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• ANTIRETROVIRAL THERAPY
NA-ACCORD: Starting HIV Treatment With CD4 Above 500 Could Reduce Mortality Risk
The latest salvo in the when-to-start-HAART debate has just been published in the April 30 issue of the New England Journal of Medicine: NA-ACCORD, a major, prospective U.S. study led by Mari Kitahata, M.D., found that when therapy was "delayed" until a patient's CD4+ cell count was less than 500, the patient was nearly twice as likely to die as those who started treatment with a CD4+ cell count greater than 500. (Article from the New England Journal of Medicine)
NA-ACCORD: NEJM Editorial Points Out Study Limitations
Although the NA-ACCORD results are "striking," they "cannot be considered definitive evidence that everyone with HIV should start receiving antiretroviral therapy," write Paul Sax, M.D., and Lindsey Baden, M.D., in a New England Journal of Medicine (NEJM) editorial. The editorial points out limiting factors that the authors feel should raise caution when interpreting the results of the NA-ACCORD study. (Article from kaisernetwork.org)
 NA-ACCORD: The CROI 2009 Presentation
The new NA-ACCORD results were just published in the New England Journal of Medicine, but the data were presented earlier this year at the 16th Conference on Retroviruses and Opportunistic Infections (CROI 2009). The Body PRO covered a summary of the study by lead author Mari Kitahata, M.D. (photo on left). (Article and podcast from The Body PRO)
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NA-ACCORD: Experts Analyze the Clinical Relevance
How will the new NA-ACCORD study results impact an HIV clinician's daily practice? In this wrap-up interview with The Body PRO at the end of CROI 2009, Joel Gallant, M.D., M.P.H., offers his take on the intriguing findings. (Gallant's analysis begins about two-thirds of the way through the interview.) (Article and podcast from The Body PRO)
For another perspective on the story, tune in to this panel discussion between HIV researcher Pablo Tebas, M.D., and HIV advocates Rob Camp and Bob Munk. (The analysis of this study begins about one-quarter of the way into their conversation.)
Update on Antiretrovirals in the Pipeline
It has been a quiet year thus far on the HIV drug development front. After frenetic activity and a spate of new HIV drug approvals in recent years, the pipeline of exciting new drugs in the pipeline appears to have largely dried up. However, several promising candidates are still working their way through development. In this overview, Paul Djuricich, R.Ph., Pharm.D., brings us up to date on today's top HIV medication prospects. (Article from Test Positive Aware Network)
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• COMPLICATIONS & PATHOGENESIS
Poly-L-Lactic Acid Increases Facial Volume More Than Six Months After Injections, Study Finds
The facial lipoatrophy treatment poly-L-lactic acid (Sculptra, New-Fill) has been heavily utilized since its approval as a facial filler for HIV-infected patients, but few studies have examined its long-term effects. However, 48-week results were recently published from a randomized Australian study involving 100 HIV-infected patients with lipoatrophy. The 50 patients who received a course of poly-L-lactic acid injections beginning at the start of the 48-week period experienced statistically significant, "modest increases" in facial volume and thickness compared to those for whom injections were deferred for 24 weeks. (Study abstract from HIV Medicine)
Are any of your patients considering facial-filler injections to treat their lipoatrophy? Have them look at this first-person video blog on TheBody.com, in which long-term HIV survivor and advocate Mark King receives his first round of injections with poly-L-lactic acid and calcium hydroxylapatite (Radiesse, Radiance) from HIV physician Gerald Pierone, M.D., Ph.D.
Low Doses of Ritonavir May Help Prevent Fat Loss
Could avoiding antiretroviral-related lipoatrophy be as simple as adding a little ritonavir (Norvir) to a patient's regimen? New findings from an international study indicate that patients who receive boosted atazanavir (Reyataz) are less likely to lose body fat than patients who receive unboosted atazanavir. (Article from Canadian AIDS Treatment Information Exchange)
Lopinavir/Ritonavir Labeling Altered to Warn of Possible QT and PR Interval Prolongation
The product label for lopinavir/ritonavir (Kaletra) has been updated to include warnings for clinicians regarding the potential impact of lopinavir/ritonavir on QT interval prolongation and PR interval prolongation. The new label notes that cases of second- or third-degree atrioventricular block have been reported among patients receiving lopinavir/ritonavir, and thus recommends greater care and monitoring when prescribing lopinavir/ritonavir to patients who may be at particular risk for developing cardiac conduction abnormalities. (Press release from the U.S. Food and Drug Administration)
In addition to the revised labeling, the makers of lopinavir/ritonavir have released a new "Medication Guide" that is specifically geared toward HIV-infected patients. The guide includes an overview of the potential adverse effects caused by lopinavir/ritonavir, warnings regarding drug-drug interactions, and a list of tips on how a patient can maximize the effectiveness of lopinavir/ritonavir doses.
 Neuropathy Still Common Among HIV-Infected Patients on HAART, Especially as They Age
More than one out of five HIV-infected patients already has peripheral neuropathy when they commence HIV therapy, and the older an individual is the greater the risk, according to results from a meta-analysis of patients enrolled in AIDS Clinical Trials Group studies. In addition, the meta-analysis found that most patients with neuropathy report none of the typical symptoms, which include numbness, tingling and pain in the extremities. Presenter Scott Evans, Ph.D. (photo on left), explains the results in this interview. (Article and podcast from The Body PRO)
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• HIV TREATMENT POLICY & FUNDING IN THE U.S.
U.S. Military Personnel to Have Joint, Virtual, Lifetime Electronic Medical Records, Obama Announces
In an attempt to smooth the transition of health care records between the U.S. Department of Defense and the Department of Veterans Affairs, the U.S. will establish a new initiative to set up electronic medical records that begin when military personnel enlist and stay with them for the remainder of their lives, President Barack Obama has announced. The U.S. military is the largest provider of health care -- and HIV care -- in the country. If the program works out, it may serve as a model for the broader U.S. health care system. (Press release from the White House)
Despite Tough Economic Times, Most U.S. ADAPs Have Been Able to Weather Storm, Report Finds
Most U.S. AIDS Drug Assistance Programs (ADAPs) have managed to continue providing the same level of treatment to low-income, uninsured and underinsured patients with HIV despite the worsening recession, according to the latest annual report on the nation's ADAPs. Although 21 ADAPs have experienced budget cuts within the past year, most programs were able to balance available resources and demand for services for the more than 100,000 patients nationwide who benefit from ADAPs, the report found. However, 62 individuals in three states -- Indiana, Montana and Nebraska -- were placed on waiting lists for medications due to a lack of funds. (Article from kaisernetwork.org)
A PDF of the full, annual report on the health of U.S. ADAPs is available online; it is authored by the Henry J. Kaiser Family Foundation and the National Alliance of State and Territorial AIDS Directors (NASTAD). The two groups also compiled this updated, state-by-state ADAP formulary list, which reveals that tremendous disparities continue in coverage of HIV-related medications across the country.
Majority of HIV-Infected South Carolinians Not Receiving Medical Assistance
Every study out of the U.S. South seems to show the same thing: If you are HIV infected and poor, you are unlikely to receive the medical care you need. The latest evidence of this is a new study out of South Carolina, published in AIDS Clinical Care on March 30, which found that up to 65% (if not more) of HIV-infected people in the state do not consistently access HIV medical care. The researchers recommend new, targeted programs to improve the situation. (Article from Journal Watch)
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• HIV TRANSMISSION & TESTING
U.S. Launches New, Five-Year, $45 Million Campaign to Educate Its Citizens About HIV
The U.S. government has announced the launch of a five-year, $45 million campaign to increase HIV awareness in the U.S. The campaign, which will be called Act Against AIDS, hopes to bring a sense of urgency about HIV risk back into mainstream society after years in which the public has become more complacent about the virus. The goal "is to put the HIV epidemic back on the front burner, on the radar screen," said Kevin Fenton, the director of the National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention at the U.S. Centers for Disease Control and Prevention (CDC). The campaign plans to saturate the country with ads in print media, public service announcements, text messages, public transit ads, radio spots, online videos and even airport dioramas. (Article from kaisernetwork.org)
For details of the newly announced Act Against AIDS plan, read this CDC fact sheet.
One of the major priorities of the plan is to boost efforts to reach the people who are most at risk in the U.S., particularly African Americans. Encouragingly, the CDC doesn't plan to go it alone: It has announced it will work with a wide range of established and respected African-American organizations, including the National Medical Association, to ensure the plan's success.
Unprotected Anal Sex Between HIV-Infected Partners Spurs Superinfection, Viral Load Spikes, Study Suggests
HIV superinfection may pose a greater danger than previously thought, according to a tiny, but intriguing, study out of Britain. In the study of eight men who have sex with men who were not receiving HAART and had unprotected anal intercourse after their HIV diagnosis, two of the men experienced at least a temporary spike in viral load (and one developed antiretroviral resistance) after a new strain of HIV was found to have become their dominant strain. The researchers recommended superinfection screening for HIV-infected patients who experience a sudden, sharp viral load increase. (Article from aidsmap.com)
 Number of HIV-Infected Women Giving Birth in U.S. Increased 40% From 2000 to 2006, Estimates Show
The number of HIV-infected women having children in the U.S. is on the rise, according to new estimates from U.S. health department researchers. As Suzanne Whitmore, Dr.Ph. (photo on left), explains in this research summary, between 8,650 and 8,900 HIV-infected women gave birth in the U.S. in 2006, compared to between 6,075 and 6,422 in 2000. The increase suggests that HIV-infected women are living longer, healthier lives, and have more options available that allow them to avoid mother-to-child HIV transmission. However, the findings also highlight the importance of providing this growing population of pregnant HIV-infected women with the services they need to protect themselves and their children. (Article and podcast from The Body PRO)
Male Circumcision Can Protect Against HSV-2 and HPV, but Not Syphilis, Study Suggests
Circumcised men are less likely to have herpes simplex virus-2 (HSV-2) or human papillomavirus (HPV) than uncircumcised men, according to the results of a two-year study conducted in Uganda by U.S. and African researchers. The study, which was backed by the U.S. National Institute of Allergy and Infectious Diseases, found that men who were circumcised at the beginning of the study were 28% less likely to become infected with HSV-2 and 35% less likely to become infected with HPV than men who remained uncircumcised. When it came to preventing syphilis, however, circumcision appeared to have no effect. (Article from the U.S. National Institute of Allergy and Infectious Diseases)
 HIV Vaccine Development in 2009: Looking Back (and Forward)
In many ways, last year was a disaster for HIV vaccine research. Headline-grabbing failures led some to fundamentally question the future of the field. But were the failures of last year truly as disastrous as some claimed -- and is the future really so bleak? We sat down with Mitchell Warren (photo on left), executive director of the AIDS Vaccine Advocacy Coalition, to discuss the current state of vaccine development. (Article and podcast from The Body PRO)
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• OUTSIDE THE UNITED STATES
 Where Antiretrovirals Are Available but Formula Is Not, Breast-Feeding Appears Not to Increase HIV-Infected Mothers' Mortality Risk
With all the focus on preventing mother-to-child HIV transmission through breast-feeding, an important question has gone largely unanswered: Does breast-feeding pose a health risk for the mother? In many developing countries, HIV-infected women must breast-feed their children, due to the lack of availability, safety or affordability of infant formula. Previous research has suggested that, in the developing world, breast-feeding might increase mortality risk among HIV-infected mothers. But an important new study out of Botswana appears to refute those findings -- provided the women have access to HAART, explains Shahin Lockman, M.D. (photo on left). (Article and podcast from The Body PRO)
Experts Tackle Emerging Myths About the Global HIV Pandemic
The more the global HIV community's top minds learn about how to fight the global HIV pandemic, the more they realize that many assumptions about the pandemic are simply false. In an effort to address these misconceptions, former UNAIDS head Peter Piot and others have authored an article in The Lancet elucidating the truth behind emerging myths about the HIV pandemic and outlining what experts have learned over the past several years from the global battle against HIV. (Press release from the Global Fund)
You can read the full article in the March 20 issue of The Lancet.
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