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October 12, 2005

In This Update:
  • HIV JournalView: Highlighted Research
  • Living With HIV
  • HIV Treatment
  • HIV-Related Complications
  • HIV Prevention & Transmission
  • HIV Outside the U.S.
  • In Memoriam

    Want to stay updated on the latest and greatest in HIV-related research, but don't have the time, money or patience to wade through a marsh of medical journals? That's what The Body Pro's HIV JournalView is for! Dr. David Wohl authors our latest issue, which includes summaries of the following noteworthy studies:

    What to Do With a Persistently Detectable Viral Load?
    If you're religiously taking your HIV meds, but your viral load is still hovering around 1,000 or higher, what should you do: continue your current regimen, and risk the development of drug resistance? Or should you switch to another regimen, which could potentially expose you to new side effects? In a new study, University of North Carolina researchers suggest that the answer depends on the treatment regimen. People who had a viral load between 1,000 and 10,000 or who were taking an NNRTI-based regimen were found to be at increased risk for developing resistance if they continued their current regimen. However, patients with a steady viral load of 1,000 or less who were not on an NNRTI-based regimen could continue their current therapy with much less risk, the researchers found. The study doesn't provide any hard-and-fast answers, but does generally suggest that a stable, low viral load means it's not urgent to switch treatment.

    Study Ties Insulin Resistance to NRTIs, Not Protease Inhibitors
    Insulin resistance (a potential precursor for heart disease) has long been associated with the use of protease inhibitors, but it may actually be NRTIs that are to blame, according to new research. A study by U.S. scientists found that NRTIs were the only class of drugs found to be significantly associated with insulin resistance. In particular, two NRTIs -- d4T (stavudine, Zerit) and 3TC (lamivudine, Epivir) -- were associated with insulin resistance and high insulin levels. Indinavir (Crixivan) was associated with elevated insulin levels, but not insulin resistance. No link to insulin problems was found for the NRTIs AZT (zidovudine, Retrovir) or ddI (didanosine, Videx).

    Obesity and HIV: A Dangerous (and Increasingly Common) Mix
    In an odd reversal from the old days of the HIV epidemic -- when facial wasting and an emaciated look were often the hallmarks of the virus -- a new report warns that the major body shape issue facing HIVers today is actually garden-variety obesity. The report, based on a study of HIV-positive Philadelphians, found that nearly 28% of women and 11% of men were obese, a known risk factor for heart disease. African-American women were more likely than non-African-American women to be obese or overweight; other risk factors for all people included having a CD4 count of 200 or higher and not smoking cigarettes. HIV medications were not found to have any impact on an HIVer's obesity risk.

    Valproic Acid and "The Cure": Setting the Record Straight
    News media leaped on the August publication of a study on valproic acid as a new form of HIV treatment, particularly given the closing sentence of the study's abstract: "This finding, though not definitive, suggests that new approaches will allow the cure of HIV in the future." Though not necessarily inaccurate, the statement led many people to become overly excited about an experimental treatment that has, thus far, only been studied in an extremely preliminary way.

    To read the full issue of The Body Pro's September issue of HIV JournalView, click here!



    An Interview With Edmund White, Legendary, Gay, HIV-Positive Writer
    Edmund White is considered by many people to be one of the most prolific, articulate writers living with HIV. Diagnosed in 1985, he was a cofounder of the United States' first (and largest) AIDS organization, Gay Men's Health Crisis, and has written some of the most sweeping and detailed accounts of what it means to be gay and living with HIV. In this fascinating interview, Mark Mascolini gets up close and personal with White, who is now 65 and just finished writing My Lives, an autobiography.



    U.S. Releases Updated HIV Treatment Guidelines
    The U.S. health department has released updated guidelines on the use of HIV medications in adults and adolescents. Among the most notable additions are cautionary notes on specific HIV therapy regimens: Regimens consisting of ddI (didanosine, Videx) + tenofovir (Viread) + an NNRTI are not recommended in people who have never before taken HIV meds. In addition, regimens containing ritonavir (Norvir)-boosted tipranavir (Aptivus) are not recommended in treatment-naive patients, based on a lack of clinical trial data and concerns about potential drug-drug interactions. Other changes to the guidelines include information on the use of once-daily Kaletra (lopinavir/ritonavir) and updated guidance for physicians on treating people who have taken HIV treatment regimens in the past.

    A New Look at the HIV Medication Pipeline
    Although the development of new HIV medications rarely makes headlines, at any given moment dozens of such drugs are making their way through the pipeline. Fortunately, the HIV community has organizations like Treatment Action Group to bring us up to date. This article by Rob Camp provides a review of the current state of drug development, including a look at some of the meds that may open up new fronts in the ongoing war against HIV.

    FDA Approves Pediatric Dosing for Ritonavir
    The U.S. Food and Drug Administration (FDA) has approved ritonavir (Norvir) for use by HIV-positive children between the ages of 1 month and 2 years. The recommended pediatric dose for ritonavir, which should be administered orally as part of combination therapy, is 350 to 400 mg twice daily. However, clinicians are advised to commence ritonavir therapy with a dose of 250 mg twice daily and then increase it by 50 mg twice daily every two to three days.



    Merck Cervical Cancer Vaccine Highly Successful in Two-Year Trial
    Merck & Co. has announced that its experimental human papillomavirus (HPV) vaccine, Gardasil, completely prevented early-stage cervical cancer and precancerous cervical lesions caused by the two most common forms of HPV. A two-year study found that Gardasil was 100% effective in preventing precancerous lesions and early-stage cancers associated with HPV types 16 and 18, which cause most cases of cervical cancer in women. In contrast, women who received a placebo had 21 cases of lesions and early-stage cancers associated with HPV types 16 and 18.

    Lower Amounts of Brain Tissue Found in People With Full-Blown AIDS
    Doctors already know that some people with AIDS may eventually develop mental problems, such as dementia. Now, U.S. researchers have used MRIs to show that advanced HIV disease may cause detectable brain damage. In a small study, they found that people who have been diagnosed with full-blown AIDS, even if they are taking HIV meds, have about 10 to 15 percent less brain tissue than HIV-negative people. The researchers noted, however, that they're not exactly sure what effect the reduced tissue might have.

    ddI + Ribavirin May Cause Mitochondrial Toxicity
    People who are infected with HIV and hepatitis C should try to avoid taking ddI (didanosine, Videx) with ribavirin, researchers say. A new study has found that, when ddI is taken for HIV at the same time ribavirin (also known by the brand names Copegus, Rebetol and Virazole) is taken for hepatitis C, a person's risk for developing a potentially dangerous side effect jumps dramatically. The side effect, mitochondrial toxicity, can cause muscle weakness, neuropathy, damage to the pancreas and some blood disorders. (Web highlight from the Journal of AIDS)



    National Latino AIDS Awareness Day, Oct. 15, 2005
    This Saturday, Oct. 15, marks the third annual National Latino AIDS Awareness Day in the United States. The HIV epidemic impacts us in so many ways that it's easy to lose sight of the huge range of Americans who are affected by the virus -- which is exactly why commemorations like National Latino AIDS Awareness Day are so important. Although only 14% of the U.S. population (and growing) is Hispanic, some 19% of all HIV-positive Americans are Hispanic, and HIV stigma within the Latino community remains high. As Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, says in this agency press release, all of us -- Latinos and non-Latinos alike -- must combine our efforts to fight not only HIV, but the fear, hatred and discrimination that continually worsen the epidemic.

    For much more news, info and personal accounts on the impact of HIV in the Latino community, browse through The Body's large collection of articles.

    Researchers Set for Study of "Global" HIV Vaccine
    A "global" HIV vaccine being developed by U.S. researchers is about to enter a pivotal phase of testing, as scientists prepare to launch a trial spanning three continents to see how well the vaccine can prevent the three major subtypes of HIV: A, B and C. "This is the first Phase II study of a vaccine candidate that is broadly relevant to the global AIDS pandemic because it combines components of HIV strains found throughout the world," said Dr. Gary Nabel, the director of the research center that is developing the vaccine.

    PEP Guidelines for Occupational HIV Exposure Are Updated (PDF)
    The U.S. Public Health Service has released updated guidelines on how healthcare workers should manage on-the-job exposures to HIV. The guidelines are aimed specifically at people who work in settings where they may become exposed to HIV -- e.g., doctors, nurses and staff members at hospitals or clinics, where needlesticks and blood-to-blood contact are somewhat more likely than usual.



    HIV-Positive Women in India Try to Turn Tide of Ignorance, Discrimination
    Many women in India are already at a disadvantage, economically and socially, due purely to their gender. Now, HIV has become their newest hurdle. In much of India, women with HIV are shunned and discriminated against. Widows of HIV-positive men are often abandoned by relatives, forced to rely on the help of strangers to support themselves and their children. Few services are available, even while HIV spreads rapidly through the country. One of these sorely needed services -- basic education -- is something that Lakshmi, 33, is trying to do something about. "My husband is a truck driver and I got HIV through him," she explains. "I had never heard of HIV or condoms before that and because I can't read, I couldn't understand any of the posters or banners." (Web highlight from BBC News)



    Although people with HIV are living longer, healthier lives than ever before, we still have to face the grim reality that prominent members of the HIV community die every day -- in the developing world, of course, but in the United States as well. This week, we pay tribute to two of these individuals: Jeff Palmer and LeRoy Whitfield.

    Jeff Palmer, 59; Pioneer in Rural AIDS Activism
    Jeff will be remembered for his tenacity, and for his dedication to improving the lives of people with HIV in his community, as well as those who lived thousands of miles away in places like southern Africa. Most of all, though, Jeff will be remembered for his honesty, his friendship, his modesty and his selflessness; he spared nothing of his own comfort or time in helping others live longer, healthier and happier lives. Jeff's mother, Shirley, said that she raised her children with a simple mantra: "We're not put on this earth to go merrily through life for ourselves." Clearly, Jeff took his mother's words to heart in his dedication to the global HIV community.

    To read some of Jeff's writings and learn more about the AIDS organization he founded, Wyoming: Positives for Positives, click here. To share your thoughts about Jeff, visit our bulletin board thread.

    LeRoy Whitfield, 36; African-American AIDS Journalist
    "Diagnosed with HIV in 1990, LeRoy, like many African Americans, was not on treatment," recalls Phill Wilson, executive director of the Black AIDS Institute, in this remembrance. "I keep struggling with the question why wasn't he on treatment. LeRoy was not an AIDS dissident. LeRoy may have been afraid, but if so his fear was of all the things young, poor, black gay men are afraid of -- rejection, loneliness, disappointment, marginalization, the invalidation of their lives. As fearless as LeRoy was as a journalist, as open as he was about living with HIV, perhaps LeRoy was never able to escape the demons that haunt us all. And how can we, when those fears are confirmed every day?" (Web highlight from the Black AIDS Institute)

    For more thoughts on LeRoy and links to a number of his articles, visit this page created by activist and author Keith Boykin.

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    Art Benefit in N.Y.
    Postcards From the Edge:
    Oct. 17-18, 2005

    Postcards From the Edge
    Every fall in New York City, Visual AIDS holds its hugely popular "Postcards From the Edge" benefit, and this year's event is fast approaching! On Oct. 17 and 18, people who come to the Robert Miller Gallery in Manhattan can view, and purchase, any of more than 1,200 original, postcard-sized works donated by many talented artists -- some of whom are widely renowned! Each postcard costs $50; all benefits go to Visual AIDS.

    To learn more about the 2005 "Postcards From the Edge" benefit, including info on how you can get a sneak preview of this year's postcards, click here!

    Ryan White CARE Act
    The Reauthorization Fight
    Has Only Begun

    The Ryan White CARE Act is one of the most important laws in the United States for uninsured people living with HIV. This fall, for the first time in five years, the Ryan White CARE Act is up for reauthorization -- meaning the entire law is being revisited, which could result in major changes in the way the act works and funding is doled out.

    What are some of the biggest issues facing this year's reauthorization, and how might they impact you? Visit The Body's main page on the Ryan White CARE Act reauthorization for background, news, policy statements and more!

    Want to take action now? Click here to send a letter to your U.S. senators and representatives urging them to increase funding for the Ryan White CARE Act.

    Visual AIDS
    Art From HIV-Positive Artists

    Image from the October 2005 Visual AIDS Web Gallery
    "Maria," 1994; Tim McCarron
    Visit the October 2005 Visual AIDS Web Gallery to view this month's collection of art by HIV-positive artists! This month's gallery is entitled "Manner of Solitude."

    Visual AIDS
    t The Body's Bulletin Boards

    "Positive Living?
    Better Off Dead?"

    (A recent post from the
    "Living With HIV" board)

    "I've been positive since 1995. I'm on my third set of meds. I'm pill fatigued and frustrated living like this. I asked for a [treatment] holiday, but my doctor explained my virus was too aggressive to take a break and be safe. I'm really bumming about this. I have [considered just stopping] and let nature take it's course. I'm tired and lonesome for true love in my life. I feel I have no real reason to stay here much longer. I'm really putting forth great effort. ... Thanks for letting me vent."
    -- Anonymous

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

    "Going on Meds"
    (A recent post from the
    "Gay Men With HIV" board)

    "I have been pos for a year or so, and my doc now says it is time for me to go on meds. I am looking for some friendly advice on two issues: (1) I assume I will have some side effects from the drugs and may have to take time off work, but I don't want to tell my boss what is causing my sickness. Any advice on what I tell him? (2) The meds my doc is recommending are nevirapine (Viramune) and Truvada (tenofovir/FTC). Does anyone out there have any experiences they can share about these drugs and their side effects?"
    -- keano4

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