mount a strong immune response prior to exposure through sexual activity.  Younger adolescents have a significantly stronger immune response than old recipients, one of the major reasons why we advocate for early vaccination with HPV.  Gardasil is likely effective in preventing penile and oral cancers, though long-term studies need to be completed.

The vaccine is ineffective if one is infected already, so early administration is important.  It can be especially beneficial to men who have sex with men and HIV-infected men who are at increased risk for HPV-associated genital cancers.  Even if you have been infected with one strain of HPV, the vaccine protects against three other strains in which you may benefit.  The vaccine will likely prevent transmission to your partner (man or woman) which can be of great benefit too.

Since the HPV vaccination has not been tested in adults aged 27 or older, it has not been recommended to them.  It could be argued that if someone was minimally sexual until their late 20s, they could potentially benefit from the vaccination.

For more information about the HPV vaccine and other recommended vaccines, consider visiting some of the websites listed below:

http://www.cdc.gov/vaccines/recs/acip/

http://www.cdc.gov/vaccines/pubs/vis/default.htm

http://www.cdc.gov/vaccines/pubs/parents-guide/default.htm

Dr. Wolfe