September 21, 2009

• Research from HIV Meetings
• HIV Treatment & Complications

• HIV in the News
• HIV Transmission & Testing

The research summaries in this section are highlights from The Body PRO's coverage of the 49th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC 2009). More coverage of this conference will be added to The Body PRO in the days to come; visit our ICAAC 2009 home page for the latest!


Virologic Suppression Is Less Likely Among Antiretroviral-Experienced, African-American Women. But Why?
A GRACE study analysis presented at ICAAC 2009 reveals that, among treatment-experienced patients, African-American women are significantly less likely than their white counterparts to achieve an undetectable viral load while on HIV treatment. Lead author Kimberly Smith, M.D., M.P.H., points to two possible explanations: Black women were more likely to drop out of the study entirely, and those who remained were less likely to adhere to their therapy. "The priorities in your life are not just about getting your pills swallowed," Smith explains. "It's about making sure you have food on the table, making sure you've got a place to live, taking care of your kids." (From The Body PRO's coverage of ICAAC 2009)


Raltegravir Exhibits More Lipid-Friendly Profile Than Efavirenz, STARTMRK Subanalysis Finds
Raltegravir (Isentress) has a more modest impact on lipid and glucose levels than efavirenz (Sustiva, Stocrin) in treatment-naive patients, according to a subanalysis of 48-week results from the STARTMRK trial that was presented at ICAAC 2009. The subanalysis found that patients experienced increases in cholesterol (total, HDL and LDL) and glucose while on either drug, and experienced an increase in triglyceride levels on efavirenz but not raltegravir. In all cases, efavirenz, which is a component of the brand-name combination drug Atripla, was found to increase lipid levels significantly more than raltegravir (although the difference in total cholesterol/HDL ratio was not statistically significant). In this interview, Edwin DeJesus, M.D., the lead author of the subanalysis, discusses the findings. (From The Body PRO's coverage of ICAAC 2009)

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H1N1 Vaccine Update: Deployment Timetable Accelerates; Only One Vaccination Needed
Good news has arrived on the H1N1 ("swine flu") prevention front: First, a vaccine is now expected to be made available in the U.S. by the first week in October. Second, only a single dose will be required rather than the two that had initially been expected. Both developments are welcome in the U.S., where the H1N1 (swine flu) epidemic is rapidly heating up once again. Health care workers and HIV-infected individuals are included among the "high-risk groups" that are to be given priority to receive the H1N1 vaccine when it becomes available in the U.S. (Article from kaisernetwork.org)

For more information on H1N1, check out our patient-friendly interview with Joel Gallant, M.D., and browse through our collection of articles.

For details on the development of in-depth H1N1 protocols for use in U.S. HIV health care settings, read this transcript of an AIDS.gov Web-based seminar featuring a panel of government researchers, clinicians and health center administrators.


D.C.-Area HIV Clinic Gears Up for Fall -- and the Flu
In the United States' capital city -- where the HIV rate is at least 3% -- HIV care providers are planning ahead for a tough flu season. According to news reports, Washington, D.C.'s Whitman-Walker Clinic, where half of the clientele is HIV infected, already has a stockpile of H1N1 testing kits and medications -- and when a vaccine becomes available, clinicians will offer that as well, of course. One of Whitman-Walker's HIV-infected clients died due to H1N1 this summer, so despite the fact that no link has been found between HIV and H1N1 mortality risk, the clinic has decided not to take any chances. (Article from kaisernetwork.org)


When to Initiate Antiretroviral Therapy: A Panel of Top Clinicians and Community Members Weighs In
When is the best time to initiate antiretroviral therapy? Official U.S. DHHS guidelines change often, and recent research has led even the most knowledgeable clinicians to revisit the question. In an attempt to gauge the current temperature with respect to treatment initiation, two prominent HIV/AIDS organizations brought together 10 clinicians and advocates, including L. Jeannine Bookhardt-Murray, M.D., Sheldon Brown, M.D., Jerome Ernst, M.D., Roy Gulick, M.D., M.P.H., John Phair, M.D., and Rona Vail, M.D. The group discussed what it feels the next iteration of the DHHS guidelines should recommend -- and what its hopes are for the future of antiretroviral treatment. (Article from ACRIA and GMHC)


Study Suggests Some Patients With Renal Dysfunction Can Still Receive Tenofovir
Tenofovir (Viread) may not be quite so dangerous for people with existing renal dysfunction as had been feared, according to a small analysis of HIV Outpatient Study participants that was published in AIDS Patient Care and STDs. Research has previously shown that tenofovir, a component of the brand-name drugs Atripla and Truvada, can sometimes cause a reduction in kidney function. However, the 19-patient study found that tenofovir only worsened kidney disease stage in five patients (approximately 25% of the study subjects), suggesting that although tenofovir does cause renal toxicity, tenofovir administration could still be considered if a patient's antiretroviral options are limited and his or her kidney function is closely monitored. (Article from the International AIDS Society)


A Patient-Friendly Overview of Body Fat Complications and HIV
Body shape changes are among the most frustrating complications for HIV-infected patients. Though they may no longer be top-of-mind concerns for some clinicians, the etiology of this gain or loss of fat is not yet completely understood, and few treatments are available for HIV-infected patients who experience them. Nelson Vergel, a longtime HIV advocate and a long-term HIV survivor himself, has spent approximately the last 15 years helping HIV-infected patients cope with this issue. In this patient-friendly article, Vergel breaks down the different body shape changes some individuals experience, and explains some of the options for treatment. (Article from ACRIA and GMHC)


U.S. Updates Pediatric Guidelines for HIV Prevention, Treatment of Opportunistic Infections
Newly revised guidelines on the prevention and treatment of opportunistic infections in children have been released by the U.S. National Institutes of Health and the U.S. Centers for Disease Control and Prevention. This is the first time the guidelines have been updated in approximately five years. (Press release from the U.S. National Institutes of Health)

The full guidelines appear in the Sept. 4 issue of the Morbidity and Mortality Weekly Report and can be downloaded in PDF format.

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New "Report Card" Finds HIV Pharmaceutical Industry Doesn't Make the Grade
Abbott Laboratories: F. Hoffman-La Roche Ltd.: D. Boehringer Ingelheim: D+. If the nine major HIV pharmaceutical companies were in school, most would probably be in detention, according to a new "report card" issued by the AIDS Treatment Activists Coalition (ATAC). ATAC graded the drug companies in five different categories, including fair pricing and drug development. A few fared rather well -- Merck & Co. and Tibotec Therapeutics both got a B overall -- but most did not. In this one-on-one interview, we discuss the report with longtime HIV/AIDS journalist and activist Bob Huff, a member of ATAC's board of directors. (Interview and podcast from TheBody.com)

To Combat HIV, We Must First Respect HIV-Infected People's Human Rights, Legal Expert Says
"Nearly three decades after the identification of the first cases of AIDS, our national dialogue continues to fail those living with HIV by failing to put human rights at the center of AIDS prevention and treatment," laments HIV legal expert Catherine Hanssens. In this article on TheBody.com (The Body PRO's sister site), Hanssens explains why fighting HIV stigma is such a critical piece of the HIV prevention puzzle -- and why any policy that is not built around respecting the rights of HIV-infected people will ultimately fail. (Blog entry from TheBody.com)


Worldwide, Health Care Workers Are Often Sources of HIV Stigma and Discrimination, Report Says
Combating HIV stigma is no easy feat. More than 25 years into the HIV pandemic, it's a problem that is still prevalent around the world. And sadly, health care settings worldwide are rife with HIV stigma and discrimination, as a recent report outlines in vivid detail. The report urges clinics, hospitals and other settings to spread more knowledge and combat ignorance among their own staff, particularly in developing countries. (Article from TheBody.com)

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Maraviroc Levels in Female Genital Tract May Support Its Use as HIV Prophylaxis
The CCR5 antagonist maraviroc (Selzentry, Celsentri) quickly achieves greater levels of exposure in the female genital tract than in blood plasma, according to the results of a seven-day study involving 12 HIV-uninfected women. The findings support the notion that maraviroc may be particularly well suited for development as an HIV prophylaxis medication, the researchers write in their paper, which was published in the August 2009 issue of JAIDS. (Study abstract from JAIDS)


Genital Ulcers May Flare Up After Women Start Antiretroviral Treatment, Study Warns
HIV-infected women may experience a genital ulcer outbreak upon initiation of antiretroviral therapy, potentially increasing their HIV infectiousness, a Kenyan study suggests. Genital ulcer disease is often associated with sexually transmitted diseases such as genital herpes or syphilis. "We found that genital ulcer disease prevalence was relatively high at baseline (almost 10%), increased almost two-fold in the first month, then returned to baseline thereafter," the researchers wrote in the online edition of JAIDS, where the article was published ahead of print on July 30. They recommend risk-reduction counseling for all women who have a history of genital ulcer disease and are commencing antiretroviral therapy. (Article from aidsmap.com)


HIV Impairs Movement of Immune Cells, Facilitating Infection, Researchers Find
HIV is able to "cripple" immune cells, thereby hindering the body's ability to mount a defense against it, German researchers have discovered. The key is a protein within HIV known as Nef. The researchers observed as Nef short-circuited an immune cell's ability to move, making it much more difficult for the cell to come into contact with other cells that may have been able to help it mount a defense against HIV. (Press release from Heidelberg University Hospital)


Annual HIV Testing May Soon Be Covered by Medicare
Medicare still does not cover the cost of an HIV test, but that may soon change. The U.S. health department has formally proposed that Medicare coverage be expanded to include HIV testing for any Medicare beneficiaries who request it. Free annual HIV testing would also be provided to "high-risk" individuals, including men who have sex with men, men and women who have unprotected sex with more than one person, injection drug users and sex workers. (Press release from the U.S. Department of Health and Human Services)

The health department is accepting comments about this proposed rule change until Oct. 9. To share your support, visit the official Web page of the proposal and click on the little "comment" icon inconveniently located after the headline "Proposed Decision Memo for Screening for the Human Immunodeficiency Virus (HIV) Infection (CAG-00409N)."

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