•  HIV JOURNALVIEW, SEPTEMBER 2007

In the September 2007 edition of The Body PRO's HIV JournalView, David Wohl, M.D., discusses recent reports on new antiretrovirals, hepatitis B coinfection and metabolic complications. Browse this month's issue for an in-depth look at:

• the TITAN study results, in which ritonavir (Norvir)-boosted darunavir (TMC114, Prezista) shined in treatment-experienced patients naive to lopinavir;
  
  
• the DUET study results, which demonstrate the effectiveness of etravirine (TMC125) in treatment-experienced patients;
  
  
• resistance implications of findings that entecavir, which is used to treat hepatitis B infection, also demonstrates activity against HIV;
  
  
• new evidence that "double boosting" -- the use of two boosted protease inhibitors -- holds no benefit over the use of a single boosted protease inhibitor; and
  
  
• how higher saturated fat intake among HIV-infected patients may be linked to the development of metabolic complications.

•  HIV FRONTLINES: NEW PODCAST SERIES AT THE BODY PRO

The Body PRO is proud to present HIV Frontlines, a new podcast series in which we talk with professionals who provide HIV care and train health care workers in resource-poor areas throughout the world. From China to Ukraine to Rwanda, these inspiring clinicians are doing their part to make a difference in regions where access to HIV treatment and care is only a shadow of what is generally available in the United States. Through these interviews, we'll get a glimpse of the realities of practicing HIV care in some of the world's poorest areas.


HIV Care in St. Petersburg, Russia: An Interview With Ben Young, M.D.
In our inaugural HIV Frontlines interview (available as an MP3 podcast and a transcript), Benjamin Young, M.D., recounts the trials and tribulations of attempting to improve HIV care in a city where incidence is rapidly increasing, tuberculosis is endemic and the health care system is struggling to keep pace. Dr. Young also discusses the impact of his work abroad on his HIV practice in the United States. Click Here

•  HIV TREATMENT & PATIENT CARE

Nelfinavir Should Not Be Prescribed to U.S. Children, Pregnant Women, Warning States
HIV-infected children and pregnant women who are initiating antiretroviral therapy should not be prescribed nelfinavir (Viracept), according to a "Dear Healthcare Professional" letter issued by Pfizer, Inc. The warning indicates that U.S. children who are stable on a nelfinavir-containing regimen need not be switched off the drug, but that a switch is recommended for pregnant women already taking nelfinavir. The warning is based on the potential cancer risk associated with ethyl methane mesylate, a chemical formed during the production of nelfinavir. Dangerously high levels of the chemical led to a full recall of nelfinavir in the European Union earlier this year, but the "Dear Healthcare Professional" letter states that levels of the chemical are much lower among nelfinavir batches produced in the United States. Click Here


Maraviroc Underperforms in Comparison With Efavirenz
The newly approved CCR5 inhibitor maraviroc (Selzentry) doesn't quite stack up against efavirenz (Sustiva, Stocrin) as a first-line therapy drug, according to the latest results from the MERIT study. As The Body PRO's Edwin DeJesus, M.D., reports, maraviroc may have performed well enough that it could be considered for use in treatment-naive patients. But he adds, "The second and most important question would be: Why would we want to do that?" Click Here


Measuring Drug Resistance to the Newest HIV Antiretrovirals
As new HIV medications near (and reach) approval, understanding which mutations are predictive of a less-than-optimal response to these agents becomes critical. Recently presented research provides insight into the emergent mutations that can indicate a growing level of resistance to antiretrovirals such as maraviroc (Selzentry) and other CCR5 inhibitors, the integrase inhibitors raltegravir (MK-0518) and elvitegravir (GS 9137), and the NNRTI etravirine (TMC125). The Body PRO’s Mark Holodniy, M.D., reports. Click Here


Lopinavir/Ritonavir Pediatric Overdose Risk Warning
Physicians and pharmacists are being urged to show particular vigilance when prescribing lopinavir/ritonavir (Kaletra) for children, following the reported death of an infant who received an overdose of the drug. The "Dear Healthcare Professional" letter notes that the correct pediatric dose of lopinavir/ritonavir should be calculated carefully based on body weight. Click Here


HIV Treatment Effective Among Patients Over 50, Study Finds
If taken properly, antiretroviral therapy can raise CD4+ cell count and suppress viral load in patients over 50 just as effectively as in younger patients, according to a new French study published in the Sept. 1 issue of Clinical Infectious Diseases. The study findings indicate that immunovirologic response in older patients is threatened not by decreased effectiveness of treatment, but rather to delayed HIV diagnosis and a greater propensity for switching regimens due to adverse effects. Click Here

•  HIV/HAART-RELATED COMPLICATIONS

Exposure to NRTIs Increases Diabetes Risk in HIV-Infected Women Over Time
Longer cumulative exposure to NRTIs is associated with an increased risk of diabetes in HIV-infected women, according to a study published in the Aug. 20 issue of AIDS. The investigators prospectively followed 2,088 participants (1,524 HIV infected and 564 uninfected) from the Women’s Interagency HIV Study. None had evidence of diabetes at enrollment. Longer cumulative exposure to NRTIs -- especially to lamivudine (3TC, Epivir) -- in HIV-infected women was associated with an increased diabetes incidence compared to no NRTI exposure (adjusted relative hazard: 1.81 for 0 to 3 years of NRTI exposure, 2.64 for more than 3 years of exposure). The study authors urge HIV care providers to regularly monitor their patients’ fasting glucose levels. Click Here


New Insight Into Link Between Some Antiretrovirals and Insulin Resistance
Mitochondrial toxicity may be an underlying cause of the insulin resistance that has been tied to the use of some antiretrovirals, according to the results of a small study presented at IAS 2007. The Body PRO's Margaret Hoffman-Terry, M.D., delves into the data behind a finding that the development of insulin resistance while on zidovudine/lamivudine (Combivir) may be due to a mechanism other than lipoatrophy induction. Click Here


Lipid Benefits Seen in Switch to Atazanavir From Another Protease Inhibitor
If undesirable lipid levels in a patient have you contemplating a switch off of his or her current protease inhibitor, atazanavir (Reyataz) may be a viable option, according to research presented at IAS 2007. The studies found that, after switching from another protease inhibitor to atazanavir, many patients saw an improvement in total cholesterol levels and triglycerides, and generally maintained a viral load below 200 copies/mL. The Body PRO’s Graeme Moyle, M.D., reports. Click Here


Study Suggests Relationship Between HIV Infection and Coronary Artery Disease
Years of research have yet to reveal a "smoking gun" that explains the mechanisms behind a greater risk of cardiovascular complications among HIV-infected patients. However, our knowledge continues to increase incrementally. One small study presented at IAS 2007 suggests a link between HIV infection and a higher risk for severe coronary artery disease. The Body PRO's Margaret Hoffman-Terry, M.D., reports. Click Here


Incorrect Antiretroviral Doses Often Prescribed to Patients With Renal Impairment
Patients with kidney impairment are often prescribed incorrect doses of NRTIs, according to University of Alabama researchers. In a study of 603 HIV-infected clinic patients published in the Sept. 1 issue of Clinical Infectious Diseases, researchers found that 31% of all antiretroviral prescriptions for renally impaired patients were incorrect. Although didanosine (ddI, Videx) was the most commonly misprescribed drug among this group, the researchers warned that fixed-dose combination medications containing NRTIs may pose a particular danger. Click Here


Predicting HCV Treatment Success Within Four Weeks May Be Possible, Study Says
A new algorithm used to gauge rapid virological response to hepatitis C (HCV) treatment may allow clinicians to determine within four weeks whether an HIV/HCV-coinfected patient will achieve a sustained virological response to his or her HCV medications, according to a new French study. The study appears in the August 2007 issue of Gut. Click Here

•  HIV TRANSMISSION

Abstinence-Only Sex Education Fails to Reduce HIV Risk, Study Says
Abstinence-only sex education programs are not an effective way of preventing HIV infection for young people in high-income countries, according to a study published in the July 26 online edition of BMJ. University of Oxford investigators compared data from 13 trials involving almost 16,000 U.S. youth, and found that, compared to an array of other sex education programs or no program at all, abstinence-only education had no effect on the risk of HIV infection, the rate of unprotected vaginal sex, condom use, number of sexual partners or the age of sexual debut. Click Here


Washing Penis Immediately After Sex Increases HIV Risk Among Uncircumcised Men, Study Finds
Washing the penis minutes after unprotected sex might increase the risk of HIV infection among uncircumcised men, according to researchers in Uganda. The study found that men who washed their penis within three minutes of sex had nearly six times the HIV risk of men who waited for 10 minutes or more. The researchers aren't certain why, but possible explanations include the acid pH of vaginal secretions, which may impair HIV survival, or the use of water with a neutral pH, which may facilitate viral survival and possible infection. Click Here

Click here to view the abstract of the study, which was presented on July 25 at the 4th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention in Sydney, Australia. You can also download a slide presentation.


Oral Sex Linked to Throat Cancer, HPV Infection
Oral sex with multiple partners and oral infection with human papilloma virus (HPV) are the greatest risk factors for cancers of the mouth and throat, according to researchers from Johns Hopkins University. Men and women who have performed oral sex on more than five partners were found to be more than twice as likely to have oral or throat cancer than people who have never had oral sex. Oral sex appeared to play a much greater role in oral cancer development than smoking cigarettes or drinking alcohol. The research was published in the May 10 edition of the New England Journal of Medicine. Click Here

•  OTHER HIV-RELATED RESEARCH & NEWS

C-Sections Riskier for HIV-Infected Women Than HIV-Uninfected Women, Study Finds
HIV-infected women are 60% more likely to experience one or more postpartum morbidities following Cesarean delivery compared to HIV-uninfected women, according to a large U.S. study published in the August issue of Obstetrics & Gynecology. The prospective, four-year, observational study found that HIV-infected women delivering via Cesarean section were more likely to a need a postpartum blood transfusion, have postpartum endometritis, develop maternal sepsis, receive pneumonia treatment or die than HIV-uninfected women delivering via Cesarean. However, the researchers admitted that the findings were limited by a lack of data regarding immune status and antiretroviral use among the HIV-infected women. Click Here


Although Smaller, U.S. ADAP Waiting Lists Persist
Although 308 HIV-infected patients remain on waiting lists to receive antiretrovirals through their U.S. AIDS Drug Assistance Program (ADAP), this is among the smallest number of HIVers on ADAP waiting lists since tracking began back in 2002. The 308 patients live in two states: Alaska and South Carolina. However, three other states (Alabama, Indiana and Michigan) have initiated ADAP cost-containment measures since April 1, such as a cap on the number of individuals who can enroll (which may lead to new waiting lists) or a limit to the drugs that are covered. Click Here

Click here to read the Aug. 16 edition of NASTAD's ADAP Watch.


Denying the Denialists: Is It Time to Fight Back?
HIV experts have long ignored so-called AIDS "denialists" and their groundless claims (e.g., HIV does not cause AIDS), but patients throughout the world have died believing in denialism. Has the time come to fight back publicly? Is scientific illiteracy in the United States and elsewhere costing too many lives? That is the contention of two U.S. researchers, who wrote an editorial published on Aug. 21 in PLoS Medicine. They contend that the time has come to fight misinformation with real science. Click Here

Lists maintained on this Web site and this Web site are used by denialists to convince patients that they need not take HIV treatment. If you know of anyone on these lists who does not subscribe to these beliefs, they can ask to have their name removed.