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This Month in HIV: A Podcast of Critical News in HIV
  

This Month in HIV: Top 10 HIV/AIDS Stories of the Past Year

May 2008

This podcast is a part of the series This Month in HIV. To subscribe to this series, click here.

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Sperm Washing Effective for HIV-Positive Men Who Want Children

On to the next one, number five.

Number five is something completely different. It looks at an issue that's incredibly important to a lot of people in our clinics, and that issue is whether they can have a baby even though they are HIV positive.

This is a really important and interesting study that was able to quantify some of the experiences that individual providers have been able to offer us. The bottom line is that we know that among women who are HIV infected and who get medications, we can reduce their risk of transmitting the virus to their babies by almost 99 percent. Maybe 95 percent of children born to HIV-positive women will be uninfected, with the proper interventions -- HIV medicines -- to mom and baby.21

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What's a little bit less clear is what to do about HIV-infected men who are in a discordant relationship -- meaning they're in a relationship with a woman who is HIV negative. Can they produce a child? We shouldn't underestimate the drive of our species to reproduce, and how much joy people get from that. It's hard to deny people with HIV that, and this has become an ethical issue as well as a scientific issue and a medical issue.

This study addressed the biological issue.22 The researchers looked at sperm washing, which is a technique where the sperm, which are not infected with HIV, are separated from the semen and surrounding cells that are infected with HIV. That sperm is used to artificially inseminate the woman, either directly or in vitro, to create a baby. This is a technique that is offered at clinics across the world, and the idea here in this study was to report on that experience.

What the researchers found was that among the over 1,000 couples who underwent the procedure, pregnancy was the result in 51 percent of these cases. There were 410 deliveries. Things looked great, and six months after the procedure, almost 1,000 women had negative HIV antibody tests. There was no known female seroconversion after this procedure.

I think that is really important information that doesn't say that it's impossible or that this is 100 percent completely safe. It says that the HIV risk is extremely low for an HIV-negative woman when this procedure is used. This is good news and this is something people are very interested in.

Unfortunately, the price really precludes a lot of people from using this procedure. But at least it's an option and it's something people can have a little more faith in if it's something they want to pursue.

It's interesting that this was a European study. Why aren't these studies done in the United States?

I think you're right. This could have been done in the United States if the different clinics that perform this procedure were able to pool their data. I think sometimes the Europeans do a great job of creating networks across countries, as we saw with the D:A:D study. One thing I'd like to mention, though, is that with any assisted reproductive technique that involves trying to increase fertility or the insemination of more than one embryo, there is a risk of twins. That was something that was seen here among the women who had that type of procedure. You may get more than you bargained for.

Dr. Wohl, wasn't the risk of twins due to the fact that these women were also receiving fertility drugs after their partners underwent the sperm washing procedure?

That's right.

It seems that in Europe they are very friendly towards HIV-positive people who want to have children. There's not a lot of encouragement here, in the United States. There isn't a lot of fertility treatment available for people who are living with HIV.

Yes, I think that's right. That may have something to do with the epidemiology of the epidemic here, versus in Europe. Also remember, this is a study of a procedure wherein we're talking about HIV-negative women. It's the guys who are the positive ones.

I think you're right that for HIV-infected women, there has been this view that their having babies carries a risk, and there is the question of whether it is really a good idea or not. I do think that's evolving and moving in a direction of being more supportive of HIV-positive women giving birth, because the intervention is so good.

In this case, we're looking at men who are positive, and their discordant relationships. I think this is interesting and novel. What most of us can understand, now that HIV-positive people are living for so long, is how one of the things that separates HIV-positive people from people who are uninfected is the ability to have a child. Now we're finding that that probably doesn't have to be the case any longer.

Genetic Screening for Hypersensitivity to Ziagen

On to number six!

Number six involves a drug we've previously talked about indirectly, and that's Ziagen. I think one of the positive aspects about Ziagen over the last year has been our ability to neutralize one of the biggest obstacles to using this drug.

Ziagen is a drug that's in the nucleoside class; it's one of those nukes like Retrovir, Viread and Videx. The problem with this drug is that about 5 to 10 percent of people who use it will develop what's called a hypersensitivity reaction.23

Anyone who's ever been prescribed this drug knows all about this because, when they go to the pharmacy, there's a big warning that they're given, that when they take this drug, they can get this hypersensitivity reaction, which is almost like an allergic reaction. If they experience this reaction, they're to stop the drug and not retake it.

Years ago there were instances where people developed this reaction, stopped taking the drug, and then started again against medical advice, and died. The possibility of death being associated with an HIV drug is really horrible, so there was a lot of concern about this medication and counseling that had to go with it.

A significant contribution to science in general has come from a couple of different studies that have looked at trying to understand who develops this hypersensitivity reaction and who doesn't.24,25

Work that has been done by a couple of different groups has linked the risk of this reaction to the type of genes a person has. Not the virus's genetics, but individual people and their genetics. There is a genetic predisposition towards this reaction in some people. The gene that's associated with this reaction is much more common in white people than it is in African Americans; and it's even rarer in many Asian groups.

People have thought hard about how to use this information. There was a very nice presentation,24 which is now published,26 looking at using this as a strategy to screen people for this gene. Those who have the gene were not given Ziagen.

The bottom line is that that strategy works really well, such that there's been almost no case of anyone developing a hypersensitivity reaction who does not have this offending gene. Screening for this gene has become clinically adopted already. It's called HLA-B*5701. We call it 5701 for short. What we're doing in clinics is screening people who we're thinking of giving Ziagen; if they have the gene, we don't give Ziagen to them. For people who don't have the gene, we feel much safer about giving them the drug.

"This is one of those examples where HIV is a leader in the medical field. In a short period of time, we've identified the gene and made it clinically relevant. ... As we speak, a clinician is ordering this test to determine whether or not they should give Ziagen to someone."

That opens up a whole new opportunity to use this medication, whereas before we might have been reluctant to do so. So I think that's good news for this medication.

Is this test expensive?

Initially it was, and I think it varies from lab to lab, but most clinics now are able to get this test done for about $50 to $150. You can think about in the scheme of things how expensive that is. It's good because it's a one-time test; there's nothing that changes. Your genes don't change.

Are genetic tests commonly used before prescribing medication in the United States?

No, and that's one of the things that really excites me about this research. For years, we've been talking about this wonderful science of using a patient's genes to tailor their medical therapy, but it's all been talk. We really haven't been able to use genetic analysis to help craft medical therapy for an individual.

This is one of those examples where HIV is a leader in the medical field. In a short period of time, we've identified the gene and made it clinically relevant such that right now, as we speak, a clinician is ordering this test to determine whether or not they should give Ziagen to someone. That's just fantastic! I think that's great.

So this is a real first for medicine in general?

That's right.

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Copyright © 2008 Body Health Resources Corporation. All rights reserved. Podcast disclaimer.

This podcast is a part of the series This Month in HIV. To subscribe to this series, click here.


  

This article was provided by TheBody.com. It is a part of the publication This Month in HIV.
 

Reader Comments:

Comment by: William (London, UK) Wed., Jan. 13, 2010 at 5:38 am EST
My name is williams, I am 35 years old male from London, UK.
I do not have HIV but i am very sad to learn that many people are dying of this disease. I can help or support someone who have this disease in any way that I could. I can also be your best friend or even lover.......
I am looking for good friends from all over the world. It doesnt matter if you have HIV or not.
I am a good Christian and do not care about age, race, color or religion as we are made by the same God...
I HATE Lies, injustice, terrorism and discrimination..
If you wanna be my friend send me an email with the subject: FRIENDSHIP.
Peace and Love to you all..
This is my email address: williampeaston@yahoo.com
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Comment by: Sima (Dsm) Sat., Jan. 24, 2009 at 11:00 am EST
Thanx for the wonderfull web site.i now know where to get different information about AIDS/HIV.
Reply to this comment


Comment by: Priscillar (South Africa, Johannesburg) Thu., Nov. 20, 2008 at 10:49 am EST
I was diagnosed last year, 2007, with a CD4 of 59. Now I am at 550, taking Truvada and Stoctrin. What are my chances of opportunistic diseases, and toxicities? I need to be linked with a friend in SA.
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Comment by: azazhu (Ethiopia) Tue., Oct. 7, 2008 at 10:06 am EDT
that is very itnteresting
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Comment by: jim (alaska) Tue., Oct. 7, 2008 at 2:12 am EDT
i get the body regularly in e-mail and I am so thankful to all the wonderful doctors that contibute. I found out I had AIDS when I was hospitalised in 2000 with pml encephalitis and thank god for great doctors and great medicines i am alive to write this and i am am doing quite well. my past doctors whom i have kept n contact with in oregon are amazed. i was paralyzed on the right side of my body and they told my mother i would not survive the week. now i am a truck driver driving big semi's! People, get tested. If applicable, get on meds and PLEASE do not miss any doses. i say this from the bottom of my heart! You can e-mail me at willow444@msn.com. have a wonderful life! GET TESTED!!!!! Thank you again wonderful doctors!!!!!!!
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Comment by: caco (florida) Mon., Sep. 22, 2008 at 11:11 am EDT
Will we ever find a cure for HIV?
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Comment by: runing.outof.time (vaal) Wed., Sep. 10, 2008 at 7:22 am EDT
we r dieying. where or when is the cure
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Comment by: simone (Rosebud,SD) Tue., Sep. 2, 2008 at 12:42 pm EDT
I'm working to get the Native American people to get tested on the Reservation we have no testing. I'm working to collaborate with IHS to start testing I'm with the CHR Program. The hardest part is trying to get the people to get tested. I'm going to do the best I can to get them tested. I just wanted to let people know that their is a problem getting people tested everywhere.
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Comment by: lashawna Mon., Aug. 11, 2008 at 8:46 pm EDT
i think people really need to understand what sex is. too many people think it's ok to have unprotected sex when it is not ok. if you are going to do something with someone, wrap it up please. be the smarter person. that goes for straight people and gay people. get it together people! life is too short, please do not make it shorter.
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Comment by: jerry morales Thu., Jul. 31, 2008 at 1:33 pm EDT
I have a comment for dissidence 101, you weren't to concerened about vaccine success when you became infected and these drugs do seem to be keeping me alive. So bravo for the new drugs. I'm on Prezista and Isentress and celebrate their arrival. I'm sorry life doesn't seem as rosey for you.
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Comment by: Casey Fri., Jul. 18, 2008 at 12:14 pm EDT
I was wondering if you knew where to find information on how to join a certain study group of individuals with HIV+ in their states?
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Comment by: Innocent Fri., Jul. 11, 2008 at 9:10 am EDT
I have recently been diagnosed HIV+ but now i have hope that i can live longer but i've got a problem with FLU & Tonsils
help....S.A
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Comment by: Jason Mon., Jul. 7, 2008 at 7:16 pm EDT
I read that CDC predicts that if someone is positive less than four months that they can eliminate the virus from the body (with meds) within an average of 7.7 years. Is this true?
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Comment by: rami Mon., Jul. 7, 2008 at 3:28 pm EDT
Thank you very much for this energy you are putting into these podcasts / reviews. i find this so importnat. this gives much hope and info. Thank you!
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Comment by: wam Sat., Jul. 5, 2008 at 12:49 pm EDT
Hi Ezekiel Otieno where are you in Kenya. I am also positive living in U.K detected about 9 mths ago single mum of three. You can email me at nan.sa08@hotmail.com
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Comment by: Gideon Lawal Mon., Jun. 30, 2008 at 9:34 am EDT
Well am kinda new to this well. i lost my brother to this disease. right now the last time i check my status i was positive too and then my cd4 count is 375 and am still on oi. i need a friend from Europe and USA and anywhere in the world to help pass through this hard time right now am having stomach pain and headache.. here is my email: gideon080seyi@yahoo.com

Hope to hear from you soon
Later
Seyi
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Comment by: mickery Sun., Jun. 29, 2008 at 2:06 pm EDT
That's a great interview that everyone (whether positive or negative) should read.
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Comment by: dorcas Thu., Jun. 26, 2008 at 8:28 am EDT
doc.a big well done 4 d enlightenment.it goes a long way to give hope and encouragement to all the infected.its a therapy.hiv is a fundamental right and not a disease that needs to be adhered to.thanks
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Comment by: abdalla Tue., Jun. 24, 2008 at 3:21 am EDT
very exciting!
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Comment by: Robert Tue., Jun. 3, 2008 at 1:42 pm EDT
Dear Drs. at "The Body"

Keep up the good work! As you say all the time, there are great drugs out there but prevention is key!

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Comment by: bruno Sun., Jun. 1, 2008 at 8:40 pm EDT
god bless us all. stay strong people.
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Comment by: jason Sat., May. 31, 2008 at 10:33 am EDT
are there some of those drugs here in the philippines and how much its cost?
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Comment by: hilary Wed., May. 28, 2008 at 6:30 pm EDT
i have just found out my wonderfull nephew is HIV. Am so upset, my world has came crashing down. Thank God i can read positive stories. i can only pray he will outlive me. This happens to other familes not mine or so i thought. feel so ashamed. i thought HIV was AIDS I'm learning, however we all pretend it is not happening. i pray for a cure.
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Comment by: araceli villafania Tue., May. 27, 2008 at 2:07 pm EDT
very good info
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Comment by: TEDDY Thu., May. 15, 2008 at 9:05 pm EDT
Good job, but we need drugs that you could take once a month,any possibility? I know the pharmaceutical companies will frown over this as it will make volumes on profitable
Reply to this comment


Comment by: johnk Wed., May. 14, 2008 at 12:55 am EDT
What a smart, sharp overview! I too think the plethora of new interesting drugs is the story of the year. They have given me lots of hope as I've undetectable for the first time in 15 years! HIV medicine has made such strides. I'm one lucky man!
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Comment by: John morse Sun., May. 11, 2008 at 10:42 pm EDT
I was diagnosed with HiV at age 70! I am currently enrolled in a trail 96 week study for HIV naieve people. I am taking MK-0518 (or Placebo) Efavirenz (or placebo) and Truvada. within three months of taking the medications My viral load was undetectable and CD was up to 415 from 275! I have been on this program for a year now.
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Comment by: dissidence101 Sun., May. 11, 2008 at 10:22 pm EDT
That's just simply amazing that the biggest story of the whole year is "THERE'S MORE DRUGS". Gezze. I have a better one. How about and to the dismay of researchers, Merck's v520 complete and utter vaccine trial failure?
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Comment by: Noni Sat., May. 10, 2008 at 3:20 pm EDT
I started treatment in 2003 with CD4 of 8.I was on d4t, 3tc. I experienced loss of fats in hips and butt and changed to azt. Problem is i always worry about what if it doesnt work because in S.A we have only limited (2) regimens available. Are we S.A allowed to have or access these plenty of meds available in U.S.A and other countries? If so how do you access them?

Worried in South Africa
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Comment by: ezekiel otieno Sat., May. 10, 2008 at 9:10 am EDT
this website has given me a lot of strength.Through this I've learnt that i can live long enough than the seven years since i knew my status and i'm not alone.
I'm requesting this website to connect me one person living positively in Europe or Asia. I am from Kenya.
Reply to this comment


Comment by: Carole Ricks Wed., May. 7, 2008 at 7:45 pm EDT
Hello Everyone;

I would like to say how happy I am for all that have found their meds to work and they are doing great, Thank God for that, because He is always looking out for us all the time. I lost my brother to Hiv/Aids last year because he didn't and wouldn't seek treatment until it was too late. I miss him very much and I also have another brother who is Hiv positive as well. He is keeping up with his doctor's visits and taking care of himself. Please know that there are programs out there that can help you if you are sick. Don't wait! Seek help right away and remember that knowledge is power. God bless you all.
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Comment by: Dr. Elizabeth Mwanukuzi Wed., May. 7, 2008 at 10:20 am EDT
It is very interesting to note that the problem of late diagnosis is not limited to resource poor countries but what is particularly challenging to us in Africa is the poor accessibility of care and treatment facilities for rural communities because of poverty and poor travel intfrastructure
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Comment by: A AL YAZOURY Wed., May. 7, 2008 at 10:02 am EDT
THANK U GUYS FOR THIS GEART WEBSITE,THANK U VERY MUCH DOC FOR YOUR GREAT EFFORTS, I SUGGEST HIV TESTING FOR EVERY PERSON ONCE THEY ARE IN THE PROCESS OF GETTING ENSURACE CARD SO THIS WILL MAKE IT MORE EASY FOR EARLY DETECTION FOR THE VIRUS AND EARLY HELP AND BETEER PROGNOSIS, GOD BLESS U ALL.
Reply to this comment


Comment by: Akan Ituk Wed., May. 7, 2008 at 9:33 am EDT
A major problem with the HIV pandemic is that most folks is yet to come in terms with the reality. They "believe" they are uninfectable and as such need not to go for HIV screening. It is not until HIV is succesfully demystified, social immunization will not be achieved.
Reply to this comment


Comment by: AMAL Wed., May. 7, 2008 at 7:46 am EDT
THANKS DOC FOR YOUR WORK, PRAYERS FROM THE HEART FOR ALL THE POZs TO GET WELL SOON. IT'S A MATTER OF TIME, ONCE YOU R IN THE ACCEPTANCE STAGE YOU CAN LIVE NORMALLY. THANKS
Reply to this comment


Comment by: Brown Family Foundation Tue., May. 6, 2008 at 9:26 pm EDT
This article was very informative. Our organization promotes HIV Prevention and Detection. We've established a program called "Sisters Can We Talk". This program consist of panel discussions and small group sessions dealing with the subject of HIV and AIDS. We utilize local organizations to provide testing at each event.

This confirms that more opportunities are needed to present testing.
Reply to this comment


Comment by: Stuart Lee Carlson Tue., May. 6, 2008 at 5:46 pm EDT
Doc, thanks for your good work!

I've been poz for over 18 years now, and can say with confidence the hiv bug is a manageable disease.

Reason for writing is this: Fat has been stripped from my arms, legs, and butt. If it would help, I am quite able to give you the litany of all the drug regimens between start to the present. In summary first drug was AZT in 1992, when CD4 was 290. Currently I am taking Isentress, Aprivus, Norvir, and Epzicom and my CD4 is 770, wowee ! and VL is und.

For all I know, it seems to be a metabolic puzzle, and fortunately, no facial wasting, thank God.

Please advise.

Cheers!
Lee
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