March 14, 2007

•  NEW PODCAST INTERVIEWS FROM CROI 2007

Over the past week, we've added much more to The Body's coverage of the 14th Conference on Retroviruses and Opportunistic Infections (CROI 2007). Be sure to listen to these newly launched podcasts (click on the links to download/play MP3 audio):

• David Wohl, M.D., reviews a few of the studies that made the biggest waves among doctors attending CROI 2007. (You can also read the full transcript.)
  
  
• Ben Young, M.D., Ph.D., discusses new research on how race and ethnicity impact HIV transmission and treatment in the United States. (Read transcript.)
  
  
• HIV advocate Julie Davids offers a wrap-up of HIV prevention research presented at CROI 2007. (Transcript coming soon.)

For a complete listing of The Body's in-depth podcast interviews from CROI 2007, click here. Also browse our CROI 2007 index of articles for expert analysis of key studies presented at the conference.

•  LIVING WITH HIV

HIV-Positive People Eat More Fat, Cholesterol Than HIV-Negative People, Study Finds
For years now, experts have debated whether HIV or HIV meds are to blame for the fact that HIVers often have high lipid levels, which can lead to metabolic and heart problems. But a new U.S. study may turn the debate upside-down: Researchers have found that HIV-positive people consume more total fat, saturated fat and cholesterol than HIV-negative people. More than three quarters of all HIVers in the study ate more saturated fat than recommended by U.S. dietary guidelines. (Web highlight from aidsmap.com)


Positive Outlook May Keep HIVers Healthier, Study Finds
You've probably heard a million times that positive thinking can keep you healthier. A recent U.S. study provides some evidence to back up the theory that emotions can affect the immune system. The study asked 174 HIVers to write an essay about a traumatic event. Independent scorers judged whether the essays demonstrated a realistic outlook, self-esteem, a willingness to address problems directly and an ability to express emotion. Over the course of four years, CD4 counts declined more slowly and viral loads were lower in people who had written the most "emotionally healthy" essays, the researchers found. "We don't know exactly how these emotions work to affect illness," said one expert. "But I don't think we're talking magic. ... It's probably a combination of behaviors that might slow progression and effects on the immune system from the emotions."


HIV-Positive Gay Games Athletes Are All Winners
When you're HIV positive, competing in the Gay Games can be about much more than just winning. Last year's Gay Games -- an Olympic-style international competition that takes place once every four years -- included many HIV-positive athletes, such as Douglas Graham Bates, 50, of Newark, Del. In 2005, Bates was off meds, in denial about his HIV status and getting sicker by the day. In October 2006, after a determined recovery, Doug took home a silver medal in the Men's Masters Physique Competition at the games. Doug and some of his fellow athletes braved illness, treatment regimen adjustments and financial constraints to get to Chicago for the 2006 games. Craig Goodman, a bowling competitor from a Los Angeles suburb, didn't take home a medal, but he, like many others, has a new goal: competing in the 2010 Gay Games in Cologne, Germany.

•  HIV TREATMENT

Maraviroc Powers Through Phase 3 Studies
It's been a rocky road for the development of a new class of HIV meds known as CCR5 antagonists: Unforseen safety issues spelled the end of the road for trials of two of these drugs, aplaviroc and vicriviroc. But one CCR5 antagonist is still going strong: maraviroc, which could receive U.S. Food and Drug Administration approval later this year. The Body's Graeme Moyle, M.D., reports from CROI 2007 on interim results from two large trials of maraviroc conducted in treatment-experienced HIVers.


Support Remains Thin for Kaletra Monotherapy
A growing number of studies show that maintenance monotherapy with Kaletra (lopinavir/ritonavir) may be fine for select people, since the drug is generally associated with a low risk of viral rebound and protease inhibitor resistance. However, it remains unclear whether this strategy can -- or should -- be applied in the real world, particularly considering how much easier it's become in recent years to take NRTI-based regimens. The Body's Paul Sax, M.D., reports from CROI 2007.


Tantalizing Evidence May Support Interleukin-2 for HIVers Not Yet on Treatment
For years, researchers have explored the immune-strengthening effects of interleukin-2, hoping it might one day play a role in HIV treatment. A new study presented at CROI 2007 examined whether interleukin-2's CD4-boosting ability could help people delay starting HIV meds in the first place. The Body's Keith Henry, M.D., reports on the results.


GS-9137: Yes, There's an Integrase Inhibitor Other Than MK-0518
MK-0518 may be grabbing more attention than most other HIV medications in development, but it's not the only game in town. Another integrase inhibitor, GS-9137 (elvitegravir), is also progressing, although it's in an earlier stage of development. The Body's Edwin DeJesus, M.D., reports on the latest GS-9137 research presented at CROI 2007.


Hepatitis B Drug May Fight HIV, Too -- And Cause HIV Drug Resistance
Scientists had long believed that the antiretroviral Baraclude (entecavir) was only capable of fighting hepatitis B. But a new study has found that entecavir also appears to reduce HIV viral load in people who are infected with both hepatitis B and HIV. However, these findings aren't a green light to start using Baraclude as HIV treatment: If anything, they raise the risk that people using Baraclude could develop HIV drug resistance, since the drug is only partly effective against HIV. (Web highlight from aidsmap.com)

In an interview at CROI 2007, HIV researcher Marshall Glesby, M.D., spoke with The Body about this study; you can download a podcast or read a transcript of that interview. (Dr. Glesby discusses entecavir toward the end of the interview.) For more information, you can also read this "Dear Health Care Provider" letter (PDF) released by the manufacturer of entecavir.

•  HIV TRANSMISSION

Despite Research Proving Needle Exchange Works, U.S. Support Is Fragile
Although evidence has been piling up for years that needle-exchange programs help prevent the spread of HIV, funding for such programs in the United States remains scarce. Since 1988, the U.S. government has banned federal funding for programs that provide needles to injection-drug users in the United States or abroad. Last week, Physicians for Human Rights lobbied Congress to repeal the ban, pointing out that about a quarter of all people who have been diagnosed with AIDS in the United States got HIV through injection drug use. However, supporters of the ban continue to argue -- despite evidence to the contrary -- that needle-exchange programs encourage risky behavior. Meanwhile, local programs are facing budget cuts: For instance, Chicago's needle-exchange program will collect 800,000 fewer dirty needles due to spending cuts, according to the program's director. In Connecticut, a state budget proposed by Gov. Jodi Rell would cut spending on needle-exchange programs by a fifth in major cities.


Many Los Angeles Latinos Not Being Tested for HIV
Many health care providers in predominantly Hispanic areas in Los Angeles County don't routinely offer HIV testing, a new study has found. In addition, less than half of the providers surveyed said they regularly offered advice about sexually transmitted diseases to their patients, despite the fact that HIV is more common among Latinos than whites in the United States. "There are two issues here: a lack of health care access for Latinos in general and the cultural stigma attached to HIV/AIDS," according to study co-author Rosa Solorio. Some health care providers also might be uncomfortable asking patients about their sexual histories: "There are still many cultural taboos in Latino culture about sex," Solorio said, adding, "We just don't talk about it publicly."

To read the details of this study, which was published in the Journal of the National Medical Association, click here (PDF).

•  HIV IN THE U.S. NEWS

Is the (PRODUCT) RED Campaign Really so Charitable?
When you buy (RED) brand Converse sneakers, iPods, MotoRazr cell phones or Gap clothing, you get a shiny, new bauble, and the Global Fund to Fight AIDS, Tuberculosis and Malaria gets part of the profits. Sounds like a good deal, no? Indeed, some are glad that corporations are finally opening their pockets to help fight global AIDS. But others see the (PRODUCT) RED campaign as a marketing ploy that will benefit wealthy companies more than HIV-positive people in developing countries. While (PRODUCT) RED has raised $25 million, critics say that companies are only donating a miniscule portion of their revenues. In addition, some participating companies refuse to disclose how much they give: Gap, for example, says that half of the profit on (RED) brand clothing is being donated to the Global Fund, but it won’t say how much is donated per item or how, exactly, it calculates its profits. (Web highlight from The Christian Science Monitor)


Women's HIV Group Featured in HBO Movie Struggles to Stay Afloat
An HIV organization highlighted in a new HBO television movie is struggling with major funding problems despite the publicity it received from the movie. Life Support is based on the real-life story of an HIV-positive woman who became a peer educator at Life Force in Brooklyn, N.Y., one of the first HIV groups to tackle the U.S. epidemic among women. The movie's main character is played by actress Queen Latifah. Life Force recently applied for -- but failed to receive -- around $400,000 in renewed funding, which will likely lead to considerable layoffs among its peer educator staff this month.


Mailing Error Reveals Names of 53 People Enrolled in California ADAP
The California Department of Health Services accidentally revealed the names and addresses of as many as 53 people enrolled in the state's AIDS Drug Assistance Program (ADAP) by mailing benefit notification letters to the wrong people. A newly hired clerk didn't realize that the letters were personally addressed and put them into envelopes, adding mailing labels to each envelope without matching them to the letters. The department informed the ADAP members of the error through certified mail and asked that people destroy incorrectly addressed letters. The clerk who made the error has been reassigned, and a spokesperson said steps would be taken to make the mailing system more foolproof. "I would hope this is an anomaly," said Jeff Bailey, director of client services at AIDS Project Los Angeles. "I would not want to give way to panic about this release. It did not go to random citizens of the state, where this information might be shared with someone outside the HIV and AIDS circle."

•  HIV OUTSIDE THE UNITED STATES

Six-Month-Old AIDS Corps Is Treating 12,000 HIV-Positive African Children
AIDS Corps, a Peace Corps-like initiative that sends U.S. doctors to Africa to treat HIV-positive children, is growing fast. When the program began last August, its 52 doctors were treating 9,000 African children. Today, corps members are treating 12,633 children in six countries, and by the end of the year they expect to have 40,000 young patients. The program addresses a tremendous problem: the dire shortage of health care professionals in sub-Saharan Africa. According to the World Health Organization, the region has more than 60 percent of the world's HIV/AIDS cases but only three percent of the world's health care workforce.


Children Infected During Infancy Can Survive Without Meds, but Need Better Services, Study Says
A new study in Zimbabwe has cast doubt on the widely held assumption that children infected with HIV as infants can't live for many years without taking HIV meds. "Instead, somewhere around 1 in 10 infected infants -- and perhaps even as high as 1 in 4 -- may survive into late childhood or early adolescence without [HIV] diagnosis or treatment," said Dr. Elizabeth Corbett, a researcher involved in the study. Although this might be welcome news, the odds of survival without treatment are still low -- and those that do survive without treatment were often diagnosed late, suffer from opportunistic infections and have stunted growth. These children also fall victim to a brutal paradox: "Because of the previous assumption that HIV-infected infants did not survive to adolescence, no concerted effort has been made to provide diagnostic or treatment programs for this age group," Corbett said. (Web highlight from Wellcome Trust)

Click here to view the study abstract in the March 15 issue of Clinical Infectious Diseases.