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July 19, 2006

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

    HIV Advocate Nelson Vergel Answers Questions About Multidrug Resistance
    When you're running low on HIV treatment options, how can you and your doctor come up with a strategy that'll give you the best chance of staying healthy? It's one of the toughest questions in HIV today, and it was on the minds of many HIVers who took part in The Body's chat with HIVer and patient advocate Nelson Vergel on July 10. During the hour-long chat, Nelson answered questions about multidrug resistance, new HIV meds in the pipeline, natural therapies for HIV-positive people, and much more! Read this transcript for a full recap.


    HIV Meds and You: It May Take Time to Find the Right Regimen
    If you're just starting HIV meds, keep in mind that each person's body reacts to medications differently -- and that if something doesn't seem right, you shouldn't be afraid to speak up and call your doctor. Eric Rodriguez, the executive director of the AIDS organization Body Positive, is now taking a regimen that he's comfortable with. However, he had such severe side effects on his first two regimens that doctors use his case as an example of how hard starting HIV treatment can sometimes be. "Don't be too embarrassed or afraid to talk to your doctor, as I had been," Eric warns. "You'll just make yourself more miserable and suffer needlessly."


    Drug Pipeline Offers Diverse New Therapies
    In the past month, two new pills have officially joined the antiretroviral club. That's exciting news, but neither Atripla (tenofovir/FTC/efavirenz) nor TMC114 (darunavir, Prezista) represent a fundamentally new type of HIV treatment. What about the development of HIV meds that work in completely different ways from current meds, which can be a huge help for people with multidrug resistance? As this overview from Project Inform explains, a wide range of cutting-edge meds in new drug classes are chugging hard through the development pipeline.



    U.S. Updates HIV Treatment Guidelines for Pregnant Women
    The U.S. health department has revised its recommendations on the treatment of pregnant women with HIV in the United States. The most notable changes include a recommendation that resistance testing be provided to all pregnant women who are not currently on HIV meds, as well as pregnant women on HIV meds whose regimens aren't suppressing HIV effectively. These recommendations dovetail with recently updated U.S. HIV treatment guidelines for all adults and adolescents, which also urge more widespread use of resistance testing. The revised guidelines for pregnant women also advise against the use of single-dose nevirapine (Viramune) in pregnant women who are already taking a potent HIV treatment regimen, since adding nevirapine in these cases won't further reduce the risk of a woman passing HIV to her baby.


    What a Vial of Blood Can Tell HIV Doctors About Your Health
    CD4 count and viral load tests are two of the most critical measures of your health as an HIVer. But they aren't the only important blood tests that doctors need to take: A complete blood count and a chem screen are two additional lab tests that can help docs monitor the health of your entire body, as well as the potential effects of HIV meds on your organs. AIDS Survival Project offers a quick overview of all of these tests in this article.

    For much more information on the various lab tests that help health care providers monitor the health of HIV-positive people and the success of HIV meds, check out The Body's collection of articles.

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      LIVING WITH HIV

    A Legacy of Tainted Blood: HIV Among Hemophiliacs
    Joshua Lunior is one of about 5,000 surviving hemophiliacs in the United States infected with HIV in the 1980s after receiving tainted blood products. Thanks to HIV treatment, he's alive and well today -- but he's not staying silent. "I could be sitting right next to you and you'd never know," Joshua says. "But I can't hide behind the fact that I look healthy. [HIV is] part of my life." The tainted-blood scandal of the 1980s is now considered by many to be one of the United States' biggest medical disasters. Hemophiliacs were especially hard hit, since they depend on regular doses of blood products to stay alive. Today, diligence is the key to not repeating past mistakes; blood products are genetically engineered and heat-treated to eliminate nearly all viruses. As for Joshua, he remains active, promoting prevention and understanding of HIV: "AIDS killed a lot of my friends," Joshua says, but "I can persevere and prove that it can't get all of us." (Web highlight from USA Today)


    Comedy Director Gets Serious for Documentary on HIV Among African Americans
    Bill Duke may have directed feel-good flicks like Sister Act 2: Back in the Habit, but when his goddaughter was diagnosed with HIV, his producing/directing career veered sharply in another direction. "The intellectual time ... it's over," Duke said. "We've got to do something. It is time for action." Duke himself called "Action!" on Faces, a documentary he produced that tells the stories of African Americans living with HIV. Six of these stories come from Washington, D.C.-area women. In D.C., one in 50 African Americans has AIDS, and one in 20 has HIV. Even in the midst of a new citywide initiative to test all residents ages 14 to 84, D.C. advocates say that African Americans have trouble believing that HIV afflicts everyone in their community, regardless of income or stature. After his goddaughter was infected by her boyfriend, Duke became a believer. He hopes his film will encourage more African Americans to get tested, practice safe sex and promote HIV prevention in their communities. (Web highlight from The Washington Post)

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      COMPLICATIONS OF HIV & HIV MEDS

    Severe Immune Suppression May Help Trigger Bone Death in HIVers, Study Finds
    Osteonecrosis, or "bone death," happens more frequently among HIV-positive people than HIV-negative people, but researchers aren't entirely sure why. However, a new study by Spanish researchers suggests that bone death may become much more likely among people with advanced HIV disease. The study of 10,000 Spanish HIVers found 54 cases of bone death; the researchers noted that people with bone death had an average CD4 count of 90, and that most had previously experienced an AIDS-defining illness, suggesting that severe immune suppression may be a major cause of the complication. (Web highlight from aidsmap.com)

    To read the abstract of this study, which was published in the July 2006 issue of the Journal of Acquired Immune Deficiency Syndromes, click here.


    People With Kidney Damage on Tenofovir May Have Been at Risk Before Taking Drug, Study Suggests
    Although some studies have found a link between tenofovir (Viread) and kidney damage, researchers aren't sure how great a role tenofovir actually plays. Results from a large, industry-supported Spanish study have found that these tenofovir-associated kidney problems are very rare and tend to develop in people who are already at risk for kidney problems. Among 1,286 Spanish HIVers receiving tenofovir for 48 weeks, only five people developed kidney damage that forced them to stop taking tenofovir, the study found. All five people had previously experienced kidney problems, the researchers said, which drives home the importance of checking a person's kidney health before prescribing tenofovir. Lowering the dose of tenofovir in people with kidney problems can reduce the risk of further damage, experts say. (Web highlight from aidsmap.com)

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      HIV TRANSMISSION

    NAACP Confronts HIV Epidemic in Black Community
    After years lagging behind the efforts of other groups, NAACP leaders have for the first time made fighting HIV a priority. On July 15, NAACP President Bruce Gordon and Chairman Julian Bond went to get HIV tests -- while the news media watched. Their trip was part of the organization's 97th annual convention, which opened with an on-site HIV rapid testing center and a health symposium titled "State of Emergency: Our Emergency: The HIV/AIDS Crisis in the Black Community." Calling HIV "the new civil rights movement," leaders urged conference attendees to get tested on site and return home to address HIV in their communities. "This is an issue we can no longer afford to ignore," said Myisha Patterson, the NAACP's new national health coordinator. "We must promote personal dialogue on this issue, encourage testing, and support additional programs that will literally save our lives." (Web highlight from San Francisco Chronicle)

    The NAACP's new stance is part of a growing (and sorely needed) amount of public attention to HIV in African-American communities. News & Notes with Ed Gordon, a National Public Radio program focusing on topics of interest to African Americans, recently aired a three-part series exploring the national and global impact of HIV in conjunction with the 25th anniversary of the first AIDS diagnosis.


    Unsafe Sex Common Among Female Injection Drug Users With HIV
    Many HIV-positive women who use injection drugs don't routinely use condoms with their HIV-negative partners, according to a recent study in several large U.S. cities. The findings highlight the many ways in which drug use among HIVers may contribute to the further spread of HIV. The study also noted that w
    omen who used condoms inconsistently were more likely to use drugs and alcohol during sex, have negative beliefs about condoms and feel less personal responsibility to protect others. Lead investigator Dr. Mary H. Latka said that "HIV-positive women may need structural interventions such as better access to drug treatment." She added, "Curbing illicit drug use would not only benefit HIV-positive women, it may also play an important role in reducing the continued spread of HIV from infected women to others." (Web highlight from Reuters Health)

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      HIV NEWS & VIEWS

    2006 AIDS Conference Will Be a Full House and HIVers Are Welcome in Canada
    In three and a half weeks, Toronto will become a temporary home for more than 25,000 of the world's HIV scientists, physicians, patients and activists, all of whom will be attending the 16th International AIDS Conference. Not to mention the 3,000 journalists, 3,000 volunteers and 1,000 exhibitors who will also take part in the events at the Metro Toronto Convention Center. "We fully expect this [conference] will be possibly the largest ever," said Darryl Perry, one of the officials organizing the conference. Even Canada's immigration officials have done their part to ensure success: Since May 2005, short-term visa applications have omitted HIV-related questions, allowing HIVers to freely visit Canada on short trips without disclosing their status. "This is an important change that'll benefit people coming to the conference," said Perry, "and it's a lasting change we are very proud of." By contrast, the United States is one of a handful of countries that forbid the entry of all HIV-positive foreigners.


    Scientists Explore HIV Link Between Humans and Monkeys
    Researchers confirmed in May that HIV originated in chimpanzees in Africa, and spread to humans who were exposed to the virus when hunting and butchering the animals. But could other diseases, or even new forms of HIV, pass from simians to humans in a similar fashion? A team of researchers at the Johns Hopkins' Bloomberg School of Public Health plans to find out, in hopes of identifying emerging strains of HIV and other bugs before they become the next global epidemic. The team, led by epidemiologist Nathan Wolfe, last year found that one in six people in Cameroon who were in regular contact with primate blood had been exposed to the simian strain of HIV. The findings are unsettling, Wolfe said. "We don't know whether HIV is done emerging. It may be the case that novel forms of HIV continue to enter the population."

    Click here for more coverage on the simian link to HIV.


    Catholic Church's Stance on HIV Evolves, Slowly
    The Roman Catholic Church has come a long way since the early years of the HIV epidemic, but many Catholic AIDS advocates note that it has quite a long way to go. Globally, the church has dived head-first into the pandemic: The Vatican estimates that Catholic-based organizations and churches provide more than a quarter of HIV services worldwide. But the church's anti-HIV efforts in the United States remain a work in progress. Advocates note that many U.S. churches have done little to fight HIV stigma in rural areas of the Midwest and South, and that U.S. priests generally remain reluctant to discuss HIV openly with members of the church. The Vatican's staunch opposition to all condom use also hasn't helped matters.

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      HIV POLICY IN THE UNITED STATES

    U.S.'s Stubborn Ban of Foreigners With HIV Reflects "Remnant of Fear," Advocates Say
    For 19 years now, the United States has refused to allow HIV-positive foreigners to enter the country -- even though it's long been proven that HIVers from overseas don't pose a public health threat. The ban, which became law in 1987 thanks to the efforts of ultraconservative former senator Jesse Helms, has persisted over the objections of major medical groups and the World Health Organization. In fact, the United States is one of very few countries in the world that has such a ban; Iran and Saudi Arabia are among the others. Officials have granted a waiver to allow international HIV-positive athletes to attend this weekend's Gay Games VII in Chicago, but the waiver has only served to spotlight how nonsensical the government's policy is in the first place. "The ban serves no scientific purpose," said Patricia Mail, president of the American Public Health Association.

    So, you might ask, how does the United States actually know whether a person coming into the country has HIV? For the most part, they don't: As this article explains, visa applications do ask a person if they have HIV, but they're allowed to ignore the question. U.S. airport officials don't administer HIV tests to foreign travelers, but if they find HIV medications in a person's baggage, officials can detain the person. Some Web sites offer advice on how foreigners can avoid detection, such as packing HIV meds in nondescript packaging or mailing them to the United States ahead of their visit.


    Massachusetts Legislature Trumps Governor's Veto, Legalizing Syringe Sales
    On July 13, Massachusetts joined 47 other U.S. states in legalizing non-prescription, pharmacy-based sales of hypodermic needles. "[W]e will have less hepatitis C infection in the state, and we will have less prevalence of HIV/AIDS. Those are two things we know are going to happen," remarked Sen. Robert O'Leary (D-Barnstable), who first sponsored the legislation four years ago. O'Leary also said studies of other states with similar programs do not show an increase in drug use or discarded needles. The legislature narrowly overrode Republican Gov. Mitt Romney's veto of the bill.

    Click here for coverage of Gov. Romney's initial veto and the response it received.

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      HIV OUTSIDE THE UNITED STATES

    G8 Nations Declare Commitments to HIV Prevention and Treatment, but Critics Are Concerned
    The Group of Eight industrialized nations, which met last weekend in Russia for their annual summit, adopted a document pledging to step up the worldwide fight against infectious diseases, including HIV, tuberculosis and malaria. In the document, the eight countries pledged to further efforts to develop an HIV vaccine, reduce tariffs for medications in developing countries, invest in microbicide research and provide universal access to HIV treatment, prevention and care programs by 2010. Critics reacted coolly to the G8 pledges, however, noting that they were short on details and avoided any concrete talk of reducing global poverty, one of the major factors fueling the HIV pandemic in developing nations.

    Click here for more reaction to G8 meeting and the countries' commitments on HIV-related issues.

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    Also Worth Noting

    Special Report
    On Metabolic Problems in HIVers

    Cover Image of 'An HIVer's Guide to Metabolic Complications'
    Body shape changes; high cholesterol or triglycerides; blood sugar problems; bone disease. They're all examples of "metabolic complications," a group of health problems that can be triggered by HIV or some HIV meds. There's a lot to learn about what causes these metabolic problems and how you can prevent them.

    That's why The Body has put together "An HIVer's Guide to Metabolic Complications" -- a straightforward, down-to-earth booklet on this complicated topic. In this booklet, we'll tell you all about the possible causes of metabolic complications, some possible ways to prevent them from happening, and what you should do if you start having any symptoms. Read the booklet online, or ask your HIV doctor or AIDS organization for a free print copy!

    (Clinics/AIDS organizations: You can order free print copies of this booklet by clicking here!)

    Connect With Others
    A
    t The Body's Bulletin Boards

    Afraid to Lose My Best Friend Because I Have HIV
    (A recent post from the
    "Gay Men With HIV" board)

    "I got diagnosed yesterday and I just don't know where to start. I'm 29, single and unemployed. I've got this one (female) friend I want to confide in, but I'm too scared of hurting her -- and even worse, losing her friendship."

    -- Wim

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

    Newly Diagnosed Husband; What Do I Do?
    (A recent post from the
    "My Loved One Has HIV" board)

    "My husband was diagnosed with AIDS about a month ago. We did not know what was wrong with him and after many doctors visits ... and a trip to the [intensive care unit], he was diagnosed with PCP, and ultimately AIDS. His CD4 count was 9. Although he is recovering from the PCP, I don't know what to expect. Can anyone point me to some resources? We have a great infectious disease doctor, but I need a place to get information for me, so I know how to take care of him. Also, I keep hearing that he can still live a good life, but is this true, or just something the doctors tell you?"

    -- sadwife

    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
    "Feast 2," 2004; Sam Tan
    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.