Newsline

• Transplants Give Life to HIV-Infected
• HIV and "Natural" Therapies: A Bad Blend
• Scientists Document Increasing Reports of HIV Superinfection
• Tenth of HIV Cases in a Study in Europe Are Resistant to Drugs
• HIV Patients Have More Heart Disease Risk Factors
• Combating Complacency About HIV Prevention
• Women Unaware of Viral Link to Cervical Cancer
• New Drug Promises Shift in Treatment for Heroin Addicts
• HIV Cases Climb Among Gay, Bisexual Men in U.S.

Transplants Give Life to HIV-Infected

Not long ago, the thought of transplanting organs into HIV-positive patients would have defied all reason. Giving scarce organs to patients who did not have long to live was considered wasteful, even unethical. Yet like so many things about AIDS, that view is slowly giving way to another: "Now, the question is whether we can ethically exclude these patients," said Dr. Stephen T. Bartlett, a surgeon at the University of Maryland Medical Center who performed a kidney transplant on an HIV-positive patient last May.

The unofficial moratorium on transplants for HIV-infected patients, in force since the 1980s, is slowly being lifted as hospital after hospital has found ways to push boundaries once thought inviolable. The argument for performing organ transplants on such patients was strengthened by a study presented this year by researchers at the University of California-San Francisco. Among 23 patients who had at least a year of follow-up after their transplants, the survival rate was about 85 percent. Outcomes overall were no different than one would expect among people without the virus.

The University of Maryland Medical Center has recruited patients for a nationwide trial in which 75 HIV-infected patients would receive kidney or liver transplants. One purpose of the clinical trial is to determine which anti-rejection drugs and which antivirals should be used and in what doses. Many doctors believe that certain anti-rejection drugs do nothing to worsen HIV infection while others should be avoided.

Dr. John Conte, who heads the heart transplant program at Johns Hopkins University, said heart transplants for people with HIV remain risky and should be done only by institutions participating in a clinical trial. For now, he said, the Hopkins program is staying out of trials, preferring to reserve the procedure for patients who stand the best chance of succeeding. (Baltimore Sun, 6.23.03)

HIV and "Natural" Therapies: A Bad Blend

Half of U.S. patients infected with HIV use alternative therapies while taking powerful AIDS cocktails, and nearly one in four choose alternative treatments that could interfere with conventional AIDS therapy. And many never share that information with their doctors, researchers have found in a recent study.

Patients often believe that so-called natural treatments are helping to keep them healthy and diminishing the unpleasant side effects of prescription drugs. But megadoses of vitamins, homeopathic remedies and some herbs can reduce the effectiveness of antiretroviral drugs. For example, the herbal antidepressant St. John's wort lowers blood levels of protease inhibitors, including indinavir (Crixivan) and ritonavir (Norvir). As a result, the medication can stop working and HIV can become resistant to antiretrovirals. Garlic can have similar effects on AIDS drugs, warned Dr. Charles Farthing, medical director of the AIDS Healthcare Foundation in Los Angeles.

"The simplest thing is to understand one drug and one herb, but the reality is most people are taking more than that," said Dr. An-Fu Hsiao, lead author of the study. Hsiao's study was sparked by his longtime interest in alternative medicine and his experiences with HIV patients, some of whom were reluctant to discuss their use of alternative therapies because other doctors had "looked down upon them."

Hsiao, a University of California-Los Angeles internist, and colleagues at UCLA and RAND Corp. analyzed data from a national survey of 2,466 HIV-positive adults, all of whom had received care for HIV-related illnesses in 1996. The researchers found that 53 percent of study participants used some form of alternative medicine; nearly 26 percent used forms that might be harmful; and 3 percent substituted alternative treatments for prescribed antiretroviral therapy.

While AIDS care providers strongly support alternative therapies like acupuncture, relaxation, massage and hypnotherapy, along with sensible use of multivitamins, they recommend patients avoid herbal remedies or megadoses of vitamins, which can damage the kidneys and other organs. The full study, "Complementary and Alternative Medicine Use and Substitution for Conventional Therapy by HIV-Infected Patients," is published in the June 1 issue of Journal of Acquired Immune Deficiency Syndromes (2003;33(2):157-165). (Los Angeles Times, 06.23.03, Jane E. Allen)

Scientists Document Increasing Reports of HIV Superinfection

Growing evidence indicates that "superinfection" with more than one strain of HIV might be more common than previously thought, possibly complicating vaccine efforts, according to experts at the International AIDS Society Conference on HIV Pathogenesis and Treatment in Paris. The scientists reported three new cases of HIV-infected people who initially were doing well without drugs but became sick years later after contracting a second strain of HIV.

"Superinfection is sobering," said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, who was not involved in the studies. "That means that although you can mount an adequate response against one virus, the body still does not have the capability to protect you against new infection, which tells you that the development of a vaccine is going to be even more of a challenge," Fauci explained. Though it is too early to tell how big a problem superinfection will become, Fauci said he does not believe superinfections are the reason patients on treatment can suddenly deteriorate.

None of the patients discussed at the conference was being treated for HIV, which can become resistant to drugs over time. At the meeting, Dr. Luc Perrin, professor of clinical virology at the University of Geneva, reported discovering superinfections in two Swiss IV drug users. In the study, Perrin followed 136 HIV-infected drug users and found that the amount of virus in the blood of five patients suddenly escalated after years of control without drugs. Testing confirmed that two of the five had a superinfection, said Perrin.

Another study by Dr. Harold Burger, of Albany Medical College in Albany, N.Y., reported genetic tests on a superinfected woman showed the two viruses mixed and produced a hybrid that took over from the original virus. It is the first documented case of two HIV strains, or subtypes, combining in one person to form a third strain -- something scientists have suspected could occur. "We just don't know how common it is. People say it's rare but we just don't know," said Dr. Anton Pozniak, an AIDS specialist at Chelsea and Westminster Hospital in London, who was not connected with the research.

"The issue is can you get a vaccine that will cover all subtypes?" said Pozniak. "This reinforces the message that we've got to stop HIV today so that we can deal with what we have now and not generate a whole load of new mutants that wouldn't have been there otherwise," Pozniak said. (Associated Press, 07.15.03, Emma Ross)

Tenth of HIV Cases in a Study in Europe Are Resistant to Drugs

The biggest study, so far, of resistance to AIDS drugs, being released today at the International AIDS Society Conference on HIV Pathogenesis and Treatment in Paris, finds that about 10 percent of newly infected patients in Europe are infected with drug-resistant strains. Dr. Charles Boucher, virology professor at Utrecht University and lead researcher of the study, called the level of resistance to some AIDS drugs "surprisingly high."

The study, nicknamed CATCH ("Combined analysis of resistance transmission over time of chronically and acute infected HIV patients in Europe"), tested 1,633 patients from 17 European countries who had just been diagnosed with HIV and who had not yet been treated for it. About 9.6 percent of the patients were resistant to at least one of the three types of antiretroviral drugs that suppress the virus. Resistance to nucleoside reverse-transcriptase inhibitors was found in 6.9 percent of those studied; resistance to non-nucleoside reverse-transcriptase inhibitors in 2.6 percent; and resistance to protease inhibitors in 2.2 percent.

Drug-resistant strains appear because the virus mutates rapidly and thrive when patients take their drugs carelessly. For patients to be newly infected with resistant strains, they must have been infected by people with HIV who had gone back to high-risk behavior despite having caught a disease that is usually fatal.

Another result of the CATCH study showed resistance was much higher, at 11.3 percent, among Europeans who had subtype B of the virus, compared to those with non-B subtypes, in whom resistance was 3.3 percent. Subtype B infects 98 percent of American patients and about 60 percent of European patients.

Other scientists suggested that an "order of battle" approach to prescribing AIDS drugs, like that used for TB medicines, should be adopted in place of the current free-for-all. One researcher said public health authorities could tell doctors which drug combinations to prescribe first, second and third as resistance was encountered. Some doctors said the study suggested that all new AIDS patients should be tested to determine the drug resistance of the strains infecting them. (New York Times, 07.16.03, Donald G. McNeil Jr.)

HIV Patients Have More Heart Disease Risk Factors

A new study by French investigators says HIV patients have a higher risk of common coronary heart disease risk factors. Dr. Genevieve Chene, from Universite Victor Segalen Bordeaux 2 in France, and colleagues evaluated the risk factors for cardiovascular disease in 223 HIV-infected patients who were treated with a drug regimen containing a protease inhibitor. These patients were compared with 527 patients in the general population who were not HIV-infected. All subjects were ages 35 to 44.

The HIV-infected men were more likely to smoke, have a higher waist-to-hip ratio, and a higher triglyceride level than the men who were not HIV-infected. Average HDL "good" cholesterol and frequency of high blood pressure were lower among HIV-infected men. Similar trends were seen among HIV-infected women, but they had higher total cholesterol levels than did women in the comparison group. The researchers reported that the estimated five-year risk of developing coronary heart disease was 20 percent higher than the general population among HIV-infected men, and 59 percent higher among HIV-infected women. However, a significant percentage of the increased risk -- 65 percent among men, and 29 percent among women -- could be attributed to the higher smoking rates.

Similar trends were found in a group of 45- to 54-year-old men with HIV. This group showed a 22 percent higher risk of coronary heart disease than the comparison group. "Risk assessment for cardiovascular disease should be a part of routine HIV care," the researchers wrote. "This should include not only laboratory abnormalities but also assessment of smoking habits, exercise activity, and family history of cardiovascular disease."

"Although absolute coronary heart disease risk remains low in HIV-infected patients treated by antiretrovirals, smoking cessation should seriously be considered," Chene said. Abnormal cholesterol levels "only marginally account for the increased risk in this population compared to uninfected patients," she said. "HIV-infected patients should be aware that they have, on average, a slightly higher risk of coronary heart disease," Chene said. (Reuters Health, 07.24.03)

Combating Complacency About HIV Prevention

Revolutionary new drugs, coupled with a new generation of gay men in their 20s without memory of the early AIDS devastation, led health officials to warn AIDS could make a comeback in the United States. Last week, new figures proved the warnings right: AIDS diagnoses had increased for the first time in 10 years.

"There needs to be a lot more attention paid to the HIV epidemic in the United States," said Dr. Jim Curran, dean of Emory University's Rollins School of Public Health, and a former AIDS director with CDC. "People need to realize there's still no cure and no vaccine. Our greatest enemy in HIV prevention is ... complacency about our epidemic here."

In 2002, 42,136 new AIDS cases were diagnosed, a 2.2 percent rise over 2001. HIV infection among gay and bisexual men was up for the third year in a row. Up to 15 percent of new HIV cases may have drug-resistant strains of the virus. "I don't think we're losing the war, but we're certainly not finished with the war," said Dr. Ronald Valdiserri, a CDC deputy director. "Part of it is complacency, part of it is indifference ..." said Terje Anderson of the National Alliance of People with AIDS. "Part of it is fatigue -- guys have been trying to stay safe for 20 years, how do you keep doing it? At a certain point people are losing their ability to do that and it's very troubling."

In April, CDC director Dr. Julie Gerberding announced a change in the country's HIV prevention strategy. Rather than addressing risky behavior in the uninfected, the new focus is on stopping HIV patients from transmitting the virus to others, reducing mother-to-child transmissions, and increasing the use of a new rapid test in non-medical settings. Activists have voiced concern about the strategy, which may take funding from current AIDS groups. Anderson said CDC's initiative is a good approach, but prevention campaigns cannot neglect community-level interventions. (Associated Press, 08.03.03, Daniel Yee)

Women Unaware of Viral Link to Cervical Cancer

A survey released Tuesday showed that many women are unaware that the human papillomavirus is the main cause of cervical cancer, and that birth control pills offer no protection against it. HPV, linked with about 95 percent of cases of cervical cancer, is one of the most common worldwide causes of sexually transmitted disease.

Fewer than one-third of the 1,000 women questioned during 15 months at a London clinic had ever heard of HPV. Less than half knew it was linked to cervical cancer. Those who knew tended to be older women who had had an abnormal cervical smear. Average age of the women surveyed was 30.

"In this relatively well-educated sample, awareness and knowledge of HPV were poor," Jo Waller of the University of London said in the report "Awareness of Human Papillomavirus Among Women Attending a Well Woman Clinic," published in Sexually Transmitted Infections (2003;79;(4):320-322).

Almost all women with cervical cancer have HPV, but studies have shown that only a small percentage of women with HPV develop cervical cancer. HPV also causes genital warts, the most easily recognized sign of HPV infection. Only one-third of the women surveyed knew that genital warts did not cause cervical cancer. "Public education is urgently needed so that women participating in cervical cancer screening are fully informed about the meaning of their results," Waller noted. (Reuters, 08.04.03)

New Drug Promises Shift in Treatment for Heroin Addicts

A newly approved substitute for methadone -- the standard for treating heroin addiction since the 1960s -- is generating enthusiastic praise from both experts and addicts, and it could triple the number of people in serious treatment for heroin addiction.

For many addicts, though not all, buprenorphine functions like methadone, blocking the craving for a high, but experts and addicts point to several advantages it has over the older drug -- the most important may be that a patient can get a supply, rather than just a dose, with a visit to a doctor and pharmacy. For many addicts, not having to go to a methadone clinic daily is an enormous advantage.

Like methadone, buprenorphine is addictive, but with a much lower risk of overdose. And unlike methadone, buprenorphine will not give an addict more than a mild high regardless of how large a dose given, and it cannot be combined with opiates or other narcotics to get higher still. Users report fewer unpleasant side effects and milder withdrawal symptoms upon discontinuing its use.

"My hope and my expectation is that buprenorphine will revolutionize heroin treatment in the United States," said Dr. Herbert D. Kleber, a professor at Columbia University's College of Physicians and Surgeons and a leading expert on heroin and buprenorphine, who was deputy director of the Office of National Drug Control Policy in the first Bush administration.

Other experts warn that much remains to be learned about buprenorphine, but add that since doctors began prescribing the drug, the experience has been overwhelmingly positive.

For decades, federal law has prohibited use of any drug but methadone for heroin addiction. Congress loosened the law in 2000, and the Food and Drug Administration ruled that doctors could prescribe buprenorphine for addiction treatment in October. To prescribe it, a doctor must first take an eight-hour course and register with the U.S. Drug Enforcement Administration. Federal law prohibits prescribing to more than 30 patients at a time. About 2,000 doctors nationally have been cleared to prescribe the drug, according to Dr. H. Wesley Clark, director of the federal substance abuse center. (New York Times, 08.11.03, Richard Pérez-Peña)

HIV Cases Climb Among Gay, Bisexual Men in U.S.

At the 2003 National HIV Prevention Conference in Atlanta, CDC reported that the number of U.S. gay and bisexual men diagnosed with HIV increased for the third consecutive year in 2002. AIDS diagnoses overall rose 2.2 percent, to 42,136 last year. "The AIDS epidemic in the United States is far from over," said Dr. Harold Jaffe, director of CDC's National Center for HIV, STD and TB Prevention.

Health officials estimate that 850,000 to 950,000 Americans have HIV. AIDS killed 16,371 people across the country last year, about 6 percent fewer than in 2001, CDC statistics say. The apparent resurgence of infections among gay and bisexual males concerns U.S. health officials. CDC data collected from 25 states with long-standing HIV reporting show that HIV diagnoses among men who have sex with men surged 7.1 percent last year. New diagnoses in this group have increased 17.7 percent since 1999. New diagnoses have remained stable in other vulnerable communities. Jaffe cautioned that an increase in testing among gay and bisexual males could account for the jump in HIV diagnoses. It does not constitute proof that this group is becoming infected at a faster rate. (Reuters, 07.28.03, Paul Simao)

Articles in the Newsline section are derived from the press abstracting service run by the National Prevention Information Network (NPIN) of the Centers for Disease Control and Prevention (CDC).

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This article was provided by Body Positive. It is a part of the publication Body Positive.