Effect of a dietary intervention and n–3 fatty acid supplementation on measures of serum lipid and insulin sensitivity in persons with HIV

"Conclusions: Diet and n–3 fatty acid supplementation dramatically reduced serum triglycerides, decreased arachidonic acid in the phospholipids fraction, and appeared to decrease the de novo lipogenesis associated with the metabolic syndrome in the intervention group."

Read more in The American Journal of Clinical Nutrition, November 20, 2009.

Low bone mineral density common in HIV-positive men

"A large proportion of HIV-positive men have low bone mineral density, Australian researchers report in the December 1st edition of the Journal of Infectious Diseases. Treatment with a boosted protease inhibitor was identified as a risk factor, and the investigators suggest that their results point to tenofovir also causing changes in the bone metabolism. The risk of fractures was sufficiently high in 16% of patients to warrant treatment. "

Read more in Aidsmap, November 19, 2009.

Routine Screening for Depression: Identifying a Challenge for Successful HIV Care

"Given the association between depressive symptomatology and poor rates of HIV viral suppression, screening and appropriate interventions for depressive symptoms are warranted in the HIV outpatient setting to improve outcomes."

Read more in AIDS Patient Care and STDs, November 20, 2009.

The Needle Nexus

"Needle exchange is AIDS prevention that works. While no one wants to have to put on a condom, every drug user prefers injecting with a clean needle. In 2003, an academic review of 99 cities around the world found that cities with needle exchange saw their H.I.V. rates among injecting drug users drop 19 percent a year; cities without needle exchange had an 8 percent increase per year. Contrary to popular fears, needle exchange has not led to more drug use or higher crime rates. Studies have also found that drug addicts participating in needle exchanges are more likely to enter rehabilitation programs. Using needle exchange as part of a comprehensive attack on H.I.V. is endorsed by virtually every relevant United Nations and United States-government agency.

"All over the world, however, solid evidence in support of needle exchange is trumped by its risky politics. Harm reduction is thought by politicians to muddy the message that drug use is bad; to have authorities handing out needles puts an official stamp of approval on dangerous behavior."

Read more in New York Times, November 17, 2009.

Comment: A major Australian government study released last month found that “Only 0.1% of drug injectors are HIV positive, but 14% would be if there were not needle and syringe programs throughout thousands of places in Australia.” See http://www.anex.org.au/downloads/NSP-Australia-ROI.pdf (large download) -- the quote is from a media release by The Association for Prevention and Harm Reduction Programs Australia.

The study also found that syringe exchange had saved $4 for every $1 spent, prevented 32,000 HIV infections and 100,000 hepatitis C infections, and saved Australia $1.28 billion in health costs, over the past decade.

The New York Times article noted, "In the United States, needle-sharing directly accounts for more than 25 percent of AIDS cases." A recent government report estimates about 16% of U.S. injection drug users are infected with HIV. (These figures are consistent, because HIV is passed on to sexual partners who may not be IDUs, resulting in the higher figure.)

Compared to Australia, that's a 160-fold increase (a 16,000% increase) in U.S. infections among IDUs in the United States, due to government and public hostility against needle exchange.

Pregnancy, not nevirapine cause of liver toxicities in HIV-positive women

"Results of US research 'challenge the notion that nevirapine is uniquely associated with hepatotoxicity during pregnancy.' The study did however show that pregnancy itself increased the risk of liver toxicities in women with HIV. The research is published in the November 27th edition of AIDS."

Read more in Aidsmap, November 18, 2009.

Surviving to die of something else: AIDS is a rare cause of death in old people with HIV

"A French study of a group of people with HIV aged over 60 has found that over a four-year period, one in seven of the group died – but not a single death was attributable to an AIDS-defining illness.

"The findings from the French COREVIH Cohort, presented at last week's European AIDS Clinical Society conference in Colgne, underline the increasingly strong realisation in HIV medicine that as patients with HIV on antiretroviral therapy age, the medical problems they face will have much more to do with diseases of ageing than AIDS-defining illnesses. The latest revision of the EACS Treatment Guidelines acknowledges this – see this report."

Read more in Aidsmap, November 18, 2009.

Early Treatment, Non-AIDS Disease Management Stressed in New European Guidelines

"Antiretroviral (ARV) therapy is now recommended for certain people living with HIV with CD4 counts between 350 and 500 cells, according to new HIV treatment guidelines released this week by the European AIDS Clinical Society (EACS). The revised recommendations, which hint at similar changes to U.S. HIV treatment guidelines expected this winter, also review the screening, prevention and management of many non-AIDS-related diseases that are more likely to be documented in people living with HIV."

Read more in POZ, November 17, 2009.

Low Vitamin D Levels in Alpine HIV Study

"A new study adds to the evidence that vitamin D deficiency is common in people living with HIV. The new data, from an Italian study reported last week at the 12th European AIDS Conference in Cologne, Germany, and summarized by the National AIDS Treatment Advocacy Project (NATAP), underscore the potential importance of testing for and treating low vitamin D levels to thwart the increased risk of bone deterioration and immune system dysfunction in those infected with the virus."

Read more in POZ, November 16, 2009.

Protease inhibitor monotherapy as a maintenance regimen: are we edging towards acceptance?

"An entire session at the 12th European AIDS Conference was devoted to trials of different ritonavir-boosted protease inhibitors (PI/r) used as the sole drug in an antiretroviral regimen.

"Several trials of protease inhibitor therapy have produced long-lasting viral suppression statistically non-inferior to two-class therapy. Most successful trials have switched patients to PI monotherapy as a maintenance regimen after starting with combination therapy but some success continues to be seen in trials using monotherapy from the start.

"The failure of a trial using a single protease inhibitor as initial regimen, however, was a warning that it is possible to take this approach too far, and doubts remain about the long-term safety of the approach in terms of its ability to suppress HIV in places like the central nervous system and genital mucosa."

Read more in Aidsmap, November 16, 2009.

November 23: New deadline to submit ideas for the National AIDS Strategy

"1. Brainstorm ideas and identify specific action steps that address the three National HIV/AIDS Strategy goals to reduce HIV incidence, increase access to care and optimize health outcomes for people living with HIV, and reduce HIV-related health disparities.

"2. Develop recommendations for each National HIV/AIDS Strategy goal that could be fulfilled by the federal government, state and local governments, non-profits, businesses and other entities. ..."

Read more in Office of National AIDS Policy, November 14, 2009.