The Wrong Story About Depression

"And here the truer story about mental health care in America begins to unfold. The trouble is not that the drugs don’t work; it’s that the care is not very good."

Read more in New York Times, January 8, 2010.

Antiretroviral Prescribing Patterns in Treatment-Naïve Patients in the United States

"The most dramatic shift in drug selection involved an increase in emtricitabine plus tenofovir plus efavirenz, from 0% in 2003 to 85% in 2007. During the study period, 205 of 482 (43%) patients required a change in initial therapy. Of these, 156 of 205 (76%) had a unique sequence of regimens. A shift toward homogeneity of initial ART was observed (85% of patients received the same first-line regimen in 2007). In contrast, regimen sequencing beyond the first regimen remained complex."

Read more in
AIDS Patient Care and STDs, January 8, 2010.

Sex with Older Partners Is Associated With Primary HIV Infection Among Men Who Have Sex With Men in North Carolina

"The mean age of sex partners differed significantly: men with PHI [primary HIV infection] had partners on average 6 years older than themselves, whereas uninfected men's partners were 4 months their junior (P < 0.001). After adjusting for race, sex while intoxicated, and having a serodiscordant/serostatus unknown partner, a participant had twice the odds of PHI if his sex partner was 5 years his senior (odds ratio 2.0, 95% confidence interval: 1.2 to 3.3). " Read more in JAIDS Journal of Acquired Immune Deficiency Syndromes, January 7, 2010.

Circumcision may protect against HIV due to changes in bacteria

"The reduction in HIV infection risk after circumcision may be the result of a decline in bacteria on the surface of the penis that assist the process of infection, according to findings from the research team that helped establish the evidence base for using male circumcision as an HIV prevention strategy.

"If this is the case, and if the bacteria can be eliminated without removing the foreskin, such a procedure might provide an important non-surgical alternative to circumcision in settings where the procedure is culturally unacceptable or difficult to implement.

"The recent study, which appears in the January 2010 edition of PLoS ONE, analysed penile swabs taken from twelve participants in the Rakai, Uganda circumcision study, which enrolled almost 5,000 uncircumcised HIV-negative men and randomised half of them to be circumcised."

Read more in Aidsmap, January 8, 2010.

Can We Treat Our Way Out of HIV?

"The timing of the interest in a test and treat strategy and this first foray into exploring its potential implementation come at a critical juncture in the history of HIV/AIDS in the United States, where recent data from the CDC indicate that the prevalence and incidence of HIV are considerably higher than had previously been thought, and the Obama administration is currently developing a National HIV/AIDS Strategy (NHAS) whose three primary goals are reducing HIV incidence, increasing access to care, and reducing HIV-related health disparities. Indeed, the test and treat strategy is possibly unique in its direct relevance to all three main goals of the NHAS."

Read more in
AIDS Research and Human Retroviruses, January 7, 2010.

Global Funding for AIDS Is Justified

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

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

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

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

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

Aging, HIV infection and the immune system

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

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

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

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

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

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

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

Read more in Aidsmap,January 5, 2010.

Year in Review 2009: HIV/AIDS Clinical Care

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

Read more in Journal Watch, January 4, 2010.

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

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

US HIV travel ban has now ended

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

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

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

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

Read more in Aidsmap, January 4, 2010.

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

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

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

Read more in Aidsmap, January 4, 2010.

Vitamin D Deficiency: A Major Public Health Problem?

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

Read more in Journal Watch, December 31, 2009.