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August 3, 2005

In This Update:
  • Breaking HIV Research & News:

  • First-Line HIV Treatment
    Second/Third-Line HIV Treatment
    Other HIV Treatment Issues
    HIV/HAART-Related Complications
  • HIV/AIDS Policy & Controversy
  • HIV Prevention
  • HIV/AIDS Outside the U.S.

    We want to hear from you!

    If you've ever had nausea, diarrhea, gas, vomiting or the like after taking your HIV medications, we'd like to hear your story -- and, if you'll allow us, to share it with our readers! The Body is putting together a new educational booklet on the gastrointestinal side effects of HAART. Part of our booklet will include quotes, opinions and tips from people who have experienced some of these side effects.

    Whether your story has a happy ending or a not-so-happy ending, is embarrassing or amusing, we'd love to know what you have to say. If you have any advice for other people who may be coping with the same side effects, we'd like to hear from you as well!

    To learn more about how you can become a part of this educational booklet, just send me an e-mail at


    Bonnie Goldman
    Editorial Director, The Body



    First-Line HIV Treatment

    NRTI-Sparing Regimens for First-Line HAART: Promising, but Still Experimental
    Almost all HIVers start treatment with a regimen that contains at least one NRTI, such as AZT (zidovudine, Retrovir), 3TC (lamivudine, Epivir) or tenofovir (Viread). But could first-line HAART regimens without NRTIs work just as well as regimens with NRTIs? As Dr. Edwin DeJesus reports for The Body, a study at IAS 2005 found that these "NRTI-sparing" regimens do indeed work well -- but they have their own side-effect risks, and aren't ready for prime time just yet.

    Not All Once-a-Day Efavirenz Regimens Are Created Equal, Study Says
    In a head-to-head comparison of three once-daily, efavirenz (Sustiva, Stocrin)-containing regimens, interim 24-week results show that all three regimens are similar in efficacy and safety for treatment-naive people. Of the three, however, the ddI (didanosine, Videx) + abacavir (Ziagen) backbone may be a less-attractive option than either ddI + 3TC (lamivudine, Epivir) or 3TC + tenofovir (Viread), largely owing to more virologic failure, a larger number of discontinuations and a heavier emergence of reverse transcriptase mutations. Dr. Edwin DeJesus reports for The Body from IAS 2005.

    Second/Third-Line HIV Treatment

    Single-Drug Regimens Worth Further Investigation, Study Suggests
    When a small study presented at last summer's International AIDS Conference suggested that simplification to Kaletra (lopinavir/ritonavir) monotherapy was worth further investigation, skepticism abounded. But, as Dr. Brian Conway reports for The Body, a follow-up study at IAS 2005 suggests this approach is definitely worth a closer look.

    New Study Supports Trizivir + Tenofovir as Second-Line Regimen
    The quadruple-drug regimen of Trizivir (AZT/3TC/abacavir) + tenofovir (Viread) may be an effective, well-tolerated selection for people whose protease inhibitor- or NNRTI-based regimen is failing -- and it may be easy to adhere to as well. Dr. Edwin DeJesus reports for The Body from IAS 2005.

    3TC Monotherapy Slows HIV Progression Better Than Treatment Interruption in Heavily Treatment-Experienced Patients
    A small Italian study suggests that heavily treatment-experienced people who are failing 3TC (lamivudine, Epivir)-containing therapy -- and who have a drug-resistance mutation known as M184V -- may be better off if they continue only the 3TC rather than interrupt treatment entirely. The study, presented at IAS 2005, found that those who continued only 3TC experienced less of a viral load increase and less of a drop in CD4 count after 48 weeks than those who fully stopped treatment. Dr. Brian Conway reports for The Body.

    Other HIV Treatment Issues

    How Much Does HAART Really Slow HIV Progression? New Report Gives a Number
    Wondering how much of a difference HIV treatment really makes? A new article in the British medical journal Lancet has found that, compared with no treatment at all, HAART can slow an HIV-positive person's rate of progression to AIDS by a whopping 86%. However, the study noted that HAART seems to be less successful in people who got HIV through injection drug use; the researchers speculated that this could be due to lower adherence, doctors' reluctance to prescribe HIV treatment to active drug users or the health risks of injection drug use itself.

    Coming Soon: An Easier Dose of Kaletra
    Although the U.S. Food and Drug Administration must still approve it, there may soon be a new Kaletra (lopinavir/ritonavir) formulation allowing for two-tablet, twice-daily dosing. Dr. Paul Sax reports for The Body from IAS 2005.

    Latent HIV Reservoir Conundrum Continues to Haunt Eradication Dreams
    Current HAART regimens may be powerful, but they still can't eradicate HIV from an HIVer's body. The reason: "latent reservoirs" of HIV that just won't go away. Dr. Mark Holodniy reports for The Body on a debate at IAS 2005 in which both respondents ended up agreeing.

    HIV/HAART-Related Complications

    Needle-Free T-20 Delivery Reduces, but Does Not Eliminate, Injection Site Reactions
    Biojector 2000 is a device that delivers meds Star Trek-style -- by using carbon dioxide, not needles, to disperse drugs through a person's skin and into the bloodstream. The makers of T-20 (enfuvirtide, Fuzeon) have been interested in Biojector 2000 because they hope it'll greatly reduce the number of uncomfortable injection site reactions that people on T-20 so often get. A small study using Biojector to administer T-20 had relatively promising results: The device was easier to use than needles, and appeared to reduce (but not eliminate) skin reactions. (Web highlight from

    Health Canada Provides Bio-Alcamid Injections for Facial Wasting; Full Approval Expected Soon
    Facial wasting has become all too familiar for some HIVers who have been on treatment for a long time. "It is the scarlet letter of AIDS," says Robert, a 46-year-old HIV-positive man in Canada. In November 2004, Robert became one of the first Canadians with facial wasting to join a pilot project to undergo injections of the synthetic gel Bio-Alcamid (an alternative to poly-L-lactic acid, a.k.a. Sculptra) to fill out his sunken cheeks. Health Canada has begun approving Bio-Alcamid injections on a case-by-case basis; a final decision on full approval is expected in two to three months.

    HAART May Help, Rather Than Hurt, Kidneys in HIVers
    Although HIV-positive people may experience kidney problems, HAART appears to generally not be a cause -- in fact, it may be protective, suggests one study at IAS 2005. Dr. Brian Conway reports for The Body.



    Medical Journals Simply Further Pharma Marketing Efforts, Former BMJ Editor Says
    If you're worried about the influence drug companies have on the results of major clinical trials, you're not alone. The past year has seen a number of prominent medical editors openly criticize the influence of the pharmaceutical industry on the world's top medical journals, which publish the results of these pivotal studies. In this provocative essay published in PLoS Medicine, Richard Smith, an editor of BMJ for 25 years, adds his two cents: "The evidence is strong that [drug] companies are getting the [study] results they want, and this is especially worrisome because between two-thirds and three-quarters of the trials published in the major journals ... are funded by the industry." (Web highlight from PLoS Medicine)

    New York Times Reports on Gaping Holes in Prison Health Services' HIV Care
    The United States' largest commercial healthcare provider for prisons is under fire for its poor treatment of HIV-positive inmates at an infamous Alabama facility. A scathing New York Times article features an interview with HIV specialist Dr. Valda M. Chidije, who recently resigned her position at Alabama's Limestone Correctional Facility -- one of the only facilities in the country that still quarantines HIV-positive inmates. The details she recounts paint a picture of HIV care at Limestone that, despite recent improvements, remains woefully inadequate, disorganized and potentially life-threatening.

    The New York Times article comes on the heels of a court-ordered report by prison medical expert Joseph Bick finding that HIV-infected patients at Limestone continue to receive "sub-optimal" HIV treatment. The report notes that, among other shortcomings at the facility, physicians incorrectly combined drugs; patients with rising HIV viral loads did not receive changes to their drug regimens; and doctors made treatment changes without telling their patients.

    California Newspapers Sound Off on HIV Reporting Issue
    In last week week's e-mail, we highlighted an evolving story in California, where the state may lose as much as $50 million in annual U.S. funding unless it abandons a code-based HIV reporting system for a name-based HIV reporting system. A pair of California newspapers recently offered their take on the situation; their opinions are excerpted here.



    The Pioneers of Mother-to-Child HIV Prevention
    The progress we've made in preventing mother-to-child HIV transmission in the United States is nothing short of incredible. Much of that progress has happened thanks to three University of Miami researchers, all of whom just happen to be women: Gwendolyn Scott, Mary Jo O'Sullivan and Margaret Fischl. They were among the first people to test the use of AZT (zidovudine, Retrovir) by pregnant women. As a recent newspaper profile explains, their efforts were initially opposed by some AIDS advocates.

    The Abandoned Trials of Tenofovir as a Prevention Pill: What Went Wrong?
    In last week's e-mail, we highlighted an article by a U.S. advocate explaining why he felt the ongoing studies of tenofovir (Viread) as an HIV-prevention pill were so important. But there's another, much more controversial side to this story -- so controversial, in fact, that the studies have already been cancelled in several developing countries. In this essay, experts Jerome A. Singh and Edward J. Mills discuss what went wrong. (Web highlight from PLoS Medicine)

    STD Prevention via Rock Concerts: An Arizona Program Tries to Make Difference
    In states such as Arizona, where abstinence-only education is the rule, teens are often left adrift when it comes to learning about sex. Perhaps as a result, Arizona has the nation's second-highest teen pregnancy rate after Nevada: In Arizona, 37 teenagers become pregnant each and every day. Arizona also has high incidences of sexually transmitted diseases (STDs) among young people. Despite the state's continued emphasis on abstinence, some groups are trying to make a difference. Planned Parenthood's Peer Reality Education Program, for instance, trains teens to talk to their peers about STD prevention -- and then sends them off to rock concerts and community events to spread the word.



    AIDS in China: Anatomy of an Epidemic
    When it comes to HIV in China, it seems there are more questions than there are answers. Is there an HIV epidemic in China or not? (There is.) Is the Chinese government doing a good job with its HIV prevention and treatment efforts, or a poor job? (A little of both.) How do you control the spread of a virus in a country so vast, and with so many people? (Not easily -- but time may be running out.) This report from The Economist offers a snapshot of these and other difficult issues. (Web highlight from The Economist)

    Photos, Essays Tell Stark Story of AIDS Orphans in South Africa
    London Free Press photographer Dave Chidley recently visited South Africa, where he found an HIV crisis he says was "staggering." In this series of articles and pictures, Chidley and others reveal just how deep the plight of South Africa's AIDS orphans has become, and what steps some are taking to help one of the most disempowered groups of people in the world. (Web highlight from the Kaiser Daily HIV/AIDS Report)

    Browse The Body's
    Coverage of IAS 2005!
    Click here for complete coverage of IAS 2005
    This e-mail newsletter contains many exclusive analyses of key research studies presented at the 3rd International AIDS Society Conference on HIV Pathogenesis and Treatment (IAS 2005). But that's only part of the story!

    Click here to visit The Body's main page for IAS 2005 -- your starting point for extensive coverage of conference highlights not only from The Body's own team of medical experts, but from throughout the Web as well!
    Meet the Winners of's 2005 HIV Leadership Awards!
    Cyndee Burton, winner of a 2005 HIV Leadership Award
    After coming face to face with the inhumanity and stigma that people living with HIV in rural Kentucky faced during the early years of the epidemic, registered nurse Cyndee Burton felt she had to do something to make a difference. And she most certainly did: Cyndee started an HIV clinic that now serves more than 200 HIV-positive people.

    Cyndee is one of 10 outstanding HIV nurses who have won a 2005 HIV Leadership Award from To meet all 73 winners of's 2005 HIV Leadership Awards, click here!

    Connect With Others at
    The Body's Bulletin Boards

    "Feeling Strange and
    a Little Lost"

    (A recent post from the
    "I Just Tested Positive" board)

    "I was just given the news that I am HIV positive. This was after a hospital stay due to weight loss and watery stools. ... I have good support from the family and friends. ... Mentally, I don't know what to think. I'm not going to see a specialist until Tuesday. I can’t help but think I am going to suddenly come down with all kinds of strange infections before then. ... I am by no means going to be able to afford the specialists, lab tests or meds to cope with this. I don’t have insurance and live paycheck to paycheck. I have visions of dying simply because I have no money. Somebody please tell me this won't happen!"
    -- Scotchula

    Click here to join this discussion thread, or to start your own!

    "Encouragement Needed!"
    (A recent post from the
    "Gay Men With HIV" board)

    "About six months ago I got sick and tired of the whole treatment thing. ... During [these] six months off meds, the opportunistic infections started kicking, most notably thrush. ... When I got my first lab results after more than six months ... I had a CD4 count of 6! My doctor told me that he couldn't give me an accurate viral load as the test can't measure past 750,000. ... I'm on treatment [again] and feeling better than I have in a long time, but it's just this feeling that I have that the end is near that's bothering me. I'd like to hear from those who have been in my position. I'm wondering how those whose numbers have been so low can bounce back from the living dead."
    -- mikey334

    Click here to join this discussion thread, or to start your own!

    Art From HIV-Positive Artists
    Image from the August 2005 Visual AIDS Web Gallery
    Untitled, 1982; Keith Haring
    Visit the August 2005 Visual AIDS Web Gallery to view this month's collection of art by HIV-positive artists! The August 2005 gallery is entitled "Body-ography."
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