• AIDS AT 25
"I Knew Patient Zero"
Michael S. Gottlieb, M.D., did not know it at the time, but when a 31-year-old man (also named Michael) was admitted to UCLA Medical Center in 1981 with fever and weight loss, he was meeting the patient who would become the first officially reported case in the global AIDS pandemic. Twenty-five years later, Michael has long since died, but Gottlieb is still treating HIV-infected patients. On the 25th anniversary of his first published report, Gottlieb takes a moment to look back on his first AIDS patient, on the tragedies and triumphs of the past quarter-century, and on the mixed hopes he holds for the future. His essay appears in the June 5 issue of The Los Angeles Times (free registration at latimes.com is required to read this article). Click Here
To read Dr. Gottlieb's 1981 Morbidity and Mortality Weekly Report article, which later became known as the AIDS pandemic's first officially reported cases, click here.
In U.S., HIV Treatment Has Saved "Three Million Years of Life," Report Says
Health care providers certainly have no need for a published report to know that HIV medications have saved lives, but it can nonetheless be encouraging to see the numbers. A new U.S. government-funded study published in the June 1 issue of the Journal of Infectious Diseases estimated that the aggregate impact of antiretrovirals in the United States, since their introduction in 1989, is 2.8 million patient-years saved. Click Here
In an accompanying editorial, Sten H. Vermund of the Vanderbilt University School of Medicine points out that 2.8 million years could be just the tip of the iceberg if HIV prevention and testing are improved worldwide: "If we address systematically the barriers to testing, care and prevention, then future modelers will describe the next 15-year period as having saved hundreds of millions of life-years, not just in North America but around the globe," Vermund writes.
For a great deal of additional news, opinions and features surrounding the 25th anniversary of the first officially reported AIDS case, browse through The Body PRO's collection of articles and podcasts.
• HIV TREATMENT & PATIENT CARE
Eventual Virologic Failure More Likely With Triple NRTIs Than Two NRTIs + Efavirenz
HIV-infected patients who have achieved viral suppression on their first antiretroviral regimen are more likely to experience subsequent treatment failure if their first regimen consists of three nucleoside reverse transcriptase inhibitors (NRTIs) instead of two NRTIs + efavirenz (Sustiva, Stocrin), according to Italian researchers. The nonrandomized, observational study, which was published in the July 1 issue of the Journal of Infectious Diseases, observed virologic failure rates among a group of 744 treatment-adherent patients who had achieved a viral load of 80 copies/mL or less on their first antiretroviral regimen. Over a combined 1,140 patient-years of follow-up, patients receiving an abacavir (Ziagen)-based, triple-NRTI regimen were found to be significantly more likely (P = .05) to experience treatment failure than patients receiving a regimen of two NRTIs + efavirenz. Although the researchers pointed out potential study limitations (including its observational design), they nonetheless concluded that the results support switching patients who achieve virologic suppression while on a triple-NRTI regimen to another, more potent regimen to maintain virologic control. Click Here
IL-2 Provides No Benefit for CD4-Guided HIV Treatment Interruptions
Recent research, most notably the SMART study, has highlighted the potential risks of CD4-guided HIV treatment interruptions. Some researchers have hypothesized that these risks could be lessened with the use of an immune-boosting agent such as Interleukin-2 (IL-2, aldesleukin). However, a recent AIDS Clinical Trials Group pilot study by Keith Henry et al appears to refute this idea. In this randomized, prospective study, which appears in the June 2006 issue of JAIDS, 47 patients interrupted treatment after achieving a viral load below 200 copies/mL and a CD4+ cell count of 500 or higher. Treatment was restarted when a patient's CD4+ cell count dropped below 350. The study found that the use of IL-2 prior to interruption did not elongate the period of time between treatment discontinuation and treatment re-initiation. The study did note, however, that the stop-at-500, restart-at-350 strategy itself generally appeared to be safe for enrolled patients, with most patients going more than a year without having to restart treatment. Click Here
Changing HIV Treatment: What the Research Shows
Is it the right time to change your patient's antiretroviral regimen -- and if it is, which choice of antiretrovirals will yield optimal results? As the armamentarium of HIV medications grows and we learn more about adverse effects and resistance, the answers to these questions have become more complicated. In this clinical overview from HIV InSite's online textbook on HIV disease, physicians from Weill Medical College of Cornell University review the findings of key research regarding why, when and how to modify antiretroviral therapy in HIV-infected patients. Click Here
Co-Receptor Conundrum: The Challenges of Turning Theory Into Reality
At the moment, there are many more questions than answers about an investigational class of HIV antiretrovirals known as co-receptor inhibitors. Although one drug in this class -- maraviroc -- remains on the path to U.S. approval, several other candidates have fallen out of the development pipeline in recent months, leading some to wonder about the utility and safety of this unique breed of antiretrovirals. In this overview, Richard Jefferys examines the rocky road to development down which co-receptor inhibitors have trodden thus far. Click Here
• HIV/HAART-RELATED COMPLICATIONS
Efavirenz No More Likely to Cause Depression Than PIs, Study Says
Patients who receive a HAART regimen containing efavirenz (Sustiva, Stocrin) are at no greater risk for developing depression than patients who receive a protease inhibitor (PI)-based regimen, according to a 355-patient study published in the June 15 issue of Clinical Infectious Diseases. In this substudy of the randomized ALIZE-ANRS 099 trial, French researchers found a high rate of depressive disorder in patients on treatment (30 patients). However, no difference in incidence of depression was observed between patients receiving efavirenz and patients receiving a PI (8% vs. 7%, P = .56) through 48 weeks of follow-up. Even when the follow-up period was extended to three years, no difference between the two arms was noted. The study (which was not funded by a pharmaceutical company) backs a major AIDS Clinical Trials Group substudy (A5097s, by Clifford et al) that last year found no significant, lasting impact of efavirenz on neuropsychological performance. Click Here
HCV Does Not Accelerate HIV Disease Progression or Impede HIV Treatment, Study Finds
Although HIV is known to increase the severity of hepatitis C (HCV) infection, HCV does not have the same impact on HIV, according to the results of a massive study by researchers from the U.S. Centers for Disease Control and Prevention. The seven-year study of more than 10,000 HIV-infected patients across the United States found that HCV coinfection did not increase an HIV-infected patient's likelihood of developing an AIDS-related illness or dying. It also found that during their first 12 months on HIV treatment, the CD4+ cell counts and viral loads of HIV/HCV-coinfected patients were similar to those of HIV-monoinfected patients, indicating no adverse effects of HIV/HCV coinfection on the success of antiretroviral HIV therapy. The study was published in the May 12 issue of AIDS. Click Here
PAH More Common in HIV-Infected Patients, Regardless of HAART
Even in the HAART era, HIV-infected patients may have a higher risk than the general population for developing an uncommon, but dangerous, cardiovascular condition known as pulmonary arterial hypertension (PAH), according to a recent study. The large, French study, which was presented at the 2006 American Thoracic Society International Conference in San Diego, Calif., found an overall PAH prevalence of approximately 0.5% in the modern treatment era -- a rate that is not statistically different from that found among HIV-infected patients before the advent of HAART. Click Here
The Rising Prevalence of HIV-Associated Renal Disease
Renal disease is growing increasingly common in HIV-infected patients due to the direct and indirect effects of HAART, write a team of German researchers in the May 15 issue of Clinical Infectious Diseases. In their review of the evolution of renal complications in HIV-infected patients during the HAART era, J. Röling and colleagues from the University of Munich discuss how the life-extending benefits of HAART among HIV-infected patients, as well as the toxicities associated with many antiretroviral medications themselves, has resulted in an increase in HIV-associated renal disease. Click Here
• HIV/STD TRANSMISSION
U.S. FDA Grants Approval for First HPV Vaccine
The U.S. Food and Drug Administration (FDA) has approved Gardasil, the first human papillomavirus (HPV) vaccine, for use by females ages 9 to 26. Merck & Co.'s vaccine protects against HPV strains 16 and 18, which account for approximately 70% of cases of cervical cancer, and strains 6 and 11, which account for 90% of genital wart cases. Studies showed Gardasil also offers protection against cases of vaginal and vulvar cancer linked to HPV infection. Click Here
Los Angeles: Syphilis Incidence Up 40% in 2005
Syphilis incidence in Los Angeles County, Calif., skyrocketed in 2005, according to a new report by county health officials. The number of new syphilis cases in L.A. jumped by more than 40% in 2005, the report found. Increases were noted in every demographic: Although the largest increase in incidence was among men who have sex with men (matching nationwide trends), new cases also rose dramatically among women, blacks and Latinos, and more modestly among whites. Click Here
For an in-depth, clinical examination of syphilis epidemiology and treatment, as well as the management of syphilis in HIV-infected patients, read this newly updated chapter of HIV InSite's Knowledge Base, an online textbook on HIV disease.
Black AIDS Institute Releases Report on HIV in African Americans
The Black AIDS Institute released a report on the impact of HIV on African Americans in the United States over the past 25 years. The 80-page report, entitled "AIDS in Blackface: 25 Years of an Epidemic," features testimony from HIV-affected African Americans and advocates. It also traces the spread of HIV among blacks in the United States and calls for the expansion of proven prevention strategies, improved access to treatment and the eradication of stigma surrounding HIV and sexual diversity. Click Here
Poverty at Heart of Heterosexually Transmitted HIV Among Blacks in North Carolina
Why is heterosexually transmitted HIV infection so much higher among African Americans than whites in the southeastern United States? University of North Carolina-Chapel Hill researchers conducted a population-based, case-control study of black men and women ages 18 to 61 reporting to the North Carolina state health department with a recent diagnosis of heterosexually acquired HIV infection. The investigators found that most of these individuals reported an annual household income of less than $16,000, a history of sexually transmitted diseases and high-risk behaviors including crack cocaine use and sex partners who injected drugs or used crack cocaine. The authors concluded, "Although most heterosexually transmitted HIV infection among African Americans in the South is associated with established high-risk characteristics, poverty may be an underlying determinant of these behaviors and a contributor to infection risk even in people who do not have high-risk behaviors." The study was published in the April 15 issue of JAIDS. Click Here
Research Supports Development of Tenofovir as HIV Preventive
Research continues to investigate the potential use of tenofovir (Viread) as a pre-exposure HIV prophylactic. There are, of course, the high-profile safety/efficacy trials by the U.S. Centers for Disease Control and Prevention that are currently enrolling in Atlanta, Ga., and San Francisco, Calif. But other studies have been conducted as well: Research presented at the 13th Conference on Retroviruses and Opportunistic Infections, for instance, provided the first measure of tenofovir extra- and intra-cellular concentrations in male and female genital tracts from Day 1 to a steady-state. In addition, results from the first phase 1 clinical trial to study an antiretroviral as a potential vaginal microbicide were published in the Feb. 28 issue of AIDS. Both studies' findings support further development and testing of tenofovir as a pre-exposure prophylactic. Click Here
• HIV NEWS & VIEWS
As UN Special Session on HIV/AIDS Ends, Countries Adopt Watered-Down Declaration
When the United Nations gathered five years ago for a special session on HIV/AIDS, it was a historic moment: For the first time, the world's leaders had come together and laid out a vision for beating back the tide of HIV. From May 31 through June 2, the United Nations held its second-ever special session on HIV/AIDS, and the results appear much less remarkable. Held in the shadow of realizations that many countries -- including the United States -- have failed to fulfill the pledges they made in 2001, this year's special session was heavily criticized by many activists as a disappointing display of politics as usual. While some officials praised the final declaration on fighting HIV adopted by the United Nations, criticism abounded -- including from The New York Times, which said the declaration was little more than a "political blueprint, not a plan of action." Click Here
Interested in viewing Webcasts of key meetings and discussions at the UN special session? Many of the session's highlights are available online, courtesy of kaisernetwork.org; click here for a full listing.
Many People in All Racial Groups Believe in HIV Conspiracy Theories, Study Finds
As the media has often reported, a fair number of African Americans believe that HIV was created by the government and is being used specifically to kill non-white people. What the media generally fails to mention, however, is that this conspiracy theory is by no means held by African Americans alone. A survey of approximately 1,500 people conducted by researchers at the University of Texas and University of Houston has found that in Texas, one out of every five Latinos, and a slightly lower percentage of whites, believe that HIV is part of a genocidal government conspiracy. Those rates are not much lower than the 29% of African Americans who said they believe in the conspiracy theory. By contrast, less than 10% of Asian Americans in the survey believed HIV was a government conspiracy. The survey results were published in the March 2006 issue of JAIDS. Click Here
• HIV OUTSIDE THE UNITED STATES
HIV Epidemic Continues to Outpace Response, Despite Gains, UNAIDS Report Says
Although HIV infection rates continue to rise worldwide, the increase at least appears to be slowing, according to the latest report from UNAIDS on the state of the global pandemic. The report highlighted a fair number of encouraging developments: For instance, global AIDS funding has quintupled since 2001, many African countries have reported a reduction in HIV prevalence, and 1.3 million HIV-infected people in developing countries are receiving antiretrovirals, up from 240,000 in 2001. But the report was clear that these steps are far from enough: Too many countries are still facing worsening epidemics, funding remains short of what is needed, and the lack of a unified, worldwide strategy for fighting HIV is hampering efforts to ramp up prevention and treatment. Click Here
If you would like to read some of the report's major findings, you can read the official UNAIDS news release accompanying the report, or download the report in its entirety as a 24MB ZIP file. Also available is an updated UNAIDS summary of global HIV facts and figures and a fact sheet outlining the progress that has been made and the challenges that still face the world's countries in the fight against HIV.
India Surpasses South Africa in HIV Incidence; Prevalence Growing Throughout Much of Asia
In 2005, India eclipsed South Africa as home to the largest number of HIV-infected people, according to a new UNAIDS report. As of the end of last year, an estimated 5.7 million Indians were infected with HIV, compared with 5.5 million in South Africa. However, India -- a country of 1.02 billion people -- has a relatively low HIV prevalence of 0.9% among adults (compared to 18.8% in South Africa). HIV prevalence has also been declining in four Indian states. The UNAIDS report estimated that, at the end of 2005, some 8.3 million people in the Asia-Pacific region were living with HIV, the second-highest regional number of cases after sub-Saharan Africa. Though prevalence has been steadily slowing in Cambodia and Thailand, it is increasing in China, Vietnam and Indonesia, and there are indications of outbreaks in Bangladesh and Pakistan. Click Here
African Countries Take a Serious Look at Male Circumcision
Five African countries -- Botswana, Lesotho, Swaziland, Tanzania and Zambia -- are in talks with UNAIDS about making circumcision more accessible to men as part of their countries' HIV prevention efforts, following a major study last year that showed male circumcision could reduce a man's risk of HIV infection by 60%. Less than 20% of men in southern Africa, where HIV prevalence is highest, are said to be circumcised. Estimates show that 3.7 million infections and 2.7 million deaths could be avoided over the next 20 years by using male circumcision as a means of prevention, said Helen Jackson of the United Nations Population Fund. Click Here