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March 15, 2006

In This Update:
  • HIV Treatment
  • HIV News & Views
  • Complications of HIV & HIV Treatment
  • HIV Transmission & Prevention
  • HIV Policy in the U.S.
  • HIV Outside the U.S.
  •   HIV TREATMENT

    Boosted Atazanavir as Good as Kaletra in Treatment-Experienced HIVers, With Fewer Side Effects
    Atazanavir (Reyataz) may be just as effective as Kaletra (lopinavir/ritonavir) in people whose HIV is multidrug resistant, while causing fewer side effects, according to recently published research. New 96-week results from a study comparing a once-daily regimen containing atazanavir + ritonavir (Norvir) to a twice-daily regimen containing Kaletra found that both worked equally well at lowering viral load. But the really noteworthy findings were in the side effects: atazanavir appeared to cause far fewer gut problems (particularly diarrhea), and was more "lipid friendly," meaning it had a more positive impact on cholesterol and triglycerides. (Web highlight from aidsmap.com)


    Resistance Testing May Be Effective Even at Viral Loads Below 1,000
    When someone's HIV medications begin to lose their edge -- when viral load starts to snake upwards and CD4 count slowly sinks -- it may be time to think about switching regimens. To help decide whether to switch meds (and what to switch to), the best practice is to get a resistance test. The catch is, it was thought that resistance tests didn't work if a person's viral load was below 1,000. Now, however, researchers have found signs that resistance tests can work for people with a low, but detectable, viral load. In a recent study, London scientists showed that people with a viral load as low as 200 -- and sometimes even lower -- can still benefit from resistance testing. (Web highlight from aidsmap.com)


    Give TMC125 to Drug-Resistant HIVers, Activists Urge
    A pair of HIV meds in development, TMC114 (darunavir) and TMC125 (etravirine), have generated plenty of excitement lately: Studies suggest they can fight HIV in people who are already resistant to many approved HIV meds, and who may be running out of treatment options. However, both of these drugs are still in clinical trials, which limits the number of people who can receive them. TMC114 is now available through what's called an "expanded access program," which provides the drug to people who may need it most -- but the same isn't true of TMC125. AIDS activists are now publicly pushing for Tibotec Pharmaceuticals, which is developing both TMC114 and TMC125, to make TMC125 more widely available as soon as possible. See how you can help.


    Pocket Guide to Adult HIV Treatment Is Updated for 2006 (PDF)
    It's almost like having an HIV doctor whenever you need one: The Pocket Guide to Adult HIV/AIDS Treatment is a free, printable reference from the Johns Hopkins AIDS Service that provides medical information about HIV meds, treatment strategies and health problems related to HIV and HIV medications. It was created for use by health care professionals, but anyone with HIV savvy can find it a valuable, handy tool. (Web highlight from the Johns Hopkins AIDS Service)

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      HIV NEWS & VIEWS

    Harper's Magazine Joins AIDS Denialism Argument
    Do you think there's no debate about whether HIV causes AIDS, or about whether HIV meds have dramatically helped people with HIV? You're right -- but apparently, somebody forgot to tell that to the outgoing editor of Harper's Magazine. In his final issue as editor in chief, Lewis Lapham decided to publish an article by Celia Farber that includes a lengthy (and implicitly supportive) discussion of the self-described "AIDS dissident" argument, which among other things claims that HIV is completely unrelated to AIDS; that people die not from HIV, but from HIV medications; and that the global scientific community has essentially created a conspiracy to hide the truth from the world. AIDS advocates and HIV health care professionals are livid that Farber's article was allowed to go to print without at least including a rebuttal, but Harper's supports the article as responsible journalism. (Web highlight from The New York Times; free registration required)

    Interested in reading the Harper's article? Click here to download it in PDF format. Once you're done reading, tell the magazine what you think by sending an e-mail to letters@harpers.org.

    Although Harper's decided not to publish any responses to the Farber article, a group of prominent HIV researchers and activists has posted numerous rebuttals of many of the statements that Farber makes. Visit aidstruth.org to read through them all.

    In this heartfelt letter, Martin Delaney, a long-time AIDS activist and founder of the AIDS organization Project Inform, offers his own take on the Farber article. "The woman has had her head buried in the sand for so long that she hasn't the faintest idea what is happening in the lives of people with AIDS," he says. "The success of the drugs used to treat HIV is so dramatic, so well demonstrated, that it is the envy of just about every other major unsolved disease out there."

    Finally, for a complete rundown of AIDS denialist claims, rebuttals and other news, check out The Body's collection of articles and links.

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      COMPLICATIONS OF HIV & HIV TREATMENT

    Steroid May Restore Some Body Fat, Muscle in HIV-Positive People, Study Says
    Oxandralone, a steroid pill, may be able to help HIV-positive men regain weight that they've lost because of their HIV infection, according to a short-term study by U.S. researchers. The study, which involved 262 HIV-positive men with HIV-associated weight loss, lasted for 12 weeks; the men were given either a placebo or one of several different daily doses of oxandralone. After 12 weeks, all of the men in the study -- even those on placebo -- had increased their body weight and body cell mass, but the men who were taking 40 mg of oxandralone per day appeared to do the best. However, oxandralone caused several side effects, including an increase in bad cholesterol and a loss of testosterone and other sex hormones.


    At Menopause, HIV-Positive Women More Likely to Have Bone Problems Than HIV-Negative Women
    Bone problems (such as osteoporosis) are a concern for many women, especially after menopause. But are women with HIV at an even greater risk? The answer may be yes, according to a moderately sized study conducted in U.S. cities. Researchers from the U.S. Menopause Study found that among 495 women with an average age of 44, HIV-positive women were more likely to have lower bone-mineral density than HIV-negative women. The study found that HIV medications did not appear to be the cause of this lower bone-mineral density. It also noted that black women appeared to be less at risk than other ethnicities. The researchers recommended that all HIV-positive women be screened for bone problems when they begin menopause, and consider taking calcium and vitamin D. (Web highlight from aidsmap.com)


    Women, HIV and Aging: An Overview of Heart and Bone Risks
    At least 10 percent of all HIV-positive Americans are 50 years old or older, estimates say -- a proportion that's virtually guaranteed to increase as medications continue to extend the lives of HIVers. But this raises another issue of growing concern, particularly for women, who are already at an increased risk for certain health problems as they get older. For older women, sorting out the interplay between HIV, aging and the side effects of medications can be very difficult. This article by HIV specialist Sharon Lee provides an overview of two common health risks in aging women with HIV: heart disease and osteoporosis.


    For Hepatitis B Treatment, Entecavir Appears More Effective Than 3TC
    In a head-to-head study of hepatitis B medications, the new drug entecavir (Baraclude) was found to be more effective than 3TC (lamivudine, Epivir). The study, conducted in Taiwan, found that 72 percent of 314 people treated with entecavir improved after 48 weeks, and 67 percent reached undetectable hepatitis B levels. By comparison, 62 percent of 314 lamivudine-treated people showed improvement after 48 weeks, and only 36 percent reached undetectable hepatitis B levels. People also appeared to develop resistance to entecavir at a very low rate.

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      HIV TRANSMISSION & PREVENTION

    Why Do Men Bareback? No Easy Answers
    What is it that drives so many men who have sex with men to bareback (have sex without condoms), even when they know it can put them at risk for HIV and other sexually transmitted diseases? "Is it all about sex, sensation-seeking, and pleasure?" asks Michael Shernoff, a therapist whose work focuses on helping gay men. "Or is it ... actually an attempt to take care of oneself and to forge a deeper intimacy, closeness, and even spiritual communion?" In his new book, Without Condoms: Unprotected Sex, Gay Men and Barebacking, Shernoff uses research and personal stories to explore this stigma-fraught issue -- and finds that when it comes to the "why" of barebacking, there are no easy answers. To learn more, read through this excerpt from Shernoff's book, which is available exclusively at The Body.


    Sexuality in Men of Color: The Impact of Culture
    It's no secret that in the United States, HIV has a disproportionate impact on people of color: Some two-thirds of Americans living with HIV are black or Latino, according to official U.S. statistics. Many of these people are also men who have sex with men -- a group of people who are still heavily stigmatized in the African-American and Latino communities. In this article, Moctezuma Garcia examines the intersection of race, culture and sexuality in the U.S. HIV epidemic, and explores some of the ways that people can begin to bridge some of these gaping divides.

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      HIV POLICY IN THE UNITED STATES

    New Appointees to U.S. HIV/AIDS Council Are Deemed Anti-Gay, Pro-Pharma
    As if U.S. AIDS advocates needed any more reasons to dislike President Bush, some recent Bush appointments to President's Advisory Council on HIV/AIDS have generated a new wave of negative buzz. Among five new appointees to the council is Reverend Herbert Lusk, an ex-football player who heads up the Greater Exodus Baptist Church. According to Advocate.com, it also so happens that Lusk is "an antigay Baptist minister with no experience in the AIDS arena," which probably won't help restore much confidence in the council among the HIV community. "It's, unfortunately, par for the course in what weve seen with Bush," said one AIDS advocate. "I think it's a slap in the face for everyone working so tirelessly against this disease, but it doesn't surprise me." Two other new council appointees have deep ties to the pharmaceutical industry. (Web highlight from Advocate.com)

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      HIV OUTSIDE THE UNITED STATES

    In India, New Efforts to Spread HIV Awareness Among Young Women, Wives
    There are now more than two million HIV-positive women in India. What's the most likely way these women are being infected? By their husbands: 80% of new HIV cases among Indian women occur within the bonds of marriage. Compounding this problem is that HIV education is sparse, and many women never even think to get tested. Activists are trying to change this reality, however; with help from the United Nations and even the Indian government, a new HIV awareness campaign for young women has begun. There are also people like Jahnabi Goswami, an HIV-positive woman who's running for a seat on the state assembly in the Indian state of Assam. She's helping to put a public face on India's HIV epidemic among women, and to encourage more education and testing. "In our society, you see people going to astrologers to know if their horoscopes match their partner's to see if they will be compatible," Goswami said, adding, "They should be going for [HIV] tests instead."



    Treatment Alone Won't Stop HIV in the Developing World, Experts Say
    A group of researchers in London warn that even if HIV medications were given free to every person with AIDS in sub-Saharan Africa, it wouldn't actually slow down the spread of the virus -- in fact, they suggest, it would more likely speed it up. In this paper, the researchers describe a new approach to assessing how HIV treatment access will impact poor areas of the world. They point out that prevention methods, particularly HIV counseling and safe-sex education, aren't just a plus; in places like sub-Saharan Africa, they are essential in reducing the number of people who are living with the virus, the researchers say. (Web highlight from PLoS Medicine)

    In an analysis of the above article, a pair of researchers in Mexico explain why the conclusions that the London researchers reached may not necessarily be true. The problem, they say, is that we still have so much to learn about how best to scale up HIV treatment programs in the developing world -- and about what impact these programs are having on people's daily lives and habits. Issues such as "prescription patterns, consistency of drug supply, adherence, and duration of viral suppression" are all key to determining the best way to make HIV treatment programs a success in developing countries, this
    analysis says.


    Late Diagnosis, Expensive Meds May Explain Poorer Treatment Response in Developing Countries, Study Suggests
    HIV-positive people who begin taking HIV medications in the developing world are less likely to survive through the first few months of treatment than HIV-positive people in developed countries, according to an international group of researchers. Late diagnoses may be largely to blame, the researchers suggest: people in developing countries had an average CD4 count of just 108 when they started treatment, versus 234 in the developing world. The researchers also said that, in addition to earlier diagnosis and treatment initiation, free treatment access could make a big difference: HIV-positive people in low-income countries had better odds of survival if they were given free HIV medications, the study found. (Web highlight from The Lancet; free registration required)

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    Also Worth Noting

    Movers and Shakers
    African-American Leaders
    Speak Out About HIV

    Dr. Alvin Poussaint
    "Black life has been so devalued in America for centuries that a lot of black people, I feel, devalue their own life -- and then they're going to devalue their health," says Dr. Alvin Poussaint, one of the United States' leading psychiatrists.

    An expert on race relations in America and the dynamics of prejudice, Dr. Poussaint was one of the first prominent people at Harvard University to respond to a call for black leaders to speak out about HIV in the African-American community.

    Dr. Poussaint recently answered a range of questions from The Body about the HIV epidemic among African Americans. Click here to read this exclusive interview!

    Dr. Poussaint'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!

    Connect With Others
    A
    t The Body's Bulletin Boards

    Depressed by the News: I Have to Start Meds
    (A recent post from the
    "Women With HIV" board)

    "I knew that one day I would have to start HIV meds, but I never thought it would be so soon. [I] went for my lab results today, and my doctor dropped the bombshell. My CD4 count has dropped drastically (from 380 to 219) and I have to start my meds ASAP. The reality of being poz has finally sunk in, and I am just hopeful I do not have any reactions."

    -- Mix

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

    Join a Study!
    Featured Clinical Trial
    of the Month

    What's Being Studied?
    Whether GS-1937, an HIV medication in development known as an integrase inhibitor, can work as well as protease inhibitors in people whose protease inhibitor regimen has already failed to work (or is now failing).

    Who's Eligible?
    HIV-positive adults living near any of the 54 study sites in the United States. Volunteers must also:

    -- have a viral load of 1,000 or higher;

    -- have taken (or be taking) protease inhibitor therapy that has lost its ability to keep HIV at bay;

    -- have been on a steady HIV treatment regimen for at least the past 30 days; and

    -- have other lab values (like liver enzymes, bilirubin and hemoglobin) within a certain range.

    Who's Sponsoring It?
    Gilead Sciences, Inc., a pharmaceutical company.

    How Can You Learn More?
    Click here to read more about this study and see a list of sites within the United States that are enrolling volunteers. You can also ask your doctor to contact John Sayre, RN, by e-mail at jsayre@gilead.com or by phone at 650-574-3000.

    Visual AIDS
    Art From HIV-Positive Artists

    Image from the March 2006 Visual AIDS Web Gallery
    "Male Reproductive System," 1997;
    Eric Rhein
    Visit the March 2006 Visual AIDS Web Gallery to view this month's collection of art by HIV-positive artists! The March 2006 Web Gallery is entitled "Anti-Bodies"; it's curated by Michael Sappol, a curator-historian at the U.S. National Library of Medicine.