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• HIV TREATMENT & COMPLICATIONS
New U.S. HIV Treatment Guidelines Recommend Initiating HAART at <350 Cells/mm3
The U.S. Department of Health and Human Services has released a long-awaited update to its guidelines for the treatment of HIV-infected adults and adolescents. Chief among the changes is that HAART initiation is now recommended for any patient with a CD4+ cell count below 350 cells/mm3, and may be considered for patients with higher CD4+ cell counts as well. Drug-resistance testing is also recommended for all HIV-infected patients entering into care, regardless of whether they are to commence therapy. The updated guidelines do not include a revised list of preferred first-line antiretrovirals; that list is expected in early 2008.
To download a PDF of the complete revised guidelines, click here.
Joel Gallant, M.D., Summarizes the New U.S. HIV Treatment Guidelines
Who better to walk you through the most important changes in the revised U.S. HIV treatment guidelines than one of the physicians on the advisory panel that revised them? The Body PRO spoke with Dr. Gallant shortly after the release of the updated guidelines to learn more about the document's most notable revisions. Read or listen to this interview for an insider's look at the new recommendations. |  |
Long-Term,
Multi-Class Drug Resistance Rare in First-Line Patients
Just 9.2% of British patients who initiate HAART with triple-class therapy develop resistance to all three antiretroviral classes within 10 years, according to the results of a 7,916-patient study published in the Lancet. In addition, the study noted that, even among patients who developed triple-class resistance, the risk of death was only 10.6% over five years. The findings may be especially relevant for developing countries, due to the poor availability of second-line antiretrovirals and new drug classes.
Rising Cancer Rates Among HIV-Infected Patients Underscore Need for Better Treatment, Expert Says
As HAART continues to extend the lifespans of HIV-infected patients, an unsettling new trend has developed: A growing number of patients are developing certain types of cancer. Although the "numbers are still relatively small overall," several malignancies have become more common among HIV-infected patients than HIV-uninfected persons, says noted HIV expert Mark Wainberg, Ph.D. In an opinion piece published in the Washington Post, Dr. Wainberg discusses how these rising cancer rates raise the importance of developing therapies for HIV that not only suppress viral load, but strengthen the immune system as well.
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• HIV TRANSMISSION & TESTING
HIV Superinfection More Common Than First Thought, Study Suggests
HIV-infected patients may become infected with a second strain of HIV far more often than previously believed, according to a small, five-year study of 36 female sex workers in Kenya that was published in PLoS Pathogens. The study found that seven of the 36 women had been superinfected with a second strain of HIV -- and that, in some cases, they were infected with the second strain as many as five years after they contracted the first strain. The researchers noted, however, that superinfection generally appeared to have no impact on a patient's viral load.
HIV Prevalence Is Nearly 5% Among MSM in Florida, Estimates Say
Approximately one out of every 22 men who have sex with men (MSM) living in Florida is HIV infected, according to new estimates from the state health department. That disconcertingly high rate becomes even more stark among specific ethnic groups: The report found that while one in 29 white MSM is HIV infected, the rate increases to one in 18 for Hispanic MSM and one in 12 for black MSM.
HIV Risk Double Among Black MSM vs. White MSM, Researchers Say
Black men who have sex with men (MSM) in the United States are twice as likely as white MSM to be living with HIV, federal researchers announced at the 2007 National HIV Prevention Conference held in Atlanta, Ga., in early December. The researchers expressed uncertainty as to the reasons behind such a large ethnic disparity, particularly in light of recent study findings that black MSM are no more likely to have unprotected sex than white MSM. However, as this article explains, other recent studies offer some possible clues.
On a related note, a recent article in the Journal of the American Medical Association, authored by Harold W. Jaffe, M.D., Ronald O. Valdiserri, M.D., M.P.H., and Kevin M. De Cock, M.D., explores the resurgence of HIV within the U.S. MSM population. "The tragedy of the epidemic for an earlier generation of MSM must not be repeated," the authors write. They propose several interventions aimed at curbing the spread of HIV among U.S. MSM.
More Than Half of U.S. OB/GYNs Still Use Opt-In HIV Testing for Pregnant Women, Survey Says
Although federal recommendations urge U.S. physicians to provide opt-out HIV testing to pregnant women, more than half of U.S. OB/GYNs still use an opt-in approach, according to a new survey published in Obstetrics & Gynecology. Most OB/GYNs do recommend HIV testing to all their pregnant patients, the survey found, but some are unclear about state requirements for recommending tests, which may conflict with federal recommendations.
Many U.S. state laws for HIV testing run counter to federal recommendations due to requirements such as pretest counseling and informed consent. States have made little progress in changing their laws to allow for routine testing, according to this report published in PLoS One.
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• U.S. HIV NEWS & POLICY
Where U.S. Presidential Candidates Stand on HIV-Related Issues (PDF)
As the U.S. presidential primary season approaches, many in the HIV health care community are no doubt wondering where this year's crop of candidates stand on some of the issues that most closely impact their practice, their patients and their clients. This comprehensive, issue-by-issue report from Gay Men's Health Crisis includes a quick reference chart on key HIV-related issues, as well as a detailed breakdown of what the top eight Republican and Democratic presidential candidates have proposed and stated.
Proposal on HIV and Immigration Disappoints Many
A year after President George W. Bush promised to make it easier for HIV-infected people to visit the United States, the government finally proposed new regulations. However, under the proposed new rules, foreign visitors with HIV would still be banned and need a special waiver to enter the country; the waiver process would just be more efficient. In addition, several advocates say the new rules, if implemented, may make it harder for some HIV-infected people to enter the United States, especially if they hope to live in the United States permanently.
The International AIDS Society joined the cacophony of HIV organizations calling for the U.S. government to reject the immigration proposal. In this strongly worded statement, the group says the proposal "only serves to reinforce a bad policy that is clearly discriminatory and has no public health basis."
Social Security Disability Applicants Face Years of Waiting
Applying for Social Security disability benefits in the United States has become an increasingly drawn-out process in recent years. Since 2000, the average wait for an appeal hearing has nearly doubled, from nine months to 17 months. Hiring more judges to hear appeals could reduce the wait, but President George W. Bush has rejected a bill that would have allowed the government to employ 150 more judges to hear disability appeals.
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• HIV OUTSIDE THE UNITED STATES
Global HIV Estimates Lowered; Better Epidemiological Practices Cited
Worldwide HIV prevalence is significantly lower than previously thought, according to the latest edition of the annual report on the HIV pandemic, which was released by UNAIDS and the World Health Organization (WHO). Due to what the organizations describe as more accurate reporting methods, this year's estimate of the number of individuals living with HIV globally has been lowered to 33 million; last year the estimate was 40 million.
To read the full UNAIDS/WHO report, click here.
The global HIV prevalence adjustment caused a major stir, as officials scrambled to explain that the revised UNAIDS figures were not an indication that the HIV pandemic does not remain a critical worldwide health emergency. The International AIDS Society released this explanation discussing the reasons behind the dip in HIV cases worldwide, while former UNAIDS official Stephen Lewis gave a passionate speech excoriating his former organization for waiting too long to correct flawed statistics, and for what he suggested was a consistent failure to drive home the devastating human impact of HIV.
HIV Incidence in Europe Up Dramatically Since 1999
HIV rates are rapidly increasing not just in many developing countries, but in the developed nations of Europe as well, according to a report from the European Centre for Disease Prevention and Control (ECDC). In European Union (EU) countries, HIV incidence has doubled since 1999, from 28.8 cases per one million residents to 57.5, the report states. In non-EU areas of Europe, the situation is even worse; in Russia and Ukraine, for instance, HIV incidence rates are approximately five times that of the EU rate. Almost one-third of HIV-infected people in Europe are estimated to be unaware of their status.
GlaxoSmithKline Withdraws Patent Applications for Two Antiretrovirals in India
HIV treatment advocates in India were likely relieved last week when GlaxoSmithKline withdrew its patent applications for abacavir (Ziagen) and zidovudine/lamivudine/abacavir (Trizivir) in India. The decision is good news for HIV-infected patients who rely on inexpensive, generic versions of antiretrovirals; if abacavir and zidovudine/lamivudine/abacavir had been patented, generic versions of them could have been outlawed. India is home to 2.5 million HIV-infected people, many of whom receive generic antiretrovirals.
Uganda Plans Free National Male Circumcision Program to Curb Spread of HIV
Ever since studies last year showed that male circumcision can reduce female-to-male HIV transmission by more than 60%, African countries have been working to implement widespread circumcision programs. Uganda is the latest to jump on the bandwagon: The country plans to introduce a free, nationwide male circumcision program. However, leaders are still working out the details of how to roll out such a massive program.
You Can't Fight HIV Without Boosting Human Rights, Declaration Says
Protecting human rights must be at the center of the global fight against HIV, according to a declaration issued by more than 30 HIV and human rights organizations worldwide. The people most vulnerable to HIV continue to face discrimination worldwide, the declaration states, and often are denied access to HIV services.
To read the declaration, entitled "Human Rights and HIV/AIDS: Now More Than Ever," click here. You can also click here to sign the declaration, or read it in French, Spanish or Russian.
TheBody.com, The Body PRO's sister site for the general population, spoke with Catherine Hanssens in October about how U.S. law can protect -- or fail to protect -- HIV-infected individuals living in the United States. Click here to read or listen to the full interview, which is part of TheBody.com's monthly "This Month in HIV" podcast series.
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