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• HIV TREATMENT & COMPLICATIONS
Smoking May Have Greater Impact on HIV-Infected Patients, Study Says
HIV-infected cigarette smokers appear to experience a more rapid decline in lung function than their HIV-uninfected counterparts, according to the results of a small U.S. study. "This is the type of decline you might expect to see in elderly individuals who have a long history of smoking," said Syed Kadri, who presented the study findings at the 105th International Conference of the American Thoracic Society in May. Most of the 63 individuals recruited for the study were men in their 40s, and half of them smoked cigarettes. After two years, declines in FEV1 (from 88% to 83.2%) and DLCO (from 77.6 to 70.0) were reported. Next, the researchers plan to examine outcomes after the smoking patients quit their cigarettes. (Press release from the American Thoracic Society)
These study findings highlight a morbid trend in HIV: As patients live longer thanks to increasingly effective antiretrovirals, the possible long-term effects of HIV (and HAART) become increasingly apparent. These findings on smoking are in line with recent research suggesting that many forms of cancer, including lung cancer, may be more common among patients with HIV. HIV researcher Eric A. Engels, M.D., M.P.H., recapped much of this research in an editorial published in the May 15 issue of AIDS.
Efavirenz + Ginkgo: Possible Recipe for Resistance, Case Report Finds
Plasma concentrations of efavirenz (Sustiva, Stocrin) may drop to nontherapeutic levels among patients who concurrently take Ginkgo biloba supplements, according to a case report by Dutch researchers published in the June 1 issue of AIDS. The report discusses the case of a 47-year-old man who, despite claims of having never missed a dose of his antiretroviral therapy since 2005, suddenly developed a detectable viral load and almost complete resistance to efavirenz. The researchers determined that a reaction between efavirenz and his Ginkgo biloba supplements was the only likely explanation. (Study summary from aidsmap.com)
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Testosterone Patch May Improve BMD, Weight, Mood in HIV-Infected Women, Small Study Suggests
HIV-infected women with low testosterone levels and the complications associated with them -- e.g., low bone mineral density (BMD) and low body weight -- may benefit from testosterone replacement therapy. A 25-patient U.S. study published in the May 15 issue of AIDS found that after 18 months, women who used a testosterone replacement patch saw improvements in lean body mass, BMD in the hip and thigh, and overall mood. Testosterone patches are not currently approved for use in the U.S., but testosterone replacement is available in other formulations. The researchers urged further study among a larger cohort to confirm the potential benefits of this approach. (Study summary from aidsmap.com)
Leptin Injections May Ameliorate Lipohypertrophy, Some Metabolic Complications
A proof-of-concept study has provided alluring signs that injections of leptin may help reduce the effects of lipohypertrophy without worsening lipoatrophy in HIV-infected patients, while improving other indicators of metabolic complications such as high cholesterol, high triglycerides and insulin resistance. In a six-month, eight-patient, open-label pilot study, patients who received leptin injections experienced a 32% reduction in visceral fat, with no changes in peripheral fat noted. Significant decreases in fasting total cholesterol and LDL cholesterol were found, while HDL cholesterol increased. Fasting insulin levels also decreased. (Full study from the Journal of Clinical Endocrinology & Metabolism, courtesy NATAP)
In addition to this intriguing study, the April 2009 issue of the Journal of Clinical Endocrinology & Metabolism includes a related editorial by Christos Mantzoros, M.D., an associate professor at Harvard Medical School. Mantzoros analyzes the study results in detail and offers his take on whether there is a future for the use of leptin replacement therapy in HIV-infected patients.
 Perinatally Infected Children More Likely to Have Language Impairment, Study Suggests
There is precious little research on the long-term effects of HIV or HAART on perinatally infected children. However, that reality is beginning to change as antiretroviral therapy allows these children to live longer. A study recently presented at CROI 2009 by Mabel Rice, Ph.D. (photo on left), for instance, suggests that children in the U.S. who were perinatally infected with HIV may, years later, be more likely to experience language development problems than children who are born without HIV. (Article and podcast from The Body PRO)
Immediate HAART Initiation Is Best for Patients Presenting With OIs, Study Finds
If a patient is concurrently diagnosed with HIV and an opportunistic infection (OI), what is the optimal course to take? Should you treat the OI before starting antiretroviral therapy, or should you initiate HAART right away? Clinicians have long debated this issue, but a recently published study by U.S. researchers may help settle the issue. The 262-patient, yearlong study spanning 39 sites in the U.S. and South Africa found that when patients were placed on HAART after an OI diagnosis, their risk of death was cut in half compared to patients for whom HAART initiation was delayed until the OI was treated. The findings were published on May 18 in PLoS One. (Article from PLoS One)
For the practical implications of these findings, take a look at this in-depth analysis of the study by David Wohl, M.D.. He selected it as one of the most influential studies of 2008 (it was presented at CROI 2008 before being published in PLoS One last month). U.S. physicians, nurses and pharmacists can earn free CME/CE credit for reading this article!
FDA Warning: Patients Using Testosterone Gels Should Take Care Not to Expose Children
Patients who use testosterone gels should use significant caution when coming into contact with children in order not to expose them to the hormone, according to a new, U.S. Food and Drug Administration (FDA)-mandated warning added to the product labels of AndroGel and Testim. The warning is based on reports that children whose skin came into direct contact with testosterone gel-treated skin developed a range of adverse effects, including inappropriate enlargement of genitalia, aggressive behavior and even increased bone age. It is recommended that any individual who uses a testosterone gel should wash his or her hands after applying it and cover up all treated areas. (Press release from U.S. Food and Drug Administration)
Novel Influenza A (H1N1) Update
In the U.S., much of the public panic over the outbreak of "swine flu," now referred to officially as "novel influenza A (H1N1)," has subsided. But the virus continues to spread: A total of 11,054 confirmed or probable cases have been reported in the U.S. as of June 3, and every state has been impacted; meanwhile, another 9,000-plus infections have been reported in 65 countries. As an HIV health care provider, what do you need to know about novel influenza A (H1N1)? For now, at least, the virus appears no more deadly than more common flu strains. But it does offer an important reminder of the precautions any HIV health care provider should take to ensure his or her patients protect themselves from this, or any, strain of influenza. Visit The Body PRO's library of articles on HIV and novel influenza A (H1N1) for the latest information and clinical guidance.
Guide for HIV-Infected Patients: Prevention and Treatment of Bone Disorders
In the last few years, studies have indicated that HIV-infected patients appear more likely to experience bone-related complications such as osteopenia and osteoporosis. But for many patients, this realization is accompanied by two inevitable questions: "What causes these bone problems to occur, and what can I do about it?" This patient-friendly overview provides a discussion of recent studies on bone complications and HIV, lists some of the risk factors that HIV-infected patients should be aware of and discusses recommended treatment options. (Article from Positively Aware)
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• HIV TRANSMISSION & TESTING
Pregnancy and HIV: What Patients Need to Know
HIV-infected women living in resource-rich areas with easy access to appropriate services are now more likely than ever to have a healthy, HIV-uninfected child. But these women still have a considerable amount to learn about pregnancy and HIV. If you have an HIV-infected female patient who is considering her pregnancy options, share this easy-to-read fact sheet. (Fact sheet from AIDS InfoNet)
Of course, the details in that fact sheet are just the tip of the iceberg when it comes to learning about HIV and pregnancy. Refer your patient to TheBody.com's extensive collection of articles for more patient-friendly information.
World Has Failed to Reach Goals in Preventing Mother-to-Child HIV Transmission, Report Says
Every day in the developing world, more than 900 babies are diagnosed with HIV. In comparison, the number of babies born with HIV in wealthy nations has been reduced to nearly nil. The vast majority of the 1.5 million HIV-infected women who become pregnant each year in resource-poor countries lack proper access to vital services and support to prevent mother-to-child HIV transmission, according to a new report from the International Treatment Preparedness Coalition. In fact, many women are not even counseled about how best to feed their newborns or how to save their own lives with proper antiretroviral therapy, the report says. (Press release from International Treatment Preparedness Coalition)
A PDF of the full report from ITPC is available online. It includes a thorough, country-by-country analysis of existing mother-to-child HIV prevention efforts and recommends methods by which to make better progress.
HIV "Family Tree" Traces Spread of Virus Through Europe
Some people pick up more than trinkets when they take a vacation. According to an international study published on May 20 in Retrovirology, tourist destinations are the focal points for the spread of HIV through Europe. By examining samples of HIV from 16 European countries and Israel, the researchers created a "family tree" that highlights the geographical transmission pathways of HIV. They found that, in popular vacation countries such as Greece, Portugal, Serbia and Spain, most new HIV infections occur among travelers, not residents; vacationers then bring the virus back to their home countries. It has long been known, of course, that HIV travels along tourism routes. Nonetheless, this study highlights the importance of gearing HIV prevention and education toward non-residents who are visiting a country in addition to the residents themselves. (Article from kaisernetwork.org)
Early Treatment for Common Parasitic Disease in Girls Could Reduce HIV Transmission in Africa, Study Says
Treating girls in rural Africa early with the anthelmintic drug praziquantel (Biltricide) could help reduce the spread of HIV, according to a study published on May 26 in PLoS Neglected Tropical Diseases. Praziquantel is used to treat schistosomiasis, which can be contracted through drinking snail-infested water. If left untreated, schistosomiasis can lead to the formation of genital sores in females, which can facilitate HIV infection. Praziquantel is relatively affordable: Researchers estimate that $22 million worth of the medication would treat all 70 million pediatric schistosomiasis cases in Africa. Girls should be protected before they become sexually active, the researchers advise, because although the drug kills the parasites that cause schistosomiasis, it cannot cure the genital sores.
Much of U.S. Public Still Sorely Needs HIV Education, Survey Suggests
Nearly three decades into the U.S. HIV epidemic, 27% of Americans still believe (or express uncertainty as to whether) they can become HIV infected by sharing a glass of water with an HIV-infected person. This is just one of a range of disturbing findings from a nationwide survey by the Henry J. Kaiser Family Foundation. The wide-ranging survey explored perceptions of HIV among the general U.S. public and found complacency, stigma and ignorance regarding HIV risk -- as well as a great deal of room for improved education efforts by health officials and care providers (Press release from the Henry J. Kaiser Family Foundation)
Encourage HIV-Uninfected Individuals to Volunteer for HIV Vaccine Trials!
Although a cure to HIV remains elusive, researchers continue to explore avenues in the development of an effective vaccine. But to succeed, these investigators need HIV-uninfected individuals from all walks of life to support and volunteer for HIV vaccine studies. Visit the U.S. health department's "Be the Generation" Web site for information and fact sheets you can provide to your HIV-uninfected patients and clients, as well as posters and a listing of vaccine trials that are currently enrolling.
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• HIV IN THE NEWS
Elton John Calls for Renewed Leadership in Fighting HIV/AIDS
"There are long-standing stereotypes and prejudices that inhibit our efforts to combat AIDS," says Elton John. The singer has been involved in HIV advocacy for more than 17 years, and is still speaking out against stigma and ignorance. At the 2009 Bio International Convention, John reminded the audience, which included the CEOs of companies that are involved in HIV vaccine development, about the decline in concern about HIV in the U.S. -- and the commensurate decline in HIV prevention and education efforts. "Our failure to [educate people] is costing lives," John chided his audience. (Article from kaisernetwork.org)
HIV-Infected Patients Sue Massachusetts General Over Records Left on a Boston Train
A billing manager at Massachusetts General Hospital (MGH), one of the top HIV medical centers in the country, accidentally left a bundle of billing tickets from 66 hospital clinic clients on a train seat in the Boston public transit system. The information on at least nine of the tickets included patients' HIV-infected status. MGH's response was less than adequate, according to HIV legal advocates involved in the case: Patients only received a form letter notifying them that their records had been lost. Now, two of the affected HIV-infected patients are suing the hospital for breach of privacy. (Article from Bay Windows)
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