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February 15, 2006

In This Update:
  • Breaking Research From CROI 2006
  • HIV Meds in Development
  • Complications of HIV & HIV Treatment
  • HIV Drug Resistance
  • HIV Transmission & Testing
  • HIV Outside the United States
  •   BREAKING RESEARCH: THE LATEST FROM CROI 2006

    Visit The Body for Complete Coverage of CROI 2006
    The Body is the place to go for in-depth coverage of the 13th Conference on Retroviruses and Opportunistic Infections (CROI 2006), the most critical HIV-related medical conference of the year, which took place Feb. 5-8 in Denver, Colo. Our team of HIV specialists and correspondents was there to cover the latest breaking research! You can read highlights from the conference throughout this newsletter, or click on the headline above to visit our CROI 2006 home page. More coverage of this conference will continue to come in every day, so check back often for the latest news! Among The Body's CROI coverage to stay tuned for: an overview of the latest and greatest HIV meds now making their way through the development pipeline, a look at structured HIV treatment interruptions and an analysis of what the end of the SMART study actually means for the future of drug holidays.


    Podcasts and Interviews: Experts Discuss CROI Highlights
    The Body's correspondents asked 17 HIV physicians, researchers and advocates -- including prominent researchers Cal Cohen, M.D., and Roy Gulick, M.D., as well as activists such as Julie Davids of the Community HIV/AIDS Mobilization Project -- to share their thoughts on the same question: What do you feel is the most important news to come out of CROI 2006? Download podcasts or read the transcripts of what they had to say!

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      HIV MEDS IN DEVELOPMENT

    Integrase Inhibitors Appear "Surprisingly Strong" in Treatment-Experienced HIVers
    "Surprisingly strong" findings have been reported on a pair of integrase inhibitors, a new class of HIV meds in development that researchers hope will provide new options for people with multidrug resistance. At CROI 2006, a study of one integrase inhibitor, MK-0518, found that it lowered viral loads to undetectable levels in up to 72 percent of multidrug-resistant HIVers when taken in combination with other meds. Meanwhile, a 10-day study of an integrase inhibitor known as GS-9137 found that the drug reduced HIV viral load by as much as 99 percent in a very small group of HIV treatment-experienced and treatment-unexperienced people.

    In interviews with The Body, a number of HIV physicians and researchers discussed just how exciting these integrase inhibitors might be for the future of HIV treatment -- especially for people who are already resistant to most existing meds. "That's very exciting for patients, I would say; that there are these new classes of drugs coming through the pipeline -- a lot of them," said Dr. Tom Wilkinson of the University of California-Los Angeles. "It's really exciting ... that the companies continue to develop drugs with new mechanisms of action," added Dr. Roy Gulick of Weill Medical College at Cornell University.


    New Chemical Compound Shows Anti-HIV Potential in Lab Tests
    A chemical compound called CSA-54 is generating cautious optimism among some researchers for what appear to be unique HIV-fighting properties. Early lab tests have shown that the compound may have the power to block HIV's ability to target CD4 cells for infection. What makes CSA-54 different from existing HIV medications is that it appears to attack HIV's membrane, affecting it in a way that prevents HIV from locking on to CD4 cells. However, it may be years before researchers find out whether CSA-54 can truly fight HIV in people. (Web highlight from BBC News)

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      COMPLICATIONS OF HIV & HIV TREATMENT

    Starting HIV Treatment Early May Reduce Risk of Kidney Failure, Neuropathy, Lipoatrophy
    Normally, doctors don't prescribe HIV meds until a person's CD4 count drops below 200. But a large U.S. study presented at CROI 2006 suggests a benefit for starting treatment earlier: HIVers who start taking meds at higher CD4 counts have a lower risk of developing kidney failure, peripheral neuropathy and lipoatrophy, according to the study. The study found that people who began treatment with a CD4 count higher than 350 were 60 percent less likely to develop kidney failure, 30 percent less likely to develop peripheral neuropathy and 60 percent less likely to develop lipoatrophy (fat loss), compared with people who started treatment with CD4 counts below 200.


    Acid-Reducing Agents Lower Blood Levels of Atazanavir, but Not Kaletra
    Got stomach acid? If you're taking atazanavir (Reyataz), think twice before taking such acid-reducing drugs as Zantac, Tagamet, Pepcid and Axid, or proton-pump inhibitors including Prilosec, Prevacid, AcipHex, Nexium and Protonix. If you're taking Kaletra (lopinavir/ritonavir), however, you may be safe: In a study presented at CROI 2006, no interactions were seen between Kaletra and these acid-reducing drugs. Dr. Paul Sax reports for The Body.


    Pain Relief for Neuropathy? A Peppery Patch May Help
    A patch containing capsaicin -- the same chemical that makes chili peppers so hot -- can relieve pain caused by peripheral neuropathy for as long as three months, according to a 307-person study conducted in New York City. The patch isn't yet available commercially, but the study found that after applying it one time for 30 to 90 minutes, HIV-positive people with neuropathy reported an average of 23 percent less pain -- and that the pain relief sometimes lasted as long as 12 weeks. The main side effects of the patch were a burning sensation lasting up to several days, and a reddening of the skin around where the patch was applied. (Web highlight from aidsmap.com)

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      HIV DRUG RESISTANCE

    More Sensitive Drug-Resistance Tests Find Higher Rates of Multidrug Resistance
    Compared to standard genotypic resistance tests, a more sensitive type of resistance test can spot a greater number of mutations -- and a greater degree of multidrug resistance -- in HIVers who have never been on treatment, according to a group of U.S. and Canadian researchers. The question is: Just because doctors can use the test to see more mutations, will they be any more likely to change their mind about which HIV meds to prescribe? Dr. Jeff Burack reports for The Body from CROI 2006.


    Multidrug-Resistant HIV Will Not Become More Frequent in United Kingdom, Statistical Model Suggests
    A theoretical model constructed by a British researcher has found that the prevalence of multidrug-resistant HIV in the United Kingdom is unlikely to increase within the next five years -- at least among gay, HIV-infected men with a moderate viral load. However, although multidrug resistance may not rise, the overall occurrence of resistance is likely to increase, the model suggests. Dr. Jeff Burack reports for The Body from CROI 2006.

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      HIV TRANSMISSION & TESTING

    New Report Notes Huge Racial Gap in U.S. HIV Diagnoses
    There's no doubt that African Americans are being diagnosed with HIV at a much higher rate than any other ethnic group in the United States. But a new report from the U.S. Centers for Disease Control and Prevention shows just how stark this "HIV gap" really is: Of the estimated 157,252 HIV cases diagnosed in 33 U.S. states from 2001 to 2004, the number of cases and rate of diagnoses were higher among African Americans than all other racial or ethnic groups combined, according to the report. The report urges the creation of a nationwide program that links government agencies with community groups to reduce the huge racial disparity.

    For much, much more on the HIV epidemic among African Americans, visit The Body's new African-American HIV/AIDS Resource Center!


    Male Circumcision May Reduce Risk of Sexual HIV Transmission to Women
    For a while now, studies have been showing that male circumcision can reduce the risk that a man will contract HIV from a woman during unprotected sex. Now, researchers have found evidence that a woman's risk of getting HIV from a man may also drop if the man is circumcised. The small study, which was conducted in Uganda and presented at CROI 2006, involved a review of medical records of couples in which the man was HIV positive and the women was not. It found that male circumcision reduced the rate of HIV transmission to the women through unprotected sex by 30 percent, and also appeared to reduce the rate of other vaginal infections.

    These new circumcision findings raised quite a stir among researchers at CROI 2006. "If we had a vaccine that was [this] effective, we would be jumping up and down," said Dr. Pablo Tebas in an interview with The Body. Dr. Ruth Dickover also pointed out that the study was short-term; it's unknown how much of a difference circumcision really makes for HIV risk over the course of a lifetime.


    A New HIV Testing Method Can Be Useful for HIV Prevention -- And, Extremely Rarely, HIV Treatment
    New research presented at CROI 2006 lends support to an HIV testing method that's been gaining steam in recent years: A procedure that can identify cases of "primary" or "acute" HIV infection, in which a person got HIV so recently (usually within the last 30 days) that a normal ELISA or Western Blot test doesn't even notice. This testing method is being hailed as a key tool in public health efforts to stem HIV transmission, since people are often most infectious in the days and weeks just after they've been infected. But there's also another reason that primary HIV testing can come in handy: In extremely rare cases, it may alert doctors to the presence of advanced HIV disease in a person who never developed antibodies to the virus (meaning that standard HIV tests would come out negative), allowing that person to receive HIV meds before it's too late.

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      HIV OUTSIDE THE UNITED STATES

    HIV in Mexico: A Battle Against Culture, Not Just a Virus
    Machismo and homophobia are deeply engrained in Mexico's culture -- and, many experts believe, are making the country's HIV epidemic worse. Mexico's National Center for the Prevention and Control of HIV/AIDS has launched efforts to combat these prejudices and raise public awareness about HIV. A recent survey conducted in Mexico found that 57 percent of respondents said they would "not want to live in the same house as someone with AIDS," and 66 percent of respondents said they would not want to reside with someone who identifies as gay.


    China Releases First Regulations Calling for Free HIV Testing, Treatment
    Years into China's growing HIV epidemic, the country's State Council -- a group of top government ministers -- has released its first comprehensive regulations on HIV prevention and treatment. The regulations require local governments to provide free, confidential HIV testing and antiretrovirals to many residents, outlaw discrimination against HIV-positive people and guarantee HIVers the right to health care, employment, marriage and education. Not all AIDS advocates in China are excited about the regulations, however: "The problem in China is not the lack of laws but whether these laws will be implemented by local governments," one leading activist noted.


    Nevirapine Cuts Mother-to-Child HIV Transmission Risk in Repeat Pregnancies, Study Finds
    Nevirapine (Viramune), the standard medication used to prevent mother-to-child HIV transmission in the developing world, reduces the risk of mother-to-child HIV transmission even if a woman becomes pregnant multiple times, according to a study presented at CROI 2006. The study's lead author said the findings contrast with earlier studies that suggested HIV might develop resistance to nevirapine after its first use, which would make the drug less useful in preventing mother-to-child transmission in subsequent pregnancies.


    Multivitamin for Pregnant HIV-Positive Women May Aid Children's Motor Development
    In rich countries, where excellent medical care is often within easy reach, many HIVers consider a multivitamin to be a normal part of their everyday diet. In the developing world, though, a daily multivitamin can play a pivotal role in HIV treatment -- especially for pregnant women. A study published two years ago found that multivitamins can help HIV-positive pregnant women stay healthy and reduce the risk of having premature or underweight babies. Now, a team of researchers has found that a multivitamin also cuts the risk that a baby born to an HIV-positive woman will have problems with motor development. Motor development problems can lead to health and learning difficulties as a baby grows older. (Web highlight from Reuters Health)

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    Also Worth Noting

    Movers and Shakers
    African-American Leaders
    Speak Out About HIV

    Sen. Barack Obama
    "The most dangerous myth about AIDS in our community is the misconception that it does not affect African Americans," says Sen. Barack Obama, the newest -- and, right now, the only -- African-American member of the United States Senate.

    The charismatic, 44-year-old Obama is the "Great Black Hope" of the Democratic Party and many progressives. He recently answered a range of questions from The Body about the HIV epidemic among African Americans. Click here to read this exclusive interview from The Body!

    Sen. Obama's interview is one of many we've conducted with some of the most prominent African-American movers and shakers in politics, AIDS activism and entertainment. This "Movers and Shakers" feature is just one small part of The Body's new African-American HIV/AIDS Resource Center!
    Join a Study!
    Featured Clinical Trial
    of the Month
    Partners AIDS Research Center

    What's Being Studied?
    How HIV-positive, long-term nonprogressors are able to control HIV without taking meds.

    Who's Eligible?
    HIVers living anywhere in the United States, and possibly outside it as well. Although the study is based in Boston, volunteers can ask their doctors to send a blood sample by mail at no cost; no travel is required. Please note that this study requires the cooperation of your healthcare provider.

    Volunteers must also:

    -- have been HIV positive for at least seven years, but never had any symptoms

    -- be between 18 and 64 years of age

    -- have a viral load below 2,000

    -- have not taken HIV meds for at least the last seven years

    -- be willing to have their blood drawn (this will only be done once)

    Who's Sponsoring It?
    The laboratory of noted HIV researcher Dr. Bruce Walker, located in the Partners AIDS Research Center at Massachusetts General Hospital in Boston, Mass.

    How Can I Learn More?
    E-mail or call Dr. Florencia Pereya or Dr. Peggy Ueda at (617) 726-5536. If you live in the Boston area and would like to make an appointment to discuss the trial at Massachusetts General Hospital, e-mail or call Mary Johnston at (617) 724-0070.

    Connect With Others
    A
    t The Body's Bulletin Boards

    Terrified of HIV Treatment Side Effects
    (A recent post from the
    "I Just Tested Positive" board)

    "[I] just tested postive. My CD4 count is 320 ... as per my doctor, I'm in [a] "gray zone." ... I may not [need] to take medications for the time being, but I'm pretty scared of the side effects. ... I know medication side effects vary, but can anyone tell me how to handle these scenarios? I had an orientation on HIV treatment a week ago, and the more I [became] aware of the side effects and opportunistic infections, the more I got freaked and scared of what will be."

    -- Calvin

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

    Visual AIDS
    Art From HIV-Positive Artists

    Image from the February 2006 Visual AIDS Web Gallery
    Untitled; Tim McCarron
    Visit the February 2006 Visual AIDS Web Gallery to view this month's collection of art by HIV-positive artists! The February 2006 Web Gallery is entitled "Nineteen Penises"; it's curated by David Humphrey.