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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.

December 3, 2009

In This Newsletter:

  UPDATED CLINICAL MANAGEMENT GUIDELINES

Treatment GuidelinesU.S. DHHS HIV Treatment Guidelines Updated: Earlier HAART Initiation Recommended
Antiretroviral therapy should now be administered to all patients with a CD4+ cell count of 500 cells/mm3 or less, with even earlier treatment initiation worth considering on a case-by-case basis, according to revised antiretroviral therapy guidelines for adults and adolescents released by the U.S. Department of Health and Human Services (DHHS) on Dec. 1. An array of other changes is featured in the revised guidelines, which were last updated more than a year ago. Other highlights include the addition of raltegravir (Isentress) to the pantheon of "preferred" first-line drugs, the relegation of lopinavir/ritonavir (Kaletra) from a "preferred" to an "alternative" first-line antiretroviral (except among pregnant women), and clarifications regarding the proper use of phenotypic versus genotypic resistance testing. (Article from TheBody.com)

Stay tuned for our upcoming one-on-one interview with David Wohl, M.D., one of the physicians on the expert panel that revises the DHHS guidelines.

The revised U.S. HIV treatment guidelines provide an intriguing counterpoint to the revised European AIDS Clinical Society guidelines issued in November, which take a less-aggressive stance on the "when to start" question, but also include an extensive new section containing prevention, testing and treatment recommendations for aging-related conditions such as malignancy, cardiovascular complications and bone disorders.

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WHO Recommends More Aggressive Approach to Antiretroviral Therapy
On Nov. 30, the World Health Organization (WHO) revised its HIV/AIDS treatment guidelines for the first time since 2006. Perhaps the most noteworthy change to the guidelines, which are meant primarily for developing countries, is that the recommended threshhold for starting HIV treatment has been raised from a CD4+ cell count of 200 cells/mm3 to 350 cells/mm3. Also among the revised recommendations is a more aggressive stance on HIV treatment for pregnant women and a recommendation that countries begin phasing out stavudine (d4T, Zerit) in favor of less-toxic alternatives, specifically zidovudine (AZT, Retrovir) and tenofovir (Viread). (Article from TheBody.com)


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  HIV TREATMENT & COMPLICATIONS

Maraviroc Gets FDA Nod as First-Line Antiretroviral in U.S.
The U.S. Food and Drug Administration (FDA) has expanded the indication for maraviroc (Selzentry, Celsentri) to officially permit the use of the drug as part of an HIV-infected patient's initial antiretroviral therapy regimen. The recommended dose of the drug varies depending on the extent to which other antiretrovirals it is prescribed with inhibit or induce the CYP3A enzyme. Treatment-naive patients must still receive a tropism assay prior to commencing maraviroc to ensure their virus is CCR5-tropic. (Advisory from the U.S. Food and Drug Administration)


Overweight Patients Experience Less CD4 Gain on HAART, Study Suggests
Until the mid-1990s, encouraging HIV-infected patients to gain weight was not unusual in the U.S.: It helped protect those patients against the destructive effects of wasting syndrome and other complications related to advanced HIV disease. But today, in areas where patients have access to HAART, those extra pounds may reduce the CD4+ cell count increase that HAART initiation generally provides, a new study suggests. (Interview and podcast from TheBody.com)


Protease Inhibitors May Reduce HPV-Related Anal Dysplasia Risk Among MSM
Can protease inhibitors protect an individual from developing anal dysplasia attributed to human papillomavirus (HPV) infection? A study from Spain involving HIV-infected men who have sex with men (MSM) suggests the answer may be yes: MSM who had used protease inhibitors were far less likely to develop HPV-associated anal dysplasia -- and, in fact, were less likely to have HPV at all. (Study summary from aidsmap.com)


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  DRUG-DRUG INTERACTIONS

Drug Interaction Warning: Etravirine and Clopidogrel
Concomitant use of etravirine (TMC125, Intelence) and the anti-clotting agent clopidogrel (Plavix) may reduce the effectiveness of clopidogrel, according to a new warning issued by the U.S. Food and Drug Administration. The note regarding etravirine was part of a broader alert regarding drugs that are potent inhibitors of the CYP2C19 enzyme, which may have similar interactions with clopidogrel. (Advisory from the U.S. Food and Drug Administration)

New Interaction Warnings Issued for Ritonavir
Health care providers should generally avoid the coadministration of ritonavir (Norvir) with the asthma inhaler salmeterol (Serevent) or salmeterol/fluticasone propionate (Advair), as well as sildenafil (Revatio) when used as a pulmonary arterial hypertension treatment, according to newly updated ritonavir product labeling. The warning states that concurrent use of ritonavir with one of these drugs could result in a serious, potentially life-threatening reaction. (Advisory from the U.S. Food and Drug Administration)

A quick reminder: If you have patients who are taking (or will soon begin taking) ritonavir, be sure to ask them whether they are taking any erectile dysfunction drugs. In addition to being the active ingredient in Revatio, sildenafil is also the active ingredient in Viagra; all of the drugs in that class (including tadalafil [Cialis] and vardenafil [Levitra]) are known to potentially interact with ritonavir, warranting a dose reduction of the erectile dysfunction drug.


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  HIV IN THE NEWS

International AIDS Conference Will Finally Return to U.S. in 2012
The International AIDS Society has announced that the 2012 International AIDS Conference, the world's largest conference on HIV/AIDS, will be held in Washington, D.C. This follows President Obama's announcement in October that the U.S.'s decades-old ban on international travelers with HIV would end in January 2010. The International AIDS Conference has not been held in the U.S. since 1990. (Press release from the International AIDS Society)

The big announcement came during a 30-minute talk by various Obama administration officials, including Secretary of State Hillary Clinton, in which they walked through the government's current efforts to fight HIV/AIDS in the U.S. and abroad, and discussed the long road ahead. You can watch a video of that discussion at TheBody.com.


Mismanagement of D.C.'s HIV/AIDS Services May Cost City Its HIV Housing Money
U.S. housing authorities have threatened to cut off the flow of federal housing assistance for Washington, D.C.'s HIV-infected residents next year if the city doesn't clean up its act. The threat comes in response to recent reports exposing gross mismanagement of HIV/AIDS funds by the city's HIV/AIDS administration. (Article from the U.S. Centers for Disease Control and Prevention)

This video report series from the Washington Post helped expose the financial mismanagement of HIV/AIDS services in the U.S. capital city.


HIV Advocates to U.S.: Send Your Money South!
"We have to have funding that follows the epidemic," said southern U.S. HIV/AIDS advocate Patrick Packer. Packer was the moderator for a White House-sponsored HIV/AIDS community discussion that took place recently in Mississippi. At the meeting, some advocates argued that federal HIV/AIDS assistance is not keeping up with galloping infection rates and a growing gap in antiretroviral treatment coverage for low-income people. (Article from Housing Works)

Mississippi's HIV/AIDS community discussion is one of the last in a nationwide series of meetings being held by the White House Office of National AIDS Policy as part of its effort to get feedback on the creation of a national plan to fight HIV. The final meetings will take place in New York City on Dec. 4 and Caguas, Puerto Rico, on Dec. 14. If you live in either of those locations, register for the meeting and make your voice heard! You can also view videos of past meetings.


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  THE PATIENT PERSPECTIVE

Everything Your Patients Need to Know About Seasonal Flu -- and How to Prevent It
Thanks to the H1N1 virus, coping with flu season has been top-of-mind more than usual this year for the general population -- and particularly so for those infected with HIV and others in high-risk groups. But many patients still don't know the answers to some basic questions: What exactly is the flu, why are some people at higher risk, and what can people with HIV do to avoid it? This informative patient-friendly overview has the answers. (Article from Project Inform)

TheBodyPRO.com has plenty of additional information on seasonal influenza and flu vaccination. Be sure also to check out our regularly updated index of articles and resources on H1N1.


Video Central at TheBody.com: The Rewards of Speaking in Public About Life With HIV
Can disclosing one's HIV status feel as liberating as coming out of the closet about being gay? That's been 24-year-old Tyler's experience. Tyler, who was diagnosed less than four years ago, says that having a good support system was critical to having the strength to tell his story. His interview is one of three featured in TheBody.com's newest collection of first-person videos from The Positive Project. (Part of Video Central at TheBody.com)


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  HIV/STD TRANSMISSION & TESTING

Scant Access to Safe Lubricants Is an HIV Prevention Issue for MSM in Africa
While international microbicide advocates continue to work toward an acceptable topical HIV prevention method, most of Africa's men who have sex with men (MSM) lack access to basic, water-based lubricants for anal sex, points out HIV/AIDS advocate Jim Pickett. As a result, he says, many African MSM resort to using no lubricant whatsoever, which increases the risks of anal sex. (Article from Test Positive Aware Network)


Why Are MSM at Risk for HIV? Look Beyond the Obvious, Study Suggests
Can poverty, homophobia and HIV stigma be what's truly driving the HIV epidemic among men who have sex with men (MSM) in the U.S.? That's the assertion of Trista Bingham, M.P.H., Ph.D. In this article, she discusses the results of a recent study on HIV risk among MSM in Los Angeles, Calif. (Article from Gay Men's Health Crisis)


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  HIV/AIDS IN THE DEVELOPING WORLD

To Prevent HIV, Test and Treat Everybody, IAS Urges
The provision of effective antiretroviral therapy doesn't just help those who are HIV infected, notes the International AIDS Society (IAS). Universal HIV testing followed by early treatment initiation for all who test positive could be a powerful (and cost-effective) HIV prevention tool, with the potential to significantly curb the worldwide pandemic, the IAS says. (Press release from the International AIDS Society)


Don't Blame Your Lack of HIV/AIDS Funding on the Global Recession, Group Tells Rich Countries
Wealthy nations have recently reneged on commitments to fund lifesaving HIV/AIDS services in resource-limited countries. The global financial meltdown has been named as a chief culprit, but officials at Doctors Without Borders aren't settling for that excuse. (Article from the U.S. Centers for Disease Control and Prevention)

Doctors Without Borders issued a full report on the global HIV/AIDS funding crisis, which is available online as a PDF.


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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.)

Also Worth Noting

Upcoming HIV/AIDS Meetings

December 3-5, 2009
San Francisco, Calif.
The Medical Management of HIV/AIDS

January 21-24, 2010
Atlanta, Ga.
2010 National African American MSM Leadership Conference on HIV/AIDS and Other Health Disparities

View more upcoming HIV/AIDS meetings >>

U.S. HIV/AIDS Plan:
Be Part of a White House-Sponsored Talk Near You!

The White House Office of National AIDS Policy (ONAP) has launched a series of HIV/AIDS community discussions throughout the U.S., with the aim of involving health care professionals, patients and advocates in the effort to craft the country's first national policy to fight HIV/AIDS.

The final meetings will take place in New York City on Dec. 4 and Caguas, Puerto Rico, on Dec. 14.

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 the following activities:

•  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.