•  COMPLICATIONS & PATHOGENESIS

CROI 2009 Review: Cardiovascular Disease and HIV
How significant a problem is cardiovascular disease for HIV-infected patients? Read or listen as David Wohl, M.D., walks us through some of the most important cardiovascular findings presented at CROI 2009. This conference included a few studies that may change the landscape of HIV care: One study, for instance, suggests that HIV is an independent risk factor for atherosclerosis, posing a danger similar to that of traditional cardiovascular disease risk factors. Other studies highlighted critical biomarkers that may be used to assess a patient's cardiovascular risk more effectively than the lipid profiles we currently utilize. (Article and podcast from The Body PRO)


High Lipids May Be Harder to Treat for HIV-Infected Patients, Study Says
Is hyperlipidemia more difficult to treat in HIV-infected patients than in HIV-uninfected patients? The answer appears to be yes, according to a large study by U.S. researchers that was published in the March issue of the Annals of Internal Medicine. However, the researchers noted at least one exception: HIV-infected patients who were taking NNRTI-based HAART along with the lipid-lowering drug gemfibrozil (Lopid) appeared to experience as significant a reduction in triglycerides as HIV-uninfected patients. (Study excerpt from the Annals of Internal Medicine)


HIV Disease Progresses More Slowly Among Patients of African Descent, Study Finds
HIV disease progression appears to take longer in patients of African descent patients compared to patients of European descent, according to a pair of new studies. One of the studies, conducted in the U.S., found that long-term HIV nonprogressors were more likely to be African American than patients whose HIV disease progressed at a normal rate. The other study, conducted in Switzerland, found that HIV-infected patients from Africa had dramatically lower viral loads and experienced a slower CD4+ cell count decline than HIV-infected patients from Europe. (Article from aidsmap.com)

•  HIV TREATMENT

An Update on the Present -- and Future -- of HIV Eradication
Have we entered a renaissance in the quest for HIV eradication (i.e., a cure for HIV)? Robert Siliciano, M.D., one of the world's foremost researchers on the subject, is at the center of a whirlwind of new developments that has many in the HIV research community buzzing. We caught up with Dr. Siliciano at CROI 2009 to discuss some of this recent research, and to get the lowdown on what the future may hold. (Article and podcast from The Body PRO)


Discovery of Potent Antibody to HIV Could Yield New Path to HIV Vaccine
An important antibody that could potentially play a key role in the design of an HIV vaccine has been identified by scientists at Duke University Medical Center. "The 2F5-like antibody is one of the gold standards for what an HIV vaccine needs to induce, but no one had ever found it before circulating in the blood of infected patients," says Georgia Tomaras, Ph.D., the senior author of the study. Previous research has shown the 2F5 antibody can neutralize 80% of transmitted HIV viruses. (Press release from Duke Medicine News and Communications)


U.S. Updates Pediatric HIV Therapy Guidelines (PDF)
The U.S. health department has updated its treatment guidelines for HIV-infected children for the first time since July 2008. Included in the revised pediatric guidelines is a caution against treating children with darunavir (TMC114, Prezista) due to a high pediatric pill burden and the lack of a liquid formulation. Also featured in the new guidelines is a revamped section discussing strategies when an HIV-infected child's treatment regimen fails. (Guidelines from AIDSinfo)

•  HIV TRANSMISSION & TESTING

Washington, D.C., Report Finds 3% of City Residents Are HIV Infected
For evidence that the U.S. has failed to do enough against HIV inside its own borders, look no further than the capital city itself: A new official report says that 3% of Washington, D.C., residents are living with HIV/AIDS, which puts the city on par with many developing countries. All modes of HIV transmission are "on the rise, and we have to deal with them," said Shannon Hader, director of the Washington, D.C., HIV/AIDS Administration. (Article from kaisernetwork.org)

The release of the D.C. HIV report became front-page news in the Washington Post and has unleashed a torrent of public reaction. "We've long known that HIV and AIDS stalk the district," says the Post itself in an editorial. "But the startling [report] released Monday shows the breathtaking devastation that the disease with no cure has unleashed."

For many in the HIV community, of course, this report comes as little surprise. "What is happening in Washington is also happening elsewhere," points out Black AIDS Institute founder and CEO Phill Wilson. "HIV prevalence exceeds 5% in nine different ZIP codes in Detroit. In New York City's Manhattan borough, 17% of black, middle-aged men are living with HIV -- a level of infection that approaches national HIV prevalence in South Africa." Of course, it is entirely possible that the situation is just as dire in Washington, D.C.: Hader acknowledged that the 3% figure is likely an underestimation, since many people in the nation's capital do not get tested for HIV.

For even more perspective on this story, you can listen to an interesting radio interview with Phill Wilson, Shannon Hader, M.D., and Jose Antonio Vargas (the writer of the Washington Post article). The full report on HIV in Washington, D.C., is also available online in PDF format.


Building a Better Rapid HIV Test
Currently available HIV diagnostic assays are not sensitive enough to detect acute infection in high-risk patients, says researcher Chris Pilcher, M.D. -- but that may be about to change. Dr. Pilcher presented a study at CROI 2009 showing that a new type of rapid HIV blood test may be especially good at detecting acute infection. "For those of us who are in the HIV acute infection prevention business, having a rapid test is sort of the holy grail of making acute HIV prevention a potentially effective strategy to reduce transmission," Pilcher says. (Article and podcast from The Body PRO)


Revised U.S. HIV Prevalence Estimate Tops 1 Million for First Time; Number of Undiagnosed Drops
New calculations put the number of people living with HIV in the U.S. at 1.1 million, a 10% increase from the age-old estimate of 1 million. Approximately 21% of those individuals have no idea they are HIV infected, the new estimates say -- a lower percentage than was previously thought. In this interview, Michael Campsmith, D.D.S., M.P.H., of the U.S. Centers for Disease Control and Prevention gives us a breakdown of the revised official figures on the state of the U.S. HIV epidemic. (Article and podcast from The Body PRO)


Patients Who Present With Opportunistic Infections Are Often Still Not Tested for HIV
Health care providers who are not HIV specialists may be adept at diagnosing classic AIDS-related complications such as Pneumocystis pneumonia or cytomegalovirus retinitis. But when a patient who has not yet been diagnosed with HIV presents in an emergency room with one of these illnesses, those same providers often neglect to connect the dots and order an HIV test, according to the results of a large new U.S. study. As study author Judy Chen, M.D., M.S.H.S., explains, her analysis of 7,451 people enrolled in private U.S. health insurance plans found that many patients who were diagnosed with AIDS-defining illnesses were never tested for HIV afterward -- even though HIV was essentially the sole possible explanation for their illnesses. (Article and podcast from The Body PRO)

•  HIV IN THE NEWS

Swiss Court Overturns HIV Exposure Conviction, Saying HIV Treatment Virtually Eliminated Risk
A major turning point may have been reached in the legal battle over HIV exposure laws: The Geneva Court of Justice in Switzerland has overturned an 18-month prison sentence for an HIV-infected man who was convicted of exposing a woman to HIV during unprotected sex without disclosing his status. The sentence was overturned based on testimony from HIV researcher Bernard Hirschel, M.D., who testified that because the man was on successful HIV treatment, his risk of transmitting HIV to the woman was 1 in 100,000. (Article from aidsmap.com)


HIV Advocates Across the U.S. Hail Choice for New AIDS Czar
There's a new HIV sheriff in town, and U.S. HIV advocates couldn't be happier. Many advocates across the U.S. are applauding President Barack Obama's appointment of Jeffrey Crowley as director of the Office of National AIDS Policy, a position more commonly known as "AIDS Czar." Crowley is an openly gay man with a proven record of working effectively with communities that are most vulnerable to HIV. He previously worked as the deputy executive director of the National Association of People With AIDS. (Article from Housing Works)

In addition to Housing Works, other major HIV organizations in the U.S. were pleased to hear of Crowley's selection. "Finally the new leadership in Washington indicates support for slowing the HIV epidemic in the United States," says Marjorie Hill of Gay Men's Health Crisis in New York City. The Los Angeles-based Black AIDS Institute also expressed optimism at Crowley's appointment while urging him specifically to join forces with African-American leaders and communities. "America simply cannot win the fight against AIDS unless it wins it in Black America," reads the Black AIDS Institute's statement. You can also read the official White House statement about Crowley's appointment online.


Obama Aims to Boost Domestic HIV/AIDS Spending in 2010
Despite the tough economic times, could things be looking up for HIV funding in the United States? President Barack Obama's proposed budget for 2010 includes an unspecified increase in domestic spending on HIV testing, prevention and treatment. Before reaching that horizon, though, HIV-fighting efforts in the U.S. have to get through 2009 -- and the budget for the current year is not as promising. (Article from Washington Blade)