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October 11, 2006

In This Update:
  • New Podcasts From TheBody.com
  • HIV Treatment
  • Health Problems for HIVers
  • HIV News in the U.S.
  • Making a Difference
  • HIV Transmission & Testing
  • HIV Outside the U.S.
  •   NEW PODCASTS FROM THEBODY.COM

    Exclusive Podcast Interviews With Top HIV Clinicians
    The 46th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC 2006) gave The Body the perfect opportunity to speak with some of the world's top HIV physicians. We sat down with Drs. Cal Cohen, Eric Daar, Benjamin Young and others to get their take on some of the most critical issues in HIV, including: When should you initiate therapy? How do you choose an initial regimen? What are the risks and benefits of structured treatment interruptions? Why are people so excited about MK-0518, the new integrase inhibitor in development? Listen to each podcast to hear what these experts had to say! (A transcript of our interview with Dr. Cohen is also available; transcripts for other podcasts will be available soon.)

    Of course, these podcast interviews are only a part of The Body's thorough coverage of ICAAC 2006. Stop in at our ICAAC 2006 home page to read highlights, or browse our complete index of coverage!

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      HIV TREATMENT

    New U.S. HIV Treatment Guidelines Feature Changes in Recommended Meds
    The U.S. health department has updated its recommendations for which HIV medications to use in first-line therapy. In the newly released revision of the department's HIV treatment guidelines, ritonavir (Norvir)-boosted atazanavir (Reyataz) and twice-daily, ritonavir-boosted fosamprenavir (Lexiva, Telzir) have been added to the list of "preferred" first-line medications, where they join Kaletra (lopinavir/ritonavir) and efavirenz (Sustiva, Stocrin). Although the guidelines note that the regimen a person takes as first-line therapy must be personalized to their unique situation, the guidelines recommend taking one of those preferred meds with either of two NRTI combinations: Truvada (tenofovir/FTC) or Combivir (AZT/3TC).


    MK-0518 Sharply Cuts Viral Loads in Many With Heavy Drug Resistance
    There are more promising study results on MK-0518, the first in a new class of HIV meds known as integrase inhibitors: In a study involving people with significant HIV drug resistance, more than 70 percent were able to reduce their viral load to below 400 after 24 weeks on an optimized regimen that included MK-0518. These are remarkable results in their own right, but especially given that MK-0518 also appears to have few major side effects and minimal drug interactions. The Body's Edwin DeJesus, M.D., reports from ICAAC 2006.


    U.S. Medical Centers Team Up to Create Database of HIV Treatment Results
    How can you gauge the risks and benefits of different HIV treatment regimens? A new alliance between seven of the United States' major medical centers may make it easier for you and your health care provider to do just that. Thanks to a $2.5 million federal grant announced this week, these medical centers will build the first collaborative electronic database of HIV treatment results. Their goal: to help researchers and physicians across the country compare the effectiveness of commonly used HIV treatments with the results of clinical trials investigating new treatments.


    Trizivir May Work as First-Line Option for Certain People With Low Viral Loads
    The fixed-dose combination drug Trizivir (AZT/3TC/abacavir) generally shouldn't be used by itself for first-line therapy -- but, according to researchers, there are some situations where a Trizivir-only regimen could work. An industry-backed study found that Trizivir worked about as well as a regimen of Combivir (AZT/3TC) + atazanavir (Reyataz) when taken as first-line therapy by people with a low viral load. As The Body's Benjamin Young, M.D., Ph.D., reports from ICAAC 2006, the findings enrich our understanding regarding treatment options for those few people who are unable to use more potent first-line regimens.


    Viral Load "Blips" May Be a Result of Lower Adherence
    Many researchers are mystified by the cause of viral load "blips" -- brief periods during which a person's viral load pops slightly above undetectable before dipping back down. But a new study by researchers from Abbott Laboratories suggests that these blips may happen at least in part because a person hasn't been taking all of his or her doses properly. The study found that the average number of days a person took his or her prescribed doses was lower in the week prior to a blip than during a matched period when a blip did not occur. The Body's Paul Sax, M.D., reports from ICAAC 2006.


    Tenofovir + Efavirenz Works Better When 3TC Is Added, Study Finds
    In the never-ending search for HIV treatment regimens that consist of as few pills as possible, researchers recently tried to see if a two-drug regimen of efavirenz (Sustiva, Stocrin) + tenofovir (Viread) worked as well as a triple-drug regimen of 3TC (lamivudine, Epivir) + efavirenz + tenofovir. As The Body's Graeme Moyle, M.D., reports from ICAAC 2006, the two-drug regimen didn't come out on top.

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      HEALTH PROBLEMS FOR HIVERS

    Dr. Bob Frascino Answers HIVers' Questions About Fatigue and Anemia
    You'll never have more fun learning about fatigue and anemia than when Dr. Bob Frascino is the teacher! Dr. Bob, one of The Body's most popular experts, recently answered a host of fatigue-related questions from HIVers at our latest online chat. Using his trademark wit and humor, Dr. Bob offered his thoughts on the fatigue's many possible causes and treatments. Read this chat transcript for the full story!


    Cardiovascular Disease and HIV: What the Latest Research Says
    Years after the first signs of a possible link between heart disease and HIV, there's still plenty of controversy surrounding the issue. Are HIV-positive people truly at a higher risk for cardiovascular problems? Are HIV meds mainly to blame, or HIV itself? The Body's David Wohl, M.D., took a look at an assortment of interesting studies presented at the International AIDS Conference this summer, each of which aimed to assess the risk of cardiovascular disease among HIV-positive people on treatment.


    AIDS Is #1 Killer of Men in San Francisco
    Although fewer and fewer people in the United States are dying from AIDS-related causes, thanks to the 1996 advent of combination HIV drug therapy, the San Francisco Department of Public Health says that as of 2003, AIDS was still the number-one cause of death among men ages 15 to 54 in the city. One scientist in the department said that AIDS was also most likely the leading cause of mortality among gay men ages 15 to 64. That assessment was shared by some AIDS advocates, who said that nearly 90 percent of the city's AIDS cases are among gay and bisexual men.


    HIV and the Kidneys: Why It Matters
    Some types of kidney problems are a greater risk in HIV-positive people than HIV-negative people, especially among African Africans. Since untreated kidney problems can lead to potentially serious complications, it's important for HIV doctors and HIVers alike to pay close attention to how well the kidneys are functioning. In this clinical overview, Dr. Lynda Anne Szczech discusses the basics of kidney disease among HIV-positive people.

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      HIV NEWS IN THE UNITED STATES

    U.S. ADAPs Still Feeling the Financial Squeeze
    Six states -- Alabama, Alaska, Indiana, Montana, South Carolina and West Virginia -- already have AIDS Drug Assistance Program (ADAP) waiting lists in place, and more states may put their residents on waiting lists in the future, according to the newest ADAP Watch from the National Alliance of State and Territorial AIDS Directors (NASTAD). ADAPs exist to provide treatment to HIV-positive people with low incomes, but experts have warned that the funds the U.S. Congress has allocated for the next fiscal year aren't enough to improve the precarious situation of many state ADAPs. "A long-term investment in the financial stability of ADAPs is essential to ensure that these critical programs avoid waiting lists," said the Executive Director of NASTAD, and through that continue to provide medications to those most in need.

    To read the full ADAP Watch released by NASTAD, click here.

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      MAKING A DIFFERENCE

    Speaking Out Through Hope: Todd Murray of Hope's Voice
    In 2004, HIV-positive San Franciscan Todd Murray gave a speech encouraging young people living with HIV to step into the spotlight and use their voices to educate the world about the virus. Shortly after he stepped down from the microphone, several young people approached Todd and told him they wanted to become speakers and peer educators. Thus was born Hope's Voice, an activist group that specializes in peer-to-peer education in high schools and on college campuses. In addition to individual speaking engagements, the group has sponsored a "Road to Hope Tour" for the past two years, in which speakers travel around the country Road Rules style and educate young people in a frank, straightforward manner.

    As the founder of Hope's Voice, Todd Murray was awarded one of The Body's HIV Leadership Awards as an inspiring person with HIV. Click here to read his in-depth profile.


    Who's Positive Launches "Operation: Get Tested" Tour
    Much like Hope's Voice (see the blurb above), an organization called Who's Positive is also working to promote HIV awareness, prevention and testing for young people with a cross-country speaking tour of U.S. high schools and college campuses. Six HIVers between the ages of 18 and 26 will pile into a bus and share their stories in 33 locations over seven weeks, from Washington, D.C., to Los Angeles, Calif. The tour kicks off on Oct. 15, National Latino HIV Awareness Day, at New York University in New York City. Is Who's Positive coming to your city? Click here to find out! (Web highlight from Who's Positive)

    Want to read the personal blogs of Who's Positive founder Tom Donohue or one of his group's speakers, Kahlo Benavidez? Both blogs are available at TheBody.com; click here to read Tom's, or click here to read Kahlo's.


    A Woman's Journey From Disclosure to AIDS Advocacy
    "I disclose not to make friends, but to save another from being infected," says Lorraine Brown. Lorraine, an African-American woman, has been living with HIV since 1986, when she was infected by her husband. Six months after she was diagnosed, she began to disclose her status to her family and friends. Gradually, she confronted their misconception that HIV was a "gay disease" and raised their awareness of the epidemic. Lorraine even discovered that she was not alone in her fight -- it turned out she was one of three HIVers in her family. With their support, Lorraine became active in her community as well. In this personal essay, she explains how she grew into a self-assured AIDS advocate, and about how her disclosure has impacted her family and community.

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      HIV TRANSMISSION & TESTING

    Routine HIV Testing May Not Be Easy to Implement in Parts of U.S.
    Complex state HIV testing laws, the reluctance of some family doctors to administer HIV tests and the costs of HIV testing itself: All are reasons why it may be a long time before the United States is able to implement new recommendations for routine HIV testing issued by the U.S. Centers for Disease Control and Prevention (CDC). The recommendations, published on Sept. 22, say that voluntary HIV testing should become a routine part of medical care everyone in the United States from age 13 to 64, and also suggested removing requirements for written consent and pre-test counseling. But laws in at least 24 states require pre-test counseling, and some states have other regulations that might obstruct physicians from implementing the CDC's recommendations. HIV tests also range in cost from $3 to $15 or more, which could present an obstacle in many health care settings where funding is already severely stretched.

    To read more about the CDC's new testing recommendations, visit The Body's page on U.S. HIV testing policies. There you'll find a full list of recommendations and an archive of opinion pieces and related articles.


    Overview of Methods to Use HIV Meds for Preventing HIV
    HIV meds are mainly used to keep HIV-positive people healthy. But in recent years, there's been a growing amount of interest in the potential for HIV medications to prevent HIV transmission in the first place. These prevention methods go by complicated names -- such as pre-exposure prophylaxis and nonoccupational post-exposure prophylaxis -- but their goal is simple: Stop HIV transmission. At ICAAC 2006, HIV prevention expert Myron Cohen, M.D., led a symposium on the use of HIV meds as prevention tools; The Body's Monica Gandhi, M.D., was there to cover it.

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      HIV OUTSIDE THE UNITED STATES

    In Scotland, Men With Partners Often Pay for (Unprotected) Sex on the Side
    Whatever you may have thought about a man's ability to be monogamous, a new study from Scotland is sure to catch your interest. A
    large survey of Scottish men at a sexual health clinic found, for one thing, that almost 50 percent of men who said they visited sex workers were also in a relationship. But perhaps even worse, many admitted they didn't use condoms when they made their visits to a sex worker. None of the 2,500 men surveyed were HIV positive, but one in five had a sexually transmitted disease such as gonorrhea or syphilis. "This shows the possibility of sexually transmitted infection," the head researcher pointed out, "and for men paying for sex abroad, the possibility of acting as a 'bridge' between different populations."


    South African, U.S. Women Donate Breast Milk to South African AIDS Orphans
    In an effort to help save the lives of AIDS orphans in South Africa, women in South Africa and the United States are sending their breast milk to children at the iThemba Lethu orphanage in Durban. The mothers of approximately three million children ages five and younger have died of AIDS-related illnesses in sub-Saharan Africa. For many of these orphaned children, "breast milk could be the difference between life and death," according to Missouri resident Jill Youse, founder of the International Breast Milk Project. Perry Reimers, who runs the breast milk bank at the orphanage, said the nutrition and immune properties in breast milk are "absolutely vital" for the orphans, many of whom are HIV positive.


    Advocacy Group Plays Cupid for HIVers in India
    The Network of Surat People Living with HIV+, an Indian AIDS advocacy group, took a break from their normal routine to play Cupid for 30 local HIVers. In India, people with HIV face tremendous stigma and are often shunned by their families and communities. Women are regularly disowned by their relatives, even if their husbands were the ones who gave them the virus. That's why the Indian group organized "HIV+ Find a Life Partner," which was designed to allow Indian HIVers to get to know each other easily and openly, with some even introducing each other to accompanying relatives. In many cases, the meetup session led to some happy endings: More than a dozen attendees decided to marry.

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    Also Worth Noting

    In Memoriam
    Dan Dunable, AIDS Advocate

    It is with great sadness that we announce the death of Dan Dunable, a longtime AIDS activist. Dan was 51; he died suddenly at his home in Atlanta, Ga. Dan worked for AIDS Survival Project in Atlanta as an HIV treatment education advocate. His many articles about HIV treatment were published on The Body.

    Visual AIDS
    Art From HIV-Positive Artists

    Image from the October 2006 Visual AIDS Web Gallery
    "The Sickness of Beauty," 1998;
    Yolanda
    Visit the brand-new October 2006 Visual AIDS Web Gallery to view our latest collection of art by HIV-positive artists! This month's gallery is entitled "Stardust: A Two-Part Show"; it's curated by Leah Oates, an artist and independent curator living in New York.

    Connect With Others
    A
    t The Body's Bulletin Boards

    Will Our Mixed-Status Relationship Ever Settle Down?
    (A recent post from the
    "My Partner Has HIV" board)

    "Does your nervousness about getting infected [by an HIV-positive partner] ever go away? Does it ever fade? Disappear? Is there ever a level or point that you reach that is comfortable, and at ease? My poz partner is beside himself. How have you effectively dealt with this long-term?"

    -- PozNRG

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

    My Boyfriend Was Just Diagnosed, and I Can't Handle It
    (A recent post from the
    "My Partner Has HIV" board)

    "My boyfriend of two years found out he's positive four weeks ago. We never used protection. ... I got tested immediately, negative. Now I have to wait three months before getting tested again. We are both going through hell. He's very depressed and angry, and I'm very anxious and scared. ... He thinks this is only his problem, but it's not. We are a couple, so it's a problem for both of us. In this very tough moment it seems to me like all the small or big problems we always had in our relationship, they all came out at the same time. ... I realize our relationship will not work, he can't support me, we are very different and he never understands my needs. Now we are fighting a lot. ... It's like right now I'm having a crisis with myself and see things more clearly. He makes me feel so bad. ... I don't want him to pass through all this alone, but I feel I can't do anything for him and I'm sure our relationship won't work. What can I do?"

    -- Anonymous

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