•  PODCAST INTERVIEWS WITH TOP CLINICIANS FROM ICAAC 2006

The 46th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC 2006) provided the perfect opportunity to speak with some of the world's top HIV physician-researchers about critical issues in patient care. The Body PRO sat down with Cal Cohen, Eric Daar, Benjamin Young and other clinicians to get their take on some of the most pertinent issues in HIV medicine today, from when to initiate therapy to the outlook for the current crop of antiretrovirals in development. Click here to listen to each of these exclusive podcasts! (A full transcript of our interview with Dr. Cohen is now available; transcripts of other interviews will be available soon.)

Of course, these podcast interviews comprise only a portion of The Body PRO's thorough coverage of ICAAC 2006. Stop in at our ICAAC 2006 home page to read highlights, or browse all of our coverage from our team of expert faculty.

•  HIV TREATMENT & PATIENT CARE

U.S. Treatment Guidelines Revised; Preferred, Alternative Medications Updated
The U.S. Department of Health and Human Services has released the latest revision to its "Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents." The revised guidelines feature streamlined, updated recommendations on preferred and alternative first-line regimens, namely:

• Boosted atazanavir (Reyataz) and twice-daily, boosted fosamprenavir (908, Lexiva, Telzir) have joined lopinavir/ritonavir (Kaletra) and efavirenz (Sustiva, Stocrin) as "preferred" medications, with the guidelines recommending that one of those medications be combined with either of two NRTI combinations: tenofovir/emtricitabine (Truvada) or zidovudine/lamivudine (Combivir).
• Three treatment options -- nelfinavir (Viracept), saquinavir (Invirase) + ritonavir (Norvir) and zidovudine/lamivudine/abacavir (Trizivir) -- have been cut from the list of alternative first-line possibilities. These options are "inferior to the preferred or alternative components; however, they may be preferred in selected settings," the guidelines state.

To download a PDF of the revised guidelines in their entirety, click here.


MK-0518 May Have Better Lipid Profile Than Efavirenz, Short-Term Study Finds
The buzz surrounding MK-0518 is growing louder. The experimental drug, the first in a new class of antiretrovirals known as integrase inhibitors, has already shown dramatic efficacy in multidrug-resistant patients. Now, 24-week results from an ongoing study of treatment-naive patients have indicated another benefit: MK-0518 appears to be more lipid friendly than efavirenz (Sustiva, Stocrin), one of the world's most preferred antiretrovirals. The Body PRO's Benjamin Young, M.D., reports from ICAAC 2006. Click Here

The promising findings regarding lipids are the latest in a string of promising study results for MK-0518. At the XVI International AIDS Conference earlier this year, a study of treatment-naive patients found that the drug, when combined with tenofovir/emtricitabine (Truvada), triggered a rate of viral decay that has not been seen since the advent of HAART in the mid-1990s. Click here to read a full report on this study from The Body PRO's Edwin DeJesus, M.D.


No Difference in HAART Response in Patients With X4-Using Virus
An accelerated CD4+ cell count decline has been found to occur when HIV uses the CXCR4 (known as X4) coreceptor instead of the CCR5 (R5) coreceptor for cellular entry. However, a study from London demonstrates that there is no significant difference in response to initial antiretroviral treatment between those with a mixture of X4 and R5-using virus and those with only R5-using virus. CD4+ cell count recovery, time to virological suppression and rates of viral suppression through 24 months were similar for X4/R5 patients and R5-only patients. The Body PRO's Graeme Moyle, M.D., who was an author on the study, reports from ICAAC 2006. Click Here


Zidovudine/Lamivudine/Abacavir May Be Appropriate for Some Treatment-Naive Patients With Low Baseline Viral Loads
Although its use is still controversial, the fixed-dose combination of zidovudine/lamivudine/abacavir (Trizivir) may be appropriate for some treatment-naive patients who have a low baseline viral load, according to the results of an industry-backed study by U.S. researchers. The study found that the triple-NRTI pill exhibited comparable tolerability and efficacy to a regimen of zidovudine/lamivudine (Combivir) + atazanavir (Reyataz). As The Body PRO's Ben Young, M.D., Ph.D., reports from ICAAC 2006, the findings enrich our understanding regarding treatment options for a minority of patients who cannot receive a "preferred" first-line therapy regimen. Click Here


Lower Adherence May Precede Viral Load "Blips"
Are low-level increases in a normally undetectable viral load, also known as "blips," a laboratory artifact that has no clinical significance? Perhaps not: A new study by researchers from Abbott Laboratories suggests that blips may be associated with lower adherence. The study found that the mean number of days a patient took his or her prescribed doses was lower in the week prior to a blip than during a matched period when a blip did not occur. The Body PRO's Paul Sax, M.D., reports from ICAAC 2006. Click Here

Looking for more research analyses from ICAAC 2006? Visit The Body PRO's ICAAC 2006 home page to browse our full coverage of this conference.


Viral Load Is Not a Reliable Indicator of CD4+ Cell Count, Study Says
A rising viral load does not presage a falling CD4+ cell count among HIV-infected patients who have not yet initiated treatment, according to a study published in the Sept. 27 issue of the Journal of the American Medical Association. The large study by U.S. researchers found only a "minimal" relationship between changes in a patient's viral load level and changes in his/her CD4+ cell count. The researchers suggested that the findings drive home the point that CD4+ cell count, not viral load, is what truly matters when it comes to deciding whether to initiate antiretroviral therapy. Click Here


U.S. Expanded Access Program Launched for TMC125, an NNRTI in Development
Clinicians caring for HIV-infected patients with multidrug resistance -- particularly to NNRTIs -- should note that an expanded access program was launched in September for TMC125 (etravirine). Studies over the past year have shown that TMC125 appears effective in treatment-experienced patients with NNRTI resistance. Tibotec Therapeutics, which is developing TMC125, expects expanded access programs to open soon in Canada and Europe. Click Here

For more information, click here to visit the main Web page of the TMC125 expanded access program.

TMC125 is one of two HIV medications that are now available through expanded access programs. The other is MK-0518, part of a new class of antiretrovirals known as integrase inhibitors. Both TMC125 and MK-0518 are being offered to HIV-infected patients with limited or no treatment options due to drug resistance. In addition, expanded access for maraviroc (UK-427,857), a CCR5 inhibitor, is expected to begin in early 2007.


The "NeuroAIDS" Dilemma: Many Questions, Few Answers
To what extent does HIV infection ultimately affect an individual's cognitive abilities? Experts are still uncertain, although there are some signs that, over the long term, HIV infection may impact a person's memory or other neurocognitive functions, even among people whose viral loads are fully suppressive on HAART. Clearly, there remain far more questions than answers on this subject, but researchers are now trying to investigate both the causes of, and potential treatments for, what some have termed "neuroAIDS." Click Here


HIV Medication Pipeline Update
At any given moment, dozens of HIV antiretrovirals are in various stages of development. Many will fail during the earliest stages of study, but some -- such as the integrase inhibitor MK-0518, the CCR5 inhibitor maraviroc (UK-427,857) and the NNRTI TMC125 (etravirine) -- have already moved into the final stage of development before potentially receiving U.S. approval. This reference chart by Treatment Action Group provides a complete, succinct rundown of all HIV medications currently in the development pipeline. Click Here


Providing Health Care to an HIV-Infected Adolescent
HIV can add complexity to even the most straightforward patient visit. But for HIV-infected patients who are also enduring the emotional and physical changes of adolescence, dealing with all of these issues at the same time can be overwhelming -- not just for the young patient, but for his/her health care provider as well. In this article, HIV pediatrician Margo Bell reviews some of the challenges and concerns involving health care for an adolescent who is infected with HIV. Click Here

•  HIV/AIDS POLICY IN THE UNITED STATES

ADAP Update: 320 Patients on Waiting Lists in Six U.S. States
As of Sept. 20, 320 individuals were on U.S. AIDS Drug Assistance Program (ADAP) waiting lists in six states: Alabama, Alaska, Indiana, Montana, South Carolina and West Virginia, according to the latest ADAP Watch report issued by the National Alliance of State and Territorial AIDS Directors. Three states -- Mississippi, Oklahoma and South Carolina -- have instituted other cost-containment measures since the beginning of fiscal year 2006, the report says. The report also warns that the uncertain financial situation for ADAPs, including the still-incomplete reauthorization of the Ryan White CARE Act, could further undermine the shaky ground on which many ADAPs stand. Without reliable financial support, waiting lists and other cost-containment measures "threaten to become a permanent feature of this critical program," the report says. Click Here


HIV Medicare Fraud Is Rampant, Panelists Say
Experts attending a roundtable discussion at the 2006 U.S. Conference on AIDS in Hollywood, Fla., concurred that fraudulent Medicare billing for HIV-related treatments is a major problem in the United States. Roundtable participants described how recruiters visit homeless shelters and assisted living facilities to look for HIV-infected persons who have Medicare disability cards. An FBI agent, who declined to be identified, said recruiters even attend meetings of Narcotics Anonymous and Alcoholics Anonymous and visit mental health facilities. Click Here

•  HIV TRANSMISSION/TESTING

Smoking May Increase HIV Infection Risk, Study Says
Tobacco smokers are 60% to 300% more likely to contract HIV than nonsmokers, according to a British study published in the Aug. 21 issue of Sexually Transmitted Infections. However, the study did not find a link between smoking and HIV disease progression. The researchers said they were unsure as to why smoking would increase an individual's HIV risk, but they note that there is increasing evidence that cigarette smoking raises the risk of all types of infections by altering the structure of the lungs or weakening the immune system. They also point out that tobacco use tends to be higher among people who are already members of high-risk groups. Click Here


New York City Increases HIV Testing by 50%, but More Testing Needed
Although universal HIV testing was just recommended by the U.S. Centers for Disease Control and Prevention, New York City began an expanded testing program in 2004. The program has increased HIV testing in city health clinics, jails and hospitals by nearly 50% in the last year. As a result, the city has already diagnosed 1,514 people with HIV in 2006, more than double the total for all of 2005. However, the expanded testing program only applies to city agencies; private hospitals, doctor's offices and AIDS organizations aren't affected, meaning many people in this city of 8 million remain untested. Click Here


Expanded Testing in Washington, D.C., Finds HIV Prevalence Double the U.S. Average
As debate simmers over the U.S. Centers for Disease Control and Prevention's new HIV testing recommendations, a Washington, D.C., program shows that universal testing does greatly increase the number of people who find out they have HIV. Initial results from a campaign to test all city residents ages 14 to 84 show that the city's HIV rate is more than twice the U.S. average. Nearly 3% of the more than 7,000 D.C. residents who have been tested since June were found to be HIV infected. Early results of the $8 million project support what local officials had feared: The United States' capital city has one of the highest HIV infection rates in the nation. Click Here


Gov. Schwarzenegger Blocks Condom Distribution in Calif. Prisons
The distribution of condoms in U.S. prisons may make perfect sense to HIV prevention advocates, but apparently not to California Gov. Arnold Schwarzenegger: He recently vetoed a bill that would have allowed nonprofit groups to distribute condoms, dental dams and similar prevention tools to California's 162,000 inmates. The bill’s author, Democratic Assemblyman Paul Koretz, argued that condom distribution in prisons is simply a smart public health measure. A multitude of studies have shown that in American prisons, sex between inmates or between inmates and correctional officers is common, and the incidence of sexually transmitted diseases is high. But Benjamin Lopez of the Traditional Values Coalition, a conservative, religious advocacy group that opposed the bill, called the idea "obscene, disgusting and absurd." Opponents of the bill also pointed out that sexual intercourse between inmates is a crime. Click Here

•  HIV OUTSIDE THE UNITED STATES

Deadly New TB Strains Threaten HIV-Infected Patients
Deadly new strains of tuberculosis (TB) appear to be spreading globally, posing an especially high health risk for HIV-infected patients in developing countries, according to the World Health Organization (WHO). Already the world's fourth most-fatal infectious disease, so-called "extreme-drug-resistant" TB (XDR-TB) strains cannot be treated using traditional medications. Two percent of all TB cases worldwide are now XDR-TB cases, and patients with HIV in developing countries are especially vulnerable. Newsweek recently interviewed Paul Nunn, who heads the WHO TB resistance team in Johannesburg, South Africa, to discuss the worsening situation. Click Here


India Increases Access to Free Antiretrovirals
In the past year, the number of treatment centers in India that provide free HIV medications has nearly doubled, according to the top official in the country's HIV/AIDS program. A part of India's national campaign to increase access to HIV treatment, these treatment centers, which have increased in number from 54 to 91, provide no-cost medications and are staffed with licensed physicians, lab technicians and counselors in Indian states with high rates of HIV. Currently, India has the largest population of HIVers in the world, with 5.7 million people estimated to be living with the virus. "Our first priority now will be to launch a massive publicity campaign to let people know ... that they should reach out for free treatment," said Sujatha Rao, head of India's National AIDS Control Organization. Click Here