•  HIV/HAART-RELATED COMPLICATIONS

HIV-Infected Patients -- Particularly Women -- More Likely to Have AMIs, New Study Finds
A large, U.S. cohort study appears to confirm that HIV-infected people experience acute myocardial infarction (AMI) more often than HIV-uninfected people. The six-year study, conducted by a research team that included Steven K. Grinspoon of Massachusetts General Hospital, compared 3,851 HIV-infected patients to more than a million HIV-uninfected controls. It found that women were nearly 300% more likely to experience an AMI if they were HIV infected, while HIV-infected men faced a 40% higher risk. The overall AMI relative risk rate was 1.75 for HIV-infected patients, a higher rate than that found in the well-known D:A:D study. However, the current study failed to shed considerable light on the reasons behind the increased AMI risk, or on the considerably higher AMI rate among women as compared to men. The researchers noted, however, that the findings underlined the need for the employment of cardiac risk-reduction strategies. The study findings were published on April 24 in the online edition of the Journal of Clinical Endocrinology & Metabolism. Click Here


No Imminent Epidemic of Heart Disease Among HIV-Infected Patients on Treatment, Expert Says
HIV-infected patients on HAART are not in imminent danger of suffering a myocardial infarction (MI), according to an editorial by James Stein, M.D., published in the April 26 issue of the New England Journal of Medicine (NEJM). Dr. Stein’s editorial appears in NEJM alongside findings from the D:A:D study, which associated the use of protease inhibitors with a 16% greater MI risk per year of exposure. Dr. Stein points out that even with the increased risk, the overall odds that a patient taking protease inhibitors will experience an MI are very low -- and other factors, like smoking cigarettes or simply being male, appear to play a much larger role than protease inhibitors. Further, Dr. Stein points out, the long-term cardiovascular effects of untreated HIV infection may well pose a higher risk than the possible cardiovascular risks associated with antiretroviral use. Click Here

To read the abstract of the full D:A:D trial data, which appears in the April 26 issue of the NEJM, click here.


HBV/HIV Coinfection: Don’t Use Entecavir Without Concomitant HAART, Guidelines Say
Entecavir (Baraclude) should not be prescribed to HIV/hepatitis B (HBV)-coinfected patients who are not already receiving HIV treatment, according to updated guidelines from the U.S. Department of Health and Human Services. The recommendation, issued in a supplement to the "Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents," is based on a series of case studies presented at the 14th Conference on Retroviruses and Opportunistic Infections in which patients receiving entecavir without concomitant HIV therapy were found to experience a notable decline in HIV viral load. One entecavir patient also developed the M184V mutation. Click Here

The research on which the entecavir warning is based was presented at the 14th Conference on Retroviruses and Opportunistic Infections earlier this year. While at the conference, Marshall Glesby, M.D., Ph.D., spoke with The Body PRO about these findings; you can download a podcast or read a transcript of that interview. (The discussion of entecavir takes place toward the end of the interview.)


Helping Your Patients Overcome Fatigue
Fatigue represents a significant problem for many HIV-infected patients, but there are steps an attentive health care provider -- and a motivated patient -- can take to prevent and treat it. Surveys have shown that up to 40% of HIV-infected patients suffer from some manner of fatigue. The cause may be directly related to HIV or HAART, but it may also be attributable to psychological strain. In this article, psychologist Judith Rabkin, Ph.D., outlines some of the causes of fatigue and details strategies for treating it. Click Here


Research on Menstruation and Aging in HIV-Infected Women
Researchers have yet to fully understand how HIV and antiretroviral drugs affect HIV-infected women physiologically, but provocative data continues to emerge. This overview of the clinical implications of HIV infection in women, authored by Anne Monroe, M.D., surveys the available research on menstruation, menopause, hormone replacement therapy, osteoporosis and cardiovascular disease. It also offers some guidance on how to manage symptoms, avoid long-term complications and determine what manner of screening is appropriate for female patients with HIV. Click Here

•  HIV TREATMENT & PATIENT CARE

FDA Panel Recommends Approval of Maraviroc
A U.S. Food and Drug Administration (FDA) panel has unanimously recommended that the FDA approve maraviroc (tentative brand name: Celsentri), the first-in-class CCR5 antagonist, despite ongoing safety concerns. Maraviroc would be used to treat HIV-infected patients with multidrug-resistant, CCR5-tropic virus. The FDA panel also called for further study of maraviroc, citing a need for more trials involving women and minorities, as well as unresolved questions about the drug’s adverse effects. The 12-member panel said that post-approval studies should focus on what role, if any, maraviroc plays in an increased risk for blood cancers, cardiovascular complications and hepatotoxicity. The FDA will likely decide by the end of June whether to approve maraviroc; though the advisory panel’s recommendation is nonbinding, the FDA usually follows it. Click Here


HIV-Infected Infants Should Receive Resistance Test, Study Suggests
Infants infected with HIV perinatally should be administered an HIV drug resistance test before commencing antiretroviral treatment, new research suggests. An evaluation of resistance data from a multicenter Pediatric AIDS Clinical Trials Group study found an alarmingly high rate of transmitted resistance among perinatally infected infants. The researchers also noted that drug-resistant HIV appeared to quickly archive in the infants' latent CD4+ cell reservoirs. Click Here

The full study, which was published in the May 15 issue of the Journal of Infectious Diseases, was accompanied by an editorial in which HIV pediatrician Paul Krogstad, M.D., offers his take on the import of the study results.


Peptide in Human Blood May Open Door to New HIV Drug Class
A peptide found in human blood appears, in lab tests, to prevent 60 different strains of HIV from infecting cells, German researchers report. The peptide, called VIRIP, targets the gp41 protein on the surface of HIV, which the virus uses to penetrate the surface of CD4+ cells. The discovery could pave the way for a new class of antiretrovirals, and may also have applications as a microbicide. Unfortunately, like enfuvirtide (T-20, Fuzeon), a VIRIP-based drug would be expensive to produce and would require administration via injection. Click Here

Click here to read the abstract in the April 20 edition of Cell.


Bone Marrow Transplant Unlikely to Eradicate HIV Infection: Case Report
A new case report from French researchers appears to debunk a hypothesis that bone marrow transplantation may be a viable method of HIV eradication. The report, published in the March 30 issue of AIDS, reviews the case of an adult male French patient who received a bone-marrow transplant to treat monocytic acute myeloid leukemia. The patient had achieved sustained, undetectable plasma HIV RNA levels while on HAART prior to the transplant; an undetectable viral load was maintained post-transplant, and researchers also found that HIV *DNA* levels became undetectable as well, leading them to believe the patient was in "HIV remission." However, HAART was interrupted due to toxicity concerns 114 days after the transplant. Within 16 days of interruption, HIV RNA and DNA levels had become detectable. The patient ultimately died after developing severe graft-versus-host disease. Click Here

•  HIV TRANSMISSION

HIV Prevention Practices Vary Among MSM in San Francisco, Studies Find
Two new studies paint a complex picture of HIV prevention strategies -- or lack thereof -- among men who have sex with men (MSM) in San Francisco. In agreement with earlier research, a study from the University of California-San Francisco found that serosorting has become more prevalent among MSM. Unfortunately, they also found that the percentage of MSM reporting high-risk sex and multiple sex partners increased. Meanwhile, a study from the San Francisco Department of Public Health found that MSM in committed relationships are less likely to engage in high-risk sexual behaviors with each other than with casual partners, a reversal from the early days of the HIV pandemic. Click Here

Click here to read the abstract of the University of California-San Francisco study, which was published in the April 26 issue of the American Journal of Public Health.


HIV Prevention That Goes Beyond A, B and C
Despite efforts to prevent the spread of HIV with the "ABC" (Abstain, Be faithful, use Condoms) approach, the pandemic rages on. Recognizing the limitations of traditional HIV prevention methods, researchers and advocates are delving deeper into the alphabet. "We will add one more 'C' for circumcision," says Gita Ramjee, Ph.D., of the South African Medical Research Council. "We will add 'D' for diaphragm, 'E' for pre- and post-exposure prophylaxis, 'F' for female controlled microbicides, 'G' for genital tract infection control, 'H' for herpes simplex virus suppression, and 'I' for immunity by vaccines." Read this article for a discussion of some innovative HIV prevention strategies. Click Here

•  U.S. HIV/AIDS POLICY

When Will Bush Lift U.S. Ban on HIV-Infected Foreigners?
To the ongoing embarrassment of HIV advocates in the United States and abroad, the U.S. government continues to prohibit HIV-infected foreigners from entering the country without a special waiver. On Dec. 1, 2006, U.S. President George W. Bush promised to issue an executive order easing the long-standing ban, but that order has yet to be issued. A government spokesperson has said the order is still "underway" and that the process is "complex," but would not give further details. In the meantime, HIV advocates at a recent forum in Washington, D.C., added to the chorus of voices calling for an end to the ban. Click Here

Under the executive order proposed by Bush last December, HIV-infected people would be allowed to enter the country and stay for up to 60 days without having to seek special permission. To learn more about the proposed change, click here.

•  HIV OUTSIDE THE UNITED STATES

HIV Prevalence High, Unsafe Sex Common Among MSM in British Cities
HIV prevalence is high among men who have sex with men (MSM) living in British cities -- and many are unaware they are infected, according to a three-city study published in the May 1 issue of Sexually Transmitted Infections. The cross-sectional survey of MSM at bars, clubs and saunas -- which included rapid HIV testing for the participants -- found that 12% of gay men in London were HIV infected, but 30% of them had no idea. Meanwhile, 22% of HIV-uninfected MSM in Brighton, London and Manchester said that, within the last year, they had experienced unprotected anal sex with someone who was HIV infected or whose status they did not know. Click Here


Government, Activists Agree to Work Together in South Africa
Hoping to put aside years of bitter disagreement, the South African government and the country's AIDS activists have joined forces to create the South African National AIDS Council (SANAC). Chaired by the Deputy President of South Africa, SANAC has no legal power but will help coordinate the country's five-year plan to halve the number of new HIV infections and increase treatment access to those who need it. The creation of SANAC represents a major development in South Africa, where for many years activists have battled with a government that is widely regarded as excruciatingly slow to respond to the country's massive HIV epidemic. Click Here