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July 12, 2006

In This Update:
  • HIV Treatment
  • Health Care for People With HIV
  • HIV Transmission & Testing
  • HIV News & Policy in the U.S.
  • HIV Outside the U.S.

    U.S. Approves First Once-a-Day Pill Containing an Entire Multi-Class Regimen
    The HIV community has been whispering about it for months, and now it's finally here: The U.S. Food and Drug Administration has approved Atripla (efavirenz/FTC/tenofovir), the first pill to combine HIV meds from two different drug classes. All three of the meds that make up Atripla have been around for years -- in fact, the combination of efavirenz (Sustiva, Stocrin) + Truvada (tenofovir/FTC) is one of the most commonly prescribed first-line HIV treatment regimens in the United States. Atripla combines them all into a single pill that only needs to be taken once a day. It's not a revolutionary advance in HIV treatment, but it does set a new high-water mark for convenience -- and it will reduce the number of health insurance copays for many people who are currently taking efavirenz + Truvada separately.

    Reducing Side Effects and Improving Treatment Success: Tips From Dr. Jon Kaiser
    When it comes to HIV treatment, HIVers in developed countries often have two major questions: 1) How can I avoid (or reduce) side effects? 2) How can I make sure my regimen lasts as long as possible? Dr. Jon Kaiser, who often writes about HIV treatment and has been treating people with HIV for 15 years, has developed a host of useful tips on making HIV treatment as reliable (and comfortable) as possible. The key, Dr. Kaiser says, is to realize that simple changes in diet or lifestyle can have a huge impact on your health even when you're already taking HIV meds.

    Researchers Try a Different Approach to HIV Treatment
    Back in April, mainstream media caught wind of an experimental type of HIV treatment that scientists have begun to test in HIV-positive people. The treatment combines genetic engineering and stem-cell science in an attempt to create what the researchers describe as a "parallel immune system" in HIVers that is more resistant to HIV than the person's natural immune defenses. The media made this out to be something of a miracle -- it appeared to work for at least one person in an ongoing study -- but as the AIDS organization Project Inform explains, it's way too early for the HIV community to be anything more than cautiously optimistic about this new form of treatment.

    To read the original newspaper article on this experimental study, click here.

    Sleuthing a Mystery: Why Do Some HIVers Never Need Meds?
    Researchers are still struggling to figure out why a small number of HIV-positive people -- about one third of 1 percent of all HIVers in the United States -- are able to keep their viral load undetectable for many years without ever taking HIV meds. "I would say we still don't have the faintest idea why these people are doing as well as they are," said Dr. Bruce Walker, a prominent HIV physician whose research focuses on these long-term nonprogressors, also called "elite controllers." Dr. Walker added, "Achieving the state that these guys have reached in their bodies -- if we could do that through some intervention, we would solve the AIDS epidemic." Walker and his research team at Massachusetts General Hospital have enrolled 176 HIV nonprogressors from across the country to participate in a new study. They're hoping that if they can recruit enough people, they can begin to see patterns that link these people together, and begin to unravel the mysteries of what makes nonprogressors tick.

    Are you an HIV nonprogressor? Dr. Walker needs you! His research team is still recruiting people for his nationwide study; click here for more info, and talk to your HIV doctor about whether you should join the study. (No traveling is necessary to participate; only a blood sample is required.)

    The Limitations of Drug Resistance Testing
    If you live in the United States and have started or switched HIV meds in the past few years, your doctor probably gave you a resistance test. Since there are so many different possible combinations of meds, resistance tests aim to figure out which meds are more likely to keep your HIV at bay. However, resistance tests aren't that simple, and the results of the tests aren't always cut-and-dry. In this detailed overview, Dr. Trevor Hawkins explains some of the limitations of HIV drug resistance testing.



    HIV Professionals' Group Defines What It Means to Be an "HIV Specialist"
    How do you know if your HIV health care provider is up to date on the latest developments in HIV treatment? HIV is one of the most rapidly developing fields in medicine, which puts a lot of pressure on health providers to stay current -- and in the United States, there are few organized ways for health providers to do so. That's why, a few years ago, the American Academy of HIV Medicine (AAHIVM) started its HIV Specialist Credentialing Program; the program provides a set of requirements that doctors, nurse practitioners and physician assistants must meet. In this article, AAHIVM explains how their credentialing program works.

    Is your HIV health care provider an AAHIVM-credentialed HIV specialist? You can use AAHIVM's search tool to find out.

    Meet the Big Shots: Immunizations to Get (and Avoid) if You're HIV Positive
    Vaccinations may not be fun, but for many people with HIV they're an important part of staying healthy and avoiding potentially dangerous illnesses like the flu, pneumonia and hepatitis. This chart provides a rundown of the different types of vaccinations that are recommended for HIV-positive people, as well as four vaccinations that should be avoided, because they could actually put your health at risk.

    How Do Doctors Approach Their Patients About Drug Use?
    Talking about illegal/recreational drug use with your health care provider is a sticky subject; you know that your drug use could affect your health -- especially if you're HIV positive and on meds -- but how can you bring it up with your doctor? Well, if it's any comfort, many doctors have just as hard a time talking with you about drug use as you might have talking with them. In this overview for health professionals, Dr. Edward V. Nuñes, Jr., discusses how doctors can talk to their patients about drug use, and what options there are for helping a person reduce their dependence on drugs. (Web highlight from PRN Notebook; free registration required)



    An Offer They Can't Refuse: Some L.A. Day Laborers Sell Sex to Make Ends Meet
    Every day at the corner of Kester and Oxnard streets in Van Nuys, Calif., hundreds of Latino day laborers are looking for work. When their quest is unsuccessful, some feel they have no choice but to turn to sex work to make money. This trend in hiring young, poor immigrant laborers for sex has Los Angeles health experts stressing the need to educate workers about HIV, which is spreading rapidly among Latinos. In a local survey of 450 day laborers, 38 percent reported being solicited for sex and 10 percent accepted the offer. Of those who accepted, the majority reported not using condoms.

    Hispanic Community in the U.S. Hit Hard by HIV Epidemic
    The HIV epidemic is a growing threat among Hispanic Americans throughout the country. While they represent only 14 percent of the total population of the United States and Puerto Rico, Latinos account for 19 percent of all HIV diagnoses since the beginning of the epidemic. Since there's no unified Hispanic culture in the United States, a range of cultural, economic and health-related factors contribute to the continued spread of HIV. A U.S. Centers for Disease Control and Prevention report shows that risk factors for HIV differ by country of birth: For instance, Hispanics from Puerto Rico are more likely to contract HIV through injection drug use, while sexual contact with men is the main cause of infection in men from Mexico. Read this article for a full statistical overview of HIV among the U.S. Hispanic population.

    Frequently Asked Questions About HIV Prevention, Risk and Testing
    It never hurts to brush up on the basics! This FAQ from the American Foundation for AIDS Research reviews some of the most common questions people have about how HIV is transmitted, who is most at risk, and what HIV testing is all about. It's a particularly helpful resource for HIV-negative people in need of a quick education on what steps they do -- and don't -- need to take to protect themselves from HIV.



    Elizabeth Taylor, Others Donate to Improve HIV Services in Hurricane-Stricken Gulf Coast
    It's been nearly 11 months since Hurricane Katrina decimated New Orleans, and while parts of the city are making a comeback, the situation is still dire for many people -- including people with HIV (at least those few who have returned). HIV services remain spotty throughout much of the Gulf Coast, and help is sorely needed. This month, actress and AIDS activist Elizabeth Taylor did her part to make a difference: Through a $40,000 donation from Taylor, as well as additional funds from Macy's department stores, the New Orleans AIDS organization NO/AIDS Task Force was able to purchase a 37-foot "CareVan," a mobile medical facility equipped with exam tables and an X-ray machine. AIDS Healthcare Foundation has also pledged resources and personnel to staff the mobile clinic.

    Washington, D.C., to Adopt HIV Names Reporting
    Later this month, the Washington, D.C., Department of Health will propose replacing the city's coded "unique identifier" system with a confidential names-based reporting system for tracking people who test HIV positive. The proposed change comes less than three months before a federal government deadline that could result in the loss of millions of dollars in funding for areas that do not adopt the recommended names-based system. Many officials and AIDS advocates have questioned whether a names-based reporting system will mean that fewer people will come forward for HIV testing, because they'll feel like testing is less confidential than it was before. However, many feel that they weren't left much of a choice: Councilmember David Catania said, "We dont have the choice to forego the federal funds. So what we have to do is develop a system to ensure the confidentiality of the names." (Web highlight from Washington Blade)



    Male Circumcision in Africa Could Save 3 Million Lives by 2026
    Last year, a study in South Africa found that circumcised men may be as much as 65 percent less likely than uncircumcised men to get HIV from a woman during unprotected sex. Based on those findings, a team of scientists has crunched some numbers to figure out just how many lives might be saved if all men in Africa got a circumcision. "Male circumcision could avert nearly six million new infections and save three million lives in sub-Saharan Africa over the next twenty years," the scientists found. (Web highlight from Reuters Health)

    To read this study, which was published in the open-access medical journal PLoS Medicine, click here.

    Also Worth Noting

    Lipoatrophy Center
    Listen to Podcasts From Experts and HIVers With Lipoatrophy

    Dr. Minas Constantinides
    Want to hear (or read) what some of the United States' top experts and HIV-positive people have to say about lipoatrophy? Check out Podcast Central at The Body's new Lipoatrophy Resource Center!

    Listen in or read transcripts as we interview physicians, researchers and HIVers to get a personal perspective on lipoatrophy's causes, treatments and how people have coped with this difficult side effect. For instance, Dr. Minas Constaninides (above), a reconstructive surgeon in New York, spoke with us about how poly-L-lactic acid (Sculptra, New-Fill) injections work.

    Connect With Others
    t The Body's Bulletin Boards

    Gay, HIV Positive
    and Loveless

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

    "I'm sure my story is not that uncommon, but when I say it to myself I realize what a social loser I am. ... I have never been asked out by someone. I try to flirt, I think I'm reasonably attractive and I'm open to whatever comes along. I've never been asked out on a date by someone at the bar or any other social setting. I have spent my life being a sex addict, trying to find this missing piece in my life. Now I'm 23, HIV positive and still alone. ... I feel like nobody would ever want me. Damaged goods filled with poison. I did meet someone and we went out for lunch one day and he made me feel so special. ... I finally thought something had changed, but it once again progressed to sex, and Im again left feeling inadequate and disgusted with myself. I just dont know what to do."

    -- Anonymous

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

    In the Theatre
    Critically Acclaimed Play Explores HIV Among Black Women in U.S., Africa

    Photo from "In the Continuum"
    Although Tony Kushner's "Angels in America" drove home the devastation that HIV wrought in the United States in the mid-1980s, precious few critically acclaimed theatre productions have delved into the impact that HIV still has today -- particularly among African Americans and people in developing countries.

    A new hit play now touring the United States and Africa is trying to change that: A raw, darkly comic, gripping drama, "In the Continuum" follows the lives of two young women as they confront HIV in very different parts of the world: one in Los Angeles, Calif., the other in Harare, Zimbabwe. The two playwrights/actors take on dozens of roles in this critically-acclaimed production.

    After an enthusiastic reception Off Broadway in New York, the play became an international hit when it traveled overseas to Zimbabwe. Beginning in August 2006, "In the Continuum" will return to the United States in a series of limited engagements in Washington, D.C.; Cincinnati, Ohio; Los Angeles, Calif.; New Haven, Conn., Philadelphia, Pa.; and Chicago, Ill. For more info, visit the play's Web site.

    Visual AIDS
    Art From HIV-Positive Artists

    Image from the July 2006 Visual AIDS Web Gallery
    "An Erotics of Art," 1980; Paul Thek
    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.