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July 31, 2009

HIV Infection and Chronic Drinking Have a Synergistic, Damaging Effect on the Brain

"Although individuals with either HIV infection or alcoholism generally performed at normal levels, individuals comorbid with HIV infection and alcoholism were impaired relative to controls and to the single-diagnosis groups on selective memory processes,” wrote the study authors. “Immediate episodic memory was impaired, whereas working memory remained intact.” Over one year, little change in performance between the groups was detected. The study’s results could not be explained by lifetime alcohol use, CD4 cell count, AIDS diagnosis or antiretroviral therapy, the researchers found."

Read more in CDCNPIN, July 31, 2009.

Diabetes treatment goals as likely to be met in HIV-positive patients as those without HIV

"Targets for the management of diabetes are as likely to be achieved in HIV-positive as HIV-negative individuals, US investigators report in the September 1st edition of Clinical Infectious Diseases."

Read more in Aidsmeds, July 30, 2009.

re: NIAID News Release, Bulletin: Study Suggests Immune Systems of Untreated HIV-Infected Individuals May Deteriorate Faster than Previously Thought

[republished with corrected link - JSJ]

"The immune systems of untreated HIV-infected individuals appear to deteriorate faster than previously thought, according to preliminary results of a small clinical trial. This finding suggests that clinicians may need to monitor people with recent HIV infection as closely as they monitor people with more advanced disease, the study investigators postulate. ...

"The trial has been stopped ahead of schedule because, during a routine interim review, an independent data and safety monitoring board (DSMB) determined that the early treatment group had a superior outcome largely driven by HIV disease progression in the deferral group."

Read more in NIAID, July 29, 2009. [CORRECTED LINK]

High Prevalence of Vitamin D Deficiency in HIV-Positive Men

"Overall, 42 percent of the men in the study had vitamin D deficiency, with 11.3 percent having severe deficiency. After considering factors such as low CD4 count and BMI, researchers found a trend toward greater vitamin D deficiency in people who had taken non-nucleoside reverse transcriptase inhibitors (NNRTIs), such as Viramune (nevirapine) and Sustiva (efavirenz) compared with protease inhibitors. Smoking also was highly correlated with extremely low vitamin D levels.

"The authors recommend routine clinical screenings for vitamin D in HIV-positive patients. They also call for further research to explain or debunk the connection between NNRTIs and vitamin D deficiency."

Read more in POZ, July 29, 2009.

Comment: It appears that the smoking result is the strongest one here -- and that low vitamin D is a significant risk for anyone with HIV. This study was done in New York City.

House Bill Lifts Ban On Needle Exchanges

"The House on Friday approved a bill that would lift the 21-year ban on using federal money for needle exchange programs, a move that could give the District and other cities more flexibility in their efforts to prevent the spread of HIV and AIDS among intravenous drug users.

"This is the first time in over 20 years that we are on the verge of recognition by the federal government of the proven cost-effectiveness and impact of syringe exchange as a very important tool for prevention of HIV infection and viral hepatitis," said Ronald Johnson, deputy executive director of AIDS Action, a Washington-based advocacy group. "Allowing the local community to use federal funds is very critical to stopping these epidemics."

"But the bill, sponsored by Rep. David Obey (D-Wis.), includes a restriction against using the money to assist any program that distributes needles within 1,000 feet of day-care centers, schools, parks, playgrounds, pools and youth centers."

Read more in Washington Post, July 25, 2009.

Comment: In Philadelphia at least, this restriction would cover just about all of the city, making Federal funding for needle exchange almost impossible here. The provision was added to get more votes for the bill.

Longitudinal association of alcohol use with HIV disease progression and psychological health of women with HIV

"Regardless of ART use, depression had a significant negative effect on CD4+ T-cell counts over time."

Read more in AIDS Care, July 2009.

July 30, 2009

Authorities raid office of Chinese health activist

"Chinese authorities seized dozens of newsletters from a nonprofit group that fights discrimination against people with hepatitis B, a campaigner said Thursday, calling the move retribution for the group's advocacy work.

"Two officials from the Beijing Cultural Law Enforcement Agency, in charge of campaigns against printed and DVD pornography and piracy, on Wednesday confiscated about 90 copies of a legal guide to fighting discrimination for people with hepatitis B.

"A spokeswoman for the agency, Li Fei, confirmed the group was being investigated for publishing material without a required license. She would not comment further.

"The 40-page guides, published by the Beijing non-governmental organization Yirenping, include information about Chinese law, a practical guide to reporting violations and filing lawsuits, as well as details about successful anti-discrimination cases, said Lu Jun, the group's founder. He denied doing anything illegal."

Read more in Newsvine, July 29, 2009.

Nevirapine matches atazanavir/ritonavir in 48-week study

"Nevirapine has equivalent efficacy to atazanavir/ritonavir when combined with tenofovir and FTC in treatment-naive patients, results from the ARTEN study show."

Read more in Aidsmap, July 29, 2009.

ddI treatment sole risk factor for noncirrhotic portal hypertension

"Prolonged treatment with ddI (didanosine, Videx) is the sole factor significantly associated with the development of noncirrhotic portal hypertension in HIV-positive individuals, Swiss investigators report in the August 15th edition of Clinical Infectious Diseases.

"The investigators recommend that 'a high index of suspicion is needed in ddI-exposed patients with clinical signs of liver disease'."

Read more in Aidsmap, July 29, 2009.

July 29, 2009

Snap survey reveals medicine stockouts still plague Kenya, Malawi, Uganda and Zambia

"During 'pill check week', researchers visited public health institutions countrywide and checked on the availability of a list of 10 essential medicines. These are medicines that should be readily available in public health facilities.

"Using innovative technology, the team then reported the results through short messaging services (SMS) to a common site, and the data has been reflected in the map above that shows areas where medication is out of stock."

Read more in, July, 2009.

Comment: Shortages of antiretrovirals and other medicines are becoming worse and worse, due to the financial crisis, and the widespread government habit of spending vastly more on war than on health.

Antidepressants May Be Helpful With Fatigue

"Antidepressant drugs may help alleviate symptoms of fatigue, even in HIV-positive people who are not otherwise depressed. These findings were presented at the Fifth International AIDS Society (IAS) Conference on HIV Pathogenesis, Treatment and Prevention in Cape Town.

"Fatigue and depression often go hand in hand. People with fatigue often struggle with depression, and people with clinical depression also frequently have fatigue."

Read more in POZ, July 28, 2009.

Genotypic tests matches tropism test in predicting who benefits from CCR5 inhibitors

"A genotypic test is just as accurate as a more expensive tropism test in determining which treatment-experienced patients are suitable for treatment with the CCR5 inhibitor maraviroc, researchers from the University of British Columbia reported at the Fifth International AIDS Society conference in Cape Town last week.

"The finding opens the prospect of much cheaper testing to determine eligibility for CCR5 inhibitor treatment, and coincides with a re-analysis of 96-week results from the MERIT study showing that maraviroc is just as effective as efavirenz in treatment-naive patients, albeit better tolerated."

Read more in Aidsmap, July 29, 2009.

Governor Schwarzenegger Slashes Lifesaving HIV/AIDS Programs

"Project Inform today expressed shock at Governor Schwarzenegger’s budget veto that gutted vital HIV care, testing, housing and prevention services in the final Fiscal Year 2010-11 budget. The California Legislature had agreed to a compromise proposal that would have allowed for responsible cuts to HIV programs, but fundamentally protected core efforts in the fight against HIV. However, the State Assembly failed to approve $1.1 billion in available revenues and the Governor used his line-item veto authority to eliminate state funding for all HIV programs except the AIDS Drug Assistance Program (ADAP) and surveillance."

Read more in Project Inform, July 28, 2009.

July 26, 2009

Efavirenz, Race Linked to Vitamin D Deficiency

"People on a regimen containing efavirenz (Sustiva or Atripla) had a higher risk of having low vitamin D levels—which can lead to bone problems—than people on a protease inhibitor regimen. The study, which also found race and season of the year to play a role in vitamin D levels, was presented at the Fifth International AIDS Society (IAS) Conference on HIV Pathogenesis, Treatment and Prevention in Cape Town. ...

"Welz’s team found that low vitamin D levels were nearly universal in their cohort of patients, but that certain groups were much more likely to have very low levels. Those with very low vitamin D levels included black patients, patients whose levels were tested during the winter, and patients currently taking efavirenz."

Read more in POZ, July 23, 2009.

Note: The patients in this study were treated in London.

Zinc Supplements Prevent Immune Decline in Chronic Substance Users

"Chronic drug users who were treated with zinc supplements were less likely to see their CD4 counts fall below 200 than people taking a placebo, according to a study presented at the Fifth International AIDS Society (IAS) Conference on HIV Pathogenesis, Treatment and Prevention in Cape Town. ...

"For the first 12 months of the study there was no statistical difference between the two groups. By the 18th month, however, people on the placebo were four times as likely to reach immunologic failure as those who got zinc supplements. This result held up even when controlling for age, gender, lack of food, baseline CD4, viral load and ARV therapy."

Read more in POZ, July 23, 2009.

Comment: This result suggests that the supplement was working in the first year, but the study had not reached statistical significance yet. Looking for treatment failure only gives one data point per patient, so it's hard to fund and enroll studies big enough and long-lasting enough to get statistical proof.

Anal cancer in men with HIV much more common in post-HAART era: could HPV vaccination help?

"The annual incidence of anal cancer amongst people with HIV has continued to increase in recent years and now stands at 128 cases per 100,000 or one case in 784 people, the Fifth IAS Conference was told on Wednesday by Nancy Crum-Cianflone of the US Infectious Disease Clinical Research Program. This is nearly 100 times the rate in the general population (1.4 per 100,000).

"In a separate presentation, Stephen Berman of the Veterans Administration Healthcare System told the conference that findings from a study of HIV/HPV co-infected army veterans implied that up to 89% of men with HIV could potentially derive at least some benefit from one of the currently-licensed HPV vaccines and 53% substantial benefit, providing that HIV infection did not compromise the normal immune response to the vaccine."

Read more in Aidsmap, July 23, 2009.

Efavirenz Five-Days-On, Two-Off, Works as Well as Continuous Treatment

"People who took a regimen including efavirenz (found in Sustiva and Atripla) for five days each week, with two-days off over the weekend, had similar viral load reductions and side effects as people who took their regimen continuously. What’s more, people on the on-off approach reported universally that they preferred intermittent therapy to continuous therapy. Cal Cohen, MD, from the Community Research Initiative (CRI) in Boston, presented the study at the Fifth International AIDS Society (IAS) Conference on HIV Pathogenesis, Treatment and Prevention in Cape Town."

Read more in POZ, July 22, 2009.

People on Sustiva Have Less Risk for Treatment Failure Than People on Kaletra

"People taking a regimen containing efavirenz (found in Sustiva and Atripla) appear to have less chance of virologic failure on treatment than people on a regimen including lopinavir/ritonavir (Kaletra), no matter their initial CD4 count. The study was presented at the Fifth International AIDS Society (IAS) Conference on HIV Pathogenesis, Treatment and Prevention in Cape Town by Heiner Bucher, MD, MPH, from the University Hospital Basel in Switzerland. The study adds another voice to a chorus of conflicting previous studies comparing the two treatments."

Read more in POZ, July 22, 2009.

Isentress Going Strong After Three Years in Treatment Starters

"Long-term data from a Phase II clinical trial show that Merck’s integrase inhibitor Isentress (raltegravir) works just as well as mainstay therapy efavirenz (found in Sustiva and Atripla) in HIV-positive individuals starting treatment for the first time. These encouraging results were reported Monday, July 20, by Eduardo Gotuzzo, MD, of the Hospital Nacional Cayetano Heredia in Lima, Peru, and his colleagues at the Fifth International AIDS Society (IAS) Conference on HIV Pathogenesis, Treatment and Prevention in Cape Town."

Read more in POZ/AIDSMEDS, July 21, 2009.

Once-daily Kaletra as safe and effective as twice-daily dosing

"Lopinavir/ritonavir (Kaletra) taken once-daily as part of a combination antiretroviral regimen worked as well as the approved twice-daily dose in previously treated patients but led to better adherence, researchers reported on Tuesday at the Fifth International AIDS Society Conference on HIV Pathogenesis, Treatment, and Prevention in Cape Town, South Africa.

"Past studies have shown that once-daily and twice-daily Kaletra work equally well in people starting treatment for the first time. Study M06-802 was designed to see whether this was also the case for treatment-experienced patients. There had been previous concerns that once-daily Kaletra might be less effective in treatment-experienced patients."

Read more in Aidsmap, July 24, 2009.

DREAM study: Extended prenatal ART protects against mother-to-child transmission of HIV at low and high CD4 levels

"Antiretroviral therapy (ART) administered during pregnancy and breastfeeding reduces the risk of a woman transmitting HIV to her infant to just 2% by the time the child is six months of age — even without caesarean sections or formula feeding, according to a retrospective analysis of participants in the Drug Resource Enhancement against AIDS and Malnutrition (DREAM) programme in sub-Saharan Africa, presented this week at the International AIDS Society conference in Cape Town. "

Read more in Aidsmap, July 24, 2009.

Mma Bana study: Mother to child transmission reduced below 1% in breastfeeding mothers who receive ART

"Antiretroviral treatment during pregnancy and breastfeeding resulted in a mother-to-child transmission rate of less than 1% in a large randomised comparison of two triple combinations in women with CD4 counts above 200 cells/mm3, the Mma Bana study, presented this week at the Fifth International AIDS Society conference in Cape Town.

"The study also showed that a triple-nucleoside analogue regimen containing abacavir is just as effective as a protease inhibitor-based regimen in a population of women with relatively low viral load (Trizivir has previously shown itself to be less effective than efavirenz-based ART in people with viral loads above 100,000 copies/ml, leading to its withdrawal from the list of recommended first-line regimens in the United States and Europe)."

Read more in Aidsmap, July 24, 2009.

Kesho Bora study: Maternal ART during pregnancy and breastfeeding prevents more infections than short-course prophylaxis

"Antiretroviral treatment for mothers started during pregnancy and continued throughout the breastfeeding period resulted in a significantly lower rate of mother to child HIV transmission when compared with the standard short-course regimen, investigators on the Kesho Bora study reported this week at the Fifth International AIDS Society conference in Cape Town.

"The Kesho Bora study, conducted in Kenya, South Africa and Burkina Faso, found that antiretroviral treatment for the mother with a protease inhibitor-based regimen was significantly more effective than short course treatment in which the mother took AZT from week 28-36 of pregnancy with AZT/3TC and single dose nevirapine at the onset of labour, and AZT/3TC for one week, while the infant received single dose nevirapine with one weeek of AZT/3TC, and was either formula fed or breastfed with weaning at 6 months."

Read more in Aidsmap, July 24, 2009.

July 25, 2009

A Quad NRTI Regimen Fails to Perform

"A quadruple combination of four drugs from the same class—Truvada (tenofovir plus emtricitabine), Retrovir (zidovudine) and Ziagen (abacavir)—is inferior to standard three-drug regimens containing either a protease inhibitor (PI) or a non-nucleoside reverse-transcriptase inhibitor (NNRTI). These data were presented at the Fifth International AIDS Society (IAS) Conference on HIV Pathogenesis, Treatment and Prevention in Cape Town."

Read more in Aidsnews, July 24, 2009.

BAN study: Giving ART to mothers or ARV prophylaxis to infants during breastfeeding equally effective at reducing HIV transmission

"Maternal antiretroviral therapy (ART) or infant prophylaxis during the time of breastfeeding are equally safe and effective in reducing post-natal mother-to-child transmission of HIV, Dr Charles Chasela of the University of North Carolina Project in Lilongwe, Malawi, reported to the Fifth International AIDS Society conference on Wednesday.

"He presented the findings of the Breastfeeding, Antiretroviral and Nutrition (BAN) Study as a late-breaker at IAS 2009 in Cape Town - making it the fifth major study at the conference evaluating ways to make it possible for an HIV-infected mother to breastfeed her infant without passing on HIV."

Read more in Aidsmap, July 24, 2009.

July 23, 2009

Aciclovir reduces disease progression and death in people with HIV by nearly 20 per cent

"HIV positive people given 400mg of aciclovir twice-daily as part of a trial to see if the drug reduced HIV transmission in serodiscordant couples were 17% less likely to progress to AIDS, to have to start antiretroviral therapy, or die, the Fifth IAS Conference was told on its final day. This effect was statistically significant (p=0.03)."

Read more in Aidsmap, July 23, 2009.

Boosted and unboosted atazanavir maintain viral suppression equally well

"Unboosted atazanavir (Reyataz) taken once-daily as part of a combination antiretroviral regimen can keep viral load undetectable in patients who discontinue ritonavir, researchers reported on Wednesday at the Fifth International AIDS Society Conference on HIV Pathogenesis, Treatment, and Prevention in Cape Town, South Africa.

In the ARIES trial, more than 500 treatment-naive HIV patients started a regimen of boosted atazanavir/ritonavir (300/100 mg) taken once daily plus the fixed-dose abacavir/3TC combination pill (Kivexa). "

Read more in Aidsmap, July 23, 2009.

Boosted darunavir monotherapy works well in two studies

"Ritonavir-boosted darunavir (Prezista) alone maintains HIV suppression in most patients who achieved an undetectable viral load on combination antiretroviral therapy, according to two studies presented this week at the Fifth International AIDS Society Conference on HIV Pathogenesis, Treatment, and Prevention in Cape Town, South Africa."

Read more in Aidsmap, July23, 2009.

July 22, 2009

Taking Steps to Improve Bone Health

"...Low vitamin D levels are clearly linked to bone mineral problems, and people can take supplements if theirs is low. This is especially important for people in Northern latitudes who don’t get as much exposure to the sun during the long and cold winters.

"Important too, are healthy lifestyle choices. “There are general lifestyle measures that are important for general health, [bone health] and prevention of cardiovascular disease, like smoking cessation. We know that smoking is a risk factor for osteoporosis. Weight bearing exercise (also helps),” Glesby notes.

"Studies in elderly HIV-negative people have found that weight bearing exercise can slow bone mineral loss. “Encouraging people to at least walk,” Glesby says, “will help with bone density.”

"Numerous studies have also found that people who are too thin for their height, called low body mass index, or low BMI, have an increased risk for bone loss. So eating a rich and healthy diet and taking other measures to prevent excessive weight loss may also be key."

Read more in POZ, July 21, 2009.

AIDS exceptionalism a defensible concept, says Stephen Lewis

"The idea that AIDS is an exceptional disease requiring an exceptional response is a perfectly defensible concept, Stephen Lewis, the former UN Special Envoy on AIDS in Africa told the opening session of the Fifth International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention last night in Cape Town.

"He also accused critics of the levels of AIDS funding of acting from base motives of resentment and professional envy.

"Lewis’s strong words are the first signs that leading figures in the AIDS field are preparing to make a much more aggressive defence of current levels of funding, following mounting criticisms that HIV is receiving a distorted share of global health resources, and that funding allocations are being driven by donor fashions rather than country needs. ...

"'You just can’t permit an intellectual contrivance - an argument in favour of accepting the size of the pie and slicing it differently, rather than demanding a larger pie - you can’t allow that to be used to justify a terrible reversal in public policy. People infected with HIV or at risk of infection, are suddenly tossed onto the landscape of treatment ambiguity, and the gains we’ve made and the momentum we’ve achieved are put at risk."

Read more in Aidsmap, July 20, 2009.

July 20, 2009

South Africa tests new Aids vaccine

"South Africa is launching clinical trials of the first Aids vaccines created by a developing country, a feat by scientists who forged ahead even when some of their political leaders shocked the world with unscientific pronouncements about the disease. ...

"A trial of 12 volunteers in the US began earlier this year.

"Mbewu said the vaccine was designed at the University of Cape Town with help from the US National Institutes of Health, which also manufactured the vaccine.

"Dr Anthony Fauci, director of the US National Institute of Allergy and Infectious Disease and a leading Aids researcher, was in South Africa for the launch."

Read more in Daily News (South Africa), July 20, 2009.

July 19, 2009

US legislation seeks to expand open access to all government funded research

"The Federal Research Public Access Act 2009 would expand the current policy that governs the National Institutes of Health to include all other agencies that spend at least $100m (£61m; 71m) a year on research. It also would cut the period from publication to full open access from 12 months to six."

Read more in British Medical Journal, July17 , 2009.

HIV: Male Circumcision Does Not Shield Women

"While several trials in recent years have found foreskin removal reduces men’s risk of HIV infection by up to 65 percent, a new study shows the procedure has no protective benefit for their female partners.... Most of the infections occurred in the circumcised group within six months of the procedure. This may have been due to some of the men not waiting for the circumcision wound to heal properly, thus exposing their partners to HIV-infected blood, they noted."

Read more in NPIN, July 16, 2009.

South Africa: Huge Surge in Maternal Deaths

"There has been a 20 percent increase in maternal deaths between 2005 and 2007, when compared to the previous three-year period, with HIV/AIDS accounting for over 40 percent of the deaths (43.7%).

"Almost four (38.4%) out of every 10 deaths were "clearly avoidable within the health care system", according to researchers, which means they could have been prevented with proper care."

Read more in, July 18, 2009.

G8 leaders must keep their AIDS promises, IAS conference told

"Professor Julio Montaner, President of the International AIDS Society rebuked international leaders for their failure to deliver on the promise of universal access to treatment and prevention made at the Gleneagles G8 summit in 2005.

“The UK put AIDS on the G8 agenda, we call on the UK to keep it on the G8 agenda …We must hold the G8 leaders accountable for their failure to deliver on their promises. It is rather incredible that the United States, the country saddled with the worst of the fiscal crisis, remains the only one of the G8 that has met its stated fiscal commitments."

Read more in Aidsmap, July 19, 2009.

WHO to consult people with HIV on treatment guidelines

"People living with HIV are to be consulted on the development of new World Health Organization treatment guidelines for low and middle-income settings, due to be released in November.

"The consultation process will begin with at a meeting hosted by the Global Network of People living with HIV (GNP+) and the Treatment Action Campaign on Monday at the Fifth International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention and Cape Town, and will be followed by an online consultation."

Read more in Aidsmap, July 18, 2009.

Efavirenz Dose Reduction Is Safe in Patients With High Plasma Concentrations and May Prevent Efavirenz Discontinuations

"Conclusions: Dose reduction may prevent toxicity-induced discontinuations in patients with high efavirenz plasma concentrations, whereas not compromising virological efficacy."

Read more in JAIDS, July 10, 2009.

July 17, 2009

Unprocessed Rage

"At about 3:00 A.M. this morning, New York State Senator Tom Duane kind of snapped. He'd had enough of the backroom politics on a bill he supported that prevents people living with HIV or AIDS and receiving public assistance from having to pay more than 30 percent of their monthly income on rent. Duane, who is openly gay and HIV positive, took to the Senate floor and delivered an impassioned 22 minute speech.

"All the pent-up rage from what people with AIDS lived through in the 1980's and early 90's, and even some of the shit we all live through today, can be heard in Tom's voice. I've always felt we've never processed all the pain we went through back then. And we're all capable of snapping from it -- letting it spill out at any moment. There's a Tom Duane lurking deep down in all of us, waiting to be heard.

"Thank you, Tom.

"Oh, and as reported by the NY Daily News, the bill passed by a vote of 52 to 1. You can watch how Tom did it below."

See the video at Peter's POZ Blog, July 17, 2009.

Gay men diagnosed during primary infection substantially reduce their risk behaviour

"Gay and bisexual men who are diagnosed with HIV in the first few weeks after infection make significant changes to their sexual behaviour, write British researchers in the August issue of HIV Medicine. While risky behaviour was common before diagnosis, three-quarters of men surveyed posed no risk of onward transmission during the three months after their test result. The authors argue that this demonstrates the value of early diagnosis."

Read more in Aidsmap, July 16, 2009.

Note: This is especially important since people are much more infectious during primary HIV infection (due to the very high viral load), and as a result, much of the spread of the epidemic happens then.

New guidance on healthcare for HIV-positive asylum seekers in detention

"The National AIDS Trust (NAT) and the British HIV Association (BHIVA) have issued best practice guidance to support asylum seekers living with HIV while they are detained by the government. The document, which was developed in co-operation with healthcare managers at detention centres, outlines steps to ensure that migrants are not forced to interrupt antiretroviral treatment and can have access to healthcare and support while their application is decided, or while waiting to be removed from the country. It describes the roles and responsibilities both of detention centre staff and HIV clinicians."

Read more in Aidsmap, July 16, 2009.

Could a document like this be prepared for the U.S.?

Circumcision in HIV-infected men and its effect on HIV transmission to female partners in Rakai, Uganda: a randomised controlled trial

"Interpretation: Circumcision of HIV-infected men did not reduce HIV transmission to female partners over 24 months; longer-term effects could not be assessed. Condom use after male circumcision is essential for HIV prevention."

Read more in The Lancet, July 18, 2009.

Also see Male circumcision and HIV risks and benefits for women.

Note: More infections occurred in the circumcision group in this study, although the difference was not statistically significant.

World's Largest Open Scientific Conference on HIV/AIDS Uses New Media Tools

"This weekend approximately 5,000 of the world’s leading scientists, clinicians, public health experts and community leaders will convene in Cape Town, South Africa, for the 5th International AIDS Society Conference on HIV Pathogenesis, Treatment, and Prevention (IAS 2009) Exit Disclaimer to “examine the latest developments in HIV-related research, and to explore how scientific advances can—in very practical ways—inform the global response to HIV/AIDS.” The conference will run July 19-22, 2009.

Can’t be there in person? Participate virtually.

"This year the conference organizers are using new media tools as an integral way to communicate updates before and during the conference. Through tweeting Exit Disclaimer, a Facebook fan page Exit Disclaimer, a Flickr group Exit Disclaimer, and a live-blogExit Disclaimer, people all over the world can follow conference updates from the comfort of their own homes and offices. People can also sign up now for daily conference bulletins Exit Disclaimer in English, French, Portuguese, Spanish, Russian or Romanian. They are also offering webcasts Exit Disclaimer of certain sessions. On Monday they will be airing a webcast of a special session, U.S.-Global HIV Policy, Research and Implementation Under the New Administration Exit Disclaimer, featuring U.S. Global AIDS Coordinator Eric Goosby and NIAID Director Anthony Fauci."

Read more in, July 17, 2009.

Health Reform Comparison Tool Now Reflects Current House Tri-Committee Legislation

"The Foundation's interactive side-by-side health reform comparison tool now includes details from H.R 3200, the America's Affordable Health Choices Act of 2009, introduced this week jointly by the three key House committees with responsibilities for health reform. The online tool allows users to compare any or all of 11 different plans, including proposals from the Senate Health, Education, Labor and Pensions Committee; the Senate Finance Committee; Senators Tom Coburn and Richard Burr and Representatives Paul Ryan and Devin Nunes; Representative John Conyers; Representative John Dingell; Senator Bernie Sanders; Representative Pete Stark; and Senators Ron Wyden and Bob Bennett. ...

"The comparison tool is a featured resource on the Foundation's health reform gateway page, which provides a centralized source for key information, news and analysis about national health reform efforts now being considered by Congress."

Read more in Kaiser Family Foundation, July 17, 2009.

Note: Kaiser Family Foundation is a good starting point for learning about health-care reform. It is one of the least biased sources available, and is written for persons who are not health-policy specialists. You might start with one of the two prepared PDF downloads. JSJ

Relationship of immunodiagnostic assays for tuberculosis and numbers of circulating CD4+ T-cells in HIV–infection

"In HIV-1 infection, TST and QFT-G-IT immune responses are both strongly related to the degree of immunodeficiency, while results of the T-Spot.TB are independent of the level of CD4 T-cell depletion."

Read more in European Respiratory Journal, July 16, 2009.


Recent disruptions in the supply of anti-retroviral (ARV) drugs and other essential medical items in at least six African countries are putting HIV patients’ lives at risk, said the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) today, in advance of the International AIDS Society Conference in Cape Town, South Africa. ...

"In South Africa, the government budget for health was cut due to the global financial crisis; finding alternative funding seems difficult in the short term.

“All around us, clinics stop enrolling patients because there are just not enough ARV supplies,” said Eric Goemaere, MSF head of mission in South Africa. “The waiting lists are growing by the day, risking that patients die before they start ARVs. It’s unbelievable that a relatively well-functioning ARV program has been allowed to be crippled in the space of just a few weeks. MSF will not be able to fill the gaps, and we seriously question why we should have to do so, in view of declared international commitments.”

Read more in MSF (Doctors Without Borders), July 17, 2009.

July 16, 2009

HIV Positive People with Elevated C-reactive Protein Have Higher Cardiovascular Risk, but It May Not Be a Good Predictor of Heart Disease

"Summary: A widely used biomarker of inflammation, C-reactive protein (CRP), is associated with cardiovascular risk in people with HIV, according to a large study reported in the July 2009 Journal of Acquired Immunodeficiency Syndromes. HIV positive people with elevated CRP had more than 4 times the risk of acute myocardial infarction (MI) than HIV negative people with normal CRP. But two other recent general population studies suggest CRP may not be a causal factor or a good predictor of heart disease."

Read more in, July 16, 2009.

GSK Announces $80 Million to Prevent and Treat Pediatric HIV

"Andrew Witty, chief executive officer of GlaxoSmithKline (GSK), announced yesterday that GSK will spend up to $80 million during the next 10 years to prevent mother-to-child HIV transmission and to support AIDS orphans and vulnerable children globally.

"Witty also announced a $17 million fund to develop new HIV drugs for children. In addition, he said that GSK intends to collaborate with other companies on fixed-dose combination pills for HIV and that GSK will voluntarily license its drug abacavir (found in Ziagen, Epzicom and Trizivir) to the generic company Aspen Pharmaceuticals."

Read more in POZ/AIDSmeds, July 15, 2009.

July 15, 2009


"The California State Board of Equalization released a legislative analysis today estimating that the state would collect up to $1.38 billion in new revenue from taxing and regulating the sale of marijuana.

"The report is based on Assemblymember Tom Ammiano’s (D-San Francisco) groundbreaking legislation, the Marijuana Control, Regulation, and Education act (AB 390) that would tax and regulate marijuana in a manner similar to alcohol."

Read more in San Francisco Sentinel, July 15, 2009.

(1) This tax-revenue estimated gain does not include savings in law-enforcement, trial, and prison costs.
(2) California already taxes medical marijuana sales.

Why Women and Men Have Differences in Disease Progression

"A study, published July 13 online in Nature Medicine, has discovered why HIV-positive women have faster disease progression than HIV-positive men with the same viral loads. The answer may be greater levels of immune inflammation.

"Though taken as a whole, women do not appear to have faster disease progression than men, it is well known that their viral loads and CD4 counts may differ from what is common in men. Women’s immune systems bring virus levels under better control than men’s systems soon after becoming infected with HIV. However, researchers have also discovered that when women and men with the same viral loads are compared, women generally progress faster. Until now, no one has proved why this is the case.

Read more in POZ, July 14, 2009.

From TAGline 2009 Vol 16 No. 3

AIDS Funding Backlash: A Conversation with Sue Perez and Gregg Gonsalves
Pressure is increasing to redirect international funding for HIV into broader health initiatives. TAG’s policy director Sue Perez and international AIDS activist Gregg Gonsalves talk about these challenges.

The HIV Entry Ban: What’s Next? A Talk with Nancy Ordover
Nancy Ordover, PhD, has served on the International Task Team on HIV-Related Travel Restrictions, convened by UNAIDS and concerned with issues relating to the human rights, public health, and economic impact of HIV entry bars on immigrants, migrants, refugees, asylees, detainees, and other mobile populations

Two New TAG Publications: Research Funding Gaps Revealed
Two new reports from TAG detail shortfalls in medical research funding for HIV, viral hepatitis, and tuberculosis.

Adapted from remarks given on May 12, 2009, at the Carnegie Institution for Science in Washington, D.C., at a celebration for the 25th anniversary of the Multicenter AIDS Cohort Study (MACS), an ongoing prospective study of the natural and treated history of HIV infection in gay men. Over 7,000 men have participated in the MACS since it began enrolling subjects in 1984. The study has produced over 1,000 research publications and has been a seminal influence on how HIV is studied, prevented, diagnosed, and treated.


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Other TAG News:

TAG Publishes Guide to Hepatitis B for people living with HIV - Available in English and Spanish
This guide provides information on the prevention, care, and treatment of HBV, and the impact of HBV on HIV disease. It is designed to be accessible to people with no medical training. Where medical terms are used, they are explained in detailed but simple language

Read more in TAGline 2009, July 14, 2009.

July 14, 2009

Brazil proves developing countries can use generic medicines to fight HIV/AIDS epidemic

"[Brown University] Brazil's nearly two-decade effort to treat people living with HIV and AIDS shows that developing countries can successfully combat the epidemic. Inexpensive generic medicines are a large part of the solution, say researchers from Brown University and the Harvard School of Public Health.

"Brazil did this, researchers said, largely by pursuing controversial policies that prompted pharmaceutical companies with exclusive drugs to lower their prices dramatically and generic companies to develop lower-cost alternatives for use in emerging markets.

'Brazil has proved it is possible to treat people with AIDS in developing countries,' said lead author Amy Nunn, assistant professor of medicine (research) at The Warren Alpert Medical School of Brown University. She added that the country saved more than $1 billion as a result of bargaining with multinational pharmaceutical companies, resulting in significant changes in global AIDS policy."

Read more in EurekAlert!, July 14, 2009.

July 13, 2009

International development minister urges firms to pool HIV patents

"Drug companies should give up their patent rights to HIV medicines to help prevent the deaths of millions of people in poor countries, a British government minister will say this week.

"The international development minister, Mike Foster, will call on pharmaceutical companies to put lives before profits, as the all-party parliamentary group on Aids publishes a report this week detailing the scale of the "treatment timebomb". By 2030, they estimate, 50 million people will need new drugs, which are currently prohibitively expensive, to keep them alive.

"Three million people are on cheap, basic HIV drug combinations, but they are only a third of those in need and resistance is growing to these drugs both in the developing world and in the west.

"New and improved drugs are urgently required, but they are expensive, and cheap generic copies of the newest drugs can no longer easily be made and sold because of tightened intellectual property rules in India and China. ...

"According to the all-party report, if HIV patents are put in a pool, generics companies – which make the cheap combinations now used in Africa – will be permitted to make low-cost copies of newer drugs and devise new combinations in a single pill, which is important for people living in poverty.

"The report lays out in stark terms the coming crisis. "It took political activism almost a decade ago to make life-saving drugs available to the poor in developing countries," it says. "Only a third of those who need it are on treatment and this treatment will not work for them forever. Political activism is needed once more to ensure that the next generation of drugs is available to the world's poorest in future."

"MP David Barrow, who chairs the group, said: "We are sitting on a treatment timebomb. We must reduce the price of second-line medicines and less toxic first-line medicines before millions need them. We cannot sleepwalk into a situation where we can only afford to treat a tiny proportion of those infected."

Read more in, July 12, 2009.

Also see Aidsmap,

Further evidence of needless treatment switches in absence of viral load testing

"Further evidence has emerged that a substantial proportion of switches to second-line treatment in a resource-limited setting, triggered in the absence of viral load testing, are unnecessary and result in an avoidable inflation in drug costs as people switch to more expensive regimens.

"The findings, published in the August 1st edition of Clinical Infectious Diseases, are likely to lend further support to calls for viral load testing to be made more accessible in resource-limited settings to confirm cases of suspected treatment failure."

Read more in Aidsmap, July 13, 2009.

July 12, 2009

Polyclonal B Cell Differentiation and Loss of Gastrointestinal Tract Germinal Centers in the Earliest Stages of HIV-1 Infection

"What Do These Findings Mean?

"Although the depletion of gut-associated CD4+ T lymphocytes in early HIV-1 infection is well known, these new results demonstrate the effects of early HIV-1 infection on gut-associated and circulating B lymphocytes. The results of this study are limited by the methods used to analyze the antibodies induced by HIV infection and by only taking tissue samples from one region of the gut. Nevertheless, the findings of polyclonal B-cell activation and damage to gut-associated lymphoid follicles soon after HIV-1 infection may have implications for HIV-1 vaccine design. Specifically, these findings suggest that an effective HIV-1 vaccine will need to ensure that significant levels of neutralizing antibodies are present in people before HIV-1 infection and that other protective immune defenses are fully primed so that, in the event of HIV-1 infection, the virus can be dealt with effectively before it disables any part of the immune system."

Read more in PLoS Medicine, July 7, 2009. [Full text available, as in all PLoS publications.]

Association of Noncirrhotic Portal Hypertension in HIV‐Infected Persons and Antiretroviral Therapy with Didanosine: A Nested Case‐Control Study

"Background.Noncirrhotic portal hypertension (NCPH) is a newly described life‐threatening liver disease of unknown cause in human immunodeficiency virus (HIV)–infected persons. Postulated pathogenesis includes prolonged exposure to antiretroviral therapy, particularly didanosine. ...

"Conclusions.We found a strong association between prolonged exposure to didanosine and the development of NCPH."

Read more in Clinical Infectious Diseases, July 9, 2009.

Risk of Developing Specific AIDS‐Defining Illnesses in Patients Coinfected with HIV and Hepatitis C Virus With or Without Liver Cirrhosis

"HIV‐related bacterial and mycotic infections are strongly associated with positive HCV serostatus and HCV‐related cirrhosis. Clinicians should take into account these data when making decisions on initiation of antiretroviral therapy for HCV‐coinfected individuals."

Read more in Clinical Infectious Diseases, July 10, 2009.

Note: Also see editorial, Coinfection with HIV and Hepatitis C Virus: More Than Double Trouble

To Fix Health Care, Some Study Developing World: Cost-Effective Medical Practices Deployed in Poor Nations Deliver Good Results, but Can They Work...

"When doctors running the AIDS clinic at the University of Alabama at Birmingham wanted to increase the number of patients who showed up for treatment, they turned to an unusual place for help: southern Africa.

"Project Connect" is based on a program used in AIDS clinics in Zambia. In the Alabama program, patients were given appointments with doctors within five days of calling the clinic. Blood tests were taken during the first visit. A social worker did an interview, trying to identify and address any issues that might prevent patients from coming back. The no-show rate dropped from 31% in 2007 to 18% through June 2009.

"Dr. Michael Saag, hugging a patient after a checkup, found a model for his AIDS clinic at the University of Alabama in a similar program in Zambia.

"We recognized that we had a problem and that Zambia had already come up with an affordable solution that could work here," says Michael Saag, a pre-eminent AIDS doctor and founding director of the Alabama clinic."

Read more in AEGIS, July 9, 2009.


"The Whitman-Walker Clinic in Arlington County, which served the Northern Virginia HIV/AIDS community for more than a decade, closed earlier this year due to financial constraints. Now a new clinic, just two blocks away from the old WWC site, has opened to take its place. The sixth regional location of the Inova Juniper Program, at 5015 Lee Hwy., offers comprehensive HIV/AIDS care, assigning all patients a team of health care professionals that includes a physician, physician’s assistant or nurse practitioner, and a social worker. ...

"As of late June, the new clinic had 198 clients, said Berube. She expects by the end of the year it will have 250. 'The HIV community is very close-knit,' she said. 'Once people know about it, they will come.'"

Read more in NPIN, July 9, 2009.

July 11, 2009

Police arrest 26 AIDS activists at Capitol protest

"A group of AIDS activists was arrested Thursday for unlawfully demonstrating in the Capitol rotunda, a Capitol Police spokeswoman said. ...

"The activists carried signs in support of funding for needle exchange, HIV/AIDS housing and programs aimed at fighting AIDS. They chanted, 'Fight global AIDS now,' and, 'Clean needles save lives.' They marched in a circle before lying down on the floor. ...

"The activists were part of a coalition of five AIDS groups from Washington, Philadelphia and New York. They included ACT UP Philadelphia, DC Fights Back, Health GAP, New York City AIDS Network and Housing Works."

Read more in, July 10, 2009.


See photos at

Full press coverage at
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July 10, 2009

New Life for Treatment Interruptions?

"Newly unearthed data from the SMART study may reawaken interest in the possibility of safely interrupting HIV treatment in at least some people.

"Emerging data from a study that came to a grinding halt more than three years ago may reopen a door that most people assumed was firmly closed: the possibility of HIV treatment interruptions. The latest report has at least one activist questioning whether the death knell of treatment interruption research was sounded too soon."

Read more in POZ HIV/AIDS Special Reports, July 10, 2009.

Comment: We are waiting for more information, especially the unpublished letter from the SMART term.

Isentress (raltegravir) indication extended for the treatment of HIV-1 infection in treatment-naïve patients

"On July 8, 2009, FDA granted approval to Isentress (raltegravir), for the treatment of HIV-1 infection in treatment-naïve patients. The recommended dose for treatment-naïve adult patients is Isentress 400 mg twice daily, with or without food.

"The use of Isentress in treatment-naïve patients is based on a 48-week randomized, double-blind, active control trial to evaluate the safety and efficacy of Isentress 400 mg twice daily + emtricitabine + tenofovir versus Sustiva (efavirenz) 600 mg + emtricitabine + tenofovir. The proportion of patients with HIV RNA < 50 copies/mL was 87% for the Isentress group compared to 82% for the Sustiva group."

Read more in, July 8, 2009.

Renal Function in Patients with Preexisting Renal Disease Receiving Tenofovir-Containing Highly Active Antiretroviral Therapy in the HIV Outpatient...

"We observed confirmed worsening of kidney disease stage in 5 of the 19 patients during follow-up. TDF use can be considered in patients with preexisting or current renal dysfunction who have limited antiretroviral treatment options, require TDF for fully active antiretroviral regimen, and can be closely monitored for incident worsening of renal function."

Read more in AIDS Patient Care and STDs, July 10, 2009.

HIV Ravages Antibody-Producing Cells Days After Infection

"Researchers may have figured out why the body is so slow in producing effective antibodies against HIV. According to study details published in the July 2009 online issue of PLoS Medicine, HIV cripples the production of antibody-producing B cells within just 17 days after infection."

Read more in POZ, July 9, 2009.

July 9, 2009

Text from the keynote speech by Charles King, president and CEO of Housing Works, at the 10th Annual Prevention and Outreach Summit in Philadelphia...

"... Imagine what would happen if we were offering housing or rental assistance to every single HIV+ person who needed it, and offering every single person who is HIV+ access to ARV’s. Just with those two structural interventions, plus one other, you could bring the epidemic to a screeching halt even before we had a vaccine or a cure. Why, because the vast majority of people who go on ARV’s before their immune systems are destroyed and are reasonably adherent…not perfectly, just reasonably…the viral load is reduced to an undetectable level.

"What does that mean? Well, it means that particularly in sexual interactions, even without condoms, it becomes very difficult to transmit the virus. We would have dramatically reduced the viral pool, making reliance on changing individual behaviors in moments of passion and ecstasy, whether natural or chemically induced, no longer the principle vehicle for preventing transmission. Couple that with clean needles for IV drug users, Medicaid or insurance-funded hormones for transgender folk, and treatment for HIV+ pregnant women, particularly at time of delivery, and we would have cut off just about every means of viral transmission. Now that is prevention that follows science!"

Read more in POZ HIV/AIDS Special Reports, July 9, 2009.

Immune suppression increases risk of death from non-AIDS-defining illnesses

"'The consistent finding of a raised risk of non-AIDS-defining death and cumulative time spent with a CD4 cell count less than 350 cells/mm3 reveals clinically important information and provides a strong argument that HIV-infected patients may benefit from early initiation of antiretroviral treatment to reduce the risk of AIDS and non-AIDS-related causes of death.'"

Read more in Aidsmap, July 9, 2009.

July 8, 2009

NGOs to file petition against Anti-Counterfeit Act in Kenya

"Generic medicines are legitimate exact copies of their brand-name original. They are not counterfeits. They should not be confused with counterfeits. The manufacturing of generic medicines is not a criminal offence. We can only afford generic medicines because they cost up to 90 per cent less than the originals, the NGOs added."

Read more in (India), July 8, 2009.

July 7, 2009

Nitazoxanide: Beyond Parasites Toward a Novel Agent for Hepatitis C

"Although there is substantial literature on NTZ as a safe and effective antiparasitic agent, the initial report of its antiviral properties in HCV-infected patients came in 2008 from Rossignol et al. This study was a double-blind, placebo-controlled trial of 50 patients with HCV genotype 4 treated with NTZ monotherapy (500 mg twice daily) for 24 weeks. Remarkably, 7 of 23 patients (30%) had an end-of-treatment response and 4 of 23 (17%) had a sustained virologic response (SVR) compared with none in the placebo arm. Of note, all patients attaining an SVR had a baseline HCV RNA < 400,000 IU/mL.

"In this issue of Gastroenterology, Rossignol et al present the results of a randomized, controlled trial evaluating the efficacy of NTZ in combination with peginterferon and ribavirin. ... The authors conclude that NTZ with peginterferon and ribavirin increases RVR and SVR rates compared with standard therapy without increasing adverse events."

Read more in Gastroenterology, March, 2009.

Note: This inexpensive treatment, FDA-approved for a different use, is now being tested as an addition to standard treatment for hepatitis C genotype 1.

HIV treatment and traditional risk factors causing hardening of the arteries

"Treatment with antiretroviral drugs can cause hardening of the arteries, Greek investigators report in the online edition of the American Journal of Hypertension. Traditional risk factors for hardening of the arteries, also known as atherosclerosis, such as cholesterol and high blood pressure, were also shown to be important."

Read more in Aidsmap, July 6, 2009.

July 2, 2009

Long-term Testosterone Therapy Is Safe and Improves Body Composition in Women with HIV

"These findings led the researchers to conclude, 'Long-term testosterone administration was well tolerated in HIV-infected women and resulted in significant improvements in body composition, bone mineral density, and quality of life indices.'"

Read more in, July 3, 2009.

Evolution of SIV toward RANTES resistance in macaques rapidly progressing to AIDS upon coinfection with HHV-6A

"Conclusions: These results provide in vivo evidence of SIV evolution toward RANTES resistance in macaques rapidly progressing to AIDS. RANTES resistance may represent a common virulence factor allowing primate immunodeficiency retroviruses to evade a critical mechanism of host antiviral defense."

Read more in Retrovirology, July 2, 2009.

Youth Who Believe They Will Die Young More Likely To Be Diagnosed With HIV/AIDS, Study Finds

"Teenagers who believe that they will die at a young age are seven times more likely than optimistic teenagers to be diagnosed with HIV/AIDS in early adulthood, according to a study released on Monday and published in the July issue of Pediatrics, the AP/Los Angeles Times reports (AP/Los Angeles Times, 6/29)."

Read more in Kaiser Daily HIV/AIDS Report, July 1, 2009.

Politico Examines Retraction, Resubmission Of Proposed HIV Travel Ban Rule

"Politico's blog "Under the Radar" explores HHS' recent decision to revise documents submitted to the Federal Register regarding a change in HIV-related immigration policy. The blog looks at differences between the original document sent to the Federal Register on Monday compared to the version slated to be resubmitted by HHS Thursday, noting that while "the proposed rule was pulled from publication in Tuesday’s edition at the request of HHS Secretary Kathleen Sebelius" late Monday because it was "'incomplete,' it was actually 12 pages longer than the replacement," with "different data than the original" that "could ease sticker shock." Politico compares the two proposals – one which estimates the number of immigrants living in the U.S. with HIV after five years; the other which estimates the number after 20 years."

Read more in Kaiser Daily HIV/AIDS Report, July 2, 2009.

Preventing HIV transmission with antiretrovirals

"Three of the most extraordinary events in global health over the past 30 years have been the emergence of the pandemic of HIV/AIDS, the development of antiretroviral therapy (ART) capable of arresting HIV progression and reducing mortality, and scale-up of therapy in low- and middle-income countries. By the end of 2007, approximately 3 million people were accessing ART in resource-constrained settings, an unimaginable achievement a few years previously, yet one whose expansion and sustainability are threatened by resource constraints and competing priorities. ...

"Their paper reported that in an HIV/AIDS epidemic of southern African severity, universal voluntary HIV testing on an annual basis followed by immediate ART could
reduce HIV incidence by about 95% within a decade..."

Read more in Bulletin of the World Health Organization, July, 2009. Also available in Chinese, French, and Russian.

July 1, 2009

HIV and ARV Therapy Accelerate Bone Loss

"Bone loss is common among people living with HIV before they begin antiretroviral (ARV) therapy, and it worsens upon starting treatment, especially if the regimen contains Combivir (zidovudine plus lamivudine), according to a new report published in the July 17 issue of AIDS. Though severe bone loss is associated with an increased risk of serious bone fractures, the Dutch study authors remind readers that this might be less of a concern among young people living with HIV. "

Read more in POZ, June 30, 2009.

Unexpected Finding: Penetration of ARVs Into Nervous System Doesn’t Protect the Brain

"While antiretroviral (ARV) drugs known to penetrate into the cerebrospinal fluid (CSF)—and thus possibly the brain—do lower HIV levels in the brain, they do not appear to protect against detrimental changes in thinking, memory and physical coordination. This is the conclusion of a study published in the July 17 issue of AIDS."

Read more in Poz, July 1, 2009.