Welcome to The Body PRO Newsletter, a bi-weekly review of the latest breaking news and research in HIV medicine, aimed specifically at informing health care professionals.

July 14, 2009

In This Newsletter:

  HIV TREATMENT & COMPLICATIONS

Raltegravir Approved for Use in First-Line Antiretroviral Therapy in U.S.
The U.S. Food and Drug Administration has now approved the integrase inhibitor raltegravir (MK-0518, Isentress) for use in treatment-naive patients. The recommended dose for treatment-naive adults is the same as for treatment-experienced patients: one 400 mg tablet twice daily, with or without food. The raltegravir package insert was also updated with revised information regarding pharmacokinetics, resistance and other issues. (Announcement from the U.S. Food and Drug Administration)


Bone Complications Common Among HIV-Infected Patients; Antiretrovirals May Be Partly to Blame
Overall, results have been mixed when it comes to research regarding the relationship between antiretroviral use and bone loss. However, according to a recent study by Dutch and Finnish researchers of 50 HIV-infected men in Europe, such a relationship does exist. The researchers found that a regimen of zidovudine/lamivudine (Combivir) and lopinavir/ritonavir (Kaletra) resulted in greater reductions in bone mineral density than a regimen of nevirapine (Viramune) and lopinavir/ritonavir, but that both regimens had a negative impact on bone mineral density, and osteopenia rates increased among patients in both study arms. The findings add to a growing body of evidence that suggests HIV health care providers and their patients should start paying much more attention to bone health, particularly as patients age. (Study abstract from AIDS)

In an editorial that was published in the same issue of AIDS, a group of Italian researchers drove home the point that bone disease is on the rise among patients with HIV, and recommended a series of preventive measures and interventions.

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HIV and Diabetes: Minimizing Risk, Optimizing Care
Does HIV increase someone's risk for developing diabetes? Although there have been a few major studies examining the potential relationship between HIV disease and diabetes, results have been mixed, and it has proven difficult to tease out specific risk factors. In a thorough overview, Anne Monroe, M.D., provides a rundown of noteworthy research on diabetes and HIV, as well as an outline of optimal clinical care for the diabetic HIV-infected patient. (Article from the San Francisco AIDS Foundation)


Early Antiretroviral Therapy Does Not Increase Drug Resistance Risk, Study Finds
If you harbor concerns that initiating antiretroviral therapy too early in the course of your patient's HIV disease may ultimately increase her or his risk for developing antiretroviral resistance, a new U.S. study may put those fears to rest. The study of 760 patients enrolled in the seminal HIV Outpatient Study found that earlier therapy does not increase a patient's resistance risk. In fact, the higher a patient's CD4+ cell count was when she or he started treatment, the less likely drug resistance mutations were to develop. The study was published on May 25 in the online edition of JAIDS. (Study abstract from JAIDS)


Didanosine Labeling Updated With New Drug Interaction Warnings, Other Revisions
The U.S. Food and Drug Administration recently approved new labeling for didanosine (ddI, Videx) EC capsules and pediatric powder. Revisions were made to a number of sections, including warnings about potential drug-drug interactions. Modifications were also made in areas dealing with dosage adjustments and possible adverse events. (Announcement from the U.S. Food and Drug Administration)


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  HIV TRANSMISSION & TESTING

Young MSM Bear Brunt of Climbing HIV Incidence in U.S., CDC Reports
There may be no starker example of the failures of sex education, HIV prevention and HIV testing efforts in the U.S. than the current state of the epidemic among young men who have sex with men (MSM). Given the devastating impact of HIV on the MSM community in the 1980s and 1990s, the latest statistics from the U.S. Centers for Disease Control and Prevention (CDC) are even more disturbing: While HIV incidence appears to be dropping within many vulnerable populations, among MSM age 13 to 24 -- especially MSM of color -- incidence rates are climbing. In a recent fact sheet, the CDC explains the disturbing numbers and offers recommendations on how to turn the tide. (Fact sheet from the U.S. Centers for Disease Control and Prevention)

To learn more about HIV prevention research and programs specifically focused on youth, browse The Body PRO's collection of resources on youth HIV education and prevention.


Drug Used After Transplants May Increase Power of Some Vaccines, Research Suggests
Could an immunosuppressant act as a vaccine booster? Researchers at the Emory Vaccine Center have found that rapamycin (Rapamune), which is administered to patients following organ transplants, can stimulate the formation of memory T cells. The Emory team believes rapamycin could be given along with a vaccine to make the vaccine more potent -- and that some HIV vaccines currently in development may particularly benefit. (Letter summary from Nature)


HIV Testing Happens Too Late Too Often in U.S., Report Says
Too many people in the U.S. -- particularly men, older people and people of color -- are diagnosed with HIV when their disease has already reached an advanced state, says a new report from the U.S. Centers for Disease Control and Prevention (CDC). The CDC analyzed individuals who tested positive between 1996 and 2005 in 34 states. They discovered that approximately 38% were diagnosed with AIDS within a year of testing positive for HIV. The CDC noted that such late HIV diagnoses not only put those patients' health at risk, but also facilitates further transmission, since those who are unaware of their status are less likely to take steps that would prevent transmission. The CDC urged full implementation its 2006 recommendation to routinely screen all people ages 13 to 64 for HIV in the U.S. (Report from the U.S. Centers for Disease Control and Prevention)


Study Confirms International Outbreak of Sexually Transmitted HCV Among HIV-Infected MSM
The latest warning against serosorting has just emerged: Outbreaks of hepatitis C (HCV) are occurring among HIV-infected men who have sex with men (MSM) in Europe and Australia, according to a study published in the May 2009 issue of Gastroenterology. The researchers determined that 84% of the men had a strain of HCV that was closely related to that found in another study participant, and that the strain was primarily being transmitted through unprotected anal intercourse in which the lining of the rectum was damaged. As a result, the researchers recommend that all HIV-infected MSM receive annual HCV screening, and that at-risk patients receive hepatitis prevention education. (Study abstract from Gastroenterology)


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  HIV IN THE NEWS

Federal Appeals Court Rejects Lawsuit Against Abbott Over Ritonavir Price Hike
Abbott Laboratories was not taking advantage of its monopoly on antiretroviral boosters to unfairly raise the price of ritonavir (Norvir), a U.S. federal appeals court has ruled. Abbott quadrupled the cost of ritonavir in 2003, setting off a wave of protests and a series of lawsuits. Abbott reached a US$10 million settlement on one lawsuit last year, and additional lawsuits are still making their way through the court system. This decision, however, seriously hurts one of the major arguments against the price hike. (Article from Bloomberg)

For an analysis of what this latest news means, read this blog post by business journalist Jim Edwards. You can also read the U.S. federal appeals court's official decision online (PDF).


U.S. Officials Formally Propose Eliminating Ban on HIV-Infected Visitors
Could the U.S. finally be on the verge of eliminating its ban on HIV-infected visitors? The government has formally proposed that HIV be removed from an official list of communicable diseases that a non-citizen is forbidden from having if he or she wants to enter the U.S., whether as a visitor or an immigrant. Because of standard rules requiring public comment and revision periods, it may be months before the rule change is officially on the books, but that the proposal itself has actually been made suggests that the homestretch has begun. (Article from TheBody.com)

Click here to add your comment about removing the ban.


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  HIV THROUGHOUT THE WORLD

High Court Repeals Anti-Homosexuality Law in Delhi, India
Being a man who has sex with men (MSM) in Delhi, India, is no longer a crime, thanks to a new ruling by the city's High Court. On July 2 the court declared India's 149-year-old law against homosexuality "unconstitutional and arbitrary" within its area of jurisdiction, which is home to about 16 million people. The decision thrilled HIV advocates and health care workers who feel that stigma against homosexuality has seriously impaired HIV prevention efforts. The International AIDS Society (IAS) applauded the move and urged the Indian government to take laws against homosexuality off the books nationwide. "Once discriminatory policies are abolished and stigma and discrimination are confronted, programs can be put in place to help and encourage those at high risk to stay free of HIV infection," says IAS president Julio Montaner, M.D. (Press release from the International AIDS Society)

The fact that being an MSM is a criminal act in many countries is an enormous stumbling block to HIV prevention efforts in those countries. TheBody.com spoke with HIV advocates and other health care workers from around the world and asked them what life was like for HIV-infected MSM in their country. Read or listen to the troubling responses.


Global Recession May Reverse Progress Made Against HIV in Resource-Poor Countries, Report Warns
The world's economic meltdown is threatening HIV prevention and treatment efforts in parts of the world where they are most desperately needed, UNAIDS and the World Bank warn. A new report breaks down how the global financial crisis already appears to be hurting access to antiretroviral therapy in some resource-poor countries, and how many fear that tougher times lie ahead unless more is done to shore up HIV-fighting efforts. "This is a wake-up call which shows that many of our gains in HIV prevention and treatment could unravel because of the impact of the economic crisis," warns Michel Sidibé, the executive director of UNAIDS. (Press release from UNAIDS)

The new UNAIDS/World Bank report comes just a few months after the World Bank issued its own report warning that several countries in the developing world could see severe cuts to their prevention and treatment programs as a result of the global economic crisis. "People with AIDS could be in danger of losing their place in the lifeboat," said Joy Phumaphi of the World Bank.


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Medical Review

This e-mail newsletter was reviewed for clinical accuracy by Benjamin Young, M.D., Ph.D. (Read his bio.)

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Also Worth Noting

CME/CE Central: Get the Credit You Deserve

Getting your CME/CE certificates at The Body PRO's CME/CE Central is quick and easy. Earn credit for an array of outstanding activities, including:

•  An Evaluation of Routine HIV Testing and Its Impact on HAART Initiation, by David Wohl, M.D.

•  Top 10 HIV Clinical Developments of 2008, by David Wohl, M.D.

•  New Developments in HIV/Hepatitis C Coinfection Management and Epidemiology: Highlights From ICAAC/IDSA 2008, by Daniel Fierer, M.D.

•  Evolving Options for First-Line Therapy: Highlights From ICAAC/IDSA 2008, by David Wohl, M.D.

•  Reappraising Key Issues in HIV Clinical Management: Highlights From ICAAC/IDSA 2008, by Benjamin Young, M.D., Ph.D.

•  CCR5 Antagonists and Tropism Testing in Clinical Practice, by David Hardy, M.D.

A wealth of additional activities awaits you at The Body PRO's CME/CE Central!

Activist Central

  Extend Ryan White Now!

  Sound the Alarm: HIV Is Not in Recession

  Write to District Court Judge Bradley J. Harris. He sentenced an Iowa man to 25 years in prison for not disclosing to another man he was HIV positive.

  Tell Congress to Make Health Care Reform Work for People With HIV/AIDS!