Fw: The Latest HIV Research & News for Health Care Professionals: July 22, 2009

[Guest guest]

If you have trouble reading this e-mail, you can read the online version at: www.thebodypro.com/newsletter.html

July 28, 2009

HIV Treatment & Complications

HIV Transmission & Testing

HIV in the News

HIV in the Developing World

Tuberculosis & HIV

• HIV TREATMENT & COMPLICATIONS

HIV's Silent Dangers May Support Case for Early HAART Initiation, Top Researcher Suggests

"During that long period when [an HIV-infected] person appears to be quite well, there are ongoing processes in their bodies, due to HIV itself ... that may be causing some damage, some unseen damage, that may ultimately have a very large impact on a person's survival, and a person's wellness," says Wafaa El-Sadr, M.D., M.P.H. El-Sadr gave a plenary talk at IAS 2009 about recent investigations into the link between inflammation and untreated HIV -- and used the opportunity to join other experts in an eloquent call for improved global access to antiretroviral therapy. (IAS 2009 coverage from The Body PRO)

In addition to reading this discussion, you can watch a video or view the slides from a separate plenary talk by El-Sadr regarding the relationship between inflammation and HIV.

HEAT Results Suggest Women, African Americans May Be Less Likely to Achieve Virologic Suppression

Race and gender may prove to be more critical factors in antiretroviral efficacy than has long been believed. In the HEAT study -- a clinical trial in treatment-naive patients that pitted abacavir (Ziagen) and lamivudine (3TC, Epivir) against tenofovir/emtricitabine (Truvada) -- , M.D., M.P.H., et al found that regardless of the arm to which a patient was randomized, fewer African Americans (versus whites) and females (versus males) achieved virologic suppression on their first-line regimen. (IAS 2009 coverage from The Body PRO)

Nevirapine Appears More Lipid Friendly Than Atazanavir, Study Finds

Patients receiving nevirapine (Viramune) may face a reduced risk of developing cardiovascular disease compared to patients who take ritonavir (Norvir)-boosted atazanavir (Reyataz), according to a study by European and Latin American researchers involving 569 antiretroviral-naive patients. The open-label, randomized, prospective study found that, in terms of treatment response, 1) nevirapine was non-inferior to atazanavir; and 2) nevirapine appeared to have a more favorable impact than atazanavir on patients' cholesterol and triglyceride levels. (Study abstract from IAS 2009)

Antidepressants May Aid Viral Suppression by Improving Adherence, Study Finds

Can antidepressant use facilitate better suppression of HIV among HIV-infected patients receiving antiretroviral therapy? The answer appears to be yes, according to a study by Tsai, M.D., Ph.D., and colleagues. The study, which focused on 418 homeless or marginally housed patients in San Francisco, found that the reason antidepressants help is simple: They made patients more likely to adhere to their antiretroviral regimen. (Interview and podcast from The Body PRO)

Inflammation Assay May Predict MI Risk for HIV-Infected Patients

To what extent can testing for C-reactive protein (CRP) levels, which have been used for 70 years as a marker for inflammation, assist health care professionals in assessing an HIV-infected patient's cardiovascular risk? Perhaps a great deal: A recent study published in JAIDS found that myocardial infarction (MI) risk more than doubled in patients with elevated CRP levels, and that HIV-infected patients were more likely to have elevated CRP levels than HIV-uninfected patients. (Study summary from aidsmap.com)

That said, it is important to note that CRP is just a marker for heart disease risk. Although some had hypothesized that CRP might actually have a causal association with heart disease, results from a massive study published in the July 1 issue of JAMA appear to debunk that idea.

Genetic Test Predicts Response to Maraviroc in Treatment-Experienced HIV Patients

A type of genotypic assay may be just as effective as a tropism test in assessing the likelihood that CCR5 antagonists such as maraviroc (Selzentry, Celsentri) will prove effective in antiretroviral-experienced patients, according to researchers from the British Columbia Centre for Excellence In HIV/AIDS. "HIV V3 Genotyping shows promise as a significantly faster and more cost-effective way to correctly identify patients who would benefit from CCR5 antagonists like maraviroc," said Harrigan, Ph.D., the study's lead investigator. (Press release from the British Columbia Centre for Excellence in HIV/AIDS)

Back to Top

• HIV TRANSMISSION & TESTING

U.S. Congress Works to Reverse Needle-Exchange Funding Ban

Could the U.S. finally be ready to remove a ban on allocating federal funds for needle-exchange programs? The 21-year-old ban was removed from a spending bill approved this month by the U.S. House of Representatives. A last-minute attempt by a Republican congressman to restore the ban was narrowly turned away. Up to 16% of annual HIV infections in the U.S. occur via injection drug use, according to amfAR. The Senate still needs to pass its own version of the spending bill and then hash out the differences before it can go to President Obama to be signed into law. (Press release from amfAR)

Computer Game Teaches Safer Sex Skills to HIV-Infected Teens

Educating a teenager about safer sex is never easy -- and it can be even more challenging when that teen is living with HIV. So how can a clinician or educator ensure that critical HIV prevention information sinks in? A team of U.S. researchers may have an answer: video games. The researchers have developed a computer game called +CLICK, which aims to improve the ability of HIV-infected youths to make informed decisions when it comes to their sexual behavior. In a pilot test, the feedback on +CLICK was so encouraging (from both the teens and their health care providers, who found it facilitated discussion) that the development team is already working on a second game -- this time, to help teens learn about antiretroviral adherence. (Article from TheBody.com)

Male Circumcision Fails to Reduce HIV Transmission to Female Partners, Researchers Find

Research has conclusively shown that male circumcision can greatly reduce the risk that the circumcised male will become HIV infected through unsafe, heterosexual sex. But what about the woman? Results from a large, two-year study in Uganda have revealed that women appear no less likely to acquire HIV after having sex with circumcised HIV-infected men compared to uncircumcised HIV-infected men. (Article from kaisernetwork.org)

Condoms Only Partially Effective Against HSV-2, Study Warns

The efficacy of condoms in preventing transmission of HIV, chlamydia, gonorrhea and other sexually transmitted diseases is well-established. But since herpes simplex virus-2 (HSV-2) can be spread by skin-to-skin contact, condoms are only partly effective. In a recent study published in the Archives of Internal Medicine, U.S. researchers found that participants who reported always using condoms were 30% less likely to contract HSV-2 than those who did not use condoms. (Article from the U.S. Centers for Disease Control and Prevention)

Advocacy Group Files Suit to Force Condom Use in Adult Films

Last month, headlines blared with the revelation that an adult film actress in Los Angeles County had become HIV infected, and that several other adult film actors may also have become infected since 2004. The HIV health care advocacy organization AIDS Healthcare Foundation responded this week by filing a petition with the county, asking the court to order L.A.'s Department of Public Health to enforce existing health regulations on the set of porn films -- including often-ignored regulations requiring condom use. However, while the public health officials say they are investigating the case, they also released a statement saying that they do not think litigation is the best response to the issue. (Article from the Los Angeles Times)

Back to Top

• HIV IN THE NEWS

How Will Barack Obama Change the Global (and Domestic) Fight Against HIV?

End the U.S. HIV travel ban? Check. Get federal funding for needle exchange? Check. Continue the U.S. commitment to paying for HIV treatment and care overseas? Check. In a wide-ranging discussion at IAS 2009, Fauci, M.D., director of the U.S. National Institute of Allergy and Infectious Diseases, Michel Kazatchkine, executive director of the Global Fund, and others review some of the Obama administration's plans to address HIV/AIDS domestically and abroad. (IAS 2009 coverage from The Body PRO)

HIV Status Not Grounds for Denying Professional Licenses, U.S. Justice Dept. Says

State licensing boards and occupational training schools may not bar people with HIV simply because of their HIV status, the U.S. Department of Justice announced this month. HIV-infected people in the U.S. are protected by the Americans With Disabilities Act, which forbids discrimination not only in job hiring, but in job training, professional school matriculation and licensing as well. (Press release from several advocacy groups)

For more information about HIV and job-training discrimination, read the justice department's recently released fact sheet on HIV and the Americans With Disabilities Act.

Clinic Worker Gets One-Year Sentence for Posting Client's HIV Status on MySpace

A patient-service representative at Straub Clinic & Hospital in Honolulu, Hawaii, was recently sentenced to one year in prison for illegally accessing and then posting online a hospital patient's HIV status. A personal feud apparently led Rhonda Wong-Fernandez to post the victim's HIV status on the social networking Web site MySpace alongside comments such as "No wonder she's so pale"; "Poor thing, she has HIV. That's why she's hating"; and "I hope she dies." The patient ultimately did, in fact, die earlier this year; Wong-Fernandez apologized for her actions. (Article summary from the U.S. Centers for Disease Control and Prevention)

Is the Future of U.S. HIV Care at Risk? Leading HIV Specialist Groups Issue Report

How will the future of HIV care in the U.S. evolve if new specialists are not joining the field? Studies indicate that when HIV-infected patients receive care from trained, knowledgeable HIV specialists, they fare better overall. However, a recent report from the American Academy of HIV Medicine (AAHIVM) and the HIV Medicine Association (HIVMA) reveals that, in the U.S., most practitioners specializing in HIV today are veterans of the field who plan to retire soon, leaving few younger specialists to replace them. The report reviews the challenges of specializing in HIV and makes recommendations that hospitals, policymakers and health organizations can adopt to make sure the HIV care field -- and, by extension, the patients it cares for -- stays alive and well. (Report from AAHIVM and HIVMA)

Back to Top

• HIV IN THE DEVELOPING WORLD

"We're Not Doing Enough," Say Global Leaders on HIV

At the very moment when the global fight against HIV has reached a turning point, the world is pulling back on its commitments, threatening to undo years of progress and potentially costing millions of lives, some of the HIV field's luminaries warn. In this wide-ranging, impassioned press conference at the opening of IAS 2009, these scientists and advocates discuss the desperate need to renew attention (and funding) to the precarious state of efforts to prevent and treat HIV in developing countries -- and the role health care providers must play for such efforts to be successful. (IAS 2009 coverage from The Body PRO)

Revisiting Priorities in the Prevention of Mother-to-Child HIV Transmission

In a talk focusing largely on the developing world, Louise Kuhn, M.P.H., drives home the importance of antiretroviral therapy for all pregnant or breastfeeding women with a CD4+ cell count below 350. She also urges a greater focus on the long-term health and survival of children born to HIV-infected mothers, beyond the simple prevention of vertical HIV transmission. "There's very little point of preventing HIV if we are simply causing other fatal diseases in these children," Kuhn says. (IAS 2009 coverage from The Body PRO)

Antiretroviral Therapy as an HIV Prevention Strategy: How Many Lives Could Be Saved?

If every individual in sub-Saharan Africa received voluntary, annual HIV testing and initiated antiretroviral therapy immediately after being diagnosed, HIV incidence would drop 95% in 10 years and more than seven million deaths would be averted, according to a theoretical model presented by Reuben Granich, M.D., M.P.H.. (IAS 2009 coverage from The Body PRO)

Image © International AIDS Society / Simon Deiner / SDR Photo

Discrimination Against HIV-Infected Immigrants Still Common Around World, Report Says

Being a migrant is often no easy experience. However, if one is an HIV-infected migrant, one may face even greater challenges entering a foreign country, Human Rights Watch reports -- whether due to a complete ban on the entry of HIV-infected people, the exclusion of migrants with HIV from receiving free health care or the deportation of immigrants who are diagnosed with HIV after entering the country. Human Rights Watch warns that these deportations are not just discriminatory; they also may force individuals back to countries with little access to antiretroviral therapy, and they often lead to treatment interruptions that cause antiretroviral resistance, comorbidities and even death. (Article from Human Rights Watch)

Back to Top

• TUBERCULOSIS & HIV

Tuberculosis Vaccine May Be Fatal for HIV-Infected Infants, WHO Warns (PDF)

In much of the world, infants are given Bacille Calmette-Guérin (BCG), an anti-tuberculosis vaccine, at birth. But for infants with HIV, BCG can be deadly, according to a new World Health Organization study. The study found that HIV increases an infant's risk of developing an often-fatal bacterial infection, disseminated BCG disease. According to the WHO, infants with HIV are more likely to acquire BCG disease than they are to gain TB immunity, so vaccination is no longer advised. Experts are concerned, however, that despite the risks, BCG vaccination will continue unabated in many developing countries. (Study from the World Health Organization)

Study Reveals Possible Explanation for Increased TB Risk Among HIV-Infected Patients

Although it has been known for some time that HIV infection increases a patient's risk for developing tuberculosis (TB), researchers are still attempting to determine the mechanism for this risk. A Harvard University study may have pinpointed one reason: It examined lung specimens from HIV-infected and HIV-uninfected patients, and found that HIV-infected patients had significantly increased levels of interleukin 10 and BCL-3, both of which negatively impacted levels of tumor necrosis factor, a cytokine involved in the immune response against Mycobacterium tuberculosis. (Article from the International AIDS Society)

Back to Top

This e-mail newsletter was reviewed for clinical accuracy by Young, M.D., Ph.D. (Read his bio.)

BREAKING RESEARCH

The Body PRO Covers IAS 2009

Much of this newsletter features breaking research and news (provided by The Body PRO and other respected sources) from the 5th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2009), which took place in Cape Town, South Africa from July 19 to July 22.

Check out our IAS 2009 home page throughout the days to come as we add new research summaries, interviews, analyses and overviews of conference highlights!

CME/CE Central: Get the Credit You Deserve

Getting your CME/CE certificates at The Body PRO's CME/CE Central is quick and easy. Earn credit for an array of outstanding activities, including:

• An Evaluation of Routine HIV Testing and Its Impact on HAART Initiation, by Wohl, M.D.

• Top 10 HIV Clinical Developments of 2008, by Wohl, M.D.

• New Developments in HIV/Hepatitis C Coinfection Management and Epidemiology: Highlights From ICAAC/IDSA 2008, by Fierer, M.D.

• Evolving Options for First-Line Therapy: Highlights From ICAAC/IDSA 2008, by Wohl, M.D.

• Reappraising Key Issues in HIV Clinical Management: Highlights From ICAAC/IDSA 2008, by Young, M.D., Ph.D.

• CCR5 Antagonists and Tropism Testing in Clinical Practice, by Hardy, M.D.

A wealth of additional activities awaits you at The Body PRO's CME/CE Central!

• Redial!

• Help Get Health Care Reform Back On Track

• Urge Your Senators to Co-Sponsor the Early Treatment for HIV Act

• Extend White Now!

• Sound the Alarm: HIV Is Not in Recession

• Write to District Court Judge Bradley J. . He sentenced an Iowa man to 25 years in prison for not disclosing to another man he was HIV positive.

About This E-Mail

This e-mail newsletter was sent to nelsonvergel@.... It is provided free of charge to our registered members of The Body PRO.

Want to change your subscription? Click here to modify your subscription information online.

Missed a newsletter? Our archive of past newsletters will keep you up-to-date.

Have any other questions or comments? Feel free to e-mail us at news@... or snail-mail us at:

The Body PRO Newsletter

The HealthCentral Network, Inc.

250 West 57 Street

New York, NY 10107