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July 22, 2004

In This Update:
  • From the Editor
  • HIV Treatment
  • U.S. HIV Drug Pricing & Treatment Access
  • HIV/HAART-Related Health Problems
  • HIV Prevention
  • U.S. HIV/AIDS Policy & Activism
  • HIV/AIDS Outside the U.S.
  •   FROM THE EDITOR

    The XV International AIDS Conference (AIDS 2004) in Bangkok, Thailand, did not offer much breaking scientific news. There are other, more focused conferences (such as ICAAC, which will be held this fall) where this kind of information is presented. As our newly launched AIDS 2004 Photo Journal shows, AIDS 2004 concentrated on the other important facets of the HIV/AIDS pandemic: HIV prevention, stigma, youth participation in the AIDS fight, the need to empower women and access to effective HIV medications for everyone who needs them.

    Some people have begun to question the usefulness of a conference like AIDS 2004, due to the expense involved in organizing (and attending) such a massive meeting. But it's important to remember that this conference remains the only major international gathering of all of those involved in the AIDS epidemic: healthcare workers, researchers, AIDS advocates, drug company reps, educators, politicians, HIV-positive people, sex workers, drug abusers and AIDS organization members from around the world.

    In addition, as evidenced by the conference's impressively large, always-bustling, heavily staffed media center, AIDS 2004 succeeded notably in at least one thing: Capturing, for at least one week, the attention of the world's media. The global AIDS pandemic still receives far less notice than it deserves, so it's a welcome sight when so many news organizations are gathered in one place to cover it.

    This week's update includes additional highlights from AIDS 2004, as well as plenty of our regular fare of news, research and useful information. If you'd like to browse through all of our conference coverage, the best place to start is The Body's AIDS 2004 home page. And be sure to check out an exciting new feature of our conference coverage: The Body's own photo journal of the week's events in Bangkok!

    - Bonnie Goldman, Editorial Director, The Body

      HIV TREATMENT

    For Some, Clinical Trials Are a Lifeline
    Although most experts don't recommend you join a clinical trial just to get the latest drugs in development, that's exactly what Matt Sharp did -- and he has no regrets. "I can't see myself sitting around and doing nothing, just waiting. I have probably been in dozens of studies that have led me to where I am today, with mostly positive, but some negative, results. I was privileged, educated and privy to the latest information, and I am lucky to be a survivor."


    HIV Drug Development Update
    Despite receiving somewhat less attention this summer than they had last summer, there are plenty of HIV medications in the pipeline. Bob Huff of GMHC Treatment Issues provides this update on several notable antiretrovirals in development -- and on some of the companies that are producing them.


    HIV Med Doses, Treatment Tools Ignore Needs of Children, Medical Group Says
    Researchers and pharmaceutical companies aren't trying hard enough to develop diagnostic tests and medication doses specifically for HIV-positive children, said a senior Doctors Without Borders official at AIDS 2004. The health of many children is put at risk because it's so much more difficult to provide HIV treatment to young people than adults, particularly in the developing world, he said.

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      U.S. HIV DRUG PRICING & TREATMENT ACCESS

    Two Lawsuits Against Ritonavir Price Increase Are Dropped
    Two major lawsuits against Abbott Laboratories for its ritonavir (Norvir) price increase are being dropped. AIDS Healthcare Foundation (AHF), which brought the lawsuits, has agreed to withdraw them in exchange for Abbott's funding of AHF treatment programs in South Africa and the United States.

    The AIDS Treatment Activists Coalition is fuming over AHF's move. In this press release, the advocacy organization calls AHF's decision to drop the lawsuits "a carefully orchestrated sell-out" that serves AHF's needs at the expense of HIV-positive people throughout the country.


    New Medicare Discount Cards Offer Inconsistent Benefits for HIVers
    Fewer Americans than expected have signed up for the new Medicare discount cards, partly due to confusion over which of the many cards available, if any, provides the best savings. As this comparison chart shows, HIV-positive people could see very different levels of savings depending on the meds they take -- and some may actually end up paying more with a Medicare drug card than they would by purchasing their drugs through Web sites like drugstore.com or canadadrugs.com.


    New Funds Will Erase Colorado's ADAP Waiting List, Expand Drug Formulary
    Colorado's AIDS Drug Assistance Program (ADAP) has received approximately $3 million to cover the 315 people currently on its waiting list. The one-time contribution will also allow Colorado's ADAP to expand its drug formulary, which currently covers just 18 antiretrovirals and none of the medications used to prevent or treat HIV-related illnesses.

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      HIV/HAART-RELATED HEALTH PROBLEMS

    Bone Cement Injections Show Success as Facial Wasting Treatment
    Injections with a solution containing polymethylmethacrylate, a type of bone cement, can safely and successfully treat facial wasting through five years of follow-up, according to the results of a study by Brazilian researchers presented at AIDS 2004. People who took part in the study reported high levels of satisfaction with the procedure and improved quality of life.


    Switching to Tenofovir May Help Reduce NRTI-Related Side Effects
    Switching HIV medications to alleviate side effects has become increasingly common. In this study, substituting an NRTI for tenofovir (Viread) resulted in improvements after 24 weeks in many areas. Although lipoatrophy improved only in 13% of patients, neuropathy was resolved in 29% of patients and there were significant changes in anemia and liver function test abnormalities. Cal Cohen, M.D., reports from AIDS 2004.


    HIV, HAART and Aging: What Interactions Should You Watch Out For?
    Aging affects us all -- something that has, unfortunately, not been true for most HIVers until HAART arrived in the mid-1990s. As people with HIV live longer and grow older, however, a new set of issues arises: How do HIV medications, not to mention HIV itself, affect age-related ailments like high blood pressure, high cholesterol, cancer and bone loss? Dr. Jerome Ernst reviews what doctors have learned so far.


    Update on HPV and Cancer in Gay Men
    Is human papillomavirus (HPV) infection more likely to occur -- and more dangerous when it does -- in HIV-positive gay men than HIV-negative gay men? The answer is still unknown, reports Frank Rhame, M.D., from AIDS 2004.


    Prostate Cancer More Common in HIV-Positive Men
    Men with HIV appear more likely to get prostate cancer than HIV-negative men, and neither HAART nor CD4 count appears to help alter those odds, U.S. researchers have found. Researchers remain puzzled as to why prostate cancer is more common in HIVers, and caution that much more research is needed before they can confirm the findings of their study. (Web highlight from aidsmap.com)

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      HIV PREVENTION

    Adding Combivir to Nevirapine Reduces Mother-to-Child Transmission, Resistance
    While single-dose nevirapine (Viramune) can be an effective way to reduce the risk of mother-to-child transmission of HIV, particularly in the developing world, studies have shown that using nevirapine alone could make the mother's HIV resistant to nevirapine, as well as all other NNRTIs. But as Margaret Hoffman-Terry, M.D., reports from AIDS 2004, using single-dose nevirapine plus Combivir (AZT/3TC) may be a feasible and cost-effective way to reduce the risk of transmission while also lowering the chances that resistance will develop.


    Rectal Microbicides: Where's the Booty Butter?
    "All hail vaginal microbicides!" Jim Pickett says. "They can't get here too soon. But hey, what about the boot (i.e., booty, butt, ass, culo, can). Just where are we at with rectal microbicides, which would be similar to vaginal products but would protect our precious triumvirate of anus, rectum and colon during anal intercourse?"

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      U.S. HIV/AIDS POLICY & ACTIVISM

    Activists Seek Help in Legalizing Medical Marijuana
    The U.S. Congress could vote this month on an amendment that would prevent the federal government from arresting people who legitimately use medical marijuana in states where the practice is legal. Want to urge your congressperson to support the bill? This update has more information.

    Meanwhile, the U.S. Supreme Court has agreed to hear a case on the constitutionality of a federal ban on the use of marijuana by people who are seriously ill. The case will most likely be argued before the court this fall.


    Illinois Legalizes Organ Transplants Between HIV-Positive People
    Illinois has become the first U.S. state to legalize the donation of organs from one HIV-positive person to another. Gov. Rod Blagojevich signed a bill into law on July 15 permitting the practice, putting the state at odds with federal guidelines, which state that organs from HIV-positive people must be discarded to prevent accidental transplantation to HIV-negative people.

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      HIV/AIDS OUTSIDE THE U.S.

    Webcast: Thai Children, Nelson Mandela Close AIDS 2004
    Thai children directly affected by AIDS performed at the AIDS 2004 closing ceremony, emphasizing to delegates the importance of their work. Impassioned speakers, including former South African President Nelson Mandela, challenged conference participants to appreciate the urgency of their task and to strive for unity in their approaches toward HIV prevention and treatment.

    Click on the following links to view this Webcast in RealPlayer or Windows Media, or to download a PDF containing the abridged transcript of the closing ceremony.


    What Has AIDS 2004 Achieved?
    Only time will tell whether AIDS 2004 has any kind of lasting impact on the global AIDS fight, but there are several areas in which the Bangkok conference might be deemed a success. BBC Health correspondent Karen Allen reviews the ways in which AIDS 2004 may have set the global agenda for battling the pandemic over the next two years. (Web highlight from BBC News)


    Generic Fixed-Dose Combination Drugs Succeed in First, Large-Scale Study
    The first, large-scale study of people in developing countries receiving generic fixed-dose combination (FDC) antiretrovirals revealed a "very robust outcome," according to Doctors Without Borders, which conducted the study and presented its findings at AIDS 2004. A total of 6,861 HIV-positive people have received generic FDCs through treatment programs run by Doctors Without Borders since 2002, according to the study; more than 80% of them were still alive one year after starting treatment, and their CD4 counts increased by an average of 137.


    AIDS and the Single Girl: Global AIDS Fighters Call for Focus on Women
    At AIDS 2004, "battles between leaders of global AIDS groups and the Bush administration centered almost entirely on the best ways to prevent the further spread of the deadly pandemic," writes John Donnelly of The Boston Globe. "And as new data underscores the vulnerability of women in contracting the virus, a new term in the global fight against AIDS -- 'cross-generational sex,' or older men having sex with girls and young women -- became a major topic of conversation in seminars and in hallways at the conference." (Web highlight from The Boston Globe)


    Discrimination, Gender Inequality Challenge HIV Prevention Efforts in South Asia
    Gender inequality and HIV-related discrimination remain the two most formidable challenges to HIV prevention efforts in South Asia, according to a July 13 satellite session at AIDS 2004. To counter the stigma of the disease, speakers said, nations must protect the rights of their HIV-positive citizens, foster equal rights for women, form partnerships between the health and education sectors and amend laws that criminalize marginalized high-risk groups.


    Voucher Program for Injection Drug Users in Asia Reduces HIV Infections
    A harm-reduction program on the China/Vietnam border, in which drug users receive vouchers redeemable at local pharmacies for clean needles, condoms and medicines, has successfully decreased after one year the number of new HIV infections among drug users, according to a study presented at AIDS 2004. Local police have agreed not to interfere with the program, and pharmacists and health authorities support the project.


    U.S. House Approves $2.2B for Global AIDS, Tuberculosis, Malaria
    The U.S. House of Representatives approved a $19.4 billion foreign aid spending bill for fiscal year 2005, which includes $2.2 billion -- about $593 million more than last year -- for HIV/AIDS, tuberculosis and malaria initiatives. Included in the bill is a $400 million allocation for the Global Fund, double the amount requested by President George W. Bush; the extra funding for the Global Fund would be diverted from the President's Emergency Plan for AIDS Relief. The Senate has yet to approve its version of the budget.


    Beijing's Insurance System to Cover HIV Medications
    Beijing has announced that the city's insurance system will begin covering the cost of 12 HIV medications next month. Workers and retirees covered under the system will be reimbursed by their employer for much of the costs.



    Researchers Unveil Portable, Battery-Powered CD4 Tester
    A new piece of CD4 monitoring test equipment, smaller than a toaster and powered by rechargeable batteries, was unveiled this week at AIDS 2004. The equipment, which can deliver results in 15 minutes at a cost of less than $5 per test, was developed by University of Texas scientists for use in limited-resource settings.

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    AIDS 2004 PHOTO JOURNAL:
    The Anti-HIV Elephant
    Image from the AIDS 2004 Photo Journal
    Don't think an elephant can be an AIDS activist? Think again. This image is just one of dozens of photos that make up our new AIDS 2004 Photo Journal. Stop in for a one-of-a-kind, close-up look at the people, places and events that made up the XV International AIDS Conference in Bangkok, Thailand!
    ART FROM HIV-POSITIVE ARTISTS
    Image from the July 2004 Visual AIDS Web Gallery
    "San Francisco, California," 1979;
    Tseng Kwong Chi
    Visit the July 2004 Visual AIDS Web Gallery to view this month's new collection of art by HIV-positive artists.