•  HIV TREATMENT & PATIENT CARE

Pocket Guide to Adult HIV Treatment Is Updated for 2006 (PDF)
Need a handy guide to HIV disease management? The Pocket Guide to Adult HIV/AIDS Treatment, written by John G. Bartlett, M.D., of the Johns Hopkins University School of Medicine, is a quick reference for clinicians seeking information on antiretrovirals, HIV treatment strategies, opportunistic infections and other issues pertaining to the management of HIV-infected patients. A PDF of the updated, 2006 edition of the guide is now available. Click Here


Intermittent Treatment-Interruption Arm of Major African Study Is Halted
It was only a few months ago that enrollment in the SMART study was stopped, generating a flurry of new debate over the future of structured treatment interruptions. Now, the treatment-interruption arm of a second major HIV treatment trial, DART (Development of Anti-Retroviral Therapy in Africa), has also met a premature end. The DART study is different from SMART in a number of important ways: Unlike SMART, DART was not designed specifically to weigh the benefits of treatment interruption against continuous therapy; the interruption strategy used in DART involved fixed cycles of 12 weeks on followed by 12 weeks off therapy, whereas SMART was CD4+ cell-count guided; and DART's patient population is African, whereas SMART enrolled patients from 33 countries. Nonetheless, the cessation of the treatment-interruption arm of the DART study is based on findings similar to those that crippled the SMART study: patients taking intermittent treatment interruptions were significantly more likely to experience an HIV-related adverse event (8.6 events per 100 patient years) than patients on continuous therapy (2.0 events per 100 patient years). The investigators specifically stated that intermittent treatment interruptions should not be recommended for patients with a pre-treatment CD4+ cell count below 200 or patients with a history of multiple HIV-related adverse events. Click Here


Boosted Atazanavir as Effective as Lopinavir/Ritonavir in Experienced Patients, With Fewer Side Effects
Boosted atazanavir (Reyataz) suppresses viral load as effectively as lopinavir/ritonavir (Kaletra) in multidrug-resistant patients, while causing fewer adverse effects, according to 96-week results from BMS Study 045. The randomized, open-label study compared a once-daily regimen of atazanavir + ritonavir (Norvir) + tenofovir (Viread) + an NRTI to a twice-daily regimen of lopinavir/ritonavir + tenofovir + an NRTI in HIV-infected patients who had experienced virologic failure on at least two HAART regimens. The researchers found that the two regimens had a similarly profound, long-term impact on viral load, but differed in toxicity: Boosted atazanavir appeared to cause far fewer gastrointestinal problems (particularly diarrhea), and had a significantly more beneficial impact on lipid levels. The study results appear in the March 21 issue of AIDS. Click Here


Genotypic Resistance Testing May Be Effective Even at Viral Loads Below 1,000
It has long been thought that genotypic resistance tests were ineffective at detecting resistance when a patient's viral load was below 1,000. However, researchers from Chelsea & Westminster Hospital in London have found evidence that genotypic resistance tests can successfully detect resistance in patients with persistent, low-level viremia. In a research letter published in the March 21 issue of AIDS, Laura Waters and colleagues found that patients with a single viral load measurement as low as 200 -- or with repeated measurements as low as 50 -- can benefit from genotypic resistance testing. Click Here

•  HIV/HAART-RELATED COMPLICATIONS

Bone Risk Higher Among Post-Menopausal Women With HIV
Osteopenia and other bone complications are a concern for many women after menopause. But are women with HIV at an even greater risk? The answer may be yes, according to a U.S. study published in the April 1 issue of Clinical Infectious Diseases. Researchers from the U.S. Menopause Study found that among 495 women with a median age of 44, HIV-infected women were more likely to have lower bone-mineral density than HIV-uninfected women. Antiretroviral use did not appear to have any significant impact on bone-mineral density. The researchers recommended that all HIV-infected women be screened for bone problems at menopause, and consider supplementation with calcium and vitamin D. Click Here


Women, HIV and Aging: An Overview of Heart and Bone Risks
At least 10% of all HIV-infected Americans are 50 years old or older, according to estimates -- a proportion that is virtually guaranteed to increase as HAART continues to extend the lives of patients. This raises an issue of growing concern: the complicated interplay between HIV, gender, aging and the adverse effects of antiretrovirals. This article by Sharon Lee, M.D., provides an overview of two common health risks in aging women with HIV: heart disease and osteoporosis. Click Here


Steroid May Restore Some Body Fat, Muscle in HIV-Infected Patients, Study Says
Oxandrolone (Oxandrin) may help restore fat and muscle in HIV-infected patients with HIV-associated weight loss, according to a 12-week study by Carl Grunfeld and colleagues for the Oxandrolone Study Group. In the study, which involved 262 HIV-infected men with HIV-associated weight loss of 10% to 20% or a body mass index of 20 kg/m² or less, volunteers were administered a daily placebo or one of three daily doses of oxandrolone. After 12 weeks, participants in all study arms had increased their body weight and body cell mass, but men in the 40 mg/day oxandrolone arm were the only group to have a body weight and body cell mass gain that was significantly greater than that of the placebo group. However, many patients experienced oxandrolone toxicity, including significant increases in transaminases and LDL cholesterol, decreases in HDL cholesterol, and significant decreases in testosterone and other sex hormones. The study was published in the March 2006 issue of JAIDS. Click Here

•  MENTAL HEALTH & HIV

Could Valproic Acid Help Treat HIV-Associated Dementia?
Valproic acid was briefly thrust under the mainstream media's spotlight in 2005, when researchers conducting a proof-of-concept study of the drug's antiretroviral properties conjectured that such a compound may eventually yield a cure for HIV. A new study on valproic acid proposes a much more modest goal: treating HIV-related dementia. Published in the March 1 issue of Neurology, the 10-week, 22-patient, placebo-controlled study found that valproic acid appeared to improve neuropsychological performance and brain metabolism in volunteers with HIV-associated cognitive impairment. Click Here


Depression in the HIV-Infected Inmate
Psychiatric disorders are exceedingly common among HIV-infected patients, and pose a challenge for any clinician. Depression, in particular, is a difficult issue, since it is often underreported and undertreated, and can have a detrimental impact on a patient's quality of life, overall health and ability to adhere to prescribed treatment. Andrew F. Angelino, M.D., and Glenn J. Treisman, M.D., Ph.D., provide this overview of screening, diagnosing and treating depression in an HIV-infected inmate. Although written for a prison health care audience, the piece is relevant to all HIV health providers. Click Here

As a case-study adjunct to this overview, Jeffrey Watts, M.D., discusses the management of an HIV-infected patient with depression, and another with a severe mental health illness.


Depression Treatment and Management: Charts for HIV Clinicians
For those seeking a quick reference on handling depression in an HIV-infected patient, the editors of the Infectious Diseases in Corrections Report offer these two charts, one recommending first-line antidepressant medications for HIV-infected patients based on their depression characteristics, the other a flowchart to aid physicians in the management of major depression in HIV-infected patients. Click Here

•  HEPATITIS

For Hepatitis B Treatment, Entecavir Appears More Effective Than Lamivudine
In two head-to-head studies of hepatitis B antiretrovirals, the recently approved drug entecavir (Baraclude) was found to be more effective than lamivudine (3TC, Epivir). The studies, which were published in the March 9 issue of The New England Journal of Medicine, found that a signifcantly higher proportion of entecavir patients than lamivudine patients achieved undetectable hepatitis B viral load levels by week 48. Rates of histologic and biochemical improvement were also significantly higher among entecavir patients. Similar adverse-event rates were reported for the two drugs. The researchers noted that there was no evidence of resistance in the entecavir patients. Click Here


Trial Finds Investigational HCV Drug Effective at Two-Week, But Not Four-Week, Dose
Albumin-interferon alpha 2b (Albuferon), an experimental hepatitis C (HCV) treatment, is more effective than peginterferon alfa-2a (Pegasys) when taken every two weeks in combination with ribavirin, according to phase 3 trial data released by Human Genome Sciences, the company developing albumin-interferon alpha 2b. About 75% of patients taking a 1,200-microgram dose of the investigational drug every two weeks in combination with ribavirin exhibited lower HCV viral load levels, compared with 66% of patients receiving 180 micrograms of peginterferon alfa-2a every seven days. The trial found that albumin-interferon alpha 2b was not as effective as peginterferon alfa-2a when taken at four-week intervals, although researchers conjectured that it might be more effective if administered in higher doses. Click Here

To see a more complete summary of the study results, read this press release from Human Genome Sciences.

•  HIV/STD TRANSMISSION

Crystal Meth Use Tied to High-Risk Sexual Activity, HIV Risk Among Heterosexual Men
Crystal methamphetamine use is associated with increased rates of high-risk sexual behavior among heterosexual men in northern California, according to preliminary results of a study published in the Morbidity and Mortality Weekly Report. The study, conducted by the California Department of Health Services' Office of AIDS, surveyed 1,000 heterosexual men in low-income neighborhoods in northern California over two years. Six percent of the participants revealed that they had used crystal meth over the past six months. The study found that 30% of meth users reported anal sex with female partners, compared with 12% of men who did not use meth; 57% of meth users had multiple sex partners, compared with 26% of nonusers; and 16% of meth users had had sex in exchange for money or drugs, compared with 4% of nonusers. Click Here


Prison Time Among Black Males Might Account for Rise in Number of HIV Cases Among African Americans
The increase in HIV incidence among African Americans coincides with an increase in the proportion of black men who have been incarcerated, according to a study by researchers from the University of California-Berkeley's Goldman School of Public Policy. The researchers examined U.S. census information and a federal database containing detailed information about 850,000 HIV-infected men and women who contracted HIV between 1982 and 1996. According to government data, in 1982 about 40% of prisoners were black, a proportion that increased to more than 50% in 1996. The researchers found that the increase of HIV cases among blacks since the 1980s, most notably among women, corresponds with the increase in the proportion of black men in prison. Other studies reportedly show that about half of all inmates have sexual relations with members of the same sex while in prison, and that the safe-sex programs and condom distribution efforts needed to help control the spread of HIV among inmates are forbidden in many prisons. Click Here


Increase in U.S. Syphilis Rate Attributed Largely to MSM
The U.S. Centers for Disease Control and Prevention has released data showing an 8% rise in U.S. syphilis incidence between 2003 and 2004, from 2.5 cases per 100,000 people to 2.7 cases. This represents the fourth consecutive yearly increase in syphilis incidence. The rise is largely attributable to a dramatic increase in new syphilis cases among men who have sex with men (MSM), which rose from 2.6 per 100,000 people in 2000 to 4.7 per 100,000 in 2004, while female cases declined from 1.7 per 100,000 to 0.8 per 100,000 between 2000 and 2003. In 2004, female syphilis cases remained stable, ending a 13-year decline in rates. The increase in syphilis incidence among MSM was marked "by high rates of HIV co-infection, high-risk sexual behavior, and use of drugs such as methamphetamines," report study authors in the March 17 edition of Morbidity and Mortality Weekly Report. "Syphilis increases have occurred among MSM who have met sex partners in Internet chat rooms," they said, highlighting the need for studying both the Internet's role in sexually transmitted disease (STD) transmission and its potential use for STD prevention. Click Here

•  HIV POLICY & FUNDING IN THE UNITED STATES

Medicare Drug Plan Problems Restrict Some HIV-Infected Patients' Drug Access in Washington
HIV-infected patients in Washington state are experiencing problems with the new Medicare prescription drug benefit, according to testimony from several AIDS advocates and government health officials at a recent hearing of the Governor's Advisory Council on HIV/AIDS. Although advocates acknowledged improvements in the "Part D" program since its launch on Jan. 1, they expressed concern that confusion among pharmacists is inhibiting access to some medications. According to advocates, some Medicare drug plans do not cover certain drugs, while many patients are unable to make copayments and are thus forced to go without treatment. Click Here


FDA Will Review Controversial Lifetime Ban on Blood Donations From Gay Men
The U.S. Food and Drug Administration (FDA) has announced it will formally revisit a policy, in place since 1985, prohibiting any man from donating blood if he has had sexual contact with another man since 1977. The American Red Cross, the American Association of Blood Banks and America's Blood Centers all acknowledge that the ban on blood donations from men who have sex with men (MSM) is unnecessary, but recommend that MSM still be barred from donating blood for one year after having sex with a man. The one-year deferral period is standard for other at-risk groups, but at the moment, only MSM and current or former sex workers are subject to a lifetime ban because of their sexual behavior. Click Here


Palm Beach Loses $1.2 Million in Federal HIV Funds; Many Services to Be Cut
While U.S. funding for the fight against HIV outside the United States continues to ramp up, some government funding for HIV services within the United States is diminishing. Palm Beach County in Florida is one of the areas hardest hit by HIV in the United States, but federal officials have cut the county's HIV funds by more than $1 million this year. In explaining the cut, the federal government said the county's funding request was riddled with errors and inconsistencies. Wherever the blame may lay, HIV health providers and their low-income clients will pay the cost: Palm Beach County already plans steep reductions in food services, legal assistance and caseworker staff for its HIV-infected residents. Click Here

Palm Beach County is not the only metropolitan area whose HIV funds have recently been cut: This month also brought news that federal funding for HIV services is being sliced by nearly $2 million in Los Angeles, Calif., and by $312,000 in Boston, Mass., which had already lost more than $1 million last year. Advocates say the funding reductions could result in significantly reduced services and delayed treatment for uninsured and indigent HIV-infected people.

•  HIV NEWS & VIEWS

Harper's Magazine Publishes Article Supporting AIDS Denialism
The self-described "AIDS dissident" argument is a nonstarter in clinical circles; there is no debate that HIV is the cause of AIDS, or that antiretrovirals have extended the lives of millions of HIV-infected individuals throughout the world. Apparently, however, somebody forgot to tell this to the outgoing editor of Harper's Magazine. In his final issue as editor-in-chief, Lewis Lapham decided to publish an error-riddled article by Celia Farber that includes a lengthy (and implicitly supportive) discussion of the "AIDS dissident" argument. HIV health providers and AIDS advocates are livid that Farber's article was allowed to go to print without at least including a rebuttal, but Harper's supports the article as responsible journalism. (Free registration at nytimes.com is required to read this article.) Click Here

Interested in reading the Harper's article? Click here to download it in PDF format. Once you're done reading, send any comments you may have to letters@harpers.org.

Although Harper's did not publish any counterpoints alongside the Farber article, a group of HIV researchers and activists, including John Moore, M.D., of Weill Medical College, has posted numerous rebuttals of many of the statements made by Farber. Visit aidstruth.org to read through them all.

In this heartfelt letter, Martin Delaney, a long-time AIDS activist and founder of the AIDS organization Project Inform, offers his own take on the Farber article. "The woman has had her head buried in the sand for so long that she hasn't the faintest idea what is happening in the lives of people with AIDS," he says. "The success of the drugs used to treat HIV is so dramatic, so well demonstrated, that it is the envy of just about every other major unsolved disease out there."

•  HIV OUTSIDE THE UNITED STATES

Women in Africa Most Affected by HIV, Need Own UN Agency to Address Needs, Envoy Says
The impact of HIV on women in Africa is so devastating that a new United Nations (UN) agency needs to be created specifically to help them, says UN Special Envoy for HIV/AIDS in Africa Stephen Lewis. "What has happened to women is such a gross and palpable violation of human rights that the funding must be found," Lewis said, adding that a well-funded and influential agency targeting women would reduce HIV infections. An estimated 4.6% of all women and girls ages 15 to 24 in sub-Saharan Africa are living with HIV, compared to 1.7% of young men. Swaziland's female HIV rates, in particular, are astronomically high: A recent government study shows that 56% of pregnant women in Swaziland between ages 25 and 29 are living with HIV, which Lewis characterized as "the highest prevalence I have ever encountered in the last five years." Click Here


Late Diagnosis, Expensive Drugs May Explain Poorer HIV Treatment Response in Developing Countries, Study Suggests
HIV-infected patients who initiate HIV treatment in the developing world are less likely to survive the first few months of treatment than HIV-infected patients in developed countries, according to a study by an international group of researchers and published in the March 11 edition of The Lancet. Late HIV diagnoses may be largely to blame for the disparity, the researchers suggest: Patients in developing countries had an average CD4+ cell count of just 108 when they started treatment, versus 234 in developed countries. The researchers also suggested that, in addition to earlier diagnosis and treatment initiation, free treatment access could have a significant impact: HIV-infected patients in low-income countries were found to have improved odds of survival if they did not have to pay for their antiretrovirals. (Free registration at thelancet.com is required to read this article.) Click Here


Treatment Alone Won't Stop HIV in the Developing World, Experts Say
A research letter by a group of London epidemiologists warns that even if free antiretrovirals were made available to every AIDS patient in sub-Saharan Africa, it wouldn't actually slow down the spread of the virus -- in fact, they suggest, it would more likely speed it up. In the paper, which was published in the April 2006 edition of PLoS Medicine, the researchers describe a new approach to modeling the effect of HIV treatment access on resource-poor regions. They point out that prevention methods, particularly HIV counseling and safe-sex education, aren't just a plus; in places like sub-Saharan Africa, they are essential in reducing the number of individuals who are living with the virus, the researchers say. Click Here

In an analysis of the above article, a pair of researchers in Mexico criticize the conclusions reached by the team of London epidemiologists. The Mexican researchers write that we still have much to learn about how best to scale up HIV treatment programs in the developing world -- and about the true, long-term, on-the-ground impact these programs have. Issues such as "prescription patterns, consistency of drug supply, adherence, and duration of viral suppression" are all key to determining the best manner in which to make HIV treatment programs a success in developing countries, the analysis says.