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January 17, 2007

In This Update:
  • HIV Treatment
  • HIV in the News
  • HIV Transmission
  • Hepatitis C & HIV
  • HIV Outside the U.S.
  •   HIV TREATMENT

    Moms Should Wait Six Months After Single-Dose Viramune Before Beginning Viramune-Based Treatment, Study Says
    In recent years, some controversy has erupted over a practice frequently used in developing countries to prevent mother-to-child HIV transmission when the mom isn't already on HIV treatment. The method involves giving an HIV-positive mother a single dose of Viramune (nevirapine) when she's in labor, which can dramatically reduce the risk that she'll pass HIV to her child during birth. The controversy centers on what happens after that single dose of Viramune: Scientists found that the Viramune dose put women at a high risk for quickly developing resistance when they started taking a full, Viramune-based treatment regimen after their baby was born. A new study provides some good news on this front: Researchers have found that the risk of resistance may be much lower if the mom holds off on Viramune-based treatment for six months after receiving single-dose Viramune during labor.


    Docs' Voices Grow Louder in Support of Earlier Start to HIV Treatment
    On the heels of a recent study by Johns Hopkins researchers that supports starting HIV meds when a person's CD4 count falls near 350, the British journal BMJ has published a commentary in which prominent doctors in London also back the 350 approach. "Guidelines should now recommend starting treatment at around 350 cells/mm3, so long as the patient is ready," the authors write. Current U.S. guidelines only recommend that HIV meds be initiated when a person's CD4 count drops to 200, although they also note that treatment can be considered when CD4 count is between 200 and 350. (Web highlight from aidsmap.com)


    The Alphabet Soup of HIV Lab Tests
    With health care providers using acronyms like CBC, FACS, RNA PCR and LFT, it's not too difficult to see why some HIVers may feel confused about their laboratory test results. In this article from Dr. Judith Feinberg and Positively Aware, 13 of the most important lab tests for HIVers are quickly explained in an easy-to-read manner. Now, when someone talks to you about your CBC or RNA PCR, it won't seem like something they fished out of a bowl of alphabet soup.

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      HIV IN THE NEWS

    California Judge Upholds State Medical Marijuana Law
    A Superior Court judge has upheld California's medical marijuana law, rejecting a challenge by three counties that the state law puts them in conflict with federal policy. Eleven U.S. states allow the medical use of marijuana, though the federal government maintains that any use is illegal. California's 1996 Compassionate Use Act allows people with AIDS, cancer, multiple sclerosis and other illnesses to use marijuana if they have a doctor's permission; about 200,000 Californians have done so. Merced, San Bernardino and San Diego counties filed a lawsuit against the state early last year claiming that, because of a discrepancy between state and federal laws, California could not require the counties to implement an identification card system for medical marijuana patients. Superior Court Judge William R. Nevitt ruled in December that the identification cards don't conflict with federal law. San Diego County officials will appeal the ruling. (Web highlight from the Bay Area Reporter)

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      HIV TRANSMISSION

    HIV Pre-Exposure Prevention Trial Focuses on African-American Men
    A major, federally funded study is under way in the United States to test whether Viread (tenofovir), when taken before a person is exposed to HIV, can help prevent HIV infection in men who have sex with men (MSM). In Atlanta, Ga., where one arm of the study is based, organizers are focusing their efforts on enrolling black MSM. "While the study is open to men of any race, we are working hard to enroll as many men of color as possible" because black men "are disproportionately affected by HIV and underrepresented in clinical trials," said Melanie Thompson, lead investigator of the Atlanta trial. Another arm of the trial is enrolling MSM in San Francisco; each arm plans to enroll 200 men.

    To find out more about the Viread HIV prevention studies, click here.


    Early Tests Promising for Algae-Based Microbicide
    Could algae help protect women against HIV? A team of Brazilian researchers think so: They’ve used algae collected from the Brazilian coast to develop a microbicide gel that was found to be 95 percent effective against HIV in preliminary lab tests. Microbicides are considered the new frontier in HIV prevention: These gels, rings, sponges or creams would enable women -- who often don't have the power to negotiate condom use with their partners -- to protect themselves against HIV. The Brazilian researchers hope their algae-based gel will be available to the general public in seven years. Other microbicides in development, which are believed to be 50 to 60 percent effective, are expected to be available within four years. (Web highlight from BBC News)


    U.S. Prisons Shun Accepted HIV Prevention Efforts, Report Says
    All U.S. prison systems fall short of accepted international guidelines for reducing HIV transmission among incarcerated people, according to a report published in the New England Journal of Medicine. In the report, contributing editor Dr. Susan Okie noted that U.S. prison officials remain leery of improving HIV prevention efforts, despite the fact that HIV rates in U.S. prisons are more than four times that of the general U.S. population, and that each year, an estimated one out of every four HIVers in the United States spends time in a correctional facility. (Web highlight from the New England Journal of Medicine)

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      HEPATITIS C & HIV

    Hep C Relapse Common, Treatment Success Uncertain Following Liver Transplant in HIV/HCV-Coinfected People
    People who are coinfected with HIV and hepatitis C often experience a relapse of their hep C infection following a liver transplant, and hep C treatment may not be as successful when these people relapse, according to a small study. There was some good news from this study, however: The researchers noted that, even among the people who relapsed and couldn't control their hep C with medications, all of them were able to resume their "normal active lives" two years after their transplant. (Web highlight from aidsmap.com)


    HIV Treatment Concerns for HIV/Hepatitis C-Coinfected People
    If you're living with both HIV and hepatitis C, then you might already know that hep C coinfection can make HIV treatment more complicated. Several HIV meds can potentially cause liver damage, which is a major concern for people with hep C, a disease that attacks the liver. In this article, HIV/hepatitis C treatment educator Tracy Swan talks in detail about the special considerations that are needed when HIV/hep C-coinfected people begin taking HIV medications.

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      HIV OUTSIDE THE UNITED STATES

    UN Calls Global Aid for AIDS-Affected Children "Tragically Insufficient"
    "The world's response to protect and support AIDS-affected children remains tragically insufficient," the United Nations (UN) has proclaimed. The evidence is plain, the UN says: Globally, only one in 10 children who need HIV treatment receives it. In 2005, less than a tenth of pregnant women with HIV in low- and middle-income countries took HIV meds to prevent their children from being infected. The UN's year-old "Unite for Children, Unite Against AIDS" program was founded to focus attention on AIDS-affected children. The program aims to provide services to 80 percent of HIV-positive mothers, and to provide some form of treatment to 80 percent of HIV-positive children in need, by 2010. Currently, 2.3 million children under age 15 are HIV positive worldwide, and 15.2 million children under 18 have lost one or both parents to AIDS.

    For more on the report, read this news release from UNICEF.


    Indian Patent Law Could Restrict Antiretroviral Access in Developing World
    As of October 2005, one third of all HIV-positive Africans on treatment were using generic meds produced by the Indian drug company Cipla, the company says. However, an Indian law that mandates greater respect for international patent standards may drastically restrict the availability of inexpensive meds to HIVers in developing nations. According to a managing director at Cipla, generic drugs produced by Indian firms might soon become 30 to 50 times more expensive. Indian companies may also be forced to stop developing generic versions of new HIV meds, which could limit future treatment options for many HIV-positive people in resource-limited areas.


    Global Access to Kaletra: An Update
    Kaletra (lopinavir/ritonavir) is one of the most powerful HIV meds on the market in the United States and Europe, and is often used in first-line therapy. But in developing countries, it generally has not been a first-line option for two major reasons: refrigeration and cost. Thankfully, a new version of Kaletra introduced last year does not require refrigeration. However, even at its "no profit" price of $500 per person per year, Kaletra is still prohibitively expensive for many treatment programs in developing countries. A group of treatment activists from the developing world recently met with Abbott Laboratories, which produces Kaletra, in London to discuss the problem. This article contains excerpts from a country-by-country report on the availability of Kaletra.

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    Also Worth Noting

    Visual AIDS
    Art From HIV-Positive Artists

    Image from the January 2007 Visual AIDS Web Gallery
    "Kali Girl (#8)," 2005; David King
    Visit the January 2007 Visual AIDS Web Gallery to view our latest collection of art by HIV-positive artists! The first gallery of the new year is entitled "Energy"; it's curated by the Tisch Summer High School Photography Program at New York University.

    Connect With Others
    A
    t The Body's Bulletin Boards

    "Has Kaposi's Sarcoma Been Forgetten?"
    (A recent post from the
    "HIV Treatment" board)

    "I have been ... positive for over two years; my numbers were strong, and my doctor saw no need to start therapy right away. Last September I contracted foliculitis/MRSA (probably from the gym) ... I became suspicious of a spot in October that wouldn't go away. ... I finally had a biopsy, and it was Kaposi's sarcoma. I was immediately put on Sustiva (efavirenz, Stocrin) + Truvada (tenofovir/FTC) and sent to an oncologist. I have no internal problems, only the spots on the outside (fewer than five), and all the spots have responded well to the HAART treatment. ...

    "While I am thankful that the Kaposi's sarcoma isn't spreading anymore and the existing lesions have shrunk, I still feel scarred and ugly. ... Exhaustive searches on the Internet have not yielded any real new info since 2003 or 2004. I know that Kaposi's sarcoma doesn't affect many people nowadays, but has anyone out there had any experience in getting rid of, or covering, the lesions in any way? I really miss going to the gym and the beach."

    -- curi0us

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

    "Where Is My Soulmate?"
    (A recent post from the
    "Living With HIV" board)

    "My name is Ope; I am 30 and a Nigerian. Looking to connect with my soul mate -- either poz or negative -- but someone with lots of love to give, a nice guy around the age of 35 [or] 40. Someone who has a good sense of humor, enjoys music and photography, loves nature and above all loves God. Expecting to hear from my soulmate soon so that we can fight this virus together. I work in a private firm in Lagos."

    -- ope

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