•  HIV TREATMENT & PATIENT CARE

Initiating HIV Therapy: An Overview
As our knowledge of antiretroviral therapy continues to improve and new antiretroviral agents become available, the debate over when to initiate HAART -- and what to prescribe as a first-line regimen -- evolves with it. In this detailed online chapter of HIV InSite's Knowledge Base, two Brown University physicians review the knowledge to date on first-line treatment for HIV infection. Click Here


CROI 2006: CD4+ Cell Count Rise Often Continues for Years After Starting HIV Treatment, Studies Find
A study by Dutch researchers has found that HAART's ability to strengthen an HIV-infected patient's immune system may persist for years after treatment is initiated. The study, an analysis of long-term data from the Dutch ATHENA cohort, found that among 505 patients who had been on continuous HIV treatment for seven years, an average CD4+ cell count increase of 70 cells/mm³/year was experienced during the first three years of treatment, followed by an increase of 30 cells/mm³/year during years four and five, and an increase of 10 cells/mm³/year between years five and seven. Meanwhile, another study by Johns Hopkins University researchers found that the higher a patient's baseline CD4+ cell count when they began therapy, the higher the patient's CD4+ cell count was likely to be after five years of treatment. In this 262-patient study, patients who initiated HAART with a CD4+ cell count over 351 cells/mm³ had an average CD4+ cell count of 681 cells/mm³ after five years. By comparison, patients who started HAART with a CD4+ cell count between 201 cells/mm³ and 350 cells/mm³ had an average CD4+ cell count of 501 cells/mm³ five years later. The Dutch and U.S. studies were both presented at the 13th Conference on Retroviruses and Opportunistic Infections. Click Here


CCR5 Antagonist PRO 140 Granted Fast-Track Status by FDA
Progenics Pharmaceuticals, Inc., announced that the U.S. Food and Drug Administration (FDA) has granted fast-track status to its PRO 140, an early-stage experimental HIV antiretroviral. The drug is a humanized monoclonal antibody directed against CCR5. Positive results from a phase 1 pharmacokinetic/tolerability study of PRO 140 were presented at the 13th Conference on Retroviruses and Opportunistic Infections in February. Click Here


CROI 2006: Long Way to Go for Immune-Based Therapies and Therapeutic Vaccines
With antiretroviral therapy still holding center stage, the role for immune-based therapy in HIV therapeutics remains meek. This can be partly attributable to the complexity of the immune response and host genetics. It doesn't help that clearly useful laboratory markers for immune control of HIV replication are still lacking. As part of The Body PRO's coverage of the 13th Conference on Retroviruses and Opportunistic Infections, Keith Henry, M.D., examines the latest research in therapeutic vaccines and immune-based therapies. Click Here


NPR Interviews New Orleans Nurse Working With Uninsured, HIV-Infected Residents After Hurricane Katrina
As part of a series of spots focusing on New Orleans six months after Hurricane Katrina, National Public Radio's (NPR's) "Fresh Air" interviewed Jeanne Dumestre, a nurse practitioner working with uninsured, HIV-infected area residents. Dumestre won The Body's HIV Leadership Award in 2005 for her dedicated, passionate work for the Louisiana State University Health Science Center's HIV outpatient program. In the interview, Dumestre discusses her experiences rebuilding her life after the hurricane and getting back to work providing care to what is now a much-smaller community of HIV-infected patients in the New Orleans area. Click Here

The Body interviewed Ms. Dumestre when she was awarded with an HIV Leadership Award in early 2005, months before Katrina hit. The full text of that interview, in which Ms. Dumestre discusses her practice, her personal story and her views on the HIV epidemic, is available in this article on TheBody.com.

•  HIV/HAART-RELATED COMPLICATIONS

CROI 2006: Interventions for Fat Changes
For HIV clinicians and their patients, the confusion surrounding the management of metabolic complications has been maddening, as different studies have produced contradictory results. Thankfully, a series of studies presented at the 13th Conference on Retroviruses and Opportunistic Infections paints a more focused picture of potential roles for several experimental methods dealing with body fat: the use of glitazones, metformin and testosterone. David Wohl, M.D., reports for The Body PRO. Click Here


HAART Reduces Illness Risk Even When Treatment Is Failing
Even if a patient's HAART regimen appears to be failing, it may still provide protection against the development of AIDS-related illnesses, assert University of Michigan researchers in the March 15 issue of Clinical Infectious Diseases. The researchers' 302-patient, observational cohort study found that HAART patients with a viral load above 100,000 copies/mL and a CD4+ cell count below 50 cells/mm³ still had a lower risk of developing illnesses such as candidiasis and pneumocystis pneumonia than HIV-infected patients in the pre-HAART era who had similar levels of immunosuppression. Click Here


CROI 2006: Cardiovascular Risk and Antiretroviral Therapy
Available evidence clearly suggests that HIV-infected patients on HAART are at an increased risk for cardiovascular events -- about 16% greater risk per year on treatment, according to recent data from the landmark D:A:D study. There is good news, however: The incidence of cardiovascular events among HAART-treated patients has actually decreased during the last couple of years. Researchers believe that this recent reduction in risk is probably thanks to the use of less-toxic antiretrovirals and more aggressive management of cardiovascular risk factors, such as tobacco use, hyperlipidemia and hypertension. The Body PRO's Pablo Tebas, M.D., reviews the latest studies on this critical issue from the 13th Conference on Retroviruses and Opportunistic Infections. Click Here


Lower Death Rate Among HIV-Infected U.S. Military; Easier Health Care Access May Be Cause
The death rate among HIV-infected U.S. military beneficiaries is lower than among many other HIV-infected populations in the United States, according to a study by a team of U.S. military researchers published in the Feb. 1 issue of the Journal of Acquired Immune Deficiency Syndromes. The researchers evaluated a cohort of HIV-infected U.S. military beneficiaries, a population with open access to medical care and low drug use/hepatitis C coinfection rates, to assess causes of death and mortality rates during the pre-, early and late HAART eras. The low death rates found among this cohort "may be the result of open access to health care," the researchers write. "A shift in the causes of death toward non-HIV-related causes suggests that a more comprehensive health care approach may be needed for optimal life expectancy; this may include enhanced screening for malignancy and heart disease as well as preventive measures for liver disease and accidents." Click Here


Mortality Rates Higher Among HIV-Infected Cocaine, Heroin Users Than Non-Users, Study Finds
A new U.S. study has found stark evidence that using cocaine or heroin is associated with a reduced lifespan in HIV-infected patients. Mortality rates were found to be three times higher in HIV-infected patients than HIV-infected patients who did not use either drug, according to the three-year, 1,851-patient study. The study found that even patients who use cocaine or heroin only intermittently -- once approximately every 10 days -- are about twice as likely to die as people who do not use either drug. Researchers also noted that HIV-infected patients' risk for developing opportunistic infections was higher while they were actively using cocaine or heroin. The study results appear in the March 1 issue of the American Journal of Epidemiology. Click Here


CROI 2006: Link Between Tenofovir and Renal Toxicity Remains Tenuous, but Monitoring Is Warranted
A range of studies presented at the 13th Conference on Retroviruses and Opportunistic Infections sheds relatively little new light on a vexing question: Does tenofovir (Viread) increase a patient's risk for renal toxicity? As Ben Young, M.D., reports for The Body PRO, the largest studies indicate little to no effect, but there may be groups of patients for which renal toxicity may be a greater concern. More careful monitoring is warranted for all tenofovir patients, regardless of risk, Dr. Young adds. Click Here


Drug-Drug Interactions May Explain Tenofovir-Associated Kidney Disease, Clinicians Suggest
The concurrent use of certain antiretrovirals that increase tenofovir (Viread) concentration levels may be the cause of "tenofovir-associated" kidney disease, postulate several clinicians in the Jan. 15 issue of Clinical Infectious Diseases. Using case reports, the clinicians speculate that rare, but serious, kidney-related disorders that develop in some patients on tenofovir may originate because of multiple interactions with antiretrovirals such as ritonavir (Norvir), lopinavir/ritonavir (Kaletra), didanosine (ddI, Videx) and atazanavir (Reyataz). The researchers recommend close renal monitoring of patients who are taking tenofovir concurrently with any of these drugs. Click Here


CROI 2006: Malignancies and HIV: Studies Investigate Potential Links
Are HIV-infected people at greater risk for cancer? The answer, based on a number of studies, seems to be yes. But how much of a risk remains an open question. Researchers are attempting to determine the answer to this and a number of other important conundrums, such as whether the pathways of cancer development are similar in HIV-infected versus HIV-uninfected individuals; how HIV infection affects the risk of developing various malignancies; what the prognosis of HIV-infected patients is following the onset of various cancers; and whether HAART affects the time to onset and the severity of cancers. Mark Wainberg, Ph.D., reports for The Body Pro from the 13th Conference on Retroviruses and Opportunistic Infections. Click Here


HIV and NHL: Safe to Administer Antiretrovirals Concurrently With Chemotherapy, Study Notes
Some physicians remain reluctant to prescribe antiretrovirals to a patient with HIV and non-Hodgkin's lymphoma (NHL) out of concern that the chemotherapeutic drugs used to treat NHL might interact with some antiretrovirals. However, according to a relatively small study conducted by German researchers and published in the April 1 issue of Cancer, these fears are unfounded: HIV-infected patients with NHL who continued HAART while on chemotherapy appeared to fare just as well as HIV-uninfected patients who only received chemotherapy. Click Here


Chinese Scientists Begin Human Trial of Chemical Compound to Treat HIV/HBV
Scientists in China have commenced human trials of a chemical compound designed to treat HIV and hepatitis B (HBV). The compound, 1,5-DCQA, is extracted from a Chinese herb called Inula britannic. Initial research indicates the compound could act as an inhibitor of HIV and HBV integrase. Dong Junxing, a researcher at the Academy of Military Medical Sciences, and colleagues initially extracted anti-HBV agents from more than 100 Chinese herbs in 1993. In 1995, the researchers began to experiment on ducks and monkeys. In the monkey trials, Dong et al found that 1,5-DCQA was effective against both HIV and HBV. The scientists are now testing the compound on approximately 200 volunteers in a six-month study. Click Here

•  HIV TRANSMISSION & TESTING

Over-the-Counter HIV Rapid Tests: Issue Summary
Until recently, the idea of offering true, "at-home" HIV tests to the general public, in which a test could be conducted and results obtained without the need to mail blood samples or use trained workers and laboratory equipment, was virtually impossible from a technical standpoint. However, the advent of rapid oral HIV testing has made the prospect of over-the-counter HIV tests a highly pertinent issue -- and one that's fraught with concerns on both sides of the argument. This U.S. Food and Drug Administration report provides an in-depth review of the benefits, risks and other issues relevant to the debate over whether rapid HIV tests should be approved for over-the-counter use in the United States. Click Here


Florida: Doctors Recommend HIV Testing for Everyone
Health care professionals should incorporate routine HIV testing into their practice for all patients, experts told more than 130 physicians and health care workers who met in February in response to a community needs assessment in Sarasota, Fla. The conference was sponsored by Florida's Manatee and Sarasota county health departments. Jeffery A. Beal, M.D., clinical director of the Florida/Caribbean AIDS Education and Training Center and a University of South Florida professor, also encouraged the gathered professionals to take a patient's sexual history as a standard part of routine medical care. This would include open-ended questions that allow physicians to identify symptoms or behaviors that may put their patient at risk for HIV. "We are missing opportunities to find people early," said Beal. Click Here


Tenofovir Safe as Microbicide; Efficacy to Be Determined
Tenofovir (Viread), when administered as a gel, is safe for intravaginal use as a microbicide to prevent HIV transmission, according to a study published in the Feb. 28 online edition of AIDS. Most of the study's 84 participants (60 of whom were HIV uninfected) reported at least one adverse event, typically involving the genitourinary tract, but the majority of adverse events were mild. In addition, researchers did not detect any new resistance mutations in the 24 HIV-infected women after 14 days of use. An international series of studies is underway to examine tenofovir's efficacy as a microbicide. Click Here


Tenofovir for HIV Prevention: Worldwide Studies Seek Some Answers
With an effective HIV vaccine still just a glimmer on the horizon, and with HIV rates holding steady or growing in many parts of the world, the need for new HIV prevention methods is obvious and urgent. Over the past several years, researchers have discovered tantalizing clues that some antiretrovirals may have preventive properties in HIV-uninfected individuals. One antiretroviral in particular has received considerable attention as a possible HIV prophylactic: tenofovir (Viread). In fact, a global series of clinical trials -- including sites in Atlanta and San Francisco, which are enrolling HIV-uninfected men who have sex with men -- is now underway to assess the safety and efficacy of tenofovir for so-called "pre-exposure prophylaxis." To learn more, read this overview from the U.S. Centers for Disease Control and Prevention. Click Here

•  HIV POLICY & FUNDING IN THE UNITED STATES

Ryan White Reauthorization Bill Submitted; HIV Clinicians' Group Responds
The U.S. Senate is finally moving toward reauthorization of the Ryan White CARE Act, the law that funds medical care and treatment for more than half a million low-income or underinsured patients with HIV in the United States. On Feb. 28, a bill to reauthorize the act was submitted to the Senate -- and prominent organizations were quick to respond. The American Academy of HIV Medicine issued this statement hailing politicians' renewed effort to reauthorize the act and approved of some of its provisions. However, the group also expressed concerns about the bill's proposed changes in funding and HIV reporting methods. Click Here


HAART Cost-Effective, but Physician Reimbursements Inadequate, Study Finds
Although HAART is a cost-effective means of treating HIV-infected patients, clinicians are inadequately reimbursed for the care they provide to patients in U.S. HIV clinics, write Michael Saag, M.D., and colleagues in the April 1 issue of Clinical Infectious Diseases. Dr. Saag and colleagues at the University of Alabama-Birmingham examined annual health care expenses for 635 HIV-infected people, and found that, despite its high cost -- about $10,000 to $15,000 annually -- HAART decreased the overall cost of health care for HIV-infected patients. However, "even with 100% billing and corrections," physician reimbursements "are inadequate to support the activities of most clinics providing HIV care," the researchers conclude. Click Here

•  HIV OUTSIDE THE UNITED STATES

Determining When to Switch Regimens in a Resource-Limited Setting
In the developing world, the decision to alter a patient's HAART regimen can be even more critical than in developed countries: With antiretroviral options often limited by poor treatment access, concerns about current toxicity or virologic failure must be weighed against the risks of new toxicities, cost and unnecessarily restricting a patient's future treatment options. One of the most vexing questions in treatment switching is: What type of measurement is most reliable in gauging whether a patient's HAART regimen should be changed? Bob Huff examines the issue in this article. Click Here


Male Circumcision Makes a Comeback in Swaziland
Male circumcision has recently gained high regard in Swaziland, based on the results of the first controlled study to show that circumcised men are less likely to contract HIV during unprotected sex than uncircumcised men. The findings, which were first published in 2005, quickly filtered into Swazi media. In the Swazi capital of Mbabane, men eager to undergo the procedure almost rioted at an overbooked clinic where circumcisions are performed. "There was a stampede," said Dr. Mark Mills, administrator at the private Mbabane Clinic. "There is not a family in Swaziland unaffected by HIV, and people are desperate." At 40%, Swaziland has the world's highest adult HIV prevalence rate, and one of the world's lowest circumcision rates. Click Here


Twelve Countries to Impose Tax on Airline Tickets to Fight HIV, TB, Malaria
Twelve nations in Europe, South America, Africa and the Middle East have agreed to join France in imposing a tax on airline tickets to help fund global programs to fight HIV, tuberculosis (TB) and malaria. At the end of a two-day international conference of 95 countries in Paris, an additional 25 countries declined to impose the tax but pledged to contribute funds to a central account created by the 13 countries that have now agreed to the tax. French President Jacques Chirac called on developed countries to impose the tax, which France plans to implement in July. The French Parliament in January passed a measure that will add a tax of up to $47 for travelers departing from French airports. The other 12 countries -- Brazil, Britain, Chile, Congo, Cyprus, Ivory Coast, Jordan, Luxembourg, Madagascar, Mauritius, Nicaragua and Norway -- that agreed to impose the tax will individually decide on tax amounts. Click Here


Africa Struggles to Spend AIDS Billions
The massive surge in spending to combat Africa's HIV epidemic is often bottlenecked by disorganized government departments, fledgling community groups and unstable health care systems, aid agency leaders say. Mozambican officials estimate that only a fraction of the 70,000 HIV-infected children eligible for antiretroviral treatment will receive it this year due to a shortage of health care professionals. Health departments in hard-hit South Africa report being unable to spend their AIDS budgets, while in Nigeria, bureaucracy has been blamed for questionable data and missed treatment goals. "We all need to begin thinking out of the box," UNAIDS Executive Director Peter Piot said during a recent inspection trip to Tanzania, after being asked why cash was not reaching community groups. Click Here