January 10, 2007

•  LIVING WITH HIV

Caveman's Diet: A Guide for Living Healthier With HIV
If you're HIV positive, can changing your diet really help you live longer and healthier? According to registered dietitian Charlie Smigelski, the answer is yes. In 14 years of working with HIVers, Smigelski has seen that diet change and supplements can reduce -- or even reverse -- the complications of HIV and HIV treatment. "You are what you eat. Think about feeding your body parts just a little better," Smigelski says. His advice is to adopt a "caveman's diet," which means eating lots of fruits and vegetables, a protein at every meal, carbohydrates that take a while for your body to digest, and nuts or seeds. "You might be in okay-enough shape," Smigelski says, "but imagine having it be even a little better."


Gay, HIV Positive and Growing Older
As more long-term HIV survivors reach their 50s and beyond, it's becoming increasingly obvious that many health care providers and policy makers are unprepared. And for HIVers in the over-50 group who are gay, it can be even harder, since they often don't receive much support from younger members of their communities. "It may be less compelling for the general population -- and particularly the queer community -- to come forward and support elder gay men [who have HIV]," says Dr. George Harrison. "Being over the hill is not a good calling card, unless you've got some sugar to go along with that daddy part." (Web highlight from the Bay Area Reporter)

•  HIV TREATMENT

Large Study Backs Starting HIV Treatment When CD4 Count Is Above 350
Current U.S. HIV treatment guidelines recommend that HIV-positive people begin treatment before their CD4 count drops below 200. However, a growing amount of research supports starting treatment earlier. A newly published study by researchers at Johns Hopkins University has found that HIV-positive people who start treatment when their CD4 count is still above 350 are far more likely to return to a "nearly normal" CD4 count within six years than people who hold off treatment until their CD4 count falls below 350. (Web highlight from aidsmap.com)

To read the abstract of this study, which was published in the Feb. 1 issue of Clinical Infectious Diseases, click here.


A New Attempt to Solve One of HIV Treatment's Biggest Riddles: When to Start?
At least one researcher is comparing it to "the holy grail of AIDS research": An ambitious study soon to be proposed by the Washington Veterans Medical Affairs Center plans to address one of the most important controversies in HIV care: When should people with HIV start treatment? U.S. guidelines recommend initiating treatment when CD4 count falls to between 200 and 350, but such a wide range leaves room for uncertainty. This new study would randomly assign 9,000 HIV-positive adults and children living around the world to start HIV treatment at one of several different times: when their CD4 count is above 500, between 300 and 350, or between 200 and 250.


CD4 Percentage May Be Useful for Deciding Whether to Start HIV Treatment
CD4 percentage may be as effective as absolute CD4 count in helping HIVers and their doctors determine whether to start treatment, according to the results of a large U.S. study. The study followed nearly 2,000 HIV-positive people who began HIV treatment between 1997 and 2004; it found that a person's CD4 percentage at the time they started meds predicted HIV disease progression (which the researchers defined as death or the development of a new opportunistic infection) just as well as a person's absolute CD4 count.

To read the abstract of this study, which was published in the Feb. 1 issue of the Journal of Infectious Diseases, click here.


Duke University Scientists Develop More Sensitive HIV Drug-Resistance Test
Current HIV drug-resistance tests sometimes miss mutant strains of HIV that may be in a person's blood, but at very low levels. However, scientists at Duke University have developed an experimental HIV drug-resistance test that can detect even small amounts of resistant HIV strains. "A lot of questions are still unanswered, but it's an important step forward," says Dr. Peter Leone, a physician at University of North Carolina-Chapel Hill and medical director of the state's HIV prevention branch. If successful, Leone says, a more sensitive resistance test could "improve the odds that the first course of treatment is going to be successful."


Helping Your Meds Help You: Tips for Choosing a New Regimen
Choosing an HIV treatment regimen can seem daunting, whether you're starting meds for the first time, restarting after a break or switching from another regimen. It's easy to feel overwhelmed by all the different treatment options, but through research, reflection and open discussion with your doctor, you can find the right regimen. In this article from Positively Aware, pharmacist Melissa Ngo offers tips, resources and food for thought as you gear up for this important decision.


In Sickness and in Health: A Conversation About Doctor-Patient Relationships
Do you ever feel like you and your doctor could use some couples counseling? You're not alone. Doctor-patient relationships can follow familiar stereotypes: the healthy relationship, the couple that doesn't communicate, the unappreciated partner, the bully. Even the complaints sound familiar: "He doesn't listen to me," or, "She doesn't do what I say." The doctor-patient relationship is an important one, especially when you're living with HIV, so you should only get involved with someone you respect and with whom you can communicate. In this Positively Aware article, Heidi Nass and Greg Milward, who are both living with HIV, discuss strategies for building good doctor-patient relationships.


Advocacy Group Calls for Alternatives to Norvir Boosting
"Boosting" some protease inhibitors with Norvir (ritonavir) can make them more effective and decrease the number of daily doses, but according to the HIV organization Project Inform, Norvir has a darker side that's often overlooked: Norvir boosting increases the cost of HIV therapy, and Norvir itself can have potentially dangerous side effects, Project Inform says. It adds that people who can't take Norvir lose a lot of HIV treatment options, since some meds can only be taken if they're "boosted" with Norvir. "Rather than taking on the harder task of building better formulations that do not require boosting, companies have fallen into the habit of just using Norvir," Project Inform states.


Protease Inhibitor in Development Fares Well in Initial Study
Encouraging results from a phase 1 safety study of their experimental protease inhibitor, PPL-100, have been announced by Ambrilia Pharmaceuticals. Unlike most other protease inhibitors, PPL-100 would not have to be boosted with Norvir (ritonavir), making it potentially attractive to people who are resistant to Norvir or want to avoid its side effects. In this preliminary study, PPL-100 appeared safe, with no serious side effects reported. The drug will next move into phase 2 studies to determine its long-term safety and effective dosing.

•  COMPLICATIONS OF HIV & HIV MEDS

Heart Disease Risk Higher Among People Coinfected With HIV, Hepatitis C
HIV-positive people who are coinfected with hepatitis C may be much more likely to have heart disease than people infected with HIV alone, U.S. researchers have found. In a study of 395 HIVers, those with both HIV and hepatitis C were almost five times as likely to have cardiovascular disease, and nearly 13 times as likely to have experienced a heart attack, as people who had HIV but not hepatitis C. (Web highlight from aidsmap.com)

To read the abstract of this study, which was published in the Jan. 11 issue of the journal AIDS, click here.


HIVers More Likely to Get Lung Cancer, and Smoking May Not Be the Only Reason
Is cigarette smoking to blame for the high rates of lung cancer among HIV-positive people, or is HIV itself somehow a cause? A massive, new U.S. study doesn't provide any solid answers, but makes researchers more certain that smoking is not the only reason HIVers get lung cancer more often than other people in the United States. The study, which linked nearly 400,000 HIV-positive Americans with cancer registries in six states, confirmed that lung cancer is more common among HIV-positive people. HIVers under the age of 30 who had been diagnosed with AIDS appeared at an especially higher risk for lung cancer. "Smoking could not entirely account for the observed elevation, especially among younger adults, suggesting a role for additional co-factors," the researchers write. (Web highlight from aidsmap.com)

To read the abstract of this study, which was published in the Jan. 11 issue of the journal AIDS, click here.

•  HIV OUTSIDE THE UNITED STATES

Shopping and Sex: An HIV Risk Factor for Iranian Women
How do you get the best deal if you're a woman shopping in Iran? Have sex with the shopkeeper. It seems this phenomenon is becoming more common in Tehran, Iran's capital city. The women willing to exchange sexual favors for clothes are often sex workers who are not informed about the risks of HIV and other sexually transmitted diseases. Although efforts to educate shopkeepers are under way, HIV prevention educators admit that "most of the shopkeepers know the risk but they can't resist the temptation," said Iran Positive Life volunteer Amir Fattahi. Iran has 13,704 registered HIV cases, but the World Health Organization and Iranian Health Ministry estimate that tens of thousands more Iranians are living with HIV.


A Dark Cloud Over the Gates Foundation's Good Works
"We're all smokers here, but not with cigarettes," says a physician in Ebocha, a Nigerian city. Ever since an oil plant set up shop outside Ebocha, spewing soot and toxic chemicals into the air and permanently lighting up the sky with towers of flame, life has taken a turn for the worst for many local citizens. What does all this have to do with HIV? Those oil plants are partly funded by the Bill & Melinda Gates Foundation -- the same charitable organization that is now pumping millions of dollars into HIV prevention, treatment and research efforts throughout the world. The situation in Ebocha shows how one of the world's greatest foundations, in its drive to invest money so it can make more cash to give away, can inadvertently cause harm to the very people it tries to help. (Web highlight from the Los Angeles Times)