•  BREAKING RESEARCH FROM CROI 2008

Comprehensive Summaries, In-Depth Analyses, One-on-One Interviews and More: The Body PRO Covers CROI 2008
There's no better place on the Web to turn for full coverage of the most important studies from the 15th Conference on Retroviruses and Opportunistic Infections (CROI 2008), which took place in Boston, Mass., in early February. Stop by for dozens of study summaries and interviews with top researchers, as well as detailed recaps of conference highlights (including downloadable slide sets). More coverage will be added over the days to come, so check back often for the latest!

Here's just a small taste of what you'll find in The Body PRO's coverage of CROI 2008:

• Cal Cohen, M.D., M.S., reviews important findings with implications for the management of HIV treatment-experienced patients.
• David Wohl, M.D., summarizes noteworthy data regarding complications of HIV and HAART.
• Kathryn Anastos, M.D., examines a bevy of studies that investigate the natural history, treatment and prevention of HIV in women.
• David Wohl, M.D., brings us up to speed on new developments in first-line antiretroviral therapy.
• Robert Schooley, M.D., provides a wide-ranging look at the study findings presented at CROI 2008 that are most likely to change the way we look at HIV disease.

•  ANTIRETROVIRAL THERAPY

Joel Gallant, M.D., Discusses Revisions to U.S. DHHS HIV Treatment Guidelines
A pair of recent updates to the U.S. Department of Health and Human Services (DHHS) HIV treatment guidelines for adults and adolescents has resulted in new recommendations on when to initiate antiretroviral therapy, as well as what antiretrovirals to initiate therapy with. The Body PRO spoke with Joel Gallant, M.D. -- a member of the expert panel that created the revised guidelines -- to get the lowdown on these new recommendations, as well as additional revisions to the guidelines that may impact the way HIV health care providers treat their patients.

To read the full, newly revised U.S. DHHS HIV treatment guidelines for adults and adolescents, click here.


"When to Start Treatment" Debate Drifts Ever Earlier
It has been just a few months since U.S. treatment guidelines began to recommend HAART initiation at a CD4+ cell count of 350 instead of 200. Yet there is already discussion about raising that threshold even higher, to further reduce the risk of morbidity and mortality. In a presentation at CROI 2008, Andrew Phillips, Ph.D., reviewed research that suggests it may be wise to initiate treatment when a patient's CD4+ cell count is still over 500.


Cal Cohen, M.D., Examines the U.S. Approval of Etravirine
What do clinicians need to know about etravirine (Intelence), the newest HIV antiretroviral approved in the United States? The Body PRO recently spoke with noted HIV researcher Cal Cohen, M.D., to get his take on this new NNRTI, which was approved for use in treatment-experienced patients with resistance to existing NNRTIs.


CCR5 Antagonists in Development: New Data on Vicriviroc and SCH532706
Maraviroc (Selzentry, Celsentri) is currently the only CCR5 antagonist on the market, but more may be just around the corner. At CROI 2008, promising data were presented on a pair of CCR5 antagonists in development: the late-stage drug vicriviroc and the Phase 1 candidate SCH532706.


Gut Reaction: Researchers Identify Possible New Avenue for Antiretroviral Development
Researchers from the U.S. National Institute of Allergy and Infectious Diseases say they have identified a previously undiscovered mechanism by which HIV commences its initial assault on gut-associated lymphoid tissue. In a study published in the March 2008 issue of Nature Immunology, the researchers explain these findings and examine their potential ramifications.

Click here for a brief summary of this story.

•  HIV/HAART-RELATED COMPLICATIONS

Abacavir, Didanosine Associated With Higher MI Risk, D:A:D Study Finds
One of the most talked-about studies presented at CROI 2008 was authored by Caroline Sabin and colleagues on behalf of the large, international D:A:D cohort. It focused on the impact of specific antiretrovirals on myocardial infarction (MI) risk in HIV-infected patients. The new data indicate that the use of abacavir (Ziagen) -- and, to a lesser extent, didanosine (ddI, Videx) -- significantly increase a patient's MI risk, though this increased danger is negligible for patients who have few other MI risk factors. The Body PRO caught up with Jens Lundgren, M.D., Chief Physician and Director of the Copenhagen HIV Programme, where the D:A:D cohort is based. In this interview, he summarizes the data and discusses the ramifications of the results.

For more information on these surprising study findings, read this study summary.


Rapid Liver Fibrosis Occurs More Frequently Among HIV-Infected Men Newly Coinfected With Hepatitis C
HIV-infected men who become coinfected with hepatitis C after their HIV infection may be at an especially high risk for rapidly progressing liver fibrosis, according to the findings of a small study in New York City presented at CROI 2008. In this interview, Daniel Fierer, M.D., explains the results of this study, and notes another finding highlighted by the research: Sexual transmission of hepatitis C among men who have sex with men may be occurring much more frequently than some clinicians commonly believe.


Immune Reconstitution May Trigger Hepatic Flares in HIV/Hepatitis B Coinfected Patients Starting HAART
Hepatic flares in HIV/hepatitis B (HBV)-coinfected patients initiating HBV-active HAART may be attributable to immune reconstitution syndrome, according to the results of a small study by Australian researchers in Thailand. In this interview from CROI 2008, Megan Crane of Monash University in Melbourne, Australia, explores the ramifications of these study findings.

•  HIV TRANSMISSION

Circumcision Is Possible Factor in Failure of Merck Adenovirus-Based HIV Vaccine
There is a fascinating new twist in the story of a failed HIV vaccine: Could circumcision have something to do with it? Researchers have been working for months to determine why Merck's adenovirus-based HIV vaccine candidate appeared to increase HIV infection risk in some patients. As The Body PRO's David Wohl, M.D., explains in this interview from CROI 2008, the researchers now believe that male circumcision (or lack thereof) may have played a major role.

For more on these intriguing study results, read this summary from aidsmap.com.


Acyclovir for HSV-2 Treatment Fails to Curtail HIV Acquisition
Defying expectations, the use of acyclovir (Zovirax) to treat herpes simplex virus type-2 infection appears to have no impact on an HIV-uninfected person's risk of HIV acquisition, according to results from an international, 3,277-patient trial. In this study summary from CROI 2008, Connie Celum, M.D., discusses the unexpectedly disappointing data from this study of women in Africa and men who have sex with men in the United States and Peru.


Premastication May Carry HIV Risk for Children, Report Suggests
In a case presentation at CROI 2008, U.S. researchers reported three instances since 1996 in which babies in the United States became infected with HIV after eating food that had been premasticated by their HIV-infected caregivers. The researchers attribute the transmission to blood present in the prechewed food. In this interview with The Body PRO, the researchers explain their findings.


Lactobacilli in Vaginal Flora May Reduce Genital Viral Load, Study Finds
The presence of lactobacillus in the vagina is associated with a significant reduction in vaginal HIV viral load, according to the results of a 57-patient prospective study in the United States. The study results, which were presented at CROI 2008, show not only that acquisition of lactobacillus in the vagina is associated with a reduction in vaginal HIV viral load, but subsequent loss of lactobacillus is associated with an increase in vaginal HIV viral load. In this study summary from CROI 2008, Jane Hitti, M.D., M.P.H., discusses the study findings.


Seaweed-Derived Vaginal Microbicide Fails to Prevent HIV, Large Study Finds
It's the latest disappointment to hit the microbicide field: A 6,200-patient study of a seaweed-derived gel called Carraguard found that the gel was not effective in preventing HIV acquisition in South African women. Left open, however, is the question of precisely why the microbicide failed. For instance, although the gel appeared safe, study participants used it only 44% of the instances in which they had sexual intercourse.


Path Cleared for Development of Maraviroc-Based Microbicide
Despite multiple setbacks in the development of a safe, effective microbicide, research continues on several fronts. One such front involves the use of antiretrovirals; tenofovir (Viread), for instance, is currently under investigation as a potential microbicide. Soon to join it: maraviroc (Selzentry, Celsentri), the recently approved first-in-class CCR5 antagonist. The International Partnership for Microbicides recently reached an agreement with Pfizer that allows the partnership to develop a vaginal microbicide using maraviroc.

•  HIV OUTSIDE THE UNITED STATES

The Body PRO Exclusive: An HIV Physician From the Bronx Changes Lives in Rwanda
In 2003, a single e-mail changed the life of Kathryn Anastos, M.D. -- and may have saved the lives of hundreds, if not thousands, of women and children in Rwanda. The e-mail, forwarded by a colleague, came from a Rwandan activist group for women and children who were victims of the genocidal civil war that tore the country apart in 1994. Hundreds of thousands of women were raped during the genocide, and as Dr. Anastos recalls, the activist group "had just learned that the perpetrators of their rapes ... were being treated -- with state of the art, triple antiretroviral therapy." Outraged that rape perpetrators were receiving modern HIV treatment while so many of their victims were not, Dr. Anastos and two other women from the United States decided to make a difference: They founded clinics in Rwanda that, with help from the Rwandan government and local staff, provide treatment and care to Rwandan women and their children. In this one-on-one interview with The Body PRO, Dr. Anastos tells her story.


WHO Releases New Guidelines for Second-Line HIV Treatment
In an attempt to simplify the choice between second-line HIV treatment regimens, speed up drug approvals and decrease prices in resource-limited regions of the world, the World Health Organization (WHO) has changed its second-line HIV treatment guidelines. WHO has narrowed down the number of second-line medications it recommends, in response to requests from governments for more direction on what to include in their countries' treatment programs. Many second-line antiretrovirals are prohibitively expensive or unavailable in developing countries, as is drug resistance testing. In addition, physicians are often uninformed regarding the proper combination of antiretrovirals to prescribe to patients who have developed HIV drug resistance.

For more on the WHO's new recommendations regarding second-line HIV treatment, read this summary from aidsmap.com, or download this report on the WHO meeting in which second-line treatment options were discussed.


South Africa Improves HIV Treatment Guidelines for Pregnant Women
Under pressure from activists and health care professionals, the South African government recently updated its HIV treatment guidelines for pregnant women. HIV-infected pregnant women in the country will now have access to two antiretrovirals -- nevirapine (Viramune) and zidovudine (AZT, Retrovir) -- instead of just nevirapine, which brings the country in line with World Health Organization recommendations and promises to further reduce the risk of vertical HIV transmission. The next hurdle for South Africa, however, is ensuring that health care workers receive the new guidelines and have access to those sorely needed medications.