Much of this week's update features our coverage of breaking research from the 44th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC 2004). Several intriguing, important studies were presented at this major, annual gathering of medical professionals -- and our outstanding team of HIV physicians was on hand to cover them!
To browse through our complete coverage of this conference, visit our ICAAC 2004 home page. More coverage will continue to arrive throughout the week!
Goldman, Editorial Director, The Body
• HIV TREATMENT
U.S. Updates HIV Treatment Guidelines
Updated guidelines on HIV treatment for adults and adolescents have been released by the U.S. Department of Health and Human Services (DHHS). Among the most important changes:
stavudine (d4T, Zerit) has been changed from a "preferred" to an "alternative" medication, due to growing concerns over side effects;
the number of preferred HAART regimens involving tenofovir (Viread) has increased;
the recently approved antiretroviral FTC (emtricitabine, Emtriva) has been added as an option to both the "preferred" and "alternative" lists of first-line regimens, particularly facial wasting and neuropathy; and
the recommendation on when to consider starting treatment for otherwise-healthy HIV-positive people with CD4 counts above 350 has been raised from a viral load of 55,000 to a viral load of 100,000.
FDA Orders Removal of Two Misleading Kaletra Ads
The U.S. Food and Drug Administration (FDA) has released a letter ordering Abbott Laboratories to stop circulating two advertisements for its antiretroviral Kaletra (lopinavir/ritonavir). The agency said the ads "exaggerat[e]" the drug's benefits and omit information about possible "life-threatening safety risks," namely dangerous interactions with other drugs. Earlier this year, the FDA also ordered Abbott to remove misleading materials claiming that ritonavir (Norvir) was the lowest-priced drug in the protease inhibitor class.
• FUZEON CHAT TRANSCRIPT
Full Transcript of The Body's Fuzeon Chat Is Now Available
Did you miss our live chat on Fuzeon (T-20, enfuvirtide) on Oct. 25? Did you attend the chat but want to review all of the questions that were answered by Louise Perry, a registered nurse experienced with Fuzeon, and Greg Braxton, an HIV-positive person currently taking Fuzeon as part of his HAART regimen? Read the full transcript of our chat to see everything our speakers had to say.
This chat is sponsored by Trimeris and Roche, the makers of Fuzeon.
• BREAKING TREATMENT RESEARCH: EXISTING MEDS
Tenofovir Found Superior to AZT as Part of First-Line Regimen
Could we be on the verge of an evolution in initial therapy options? That's what Dr. Cal Cohen says in his report from ICAAC 2004 on a head-to-head study of two first-line regimens. Tenofovir (Viread) appeared to be superior to AZT (zidovudine, Retrovir), both in terms of safety and the likelihood of success.
FTC and 3TC: Birds of a Feather, New Research Suggests
Much of our knowledge of FTC (emtricitabine, Emtriva) is based on earlier studies of its close cousin 3TC (lamivudine, Epivir). Direct comparisons of FTC and 3TC are increasing, though -- and they are confirming our assumptions about the efficacy, safety and tolerability of this new NRTI. Dr. Edwin DeJesus, reports from ICAAC 2004.
Four-Drug, NRTI-Only Regimen Shows Promise
The idea of using three-drug regimens consisting entirely of NRTIs took a big hit this year, as multiple studies have shown such a strategy to be frequently unsuccessful. However, a four-drug, NRTI-only regimen -- in this case, Trizivir (AZT/3TC/abacavir) plus tenofovir (Viread) -- has shown favorable results in a new study. Dr. Paul E. Sax reports from ICAAC 2004.
Brief Viral Load "Blips" Not a Sign of Emerging Resistance, Study Suggests
Viral load "blips" -- brief, small spikes in a normally undetectable viral load -- are mostly a result of variations in the viral load tests themselves, not a sign of emerging resistance, according to the results of an intensive, short-term study of 10 patients. Dr. Mark Holodniy reports from ICAAC 2004.
• BREAKING TREATMENT RESEARCH: NEW MEDS
Member of New Drug Class Makes Progress in Early Study
It may not yet have a name, but the CCR5 inhibitor known as 837140 is already beginning to make a stir. The drug, part of an experimental class of medications that seeks to prevent HIV from entering a CD4 cell, appeared to be both safe and effective in a 10-day trial involving HIV-infected patients. Dr. Mark Holodniy reports from ICAAC 2004.
NRTI in Development Appears Effective In People With NRTI Resistance
D-D4FC (Reverset) is an NRTI in development that appears to have activity even in HIV-positive people with many NRTI-resistant mutations, according to 10-day data from a 10-patient study. Dr. Paul E. Sax reports.
Experimental NNRTI Advances in Early Clinical Trial
Early research on one of the relatively few NNRTIs in development, GW695634, shows that the drug is generally well tolerated in healthy male volunteers, Dr. Paul E. Sax reports. There were no serious side effects reported through 10 days, although 3 of 39 patients discontinued the drug because of rash, and a small, transient decline in blood pressure was noted.
• WOMEN & HIV
HIV Infection Tied to Sexual Dysfunction in Women
Can just being HIV positive cause sexual dysfunction in women on HAART? Dr. Margaret Hoffman-Terry reports from ICAAC on a small French study that shows just that.
Impact of HAART Meds on Women
All HIV meds come with side effects, but some side effects are worse in women than in men. In this overview, Anne Monroe briefly discusses some of the HAART side effects that are of particular concern for women.
HIV, HAART and Menopause: The Effects of Estrogen Replacement
If you're HIV positive and going through menopause, is it safe to take estrogen replacement therapy (ERT)? Just as for HIV-negative women, there are many factors to consider before starting ERT -- especially if you're also taking HIV medications. Dr. Patricia Kloser explains.
• HIV TREATMENT ACCESS & POLICY IN THE UNITED STATES
HIVer Learns How to Use the System to Get His Meds
Henry E. Dendy had to quite literally fight North Carolina's healthcare system for his life: He spent endless hours filling out forms and trying to navigate the complex requirements for the state's AIDS Drug Assistance Program, Medicaid and drug companies' patient assistance programs. In the end, Henry's persistence paid off: He learned the system and got the meds he needed. Now he works to make sure other HIVers in North Carolina get access to their HIV treatment as well.
Medicaid and Medicare: Effective, But Gaps Are Growing
The United States is the only Western industrialized country that hasn't found a way to provide health care to all its citizens. Although government programs like Medicaid and Medicare have done an admirable job of serving vulnerable people, they remain part of a fractured system with many gaps. In this report, Anne Donnelly explains Medicaid and Medicare eligibility requirements, benefits and gaps in coverage.
Montana Legalizes Medical Use of Marijuana; Setback in Oregon
Conservative efforts advanced in most areas of the country on Nov. 2, but in Montana, voters overwhelmingly approved an initiative to allow the use of marijuana for medical purposes by people with chronic illnesses, including HIV. In Oregon, meanwhile, voters turned down an effort to expand the state's previously approved medical marijuana program, which would have increased the amount of marijuana a person can possess and required nonprofit groups to obtain state-issued licenses to distribute marijuana.
• HIV/STD TRANSMISSION
Vaccine for Human Papillomavirus Extremely Effective, Study Says
An experimental vaccine can provide long-term protection against human papillomavirus (HPV), one of the most common sexually transmitted diseases and the cause of cervical cancer, according to study results presented at ICAAC 2004. Four years after receiving the vaccine, 94 percent of women in the study were protected from HPV-16, a strain that accounts for about half of all cervical cancers. None of the women developed precancerous conditions.
Sexual, Male-Male Transmission of Hepatitis C Discovered Among HIVers
Although transmission of hepatitis C occurs almost entirely through blood-blood contact, a small French study has discovered 12 cases in which HIV-positive men became infected with hepatitis C through unprotected sex with other men. (Web highlight from Medscape Medical News)
HIV Outbreak May Be Nearing for Mexican Migrant Workers
We may be on the verge of an HIV outbreak among Mexican migrant workers in California, according to a pair of new University of California studies. HIV infection rates have risen sharply among Mexican migrant workers, the studies found; the workers are infected with HIV at a rate three times higher than that of the general U.S. and Mexican populations.
U.S. Doctors Warned of Potential Outbreak of Rare STD Among Gay, Bisexual Men
Doctors and clinics in the United States have been warned about the potential spread of Lymphogranuloma venereum (LGV), a normally rare sexually transmitted disease (STD) that has recently been spreading among men who have sex with men in the Netherlands in other parts of Europe. LGV is caused by specific strains of chlamydia; in the Netherlands outbreak, men developed symptoms such as gastrointestinal bleeding and inflammation of the rectum and colon.