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July 5, 2006

In This Update:
  • HIV-Related Policy in the U.S.
  • HIV Treatment
  • Drug Resistance Chat on July 10
  • Complications of HIV & HIV Meds
  • AIDS at 25
  • News & Views
  • HIV Outside the U.S.
  •   HIV-RELATED POLICY IN THE UNITED STATES

    HIVers Can Be Sued for Transmission, Even if They Don't Know Their Status, California Court Rules
    Can an HIV-positive person be sued if they transmit HIV to someone else -- even if the HIV-positive person didn't know they had the virus? The answer appears to be yes, according to a California Supreme Court ruling. In a 4-3 decision, the court ruled that an HIV-positive woman was allowed to sue the sexual partner from whom she contracted the virus, even though the man says did not know he was HIV positive at the time he infected her. The court said that an HIV-positive person who has never been tested can still be sued for negligent HIV transmission if he or she "has reason to know" that he or she might have HIV. One of the dissenting judges warned that the decision "potentially licenses invasions into sexual privacy of all sexually active Californians and may even invite abuse of the judicial process."


    U.S. State Department Must Stand Trial for Denying Employment to HIV-Positive Man
    The U.S. State Department refused to hire Lorenzo Taylor when they found out he was HIV positive, so Taylor decided to fight back -- and a recent court decision has upheld his right to do so. A U.S. appeals court panel unanimously ruled that the State Department must stand trial for failing to hire Taylor as a foreign-service officer solely because he has HIV. Lambda Legal attorney Jon Givner said he is "pleased to see that the court sees through the faulty reasoning used [by] the State Department to substantiate discriminatory and baseless policy." State Department regulations say that being HIV positive automatically excludes them from being hired, although current employees who test positive are allowed to work as long as their health allows. Lambda Legal has an ongoing petition campaign to urge Secretary of State Condoleezza Rice to reverse the policy.


    Governor of Massachusetts Says No to Over-the-Counter Needle Sales
    Forty-seven other states have already given it a thumbs-up. The Massachusetts legislature is overwhelmingly for it. But that wasn't enough reason for Massachusetts Gov. Mitt Romney, a Republican, to veto a bill that would legalize over-the-counter sales of hypodermic needles in his state. Romney's administration blamed a spike in heroin overdoses for his decision: "We cannot in good conscience say that we should make needles more available to heroin addicts," said Romney's lieutenant governor, Kerry Healey. However, critics expressed skepticism of Romney's logic. The state legislature is expected to override Romney's veto and make the bill into law.

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      HIV TREATMENT

    A Drug Pricing Victory: TMC114 Price Will Be Far Below That of Some Other HIV Meds
    To the pleasant surprise of some AIDS treatment advocates, the maker of TMC114 (darunavir, Prezista), a protease inhibitor that was approved in the United States last week, has agreed to set the drugs price well below that of some other recently approved HIV meds. Although still extremely expensive, TMC114 will cost $6.25 per pill, or $25 per day (that adds up to about $9,000 per year). Thats almost half the cost of T-20 (enfuvirtide, Fuzeon) and well below the cost of tipranavir (Aptivus), a protease inhibitor that was approved just last year. "This was exactly the kind of bold move sought by the community," says Project Inform, which led a nationwide push to ensure a fair price for TMC114. Project Inform urges people to contact the company that produces TMC114 to praise it for its decision: "It isn't often that Project Inform or other advocacy organizations call for support of drug company, but we must be fair. When they act in a socially responsible manner by responding to community needs, we need to reinforce that behavior." Click on the link above for more from Project Inform, including the full address where you can write to the company that produces TMC114.


    Many Questions Remain About TMC114, Treatment Advocate Notes
    "Development of [TMC114 (darunavir, Prezista)] was spectacularly fast," writes HIV treatment advocate Rob Camp of Treatment Action Group. HIV meds tend to be approved very quickly (relative to drugs for other diseases), but TMC114 shot through the pipeline faster than most, leaving a slew of unanswered questions about the drug's usefulness and potential long-term side effects. Although there are lots of advantages to TMC114, there is a lack of study data on many important issues, Camp writes. In this detailed review, he presents some of the questions that still remain about TMC114's optimal dose, its benefits in women, potential drug interactions and long-term side effects, and a more accurate sense of the types of drug-resistant HIV-positive people for whom TMC114 is likely to work best.



    Accessing the Medicare Prescription Drug Plan
    Are you an HIV-positive person living in the United States who's eligible to sign up for a prescription drug plan through Medicare Part D, but you missed the May 15 registration deadline? It's still possible to sign up, although you may have to pay additional fees to do so. Read through this fact sheet from AIDS Survival Project for more information on accessing coverage, choosing plans and learning about the monetary costs of participating.

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      REMINDER: HIV DRUG RESISTANCE CHAT NEXT MONDAY, JULY 10!

    The Date: Monday, July 10, 2006

    The Time: 3:30 p.m. Eastern Time/12:30 p.m. Pacific Time

    The Chat: HIV treatment advocate Nelson Vergel will answer your questions about treatment options for HIV-positive people with multidrug resistance. He'll also talk about some of the hottest topics in HIV treatment, including the recent approval of TMC114 (darunavir, Prezista), the announcement of side-effect risks with tipranavir (Aptivus) and the status of other drugs in the development pipeline. Nelson will also provide helpful tips on healthy living for treatment-experienced HIVers.

    Nelson, the founder of salvagetherapies.org, is one of the leading patient advocates in the field of multidrug resistance. He has been HIV positive for 23 years; his HIV is resistant to most currently approved medications, but his viral load recently dropped to undetectable on a combination of new drugs in development that are being tested in a clinical trial.

    To sign up for an e-mail reminder about this chat, or to presubmit a question you'd like Nelson to answer, click here!

      COMPLICATIONS OF HIV & HIV MEDS

    FDA Warns of Hemorrhage Risk With Tipranavir
    The U.S. Food and Drug Administration (FDA) has issued a "Dear Healthcare Provider" letter to warn clinicians about the what appears to be a higher-than-normal risk of intracranial (within the skull) hemorrhage in HIVers who take tipranavir (Aptivus) and ritonavir (Norvir). Tipranavir was approved in 2005 for use by HIV-positive people with multidrug resistance. The FDA letter says data from clinical trials showed that 13 out of the 6,840 people who received tipranavir + ritonavir experienced intracranial hemorrhage, and eight of those people died. Although the complication was rare and its cause uncertain, a "black box warning" is being added to tipranavirs labeling, and doctors are being urged to use caution when prescribing tipranavir + ritonavir to people "who may be at risk for increased bleeding from trauma, surgery or other medical conditions, or who are receiving medications known to increase the risk of bleeding, such as antiplatelet agents or anticoagulants."

    Looking to learn more about tipranavir (Aptivus)? This fact sheet from the AIDS Community Research Initiative of America contains background info, a rundown of the drugs uses and potential side effects, and a summary of clinical trial results.


    d4T, ddI May Increase "Fatty Liver" Risk in People With HIV and Hepatitis C
    People coinfected with HIV and hepatitis C have a much higher risk of developing a condition known as "fatty liver" if they're taking d4T (stavudine, Zerit) or ddI (didanosine, Videx), according to the results of a 183-person U.S. study. Fatty liver, known by clinicians as hepatic steatosis, can cause severe nausea, vomiting and abdominal pain, and can be life threatening on rare occasions. The U.S. study found that HIV/hepatitis C-coinfected people who were taking d4T or ddI were five times more likely to develop fatty liver than people who were not taking any HIV meds in the same class. d4T and ddI are both nucleoside reverse transcriptase inhibitors (NRTIs), which some studies have suggested pose a risk to liver health. Although the researchers think they have found a link between fatty liver and d4T/ddI, they don't recommend avoiding the drugs entirely -- instead, they warn that they "should be used cautiously." (Web highlight from aidsmap.com)

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      AIDS AT 25

    The Good and the Bad: AIDS Has Not Gone Away, Dr. Howard Grossman Says
    "Death was a constant companion in 1995," recalls Dr. Howard Grossman, one of the United States most prominent HIV physicians and the head of the American Academy of HIV Medicine, an HIV specialist group. One day that year, in the span of a few hours, Dr. Grossman lost two of his patients, as well as one of his best friends. Not long after that, combination HIV treatment became available, and everything changed: "In my practice alone in 1995 there were 37 deaths. In 1996 it dropped to 10, in 1997 to four and in 1998 to zero," he says. But despite these miraculous advances, the HIV epidemic in the United States today is far from a vase of roses, Dr. Grossman writes. "We've still lost a lot of patients since 1995. Their deaths must serve as another reminder that, for all our success, AIDS has not gone away."

    For many more perspectives on the AIDS epidemic's 25th anniversary, including podcasts and in-depth overviews, check out The Body's large collection of articles and links.

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      NEWS & VIEWS

    Big Names to Headline Next Month's International AIDS Conference
    Former U.S. President Bill Clinton, Bill and Melinda Gates, and the actor Richard Gere will be among many prominent speakers making an appearance at the XVI International AIDS Conference, which begins on Aug. 13 in Toronto, Canada. Although in recent years this conference has been pretty light on major scientific breakthroughs, it remains the largest international gathering of HIV/AIDS activists, prevention and treatment experts, physicians and researchers. Held once every two years, it provides an incredible opportunity for the world's HIV/AIDS leaders to meet and share their knowledge about strategies for preventing and treating HIV in every corner of the globe.


    Gay Games Profiles: Athletes With HIV Show Their Winning Attitudes
    "You can overcome all drama and still succeed," says HIVer Conscious Soden. Haunted by a traumatic childhood and an early adult life of drug and alcohol abuse, Soden is one of thousands of athletes from around the world expected to gather in Chicago, Ill., to take part in the 2006 Gay Games -- the Olympics of the world's gay community. In this article, Keith Green profiles a few of this year's HIV-positive competitors, including Soden, bowler Craig Goodman and swimmer James Ballard, who remembers a time not too long ago when it was difficult for his swim squad to even find a place to practice: "In San Francisco (1986), we had to travel to Oakland to find a pool because nobody wanted a group of gay swimmers to take over their pool," he recalls.

    Of course, even in 21st-century America there remains plenty of controversy over the Gay Games. In February, the U.S. Department of Homeland Security decided it would waive the countrys regulation barring HIV-positive nonresidents from entering the United States. Conservative groups, including the Illinois Family Institute, were up in arms; they said the waiver posed a potential public health threat because one of the games sponsors, a men's bathhouse, promoted "reckless sexual behavior" that could "pave the way for spreading" HIV. Nothing appears to have come out of the institute's vehement protests, however; there has been no word of a renewed crackdown on HIV-positive athletes coming into the United States to participate in the games.

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      HIV OUTSIDE THE UNITED STATES

    Uganda May Be Running Out of HIV Medications
    Uganda's supply of HIV meds is dwindling, leading some HIV treatment centers to stop accepting new patients, according to Tonny Takenzire, an official with the National Guidance and Empowerment Network of People Living with HIV. "Even national referral hospitals would be running out of antiretroviral drugs because the support from the Global Fund [to Fight AIDS, TB and Malaria] has been delayed by procurement," he said. Uganda, home to one million HIV-positive adults and children, has only one supplier of HIV meds.


    France Begins Airline Tax to Boost AIDS Funding
    July 1 marked the first day that all airline travelers leaving France had to pay a special tax meant to boost funding for the global fight against HIV, tuberculosis, malaria and other diseases. The tax ranges from an extra euro ($1.27 in U.S. currency) for economy-class flights within Europe all the way up to 40 euros (US$51) for the most-expensive first-class ticket. The surcharge is expected to generate US$256 million per year. Several other countries have announced plans to institute a similar tax.

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    Also Worth Noting

    Lipoatrophy Center
    Thoughts on Fat Loss From a Doctor Who Is a Patient

    Dr. Bob Frascino
    As an HIV health care provider and a person living with the virus since 1991, Dr. Frascino has a unique perspective. As someone who has struggled with lipoatrophy himself, he knows all too well what his patients are experiencing.

    The Body's interview with Dr. Frascino (available as a transcript and a podcast) is part of our newly launched Lipoatrophy Resource Center, the most comprehensive source on the Web for the latest news and information about this difficult side effect. Visit the center for news, research updates, overviews, comparisons of facial fillers, tips on how to get insurance coverage for lipoatrophy surgery and compelling accounts of what it's like to live with lipoatrophy.

    Connect With Others
    A
    t The Body's Bulletin Boards

    Newly Gay -- and
    HIV Positive

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

    "I just found out this week I am infected. I am a divorced man and have three children. ... The person I was with [before my wife] says he isn't infected to his knowledge. But it has to be him. ... My ex and my children don't know I am gay and certainly won't know that I have this virus. I of course will be very careful with them. The guy I was dating most recently isn't calling me after learning the news. That hurts, but is not unexpected. I don't expect to do much dating anymore. I don't feel like my life is over, just more burdened. I also feel there is a silver lining to everything and God doesn't give us anything we can't handle. I intend to keep my body strong with nutrition and exercise and my mind strong with staying as positive as I can."

    -- ATLdad

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

    Visual AIDS
    Art From HIV-Positive Artists

    Image from the July 2006 Visual AIDS Web Gallery
    "Color Virus," 1998; Joe DeHoyos
    Visit the newly launched July 2006 Visual AIDS Web Gallery to view our latest collection of art by HIV-positive artists! The July gallery is entitled "Vital Signs"; it's curated by Catharina Manchanda, curator at the Mildred Lane Kemper Art Museum at Washington University in St. Louis.