•  HIV TREATMENT & COMPLICATIONS

Understanding and Inhibiting Integrase in the Treatment of HIV Disease
The United States is likely to approve the first HIV integrase inhibitor in 2007, and another may get the green light next year. With the introduction of this new class of medications right around the corner, there is growing interest among clinicians in understanding how these agents work, as well as how they are likely to impact HIV therapy once they become an integral part of our treatment armamentarium. This PRN Notebook overview (which requires free registration to access) provides an in-depth look at HIV integrase and the agents currently in development that seek to inhibit it. Click Here


Image Library of HIV Complications Created by Swiss Physician
Need an image, table or illustration of an HIV-related complication for a PowerPoint slide or other presentation? Bernard Hirschel, Chief of the HIV/AIDS Division at the Geneva University Hospital in Switzerland, has compiled an impressive online repository of images, illustrations and tables related to the complications of HIV. Use of the site is free, though registration is required to use some areas. Click Here


Patients Over 50: HIV Treatment Success as Likely, but Complications More Common
HIV-infected patients over the age of 50 are just as likely to achieve antiretroviral therapy success as their younger counterparts, but are more likely to experience a range of complications after commencing treatment, according to the results of an Italian study published in the November 2006 issue of HIV Medicine. The study compared 48-week outcomes among 159 older, HIV-infected patients and 118 younger, HIV-infected patients in Milan, Italy. Although treatment tolerability, CD4+ cell count increase and virological suppression rates were similar between both patient groups, older patients experienced greater rates of abnormal glucose, serum creatinine, total cholesterol, HDL and triglyceride levels -- much as they do among the HIV-uninfected population. The study also found that younger HIV-infected patients appeared more likely to have abnormal ALT levels, while older HIV-infected patients were more likely to experience moderate or severe liver and renal toxicities. Cumulatively, the results point to the need for greater attention to the interaction between age and antiretroviral use, the researchers say. Click Here

•  HIV TRANSMISSION & TESTING

Anal Gonorrhea, Chlamydia Infections Possible Without Unprotected Anal Sex
Anal infection with gonorrhea or chlamydia is possible even if an individual has not had unprotected anal sex, according to an Australian study published in the online edition of Sexually Transmitted Infections. The study of 1,427 HIV-uninfected men in Sydney found that, although receptive, unprotected anal intercourse was strongly associated with anal gonorrhoea and chlamydia infections, more than a third of patients with either infection did not report having unprotected anal sex. Other, non-intercourse practices, such as fingering and rimming, appeared to account for those other transmissions. Based on the study findings, the researchers recommended anal screening for "all sexually active gay men, not just those who report unprotected anal sex.” Click Here


Interventions Reduce HIV/STD Risk Behavior Following Prison Release
Inspiring incarcerated and formerly-incarcerated people with an HIV prevention message can be difficult, but comprehensive prevention education can work, according to a U.S. Centers for Disease Control and Prevention (CDC)-sponsored study of young men who were recently released from prison. Participants in the study received either a single-session intervention, which included an HIV risk assessment and risk-reduction planning, or an "enhanced intervention," which included the above, plus five sessions of expanded life counseling. The study found that the more comprehensive intervention significantly reduced sexual risk behaviors 24 weeks after release. In this interview, David Wohl, M.D., Co-Chief Editor of the Infectious Diseases in Corrections Report, speaks with lead investigator Richard Wolitski, Ph.D., about the significance of the study, as well as the CDC's plans to make the intervention program widely available. Click Here


Report Highlights Limits of Acute HIV Testing, Calls for Greater Clinician Awareness
Nucleic acid testing, a method being employed increasingly throughout the United States to diagnose cases of acute HIV infection, carries a risk of false negatives that requires more careful attention on the part of health care professionals, warn Washington state researchers. In the Feb. 1 issue of Clinical Infectious Diseases, the researchers report on three unusual cases that, they assert, point to the potential for pooled nucleic acid testing to result in false-negative test results. The researchers urge health care professionals to rely on more than just nucleic acid testing itself -- e.g., conducting individual risk assessment and observing physical symptoms -- when interpreting test results. Click Here


Epstein-Barr Virus Is Sexually Transmitted, Study Finds
A new study adds to the list of reasons health care workers can cite to highlight the importance of safer sex for HIV-infected people: Epstein-Barr virus (EBV), which has been linked to a higher risk of non-Hodgkin's lymphoma, has now been identified as a sexually transmitted disease. Although physicians have long known that EBV can be transmitted through saliva, a study of more than 2,000 students at the University of Edinburgh in the United Kingdom revealed that students who were sexually active -- especially those who had multiple partners or did not use condoms -- were more likely to have the virus. The findings appear in the Feb. 15 issue of the Journal of Infectious Diseases. Click Here

"Why has it taken so long to think of EBV as a sexually transmitted agent at least some of the time?" asks Joseph S. Pagano, M.D., of the University of North Carolina-Chapel Hill in an accompanying editorial. In his commentary, Dr. Pagano explores the answer to this question and discusses the ramifications.

•  HIV IN THE NEWS

Federal Agents Raid Medical Marijuana Storefronts in Los Angeles
Using medical marijuana is legal in California, but federal agents nonetheless raided 11 medical marijuana outlets in Los Angeles County earlier this month. U.S. Drug Enforcement Administration officers detained more than 20 people for questioning and seized several thousand pounds of processed marijuana, hundreds of marijuana plants, guns and cash. The raids are a symptom of the ongoing tension between California state law, which permits medicinal use of marijuana, and federal law, which considers marijuana possession illegal under any circumstances. Click Here

•  HIV OUTSIDE THE UNITED STATES

South African AIDS Crisis Causes Labor Shortage for 2010 World Cup Preparations
South African construction firms are struggling to find enough labor to meet their goals for the 2010 Fédération Internationale de Football Association World Cup. The multi-billion dollar stadium and infrastructure building project lacks local engineers and technicians to handle the construction boom in the nine host cities, and engineering consultants blamed high HIV rates for the dearth. Around 5.5 million South Africans (one in 11 people in the country) are HIV infected. Engineering consultants say that HIV threatens to kill off a generation of young engineers in Africa at a time when they are in high demand. Click Here


From U.S. to Developing World, HIV Pediatrician Hopes to Save Young Lives
In the United States and many other wealthy nations, there are few children born with HIV today, thanks to the effective use of antiretroviral therapy among HIV-infected pregnant women. In developing countries, however, HIV continues to take a devastating toll on children. Mark Kline, M.D., president of the Baylor International Pediatric AIDS Initiative, has seen both of these trends unfold firsthand: After spending years treating HIV-infected children in the United States, he now works in Africa, Latin America and Romania, where the future for children with HIV is bleak. In this National Public Radio podcast, he explains how he's trying to do his part to transform these children's futures. Click Here


Formula Feeding as Good as Short-Term Breastfeeding When Antiretrovirals Are Unavailable, Study Finds
Pregnant HIV-infected women in Africa face a terrible dilemma. Effective antiretroviral therapy remains unavailable throughout large swaths of the continent, and the risk of vertical HIV transmission increases each time a mother breastfeeds her child. Thus, mothers are generally encouraged to take one of two approaches to feeding their newborns: use replacement formula (which can be difficult given that access to clean water is often limited) or breastfeed children for only a few months after they are born. A new study by French and Ivory Coast researchers finds that, where clean water is available and "HIV-positive mothers are well supported, either of the two feeding options currently recommended ... are likely to be equivalent in terms of the baby's chances for survival and health," according to an editorial summary of the study. The study was published in the January 2007 issue of PLoS Medicine. Click Here

In an accompanying editorial, Grace C. John-Stewart, M.D., M.P.H., Ph.D., of the University of Washington-Seattle analyzes the implications of these study findings; she notes that the results provide "reassuring" data that replacement feeding can be a safe alternative to breastfeeding where both access to clean water and adequate support for the mother are available.