News & Notes
Some HIV Patients May Be Able to Be Weaned Off DrugsA new report published in Nature shows that people with HIV who are treated with antiviral drugs quickly after infection can teach their immune systems to suppress the virus without using drugs, indicating that there is a way for a small number of people to take drug holidays or stop treatment and still control their HIV infection, according to Eric Rosenberg, chief author of the study and an instructor at Harvard Medical School. Researchers will now try to find a way to help chronically infected HIV patients fight the virus using highly active antiretroviral therapy, or HAART, a combination of three or more antiviral drugs that can stop HIV from replicating; quick treatment with HAART has been shown to suppress the virus to undetectable levels. Rosenberg and colleagues studied 16 patients who were recently infected with HIV, and two of eight patients who chose to stop HAART maintained low enough levels of the virus to stay off antiviral drugs through two respites from the regimen, though the other six showed returns to detectable levels of HIV. Bruce Walker of Harvard supervised the research, and is cautious, saying that they must monitor the lives of the eight patients and see if they live longer, but the study's authors are optimistic because they believe the patients benefited from treatment interruption before the regimen caused permanent damage to the immune system, indicating that stopping and restarting treatment could allow the body to produce enough CD4 cells to keep HIV under control for years. (Washington Post (www.washingtonpost.com) (09/28/00) P. A2; Brown, David)
Early Use of AIDS 'Cocktail' Boosts Immune SystemHarvard Medical School researchers, led by Bruce Walker, have found that early treatment with a cocktail of AIDS drugs can boost the immune system and its T-cells. A study of eight HIV patients aged 30 to 44 who stopped taking triple medications showed increases in CD4 and CD8 T-cell counts even after five remained off therapy while three others resumed highly active antiretroviral therapy (HAART). Walker stated that the T-cell responses were encouraged by early treatment. The results are published in the weekly Nature. Anthony Fauci of the National Institutes of Health reported earlier this year that interruptions of HAART for a week or two could help patients avoid side effects and maintain low HIV levels. Treatment interruptions would also save thousands of dollars for AIDS patients. (Reuters (www.reuters.com) (09/27/00); Zabarenko, Deborah)
Hemophilia Drug Requires ApplicationsBayer Corporation has asked patients to apply for a new drug for hemophiliacs through a corporate program, instead of going to a pharmacy. The new drug, Kogenate FS, will be given to patients whose applications are approved first. The drug is a genetically engineered version of a protein missing in people with hemophilia A. According to Dr. Stephen Schondelmeyer of the University of Minnesota, the Bayer program uses an approach that companies conducted with early AIDS drugs, when drugs were given in limited number to mail-order companies. However, the system is to be used only in the short-term. Kogenate FS is a new version of a synthetic clotting factor, which is preferable to human blood used for clotting because it does not carry the risk of hepatitis C and HIV infection. (New York Times (www.nytimes.com) (09/27/00) P. C1; Petersen, Melody)
Latent HIV Reservoir Develops Early in Activated T CellsA report in the Journal of Virology (2000;74:7824-7833) reveals that latent HIV reservoirs form when the virus infects activated T cells that can enter a resting state. Dr. Robert Siliciano of Johns Hopkins University School of Medicine reports that the latent HIV reservoir stems from R5 viruses, which do not enter resting T cells. The authors believe that the latent reservoir continues to infect other cells that also become resting cells. (Reuters Health Information Services (www.reutershealth.com) (09/26/00))
Effects of Testosterone and Progressive Resistance Training in Eugonadal Men with AIDS Wasting: A Randomized, Controlled TrialA study of 54 men with AIDS wasting evaluated the effects of testosterone therapy and progressive resistance training upon the men's body weight and muscles. The men were recruited through the HIV practice at Massachusetts General Hospital in Boston. The patients were grouped according to their ideal body weight. They were randomly assigned to receive injections of testosterone or placebo, and to take place in resistance training for 12 weeks or no training at all. The patients in strength training performed 20 minutes of exercise three times a week. The results of the study reveal that lean body mass and muscle increased in those undergoing training and testosterone therapy. The levels of high-density lipoprotein (HDL) cholesterol increased in those training but fell in those taking hormones. The viral load fell in those taking testosterone. Therefore supervised exercise can significantly increase muscle mass and offer higher HDL cholesterol levels to men with AIDS wasting, offering a way for men to change muscle loss into gain. (Annals of Internal Medicine Online (www.annals.org) (09/05/00) Vol. 133, No. 5, P. 348; Grinspoon, Steven; Corcoran, Colleen; Parlman, Kristin; et al.)
Women's Interest Group Urges Worldwide Effort to Combat AIDS in AfricaThe National Council of Negro Women has released a report called A Devastating Tragedy: AIDS in Africa, calling for more effort to help women in sub-Saharan Africa fight AIDS. According to the report, 40 percent of HIV-infected pregnant women in the region transmit the virus to their babies during birth. The group, based in Washington D.C., called for more debt forgiveness and better access to health care for African women. Improving attitudes towards AIDS patients and promoting the use of condoms are necessary to help empower women. (Reuters Health Information Services (www.reutershealth.com) (10/05/00))
Perfect Vaccine for HIV Not Likely, Researcher WarnsThe 13th International AIDS Conference, held earlier this summer in Durban, South Africa, brought together over 15,000 physicians and scientists from all over the world. During her address to conference participants, Chiron Corp.'s Margaret Liu said that creating an HIV vaccine that would prevent infection is a daunting goal. "For a pathogen such as HIV that is capable of entering the genome of cells, the challenge to make a vaccine that would prevent any infection at all is indeed great and may be too big a first step," she noted. While there have been many advances in virology and cell biology, more knowledge is needed about the various strains of HIV and their pathogenesis. Liu warned researchers to follow proven scientific data and to make no assumptions about the best path to follow. Progress made in the study of immune responses among prostitutes has helped provide clues to why some people are lifelong nonprogressors. More is known about the structure of HIV as well, Liu said. Several vaccine candidates are being put into development, including a gene-based vaccine. Liu highlighted the study of natural immunity and efforts to learn about cellular responses and not just antibody response. Using certain proteins from different strains could create a vaccine that tackles several strains of HIV. The many faces of cellular immunity must also be taken into account, as killer T cells release molecules that have a potential role in a vaccine. Liu said that in the war against AIDS, "we must understand HIV, what its structure is like, and how it infects and causes diseases in order to be able to defeat it." (AIDS Alert (www.ahcpub.com/online.html) (09/00) Vol. 15, No. 9, P. 97)
New Rapid HIV Test Accurate, Easy to UseThe OraQuick HIV-1/2 rapid HIV test, produced by Epitope Inc. of Beaverton, Oregon, could receive approval from the Food and Drug Administration (FDA) within a few months. Earlier this year, the FDA granted Epitope an investigational device exemption, and the company plans to file a pre-market approval application early next year for HIV-1 and HIV-2 testing using the new product. For the test, the user swabs his or her gums with the device and then places it into a container of developer solution. In less than 20 minutes, a colored line will appear to demonstrate that the test was conducted properly, and a second line appears if the individual has HIV. According to Lt. Hassan Zahwa of the HIV Diagnostic Laboratory at Walter Reed Army Institute of Research in Rockville, Md., the test's "sensitivity is 100 percent; its specificity is greater than 99.5 percent, and it is very easy to use since it works on serum, plasma, or saliva, and it requires no reagents to be added, and all materials are included in the kit." Zahwa suggested that the U.S. Army could use the rapid HIV test to help healthcare workers who may experience accidental needle sticks, potentially even in the field or in foreign countries, and also possibly to test pregnant servicewomen for HIV before they give birth, so physicians could administer antivirals, if needed. (AIDS Alert (www.ahcpub.com/online.html) (09/00) Vol. 15, No. 9, P. 115)
Intrauterine Device and Upper-Genital-Tract InfectionThe risk of upper-genital-tract infection prevents many from using intrauterine devices (IUDs). Women with symptomless gonorrhea or chlamydial infection with an IUD have a higher risk of salpingitis, tubal infertility, than women having an IUD placed without gonorrhea infection. The study included 4,031 women in China who had IUDs inserted. Another trial of 445 women receiving the IUD with the presence of chlamydia infection showed that none developed pelvic-inflammatory disease (PID). Women with gonorrhea had a greater risk for PID when inserting an IUD. The use of IUDs in women with HIV infection is another concern. A study in Nairobi, Kenya showed that women with HIV infection had IUD complication rates similar to uninfected women. There is little information regarding the acquisition of gonorrhea or chlamydia after IUD insertion. Early studies show that IUD use does not increase the risk of chlamydia. Modern IUDs are safer than ever before, and women without cervical infections have the lowest risk of upper-genital-tract infections related to IUD use. (Lancet (www.thelancet.com) (09/16/00) Vol. 356, No. 9234, P. 1013; Grimes, David A.)
South Africa Launches Campaign to Clear Up Confusion on AIDSSouth Africa's government is starting a huge advertising campaign to ensure condom use does not stop because of confusion over President Mbeki's questioning of the link between HIV and AIDS. The campaign will encourage abstinence and fidelity but will also promote condom use to prevent HIV infection, and it is based on the idea that HIV causes AIDS. The educational effort, which will cost about $275,000, will be promoted in all major newspapers and on public radio stations during the next two weeks. (Agence France Presse (www.afp.com) (10/05/00))
AIDS Response Programs Target Black CommunityU.S. Surgeon General David Satcher said Tuesday that young gay men, particularly African Americans, could be the most vulnerable and difficult to reach in the AIDS epidemic. "This is a group that we're very concerned about, who continue to see themselves on the fringes of society," he said. According to Satcher, 7 percent of young gay men have HIV, but 20 percent of African-American gay men are HIV-positive. Satcher, speaking at a news conference during the U.S. Conference on AIDS in Atlanta, noted that most (80 percent) were not aware of their infection until they were tested. The surgeon general also discussed two federal programs, the Crisis Response Team and Leadership Campaign, which aim to help minority communities fight AIDS. Sixteen cities now have crisis response teams. (Atlanta Journal and Constitution (www.accessatlanta.com) (10/04/00) P. 9D; Staples, Gracie Bonds)
More Than Half of Sexually Active HIV-Infected Heterosexuals Report Risky Sexual BehaviorDr. Amy Lansky and colleagues at the Centers for Disease Control and Prevention have found that sexually active, HIV-positive heterosexuals in the United States are more likely than not to report their sexual risk behaviors. Data from 4,743 HIV-infected heterosexuals showed that close to 50 percent were not sexually active, 13 percent reported having a sex partner who also had HIV, and 60 percent of the remaining individuals reported at least one heterosexual risk behavior for HIV transmission. Compared to nonusers, drug users were more likely to not use condoms and to have multiple sex partners. The researchers, who reported their findings in the September issue of Sexually Transmitted Diseases (2000;27:483-489), noted that the high number of sexually active people with HIV who had unprotected intercourse highlights the need for continuing risk-reduction counseling among these individuals. (Reuters Health Information Services (www.reutershealth.com) (10/02/00))
Gonorrhea Shows its Resistant Side; Disease Control Agency Tells Doctors of New RecommendationsNew findings from Hawaii and Missouri reveal that gonorrhea is becoming resistant to more antibiotics, according to federal health officials. The Centers for Disease Control and Prevention has issued new recommendations for doctors who treat the sexually transmitted disease. About 10 percent of gonorrhea cases in Hawaii last year were resistant to ciprofloxacin, while doctors in Kansas City, Missouri, found that 12 men had gonorrhea resistant to azithromycin. The studies reflect the increasing difficulty of treating gonorrhea, as fewer drugs effectively fight the infection. Susan Wang, an epidemiologist at the CDC, notes that "as we lose fluoroquinolones and eventually azithromycin, we will drastically reduce the number of oral antibiotics that we can use to treat gonorrhea," and then doctors will have to start using injectable and more expensive antibiotics. Left untreated, gonorrhea can lead to infertility, ectopic pregnancy, and can facilitate HIV transmission. Cases of gonorrhea in the United States reached an all-time low in 1997, with 326,564 cases reported; however, that number increased to 360,076 cases last year. (Milwaukee Journal Sentinel (www.jsonline.com) (10/02/00) P. 5G; Altman, Lawrence K.)
Back to the November 2000 Issue of Body Positive Magazine.
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