•  HIV TREATMENT & PATIENT CARE

NEW CME/CE ACTIVITY: New Developments in HIV Drug Resistance and Options for Treatment-Experienced Patients
The Body Pro's newest, free CME/CE-accredited activity is now available for U.S. pharmacists as well as physicians and nurses! Bonaventura Clotet, M.D., Ph.D., and Cal Cohen, M.D., M.S., provide an in-depth review of recently presented research from two European conferences. This insightful activity includes the latest data on atazanavir (Reyataz) and tenofovir (Viread) mutations, and discusses the potential of TMC114 (darunavir) and TMC125 (etravirine) to augment the armamentarium of effective antiretrovirals for multidrug-resistant patients. Click Here


HIV Physicians and Patients Have Different Perceptions of Treatment, Survey Finds (PDF)
A nationwide survey of HIV-infected patients and physicians has found that the two groups often hold divergent views on HIV care. The 13-city survey of 152 physicians and 399 patients, conducted by the International Association of Physicians in AIDS Care, yielded a trove of interesting results. For instance, physicians treating HIV-infected patients reported a much higher degree of optimism about their patients' long-term health: 72% of physicians said they expected their patients to live a normal life span, compared to 59% of HIV-infected patients who felt the same way. The survey also found that, although the majority of patients felt they had an "equal partnership" with their physicians when it came to making HIV treatment decisions, less than half of physicians shared the sentiment; many said that the relationship was not equal, and that it was the physician, not the patient, who had the greater decision-making power. The survey also revealed a huge perception gap in patients' level of clinical understanding: Ninety-five percent of physicians said that at least half of their HIV-infected patients often fail to understand what they are told about HIV and HIV treatment; 66% of patients, however, reported that they almost always understood what their doctors told them, signaling possible failures in communication between providers and patients. Click Here


Structured HIV Treatment Interruptions: SMART or Stupid?
It has been several months since the HIV treatment world was turned on its head by the premature cessation of SMART, one of the largest studies ever to investigate any kind of HIV treatment strategy. Although many were hopeful that SMART would discover some value in a CD4-guided approach to HIV treatment interruption, SMART met an unexpectedly early demise when preliminary data indicated that patients following the CD4-guided strategy developed AIDS-related illnesses at a much higher rate than patients who remained on treatment continuously. SMART's cancellation has led to a great deal of hand-wringing over why the study went wrong, and what this bodes for the future of HIV treatment interruptions. In this analysis, Richard Jeffreys takes another look at why the SMART study was halted -- and what lessons, if any, can be learned from the results. Click Here

•  HIV/HAART-RELATED COMPLICATIONS

U.S. Physicians Develop Diagnostic Tool for Immune Reconstitution Syndrome
University of Cincinnati physicians have developed a questionnaire that they say can correctly diagnose cases of immune reconstitution syndrome (IRS) in HIV-infected patients with 79% sensitivity and 88% specificity. The questionnaire was based on an examination of the variables that confer a greater risk for IRS, including opportunistic infections prior to treatment initiation, hemoglobin levels and CD8 count. Click Here


Women on HIV Treatment Who Smoke Have Lower CD4 Count, Higher Viral Load
Smoking cigarettes can blunt the benefits of HIV medications in HIV-infected women, a new report from the Women's Interagency HIV Study has found. The long-term study of 924 HIV-infected, predominantly low-income women on HAART, which was published in the June 2006 issue of the American Journal of Public Health, found that women who smoked tended to have a lower CD4+ cell count, a higher viral load, a 36% greater risk of developing an AIDS-related complication and a 53% greater mortality risk. Click Here


New Research on Hepatitis C Drugs in Development
Although hepatitis C and HIV were both isolated in the 1980s, far fewer medications are now available to treat hepatitis C than HIV. Unfortunately, although the hepatitis C treatments that do exist are often effective, they frequently cause adverse effects and have less-than-ideal rates of sustained virologic response. Thankfully, there are a number of medications in the pipeline that may hold the promise of more effective hepatitis C treatments. Daniel Raymond of AIDS Community Research Initiative of America provides a research update on some of the more promising candidates in this article. Click Here

A symposium at February's 13th Conference on Retroviruses and Opportunistic Infections in Denver, Colo., also discussed new research on experimental hepatitis C medications. Click here for a recap.

•  HIV TESTING & PREVENTION

Updated Overview of HIV Antibody Assays
HIV testing has evolved considerably over the past several years: From the rise of rapid testing to the increased use of detuned assays to spot cases of acute HIV infection, new technologies have added to, and improved upon, the HIV diagnostic tools available to health professionals. In this comprehensive overview for HIV InSite's Knowledge Base, an online textbook on HIV disease management, Niel Constantine, Ph.D., of the University of Maryland School of Medicine, discusses in detail the use of standard and alternative assays for the detection of HIV infection, and the limitations of current testing methods. Click Here


San Francisco Becomes First U.S. City to Require Only Oral Consent for HIV Tests
San Francisco, Calif., on May 16 became the first city in the United States to require only verbal consent from people who wish to be tested for HIV at public clinics and hospitals. Requirements were dropped for written consent and pretest counseling in hopes of making the testing process easier. The decision comes on the heels of an announcement from the U.S. Centers for Disease Control and Prevention, which plans to release new HIV testing recommendations in June that suggest exactly the steps San Francisco has now taken. Pretest counseling will still be provided at San Francisco's public clinics and hospitals for anyone who requests it. Click Here


New AIDS Vaccine Clearinghouse Launches on Web
The AIDS Vaccine Advocacy Coalition (AVAC) has launched the AIDS Vaccine Clearinghouse, a source of HIV vaccine information available on the Internet. "The AIDS Vaccine Clearinghouse is a virtual AIDS vaccine community where researchers, advocates, community members, policy makers and the media can go for information, updates and interaction with others," said Mitchell Warren, executive director of AVAC. With more than 30 HIV vaccines now in development throughout the world, the need for a single, comprehensive source of reliable information on the subject will only continue to grow. Click Here


New Sperm-Washing Method Appears to Eliminate HIV Risk for Female Partner, Baby
An improved method of sperm-washing appears to remove even a theoretical risk of HIV infection for an HIV-uninfected woman seeking to conceive a child with an HIV-infected man, according to Japanese researchers. In a study published in the April 24 issue of AIDS, the researchers revised the "swim-up" method of sperm washing and designed an ultrasensitive HIV RNA/DNA test to confirm that the sperm of all 48 HIV-infected male participants was completely free of HIV -- including the proviral HIV DNA that researchers had previously theorized could be a possible transmission vector with the existing swim-up method. Forty-three serodiscordant couples then underwent intracytoplasmic sperm injection or in vitro fertilization using the washed sperm; no women were infected with HIV during the procedure, and 20 women conceived, resulting in the births of 27 babies -- none of whom tested positive for HIV. Click Here


Rare STD Continues to Spread Among Gay Men, HIV-Infected People in U.S., Europe
Throughout the past year, The Body PRO has highlighted reports on the spread of a rare form of chlamydia called lymphogranuloma venereum (LGV), a sexually transmitted disease (STD) that seems to mostly affect gay men, particularly those with HIV. Although normally not found in Western countries, the number of LGV cases in the United States and Europe has been steadily climbing. Although it can be quickly treated with antibiotics, the disease may be difficult to diagnose and, if left untreated, can cause severe gastrointestinal and urogenital damage. Click Here

To read more about the spread of LGV in Europe, where hundreds of individuals have now been diagnosed, click here.

•  HIV POLICY IN THE UNITED STATES

Senate Committee Approves Major Revisions to Ryan White CARE Act
A U.S. Senate committee voted 19-1 to approve a bill that would alter the Ryan White CARE Act by allocating more federal HIV funding to southern and rural states. The measure proposes several changes to the CARE Act, such as revising formulas for funding calculations to include HIV cases and not just AIDS cases; requiring that 75% of CARE Act funding is spent on primary care; requiring that facilities receiving federal funding conduct mandatory HIV testing; creating a tier system to fund both small and large cities; directing unused funds from states into AIDS Drug Assistance Programs (ADAPs); and mandating a minimum AIDS drug formulary list that all state ADAPs would have to provide to patients. Sen. Hillary Rodham Clinton (D-N.Y.), the only senator to vote against the bill, said states with urban centers are most affected by HIV and should not have their funding reduced. Clinton said that New York state could lose $20 million under the proposed revisions. The bill now moves to the full U.S. Senate for debate. Click Here


Report: U.S. May Be a Global AIDS Leader, But It's Failing Its Commitments at Home
Over the past few years, the United States has transformed itself into a leader in the fight against HIV in developing countries. It is a wonderful evolution for this country, to be sure -- but is the United States also giving the amount of attention it should to HIV health care providers and their patients within U.S. borders? A new report from the Open Society Institute answers this questions with an emphatic "no": At the same time the United States pushes for lower HIV infection rates and better access to treatment overseas, HIV incidence rates within the United States have remained stagnant, and more than half of the Americans who need antiretroviral treatment is not receiving it, the report says. Click Here

•  HIV NEWS & VIEWS

"Missing Link" Found: Origin of HIV Confirmed in Cameroon, Researchers Say
U.S. and European researchers have confirmed that HIV originated in wild chimpanzees and likely crossed over into humans in Cameroon. In a study published in the online edition of Science on May 25, the team of researchers reports detecting antibodies to SIVcpz, the closest simian relative of HIV-1, in the fecal droppings of several communities of a specific subspecies of chimpanzee residing in southern Cameroon. The findings establish this chimpanzee as the natural reservoir of HIV-1, the researchers conclude. The research does not shed any light on how the virus first jumped from chimpanzees to humans, although Hahn and colleagues theorize that the transition occurred after exposure to chimpanzee body fluids during the hunting and butchering of bush meat. Click Here


AIDS at 25: The Path Ahead
Ask your average American about HIV today, and he or she will probably tell you either that HIV is still a death sentence, or that the country's HIV problem has simply gone away. The majority of Americans remain blind to the critical problems caused by decreased HIV funding in the United States. It seems that many people have forgotten -- if they ever truly knew -- the United States' own tortured history with HIV. The astonishing medical advances of the past 10 years in HIV are taken for granted. In this article chock full of interviews with prominent AIDS advocates and journalists, David Foucher explains why all of us must remember our past if we are to win the fight against HIV in the future. Click Here

•  HIV OUTSIDE THE UNITED STATES

Rwandan Genocide Survivor With HIV Tells Her Story
Of 132 people in Margaret Mukacyaka's extended family, 127 were murdered. Like many survivors of Rwanda's 1994 genocide, her grief does not end with the loss of loved ones: her son and her HIV status are legacies of her ordeal. As a 16-year-old student, Margaret was imprisoned by members of the Hutu militia and raped for weeks until she was rescued. Alone, pregnant and newly HIV infected, Margaret slowly picked up the pieces of her life. Today, she is on treatment, has finished school and has a job as a social worker, helping other female survivors like herself. She acknowledges that her strength sometimes fails her, but she says, "[W]hen I'm in the spirit of prayer, I know I can keep going." Click Here


How Did Brazil Become a Model for the Fight Against HIV?
Brazil could easily have met the fate of so many other developing countries that have been decimated by HIV. But it did not: Instead, Brazil has become a shining example of all that a country can do correctly to prevent the virus from killing its people. How did Brazil achieve what so many other countries have failed to accomplish? As Susan Okie, M.D., reports in the May 11 issue of the New England Journal of Medicine, the reasons are many: from quick action to aggressive HIV prevention efforts to free, universal access to antiretrovirals, Brazil has managed to save a countless number of its citizens' lives. Click Here


Bill Clinton Discusses Quest to Improve HIV Care Worldwide
Former U.S. President Bill Clinton is on a mission to bring HIV treatment to the developing world. "There are many thousands of people ... working tirelessly to combat and treat this disease," Clinton writes in this personal essay. "It's thanks to these efforts that there are now 1.3 million people getting the medicines they need to stay alive. But 1.3 million isn't enough when millions more need treatment." The William J. Clinton Presidential Foundation has been working since 2002 to lower the cost of testing and medication in the world's poorest nations. In cooperation with the makers of generic HIV meds, 55 countries have joined the Foundation's treatment alliance -- member nations are able to buy a year's supply of antiretrovirals for one patient for as little as $140. In this essay, Clinton outlines the joys and disappointments of his quest for universal treatment access, and the mountain of work that he feels still remains before that goal can be achieved. Click Here