•  BREAKING RESEARCH FROM CROI 2006

Visit The Body Pro for Complete Coverage of CROI 2006
The Body Pro is your go-to resource for in-depth coverage of the 13th Conference on Retroviruses and Opportunistic Infections (CROI 2006), the most pivotal HIV-related clinical conference of the year, which took place Feb. 5-8 in Denver, Colo. Read highlights from the conference throughout this newsletter, or click on the headline above to visit our CROI 2006 home page for additional summaries and critical analyses. Check back often in the days and weeks to come; more coverage will arrive, including an overview of the antiretroviral pipeline, an examination of new developments on metabolic complications, and an analysis of how the end of the SMART study will impact patient and provider decisions regarding structured HIV treatment interruptions. Click Here


Podcasts and Interviews: Top Clinicians Discuss CROI Highlights
The Body Pro asked 18 HIV clinicians, researchers and advocates -- including Cal Cohen, M.D., Roy Gulick, M.D., and Mark Wainberg, Ph.D. -- to share their thoughts on the same question: What do you feel is the most important news to come out of CROI 2006? Download podcasts or read the transcripts of what they had to say! Click Here

•  ANTIRETROVIRALS IN DEVELOPMENT

CROI 2006: Integrase Inhibitors Appear "Surprisingly Strong" in Treatment-Experienced Patients
The prospects for development of new antiretroviral options for heavily treatment-experienced patients appeared to grow significantly brighter at CROI 2006, where studies on a pair of experimental integrase inhibitors showed strong activity in multidrug-resistant patients. A dose-ranging study of Merck's pipeline drug MK-0518, when taken along with an optimized background regimen in patients with resistance to all three major antiretroviral classes, found a viral load reduction to undetectable levels in up to 72% of treatment-experienced patients within 16 weeks. Meanwhile, a 10-day monotherapy trial involving Gilead Sciences, Inc.'s GS-9137 was conducted on 40 HIV-infected patients, half of whom were treatment experienced. Patients receiving GS-9137 experienced up to a 2 log decrease in viral load in the most effective dosing arm. Click Here

Buzz over the positive integrase inhibitor findings quickly spread through the conference; for many researchers, the studies were the highlight of CROI, particularly when considered alongside positive results for another experimental drug, the maturation inhibitor PA-457. In an interview with The Body Pro, Roy Gulick, M.D., noted, "The good thing for treatment-experienced patients -- even people that have failed all the drugs we have today -- is that all these drugs with new mechanisms of action show activity in that group." Paul Sax, M.D., summed up the buoyant mood: "We had a sense of a very rich pipeline in the past couple of years, but this year you're starting to see actual results in HIV-positive people, so that's why it's exciting."


New Compound Shows Unique Antiretroviral Potential in Lab Tests
CSA-54, one of a family of compounds known as Ceragenins, is generating cautious optimism among some researchers for an apparent ability to inhibit HIV infection of CD4+ cells. Early in vitro tests have shown that the compound completely blocked HIV's ability to target CD4+ cells for infection, according to a release by Ceragenix, the company that has licensed the drug. A researcher involved in the study said the resuls indicate that CSA-54 directly attacks the viral membrane of HIV, interfering with the virus’s ability to interact with target CD4+ cells. Since the viral membrane of HIV remains unchanged even when the virus mutates, the compound is likely to be effective against all HIV strains, the researcher said. Click Here

•  HIV TREATMENT & PATIENT CARE

CROI 2006: Earlier HAART Initiation May Reduce Risk of Kidney Failure, Neuropathy, Lipoatrophy
HIV-infected patients who begin continuous HAART with a CD4+ cell count above 350 have a lower risk of developing kidney failure, peripheral neuropathy and lipoatrophy, according to the results of a large U.S. study presented at CROI 2006. The study found that patients who began treatment with a CD4+ cell count higher than 350 were 60% less likely to develop kidney failure, 30% less likely to develop peripheral neuropathy and 60% less likely to develop lipoatrophy, compared with patients who had a CD4+ cell count of less than 200 at the time of treatment initiation. Click Here


CROI 2006: Acid-Reducing Agents Reduce Blood Levels of Atazanavir, but Not Lopinavir/Ritonavir
H₂ blockers and proton pump inhibitors are widely used by HIV-infected individuals, raising concerns about the potential for interactions with popular protease inhibitors. A study presented at CROI 2006 by researchers from Abbott Laboratories evaluated the effect of the H₂ blocker ranitidine (Tritec, Zantac) and the proton pump inhibitor omeprazole (Prilosec) on the pharmacokinetics of the new tablet formulation of lopinavir/ritonavir (Kaletra) and boosted atazanavir (Reyataz). Encouragingly, the results showed no evidence of drug-drug interaction with lopinavir/ritonavir tablets and acid-reducing agents. However, the agents’ interaction with atazanavir was confirmed: they lowered levels of ritonavir-boosted atazanavir by 48% to 62%. Paul Sax, M.D., reports for The Body Pro. Click Here


CROI 2006: Capsaicin Patch May Relieve Peripheral Neuropathy Pain
A patch containing capsaicin -- the same chemical that gives chili peppers their heat -- can relieve some of the pain caused by peripheral neuropathy for as long as three months, according to a 307-patient study conducted by U.S. researchers and presented at CROI 2006. The study found that after administering a single, 30- to 90-minute application of the capsaicin-containing patch, HIV-infected patients with neuropathy reported an average of 23% less pain -- and that the pain relief persisted for as long as 12 weeks. The primary adverse effects of the patch were mild to moderate, transient application site reactions, including a burning sensation and reddening. Click Here


Prevalence of Multidrug-Resistant HIV Will Not Increase in United Kingdom Through 2010, Statistical Model Suggests
A theoretical model constructed by a British researcher has found that the prevalence of multidrug-resistant HIV in the United Kingdom is unlikely to increase within the next five years, and may even decrease -- at least among among gay, HIV-infected men with a moderate viral load. Jeff Burack, M.D., reports for The Body Pro from CROI 2006. Click Here

•  HIV TRANSMISSION & TESTING

New Report Notes Huge Racial Gap in U.S. HIV Diagnoses
It is well understood that HIV diagnoses are occurring far more rapidly among African Americans than any other ethnic group in the United States. But a new report from the U.S. Centers for Disease Control and Prevention shows just how stark this racial divide really is: Of the estimated 157,252 HIV cases diagnosed in 33 U.S. states from 2001 to 2004, the number of cases and rate of diagnoses were higher among African Americans than all other racial or ethnic groups combined. The report urges the creation of a nationwide program that links government agencies with community groups to reduce the huge racial disparity. Click Here


CROI 2006: Male Circumcision May Reduce Risk of HIV Transmission to Women
Male circumcision might reduce the risk of HIV-infected men transmitting HIV to their female partners, according to a relatively small study conducted in Uganda and presented at CROI 2006. The study, which involved a review of medical records of couples in which the man was HIV infected and the woman was not, found that male circumcision reduced the rate of HIV transmission to the woman by 30%, and also appeared to reduce the rate of infection with trichomonas and bacterial vaginosis. The study findings come on the heels of research released last year that suggested male circumcision could reduce the risk of female-to-male transmission by 60%. Click Here

These new circumcision findings raised quite a stir among researchers at CROI 2006. "If we had a vaccine that was [this] effective, we would be jumping up and down," said Pablo Tebas, M.D., in an interview with The Body Pro. However, Ruth Dickover, M.D., pointed out that the study was short-term; it is currently unknown how much of a difference circumcision really makes for HIV risk over the course of a lifetime.


CROI 2006: Primary HIV Testing Can Be Useful for HIV Prevention -- And, Extremely Rarely, HIV Treatment
New research presented at CROI 2006 lends support to an HIV testing method that has gained steam in recent years: A procedure that can identify cases of primary or acute HIV infection. This testing method is being hailed as a key tool in public health efforts to stem HIV transmission, since individuals are often most infectious during the primary stage of infection. But there is another, lesser-known reason why primary HIV screening can come in handy: In extremely rare cases, it may alert physicians to the presence of advanced HIV disease in a patient who never developed antibodies to the virus, allowing that person to receive antiretroviral treatment he or she may otherwise never have gotten. Tim Wilkin, M.D., reports for The Body Pro. Click Here

•  HIV OUTSIDE THE UNITED STATES

HIV in Mexico: A Battle Against Culture, Not Just a Virus
Machismo and homophobia are deeply engrained in Mexico's culture -- and, many believe, are making the country's HIV epidemic worse. Mexico's National Center for the Prevention and Control of HIV/AIDS has launched efforts to combat these prejudices and raise public awareness about HIV. A recent survey conducted in Mexico found that 57% of respondents said they would "not want to live in the same house as someone with AIDS," and 66% of respondents said they would not want to reside with someone who identifies as gay. Click Here


China Releases First Regulations Calling for Free HIV Testing, Treatment
Years into China's growing HIV epidemic, the country's State Council -- a group of top government ministers -- has released its first comprehensive regulations on HIV prevention and treatment. The regulations require local governments to provide free, confidential HIV testing and antiretrovirals to many residents, outlaw discrimination against HIV-infected people and guarantee HIV-infected residents the right to health care, employment, marriage and education. Not all AIDS advocates in China are excited about the regulations, however: "The problem in China is not the lack of laws but whether these laws will be implemented by local governments," one leading activist noted. Click Here


CROI 2006: Nevirapine Cuts Mother-to-Child HIV Transmission Risk in Repeat Pregnancies, Study Finds
Nevirapine (Viramune) reduces the risk of mother-to-child HIV transmission even over multiple pregnancies, according to a study conducted in Uganda and presented at CROI 2006. The study's lead author said the findings contrast with earlier studies that suggested HIV might develop resistance to nevirapine after its first use to prevent vertical HIV transmission, which would make the drug less effective when used in subsequent pregnancies. Click Here


Multivitamin for Pregnant HIV-Infected Women May Aid Children's Motor Development
In wealthy countries, where quality medical care is often within easy reach, multivitamins are often taken for granted, and their potential impact on patient health may receive little attention. In the developing world, however, a daily multivitamin can play a pivotal role in HIV treatment -- especially for pregnant women. A study published two years ago found that multivitamins could help maintain the health of HIV-infected pregnant women and reduce their risk of giving birth to premature or underweight babies. Now, a team of researchers has found that a multivitamin also cuts the risk that a baby born to an HIV-infected woman will experience motor development problems. Click Here