•  NEW, FREE CME/CE AT THE BODY PRO

NEW ACTIVITY: Challenging Cases in HIV: Implications of Anemia
Anemia, in addition to being a possible complication of HIV disease itself, is also a common HIV treatment-related adverse effect. Like many health complications, anemia can significantly affect the overall well-being of HIV-infected patients and may interfere with treatment adherence. In this two-part, slide-based continuing education activity, Douglas T. Dieterich, M.D., and David H. Henry, M.D., use a case-study format to review the incidence and impact of anemia in patients with HIV, and to provide recommendations for the incorporation of anemia assessment and treatment strategies into clinical practice. Free CME/CE credit is available for U.S. physicians, nurses, nurse practitioners and pharmacists! Click Here

This new activity is just one of several that have recently been launched at The Body Pro’s CME/CE Central! Other recent additions include:

• Update on Management of the HIV/Hepatitis B- or HIV/Hepatitis C-Coinfected Patient, by Maurizio Bonacini, M.D.
  
  
• Optimizing Therapy for Patients With Multidrug-Resistant HIV, by Charles Hicks, M.D., Angela D.M. Kashuba, B.Sc.Phm., Pharm.D., D.A.B.C.P., and Sharon Walmsley, M.D.

Click here to browse our full selection of informative activities!

•  HIV/HAART-RELATED COMPLICATIONS

Momentum Grows for HLA-B*5701 Testing to Prevent Abacavir Hypersensitivity
The evidence is mounting in support of testing for the presence of the HLA-B*5701 allele prior to abacavir (Ziagen) exposure as a means to dramatically reduce the incidence of hypersensitivity reaction. The latest data to back this theory comes from a prospective study conducted in the United Kingdom. The Body PRO’s Graeme Moyle, M.D., reports from the 8th International Congress on Drug Therapy in HIV Infection. Click Here


Mitochondrial DNA Depletion May Help Explain IVF Failures in Women on HAART
A reduction in mitochondrial DNA (mtDNA) within oocytes may account for the decreased likelihood of successful in vitro fertilization (IVF) among HIV-infected women on HAART, according to the results of a small study presented at the 8th International Congress on Drug Therapy in HIV Infection. The study enrolled eight infertile, HIV-infected women receiving HAART, all of whom had an undetectable viral load and a mean CD4+ cell count of 781 cells/mm³. Overall, mtDNA content in oocytes from the HIV-infected women was 48% less than the mtDNA oocyte content for HIV-uninfected controls (P = .001). Depletion of mtDNA is believed to be responsible for much of the toxicity caused by some antiretrovirals, most notably the nucleoside analogues didanosine (ddI, Videx) and stavudine (d4T, Zerit). Such mitochondrial depletion is thought to result in adverse effects such as pancreatitis, peripheral neuropathy and lipoatrophy. Click Here


Waist Size No Different in HIV-Infected Men on HAART Than in HIV-Uninfected Men
New data from the massive Multicenter AIDS Cohort Study suggest that there is no phenomena of waist fat gain unique to HIV-infected men on HAART. Researchers used circumference measurements to track men's hip and waist size over a four-year period. Their findings, which appear in the Nov. 1 issue of JAIDS, show that HIV-infected men on HAART were no more likely to gain waist fat than HIV-uninfected men. However, the researchers did find that HIV-infected men on treatment seemed to gain hip fat more slowly than HIV-uninfected men, with the resulting change in waist/hip ratio making it appear as though their waists had increased in circumference. These findings may help clarify diagnostic criteria for lipohypertrophy. Click Here


AIDS Event Risk Greater Among Patients Not Achieving >200 CD4+ Cell Count on Treatment
It is widely known that a CD4+ count below 200 cells/mm³ puts a patient at a greater risk for AIDS-defining illnesses. But what if the patient is on virologically suppressive therapy at the time? According to data from a British Columbia cohort, achieving an undetectable viral load on first-line HIV treatment is not, in itself, enough to offset the inherent dangers of a CD4+ cell count that remains below 200 cells/mm³ while on treatment. The Body PRO’s Mark Holodniy, M.D., reports from ICAAC 2006. Click Here


Adverse Liver Events on Tipranavir Are Common, but Resolve Over Time
Although a regimen containing tipranavir (Aptivus) + ritonavir (Norvir) is generally effective in patients who are resistant to other protease inhibitors, one concern with this regimen has been its potential liver toxicity. However, a new study by an international team of researchers has found reason for cautious optimism. Yes, tipranavir + ritonavir can, and often does, increase liver enzyme levels, the researchers found. However, less than 1% of patients in the study who received tipranavir + ritonavir experienced severe adverse liver events related to those high levels, and most patients who developed highly elevated liver enzymes tended to see a reduction over time. The Body PRO's Margaret Hoffman-Terry, M.D., reports from ICAAC 2006. Click Here

•  HIV TREATMENT & PATIENT CARE

Incidence of Multidrug-Resistant Virus May Be Declining in HAART Era
The presence of multidrug-resistant (MDR) HIV poses significant challenges with regard to treatment and transmission. However, although research suggests that the prevalence of MDR HIV is escalating as patients gain more exposure to multiple classes of drugs, new findings from a large Portuguese database suggest that the incidence of MDR HIV is actually decreasing, likely due to improvements in the efficacy of HIV drugs. The Body PRO’s Simon D. Portsmouth, M.B.Ch.B., reports from the 8th International Congress on Drug Therapy in HIV Infection. Click Here


New Treatment Paradigms for Treatment-Experienced Patients
These are exciting times in HIV antiretroviral therapy, given the recent U.S. approval of several new agents and the development of additional agents that are nearing approval. David Cooper, director of the National Centre in HIV Epidemiology and Clinical Research at the University of New South Wales, recently provided a rundown of the current crop of new antiretrovirals, and discussed strategies for their utilization in treatment-experienced patients. The Body PRO’s Simon D. Portsmouth, M.B.Ch.B., reports from the 8th International Congress on Drug Therapy in HIV Infection. Click Here


Conference Provides Thorough Look at Tipranavir Through Studies on Efficacy, Resistance and Safety
Several studies confirm the potency and durability of tipranavir in heavily treatment-experienced patients, namely due to its high genetic barrier to resistance. However, although the agent is an attractive and relatively safe option for individuals in need of potent salvage antiretrovirals, preliminary toxicity and efficacy concerns preclude its use in treatment-naive individuals. The Body PRO's Mark Wainberg, Ph.D., reports from the 8th International Congress on Drug Therapy in HIV Infection. Click Here

Looking for additional coverage of the 8th International Congress on Drug Therapy in HIV Infection? Click here to view highlights and browse a complete index of The Body PRO's expert analyses.


Component of Green Tea Appears to Inhibit HIV/CD4+ Receptor Binding
A flavinoid found in green tea may act as an inhibitor of HIV surface binding with CD4+ cells, according to the results of in vitro experiments by British and U.S. researchers. The flavinoid, epigallocatechin gallate (EGCG), has anti-inflammatory and antimicrobial properties, and cancer drugs based on it are now in clinical trials. Researchers have known for some time that EGCG inhibits HIV in lab experiments; the new research sheds light on the mechanism by which it does so. The full report was published online in the October 2006 issue of the Journal of Allergy and Clinical Immunology. Click Here


Researchers Seek to Treat HIV With Genetically Modified Version of Patient’s Own HIV Strain
Results from a phase 1 study of five HIV treatment-experienced patients show promise for an experimental method involving a patient-specific, genetically based approach to HIV therapy. Researchers from the University of Pennsylvania and the Vaccine Research Center at the U.S. National Institutes of Health “gutted” HIV taken from each patient, then altered its genetic structure to cripple its reproductive capability and reintroduced it into the patient. After three years of followup, none of the patients showed adverse effects, and the immune function of four patients actually improved. Phase 2 trials in HIV patients with well-suppressed viral loads are now underway. Click Here


Radioactive Antibodies Examined as Potential Antiretroviral Treatment
A proof-of-concept study by U.S. and German researchers suggests that a method of attaching radioactive isotopes to HIV-specific antibodies may be effective in destroying HIV-infected cells during acute or chronic infection. In this study, the technique, which is used in cancer therapy, was employed in mice; the researchers had hypothesized that radioactive isotopes could be used to cluster around HIV-infected cells, killing them while leaving other cells unharmed. Click Here

•  HIV/STD TRANSMISSION

No Evidence to Support Link Between HIV Stigma and HIV Incidence, Experts Write
There is no denying the negative impact of HIV stigma on the well-being of HIV-infected people. But does stigma have a similarly negatively impact on HIV prevention efforts? Not according to Daniel Reidpath of Brunel University's Centre for Public Health Research and Kit Yee Chan of Deakin University's School of Health and Social Development. In a PLoS Medicine essay, the two write that blaming stigma for fueling the HIV pandemic oversimplifies the problem: It "gives too much weight to individual behavioral change as the answer to HIV prevention," they say, and neglects other complex social issues that affect HIV transmission. Click Here


Few Americans Favor Abstinence-Only Sex Education
The U.S. government spends an astonishing $170 million a year on abstinence-only sexual education programs. Experts on sex education say the approach is ineffective and unrealistic -- and, it turns out, most Americans agree. In a survey of nearly 1,100 U.S. adults, 82% favored sex education that includes information about how to prevent pregnancy and sexually transmitted diseases, as well as abstinence. Even conservatives, who one might least expect to favor teaching young people about safer sex, said they prefer comprehensive sex education over preaching chastity and nothing else.The findings "highlight a gap between policy, science, and public opinion," says lead author Amy Bleakley of the University of Pennsylvania. Click Here


Are Microbicides the Future of HIV Prevention?
The creation of a viable microbicide could provide millions of women (and, hopefully, gay men) with the power to protect themselves from HIV and other sexually transmitted diseases. But how realistic are our expectations? In this letter, Lori Heise, the director of the Global Campaign for Microbicides, provides a down-to-earth analysis of the issue. She warns that, while continued excitement about microbicide development can be used to keep the spotlight (and money) on research efforts, realism is also important: Drug development and approval is complex and time-consuming, and even after a microbicide has been approved, its cost may keep it out of the hands of the people who need it most. Click Here


HIV Testing Is Common Among Men Who Have Sex With Men -- But So Is Risky Behavior
Although HIV awareness is high among men who have sex with men (MSM) in the United States, so are behaviors that can put them at risk for HIV and other sexually transmitted diseases, according to a new survey released by the U.S. Centers for Disease Control and Prevention. Promising data included the finding that more than 90% of the 10,030 MSM surveyed had been tested for HIV, with 77% saying they'd been tested within the last year. However, high-risk sex also appeared common: 58% of respondents reported having unprotected anal intercourse with their significant other, and 34% with a male casual sex partner. In addition, 42% of the MSM surveyed said they used non-injection recreational drugs. Click Here


Black Community Must Battle Homophobia to Cut HIV Rate, Report Says
The National Minority AIDS Council (NMAC) has issued a report on HIV in the African-American community that calls for greater efforts to target the marginalization, stigma and discrimination against black men who have sex with men (MSM) in the United States. According to data from CDC, 51% of new HIV/AIDS diagnoses in 2004 were in African Americans, though blacks account for just 13% of the U.S. population. Men represent 63% of new African-American HIV/AIDS diagnoses, and gay and bisexual men accounted for 49% of these cases. "Perhaps the most important factor in reducing HIV risk for black gay men is the one that receives the least attention, and that is eliminating the homophobia and related stigma, discrimination, and violence experienced by many black gay men," said Phill Wilson, CEO and founder of Black AIDS Institute. Click Here


San Francisco to Study Whether Meds Can Reduce Meth Use -- And Risky Sex -- Among Gay Men
While debate continues over how widespread crystal methamphetamine use is in the gay community, the San Francisco Department of Public Health has decided to take action: The department recently announced three separate studies to determine the efficacy of medications in reducing (or stopping) meth use, and in the process reduce high-risk behaviors among men who have sex with men (MSM). The medications -- all currently approved by the U.S. Food and Drug Administration for other uses -- correct chemical imbalances in the brain that increase cravings and withdrawal symptoms. "[The health department] is really taking the lead in trying to find ways to treat meth dependence both in terms of drug addiction but also possibly as an HIV prevention strategy," said Grant Colfax, who is supervising the studies. Click Here


Gonorrhea Found Most Frequently in Throats of Gay Men
A San Francisco study of 603 gay men (all of whom were HIV uninfected when the study began) found that 6% had gonorrhea of the throat, and that most exhibited no symptoms. The 6% rate was much higher than the rate of gay men found to be infected with gonorrhea in their penis (1%) or rectum (2%). The researchers recommended that all sexually active gay men receive an annual throat swab to check for gonorrhea, and that gay men who have multiple or anonymous partners receive swabs every three to six months. Gonorrhea in the throat generally resolves after several months, but while the infection is present it can act as a "reservoir" for gonorrhea transmission to other men, the researchers note. Click Here

•  HIV/AIDS POLICY IN THE UNITED STATES

U.S. AIDS Policy May Shift Now That Democrats Control Congress
Beginning next year, Democrats will control both chambers of the U.S. Congress for the first time since 1994. What will that mean for U.S. AIDS policy? Only time will tell, but the power shift could have an impact on some key policy areas. For instance, the reauthorization of the Ryan White CARE Act, which funds U.S. HIV programs, has already been stalled for more than a year by Democratic leaders, who oppose Republican-proposed revisions that would shift funding from urban to rural areas. Meanwhile, the President's Emergency Plan for AIDS Relief, which allotted $15 billion to helping fight HIV overseas, needs to be renewed in 2007. Democrats favor increased funding and oppose requiring countries to devote one-third of U.S. funding to abstinence-only programs. Convincing conservatives to change the abstinence-only requirement may be tough, but come January, Democrats will have a real chance to assert themselves. Click Here

•  HIV RESEARCH NEWS

Simian Viral Strain Most Similar to HIV Found in Wild Gorilla Populations
Scientists have discovered a virus in gorillas that is more similar to HIV than any other related HIV strain previously found in apes, according to a study published in the Nov. 9 issue of Nature. The study marks the first time any researchers examined wild gorillas for a simian version of HIV, according to lead author Martine Peeters, a virologist at Universite Montpellier. The researchers plan to conduct further studies to determine the prevalence, geographic distribution and history of the strain (which has been dubbed SIVgor), as well as the means by which gorillas contracted the strain. "We think chimpanzees transmitted it to gorillas, but we don't know who transmitted it to humans -- the gorilla or the chimp," Peeters said. Click Here

•  HIV OUTSIDE THE UNITED STATES

Global AIDS Report Provides Grim Numbers, but Reasons for Hope
UNAIDS has issued its 2006 report on the global AIDS pandemic, and once again the numbers are grim:

• In the past 12 months, 2.9 million people died from AIDS-related illnesses and 4.3 million were newly infected with HIV.
  
  
• Worldwide HIV prevalence stands at nearly 40 million -- and despite efforts to increase global awareness of HIV, prevalence of the disease has not declined in a single region.
  
  
• HIV continues to devastate Sub-Saharan Africa, despite recent gains against incidence rates in several countries.
  
  
• While HIV incidence has stabilized in Latin America and the Caribbean, it is on the verge of exploding in Eastern Europe and Central Asia.

Still, in the midst of its pages of sobering data, the report offers a few glimmers of hope. For instance, wide-scale access to antiretrovirals in low- and middle-income countries has saved thousands of lives. Also, the report points out that behavior change acts as a highly effective strategy for HIV prevention: In several African countries, the prevalence of HIV among young pregnant women is falling, at least in part because young people are delaying their first sexual experience, having sex with fewer partners and using condoms more frequently.


WHO: Taking Steps Now Could Prevent 28 Million AIDS Deaths by 2030
Preventing new HIV infections and expanding the distribution of antiretrovirals could cut global AIDS deaths from an estimated 117 million by 2030 to 89 million, according to a new report from the World Health Organization (WHO). "What happens in the future depends very much on what the international community does now," said Colin Mathers, who co-authored the report with Dejan Loncar. The report analyzed data from more than 100 countries and is an update of mortality projections made a decade ago, which assumed global infections would begin decreasing around the year 2000. Instead, AIDS is on track to become a leading cause of death worldwide. "It will be increasingly hard to sustain treatment programs unless we can turn off the tap of new HIV infections," said Richard Hays, epidemiology professor at London's School of Hygiene and Tropical Medicine. The full open-access report was published in PLoS Medicine. Click Here


0.24 Million South Africans Now Receive Free Antiretrovirals
At the end of September, a total of 235,378 HIV-infected South Africans were receiving free antiretrovirals through the country’s public health system -- an increase of about 60,000 from the 178,000 patients who were enrolled in the program at the end of June, according to the South African Health Ministry. A spokesperson for the ministry, said officials were surprised by the jump: "We have never heard of any other country that has achieved almost an average of 20,000 people being put on treatment a month," he said. While activists welcomed the increase, some are unclear as to how the government arrived at the figures. "We still lack a proper system for monitoring the numbers of people on treatment and also for evaluating the benefits for people on treatment," said Mark Heywood of the AIDS Law Project and Treatment Action Campaign. An estimated 5.5 million HIV-infected people are now living in South Africa, according to UNAIDS. Click Here

On World AIDS Day, the South African Health Ministry announced a new, five-year plan aimed at reducing HIV incidence by 50%. The plan also pledges to provide care for 80% of HIV-infected and affected people.