•  HIV TREATMENT & COMPLICATIONS

NIH Study Revives Concept of "HIV Eradication" Through Early Treatment
If HAART is initiated early and sustained for an extended period of time, it may be possible to "completely eliminate" latent HIV reservoirs in resting CD4+ cells, according to a team of researchers led by U.S. National Institute of Allergy and Infectious Diseases Director Anthony Fauci. The team's findings are published in the June 15 issue of the Journal of Infectious Diseases. Based on observations of the decay rate observed in the reservoir of latently infected CD4+ cells in seven HIV-infected patients who initiated therapy within months of seroconversion, Fauci et al theorize that it would take an average of 7.7 years to completely eliminate all HIV-infected resting CD4+ cells. However, in an accompanying editorial, David Margolis and Nancie Archin counter Fauci et al's contention, offering multiple explanations for why HIV eradication may not be successfully achieved through this strategy. Click Here

To read the Fauci et al study, click here; the accompanying editorial is available here.


Rosiglitazone May Increase Risk of Serious Cardiovascular Events
The widely used diabetes drug rosiglitazone (Avandia) may increase a patient's risk for serious cardiovascular complications, including myocardial infarction and death, according to a new warning issued by the U.S. Food and Drug Administration (FDA). The warning is based on a meta-analysis by Steven E. Nissen, M.D., and Kathy Wolski, M.P.H., which was published on May 21 in the online edition of the New England Journal of Medicine (NEJM). The FDA is not recommending that rosiglitazone be pulled from pharmacy shelves, however. In addition to its on-label use as a diabetes treatment, rosiglitazone has also been studied as a potential lipoatrophy treatment for HIV-infected patients, with mixed results thus far. Click Here

GlaxoSmithKline, which produces Avandia, has sharply criticized the study's findings. In a press release, Glaxo said its own research has found that Avandia is no more likely to cause heart problems than other diabetes drugs, and alleged that the study was flawed. A more balanced look at the new study is provided by an editorial, also published in NEJM, which takes a more in-depth look at Avandia (and similar drugs), heart problems and the U.S. drug-approval process.

Avandia was made available in the United States through a rapid-approval process similar to that used for HIV meds. As National Public Radio's Morning Edition explains, the news about Avandia may bring renewed scrutiny of the rapid-approval process, which focuses on getting a drug to market as quickly as possible, before its clinical trials have thoroughly investigated its potential toxicities.


Study May Disprove Link Between HIV/HCV Coinfection and Diabetes, Lipoatrophy
A pair of large U.S. studies appears to contradict long-held concerns that patients coinfected with HIV and hepatitis C (HCV) may face a higher risk of diabetes and lipoatrophy than patients infected with HIV alone. One study, by Indira Brar et al, found that treatment-naive HIV-infected patients appear no more likely to develop diabetes than the U.S. population at large -- and that coinfection with HCV had no significant impact on diabetes risk. The other study, by Phyllis Tien et al, found that as a group, HIV/HCV-coinfected patients are no more likely than HIV-monoinfected patients to lose subcutaneous adipose tissue volume -- and that, at least in HIV-infected men on stavudine (d4T, Zerit), coinfection may actually have a mitigating effect on leg fat loss. Click Here

You can read the abstracts of both of these studies -- the diabetes study and the lipoatrophy study -- in the May 1 issue of JAIDS.


The Interplay of Aging and HIV
Aging can impact the health of HIV-infected patients, whether they are long-term survivors or newly diagnosed 50-year-olds. In this article, Richard Havlik, M.D., formerly of the U.S. National Institute on Aging, discusses the interplay between common aging processes and the adverse effects of HIV or HIV antiretrovirals. Fortunately, in many cases these comorbidities can be addressed. Click Here


Stopping Bone Loss: Study Examines Annual Zoledronate Injection
Low bone mineral density is a common complication among HIV-infected patients, with many potential treatment strategies. A New Zealand study published in the April 2007 issue of the Journal of Clinical Endocrinology & Metabolism examined whether a yearly intravenous infusion of zoledronate (zoledronic acid, Zometa), which has been found to treat bone loss in postmenopausal women, could do the same for HIV-infected men on HAART. The results appear promising: According to Mark J. Bolland et al, who performed the small, two-year study, an annual injection with zoledronate can be "a potent and effective therapy for the prevention or treatment of bone loss in HIV-infected men." Click Here


Lung Transplant Performed on HIV-Infected Patient for First Time
The world's first lung transplant in an HIV-infected patient was performed late last month in Italy. The patient, who had terminal respiratory problems, is recovering well from the operation, according to physicians. Organ transplants are becoming increasingly possible thanks to continual advances in HIV treatment: "We have seen a definite improvement in the long-term survival [of people with HIV], which has allowed for some to be considered for organ transplants," said Paolo Grossi, an infectious diseases specialist who is caring for the lung-transplant patient. Click Here


French Woman Has Multiple Organ Failure During Primary HIV Infection
Diagnosing acute HIV infection can be a challenge, and treating it can be controversial, but early diagnosis and treatment may also save lives. French physicians have reported a case of multiple organ failure in a 16-year-old woman who was recently infected with HIV. She was admitted to the hospital with liver and kidney failure in addition to impaired heart function; after a week of antiretroviral therapy, she was released with normal organ function. "To our knowledge, this is the first report of acute liver failure during primary HIV infection," wrote the investigators in the Feb. 1 issue of Clinical Infectious Diseases. "Multiple organ failure may be added to the list of severe manifestations of acute HIV infection." Click Here

•  HIV TRANSMISSION

HIV-Uninfected Serosorters May Increase Their Risk for HIV, Study Says
HIV-uninfected gay men who practice serosorting -- the selection of sex partners based on similar HIV status -- may actually be increasing their HIV risk, according to a research letter published in the May 31 issue of AIDS. The reason, according to David M. Butler and Davey M. Smith of the University of California-San Diego, is that individuals who believe they are HIV uninfected may actually have been recently infected, but have not yet received a positive HIV test result. The researchers calculated that an HIV-uninfected person who serosorts may actually be at a higher HIV risk than an HIV-uninfected person who only had unprotected sex with HIV-infected patients on suppressive therapy. Click Here


Guide to Post-Exposure Prophylaxis Offers Fast Answers
Acting fast is critical when you are considering administering post-exposure prophylaxis (PEP) to a patient who may have been exposed to HIV. After all, PEP can only prevent HIV infection if it is started less than 72 hours after a potential exposure. Fortunately, this article offers concise, step-by-step guidelines for assessing candidates for PEP, selecting antiretroviral regimens to prevent infection and contacting experts on PEP with whom to consult if you need additional guidance. Click Here

•  U.S. HIV NEWS & POLICY

Bush Requests $30 Billion, Five-Year Extension of PEPFAR
President George W. Bush called on the U.S. Congress to double current funding levels for the President's Emergency Plan for AIDS Relief (PEPFAR) to $30 billion for an additional five years after the program's original mandate expires next year. Paul Zeitz, executive director of the Global AIDS Alliance, said it is "important that [Bush] affirmed" PEPFAR, which has significantly buttressed efforts to increase access to HIV treatment in developing countries. However, Zeitz tempered his praise with ciriticism: "By 2013 there will be 12 million people that urgently need" access to antiretrovirals, he said, adding, "We're not getting ahead of the AIDS crisis. We're tempering it." Click Here


FDA Refuses to Reverse Ban on Blood Donation by MSM
Men who have had sex with men at least once since 1977 are barred from donating blood in the United States. While the ban is considered discriminatory by some (including the Red Cross), the U.S. Food and Drug Administration (FDA) is not backing down. In May, it reaffirmed its current policy, saying it will not loosen the restriction. Click Here


Senate Votes to Give FDA Sweeping New Powers
The U.S. Senate has overwhelmingly approved a bill that would dramatically increase the U.S. Food and Drug Administration (FDA)'s power to monitor drug safety during the post-approval phase -- and to enforce changes as it deems necessary. The Senate's move came not long before the revelation that the diabetes drug rosiglitazone (Avandia) may increase cardiovascular risk, a story covered earlier in this newsletter. Click Here

•  HIV OUTSIDE THE UNITED STATES

Shortage of Health Care Workers Cripples HIV Treatment in Africa
Efforts to save the lives of HIV-infected Africans typically focus on provision of antiretrovirals and the establishment of new clinics. But experts on HIV care in Africa warn that aid efforts must address a more fundamental issue: the critical shortage of physicians and nurses in African countries hit hard by HIV. As treatment access ramps up in developing countries, the dearth of health care workers becomes more critical, as clinics go unstaffed and antiretrovirals sit undispensed. Click Here


HIV-Infected Women Lack Antibody to Pregnancy-Associated Malaria: Study
HIV-infected women who have experienced multiple pregnancies may be at an increased risk for pregnancy-associated malaria, according to a study by an international team researchers led by Kevin Kain and published in the May 2007 issue of PLoS Medicine. Kain et al found that women who had more than one pregnancy sometimes posessed an antibody that could clear parasites in their placentas, but the antibody was not present among HIV-infected women. Click Here