GAD65Abs Are Not Associated With Beta-Cell Dysfunction in Patients With T2D in the GRADE Study.

Context: Autoantibodies directed against the 65-kilodalton isoform of glutamic acid decarboxylase (GAD65Abs) are markers of autoimmune type 1 diabetes (T1D) but are also present in patients with Latent Autoimmune Diabetes of Adults and autoimmune neuromuscular diseases, and also in healthy individuals. Phenotypic differences between these conditions are reflected in epitope-specific GAD65Abs and anti-idiotypic antibodies (anti-Id) against GAD65Abs. We previously reported that 7.8% of T2D patients in the GRADE study have GAD65Abs but found that GAD65Ab positivity was not correlated with beta-cell function, glycated hemoglobin (HbA1c), or fasting glucose levels. Context: In this study, we aimed to better characterize islet autoantibodies in this T2D cohort. This is an ancillary study to NCT01794143. Methods: We stringently defined GAD65Ab positivity with a competition assay, analyzed GAD65Ab-specific epitopes, and measured GAD65Ab-specific anti-Id in serum. Results: Competition assays confirmed that 5.9% of the patients were GAD65Ab positive, but beta-cell function was not associated with GAD65Ab positivity, GAD65Ab epitope specificity or GAD65Ab-specific anti-Id. GAD65-related autoantibody responses in GRADE T2D patients resemble profiles in healthy individuals (low GAD65Ab titers, presence of a single autoantibody, lack of a distinct epitope pattern, and presence of anti-Id to diabetes-associated GAD65Ab). In this T2D cohort, GAD65Ab positivity is likely unrelated to the pathogenesis of beta-cell dysfunction. Conclusion: Evidence for islet autoimmunity in the pathophysiology of T2D beta-cell dysfunction is growing, but T1D-associated autoantibodies may not accurately reflect the nature of their autoimmune process.

Community planning, HIV prevention, and a needs assessment for men who have sex with men: the South Beach Health Survey.

OBJECTIVE: The objective of this study was to plan for a series of culturally competent and sexually appropriate public health interventions for a highly mobile population of men who have sex with men (MSM). GOAL: The goal of this study was to conduct a comprehensive needs assessment. STUDY: A cross-sectional survey with a multistage probability sample of unmarried adult MSM living in households was conducted. RESULTS: A total of 918 residential units were screened, 154 eligible men were identified, and 140 mostly white (56%) and Hispanic (34%) MSM (median=33.5 years old) were enrolled (90.9% response rate). Almost half (47%) reported engaging in unprotected anal intercourse in the previous 12 months. Drug use was common. Almost one third (31.0%) tested positive for the HIV antibody. Estimated annual incidence of HIV infection was 10.0%. CONCLUSIONS: Population-based HIV antibody testing revealed a remarkably high annual incidence of HIV infection. A community-based organization was transformed to implement a social marketing campaign and provide other disease prevention services for MSM.

HIV testing among men who have sex with men: how often should one test?

HIV counseling and testing has been a cornerstone of AIDS prevention strategies, with men who have sex with men being specifically targeted for the counseling and testing. Unfortunately, it appears that exposure to HIV counseling and testing has little effect on the behaviors of those who test negative. The Centers for Disease Control and Prevention recently altered its recommendations on when and how often men who have sex with men should undergo testing for HIV and other sexually transmitted diseases, now recommending annual testing for sexually active men who have sex with men, with even more frequent testing for men who have sex with men who engage in highest risk behaviors. Using data from our study, we evaluated the new recommendations with respect to HIV testing. Overall, 81% of the men who have sex with men in our sample reported never having tested positive for HIV. Among these men who have sex with men in South Beach nearly 8% tested positive on their current test. Slightly more than half of the men who tested positive on their current test had not been tested in the past 12 months; slightly fewer than half reported they had tested negative within the prior 9 months. Reporting multiple (4 or more) anal sexual partners during the past 12 months was significantly associated with a positive test result. Our results support the new CDC guidelines regarding more frequent testing for sexually active men who have sex with men, with having a high number of anal partners being a significant indicator of need for testing more often than annually in our population.

HIV infection and associated risks among young men who have sex with men in a Florida resort community.

OBJECTIVE: Several recent studies have reported high rates of sexual risk-taking and HIV infection among young men who have sex with men (MSM). Most of these studies used samples of convenience. The authors obtained population-based data on young MSM living in South Beach (Miami Beach, Florida), a resort community where some of the highest AIDS rates in the United States have been reported. METHODS: A household probability sample was drawn to survey unmarried 18- to 29-year-old MSM living in South Beach. Subjects were interviewed, completed self-administered questionnaires, and provided oral specimens for HIV antibody testing. RESULTS: From the 2,622 screened residential units, 100 mostly white and Hispanic MSM (92.6% of eligible participants) were enrolled in the study. Fifteen percent of the sample tested positive for antibodies to HIV. White and Hispanic MSM had similar rates. Forty-five percent of the sample reported engaging in unprotected anal intercourse (UAI) in the prior 12 months, and 31% reported UAI with a nonprimary partner. The estimated annual incidence of HIV infection was 6.3%. CONCLUSION: The high prevalences of UAI and HIV infection in South Beach attest to a previously undocumented public health concern. The extremely high estimated incidence for young MSM in South Beach highlights the urgent need for more effective risk-reduction interventions and further epidemiological research on resort areas.