Fixing the Body: An Immune-Based Approach to HIV

"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

"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

"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

"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

"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

"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

"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

"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

"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

"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

"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

"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?

"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

"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

"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

"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

"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

"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.

UNITAID EXECUTIVE BOARD APPROVES BREAKTHROUGH PLAN TO MAKE AIDS TREATMENT MORE WIDELY AVAILABLE AT LOWER COST

"Today UNITAID's Executive Board made a landmark decision to establish a Patent Pool for AIDS medicines. The pool, scheduled to start operating in mid-2010, aims to make newer medicines available in patient-adapted form, at lower prices, for low- and middle-income countries. UNITAID has committed to provide start-up funds of up to US$ 4 million over the next year. Expected savings exceed one billion dollars a year, which will make more medicines available for more people.

"'This is an historic day,' said Philippe Douste-Blazy, Chair of UNITAID's Executive Board. 'UNITAID has now put in place a mechanism that will make medical advances work for the poor, while compensating companies for sharing their technology.'

"The Patent Pool will allow generic companies to make lower cost versions of widely patented new medicines by creating a common space for patent holders to license their technology in exchange for royalties. This will spur competition and further bring down the price of vital new and effective medicines, giving hope to millions of patients. Companies with which UNITAID has had consultations include Gilead, Tibotec, Merck and Sequoia.

"UNITAID has identified 19 products from nine companies for potential inclusion into the pool. The pool will facilitate the development of fixed-dose combinations (FDCs). For some years now clinical evidence has revealed that these combinations are the best way for patients to access safe, effective treatment. Until now, patents have created barriers to developing FDCs combining newer and more effective drugs from different companies. Today, with the first concrete step in the realisation of the Patent Pool, the door is open for new FDCs to enter the market.

"'FDCs are especially important in the treatment of children, who make up 10% of current treatment needs,' said Jorge Bermudez, UNITAID Executive Secretary. 'The Patent Pool will greatly help us accomplish our mission of scaling up treatment access, particularly for specific target groups otherwise neglected by the market – that is, children and people who fail on older therapies.'

"The idea of a Patent Pool has been in discussion for a number of years. In 2006, Knowledge Ecology International and Médecins Sans Frontières proposed it to UNITAID. Today UNITAID has become the first international body to translate this idea into reality."

Read more in UNITAID, December 14, 2009.

Drinking cups of tea and coffee 'can prevent diabetes'

"Tea and coffee drinkers have a lower risk of developing type 2 diabetes, a large body of evidence shows.

"And the protection may not be down to caffeine since decaf coffee has the greatest effect, say researchers in Archives of Internal Medicine.

"They looked at 18 separate studies involving nearly 500,000 people. This analysis revealed that people who drink three or four cups of coffee or tea a day cut their risk by a fifth or more, say researchers.

"The same amount of decaffeinated coffee had an even bigger effect, lowering risk by a third. ...

"'If such beneficial effects were observed in interventional trials to be real, the implications for the millions of individuals who have diabetes mellitus, or who are at future risk of developing it, would be substantial.""

Read more in BBC News, December 15, 2009.

Companies Shed More Light On Health Bill Lobbying

"Several news outlets report on the lobbying efforts of interest groups, including drug makers, big business and insurers.

"USA Today: 'Sweeping ethics rules passed by Congress in 2007 require corporate interests that lobby Washington to reveal more information than ever, such as how much they donate to politicians' favorite charities. Yet companies don't have to detail how much money they give to powerful trade associations, nor does federal law require trade groups to disclose the amount they receive from each member for political activity.' ..."

Read more in Kaiser Health News, December 14, 2009.

Tens of Millions of TB Patients Cured

"The cure rate goal for TB internationally has been reached for the first time since the target was set in 1991. Some 2.3 million people were cured of TB in 2008, and the cure rate of 87 percent exceeded the 85 percent global target. Much of the credit was given to aggressive implementation of Directly Observed Therapy, Short-course, or DOTS, the strategy of having health professionals witness first-hand that TB treatments are taken correctly."

Read more in NPIN, December 14, 2009.

Disappointment as microbicide fails to protect against HIV

"PRO 2000 microbicide gel failed to protect women against HIV infection in the largest microbicide study to date, partners in the Microbicide Development Programme’s 301 study have announced. ...

"The study recruited 9385 women, compared to 3099 women in the HPTN 035 study, and because of the larger number of participants, more infections took place in the study. As a result MDP 301 has much greater power to detect differences in infection rates.

"However, after one year of microbicide use, there was no significant difference in the risk of infection between women who received PRO 2000 or the placebo gel. PRO 2000 failed to show a protective effect (hazard ratio 1.05 [95% confidence interval 0.82 – 1.34], p=0.172).

"There were 130 HIV infections out of 3,156 women who were given 0.5% PRO 2000 gel (4.5 per 100 person years), and 123 HIV infections out of 3,112 given the placebo gel (4.3 per 100 person years). ...

"The future

"The full results of MDP 301 are likely to be presented and published early in 2010, and the field is now awaiting the results of a South African study of a microbicide containing the antiretroviral drug tenofovir.

"That study, the CAPRISA 004 trial, is testing the use of tenofovir gel in women in KwaZulu-Natal, and the results are expected to be presented in the summer of 2010.

"CAPRISA 004 is a pilot study, and will be followed by results from the VOICE study, which is directly comparing a tenofovir gel with oral tenofovir pre-exposure prophylaxis (PrEP) in 4200 women at 10 sites in South Africa, Malawi, Uganda, Zambia and Zimbabwe."

Read more in Aidsmap, December 14, 2009.

[Washington DC] HIV funds bypassing areas in need

"'We're in one of the most powerful cities in the world. It's not fair to these kids that we didn't get it right.'"

Read more in Washington Post, December 13, 2009.

Lost to AIDS, but Still Friended

"'There is a real hunger for information about this period, this history and these lost lives,' said that friend, Chris Bartlett, a former classics scholar who has set out to rescue the memories of those lives, specifically 4,600 gay Philadelphia men who perished of AIDS in the 1980s and ’90s. While the memorializing impulse is ancient, the method Mr. Bartlett came up with is as new as the latest app; he has created a social networking site for the dead.

"Modest by the standards of memorial Web sites like Tributes.com — a for-profit company that amasses 80 million obituaries — Mr. Bartlett’s site, gayhistory.wikispaces.com, is far from the first AIDS commemoration. But its appearance now links it to a resurgence of attempts to reclaim the memories of thousands who died during a calamitous era, when H.I.V. was still a death sentence."

Read more in New York Times, December 11, 2009.

Transmission of Drug-Resistant HIV Drops 12-Fold in Vancouver

"The transmission of drug-resistant strains of HIV has dropped dramatically in Vancouver, according to a study published January 1 in Clinical Infectious Diseases. The study authors claim the 12-fold reduction in transmitted resistance is at least partly due to the fact that nearly 90 percent of people taking antiretroviral (ARV) therapy are now able to keep their HIV fully suppressed."

Read more in POZ, December 11, 2009.

Immunologic and Virologic Predictors of AIDS-Related Non-Hodgkin Lymphoma in the Highly Active Antiretroviral Therapy Era

"Among HIV-infected individuals in the HAART era, NHLs are linked to immunosuppression and extended periods of uncontrolled HIV viremia."

Read more in JAIDS, December 9, 2009.

Use of HIV Resistance Testing After Prolonged Treatment Interruption

"Conclusions: HIV genotypic resistance assays may identify mutations even when performed after a prolonged treatment interruption and may offer clinically significant information. Current guidelines that discourage resistance testing after treatment interruptions of longer than 4 weeks should be re-evaluated."

Read more in JAIDS, December 9, 2009.

CD4+ T-Cell Restoration After 48 Weeks in the Maraviroc Treatment-Experienced Trials MOTIVATE 1 and 2

"Objectives: To determine factors associated with CD4 responses to maraviroc (MVC)-containing regimens in treatment-experienced patients. Methods: Forty-eight-week data from MOTIVATE 1 and 2 was used to assess MVC once or twice daily versus placebo (PBO), each with optimized background therapy (N = 1047). ... Conclusions: MOTIVATE patients receiving MVC had larger CD4+ T-cell increases than those receiving PBO, even after adjusting for the greater virologic potency of MVC-containing regimens. This additional CD4 response was associated with a longer time to the development of AIDS-defining events on MVC. (C) 2009 Lippincott Williams & Wilkins, Inc."

Read more in JAIDS, December 9, 2009.

Oxidative Stress in HIV-Infected Individuals: A Cross-Sectional Study

"HIV infection increases the oxidative stress process, and antiretroviral combination therapy increases protein oxidation and preexistent oxidative stress. The latter induces production of reactive oxygen species. Lipid peroxidation (LPO) is a means of determining oxidative stress. There is also a deficiency of glutathione in HIV infection. Persistent oxidative load leads to an accelerated rate of consumption of glutathione (GSH). This study measured LPO and GSH levels in plasma of HIV-infected individuals with or without therapy and compared these with healthy controls. ... The mean glutathione level in HIV-infected individuals was significantly lower in compared to healthy controls (p value<0.0001). There was a significant positive correlation between absolute CD4 cells and GSH levels (ρ=0.182, p=0.045). There is increased oxidative stress in HIV-infected patients. Whether supplementation with antioxidants will reduce this oxidative stress is still unknown." Read more in AIDS Research and Human Retroviruses, December 10, 2009.

The Association Between Alcohol Consumption and Prevalent Cardiovascular Diseases Among HIV-Infected and HIV-Uninfected Men

"Conclusions: Among HIV-infected men, hazardous drinking and alcohol abuse and dependence were associated with a higher prevalence of CVD compared with infrequent and moderate drinking even after adjusting for traditional CVD risk factors, antiretroviral therapy, and CD4 count."

Read more in JAIDS, December 9, 2009.

[13C]Methionine Breath Test as a Marker for Hepatic Mitochondrial Function in HIV-Infected Patients

"Metabolic disturbances such as dyslipidemia, lipodystrophy syndrome, visceral obesity, hyperlactatemia, diabetes mellitus, and hepatic steatosis have been recognized as serious complications in long-term antiretroviral-treated HIV-infected patients. The oxidative capacity of liver mitochondria plays a central role in their pathogenesis and can be analyzed using the [13C]methionine breath test. ... Patients with hepatic steatosis, hypertriglyceridemia, lipohypertrophy, and older age showed reduced methionine metabolism. Hepatic mitochondrial function is impaired in antiretroviral-treated HIV-infected patients with disturbances of lipid metabolism."

Read more in AIDS Research and Human Retroviruses, December 9, 2009.

Palmitic Acid Is a Novel CD4 Fusion Inhibitor That Blocks HIV Entry and Infection

"We investigated a large number of natural products, and from Sargassum fusiforme we isolated and identified palmitic acid (PA) as a natural small bioactive molecule with activity against HIV-1 infection. ... Understanding the structure–affinity relationship (SAR) between PA and CD4 should lead to the development of PA analogs with greater potency against HIV-1 entry."

Read more in AIDS Research and Human Retroviruses, December 9, 2009.

Full results of DART lab monitoring study published

"The results of the DART study, which showed that patients who did not undergo routine CD4 cell or drug toxicity laboratory monitoring were only marginally more likely to experience disease progression or die while receiving antiretroviral therapy during a five-year study in Zimbabwe and Uganda, were first presented at the International AIDS Society conference in Cape Town in July.

"The study was designed to determine whether antiretroviral therapy could be implemented safely and effectively in a resource-limited setting without routine use of expensive laboratory tests."

Read more in Aidsmap, December 9, 2009.

New U.S. Plan on AIDS Slows Growth in Treatment

"As the Obama administration slowly unveils its global AIDS plan, the drive to put more people on drugs is being scaled back as emphasis is shifted to prevention and to diseases that cost less to fight, including pneumonia, diarrhea, malaria and fatal birth complications. ...

"'I’m holding my nose as I say this, but I miss George W. Bush,' said Gregg Gonsalves a long-time AIDS campaigner. 'On AIDS, he really stepped up. He did a tremendous thing. Now, to have this happen under Obama is really depressing.' ...

"Chris Collins, director of public policy at amfAR, the AIDS research foundation, said: 'We can’t keep kids alive to age 13 till they die of something more expensive. Also, a high percentage of health care workers are infected; we’ve got to keep them alive.'

"AIDS advocates said they had heard that, since taking office in June, Dr. Goosby had pressed hard for treatment for five million people [instead of four million] but had lost."

Read more in The New York Times, December 8, 2009.

Also see talk by Gregg Gonsalves on World AIDS Day, December 1.

UCLA researchers demonstrate that stem cells can be engineered to kill HIV

"'We have demonstrated in this proof-of-principle study that this type of approach can be used to engineer the human immune system, particularly the T-cell response, to specifically target HIV-infected cells,' said lead investigator Scott G. Kitchen, assistant professor of medicine in the division of hematology and oncology at the David Geffen School of Medicine at UCLA and a member of the UCLA AIDS Institute. 'These studies lay the foundation for further therapeutic development that involves restoring damaged or defective immune responses toward a variety of viruses that cause chronic disease, or even different types of tumors.'

"Taking CD8 cytotoxic T lymphocytes — the 'killer' T cells that help fight infection — from an HIV-infected individual, the researchers identified the molecule known as the T-cell receptor, which guides the T cell in recognizing and killing HIV-infected cells. These cells, while able to destroy HIV-infected cells, do not exist in enough quantities to clear the virus from the body. So the researchers cloned the receptor and genetically engineered human blood stem cells, then placed the stem cells into human thymus tissue that had been implanted in mice, allowing them to study the reaction in a living organism.

"The engineered stem cells developed into a large population of mature, multifunctional HIV-specific CD8 cells that could specifically target cells containing HIV proteins. The researchers also found that HIV-specific T-cell receptors have to be matched to an individual in much the same way that an organ is matched to a transplant patient."

Read more in UCLA press release, December 7, 2009.

Tuberculosis and HIV within prisons skyrocketing, a public health threat

"Overcrowding, low access to health care, lack of political will and the prominence of high-risk populations among prisoners all contribute to a “perfect storm” for HIV and TB infection among prison populations worldwide, researchers announced at the 40th Union World Conference on Lung Health this Saturday in Cancun, Mexico.

"Dr. Fabienne Hariga of the UN Office on Drugs and Crime and UNAIDS’ Dr. Alasdair Reid both highlighted dismal health statistics for those behind bars. According to Hariga, up to 65% of some prison populations are infected with HIV.

"Adding to this, says Reid, TB rates in prisons are up to fifty times higher than in the general population. Increased rates are found in prisoners who have served longer sentences, tying TB acquisition with prison time. Prisoners are also more likely to die from TB and/or default from treatment than non-incarcerated populations."

Read more in Aidsmap, December 7, 2009.

Sweden to cut aid to Uganda over anti-gay law

"Offenders would face death for having sex with a minor or a disabled person, or for infecting their partners with HIV. It would also punish attempted homosexuality as well as the failure of a third party to report homosexual relationships. ...

"In Canada, Prime Minister Stephen Harper’s conservative government called the proposed law 'vile and hateful', while Britain’s Gordon Brown raised the issue with President Museveni during the recent Commonwealth summit in Trinidad and Tobago. Ms Carlsson said the law would make it 'much more difficult' for Sweden to continue helping Uganda."

Read more in Sunday Monitor [Kampala], December 6, 2009.

Comment: More information is needed on allegations that the proposed law was due to enormous amounts of money from a secretive, politically connected group in the United States.

Also, the rights of people with a disability should be considered. It is hard enough for them to find sexual partners already. Most disabled people are as mentally competent as anyone else, so they can certainly give or withhold consent.

GSK warn US doctors of possible association between fosamprenavir and heart attack

"The move comes after a French study (FHDH ANRS CO4) presented to the Conference on Retroviruses and Opportunistic Infections earlier this year showed that each year of therapy with the drug increased the risk of heart attack by 54%.

"GSK are also reminding healthcare professionals of the importance of monitoring cholesterol and triglycerides before and during treatment with fosamprenavir. The company also recommends that other risk factors for cardiovascular disease, such as high blood pressure, diabetes and smoking should also be evaluated."

Read more in Aidsmap, December 3, 2009.

Gene-Based Drug Fights Hep C in Chimps—Maybe HIV One Day

"A new type of drug targeting a portion of hepatitis C virus (HCV) known as microRNA substantially reduced HCV levels in chimps and continued to work for several months after dosing stopped, according to an announcement by the Southwest Foundation for Biomedical Research (SFBR) in San Antonio. What’s more, say the researchers, the novel treatment approach might also work against other viruses such as HIV."

Read more in POZ, December 4, 2009.

Two standards of care for HIV: Why are Africans being short-changed?

"The impact of the XIIIth International Conference on AIDS in Durban, South Africa, in 2000 was much more than scientific. It also highlighted the non-acceptability of continuing to deny access to life-saving antiretroviral drugs to HIV-infected people in developing countries. This was in spite of efforts by then President Thabo Mbeki of South Africa to undermine the conference through his ridiculous and irresponsible insinuations that HIV might not be the cause of AIDS. Since 2000, it is estimated that the numbers of people in Africa receiving antiretroviral therapy has increased to approximately four million from about 7000 at the time of the Durban Conference. However, the fact is that almost all HIV-infected persons in developing country settings are today receiving therapies that are considered to be sub-standard by Western criteria."

Read more in Retrovirology, December 1, 2009.

Lack of Fluoroquinolone Resistance in Non-Typhoidal Salmonella Bacteremia in HIV-Infected Patients in an Urban US Setting

"Unlike reports from Asia, no fluoroquinolone resistance was identified in any of the Salmonella strains isolated in this setting. Optimal treatment of NTS in the HIV-infected patient in the United States should include therapy with fluoroquinolones as well as attaining complete viral suppression and immune reconstitution with ART."

Read more in Journal of the International Association of Physicians in AIDS Care (JIAPAC), December 1, 2009.

New Initiative: “Positive Charge” to Help Address Barriers and Provide Support to People Living with HIV/AIDS

"The National AIDS Fund (NAF) and Bristol-Myers Squibb Company (NYSE: BMY) announced today their intention to launch “Positive Charge,” a new multiyear initiative aimed at helping to break down the barriers that prevent people living with HIV from receiving HIV care, treatment and necessary support. The initiative is slated to launch in January 2010. ...

"Bristol-Myers Squibb commissioned a national survey over the past year to better understand the barriers to HIV testing, care and treatment. The survey concluded that there are significant personal, societal and structural barriers that prevent people from taking action. 'It’s sad, but true that in 2009, stigma still plays a huge role in preventing people from getting tested and into care,” said Ms. Ferree. “We are proud to work in collaboration with Bristol-Myers Squibb to help break down these barriers by creating a targeted initiative that supports collaborative and highly coordinated, community-based efforts to reduce barriers and provide the supportive services people living with HIV/AIDS need to effectively access health care.'"

Read more in National AIDS Fund, November 30, 2009.

Comment: We are skeptical of pharmaceutical industry initiatives. Most are self-centered fragments that don't deal well with the big picture, the overall needs, though the community may use the programs due to desperation. We take this effort more seriously because it seems to have a solid basis in mutual self-interest, and have a plausible partnership as well. Addressing and overcoming the real barriers to medical care for HIV is essential, to support individuals and also to reduce transmission, decreasing the epidemic. And a successful program will profit corporations, by bringing many thousands of new people into medical care, including antiretroviral prescriptions in many cases.

Expert Panel Revises U.S. HIV/AIDS Treatment Guidelines; Recommends Starting HIV Meds Earlier

"On Dec. 1, the U.S. health department released an updated set of HIV treatment guidelines. Although these guidelines aren't official U.S. policy, they're regarded as the most reputable set of expert recommendations in the country, and many HIV health care workers are likely to follow them. The guidelines themselves were revised by a panel of 30 HIV/AIDS experts from across the U.S.

"We'll summarize a few of the major changes in the revised guidelines below. A more detailed, official listing of changes is available online, as is a 168-page PDF of the full guidelines. ..."

Read more in The Body Pro, December 1, 2009.

Comment: This is the long-expected recommendation to start antiretrovirals at any CD4 count below 500 (instead of 350). Half the panel also thought that treatment should begin above 500; the other half considered this optional, except in three special situations. There is also guidance for treating HIV2, a virus found mostly in West Africa that causes a less severe form of AIDS. See the short summary of changes, in the first link above.

[Interview: AIDS Treatment News, yesterday and today]

"John S. James, who started an AIDS Treatment newsletter, talks about his work during an interview at a coffee shop in West Philadelphia on November 30, 2009. James will be honored at the Pennsylvania Academy of Fine Arts this week. ...

"Philadelphia FIGHT's event will take place tomorrow [December 2] at the Pennsylvania Academy of Fine Arts at 128 N. Broad Street from 6 to 8:30 p.m. The event is open to the public and will benefit the Jonathan Lax Treatment Center, FIGHT's HIV primary care clinic."

Read more in Philadelphia Daily News, December 1, 2009.

AIDS cure isn't out of reach

"Outside medical research circles, though, the idea of a cure for AIDS is rarely discussed seriously. There is no special organization or department at the National Institutes of Health dedicated to a cure. There are no editorials in the press calling for more research into "HIV eradication," the technical term for a cure. There is no annual research update on the subject for the general public or annual prize for the most promising work in the field - even though 33 million people have HIV and 25 million have died of AIDS.

"Yet, in private conversations, small meetings, and medical journals, leading researchers are calling for a renewed focus on eradicating the AIDS virus. They also have identified promising avenues for attacking the problem. Although few people realize it, eradication studies require fewer patients than the huge trials needed to test a vaccine, and they can often be done more quickly.

"At the same time, the National Institutes of Health - perhaps our best hope for funding a cure for AIDS - has been underfunded since 2003. One consequence has been less money for HIV eradication research, and less hope for younger scientists and innovative ideas."

Read more in The Philadelphia Inquirer, December 1, 2009.

Jefferson researchers identify new mechanism of blocking HIV-1 from entering cells

"A major drawback to using Fuzeon and related drugs that target N-HR is the rapid emergence of HIV-1 strains resistant to the drugs. Dr. Root's study suggests that the resistance phenomenon is related to the slow speed of gp41 deactivation induced by these fusion inhibitors. HIV-1 appears to have more difficulty developing resistance to drugs that can remain bound to gp41 for much longer than gp41 takes to deactivate, even if the drugs are no more potent than Fuzeon against the original HIV-1 strain. Armed with this knowledge, Dr. Root and his team have developed a new strategy to improve the antiviral activities of N-HR-targeting fusion inhibitors."

Read more in Thomas Jefferson University, November 30, 2009.

AIDS-free generation of children achievable, says UN report

"A generation of children free from AIDS is possible, according to the Children and AIDS, Fourth Stocktaking Report released today by UNICEF in partnership with the joint United Nations Programme on HIV/AIDS (UNAIDS), World Health Organization (WHO) and the United Nations Population Fund ( UNFPA). However, the authors note the world is not yet on track to meet targets for prevention, treatment, care and support.

"Issuing a call for action they urge that in a climate of economic uncertainty long-term targets are kept in mind and short-term commitments are honoured if women, children and young people are to have opportunities to live and thrive in a world free of AIDS.

"Wise investment in HIV and AIDS at the country level will require us to ‘know the epidemic’, how to respond appropriately and the associated costs of that response, and how that response is affecting the health and wellbeing of women and children," says UNICEF."

Read more in Aidsmap, November 30, 2009.

H1N1, Latent Reservoirs and ViiV: 2009 in Review

"The good news is that we continue to make progress. In honor of World AIDS Day [December 1 - see http://www.worldaidscampaign.org/ and http://www.aids.gov/world_aids_day.html], we decided to summarize the year’s top 10 treatment stories as a way to think about the accomplishments we’ve witnessed and the potential future they promise."

Read more in POZ, November 24, 2009.

‘Drug holidays’ best predictor of treatment failure, adherence studies find

"Failure to take every dose on time is not a good guide to whether patients will fail their therapy, according to studies from several countries presented at the European AIDS Conference.

"A better guide, and one that correlated with the number of pills taken, was whether patients had taken ‘drug holidays’ defined as at least two days of missed therapy."

Read more in Aidsmap, November 23, 2009.

Standard heart disease risk factors may underestimate risk in people with HIV

"The algorithms that are used to calculate the future risk of a heart attack and to decide which patients need clinical interventions may underestimate risk in people with HIV, the European AIDS Conference was told recently.

"Dr Giovanni Guaraldi of the University of Modena in Italy said that 41% of a group of patients he studied qualified for medical interventions such as statin therapy to prevent heart disease, on the basis of a direct electron-beam tomography (CAT) scan which detected calcification and hardening of the arteries.

"In contrast two different heart disease algorithms, the European Society for Hypertension Guidelines (ESH) and the Framingham Risk Score (FRS), suggested medical intervention for 33% and 35% of patients respectively, thus omitting 6%-8% of high risk patients.

"The European and Framingham guidelines were particularly likely to miss younger and/or female patients with hardening of the arteries, Dr Guaraldi said.

"Guaraldi said: 'At present we have to stratify patients according to the Framingham algorithm, but this is not validated in HIV patients and may underestimate disease.'"

Read more in Aidsmap, November 25, 2009.

Pre-exposure prophylaxis: cost-effectiveness dilemmas analysed by Australian study

"The base-case model assumed a current HIV prevalence of 9% in this population and that PrEP using tenofovir and FTC would cost $7536 a year (in US dollars). The annual cost of managing a case of HIV infection was put at $13,920 a year and the base-case scenario assumed a PrEP efficacy of at least 87%, similar to 100% attempted condom use. The prevalence of drug-resistant HIV was assumed to be low (under 3%) as was the incidence of serious adverse drug reactions (under 4%)."

Read more in Aidsmap, November 25, 2009.

Long-term HIV treatment doesn't damage kidney function

"Long-term HIV treatment has not caused a deterioration in kidney function among French patients, investigators report in the December 15th edition of Clinical Infectious Diseases. “Renal function is remarkably stable over seven years among combination antiretroviral therapy-treated patients”, they comment.

"Although the investigators did find some evidence of deterioration in kidney function, they note that this was to be expected in an ageing population. They believe the long-term stability of kidney function in the majority of patients can be attributed to good control of HIV replication."

Read more in Aidsmap, November 26, 2009.

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.

Higher Viral Loads Associated With Metabolic Syndrome

"People with higher HIV levels are more likely to have a cluster of symptoms—called metabolic syndrome—associated with cardiovascular disease than people with lower viral loads, according to a study published in the December [2009] issue of the Journal of Acquired Immune Deficiency Syndromes.

For the last decade, scientists have been working diligently to understand why certain people with HIV appear to be at higher risk for developing cardiovascular disease"

Read more in POZ, November 12, 2009.

HPV Therapeutic Vaccine Works in an Early Trial

"A therapeutic vaccine designed to help the immune system better control human papillomavirus (HPV) was nearly 50 percent effective in eliminating precancerous genital lesions, according to a study published November 5 in The New England Journal of Medicine. These encouraging data raise hopes for treating other HPV-related cancers, notably of the cervix and anus.

"Currently, two vaccines are approved in the United States to prevent infection with the strains of HPV that can cause cervical and anal cancer: Merck’s Gardasil and GSK’s Cervarix. Neither vaccine, however, has any effect on HPV once a person has become infected with the cancer-causing strains of the virus."

Read more in POZ, November 13, 2009.

New Paradigms of First-Line HIV Therapy: Determining When (and With What) to Start

"The cohorts alone probably wouldn't be sufficient to drive dramatic changes in clinical practice, but it's coming along with the fact that we have so many antiretroviral treatment options that are currently very well tolerated, with extremely high levels of efficacy, relatively low levels of toxicity and low levels of resistance, and many other options. So even if resistance were to develop, we'd still be able to successfully treat patients.

"We took the small, randomized control trial, dramatic changes in the types of therapies that are available for our patients and then built on top of that.

"One other major observation has come out over the last several years with respect to this relationship between ongoing viremia and high levels of immune activation and inflammation, and how this might affect other end organs -- other than things like the immune system -- such as endothelial function, which can have an impact on cardiovascular disease and renal disease.

"And that is that, with all of this, there's an increasing case being built, even in the absence of a large, randomized control trial, for perhaps recommending antiretroviral therapy to virtually every HIV-infected patient who, importantly, is ready, willing and able to commit to treatment."

Read more in The Body Pro, November 11, 2009.

Bill Clinton: Health care reform vital to HIV/AIDS patients

"The homeless are three to nine times more likely to have HIV or AIDS than people with stable housing, according to a 2004 study by the Centers for Disease Control and Prevention and the Department of Housing and Urban Development. In his speech, Clinton attributed this fact to the high cost of medications and treatments and said public health care could curb homelessness for those with the virus.

"Health care reform is not only morally right, but because reform would encourage preventive care, it would save money in the long run, Clinton said."

Read more in Chicago Tribune, November 12, 2009.

HIV/AIDS is leading cause of death of women of reproductive age: UN report

"Globally, the leading cause of death among women of reproductive age is HIV/ AIDS. Girls and women are particularly vulnerable to HIV infection due to a combination of biological factors and gender-based inequalities, particularly in cultures that limit women’s knowledge about HIV and their ability to protect themselves and negotiate safer sex."

Read more in Women and health: today's evidence tomorrow's agenda: WHO global report, November 9, 2009.

Topical Treatment Works Well for Anal Lesions

"Trichloroacetic acid (TCA), a topical liquid sometimes used to treat genital warts, may also be useful as a therapy for anal intraepithelial neoplasia (AIN) in HIV-positive and HIV-negative people, according to a study published in the December issue of the Journal of Acquired Immune Deficiency Syndromes.

"Anal lesions from human papillomavirus (HPV) infection are a precursor to anal cancer. They are remarkably common in men who have sex with men (MSM), especially HIV-positive MSM. This is of particular concern, as anal cancer rates among HIV-positive people are on the rise."

Read more in POZ, November 10, 2009.

Global cost of HIV treatment and prevention could reach $35 billion by 2031

"Without a serious change in approach AIDS will still be a major pandemic and funding required in resource-poor countries could reach an estimated $35 billion annually, three times the current level, by 2031—the fiftieth year of the pandemic— according to modelling carried out for the AIDS 2031 project by Robert Hecht and colleagues and published in the November/December edition of Health Affairs.

"Results from the Cost and Financing Working Group, AIDS 2031, headed by Robert Hecht were presented at a Health Affairs briefing on Capitol Hill ‘Meeting HIV/AIDS cost demands: is the global response working?’ in Washington, DC on November 10 2009. Others presenting at the briefing included: Anthony S. Fauci, Tom Walsh, Daniel Wikler, Alan E. Greenberg and Shannon L. Hader.

"Results support policy choices focusing on investments in high-impact prevention for most-at-risk groups—sex workers, men who have sex with men, and injecting drug users—, efficient treatments, new prevention tools together with significant behaviour-change efforts. These could help cut costs by half as well as help control the pandemic."

Read more in Aidsmap, November 10, 2009.

Highlights from the 2009 U.S. Conference on AIDS

"And this year there was a new emerging theme - that of new media’s role in the response to HIV. Case in point - at last year’s USCA in Florida, we had seven people attend our new media workshops. This year we had over 150 participants!"

Read more in AIDS.gov Blog, November 3, 2009.

Methamphetamine Treatment Increases in Vitro and in Vivo HIV Replication

"Our results provide further insights into the mechanisms by which methamphetamine accelerates disease course in HIV-infected individuals."

Read more in Methamphetamine Treatment Increases in Vitro and in Vivo HIV Replication, November 7, 2009.

Note: "Crystal" caused faster HIV replication in laboratory cells, and also in genetically engineered mice.

Sulfur Metabolism in AIDS: Cystamine as an Anti-HIV Agent

"Numerous reports have documented disturbances of sulfur metabolism in AIDS patients. There is a generalized loss of sulfur from the body, measured as cysteine and glutathione. ... A clinical trial of cystamine in AIDS is indicated."

Read more in AIDS Research and Human Retroviruses, November 3, 2009.

DOCTORS WITHOUT BORDERS WARNS OF LOOMING HIV FUNDING CRISIS

"A retreat from international funding commitments for AIDS threatens to undermine the dramatic gains made in reducing AIDS-related illness and death in recent years, according to a new report released today by the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF).

"International support to combat HIV/AIDS is faltering, as reflected in significant shortfalls among two of the world’s main funding mechanisms for HIV/AIDS. The board of directors of the Global Fund, a key financer of AIDS programs in poor countries, is unable to respond to countries’ needs. The board will vote next week in Addis Ababa whether or not to suspend all new funding proposals in 2010. The US President's Emergency Plan for Aids Relief (PEPFAR) , the American government’s AIDS program, is capping funding for two more years. This means that new patients will be turned away for treatment.

Report: Punishing Success: Early Signs of a Retreat from Commitment to HIV Care and Treatment."

Read more in Doctors Without Borders press release, November 5, 2009.

Therapeutic Vaccines: Steady Wins the Race

"Also of interest are personally tailored vaccine strategies, such as the one that made a splash earlier this month at AIDS Vaccine 2009, the annual meeting of the Global HIV Vaccine Enterprise, in Paris. AGS-004, being developed by North Carolina–based Argos, customizes immune system cells from each individual, using HIV fragments known as messenger RNA, to maximize an HIV-positive person’s immune response to the virus. To do this, dendritic cells are removed from the body and combined with mRNA taken from the same individual’s HIV. The data presented at the Paris conference showed that the vaccine, when given just before an ARV treatment interruption, kept viral loads at least 1 log—more than an 80 percent reduction—below pre-ARV therapy levels in 13 of 16 patients."

Read more in POZ, November 3, 2009.

NIAID Director Fauci Discusses Compelling Scientific Challenges in HIV/AIDS Research

"Even if access to scientifically proven HIV services were greatly improved by increased funding or improved efficiencies, slowing and ultimately ending the HIV/AIDS pandemic also will likely require major advances in two areas. First, curing a sizable proportion of those already infected with the virus such that lifelong therapy is not required; and, second, developing more powerful prevention tools to slow the rate of new infections. The authors assert that the scientific challenges related to these two goals are the most important issues in HIV/AIDS research today."

Read more in NIH News, November 3, 2009.

Reassurance for HIV-positive women about short-term risk of bone loss

"Short-term rates of bone loss are similar in younger HIV-positive and HIV-negative women, US investigators report in a study published in the online edition of the Journal of Acquired Immune Deficiency Syndromes.

"Although HIV-positive women had lower bone mineral density in the lower spine and neck on entry to the study, they had similar rates of bone loss during follow-up. Moreover, HIV treatment was not a risk factor for bone loss.

"'Our results provide some reassurance that short-term bone loss is modest in the majority of premenopausal, weight stable HIV+ women', write the investigators."

Read more in Aidsmap, November 5, 2009.

GSK and Pfizer launch joint HIV venture, ViiV Healthcare

"The company says that their research will not solely focus on creating new molecules, but will try to develop new formulations that are easier to adhere to, including paediatric fixed-dose combinations.

"Dominique Limet, the new chief executive, told Reuters that 'Our intent is to look at what we can do with the portfolio we get from Pfizer and Glaxo to build new combinations which will completely transform the way we treat HIV.'

"The company also states that it is committed to broadening access to medicines around the world and maintaining GSK’s Positive Action programme, which supports community projects."

Read more in Aidsmap, November 3, 2009.

New hepatitis C protease inhibitors achieve 80% ‘cure’ rate in patients with genotype 1 infection

"A course of hepatitis C (HCV) combination therapy including the experimental HCV protease inhibitor telaprevir (VX-950) has produced a sustained viral response (SVR) in over 80% of treatment-naïve, hepatitis C-mono-infected patients with HCV genotype 1.

"Another study found similar rates achieved by another protease inhibitor, boceprevir. The findings were annouced on Tuesday at the American Association for the Study of Liver Disease (AASLD) meeting in Boston, USA."

Read more in Aidsmap, November 3, 2009.

Zuma Rallies S. Africa to Fight AIDS

"In a culmination of his party’s major shift on AIDS, a disease that has led to plunging life expectancies here, President Jacob Zuma last week definitively rejected his predecessor’s denial of the viral cause of AIDS and of the critical role of antiretroviral drugs in treating it.

"Almost 10 years to the day after President Thabo Mbeki first suggested that AIDS drugs could pose “a danger to health” in an Oct. 28, 1999, speech in Parliament, Mr. Zuma declared Thursday in the same chamber, 'Knowledge will help us to confront denialism and the stigma attached to the disease.'

"In a country that now has more H.I.V.-infected people and annual AIDS deaths than any other, Mr. Zuma’s clarion call for a battle against the disease, six months into his term as president, led to rejoicing among advocates who had long sought such national leadership."

Read more in New York Times, October 31, 2009.

White House announces end to HIV travel ban

"President Obama called the 22-year ban on travel and immigration by HIV-positive individuals a decision "rooted in fear rather than fact" and announced the end of the rule-making process lifting the ban.

"The president signed the Ryan White HIV/AIDS Treatment Extension Act of 2009 at the White House Friday and also spoke of the new rules, which have been under development more more than a year. "We are finishing the job," the president said.

"The regulations are the final procedural step in ending the ban, and will be published Monday in the Federal Register, to be followed by the standard 60-day waiting period prior to implementation."

Read more in Washington Post blog, October 30, 2009.

HIV tamed by designer 'leash'

"Researchers have shown how an antiviral protein produced by the immune system, dubbed tetherin, tames HIV and other viruses by literally putting them on a leash, to prevent their escape from infected cells. The insights reported in the October 30th issue of the journal Cell, a Cell Press publication, allowed the research team to design a completely artificial protein -- one that did not resemble native tetherin in its sequence at all -- that could nonetheless put a similar stop to the virus.

"Tetherin is essentially a rod with anchors at either end that are critical for its function," says Paul Bieniasz of Howard Hughes Medical Institute and the Aaron Diamond AIDS Research Center at The Rockefeller University. Either one of those anchors gets incorporated into the envelope surrounding HIV or other viruses as they bud through the plasma membrane of an infected cell. "One anchor gets into the virus and the other in the cell membrane to inevitably form a tether.

"We showed we could design a completely different protein with the same configuration – a rod with lipid anchors at either end – and it worked very well," he continued. The finding helped to confirm that tetherin is capable of acting all on its own, he added.

"They also explain tetherin's broad specificity to protect against many viruses. "It is just targeting lipids," Bieniasz said. "It's not about viral proteins." That's conceptually important, he continued, because there is no specific interaction between tetherin and any viral protein, which makes it a more difficult problem for viruses to evolve resistance. Rather than tweaking an existing protein-coding gene, "the virus has to make the more difficult adjustment of acquiring a new gene antagonist [of tetherin]."

"Unfortunately, many viruses have managed to do just that. In the case of HIV, a protein called Vpu counteracts tetherin. They now show it does so by sequestering the host protein, which prevents its incorporation into the virus. The new insight into tetherin's and Vpu's modes of action, however, may lead to the development of Vpu blockers that could free up the innate host defense and inhibit HIV's spread, Bieniasz suggests."

Read more in EurekAlert!, October 29, 2009.

Beyond Thailand: Making Sense of a Qualified AIDS Vaccine "Success"

By Jon Cohen: "When researchers announced on 24 September that an AIDS vaccine trial had positive results for the first time in history, many wondered whether they were real. Some prominent skeptics remain, but that debate has largely given way to intense discussions about how to build on this surprising finding. Already, researchers have begun discussing the staggering challenge of probing blood samples from the more than 16,000 people in Thailand who participated in the trial to figure out which immune responses led to the modest protection reported. The key question is whether the study will help reveal the long-sought immune responses that correlate with protection."

Subscribers only read more in Science, October 30, 2009.

S.F. AIDS meeting has real-world focus

"More than 3,000 public policy experts, health educators, patients and their advocates are expected to attend this week's U.S. Conference on AIDS in San Francisco. ...

"A lot of AIDS and HIV conferences are about the data and the numbers and the research, or they're for the doctors. This is really geared toward the grassroots people," said Jason Riggs, a spokesman for the Stop AIDS Project in San Francisco. "It's about providing training and networking, so people can advocate in their own communities for the things that people affected by HIV really need."

Read more in San Francisco Chronicle, October 29, 2009.

High prevalence of anal chlamydia in Swiss HIV-positive gay men

"A large proportion of HIV-positive gay men in Switzerland have anorectal infection with chlamydia, investigators report in the November 15th edition of Clinical Infectious Diseases. The researchers suggest that undiagnosed anal chlamydia infections could be contributing to the continued spread of HIV amongst gay men in Switzerland."

Read more in Aidsmap, October 29, 2009.

Darunavir/ritonavir, etravirine and raltegravir has 'remarkable' success in children with resistant virus

"A combination of darunavir/ritonavir, etravirine, and raltegravir is “remarkably” effective in HIV-positive adolescents with extensive prior experience of antiretroviral therapy, French investigators report in the November 13th edition of AIDS. The study involved twelve adolescents, and all but one had a viral load below 400 copies/ml after a year of treatment with this combination. Impressive improvements in CD4 cell counts were observed and there were no serious side-effects.

"'This [study] demonstrates that, as in adults, the majority of extensively treated adolescents can be virologically controlled with by a salvage regimen consisting of a combination of new drugs, despite a long record of suboptimal treatment and viral multiresistance', write the investigators."

Read more in Aidsmap, October 30, 2009.

Scientists Discover Gene that 'Cancer-Proofs' Rodent's Cells

"Despite a 30-year lifespan that gives ample time for cells to grow cancerous, a small rodent species called a naked mole rat has never been found with tumors of any kind—and now biologists at the University of Rochester think they know why.

"The findings, presented in today's issue of The Proceedings of the National Academy of Sciences [October 27], show that the mole rat's cells express a gene called p16 that makes the cells "claustrophobic," stopping the cells' proliferation when too many of them crowd together, cutting off runaway growth before it can start. The effect of p16 is so pronounced that when researchers mutated the cells to induce a tumor, the cells' growth barely changed, whereas regular mouse cells became fully cancerous."

Read more in University of Rochester press release, October 27, 2009.

Hepatitis C coinfection doesn't increase risk of progression to AIDS

"A meta-analysis of over 30 studies involving in excess of 100,000 patients with HIV has shown that hepatitis C co-infection does not increase the risk of progression to AIDS. The study is published in the November 15th edition of Clinical Infectious Diseases, and is now available online.

"However, the researchers did find that in the period since effective anti-HIV treatment became available, co-infected patients still have a 35% higher risk of death compared to patients who only have HIV. The investigators believe that that 'the major contributor to mortality among coinfected subjects during the HAART [highly active antiretroviral therapy] era is likely to be liver disease.'

"Antiretroviral therapy means that many people with HIV can look forward to a long and healthy life. However, the predicted prognosis of individuals co-infected with HIV and hepatitis C is significantly shorter than that of patients who are infected with HIV alone."

Read more in Aidsmap, October 27, 2009.

Fighting H.I.V., a Community at a Time

"Federal health officials are preparing a plan to study a bold new strategy to stop the spread of the AIDS virus: routinely testing virtually every adult in a community, and promptly treating those found to be infected."

Read more in New York Times, October 26, 2009.

TRIPS+ negotiations - death sentence for thousands Ukrainians - please support our protest!!!!

"Dear friends,

"I would like to turn for your support in our advocacy effort to prevent harmful effect of TRIPS+ that Ukraine is currently pushed to accept in EFTA negotiations. We received this information from the reliable source right on the day of the negotiations as the process itself is extremely closed and healthcare sector is not involved into this process. The TRIPS+ provisions are extremely strict and carry real risk of interruption of treatment for more than 10 000 patients with HIV that are on HAART in Ukraine now, but present overall danger for the whole healthcare sector of Ukraine and particularly to the area of access to essential medicines.

"Ukraine is pushed to accept:

"Patent term extensions for medicines for 5 years: the condition which is not taken even in western countries (like US)

"Data exclusivity for 8 years for medicines

"Patent for the new use of old medicines

"These are some of the most outrageous demands that Ukraine has faced with. Accepting such conditions will mean blockage of use of generic medications that currently are the key part of the 1st and 2nd line treatment schemes of HAART in Ukraine which will lead to potential treatment interruption for thousands of people. In nearest future, Ukraine is signing upon death penalty for thousands of people who will require innovative treatment regimen, who are suffering from co-infection of HIV/Hepatitis C and finally for people with MDR-TB which is becoming a first cause of mortality in Ukrainians living with HIV.

"We call upon you to send your letters of protest against accepting these draconian regulations by Ukraine to the current officials and addresses:

Ministry of economy of Ukraine
Ukraine, Kyiv, Grushevskogo Str. 12/2
Mr Danilishin Bogdan Michailovich
Fax: ph. (+38044) 272-5507, fax (+38044) 272-5546
Email: a_hryshko@hotmail.com

Ministry of Health of Ukraine
Ukraine, Kyiv, Grushevskogo 37
Mr Knyazevich Vasil Michailovich
Tel/Fax +38044 253 24 72


"If you have any questions – please write to me directly

Konstantin Lezhentsev
All-Ukrainian Network of PLWH
87 "В", Mezhyhirska St.,
Kyiv, Ukraine 04071
Tel.: +38 (044) 467 7567; 467 7569; 467 7584; ext. tel. 746
Fax: +38 (044) 467 7566"


Comment, by JSJ: The bullying of smaller countries continues -- to make them sacrifice lives of their people for the benefit of foreign profiteers.

Apparently Obama cannot help because he needs the pharmaceutical industry to help get U.S. healthcare passed.

Co-Payment Assistance for Wasting Drug Serostim

"People with private health insurance using Serostim (recombinant human growth hormone) can now save up to $200 per month on their monthly co-payments, according to information released by the drug’s maker, EMD Serono. The co-payment card, available through health care providers prescribing Serostim, can be used up to six times during a one-year period."

Read more in POZ, October 21, 2009.

Wingnuts Target Jennings & Harvard's ACT UP Exhibit

"They're running out of ammo. The right-wing nuts that have been trying, and miserably failing, to bring down Kevin Jennings, Obama's "safe schools czar," are now trying to use ACT UP as a smear (see WorldNetDaily). It seems Kevin was one of many supporters for a currently running exhibit at Harvard titled ACT UP New York: Activism, Art, and the AIDS Crisis, 1987-1993, which the wingnuts are calling "radical porn" (click on the exhibit poster for a closer look). Even worse, he may have even been a member of ACT UP way back when. The horror!"

Read more in Peter's POZ Blog, October 22, 2009.

Syringe programs return $4 for every $1 invested

"Distributing syringes to drug injectors had prevented at least 32,000 HIV infections and 100,000 hepatitis C infections across Australia in the past 10 years, new research has found.

"Harm reduction campaigner, Mr John Ryan, said the national Return on Investment 2 study showed that needle and syringe programs (NSP) had saved Australia $1.28 billion in health costs in the past decade years.

"The study was funded by the Federal Government’s Department of Health and Ageing. It was conducted by the National Centre in HIV Epidemiology and Clinical Research. The study will be launched on Thursday October 22 in Sydney.

"'Nationally, more than 32,000 HIV and almost 100,000 hepatitis C infections have been prevented by providing sterile syringes and counselling to injectors in the past nine years,' said Mr Ryan who is Chief Executive Officer of the Association for Prevention and Harm Reduction Programs Australia (Anex).

"Australia has one of the most extensive NSP networks in the world. It has one of the lowest HIV rates among injectors globally.

"'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,' Mr Ryan said.

"Heroin remains the most commonly injected illicit drug in Australia, followed by amphetamines. The lower the HIV rate among injectors, the safer the general community was, Mr Ryan said.

"'This proves yet again that syringe programs protect the community and are excellent value for money. Total government funding for NSP nationally was only $27 million a year on average. But, that has saved taxpayers more than $1.3 billion since 2000,” said Mr Ryan. Distributing syringes to drug injectors had prevented at least 32,000 HIV infections and 100,000 hepatitis C infections across Australia in the past 10 years, new research has found.

"Harm reduction campaigner, Mr John Ryan, said the national Return on Investment 2 study showed that needle and syringe programs (NSP) had saved Australia $1.28 billion in health costs in the past decade years.

"The study was funded by Federal Government’s Department of Health and Ageing. It was conducted by the National Centre in HIV Epidemiology and Clinical Research. The study will be launched on Thursday October 22 in Sydney. ...

"The full report is called Return on Investment 2: evaluating the cost effectiveness of needle and syringe programs in Australia. It can be downloaded at www.anex.org.au"

Read more in Return on Investment 2 [large download], October 21, 2009.

Etravirine, darunavir/ritonavir and raltegravir very effective in highly treatment-experienced patients

"A combination of raltegravir, etravirine and darunavir/ritonavir is highly effective at suppressing viral load to undetectable levels in treatment-experienced patients, French investigators report in the November 1st edition of Clinical Infectious Diseases.

"All 100 patients in the 48-week, prospective, non-comparator study had multiple resistance mutations to protease inhibitors and nucleoside reverse transcriptase inhibitors (NRTIs). Nevertheless, after a year of treatment with the three new drugs, 86% had a viral load below 50 copies/ml."

Read more in Aidsmap, October 19, 2009.

Towards a genetic AIDS vaccine

"The study by Philip Johnson and his colleagues of the Children’s Hospital in Pennsylvania published in a recent issue of Nature Medicine presents an unorthodox, yet surprisingly simple approach. These authors used gene transfer technology to produce antibody-like molecules in the blood that effectively block viral infection [2]. First, they created artificial antibody-like proteins called immunoadhesins that were specifically designed to bind to the simian immunodeficiency virus (SIV) that infects macaques to cause an AIDS-like disease. Second, a gene therapy approach was used to deliver the antiviral immunoadhesin gene into the macaques. This immunoadhesin gene therapy approach bypasses the immune system altogether, and promising results were reported in the pre-clinical macaque model. The insights gained from how to achieve protection against SIV infection by a gene therapy approach could possibly be translated to the control of HIV-1 infection in humans."

Read more in Retrovirology, October 16, 2009 (anyone can download a provisional PDF of the article).

Relapse common in HIV/HCV co-infected patients after treatment for HCV

"Relapse after apparently successful treatment for hepatitis C virus occurs in over a third of individuals who are co-infected with HIV and hepatitis C, Spanish investigators report in the November 1st edition of Clinical Infectious Diseases.

"Relapses were more common in co-infected patients who carried the harder-to-treat hepatitis C 1 and 4 genotypes. Most relapses occurred within three months of the completion of hepatitis therapy, and re-infection with hepatitis C accounted for most of the apparent relapses seen after this time."

Read more in Aidsmap, October 19, 2009.

Note: Also see If HCV Treatment Relapse Occurs, It Occurs Quickly, in POZ.

Vitamin D for Cancer Prevention: Global Perspective

"RESULTS/CONCLUSIONS: It is projected that raising the minimum year- round serum 25(OH)D level to 40 to 60 ng/mL (100–150 nmol/L) would prevent approximately 58,000 new cases of breast cancer and 49,000 new cases of colorectal cancer each year, and three fourths of deaths from these diseases in the United States and Canada, based on observational studies combined with a randomized trial. Such intakes also are expected to reduce case-fatality rates of patients who have breast, colorectal, or prostate cancer by half. There are no unreasonable risks from intake of 2000 IU per day of vitamin D3, or from a population serum 25(OH)D level of 40 to 60 ng/mL. The time has arrived for nationally coordinated action to substantially increase intake of vitamin D and calcium."

Read more in OncologySTAT, October 16, 2009.

Comment: Personally I've been taking 1,000 IU, and may stay with that for now.

IL-2’s Downfall Might Have Been Inflammation

"The failure of Proleukin (Interleukin-2, IL-2) to demonstrate a clinical benefit in the SILCAAT and ESPRIT studies earlier this year might have resulted because the drug increased immune system inflammation, according to an article published October 15 in The New England Journal of Medicine (NEJM)."

Read more in POZ, October 15, 2009.

Columbia University Publishes Free HIV Handbook Online

"Columbia University in New York City has published a revised edition of its comprehensive HIV/AIDS handbook, intended for those at risk of HIV infection and people currently living with the virus. You can download the 116-page document for free using the link here.

"The Columbia Handbook on HIV and AIDS combines and updates two previous works originally published by Simon & Schuster (Pocket Books): The Essential AIDS Fact Book and The Essential HIV Treatment Fact Book. The new handbook, which some have called an AIDS bible, offers key information on HIV transmission and prevention methods plus the basics of HIV treatment."

Read more in POZ, October 13, 2009.

HIV Eradication: One Step Closer

"Hopes for HIV eradication have been stymied by the current crop of antiretroviral drugs’ inability to get at the reservoir of inactive HIV-infected CD4 cells that hide in the body. Now, Robert Siliciano, MD, PhD, from Johns Hopkins University says not only that it’s possible to get at these cells, but that his lab is already on track to identifying drugs that can wake up these cells. The discovery represents a significant step on the path to ultimately curing HIV. ...

"The only way to get at this virus is to activate the resting memory CD4 cells, but turning them all on at the same time could be deadly. So how can you turn on only the cells that are infected?

"This seemingly impossible task is exactly what Siliciano and his colleagues set out to tackle. Using a line of cells that they’ve developed, researchers can determine whether various chemical compounds can activate resting CD4s infected with HIV. They’ve already found a handful of compounds that can selectively activate infected cells. While none of these are likely to be safe enough for human use, Siliciano’s group is going to keep looking, and their accomplishment represents a significant step forward in the search for a cure.

"'I’d always been pretty pessimistic about this whole approach,' Siliciano says, “but in looking at about 4,000 drugs, we got nine 'hits.' It wasn’t actually that hard to find these drugs.'"

Read more in POZ, October 13, 2009.

Robert Scott, M.D. - Renowned American HIV specialist dies

"Dr Robert Scott, a renowned American doctor who has worked treating HIV and AIDS patients in Zimbabwe for nearly 10 years, has died.

"The Late Dr. Robert Scott, M.D. Dr Scott passed away on October 8 in Oakland, California from complications arising from blood clots. Dr Scott was known both as an HIV/AIDS specialist and an advocate for people living with HIV/AIDS in America as well as in Zimbabwe. ...

"All the patients in Zimbabwe were treated free of charge through the efforts of the AIDS Ministry, which he co-founded at his home church, the Allen Temple Baptist Church in Oakland California."

Read more in The Zimbabwe Times, October 12, 2009.

H1N1 Vaccine Studies in HIV-Positive Youth and Pregnant Women

"'These studies are important because HIV infection and pregnancy both increase the risk for a poor immune response,' explained Anthony Fauci, MD, the director of NIAID. 'Moreover, children, young people and pregnant women are at higher risk for more severe illness from the 2009 H1N1 influenza virus ("swine flu") than other groups, and HIV-infected individuals in these populations may be particularly vulnerable.'"

Read more in POZ, October 12, 2009.