AIDS Treatment News

Global Funding for AIDS Is Justified

2010-01-06T23:44:00.000-05:00

"HIV costs much more to prevent and treat, the opponents of PEPFAR argue, compared with other deadly diseases. Therefore, they say, a larger share of the world’s health care funds ought to be spent on preventing and treating these other diseases, and less on HIV specifically. The underlying assumption is there will always be too few resources to meet global health care needs.

"In response, two Harvard University professors—Rochelle Walensky, MD, MPH, and Daniel Kuritzkes, MD—are making the case in the January 15 issue of Clinical Infectious Diseases (available now online) that programs such as PEPFAR have not only succeeded in their mission, but have also had benefits that go far beyond their original intent.

"PEPFAR, Walensky and Kurtizkes contend, has been an unqualified success in regards to its originally stated mission. By October 2008, they write, 10.1 million people worldwide were receiving HIV care, and 2.1 million were receiving HIV treatment. 'AIDS-related mortality in PEPFAR countries decreased by 10.5 percent relative to non-PEPFAR countries,' they state, 'a difference that translates into 1.2 million lives saved.'

"The pair also laud the impact of HIV-specific care and treatment on many other aspects of health in PEPFAR-funded countries, writing, 'Antiretroviral treatment and [PCP pneumonia medication] provided to HIV-infected adults in a Ugandan cohort was not only associated with a 95 percent decrease in mortality of infected adults, but also an 81 [percent] reduction in mortality of uninfected children and a 93 percent decrease in orphanhood.'"

Read more in POZ Special Report, January 5, 2010.

Aging, HIV infection and the immune system

2010-01-06T23:21:00.000-05:00

"In the November 9th issue of New York Magazine, David France reports on the emerging issue of accelerated aging in people with HIV infection. The article offers a series of disturbing vignettes about the complications some individuals are facing as they age, such as bone problems and impaired cognitive function, and raises important questions about how much attention is being paid to the issue by current research, particularly in terms of pursuing new therapeutic options. [1]

"However, beyond mentioning inflammation, the piece does not really delve into the underlying immunological parallels between HIV infection and aging and consider how they might fit into the picture. This is a potentially important omission, as there is accumulating evidence that the accelerated aging of the immune system that has been documented in people with HIV is likely to be related to many of the clinical phenomena described in France’s article."

Read more in HIV Treatment Bulletin, November/December 2009.

New resistance becoming rarer as more patients achieve undetectable HIV viral load

2010-01-06T23:13:00.000-05:00

"There has been a drastic fall in the incidence of new cases of drug-resistant HIV amongst patients taking antiretroviral therapy in the Canadian province of British Columbia.

"In the January 1st edition of Clinical Infectious Diseases investigators report that the incidence of newly detected resistance fell twelve-fold between 1996 and 2008.

"'There has been a drastic decrease in the incidence of new cases of HIV-1 drug resistance, despite increases in annual (and, especially, cumulative) exposure to antiretrovirals”, write the investigators. They also note “this has occurred alongside a steady increase in the proportion of patients achieving virological suppression.'"

Read more in Aidsmap,January 5, 2010.

Year in Review 2009: HIV/AIDS Clinical Care

2010-01-04T23:59:00.001-05:00

"Each year, the physician-editors of Journal Watch AIDS Clinical Care offer their perspective on the year's most important stories in HIV medicine. In reviewing these stories for 2009, one is struck by a remarkable sense of progress in the field, especially in prevention. ... Although there is a relative lack of novel new agents in development, the reason behind this shortage is only positive — our currently available therapies are more effective than ever, so much so that treatment guidelines are moving in the direction of recommending therapy for virtually everyone with HIV infection."

Read more in Journal Watch, January 4, 2010.

Comment: The publishers of the New England Journal of Medicine also publish Journal Watch, and offer 10 articles reviewing HIV in 2009, free for anyone (most Journal Watch articles require a subscription). The links to these 10 articles are included in the one above.

Also, Journal Watch published a similar review of 2009 advances in psychiatry, including depression, and how to stay healthy. The first article, with links to the others, is at http://psychiatry.jwatch.org/cgi/content/full/2010/104/1

US HIV travel ban has now ended

2010-01-04T23:51:00.000-05:00

"HIV-positive individuals can legally visit and migrate to the US from today.
President Obama announced the end of the ban at the end of October 2009, but there was a 60-day waiting period before this finally came into effect.

"Introduced early in the HIV pandemic, the US travel ban prevented visits to the US by people with HIV except in exceptional circumstances. Although it was widely flouted, individuals with HIV who were detected by US immigration staff were refused entry to the country and deported. ...

"Following the removal of the ban, the International AIDS Society confirmed that the 2012 International AIDS Conference will be held in Washington D.C. The US capital has an HIV prevalence of 3% - the threshold for a severe, generalised epidemic is 1%. ...

"A list of countries and their entry policies for people with HIV can be read here"

Read more in Aidsmap, January 4, 2010.

Longer duration of infection with HIV linked with hardening of coronary arteries

2010-01-04T23:45:00.000-05:00

"Using CT scans, US investigators have found that young men with HIV are significantly more likely than their HIV-negative peers to have hardening of the arteries. In a study published in the on-line edition of AIDS the researchers also found that arterial disease was so severe in 7% of men with HIV that it was blocking blood flow. Longer duration of HIV infection was the most important risk factor for hardening of the coronary arteries.

"'The current study shows an increased prevalence and greater degree of subclinical coronary artery disease in asymptomatic young HIV-infected men without prior history of cardiovascular disease', write the investigators."

Read more in Aidsmap, January 4, 2010.

Vitamin D Deficiency: A Major Public Health Problem?

2010-01-02T12:04:00.000-05:00

"During the past decade, we've learned two remarkable things about vitamin D. First, many adults and children in the U.S. and other developed nations have vitamin D deficiency (JW Gen Med Mar 20 1998). Second, the adverse health effects of vitamin D deficiency could extend well beyond bone disease to encompass excess risk for cancer (particularly colon, prostate, and breast), hypertension, autoimmune diseases (e.g., multiple sclerosis, type 1 diabetes), and other diseases. Vitamin D deficiency also might be associated with all-cause and cardiovascular mortality."

Read more in Journal Watch, December 31, 2009.

Fixing the Body: An Immune-Based Approach to HIV

2009-12-31T16:47:00.001-05:00

"8. Why would we think this drug [Cytolin] might work?

"Because before 1996 when viral cocktails were invented, doctors used this drug on many patients (188 of them) and we know from the records of those patients that the drug seemed to help them.

"In general, using the antibody showed some return in the ability to fight illnesses, an increased number of T cells, and a drop in the amount of virus. The way scientists measured this was to use a test of the body’s ability to recognize enemy germs, a skin test and it was clear that people who were not able to fight some illnesses got this ability back after using the antibody. Some of the well known scientists who worked with this antibody years ago were contacted by the non-profit organization Search For A Cure and interviewed. All of them indicated that they would like to see Cytolin studied because they felt it had potential."

Read more in Search for a Cure, December 2009.

In New Way to Edit DNA, Hope for Treating Disease

2009-12-29T17:10:00.000-05:00

"At the University of Pennsylvania, Dr. Carl June and colleagues have used the technique to disrupt a gene in patients’ T cells, the type attacked by the AIDS virus. They have then infused those cells back into the body. A clinical trial is now under way to see if the treated cells will reconstitute a patient’s immune system and defeat the virus.

"The technique, which depends on natural agents called zinc fingers, may revive the lagging fortunes of gene therapy because it overcomes the inability to insert new genes at a chosen site. Other researchers plan to use the zinc finger technique to provide genetic treatments for diseases like bubble-boy disease, hemophilia and sickle-cell anemia.

"In principle, the zinc finger approach should work on almost any site on any chromosome of any plant or animal. If so, it would provide a general method for generating new crop plants, treating many human diseases, and even making inheritable changes in human sperm or eggs, should such interventions ever be regarded as ethically justifiable."

Read more in New York Times, December 29, 2009.

Vaccine Prevents SIV Disease Progression in Monkeys

2009-12-29T01:16:00.000-05:00

"The results of a recent animal study suggests researchers may be one step closer to developing a vaccine to prevent or slow HIV disease progression in people who become infected with the virus, according to an article published December 11 in the journal Vaccine and reported by Science Daily.

"Some vaccines against diseases, like Polio, have relied on delivering a whole virus—either live or killed—to trigger a protective immune response against the disease. HIV is so dangerous, however, that researchers usually take fragments of the virus and combine it with other less harmful viruses. They in turn deliver the HIV fragments to the immune system to trigger a protective response. The harmless virus used to deliver the fragments is called a vector. With HIV, the vector can determine the success of the vaccine as much as the choice of which HIV fragments are used.

"One promising vector that has been suggested and studied is a weakened form of the rabies virus. To determine whether a vaccine made up of a weakend rabies virus and fragments of HIV’s primate counterpart—simian immunodeficiency virus (SIV)— could monkeys against SIV infection or disease progression, Elizabeth Faul, PhD, from Thomas Jefferson University in Philadelphia, and her colleagues tested two versions of such a vaccine in 12 monkeys. Encouraging results, the authors state, would potentially pave the wave for a similar approach using HIV fragments to vaccinate humans. ...

"The authors acknowledge that the vaccine did not protect against infection, but expressed excitement that they were able to cause such a large immune response that could protect against disease progression with only two vaccine injections."

Read more in POZ, December 28, 2009.

EACS releases three updated management guidelines

2009-12-29T01:09:00.000-05:00

"The European AIDS Clinical Society publishes three management guidelines that make extensive use of summaries, bullet point list and supportive tables to produce resources that are easy to follow. The three main updates (version 5) were launched at this year’s conference.

"PDF versions are now available to download from the societies website..."

Read more in HIV Treatment Bulletin, November/December 2009.

Association between inflammation and sleep apnea in the MACS cohort

2009-12-27T22:08:00.004-05:00

"Prompted by the concern that systemic inflammation may contribute to sleep apnea, Susheel Patil and colleagues from Johns Hopkins University presented an interesting analysis from the gently named SIESTA study (Study of Immune Effects on Sleep, (HIV) Treatment and Apnea).

"The study looked at obstructive sleep apnea (OSA) and the relationship with inflammation markers (TNF-alpha soluble TNF-a receptors I and II and IL-6), in three groups of men from the MACS cohort: HIV-positive and not on HAART (n=41), HIVpositive and on HAART (n=58) and HIV negative (n=60). ...

"When looking at participants with normal BMI (<25 kg/m2) however, the relationship indicated a trend for higher prevalence in the no-HAART group: 25% HIV-negative (n=20), 24% on HAART (n=29) and 50% in the no HAART group (n=22); (p=0.1)"

Read more in HIV Treatment Bulletin, November/December, 2009.

Visceral adipose tissue returns to baseline after stopping therapeutic intervention with rHGH

2009-12-27T22:02:00.005-05:00

"Central fat accumulation remains one of the most distressing but least understood metabolic complications, with very limited management options. Several studies have reported that recombinant Human Growth Hormone (rHGH) can reduce central visceral adipose tissue (VAT), although earliest studies at higher doses (4-6 mg/day) were associated with significant toxicity. Additionally, any benefit seemed dependent on maintaining treatment, and the optimal dose remained to be established.

"It was important to see the 3-years results from a study from the Massachusetts General Hospital, presented by Steven Grinspoon, carried out in people with reduced growth hormone (GH) secretion (peak GH <7.5 ng/mL). ..."

Read more in HIV Treatment Bulletin, November/December, 2009.

Intermuscular tissue is decreased in HIV infection

2009-12-27T22:00:00.000-05:00

"The first study in the main conference looked at a intermuscular adipose tissue (IMAT) - the distribution of fat that is beneath the muscle facia and muscle tissue – as a new parameter of metabolic disturbances. Led by Carl Grunfeld with the FRAM study, this group has provided important insight into the association of HIV to metabolic changes by using full body MRI to identify changes and including an HIV-negative control group. Results from the study concluded that fat loss and fat gain are separate unrelated dysfunctions and that fat loss rather than fat accumulation is the driving mechanism behind HIV-related changes."

Read more in HIV Treatment Bulletin, November/December, 2009.

HIV-Positive Children Surviving and Thriving

2009-12-23T23:14:00.000-05:00

"The death rates of children living with HIV have decreased ninefold since combination antiretroviral (ARV) therapy became widely available in the mid-1990s, according to results from a large pediatric HIV study published in the December 15 issue of the Journal of Acquired Immune Deficiency Syndromes. But there’s still tremendous room for improvement: Young people with HIV continue to die at 30 times the rate of youth of similar age who do not have HIV."

Read more in POZ, December 22, 2009.

Heavy Drinking Raises Heart Disease Risk in HIV-Positive Men

2009-12-21T22:39:00.000-05:00

"Looking only at the HIV-positive veterans and after controlling the data to exclude common traditional causes of CVD [cardiovascular disease] — such as age, cholesterol levels, high blood pressure and cigarette smoking — hazardous drinking was associated with a 74 percent increase in the risk of congestive heart failure (CHF), whereas alcohol abuse and dependence was associated with a 67 percent increase in the risk of coronary heart disease (CHD) and a 99 percent increased risk of CHF. Past drinkers—those who hadn’t used alcohol in the preceding 12 months—faced a 78 percent increased risk of a stroke.

"Interestingly, when the researchers looked at the HIV-negative veterans and controlled for traditional risk factors, there was no statistically significant association between alcohol consumption and CVD risk. This lack of association, the authors write, 'suggest[s] that the effect of alcohol may be more pronounced among those infected with HIV.'"

Read more in POZ, December 21, 2009.

Symptoms of Psychological Distress: A Comparison of Rural and Urban Individuals Enrolled in HIV-Related Mental Health Care

2009-12-21T22:29:00.002-05:00

"Rural participants had significantly higher mean scores on the hostility dimension of the BSI [Brief Symptom Inventory], F(1, 93)=8.77, p=0.004, than their urban counterparts. Furthermore, the rural participants had a greater proportion of individuals who had a T-score ≥63, a level indicative of a need for further psychological evaluation, for generalized anxiety, hostility, and psychoticism. The results indicated that rural individuals presented with higher levels of symptoms of psychological distress than their urban counterparts. These differences may be reflective of situational circumstances in rural areas where access to care, social isolation, and perceived stigma may delay screening for, and treatment of, psychological distress."

Read more in AIDS Patient Care and STDs, December 21, 2009.

Crazy for the Holidays

2009-12-21T03:19:00.000-05:00

"Depending on how you slice and dice the numbers, up to 15 million people in the United States will experience major depression each year. Forty million people suffer from some degree of serious anxiety ...

"Stats show that for people living with HIV, incidences of depression are even worse. Up to half of HIV-positive people in most studies have struggled with depression. Nobody can say for sure whether the increased rates are due to the fact that people who get depressed are more likely to become infected, or whether people who get infected are more likely to become depressed. I suspect it’s both. ...

"One of the most tragic things about living with mental illness, just like with HIV, is that you often feel like you are the only one. The illness also keeps you silent. You just feel like you can’t tell anyone how bad it really is."

Read more in POZ, December 19, 2009.

A Few Things That Are Certain

2009-12-21T03:11:00.000-05:00

"So let me start out by stating the bottom line: If the national strategy is a plan to end AIDS, then it must include real strategies that end homelessness and housing instability for people living with HIV and those most at risk. Anything short of that is a plan to maintain the epidemic, not to bring it to an end.

"Now I know that some will argue that this statement overreaches. But the reality is that we have now poured billions of dollars into individual-level interventions when so much research points to the many socioeconomic drivers of the epidemic. Homelessness is one leading driver that is proved to be amenable to intervention and has been shown to have a direct, independent and powerful impact on both prevention and health outcomes.

"Very simply, prevention interventions that focus on changing the behavior of individuals are doomed to fail if we deny these individuals access to a proven, cost-effective prevention and health care intervention—a safe and secure place to live. The research—and there is a lot of it now—clearly shows that persons who lack stable housing are far more likely to become HIV infected, will have limited access to care once they are infected, and will live less healthy and shorter lives than persons just like them who are fortunate enough to have a home.

"Why is housing so critical? Because having a safe, secure place to live is fundamental to the basic activities of daily living. When one is homeless or facing housing instability, immediate survival must, by necessity, take priority over other activities and choices."

Charles King, Housing Works, New York

Read more in POZ, December 18, 2009.

Treatment for Everyone With HIV?

2009-12-21T03:02:00.000-05:00

"The panel now recommends people with CD4 cell counts of 500 or below start HIV treatment right away. Previously, the guidelines recommended waiting until CD4s fell to below 350. The panel was split 50/50 about whether people with over 500 CD4s should start; half of the panelists essentially recommended treatment for everyone with HIV. Aside from the personal health benefits of being on ARV treatment, the panelists in favor of very early treatment also cited a public health benefit—suppressing viral loads in a large number of people to slow the ongoing spread of HIV.

"In contrast, the more skeptical activists and providers contend that while very savvy and experienced physicians and patients know enough about the data—or the lack thereof—to assess the risks and benefits of earlier treatment, most providers and patients don’t. Paul Dalton, a longtime activist who is an HIV-positive member of the DHHS panel, stresses that these caveats are discussed in the heavily annotated discussion sections of the guidelines. “My belief is that many users of the guidelines look at our tables and look at our bullet points, but don’t look at the discussion sections,” he says."

Read more in POZ, December 18, 2009.

Reyataz and Sustiva Co-Pay Programs Expanded

2009-12-21T02:57:00.000-05:00

"The prescription co-payment programs run by Bristol-Myers Squibb (BMS) will now begin with the first dollar a person pays a pharmacy or mail-order service for his or her Reyataz (atazanavir) or Sustiva (efavirenz) prescriptions. Previously, people with HIV had to cover the first $50 of their co-pay before the BMS programs began to contribute."

Read more in POZ, December 18, 2009.

HAART Associated With A Reduced Risk Of Suicide In HIV-Infected Patients

2009-12-20T02:38:00.000-05:00

"A study published Wednesday in the American Journal of Psychiatry shows that HIV-positive individuals experienced reduced rates of suicide after the initiation of highly active antiretroviral therapy (HAART)."

Read more in The AIDS Beacon, December 19, 2009.

New Insight Into Selective Binding Properties of Infectious HIV

2009-12-18T01:47:00.002-05:00

"The lead investigators, Dr. Zoltan Beck and Dr. Carl Alving, researchers with MHRP in the Division of Retrovirology, Walter Reed Army Institute of Research (WRAIR), explain that the data show that although infectious HIV-1 virus particles that bind to red blood cells comprise only a small amount, perhaps as little as a mean of 2.3% of a typical HIV-1 preparation, erythrocyte-bound HIV-1 is then approximately 100-fold more infectious than free (non-cell-bound) HIV-1 for infection of target cells.

"The study concludes that infectious virions constitute only a small fraction of a typical HIV-1 preparation and that, in a laboratory setting, all of the infectious virions can bind to red blood cells and other non-permissive cells (i.e., cells that cannot be infected). ...

"Dr. Beck adds, 'This study suggests that erythrocytes [red blood cells] might serve as an important, and perhaps hidden, reservoir for infectious HIV-1 virions.'"

Read more in ScienceDaily, December 15, 2009.

Most NNRTI-experienced patients in southern Africa will benefit from etravirine

2009-12-18T01:19:00.000-05:00

"Nearly all patients in southern Africa who have received treatment with the NNRTIs efavirenz or nevirapine would benefit from therapy with etravirine, a study published in the December 15th edition of the Journal of Acquired Immune Deficiency Syndromes suggests.

"Over 90% of patients previously exposed to efavirenz or nevirapine in the southern African treatment programmes will remain susceptible to etravirine despite prolonged exposure to first-line NNRTI-based regimens", comment the investigators."

Read more in Aidsmap, December 18, 2009.

Heavy drinking increases cardiovascular disease risk for men with HIV

2009-12-17T03:00:00.000-05:00

"Heavy drinking increases the risk of cardiovascular disease for men with HIV, US investigators report in an article published in the online edition of the Journal of Acquired Immune Deficiency Syndromes.

"'Hazardous drinking and alcohol abuse or dependence were significantly associated with an increased prevalence of cardiovascular disease as compared with infrequent or moderate drinkers', comment the investigators. ...

"'The effect of alcohol [in causing illnesses] may be more pronounced among those infected with HIV', conclude the investigators."

Read more in Aidsmap, December 15, 2009.