•  FULL COVERAGE OF AIDS 2006 AT THE BODY PRO

The XVI International AIDS Conference (AIDS 2006), the largest HIV conference in history, has concluded, leaving in its wake hundreds of newly presented studies. Although the research community no longer looks to the International AIDS Conference for reports on major scientific breakthroughs, there was nonetheless a tremendous amount of data released at AIDS 2006, some of it with clinical relevance. Selected highlights are included in this newsletter, but be sure to visit The Body PRO's AIDS 2006 home page for a complete rundown.

In addition to our traditional expert coverage of breaking research from AIDS 2006, The Body PRO -- in conjunction with The Body, The Body PRO's sister site for the general population, as well as kaisernetwork.org -- is also proud to provide extensive, multimedia coverage, including:

• Podcasts and transcripts of interviews with top researchers, advocates and HIV-affected individuals from around the world
  
• An exclusive photojournal that provides a close-up glimpse of the sights and experiences of the conference
  
• Webcasts of key plenary sessions, late breakers and press conferences provided by kaisernetwork.org

For the latest news and more from the conference, visit The Body PRO's AIDS 2006 home page.

•  EXCLUSIVE PODCASTS FROM AIDS 2006

What Makes HIV Nonprogressors Tick? An Interview With Bruce Walker, M.D.
Bruce Walker, M.D., of Massachusetts General Hospital in Boston, Mass., is currently attempting to recruit 2,000 patients for an unprecedented study on HIV-infected "elite controllers" and long-term nonprogressors, patients who are able to maintain low or undetectable viral loads indefinitely despite never having received antiretroviral therapy. In this interview with The Body PRO, Dr. Walker discusses the study and his hopes for how the research could open a new door to the development of an effective HIV vaccine. Click Here


Body Fat Changes in People With HIV: A Talk With Todd Brown, M.D.
Todd Brown, M.D., is an HIV researcher with the Johns Hopkins School of Medicine; his research focuses on metabolic and skeletal problems in HIV-infected people. In this interview with The Body PRO's David Wohl, M.D., Dr. Brown discusses the research he presented at AIDS 2006 regarding lipodystrophy in HIV-infected patients. Click Here


Interview With Phyllis Tien, M.D., University of California, San Francisco
The Body PRO’s David Wohl, M.D., talks with Phyllis Tien, M.D., about a study she presented at AIDS 2006 regarding HIV/hepatitis C (HCV)-coinfected patients who test HCV-seronegative using a standard HCV antibody test. Dr. Tien is an assistant adjunct professor of medicine at the University of California, San Francisco. Click Here


Conference Wrap-Up With Myron Cohen, M.D.
HIV prevention expert Myron Cohen, M.D., Chief of the University of North Carolina (UNC) Division of Infectious Diseases and Director of the UNC Center for Infectious Diseases, spoke with The Body PRO at the conclusion of AIDS 2006. He discusses some of the key take-home messages from the conference. Click Here

•  HIV TREATMENT & PATIENT CARE

48-Week POWER Results Show Continued Efficacy for TMC114
The newly approved protease inhibitor TMC114 (darunavir, Prezista) has shined in 24-week clinical trials involving patients with triple-class resistance. Can it still hold up after 48 weeks against comparator protease inhibitors? Graeme Moyle, M.D., reports for The Body PRO on the latest data from the POWER studies, which were presented at AIDS 2006. The data show that TMC114 + ritonavir (Norvir) continues to yield a viral load and CD4+ cell count response that are superior to that of other protease inhibitors. Click Here


Boosted Fosamprenavir Non-Inferior to Lopinavir/Ritonavir in First-Line Therapy Trial
Boosted fosamprenavir (Lexiva, Telzir) is at least as potent as lopinavir/ritonavir (Kaletra), which has long been considered the standard of care among protease inhibitors in first-line therapy, according to results from a large, industry-sponsored study -- the largest ever to compare two boosted protease inhibitors head to head. As Edwin DeJesus, M.D., reports for The Body PRO from AIDS 2006, this new data should clear the way for fosamprenavir to be added to the list of recommended first-line therapy options in the U.S. treatment guidelines. Click Here


Efavirenz-Based Regimens Best Lopinavir/Ritonavir Regimens in Head-to-Head Trial
In the first non-industry-sponsored, head-to-head trial of efavirenz (Sustiva, Stocrin)-based regimens versus lopinavir/ritonavir (Kaletra)-based regimens, a statistically higher proportion of patients in the efavirenz arm achieved a viral load of less than 50 copies/mL at 96 weeks. The same results were seen for patients with low CD4+ cell counts or high viral loads at baseline -- an unexpected result, considering lopinavir/ritonavir has long been considered a more desirable option among patients with advanced disease. Edwin DeJesus, M.D., reports for The Body PRO from AIDS 2006. Click Here


Treating Patients With Lopinavir/Ritonavir Alone Still Risky
Many patients with sustained virologic suppression on their current regimens can be maintained on lopinavir/ritonavir alone, according to newly presented research at AIDS 2006. However, the implicit risks of lopinavir/ritonavir monotherapy -- namely that it has less virologic activity than conventional HAART regimens and may increase the likelihood of protease inhibitor resistance upon viral rebound -- still place it firmly in the category of "only for select patients." Paul Sax, M.D., reports for The Body PRO. Click Here


Inconclusive Early Results From Study on Tenofovir as Pre-Exposure Prophylaxis
Early results from an international trial investigating the potential use of tenofovir (Viread) as pre-exposure HIV prophylaxis show possible effectiveness. However, because so few cases of HIV transmission actually occurred during the study (regardless of whether the volunteers received pre-exposure prophylaxis), the effectiveness of tenofovir as a prevention pill remains far from assured. Lisa Hirschhorn, M.D., reports for The Body PRO. Click Here


Tenofovir/Emtricitabine Superior to Zidovudine/Lamivudine in Head-to-Head Study
The fixed-dose combination drugs zidovudine/lamivudine (Combivir) and tenofovir/emtricitabine (Truvada) are both commonly prescribed as first-line therapy. But 96-week results from an industry-sponsored trial by Joel Gallant, M.D., and colleagues found that tenofovir/emtricitabine not only caused fewer adverse effects than zidovudine/lamivudine; it also caused a significantly higher number of patients to achieve a viral load below 400 copies/mL and yielded a higher CD4+ cell count increase. Mark Nelson, M.B.B.S., reports for The Body PRO from AIDS 2006. Click Here

For much more news and research on first-line therapy from AIDS 2006, click here.


Boosted Protease Inhibitors Are More "Forgiving" of Poor Adherence: Study
A small study shows that there is a higher degree of medication "forgiveness" when boosted protease inhibitors (lopinavir/ritonavir [Kaletra] in particular) are utilized rather than unboosted protease inhibitors. That "forgiveness" may translate into continued suppression of HIV, even if a patient’s adherence level is well below the recommended 95%. Paul Sax, M.D., reports from AIDS 2006 for The Body PRO. Click Here


Impressive MK-0518 Potency Data Leads to Expanded Access Program
The experimental integrase inhibitor MK-0518 may be available to treatment-experienced patients through an expanded access program within the next several months, according to an announcement by Merck & Co., Inc., at AIDS 2006. The decision to expand access to MK-0518 came after a randomized, 24-week study found an undetectable viral load among 90% of the HIV-infected, multidrug-resistant patients in the trial who took the prescribed amount of MK-0518 in combination with lamivudine (3TC, Epivir) + tenofovir (Viread). The expanded access program would make MK-0518 available internationally to HIV-infected patients with limited or no treatment options. Click Here


Short-Term Treatment During Primary Infection May Delay CD4+ Drop, Study Finds
In the largest study to date on treatment during primary HIV infection, researchers have found that taking antiretrovirals for a median of nine months during the primary infection stage can delay the time it subsequently takes for a patient’s CD4+ cell count to drop below 350 or viral load to climb above 100,000 copies/mL. Brian Conway, M.D., reports for The Body PRO from AIDS 2006. Click Here


Selenium Improves HIV Treatment Response in Nigerian Randomized Study
Dramatic results from a large study in Nigeria suggest that patients with advanced HIV disease who take selenium supplements along with their antiretrovirals could experience a CD4+ cell count boost twice as quickly as patients who take antiretrovirals alone. All of the 340 Nigerians who took part in the 72-week study had extremely low CD4+ cell counts when they started treatment, suggesting the impact of selenium may be much greater for patients who are diagnosed late in the course of their infection. Patients who took a daily dose of 200 micrograms of selenium with their antiretrovirals also experienced more weight gain, fewer opportunistic infections and higher hemoglobin levels. Click Here


HLA Testing May Help Predict Abacavir Hypersensitivity
Hypersensitivity reaction strikes as much as 8% of patients taking abacavir (Ziagen) in clinical trials. But abacavir is a pivotal component of many HAART regimens, which raises an interesting question: Is there any way in which clinicians can predict who is least likely to develop abacavir hypersensitivity? As Margaret Hoffman-Terry, M.D., reports for The Body PRO from AIDS 2006, a relatively inexpensive method known as HLA testing may improve the diagnostic accuracy of predicting this dangerous adverse effect. Many clinicians in Australia and the United Kingdom have already adopted the use of HLA testing in their practice. Click Here


HAART Still Effective 10 Years On, but Some Causes for Concern Emerge
Ten years after its introduction, HAART remains effective, although many patients do not commence therapy early enough, say University of Bristol researchers in a study published in the Aug. 5 issue of The Lancet. Despite widely held concerns that the progressive emergence of drug resistance would lead to increased mortality, this has not occurred, the researchers say -- although mortality also did not appear to decrease during the course of the study. The study also noted that tuberculosis has become a dangerous coinfection in some patients, and that patients on average have been starting treatment with more advanced disease in recent years, rather than starting treatment earlier in the course of their disease progression. The study, which is based on data from more than 22,000 HIV-infected patients in Europe and North America who started treatment between 1995 and 2003, showed that patients' median CD4+ cell count at treatment initiation increased from 170 cells/mm³ in 1995-1996 to 269 cells/mm³ in 1998, then dropped to around 200 cells/mm³. Click Here

•  HIV TRANSMISSION/TESTING

HIV Superinfection May Be More Common Than Previously Thought, Researchers Say
Cases of infection with multiple strains of HIV may be more common than previously believed, according to research presented at AIDS 2006. A recent study of 57 HIV-infected women in Mombasa, Kenya, found eight cases of superinfection -- a 14% prevalence rate, which is dramatically higher than any previous estimates made within the United States. The researchers believe that many of the women contracted the second HIV strain within a year of their initial infection. Click Here


HIV Prevalence Increases in the U.S.; 48% Are Black
The number of people with HIV continues to rise in the United States, increasing by 6.3% per year from 2000 to 2004 in 33 U.S. states, according to U.S. Centers for Disease Control and Prevention researchers. In addition, African Americans comprise 48% of all people living with HIV in the 33 U.S. states, although they make up only 13% of the total population in those states, the researchers found. Mark Holodniy, M.D., reports for The Body PRO from AIDS 2006. Click Here

•  HIV POLICY & TREATMENT ACCESS

Many Rich Nations Not Paying Their Fair Share in Global HIV Fight, Report Card Says
Many of the world's wealthiest countries are failing to live up to their commitments to fund the global battle against HIV, according to a report card prepared by health advocates and released at AIDS 2006. The report card graded countries based on how much money they had pledged to the Global Fund to Fight AIDS, Tuberculosis and Malaria for 2006 and 2007. Only three wealthy nations -- France, Ireland and Sweden -- received a grade of A for both years, while nine countries were given two F's. The United States received a C for 2006 and an F for 2007. Click Here

To download a PDF of the report card, click here.


Second-Line Antiretrovirals Still Far Too Expensive, MSF Says; Governments Have "Heads in the Sand"
Although the world has made great advances in getting HIV medications to people who need them in resource-poor areas, many HIV medications remain too expensive in the developing world, especially second-line antiretrovirals, says Medecins Sans Frontieres (MSF). At AIDS 2006, MSF warned of the rising prevalence of HIV drug resistance in poor countries and appealed for greater attention to the need for further price reductions. "Most patients whose lives had been saved by first-line treatment will be abandoned the moment they need second-line drugs unless governments pull their heads out of the sand and start tackling this issue," said Ibrahim Umoru, an MSF peer educator from Nigeria, at the conference. Click Here

To read an MSF press release on this issue, click here.


U.S. ADAP Waiting Lists Shrink, but Not for Long, Report Warns
The number of Americans on AIDS Drug Assistance Program (ADAP) waiting lists has dropped sharply in the last few months, but the respite may be only temporary, according to the latest "ADAP Watch" released by the National Alliance of State and Territorial AIDS Directors. The report said that 310 people in five U.S. states were currently on a waiting list to receive HIV meds, down from 791 people in nine states in February. However, some of the states that were able to eliminate their waiting lists this year are on the verge of starting new ones, and several other states have recently introduced new restrictions or expect to do so soon, the report says. Click Here

•  HIV OUTSIDE THE UNITED STATES

African Nations Report "Mixed" Success With ABC Prevention Method
The "ABC" method -- abstain, be faithful, use condoms -- is the lynchpin of the United States' global HIV prevention efforts, but some developing countries have encountered difficulties implementing it, according to reports by African nations at AIDS 2006. In Botswana, in areas where intense door-to-door education efforts took place, many people still didn't appear to know that being faithful was an important part of HIV prevention. In Kenya, although about half of teenagers in a survey understood why abstinence was important, only 23% understood faithfulness, and only 13% could explain the importance of condoms. Click Here


The Debate Heats Up: Should Men in Developing Countries Be Circumcised?
Researchers and AIDS advocates engaged in a spirited debate at AIDS 2006 over whether male circumcision is a safe and effective method for reducing the spread of HIV in developing countries. Although recent studies suggest that it is, cultural beliefs may make the widespread acceptance of circumcision a daunting prospect in some areas. "The cultural meaning of this act is much more profound than this kind of research can take account of," said Gary Dowsett, an Australian sociologist. Click Here

To watch a Webcast of this debate, which took place on Aug. 15, click here.