Reports From the 10th Conference on Retroviruses and Opportunistic Infections
Boston, February 2003
Reports of new HIV infections and AIDS cases have risen for the first time in a decade, U.S. health officials said Tuesday. "AIDS complacency" means people are not getting tested for HIV and are passing it to others through unprotected sex and other practices, said Dr. Ronald Valdiserri, deputy director of the National Center for HIV, STD and TB Prevention at CDC. At the conference, Valdiserri said that in the 25 states reporting new HIV diagnoses to the federal government, the number of cases increased by 8 percent between 1999 and 2001. "We see a 14 percent increase in HIV diagnoses over this two-year period in men who have sex with men and a 10 percent increase in heterosexual transmissions," he said in an interview. The 25 reporting states represented about 25 percent of HIV cases in the country, Valdiserri said, but did not include New York and California -- the two states with the most cases. About half the new HIV cases are women who were infected by men, according to CDC.
"We are very concerned that it could represent a reversal in the trends that we believe have been relatively stable ... at about 40,000 new cases every year," Valdiserri said. "We have seen a slight increase in reported AIDS cases for the first time since 1993. It is just a 1 percent increase, but it's the first time since 1993."
While welcoming life-prolonging HIV drugs, health officials have worried that people often forget how dangerous HIV is. "We are still talking about a deadly disease for which there is no cure," Valdiserri said. "We are still dealing with this perception that HIV/AIDS is not a problem in America -- it is just a problem overseas. ... We are still very concerned about the estimated 280,000 people in America who are infected with HIV and don't know it."
Valdiserri said CDC had investigated syphilis outbreaks among gay and bisexual men and found that 43-59 percent of those with syphilis knew they were HIV-positive, suggesting they were having unprotected sex despite knowing they could pass on the virus. (Reuters, 02.11.03)
During his keynote address to the conference, former President Bill Clinton praised President George W. Bush for pledging to spend $15 billion to fight AIDS in Africa. But he also said steps must be taken to ensure that countries getting the cash are prepared to spend it effectively. "It's a big step forward," Clinton said of Bush's initiative. But he said Congress must be pushed to approve the money -- and the government must make sure that the countries getting it have systems in place so that it reaches those who need it.
Clinton said his own foundation is working with 15 Caribbean countries and three in Africa to help them train nurses, set up clinics, purchase and distribute medications and institute prevention efforts. He said that while AIDS has fallen out of the public eye in recent years, the global epidemic threatens to undermine fledgling democracies around the world. During an earlier press conference, Clinton said he is concerned also about rising HIV rates among young gay men and minority women in the U.S. "People in some population groups no longer think AIDS is a problem," he said, referring particularly to young gay men. "They just don't think about it much."
Clinton admitted he made a mistake during his presidency in opposing needle exchange programs that allow addicts to trade in used needles for clean ones. "We have to put science over politics," he said. Clinton said he hopes most of the U.S. AIDS money is distributed through the UN Global AIDS Fund, but said he is not opposed to private, faith-based organizations getting involved as well. (Boston Herald, 02.11.03, Michael Lasalandra)
New AIDS medicines in laboratory development or currently in human trials are fueling hopes that a new era of treatment is dawning. Scientists at the conference presented details of at least 10 promising drugs that might expand the roster of medicines thwarting the virus.
"The pipeline of new drugs has an impressive number of candidates in it. This is something we haven't seen in many years," said Dr. John Mellors, chief of infectious diseases at the University of Pittsburgh. Mellors estimated that a half-dozen drugs in clinical trials could help with drug resistance found both in patients with newly diagnosed AIDS and those finding that their medicines no longer work. Mellors and a panel of researchers found that 10 to 12 medications are in early phases of study -- compared with just one or two drugs in clinical trials a few years ago.
As an indicator for advancement: While the AIDS medicine T-20 continues to await approval by the Food and Drug Administration, researchers are already developing a related drug as a backup if a patient's virus outsmarts the T-20 formulation. Among the prospective drugs garnering attention at the conference is the drug TNX-355. While results are preliminary, early human trials of TNX-355 showed that HIV levels dropped by as much as 97 percent in some patients. The drug also is appealing to both researchers and patients because it is given as a single IV dose, lasting up to two or three weeks.
But Dr. Calvin Cohen, research director of Community Research Initiative of New England, who regularly guides clinical trials of AIDS drugs, talked about the time frame from research to patient and the pitfalls of side effects never anticipated by researchers. "It's wonderful to see the drug industry looking and to see some of these results. But it's also important not to rely on new drugs to get us out of this mess," said Cohen, who is also research director for Harvard Vanguard Medical Associates. (Boston Globe, 02.12.03, Stephen Smith)
Over the past five years, the argument that HIV-infected people can safely stop taking their medicine for extended periods, and possibly benefit from the breaks, has been alternately championed and rejected. Studies presented at the conference make clear that the argument is not settled and is actually more muddled than ever.
New research suggests that longer, more open-ended interruptions of treatment may be more useful than presumably safer, shorter breaks for some patients. However, it is uncertain as to whether there is a net benefit to taking the breaks. "It's much more complicated than we think," said John W. Mellors, an AIDS physician at the University of Pittsburgh and a conference organizer. "The message is, people shouldn't be willy-nilly interrupting treatment."
A Thai study compared three strategies: continuous treatment with three drugs; interruption that was allowed to proceed provided the patient's CD4 cell count (key in measuring immune-system robustness) remained above a specified threshold; and week-on/week-off interruptions. Mortality, complications and quality-of-life measures among the three groups yielded no differences at the end of a year. However, patients on the CD4-guided strategy actually did better in controlling viral load in the bloodstream than people in the week-on/week-off group, and only took drugs for about one-third of the year. A Spanish study compared the yearlong experience of patients randomly assigned to continue antiretroviral treatment or to stop and restart only if either CD4 cell count or viral load cutoffs were reached. Over a year, about 60 percent of the treatment interruption group had to start taking medicines again (after an average eight-week break), while 40 percent stayed off the drugs with no obvious ill effects.
Researchers in a U.S. study compared seven rounds of eight weeks on/four weeks off treatment with continuous antiretroviral therapy, testing a theory that the immune system may be boosted by periodic exposure to HIV swarms (occurring when treatment stops), after which the body might suppress the virus more aggressively or without medicine. No evidence of this happening was found. However, the interrupting therapy group was more likely to develop drug-resistant virus, causing researchers to stop enrolling patients in the trial. Overall, the results of the various studies suggest that frequent interruptions may promote the emergence of drug-resistant virus, especially for patients taking certain drugs that stay in the bloodstream for weeks after the last dosage. Alternatively, it appears that there are people whose immune systems can suppress the virus adequately for long periods of time. It may be possible to identify such people through CD4 or viral load thresholds. A large study through government-sponsored HIV clinics in the United States is testing this idea. (Washington Post, 02.13.03, David Brown)
The Internet appears to be a virtual meeting place for gay men willing to engage in high-risk sexual behaviors that often lead to transmission of HIV, according to research presented at the conference. Gay men who meet sexual partners online are more likely to engage in unprotected intercourse with them than they are with partners met elsewhere, according to a survey by researchers in New York. Furthermore, those already infected with HIV are more likely to have high-risk encounters with online partners than are people who are not infected. "The Internet is a new venue associated with high-risk sex," said Sabina Hirshfield, of the Medical and Health Research Association of New York City. The researchers last summer recruited about 3,000 visitors to the Web site gay.com to answer a 60-question survey about their sexual practices over the previous six months. Men from all 50 states were represented, 85 percent were white, and nearly 90 percent had attended college for at least a while. About 8 percent were HIV-positive. Eighty-four percent said they had met sexual partners online. Those men were slightly more likely to report unprotected anal intercourse (64 percent) in the previous six months than men who did not meet partners online (58 percent). Significantly, however, the HIV-positive men who found partners on the Internet were more likely to report having unprotected intercourse than other men using the Internet for the same purpose.
Hirshfield told her listeners that the study suggests "it may be possible to reach high-risk [men] through Internet interventions." Other hazardous encounters were examined in a study of HIV-positive inmates released from North Carolina prisons. David Wohl and colleagues at the University of North Carolina interviewed about 90 such inmates -- roughly half men and half women -- before they finished their prison terms, and then two months later. About half reported sexual activity soon after release, and 30 percent said it was unprotected sex with a longstanding partner who was either uninfected or whose HIV status was unknown. About one-third of the total group said they thought it was "likely" or "somewhat likely" that they would eventually infect their main partners.
Wohl speculated that prisons' main role in the AIDS epidemic was not as sites where infection was acquired, but as places from where infected people prone to risky behaviors cycled in and out of the population. Intensive prevention efforts could be directed at them, he suggested. (Washington Post, 02.12.03, David Brown)
This article was provided by Body Positive. It is a part of the publication Body Positive.