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June 14, 2006

In This Update:
  • AIDS at 25
  • HIV Treatment
  • HIV Vaccine Development
  • HIV Transmission
  • Transmission of Other STDs
  • Injection Drug Use
  • HIV Outside the U.S.
  •   AIDS AT 25

    How It All Began: HIV Before the Age of AIDS
    All the research and speculation about the origins of HIV can seem irrelevant to the daily reality of living with the virus. Why dwell on the past when we're struggling with an epidemic now? But researchers continue to sleuth out the history of HIV, hoping their findings will lead to practical results such as a vaccine, better treatment or maybe even a cure. Despite the recent finding that HIV originated in chimpanzees in Cameroon, a number of questions about the origin of HIV remain unanswered: How long has HIV been in the population? How did the virus pass from chimps to humans? And why doesn't HIV's viral ancestor, SIV, kill or sicken the chimps who have it? (Web highlight from PBS Frontline)

    Has HIV Lost Its Allure as a Celebrity Cause?
    "In the beginning, there was a lot of support from Hollywood," said Victor McKamie, the executive director of Los Angeles' Minority AIDS Project, one of many U.S. AIDS organizations struggling to fund itself. "People were calling us asking what they could do to help. Now we can't even get them to return our calls." Although many celebs still rally to the HIV cause, now that the epidemic has reached its 25-year anniversary and the disease is no longer a death sentence in developed countries, many celebrities have found other issues they would rather fight for. Others are spreading their activist message out across a wide range of causes, as actress Jessica Alba did in her acceptance speech at a recent awards ceremony: "Practice safe sex and drive hybrids if you can." (Web highlight from the Orlando Sentinel)



    Viral Breakthrough More Likely With 3-NRTI Regimens, Study Warns
    You take HIV meds to get your viral load under control and keep it that way. But when it comes to keeping that viral load down, not all regimens are alike. In fact, one type of regimen may be worse than other, commonly used regimens: We're talking about regimens that consist entirely of three nucleoside reverse transcriptase inhibitors (NRTIs), such as AZT + 3TC + abacavir, the three meds that make up the combination drug Trizivir. Over the past few years, large studies have suggested that these three-NRTI regimens are inferior to other types of regimens. Now, a large study by Italian researchers may drive yet another stake into the heart of the three-NRTI strategy. The study -- sponsored by a nonprofit group of European doctors -- involved 744 people who were on a regimen that was successfully suppressing HIV. It found that people taking a three-NRTI regimen were more likely to see their viral load rise again than people whose regimen consisted of two NRTIs plus efavirenz (Sustiva, Stocrin). Although the study's results were not considered conclusive, the researchers nonetheless said that the findings support the idea that people on three-NRTI regimens should consider switching to more potent treatment even if their viral load is undetectable. (Web highlight from

    If you'd like to read the abstract of this study, which was published in the Journal of Infectious Diseases, click here.

    HIV Treatment Interruptions: Interleukin-2 Doesn't Help, but a CD4-Guided Strategy May Be OK
    Recent research, most notably the SMART study, has highlighted the potential risks of certain kinds of HIV treatment interruptions. Some experts have wondered if these risks could be reduced if a person takes an immune-boosting drug, such as interleukin-2 (IL-2). However, a recent AIDS Clinical Trials Group study (led by The Body's own Dr. Keith Henry) appears to refute this idea: In the study, 47 people stopped their HIV therapy after they reached a viral load below 200 and a CD4 count of 500 or higher. Before stopping therapy, however, some people were given IL-2, to see if taking the drug could keep their CD4 count from dropping after they interrupted treatment. Unfortunately, the researchers found the IL-2 didn't help at all. However, they did find that the treatment interruption strategy used in the study -- stop at a CD4 count of 500, restart at 350 -- generally appeared to be safe, with most people going more than a year without having to restart treatment. (The SMART study tested a riskier strategy, in which people stopped treatment at a CD4 count of 350 and restarted at 250.) (Web highlight from

    To read the abstract of this study, which was published in the Journal of AIDS, click here.

    New HIV Medication Class Moves Forward in Clinical Trials
    PA-457, the first of a new class of HIV meds known as maturation inhibitors, is about to begin a new clinical trial to see how well it works in HIVers whose current regimen is failing. Like other new medication classes, the primary lure of maturation inhibitors is that they may provide new options for people who most need them: those who have developed resistance to most existing HIV meds. Earlier studies on PA-457 suggest that the drug shows promise; however, even if it sails through its upcoming clinical trials, PA-457 would probably not be approved in the United States until 2009 at the earliest. (Web highlight from New Scientist)



    HIV Vaccine Doesn't Have to Prevent HIV in Order to Save Lives, Study Finds
    Many of us probably think of vaccines as drugs that protect a person from becoming infected with a disease-causing bug. And that is the goal of most vaccine research -- but in the case of a virus as insidious as HIV, it's not the only way a vaccine can save lives. A recent U.S. government-sponsored study found that monkeys who were given a certain type of immune-boosting vaccine against the simian cousin of HIV weren't actually protected from infection, but they did maintain higher CD4 counts for far longer than monkeys who didn't get the vaccine. The researchers noted that there are two similar HIV vaccines currently in human trials.

    For a more in-depth look at the findings of this study, click here.



    HIV Rates Continue Unchecked Among Gay, Bisexual Men in New York
    The resurgence of HIV among men who have sex with men (MSM) shows no sign of slowing in New York City, health officials say. Between 2001 and the first half of 2005, the proportion of new HIV diagnoses who were MSM leaped from 26 to 39 percent. A closer look at the numbers, however, tells a more nuanced story: For instance, new HIV diagnoses actually decreased among MSM over the age of 30, but increased for MSM younger than 30. Experts also aren't sure whether MSM rates are actually rising, or whether the HIV rates of other groups have been dropping while MSM rates stay the same.

    Erectile Dysfunction Common Among College Men Using Condoms; HIV Risk Higher
    Young men may commonly experience erectile dysfunction (ED) while trying to use a condom, according to a survey of sexually active men at three Chicago, Ill., colleges -- and those young men who have ED may also be more likely to put themselves at risk for HIV. The survey of 234 men, most of whom were white and nearly all of whom were heterosexual, found that 25 percent reported sometimes experiencing ED when trying to use a condom. Men who had problems while using a condom were four times more likely to report inconsistent condom use and five times more likely to have multiple sex partners. The survey also found that 6 percent of the men reported using ED drugs such as Viagra -- "a surprisingly high proportion of young, heterosexual men," said principal investigator Najah Senno Musacchio. The majority said they used the drugs specifically to treat erectile dysfunction (as opposed to increasing sexual pleasure), but only one got the drugs from a medical provider; the rest got them from friends or the Internet.



    U.S. FDA Grants Approval for First HPV Vaccine
    The U.S. Food and Drug Administration (FDA) has approved Gardasil, the first human papillomavirus (HPV) vaccine, for use by girls and women between the ages of 9 and 26. The vaccine protects against four specific strains of HPV: HPV-16 and 18, which account for about 70 percent of cervical cancer cases, and strains 6 and 11, which account for 90 percent of genital wart cases. Studies showed Gardasil also offers protection against cases of vaginal and vulvar cancer linked to HPV infection.

    Syphilis and HIV
    We know more about sexually transmitted diseases -- and how to prevent them -- than we ever have before, and yet syphilis rates are increasing in the United States, which probably means that more people are having unprotected sex. Although we mostly talk about HIV in our newsletters, syphilis isn't exactly a walk in the park either, and it can potentially complicate matters for people with HIV. (HIV-negative people with syphilis are also at a higher risk for becoming infected after an HIV exposure.) To learn much more about syphilis and how it interacts with HIV, read this clinical overview by a pair of University of California-San Francisco physicians. (Web highlight from HIV InSite)



    Safe Injection Sites May Increase Number of Drug Users Seeking Addiction Treatment, Study Says
    Critics of safe-injection sites, where health professionals supervise users who inject drugs they've obtained elsewhere, often argue that such facilities only encourage drug users to keep on using. But a new study adds to the growing mountain of evidence that these critics are wrong: Researchers at the only experimental safe-injection site in North America (located in Vancouver, Canada) have found that the facility has actually increased the number of people who seek addiction treatment. Injection drug users were twice as likely to go into detox once they started using the facility, compared to before it was open -- and the more often they went, the more likely they were to go into treatment. The study was published in the New England Journal of Medicine.



    Mixed Progress on HIV Prevention in Saudi Arabia
    Saudi Arabia, known for its conservative government and spotty history of HIV prevention and treatment, is getting serious about HIV awareness, according to government and United Nations officials. "As a new [HIV prevention] strategy, we are trying to reach the people through religious leaders. We have conducted programs for imams who deliver sermons at the mosques," says Dr. Khadija T. Moalla, a senior regional official with the United Nations Development Programme (UNDP). In addition to the UNDP's efforts, the Saudi government has launched a national HIV awareness campaign. Four free testing and treatment centers are already open in Saudi cities, offering services to people with HIV and their families; more are in the works. Since 1984, 10,000 people living in Saudi Arabia have been diagnosed with HIV, only 2,000 of whom are Saudis. Unfortunately, in what it considers a valid attempt to curb the spread of HIV, the Saudi government refuses to issue employment visas or temporary resident certificates to anyone who is HIV positive. In addition, according to many reports, all non-Saudis who test positive are deported. (Web highlight from Arab News)

    No Let-Up in Australia's HIV Epidemic: UNAIDS Report
    It's latest example of what appears to be a reversal of HIV trends in many of the world's richest countries: UNAIDS has warned that the number of new HIV diagnoses in Australia is returning to the disturbing levels seen in the early 1990s. "Australia's long-established AIDS epidemic is not dissipating," the newly released UNAIDS report says. "Newly acquired HIV infections, largely attributable to unprotected sex mostly between men, are increasing, which plausibly reflects a revival of sexual risk behavior." Indigenous people appear to be bearing the brunt of the increase in HIV diagnoses.

    Also Worth Noting
    Free CME/CE Credit
    HIV Health Professionals:
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    The Body PRO, The Body's sister site for health professionals, offers a host of free, informative CME/CE activities for U.S. physicians, nurses and pharmacists. Earn credit now for any of these activities:

    New Developments in HIV Drug Resistance and Options for Treatment-Experienced Patients, by Bonaventura Clotet, M.D., Ph.D., and Cal Cohen, M.D., M.S.

    HIV Antiretroviral Agents in Development, by Edwin DeJesus, M.D.

    Cardiovascular Risk Factors and Metabolic Complications in HIV-Infected Patients Receiving HAART, by Graeme Moyle, M.D.

    Top 10 Research Publications in HIV Care -- 2005, by David Wohl, M.D.

    Not a member of The Body PRO? Registration is quick, easy and completely free. Sign up now!

    Visual AIDS
    Art From HIV-Positive Artists

    Image from the June 2006 Visual AIDS Web Gallery
    "Isis Rising," 1998; Fran Lewis
    Visit the June 2006 Visual AIDS Web Gallery to view this month's collection of art by HIV-positive artists! This month's gallery is entitled "Magick Eyes"; it's curated by Malik Gaines, an independent critic and curator, and Alex Segade, a film and video director.

    Connect With Others
    t The Body's Bulletin Boards

    My Daughter-in-Law Has Given Up on Life
    (A recent post from the
    "My Loved One Has HIV" board)

    "My HIV-negative son and three HIV-negative grandchildren may soon lose their HIV-positive wife and mother. My son and daughter-in-law seem not to be taking their situation as seriously as I have been. She does not take her meds and he seems to have just accepted from the beginning that she would die. They are not fighting, just waiting for the end.

    "When I asked [my son] could give me no specifics -- did not know CD4 count or viral load -- but said she was down to 75 pounds, was not eating and that her CD4 count had been in single digits. She does not take her meds because they make her sick. With meds, he has said they give her one year; without, six months. ...

    "I don't think [my son] has really considered what this will mean, and her self-esteem is so low she has just decided that this is the hand that fate dealt her. I don't know what to think or even feel. Can anyone give advice?"

    -- motherinlaw

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

    Just Diagnosed and Ready for Life to Go On
    (A recent post from the
    "I Just Tested Positive" board)

    "Being a gay man, I have a HIV test every six months. The last one was positive. ... I was infected by someone who was unaware they were positive, so I really harbor no ill will towards the person. ... Letting him know went well for both of us and we are still good friends.

    "My [doctor] was really great about telling me my diagnosis; she let me know that while my life will be more complicated from here on out, the treatments have really come a long way, and with proper treatment, there is no reason why I shouldn't remain healthy. ...

    "I really suspected I had been infected when I had the classic symptoms of an early infection in January (severe flu-like symptoms that lasted about a week, and swollen lymph glands). So while the diagnosis was not entirely a shock to me, it still was not what I wanted to hear. But life goes on, and I am going to do what it takes to manage this disease."

    -- thevillebear

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