•  ANTIRETROVIRAL THERAPY

Could Nanotechnology Be the Next HIV Treatment Frontier?
To science-fiction aficionados, the phrase "nanotechnology" may conjure images of hordes of microscopic robots destroying humankind from the inside out. But within the field of HIV treatment research, the term inspires far more realistic imagery. Take, for example, a solution that combines antiretrovirals with tiny crystals so that when the solution is injected into a patient's bloodstream, it slowly breaks down over a period of weeks or even months, obviating the need for daily HIV therapy. This and other nanotechnologies are already under investigation in laboratory studies and early clinical trials, raising hopes for the development of ever-more-patient-friendly HIV treatment options.


Discordant Response to HAART May Increase Disease Progression Risk, Study Finds
HIV-infected patients who fail to achieve both an undetectable viral load and a CD4+ cell count increase within three to nine months after HAART initiation may face an increased risk of developing an opportunistic infection (OI) or dying, according to a University of Alabama study published in the April 15 issue of JAIDS. The retrospective study included 404 treatment-naive patients initiating therapy between 1995 and 2004; clinical outcomes were followed for a median of three years. Approximately one out of every four patients experienced a discordant response to their first three to nine months of therapy; these patients were 2.3 times more likely to die or develop an OI than patients with a concordant, successful response to HAART.


Caution Urged With Pediatric Dosing of Atazanavir
New dosing recommendations for children and adolescents under the age of 18 have been added to the labeling for atazanavir (Reyataz). The recommendations urge clinicians to adjust the dose of the drug based on a child's body weight. They also note that there are insufficient data to recommend the use of atazanavir in children under the age of 6, or the use of unboosted atazanavir in patients between the ages of 6 and 13.


"Undetectable" Does Not Equal Zero, Long-Term Study Affirms
Extremely low viral loads persist in HIV-infected patients even after seven or more years of successful HAART, according to the results of a study published in the March 11 issue of the Proceedings of the National Academy of Sciences. U.S. researchers took a series of ultrasensitive viral load tests in 40 patients who, for up to seven years after HAART initiation, had "undetectable" viral loads according to standard assays. At least one of the ultrasensitive tests in each patient indicated a viral load of 1 copy/mL or higher. (In total, 77% of all viral load tests came back between 1 and 99.) The findings lend credence to arguments supporting several "phases" of viral decay, as well as the presence of HIV reservoir sites that appear unreachable by conventional antiretrovirals, the researchers suggest.


Interleukin-2 Cannot Maintain CD4+ During HIV Treatment Interruption
Undeterred by a bevy of poor study results, researchers continue to investigate a pair of HIV treatment strategies: the use of structured HIV treatment interruptions and the immune-boosting drug interleukin-2. A recent study attempted to bring these two out-of-favor strategies together, in hopes that interleukin may help delay CD4+ cell count deterioriation during treatment interruption. Unfortunately, as study leader Brian Porter, M.D., Ph.D., explains in this study summary from CROI 2008, the results were not promising.

•  COMPLICATIONS & COINFECTIONS

Black or White, Abacavir HSR Test Is 100% Sensitive
The widely used genetic test that gauges a patient's risk for abacavir (Ziagen) hypersensitivity reaction (HSR) is as effective in black patients as it is in white patients, according to a study published in the April 1 issue of Clinical Infectious Diseases. Earlier research had suggested the assay, which tests for the presence of the HLA-B*5701 allele, might not be as accurate in blacks, but the new study appears to put those fears to rest: Five of five black patients with immunologically confirmed HSR tested positive for the HLA-B*5701 allele. The study itself involved 199 patients, 69 of whom were black; abacavir HSR is far more rare among black patients than white patients.


Oral, Anal Gonorrhea Often Goes Undiagnosed in Gay Men, U.S. Study Finds
An estimated 35% of rectal gonorrhea infections and 25% of pharyngeal gonorrhea infections may go undiagnosed and untreated in U.S. men who have sex with men, according to results from a large, four-year study in eight major U.S. cities. The study authors blamed insufficient training, lack of available tests and regulatory hurdles for the missed infections. Among other steps, the researchers recommend using repeated exposure -- rather than symptoms -- as a gauge for gonorrhea testing at non-genital sites, since many gonorrhea infections may be asymptomatic.


A Guide to the Tuberculosis Drug Pipeline
Tuberculosis (TB) remains the leading cause of death for HIV-infected patients around the world, and drug-resistant strains of the bacteria are becoming increasingly prevalent. The need for the development of effective new TB therapies is greater than ever -- and, fortunately, we have seen some recent movement on the TB treatment front. This guide from Project Inform outlines new TB drugs in development that may increase efficacy rates and prove more tolerable than existing drugs.

•  HIV IN THE NEWS

Hidden Casualties of the War on HIV: Physicians Who Lost Their Way
During the deadliest years of the U.S. HIV epidemic, Ramon Torres, M.D., was one of the HIV community's fiercest warriors. A highly regarded, prominent physician, Dr. Torres has been credited with saving the lives of thousands of HIV-infected patients in an era when an HIV diagnosis was equated with a death sentence. Then HAART arrived, everything changed -- and Dr. Torres began to lose his way. In this striking, in-depth profile, New York magazine takes a closer look at the rise and fall of Dr. Torres, and shines a light on an aspect of the changing epidemic that goes largely unnoticed: What happens to an army of physicians who had spent their careers fighting an urgent war against a ruthless enemy, only to find that enemy suddenly tamed.

•  HIV EPIDEMIOLOGY & TRANSMISSION

New CDC HIV Surveillance Report Features Expanded U.S. Incidence Data (PDF)
After a lengthy delay, the U.S. Centers for Disease Control and Prevention (CDC) released the latest edition of its HIV surveillance report in late March. The number of U.S. states included in the report's annual HIV incidence estimates increased from 38 to 45; as a result, the official tally of new HIV infections in the United States rose from 33,044 in 2005 to 50,834 in 2006. California, Delaware, Illinois, Maine, Oregon, Rhode Island and Washington implemented confidential name-based HIV infection reporting in 2006, allowing their inclusion in the new CDC surveillance report, which features data through the end of 2006. The surveillance report features a wealth of stratified data on HIV and AIDS rates in the United States; among other notable highlights is a significant reduction in AIDS-related deaths from 2005 to 2006.


New York City Hospitals Will Offer 150,000 Free HIV Tests
New York City's public hospitals will provide oral rapid HIV tests to 150,000 people at no charge beginning this spring, city health officials announced. In addition, the city has teamed up with religious and community leaders to encourage individuals at risk to seek out testing, particularly young African Americans and Hispanics. "We are not going to be judgmental. We just want to save lives," promised Calvin Butts, pastor of the Abyssinian Baptist Church in Harlem.


Southern California Reaches Out to Mexican Migrants at Risk for HIV
How do you convince a man who is working in the United States illegally to take an HIV test? For starters, how about some cold, hard cash? Handing out $5 gift certificates is one way that HIV prevention advocates in San Joaquin County, Calif., have tried to reach out to Mexican migrants, a difficult-to-access group of people who, research suggests, increase their risk for HIV when they cross the border to find work in the United States. In addition to programs within the United States, Mexican HIV prevention workers are also attempting to reach out to Mexican migrant workers before they cross the border.

At CROI 2008 in February, The Body PRO spoke with Melissa Sanchez of the California HIV/AIDS Research Program regarding her study on high-risk behavior among migrant workers arriving in the United States from Mexico. Click here to read or listen to a summary of this intriguing study.

For dozens of additional study summaries, expert overviews and CME/CE coverage from CROI 2008, visit The Body PRO's CROI 2008 home page.


Baltimore Needs More Ambitious HIV Prevention Efforts, Editorial Says
Is Baltimore, Md., doing enough to stem its tide of HIV infection? The city has the second-highest HIV incidence rate in the United States and 16,000 of its approximately 630,000 residents are HIV infected, but city health officials' response to HIV needs to be more ambitious, a Baltimore Sun editorial claims. Baltimore's health department is currently doing a comprehensive review of the city's HIV prevention programs, but the newspaper calls for steps to be taken now, including the provision of shelter to homeless people with HIV and more effective HIV education in public schools.


Study Identifies "Mini-Epidemics" of HIV Among London MSM
The outbreak of HIV among men who have sex with men (MSM) in London may not have been a generalized, sustained string of infections, but rather an episodic series of clustered transmissions, according to a study published in the March 2008 issue of PLoS Medicine. Data collected from more than 2,000 HIV-infected individuals in the city -- most of whom were MSM -- showed that many contracted the virus in small population clusters within a short period of time, creating multiple "mini-epidemics." Many in the study subsequently retransmitted the virus while they were still in the acute stage of infection, often before they themselves were diagnosed. The researchers argue that focusing HIV prevention campaigns in London's bars and nightclubs could help curb HIV incidence in the city.


Researchers Explore Link Between Homelessness and HIV Risk
Approximately 50% of HIV-infected individuals in New York City were homeless or in an unstable housing situation during the year in which they were diagnosed with HIV, according to a recent study. But exactly how does homelessness put individuals at risk for HIV, and what can prevention experts and health care professionals do to reduce those risks? Researchers and advocates recently explored these questions at a forum in New York City. You can read summaries of key forum presentations or download the full reports.

•  HIV PREVENTION & PATHOGENESIS

A Cure for HIV: Restoring Hope to a Long-Lost Cause
"We cannot coddle the virus with a lifetime of drugs," writes HIV advocate Martin Delaney. "The only way to effectively conquer the epidemic is to cure the disease." Given the stream of ever-more-effective, less-toxic antiretrovirals, Delaney worries that too many have become complacent about the current state of HIV treatment. In this in-depth analysis, Delaney explains why it remains critical to push for a cure to HIV and explores what it will take to finally find one.


The Aftermath of STEP: Where Does HIV Vaccine Research Go From Here?
The long, painful road toward the development of an HIV vaccine got much longer and more painful over the past several months. STEP, the most important study to date on an experimental HIV vaccine, found that immunization had no protective effect -- and may have actually increased HIV risk for individuals with pre-existing immunity to the vaccine vector. This failure is just one in a string of defeats on the HIV vaccine front over the past few years. Is there still hope for the future of vaccine development? In this overview, two members of the AIDS Vaccine Advocacy Coalition discuss the outlook.


Time to Take a Step Back, Say Experts at HIV Vaccine Summit
HIV vaccine development need not be halted entirely despite a series of recent failures, but it is time to reconnect with basic science before moving forward, argues one of the United States' most senior health officials. "We need to turn the knob toward [basic scientific] discovery," said Anthony Fauci, head of the U.S. National Institute of Allergy and Infectious Diseases, at an HIV vaccine summit held recently by the U.S. National Institutes of Health. At the meeting, Fauci and other experts urged researchers to take a step back and concentrate on developing a better understanding of how HIV works.


Specific Genetic Patterns Associated With Slower HIV Disease Progression
U.S. researchers have identified specific genetic patterns that appear to impact the effect of HIV and HAART on CD4+ cell count. In a study published in the April 2008 issue of Nature Medicine, researchers explored the roles of two genes -- CCR5 and CCL3L1 -- on HIV disease progression. Their findings suggest that genetic screening may eventually prove a useful method for determining whether a given HIV-infected patient is at risk for a more rapid CD4+ cell decline than usual, and thus may benefit from earlier initiation of therapy.

The full study is available in the April 2008 issue of Nature Medicine.

In a separate study published in PLoS Pathogens, researchers found that not only can specific host genetic factors impact HIV progression rates by triggering the formation of less-fit HIV mutations, but that others can become infected with the less-fit strain even if they lack the same genetic advantage. The researchers suggest the findings may have applications for HIV vaccine development.

•  MENTAL HEALTH & QUALITY OF LIFE

Stigma Still Clings to HIV-Infected Women in United States
It's "the worst part of having HIV," says activist Marvelyn Brown. She's not talking about antiretrovirals, complications or the cost of treatment: She's talking about stigma, which remains deeply entrenched within U.S. society. A recent survey conducted by amfAR revealed that the U.S. public still has highly negative perceptions of HIV-infected women, and particularly expressed discomfort at the idea of interaction with a female health care provider who was HIV infected. Fifty-seven percent of survey respondents said they would feel uncomfortable having a female physician who was HIV infected; 59% said the same of their child-care provider, and 68% said so of their dentist.