Fw: HIV and Hepatitis.com: e-Newsletter for Tuesday, August 10, 2010

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Sent via BlackBerry by AT&TFrom: "HIVandHepatitis.com" <newsletter@...>Date: Mon, 9 Aug 2010 21:00:37 -0400 (EDT)<powertx@...>Reply newsletter@...Subject: HIV and Hepatitis.com: e-Newsletter for Tuesday, August 10, 2010 e-Newsletter for Tuesday, August 10, 2010 Untreated People with HIV Have an ElevatedRisk of Death Even at High CD4 Cell CountsBy Liz Highleyman SUMMARY: HIV positive people who still have a relatively high CD4 cell count and are not yet taking antiretroviral therapy (ART) are more likely to die prematurely than the HIV negative general population, but the elevated risk varies dramatically across groups, according to a large observational analysis of several European and North American cohorts described in the July 31, 2010 issue of The Lancet. While injection drug users had a 9-fold higher risk of death, the increase was just 30% for gay men. These findings, the investigators suggest, add to the evidence favoring earlier treatment initiation. When to start antiretroviral treatment is an issue of ongoing debate. A growing body of evidence suggests that starting treatment sooner -- at a higher CD4 cell count -- may be beneficial, perhaps by gaining earlier control over immune activation and inflammation related to ongoing HIV replication. Concerns remain, however, about potential long-term drug toxicities, as well as suboptimal adherence and drug resistance, if people start treatment before they experience appreciable immune system damage.It is clear that ART should start before the CD4 count falls into the opportunistic infection danger zone below 200 cells/mm3. The World Health Organization's global HIV treatment guidelines now recommend that everyone -- including people in resource-limited settings -- should start ART when their CD4 count falls below 350 cells/mm. In December 2009, the panel updating the U.S. DHHS treatment guidelines raised the initiation threshold from 350 to 500 cells/mm3. Some experts believe that starting even earlier is better; San Francisco General Hospital, for example, recently instituted a policy of offering treatment to everyone diagnosed with HIV.To shed more light on this issue, Lodwick and colleagues with the Study Group on Death Rates at High CD4 Count in Antiretroviral Naive Patients compared mortality among HIV positive people with relatively well-preserved immune function who had not yet started ART versus that of the general population.The investigators analyzed data from more than 40,000 participants from about 2 dozen countries in the European Union and North America, including participants in the Netherlands ATHENA cohort, CASCADE, UK CHIC, Danish HIV Cohort Study, EuroSIDA, Italian ICONA cohort, Spanish PISCIS and CoRIS cohorts, Swiss HIV Cohort Study, Multicenter AIDS Cohort Study (MACS), and Women's Interagency HIV Study (WIHS).Data were included from January 1990 through December 2004 for participants aged 20-59 years who had at least 1 CD4 cell measurement greater than 350 cells/mm3 before starting ART; that is, people who were diagnosed at later stages of disease and already had considerable immune system damage were excluded from this analysis. Full Article... HIV and AIDS - Top New Articles Untreated People with HIV Have an Elevated Risk of Death Even at High CD4 Cell Counts SUMMARY HIV positive people who still have a relatively high CD4 cell count and are not yet taking antiretroviral therapy (ART) are more likely to die prematurely than the HIV negative general population, but the elevated risk varies dramatically across groups, according to a large observational analysis of several European and North American cohorts described in the July 31, 2010 issue of The Lancet. While injection drug users had a 9-fold higher risk of death, the increase was just 30% for gay men. These findings, the investigators suggest, add to the evidence favoring earlier treatment initiation. Most People on Antiretroviral Therapy Continue to Experience CD4 T-cell Gains for at Least 7 Years SUMMARY A large majority of HIV positive people who start antiretroviral therapy (ART) at the thresholds recommended by recent treatment guidelines (350-500 cells/mm3) are likely to achieve CD4 cell levels approaching the low end of normal, according to a study described in the July 31, 2010 issue of AIDS. However, a small percentage -- especially among those who started treatment with significant immune deficiency -- may not achieve complete CD4 cell recovery despite viral suppression on ART. Routine Opt-out Screening in Emergency Rooms Identifies Few Additional People with HIV SUMMARY Routine opt-out HIV screening in an urban emergency department -- testing not targeted specifically to people thought to be at risk -- identified only a " modest " number of additional cases compared with standard diagnostic testing, according to a U.S. study reported in the July 21, 2010 Journal of the American Medical Association (JAMA) HIV/AIDS theme issue, released to coincide with the XVIII International AIDS Conference (AIDS 2010) last month in Vienna. Most of the additional people found to be infected had late-stage disease, suggesting that a better method is needed to identify HIV positive individuals sooner so they can benefit from timely care. Raltegravir (Isentress) Label Updated to Include 96-week Study Data SUMMARY Merck announced last week that the U.S. Food and Drug Administration (FDA) has approved new product label information for its integrase inhibitor raltegravir (Isentress) that includes 96-week data from the pivotal BENCHMRK trials of treatment-experienced patients and the STARTMRK trial of people starting antiretroviral therapy for the first time. Overall, these long-term results indicate that raltegravir has durable antiviral activity over 2 years. CDC Announces $42 Million in HIV Prevention Grants to Community-based Organizations SUMMARY The Centers for Disease Control and Prevention (CDC) last week announced that it has awarded more than $40 million in funding for HIV prevention programs to more than 130 community-based organizations across the U.S. Half the organizations receiving grants serve men who have sex with men and a majority focus on African-Americans, the groups with the highest rates of new HIV infections. HIV and AIDS Main Section Hepatitis B and C - Top New Article Kerry Introduces Senate Bill to Create National Viral Hepatitis Strategy SUMMARY Massachusetts Senator Kerry last week introduced a Senate version of a bill to provide $600 billion in funding and create a national strategy to fight hepatitis B and C and prevent liver cancer, along the lines of the recently released National HIV/AIDS Strategy. A companion viral hepatitis bill, intrdoduced by Rep. Mike Honda (D-CA), is currently making its way through the House of Representatives. HCV Main Section HBV Main Section HIV/HCV and HIV/HBV Coinfection - Top New Articles HIV/HCV Coinfected People with Normal Liver Enzymes Respond Well to Interferon-based Therapy SUMMARY HIV positive people with normal levels of the liver enzyme alanine aminotransferase (ALT) who received hepatitis C therapy using pegylated interferon plus ribavirin responded as well as individuals with elevated ALT, according to findings presented at the XVIII International AIDS Conference (AIDS 2010) last month in Vienna. Drug Resistance Linked to Faster Hepatitis B Liver Disease Progression in HIV/HBV Coinfected Patients SUMMARY HIV/HBV coinfected individuals may be less likely to have hepatitis B virus (HBV) with mutations conferring resistance to lamivudine (3TC; Epivir), but those who do have drug resistance experience faster liver disease progression and are more likely to develop cirrhosis, according to a study from Romania presented last month at the XVIII International AIDS Conference (AIDS 2010) in Vienna. HIV/HCV Coinfection Main Section HIV/HBV Coinfection Main Section Release Date: August 2010 Expiration Date: July 31, 2011 Independent Coverage of the XVIII International AIDS Conference (AIDS 2010)2010 CME/CE Talking Slides UpdateJuly 18-23, 2010 - Vienna Austria The certified CME/CE Talking Slides provide independent coverage from the XVIII International AIDS Conference (AIDS 2010). During this conference many issues were addressed that clinicians face when they care for patients with HIV/AIDS including: Updates on effective prevention approaches New ARV therapies in development What ARV therapies should be preferentially chosen for initial therapy and for those patients with ARV resistanceIntended Audience:Physicians, Physician Assistants, Registered Nurses and Pharmacists who are involved in the care of persons with HIV/AIDS.Learning Objectives:Upon the completion of this CME/CE activity, the participant should be able to: 1.Explain how recent study results in antiretroviral therapy apply to clinical practice 2.Discuss significant developments and strategies in antiretroviral therapy 3.Describe recent antiretroviral toxicity, drug interaction, and side-effect data and strategies for management CLICK HERE to remove your email address from our e-Newsletter database. 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