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August 9, 2006

In This Update:
  • HIV News & Views
  • Living With HIV
  • HIV Treatment
  • HIV-Related Health Problems
  • HIV Outside the U.S.
  •   HIV NEWS & VIEWS

    As AIDS Conference Ramps Up, Experts Temper Optimism With Stark Reality
    With the largest-ever International AIDS Conference slated to begin this weekend, HIV experts are taking stock of the 25-year fight against HIV. UNAIDS reported in May that the global proportion of people with HIV "is believed to have peaked in the late 1990s and to have stabilized subsequently." Additionally, advances in treatment options and availability, increased funding for research and decisive action by policy-makers are cause for celebration. However, great news has to be balanced with the reality that AIDS claimed 2.8 million lives and HIV infected 4.1 million new people in 2005 alone. (Web highlight from Agence France Presse)

    One last reminder: TheBody.com is your source for complete coverage of the XVI International AIDS Conference! Beginning this weekend, we'll provide news, breaking research, podcasts, expert interviews, photos and much more! Click here to stay abreast of the latest from the conference.

    For more articles on the 25th anniversary of the AIDS pandemic, click here.


    ADAP Waiting Lists Shrink, but Not for Long, Report Warns
    The number of Americans on AIDS Drug Assistance Program (ADAP) waiting lists has dropped sharply in the last few months, but the respite may be only temporary, according to the latest "ADAP Watch" released by the National Alliance of State and Territorial AIDS Directors. The report said that 310 people in five U.S. states were currently on a waiting list to receive HIV meds, down from 791 people in nine states in February. However, some of the states that were able to eliminate their waiting lists this year are on the verge of starting new ones, and several other states have recently introduced new restrictions or expect to do so soon, the report says.


    Back From Media Purgatory: HIV Finally Hits TV Airwaves
    With HIV stigma and discrimination still running rampant in much of the world, HIV might seem to be anything but appealing television -- and for a very long time, most TV shows avoided any serious mention of the virus. However, some of today's most popular programs -- "ER," "House," "Without a Trace" -- have recently featured realistic, in-depth HIV plotlines. Wonder why things have changed? It's because governments, public health organizations and media companies around the world are finally working together to convert television into a powerful HIV awareness tool. "More than a decade ago," recalls Drew Altman, president of the Henry J. Kaiser Family Foundation, "we did survey after survey showing the media were the number one source of medical information in this country and around the world, especially for young people." Until recently, however, the U.S. Centers for Disease Control and Prevention felt that a full-blown partnership with Hollywood would be a bad idea, since they assumed nobody would take HIV seriously if it were woven into slickly produced TV shows. Their fears were unfounded, however: Research has shown that incorporating HIV and other health messages into today's programs is likely to raise people's awareness and understanding. (Web highlight from USA Today)

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      LIVING WITH HIV

    The Graying of AIDS: Older HIVers Tell Their Stories
    As people with HIV survive into middle age and beyond, they confront the ordinary ailments of age along with the medical and social realities of living with the virus. Too often older HIV-positive people are invisible, overshadowed in the public eye by their younger counterparts. In this multimedia exclusive from TIME magazine, six men and women with HIV between the ages of 51 and 73 discuss stigma, HIV prevention for seniors and keeping hope alive. (Web highlight from TIME magazine)

    What are the particular medical challenges that people over 50 face? Being HIV positive while experiencing the normal process of aging can be confusing, since it may not be so easy to tell what's causing your health problems: Are you experiencing high blood pressure as a result of your HIV meds, genetics or lifestyle? Is your belly growing because of middle age, lack of exercise or because of something that your meds are doing? What are the possible drug-drug interactions if you're taking medications for high blood pressure, osteoporosis or other age-related illnesses? Check out this TIME magazine article for an overview on this issue.


    Infected at 17, Keith Green Comes to Terms With HIV
    Twelve years after his HIV diagnosis, Keith Green is a 29-year-old HIV-positive man who's thriving and at peace with himself. But from time to time, he still wonders what his life would have been like if he had never been diagnosed. "I wonder about the family that I might have had. ... What my career would be like. And what I would be doing now if HIV had not changed the entire course of my life." But a little voice in his head -- the same one that, when he was 17, helped him cope with his diagnosis -- tells him now that there's no need to dwell on what-ifs. "That little voice ... constantly tells me to be patient. And, for some reason, I trust it. I have absolutely no reason not to. The path that trusting it has led me on has been one filled with blessings and miracles."

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      HIV TREATMENT

    New Study Results May Breathe Life Back Into CD4-Guided Treatment Breaks
    Earlier this year, poor results from the SMART study appeared to seriously hurt the prospects for an HIV treatment strategy that involves stopping and restarting meds when a person's CD4 count reaches a certain level. But newly published data from another major study, Staccato, suggests that these "CD4-guided" treatment holidays may still have a place in HIV treatment. Contrary to the findings of the much larger SMART trial, the 430-person Staccato trial found that people who stopped treatment with a CD4 count over 350 and a viral load below 50, and then restarted treatment when their CD4 count dropped below 350, were no more likely to develop AIDS-related illnesses or drug resistance after 22 months than people who took HIV meds the entire time. There were trade-offs, though: people who stopped treatment were more likely to develop thrush and tended to have a lower CD4 count, while people who stayed on treatment were more likely to have diarrhea or neuropathy. "Staccato indicates that ritonavir-boosted protease-inhibitor-based HAART can be interrupted without undue harm, provided that CD4 counts are monitored," the study authors concluded. (Web highlight from aidsmap.com)

    The Staccato results were published in a special HIV-focused issue of the British medical journal The Lancet. The special issue, which was published in advance of this weekend's XVI International AIDS Conference, grew out of a partnership with (PRODUCT) RED, an international alliance of companies that promises to devote a part of its profits to the Global Fund to Fight AIDS, Tuberculosis and Malaria. The special issue includes dozens of commentaries, editorials, book reviews, research articles and opinion pieces. (You can browse the issue by clicking here; free registration is required, and some of the more clinical articles require a paid subscription to read.)


    New CME/CE at The Body PRO: Optimizing Therapy for People With Multidrug-Resistant HIV
    We're 10 years into an HIV treatment revolution that has transformed HIV in developed countries from an almost inevitably fatal disease to a manageable one. However, there's still one group of people who have burned through multiple treatment regimens and have yet to be undetectable. These are people with multidrug-resistant HIV. In this free CME/CE activity for health care professionals, Dr. Charles Hicks, Dr. Angela D.M. Kashuba and Dr. Sharon Walmsley take a close look at the latest research on multidrug resistant HIV and examine new ways of managing the treatment of this group. (This activity is available only on The Body PRO, The Body's sister site for health professionals. Registration is quick and free!)


    Survey Reveals Patients Less Concerned About HIV Drug Resistance Than Docs
    Understanding the risk of HIV drug resistance is critical for people on HIV treatment, whether they're just starting therapy or have been taking meds for years. But according to a survey commissioned by the American Academy of HIV Medicine (AAHIVM), physicians are nearly twice as likely to be "extremely" or "very" concerned about HIV drug resistance as people living with HIV. AAHIVM's recommendations? Increased physician-patient dialogue and consumer-friendly education tools to help people with HIV better understand the potential impact of HIV drug resistance on their overall health.

    To listen to the press conference at which this issue was discussed by several experts, including HIV physicians Dr. Howard Grossman and Dr. Marty Markowitz, click here.

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      HIV-RELATED HEALTH PROBLEMS

    Risk of Blood Clots Increases Among People With Low CD4 Count
    If you've got a low CD4 count -- i.e., less than 200 -- you remain at risk for many opportunistic illnesses and complications. Experts have now added another complication to that list: deep vein thrombosis, or blood clots in veins that are far below the surface of the skin. A new study has found that HIV-positive women with a CD4 count below 200 had very low levels of a protein the body makes that reduces clotting. Deep vein thrombosis is treatable, but if left untreated it can cause internal bleeding, difficulty breathing or heart failure. (Web highlight from aidsmap.com)


    UK Study Finds Clear Association Between Fisting and Hepatitis C Infection Among HIVers
    HIV-positive gay men who engage in fisting are at least nine times more likely to become infected with hepatitis C, according to a four-year study in the United Kingdom (UK). In recent years, there has been a marked increase in acute hepatitis C infections among HIV-positive gay men in the UK. In this study of gay, HIV-positive men, researchers found that hepatitis C risk was higher among men who reported fisting, rimming, using sex toys or snorting recreational drugs with their last two sexual partners. Of those sexual activities, fisting was the most strongly linked to hepatitis C infection. (Web highlight from aidsmap.com)

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      HIV OUTSIDE THE UNITED STATES

    South African Newspaper Fights HIV Stigma by Highlighting Personal Stories
    Shame surrounds HIV in South Africa, and the disease is often shrouded in silence. To fight HIV's stigma, The Sunday Times of Johannesburg is publishing personal accounts written by people living with or affected by HIV. In this article, a gay, HIV-negative man writes about his former boyfriend Zakhele, a handsome, shy, HIV-positive man he met in Durban. Their relationship was a challenge from the beginning and deteriorated swiftly. But two months after they broke up, the author writes that he treasures the time he spent with Zakhele, despite the difficulty of their relationship. "During the 15 months I lived with him," he says, "I learned to face my own fears and not to stereotype people with HIV. I am now armed with all the information I need." He hopes that the rest of his society will also learn to embrace HIV-positive people. (Web highlight from The Sunday Times, Johannesburg)


    A TheBody.com Exclusive: Dr. Ben Young Recounts the Brutal Impact of HIV in Ukraine
    When most people in the United States think of HIV in non-developed countries, they visualize Africans, Asians or South Americans who are doomed to die because they lack access to HIV treatment. Few people in the United States are aware how dire the health care situation in the former Soviet Union is. Researcher and clinician (and one of The Body's experts) Dr. Benjamin Young travels to a clinic in Kiev, Ukraine, every few months to help train health care providers in HIV. Each time he goes, Dr. Young is shocked at what he sees: "It's like walking onto a college campus where everyone is dying," he says. In this exclusive article, Dr. Young recounts his latest visit and speaks with two of the women who run an HIV clinic in Kiev, the capital of Ukraine.


    Entire World Should Avoid d4T-Based Treatment, World Health Organization Says
    It's the dirty little secret of the developed world: Once drug companies develop meds that are less toxic than the old ones, they dump the old ones on poor countries. In the world of HIV, this has happened with d4T (stavudine, Zerit) -- a powerful antiviral, but one that can have dramatic side effects like neuropathy, lactic acidosis and lipoatrophy (fat loss). Although d4T is seldom used in the developed world, it is part of the most popular fixed-dose combination drug in the developing world. And, right up until this week, the World Health Organization recommended this regimen as the regimen to take for initial therapy in developing countries. However, this may finally begin to change, as the World Health Organization has updated its guidelines. The new guidelines recommend avoiding d4T entirely in favor of other meds in the same drug class. (Web highlight from aidsmap.com)

    Interested in reading the new World Health Organization guidelines? You can download them in PDF form by clicking here.


    Saudi Arabia's Hidden HIV Epidemic
    Despite legislative and medical advances, many HIV-positive people in Saudi Arabia feel that not enough is being done to build acceptance or understanding of HIV. "You live in constant fear of being found out and attacked," said Feisal, a gay, HIV-positive Saudi citizen, who spoke on condition that only his middle name be used, for fear of discrimination. "I'm sure a lot of people would think I deserve what I have if they knew about it." For years Saudi Arabia kept its growing HIV crisis a secret. Even now that official statistics are being released, many doctors believe the country is vastly underreporting HIV prevalence. In this conservative Muslim nation, talk of sex is taboo and many religious leaders speak of HIV as the "wrath of God," making even traditional efforts at HIV prevention and education challenging. "There is a war against the disease," says one man. "They accept the sick, but don't want to deal with them as people." (Web highlight from The New York Times; free registration required)


    Many of the Faces of Global AIDS Belong to Children
    More than 2 million children live with AIDS and more than 15 million are orphaned worldwide because of HIV, yet concerted efforts to address their needs are sorely lacking. Children who lose their parents to AIDS are often left in poverty to fend for themselves. In low- and middle-income countries, less than 5 percent of HIV-positive children receive the treatment they desperately need. However, there are signs that children with HIV are finally stirring the world into action. In a recent meeting with United Nations Secretary General Kofi Annan, pharmaceutical companies agreed to prioritize the development of pediatric HIV medications. At the XVI International AIDS Conference next week, several sessions will focus on HIV and children. (Web highlight from The Lancet; free registration required)


    HIV Prevention Trials in Developing Countries: An Ethical Dilemma
    Is it ethical to set up a clinical trial of an experimental HIV prevention method in a part of the world where people don't have easy access to HIV treatment should they become infected? This question has generated some heated debate among experts and advocates, and has already led to the cancellation of a few trials. The key issue is this: Experts want to balance the need to explore new frontiers in prevention with their fundamental commitment to ensuring people's health and safety. Fortunately, several options are now being discussed that may achieve this balance, including the possibility of only holding HIV prevention trials in countries with established treatment programs, or requiring trial sponsors to pay for the health care of anybody who contracts HIV during a trial. Anna Forbes of the Global Campaign for Microbicides discusses these options in this opinion piece. (Web highlight from PLoS Medicine)


    HIV Death Toll Approaching 12,000 in Russia; Many More Infections Suspected
    Despite Russian President Vladimir Putin's pledge of US$105 million in 2006 to help fight HIV, the HIV death toll is quickly approaching 12,000 in his country. Since the first reported case of HIV in Russia in 1987, more than 362,000 people have been diagnosed, according to official figures. However, AIDS advocates believe the official number only accounts for one third of the actual total. The main way HIV is transmitted in Russia is through intravenous drug use, but the number of people being infected sexually is rapidly growing. (Web highlight from Interfax)

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    Also Worth Noting

    Visual AIDS
    Art From HIV-Positive Artists

    Image from the August 2006 Visual AIDS Web Gallery
    "Glow Toy," 1996; Luna Luis Ortiz
    Visit the Visual AIDS Web Gallery to view this month's collection of art by HIV-positive artists! The August gallery is entitled "Between Ten"; it showcases the work of seven artists bracketing the 10 years since the introduction of combination HIV treatment in 1996. The Web gallery highlights some of the works in a larger exhibit to be shown at the XVI International AIDS Conference in Toronto, Canada, next week.

    Multimedia Coverage
    The Body Is Your Home for the XVI International AIDS Conference

    AIDS 2006: Toronto, Canada; Aug. 13-18, 2006
    The largest HIV conference in the world takes place from Aug. 13-18 in Toronto, Canada -- and The Body will be on hand with extensive reports! While at the XVI International AIDS Conference, we'll be conducting podcast interviews with researchers, activists and other attendees; keeping a photo journal throughout the week; and providing expert analyses of important research presentations. We'll also feature live Webcasts of key conference events from kaisernetwork.org! Bookmark our conference home page and check back throughout the conference for the very latest.

    Connect With Others
    A
    t The Body's Bulletin Boards

    My Newly Diagnosed Girlfriend Is Pushing Me Away
    (A recent post from the
    "My Loved One Has HIV" board)

    "I met this wonderful woman on the Internet about five months ago. ... She was abused by her last boyfriend, and a year after leaving him, was raped. Along with the trauma of the incident, she was also dealing with the fact that she could be HIV positive, so she would not entertain the idea of meeting me until she got her test results at the six-month mark. ... Well, we ended up falling deeply in love with each other and have worked up a nice little relationship together, even though it's only telephone and Internet chat/e-mails. I have told her repeatedly that even if she is HIV positive, I still want a relationship with her. ...

    "She got her results on Thursday and found out she is indeed HIV positive. She's still in shock ... She thinks her life is over and she seems to want to just give up and wait to die. ... She's also telling me to go away and move on and that she can't have a relationship with me now. I'm fully committed to her whether or not she's HIV positive. Is this a normal reaction ... to push your lover away? Should I just give her some time and not force my way in to helping her deal with this? ... What is the best thing I can do to help her right now?"

    -- LUVmyHIVposGIRL

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

    Should I Tell?
    (A recent post from the
    "Living With HIV" board)

    "I recently went to a party. By the end of the night, everyone was drunk and clothes began to come off. One guy was really into me. Before I knew it, he was touching and then giving me oral sex. Later, he put a condom on me ... [things got hot and heavy] but I did not cum. The condom was put on right, so he was not at any real risk. Do I need to call him and tell him that I'm HIV positive?"

    -- Anonymous

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