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November 30, 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.

November 29, 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 and], 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.

November 23, 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.

November 22, 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 (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.

November 19, 2009

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 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.

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.

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.

November 12, 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.

November 10, 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.

November 8, 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 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.

November 5, 2009


"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.

November 1, 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.