Judge’s Ignorance of AIDS Draws Fire

January 30, 2007

An Ontario judge is at the centre of a misconduct investigation after insisting a witness who is HIV-positive and has Hepatitis C don a mask while testifying in his courtroom.

Three groups have complained to the Ontario Judicial Council about the conduct of Barrie judge Justice Jon-Jo Douglas, who later moved the case to a bigger courtroom in order to create more distance between the witness and the bench.

The judge refused to accept Crown counsel Karen McCleave's entreaties there was no need for such measures.

"The HIV virus will live in a dried state for year after year after year and only needs moisture to reactivate itself," Douglas insisted, according to a transcript of the Nov. 23 trial proceedings.

"This is outlandish," Bluma Brenner, an assistant professor at the McGill AIDS Clinic at McGill University in Montreal, said yesterday. A drop of human immunodeficiency virus drying on the floor "would be inactivated within 20 minutes," Brenner said in an interview.

But Douglas, a former Crown attorney appointed to the Ontario Court of Justice 10 years ago, was not prepared to continue the trial until he was satisfied "the safety and integrity of this courtroom" was protected.

"I mean, he speaks within two feet of me with two serious infectious diseases," Douglas told McCleave. "Either you mask your witness and/or move us to another courtroom or we do not proceed."

At one point, court staff returned after a recess wearing rubber gloves and placed documents touched by the witness in plastic bags.

Douglas, who continues to preside in Barrie, declined to speak with the Star yesterday.

In their Jan. 17 letter of complaint, the Canadian HIV/AIDS Legal Network and the HIV and AIDS Legal Clinic (Ontario) say Douglas's response to the witness, a complainant in a sexual assault case, reveals "shockingly discriminatory thinking" and is a "particularly extreme example of unacceptable conduct by a judicial officer."

The organizations say the case also raises questions about the extent to which judges are informed about HIV/AIDS and related human rights issues.

Their complaints target not only Douglas, but two courts – his own and the Superior Court of Justice, for failing to clearly condemn the behaviour.

The Crown applied to the Superior Court of Justice to have Douglas removed from the case for creating an appearance of bias. But Justice Margaret Eberhard declined, saying while his approach may have been wrong, Douglas had jurisdiction to take the steps he felt necessary to ensure courtroom safety.

Ontario's Criminal Lawyers Association has also lodged a complaint with the judicial council. The lawyers' group contends Douglas did not bring a judicial temperament to trial proceedings and treated a witness differently on the basis of irrelevant personal characteristics. Contacted yesterday, association president Frank Addario declined to discuss the allegations. The complaints are being investigated by a judicial council subcommittee, which will determine if a public inquiry into Douglas's fitness to remain on the bench is warranted.

Meanwhile, Douglas hastily resigned from the board of Stevenson Memorial Hospital in Alliston on Jan. 14, just over a month after he was appointed.

The controversy surrounding the witness began on Nov. 23, during the trial of a man charged with sexually assaulting a fellow inmate at the provincial jail in Penetanguishene.

The alleged victim testified he was HIV-positive and had Hepatitis C, but didn't inform his alleged attacker because he was traumatized. "I could be ... shanked," said the man, whose identity is shielded by a publication ban.

According to a trial transcript, during the lunch break, Douglas bumped into defence lawyer Angela McLeod and voiced concern the witness had been allowed to testify without the court being informed of his health status.

When court resumed, Douglas raised the issue with McCleave, the Crown attorney as well. "I am frankly shocked that in this day and age we were not advised," he said.

McCleave replied she knew of no issues arising from the witness being in the courtroom or touching "a couple of pieces of paper" that were introduced as evidence.

That's when Douglas offered his view that HIV will live "for year after year after year" in a dried state.

McCleave explained that she wasn't prepared to ask the witness to wear a mask in court when he faces no such requirement in the community. There were also practical problems with the judge's request, she suggested – the court reporter might not be able to accurately record his testimony.

Douglas refused the Crown's request to grant a mistrial, declined to recuse himself from the case and refused to consider granting bail to the accused, Lee Wilde, when it became clear the trial would have to be adjourned until the judge's concerns were addressed.

A new trial will begin Feb. 14.

An official with the National Judicial Institute in Ottawa, which has developed educational programs for judges, said while the curriculum addresses "emerging social issues," there's no course specifically addressing HIV/AIDS – though one is being planned. It should be up and running within "a couple of years," she said.

By Tracey Tyler, Toronto Star

HIV Rate Soars among Vancouver's Native Drug Users

February 1, 2008

Startling new research reveals that aboriginal drug users living in Vancouver's Downtown Eastside are contracting HIV-AIDS at twice the rate of non-aboriginal users.

Over the four-year study, 18.5 per cent of aboriginal men and women who injected such drugs as cocaine and heroin became HIV-positive, compared with 9.5 per cent of non-aboriginal intravenous drug users.

"This is a tragedy," Evan Wood, a research scientist at the B.C. Centre for Excellence in HIV/AIDS, said in an interview. "Many people in the aboriginal community are reaching out for care and the care isn't there."

Dr. Wood, the lead author of the research, said the higher rates of infection among natives are not due to biological factors but rather to patterns of social networking: The fact that aboriginal people interact principally with other aboriginals heightens their exposure and speeds the spread of HIV-AIDS.

Better social programs tailored to aboriginals could help alleviate that situation, he said.

In fact, even before researchers started tracking new infections, they found that the proportion of aboriginal drug users with HIV-AIDS was already higher - 25.1 per cent versus 16 per cent for non-aboriginals.

The research suggests that, all told, two in every five drug users in downtown Vancouver who identify as being Indian, Inuit or Métis are infected with HIV-AIDS, a rate higher than some areas hardest hit by the pandemic in the developing world.

Among non-aboriginals, the HIV-AIDS infection rate among IV drug users is about one in four, still a disturbingly high number.

The study, published today in the American Journal of Public Health, shows that aboriginal and non-aboriginal injection drug users have essentially the same risk factors and behaviours, such as needle sharing, selling sex and practising unsafe sex.

But the social side is key. Lucy Barney, a nurse-researcher at the Children's & Women's Health Centre of British Columbia and co-author of the paper, said "people congregate in social networks where they feel safe - with their peers. This is a real problem when your peers are addicts and end up sharing needles."

However, Ms. Barney, a member of the Lillooet Titqet Nation, said the real explanation for the higher rates of HIV-AIDS infection goes beyond these daily interactions. It has its roots in poverty, unemployment, lack of housing and dislocation that plague many aboriginal communities and send young people to the streets of Vancouver seeking solace.

"Many of our people are walking around with no purpose in life, with no hope," she said. "Give them hope and there won't be so many drug addicts and alcoholics and there won't be so much HIV-AIDS."

Both researchers stressed that there need to be more "culturally appropriate" services offered to aboriginal IV drug users, including housing, rehabilitation facilities and health services.

Ms. Barney said that while many programs are aimed at aboriginal people, there is a lack of co-ordination. Dr. Wood agreed and said the "findings suggest the need for immediate action on the part of health policy-makers." He bemoaned the fact that the current strategy seems to deal with IV drug use principally as a law-enforcement issue rather than a public-health issue.

The study notes that aboriginal drug users have higher rates of incarceration than non-aboriginals and that doing prison time is a definite risk factor for contracting illness and a drug habit. An estimated one in five HIV-AIDS infections are contracted in prison.

The data for the study were derived from two similar cohorts of injection drug users, the Vancouver Injection Drug Users Study and the Scientific Evaluation of Supervised Injection.

A total of 2,496 individuals were recruited between May, 1996, and December, 2005, of whom 585 identified as being aboriginal - Indian, Inuit or Métis. During the study period, 159 people became newly infected with HIV-AIDS, including 44 aboriginals.

The study found that those most likely to contract HIV-AIDS were people who routinely injected cocaine. (Cocaine can be injected up to 30 times a day, while heroin is injected far less frequently.)

Aboriginal participants in the study were more likely to be female and younger than non-aboriginals.

They had higher rates of daily cocaine injection and of involvement in the sex trade. Aboriginal people in Vancouver's Downtown Eastside are also less likely to get drug treatment such as methadone and to take drugs to treat their HIV-AIDS infection.

By André Picard, Toronto Globe and Mail

California Shelter Helps the Homeless and the Environment

January 28, 2008

An Oakland, California homeless shelter—which will provide care for people living with HIV, diabetes and other chronic conditions—will be one of the first “green,” or environmentally conscious, shelters ever built, The New York Times reports (nytimes.com, 1/28).

According to the article, the Crossroads shelter will accommodate 125 residents. The facility will have a solar-paneled roof, hydronic heating, practical ceiling fans, nontoxic paint and furniture fashioned from pressed wheat. The Times reports it will also feature an examination room, a wing for homeless families, an infirmary for those just released from the hospital and a dorm and bathroom solely for transgender residents.

Established by social worker Wendy Jackson, executive director of the East Oakland Community Project, Crossroads aims to provide residents with a healthy environment—while also keeping the environment healthy.

“The homeless care about the environment,” says Michael Stoops, acting executive director of the National Coalition for the Homeless. “If they can be part of a facility that is reducing energy costs and saving the planet, homeless folks are all in favor of that, just like most Americans.”

http://www.poz.com

South Dakota Senate Says Intentional HIV Infectors Must Register as Sex Offenders

January 28, 2008

On January 24, the South Dakota Senate approved legislation that would require people who are convicted of intentionally infecting sex partners with HIV to register as sex offenders upon being released from prison, reports the Associated Press/Rapid City Journal (rapidcityjournal.com, 1/24).

According to State Senator Sandy Jerstad (D-Sioux Falls), the maximum prison term for intentionally spreading HIV is 15 years. “[The] victims will have to take HIV tests for years, and they live with the consequences of this crime for the rest of their lives,” she said.

The article reports two people in South Dakota have been convicted of intentionally spreading HIV. The legislation is now on its way to the state House.

http://www.poz.com

AIDS Advocates Mount Congressional Drive for More US Funding

January 30, 2008

Washington, DC - One of the highlights of President Bush’s State of the Union initiatives for African countries was his appeal for congress to double his 2003 five-year commitment of 15 billion dollars for fighting HIV-AIDS. However, advocates promoting congressional legislation in the weeks and months ahead say the president’s 30 billion-dollar request amounts to little or no new funding increases for AIDS treatment, since the raised levels he asked for Monday night have already been approved by congress in earlier budgets. A coalition of AIDS advocacy groups headed to Capitol Hill Tuesday to lobby key congressional leaders to raise annual HIV-AIDS appropriations above 6 billion dollars for next year and beyond. Communications director David Bryden of the Global AIDS Alliance describes how the coalition is pursuing additional AIDS funding with congress.

“One of the things that we have done is to thank members of congress who have been really clear in proposing levels of funding and also proposing changes in the policy on AIDS to reflect the needs of Africa. That’s one of the things that we were doing today. We thanked Senator Biden and Congressman Lantos for their tremendous leadership on this issue. In terms of weighing in with these committees and these hearings, a number of experts who have been testifying have been making a number of points that we’ve made, and we’ll be looking very closely at the legislation as it’s drafted and considered. And we’re hoping that Americans across the country will weigh in with their members of congress to say that this is a process that really matters. The United States should get this policy right, and that they expect their members of congress to see that that’s done,” he said.

Bryden explains how the Bush Administration’s budget arithmetic on AIDS for 2009, while worthy, could scale back meaningful growth in African clinics and treatment programs.

“There’s no question that it has already had a positive impact on the area of HIV-AIDS treatment. And I think that if the program were to be flat-funded, there’s no question it could continue to have a positive impact, although at a reduced level. And the United States would not really be able to keep the promises that we’ve made at the international level on this issue. But I think that by the end of the president’s term, he will achieve his goals on treatment, which is two million people on HIV-AIDS treatment. And if it weren’t for the president, these people wouldn’t be on treatment,” he said.

In contrast to the 30 billion-dollar Bush plan, David Bryden says various American health groups and AIDS advocates are proposing to boost global funding to 41, 50, and 59 billion dollars over the next five years.

“Once you include TB and malaria spending, we’ve advocated that TB programs must be dramatically expanded. And the president’s budget proposals each year have not reflected the need for what needs to be spent on TB, or malaria for that matter. The malaria picture is somewhat better because he has his presidential malaria initiative (PMI). But the TB initiative is particularly neglected, so our organization fully supports more funding for TB, particularly because so many people suffering from HIV-AIDS are suffering from TB and dying of TB,” he said.

By Howard Lesser, http://www.voanews.com

A Snapshot of HIV in America

January 30, 2008

The U.S. Centers for Disease Control and Prevention (CDC) released a snapshot of HIV infection in the country on January 29. The report showed that about a half of one percent of adults ages 18 to 49 living in households are also living with HIV, Reuters/Yahoo News reports (news.yahoo.com, 1/29), putting the number of HIV-positive people in the U.S. at about 600,000. The study excluded people who are incarcerated, homeless and in institutions.

The study, which included 11,928 adults, confirms other research that show that black men are more likely than any other group of Americans to be HIV positive. Black men ages 40 to 49 had the highest HIV infection rate, at close to 4 percent. What’s more, people with genital herpes were 15 times more likely to also be HIV positive.

The findings do not include data about how many people are newly infected with HIV each year. Some AIDS experts and activists believe that these numbers, which are expected to be released soon, might put the number of new HIV infections nearly 50 percent higher than was previously expected—at 55,000 or 60,000, instead of 40,000.

The full report is available online at: http://www.cdc.gov/nchs/data/databriefs/db04.pdf

http://www.poz.com

Marijuana Vending Machines in US

January 28, 2007

Vending machines distributing the drug marijuana are to begin operating in the US state of California.

The machines can only be used by people who have been prescribed the drug for health reasons.

Patients will have to provide a prescription, and be fingerprinted and photographed before being allowed to use the facilities.

Eleven US states allow the medicinal use of marijuana, primarily for pain relief, but it remains controversial.

Vince Mehdizadeh, owner of the Herbal Nutrition Centre in Los Angeles, where one of the two first machines is based, said it would allow patients to buy extra supplies whenever needed.

Series of Checks

Once the users have been photographed, fingerprinted and have shown their prescription, they will be issued with a card which can be used in the machines, he told KWTX News 10 in the US.

"They'll be greeted by a security guard right there. They'll slide the card in and they'll fingerprint in to verify that it's them," he was quoted by KWTX News 10 as saying.

"A camera takes a picture of them, verifying that they're actually at the machine. And they get the medicine and they move on."

The operators think that vending machines issuing prescription drugs could become a common sight in the US.

Proponents say marijuana is a valuable tool for relieving pain and stimulating appetite in the sick.

However, it remains banned by the 1970 Controlled Substances Act and the US federal government does not currently recognise any legitimate medical use.

http://news.bbc.co.uk

Daily Cannabis Use Associated With Worse Fibrosis In Patients With Chronic Hepatitis C

January 29, 2008

Regular cannabis use is associated with moderate to severe liver fibrosis in patients infected with chronic hepatitis C virus, according to a study published in Clinical Gastroenterology and Hepatology. A fifth of patients in the study were coinfected with HIV and hepatitis C and the association between daily or near-daily cannabis use and moderate to severe fibrosis was also present in these patients.

On the basis of their findings, the investigators recommend that patients with hepatitis C should be counselled that regular cannabis consumption is associated with severe fibrosis. This information is especially important for HIV/hepatitis C coinfected patients as HIV is already associated with accelerated hepatitis C disease progression. Furthermore HIV-positive patients in the study were significantly more likely to be regular users of cannabis and to use the drug for medicinal purposes.

Hepatitis C virus infection is a major public health concern, and it is thought that the amount of illness caused by hepatitis C-associated fibrosis and cirrhosis will increase significantly in the near future.

Factors associated with the progression of hepatitis C disease and the development of cirrhosis include male gender, older age at the time of hepatitis C infection, heavy alcohol consumption and coinfection with HIV.

Cannabis is widely used for recreational and medicinal purposes. The drug contains 60 active cannabinoids and cirrhotic livers are more receptive to cannabinoids. Earlier research suggests that cannabinoids have an important, but yet to be identified, role in the progression of liver fibrosis.

Given the prevalence of cannabis use and the suggestion that it could worsen liver disease, investigators from the University of California San Francisco designed a study to determine the effect of cannabis on the severity of fibrosis in patients with chronic hepatitis C virus.

The study recruited patients between 2001 – 2004. A total of 204 patients were eligible for inclusion in the investigators’ analysis, 21% of who were HIV-positive.

Patients were interviewed to obtain information about their demographics, risk factors for hepatitis C, and drug and alcohol use. Blood tests were performed to measure hepatitis C viral load (and, if coinfected, HIV viral load), and liver function. All the patients also had liver biopsies to determine their degree of fibrosis or cirrhosis.

The patients had a median age of 47 years, 69% were male, 49% were white and 33% African American. The majority of patients had the hard-to-treat hepatitis C genotype 1 and the estimated duration of hepatitis C infection was 26 years.

Daily or near daily cannabis use was reported by 14% of patients. Daily cannabis users had significantly lower median body mass index than non-daily users of the drug (25.2 kg/m2 vs. 26.4 kg/m2, p = 0.007), were more likely to be prescribed the drug for medicinal purposes (57% vs. 9%, p < 0.001), and were more likely to be coinfected with HIV (39% vs. 18%, p = 0.011).

CD4 cell counts were comparable in HIV-positive patients who used cannabis daily and non-daily users of the drug (368 cells/mm3 vs. 411 cells/mm3).

The proportion of patients with no fibrosis was 28%, mild fibrosis was present in 55% of individuals, and 17% had moderate-to-severe fibrosis.

Median AST was above the normal range at 48 iu/l, but median AST levels were just within the normal range at 56 iu/l.

There was no evidence that daily or near-daily cannabis use was associated with mild fibrosis. But the investigators did find that daily or near-daily use of cannabis was associated with moderate or severe fibrosis (odds ratio [OR], 6.78; p = 0.005 compared to non-daily users).

Less frequent users of cannabis, those who used the drug weekly or monthly, did not have an increased risk of moderate or severe fibrosis.

The effects of cannabis use on the risk of moderate and severe fibrosis were similar for patients who only had hepatitis C virus and for those who were coinfected with HIV.

Other risk factors for moderate to severe fibrosis included lifetime heavy alcohol consumption (OR, 1.72 per ten years, p = 0.044), and the number of portal tracts (eleven or above compare with five or below, OR, 6.92, p = 0.021).

“We have shown that daily cannabis use is an independent risk factor for moderate to severe fibrosis and one of substantial magnitude, with daily cannabis users having nearly 7-fold higher odds of moderate to severe fibrosis compared to non-daily users,” write the investigators.

Patients coinfected with HIV were significantly more likely to report daily use of cannabis and to have the drug prescribed for medicinal purposes, note the investigators. They therefore suggest “the recommendation to avoid cannabis use might be especially important for hepatitis C virus- HIV coinfected persons, given that fibrosis progression is already enhanced in this group.”

The investigators conclude, “we would advise that individuals with chronic hepatitis C virus infection be counselled to reduce or abstain from cannabis use.”

Reference

Ishida JH et al. Influence of cannabis use on severity of hepatitis C disease. Clinical Gastroenterology and Hepatology 6: 69 – 75, 2008.

By Michael Carter, www.aidsmap.com

Aging Grace: Facing the Uncertainties of Growing Older With HIV

January 29, 2008

On the morning of January 6, readers of The New York Times awoke to a sobering headline: “AIDS Patients Face Downside of Living Longer.” The article highlights the stories of two fifty-something HIV-positive men, both of whom boast a disheartening list of ailments more typically found in much older people. Both men seem uncertain about how they might navigate a bleak future filled with illness. The article credits antiretroviral drugs for giving one man back his life and hopes for the future, but poses the question, “at what cost?”

Some readers recognized their own struggles in the men’s stories and felt validated. Steven Deeks, MD, a prominent AIDS researcher and doctor at the University of California San Francisco’s General Hospital, said, “Several patients sent me e-mails saying that finally someone was talking about the important issues that were affecting them.”

Others, like Rona Vail, MD, an HIV specialist at Callen-Lorde Community Health Center in New York City, worried the article may have stated the problem of living with HIV in such dire terms that it could make people with HIV more pessimistic about their futures. “We’re already such an ageist community that I worry people will be that much more afraid of getting older,” she said.

The article clearly touched a sore nerve when it highlighted the lack of existing research that might explain how much worse the aging process may be for people living with HIV. Confronted with a limited amount of data to help predict what lies ahead, it is no wonder some HIV-positive people and health care providers are anxious about what the future may hold.

Fortunately, researchers have begun to investigate both the prevalence of varying age-related illnesses in people living with HIV and how underlying mechanisms behind some of those health problems might work. Some ailments, like heart disease, have received a great deal of attention, and experts are growing more confident that they understand the contribution HIV plays in worsening the condition. One piece of good news is that lifestyle changes and certain treatments shown to be effective in HIV-negative people are also proving beneficial for people living with HIV.

The challenges of aging, of course, go beyond physical concerns. Aging also affects our minds and emotions. A number of studies have found that depression and social isolation are more common in older HIV-positive adults. These conditions can be dealt with—provided that people are aware of the problem and willing and able to do something about it.

The bottom line is that while there are many unknowns when it comes to growing older with HIV, and while some HIV-positive people may face greater health problems than their HIV-negative counterparts, there also is a great deal that can be done—for the mind, body and heart—to ensure people who are living with HIV have the opportunity to age as gracefully as those who are not.

What’s more, those who have already faced the difficulties of HIV throughout their lives may be better positioned to deal with new health challenges that emerge later in life. Charles Emlet, PhD, an associate professor of social work at the University of Washington at Tacoma, and an expert on HIV and aging, is impressed by the ability of so many people living with HIV to overcome hardship and illness. He says, “For many [positive] people that I’ve talked to, [even] in the midst of all these issues of [aging, illness] and loss, there’s a sense of resilience and strength.”

What Do We Know About HIV and Aging?

When asked this question, several experts point to our growing knowledge of heart disease in those with HIV. “We now know that HIV itself is an inflammatory condition and that heart disease is related to inflammation. So just being HIV positive can increase that risk. That’s what we found out in the SMART study. When people went off their [HIV] meds they were more likely to have heart disease than people who stayed on their meds,” says Vail.

On the other hand, HIV meds can also contribute to the problem. Vail adds, “Certain medications will increase your triglycerides and bad cholesterol, but HIV all by itself lowers your good cholesterol and raises your triglycerides. So I think there’s a lot of interplay between the two.”

Lifestyle factors also play a major role in heart health. In a 2006 groundbreaking study of HIV-positive New Yorkers aged 50 and older titled “Research on Older Adults with HIV” (ROAH), the AIDS Community Research Initiative of America (ACRIA) found that 57 percent of those surveyed were current smokers and that 84 percent had a history of smoking.

“Traditional risk factors are very important in why we are seeing early heart disease and cancer. It's possible that these risk factors are more important in the context of HIV infection because individuals are being exposed to the traditional risk factors plus their HIV,” says Deeks. He adds, “It may be that one plus one is far greater than two in terms of the impact of a risk factor on aging-related complications.”

In a finding that surprised many, another heart disease risk factor—being overweight—was also found to be more common in a cohort of people living with HIV. Being overweight increases a person’s likelihood of developing adult-onset type II diabetes, which in turn greatly increases a person’s risk of heart disease. The current research shows that some HIV medications can reduce the body’s ability to handle blood sugar, but the role that HIV itself plays on blood sugar levels remains less certain.

“Everybody has to face aging, but [people living with HIV are] going to be facing much more serious issues, for instance diabetes,” says Jules Levin, a long-time survivor of HIV and hepatitis C and the Executive Director of the National AIDS Treatment Advocacy Project (NATAP) in New York City. He asserts, “Diabetes has yet to be really addressed in HIV.”

What About the Impact of HIV on Bones?

Levin is quite familiar with another age-related issue—poor bone health, also known as osteopenia and osteoporosis. He feels that low bone density—which, research suggests, occurs more frequently in HIV-positive people, notably those on antiretroviral therapy—was responsible for a broken wrist he suffered a few months ago. The condition also made it harder for his body to heal the broken bone. He says, “I’d heard people talk about [osteopenia and HIV], but I was doing so well [that] I ignored it. I should have had a DEXA scan. Everybody with HIV should have a DEXA [scan].”

DEXA, or dual-energy x-ray absorptiometry, scans can determine the density, and thus the health, of your bones. They are typically reserved for people who have common osteoporosis risk factors, such as women who’ve gone through menopause or people with thyroid conditions or a history of corticosteroid use. Consequently, people who want a DEXA scan but don’t fall into the typical risk categories may face a battle with their insurers.

“The problem is there are no recommendations [about the need for DEXA scans for those with HIV] from our thought leaders,” says Levin. “There’s no education of the community and doctors, and there’s no research going on. And that’s why people have trouble getting their insurance companies to pay for DEXA scans.”

A related problem being seen in younger people with HIV is bone death, or avascular necrosis, which can necessitate hip and other joint replacement surgeries. When asked whether it’s the virus or the HIV meds most contributing to bone problems, Vail says, “I don’t think we have the information.”

In many cases, increasing calcium intake, quitting smoking and exercising regularly can prevent or halt the progression of bone problems. There are also treatments for osteoporosis, but pills aren’t always the best answer.

In fact, turning to pills to treat the multitude of ailments affecting older people, given how those pills can interact with each other and with HIV meds, is one area that begs for additional research. When asked to identify one of the bigger unanswered questions on HIV and aging, Vail answered, “More information about drug interactions [is needed]. As people get older, they need to be on a ridiculous number of medications.”

Another important area requiring further exploration is defining when and how physicians should screen for age-related illness in their HIV-positive patients. “Should we be screening differently?” asks Vail. “We use age 50 [as a guide for when to start] colonoscopy, and prostate testing, but is this [age also] appropriate for HIV? When should we be screening for osteoporosis? We need more and more data on better screening and early detection of cancers, and other kinds of problems.”

How Does HIV Affect the Mind Over Time?

As we age with HIV, the disease shows its effect on our minds, as well as our bodies. Given such high rates of AIDS-related dementia early in the epidemic, there has been some concern in the research community that people aging with HIV may suffer more from cognitive disorders—despite being on effective antiretroviral therapy—than their negative counterparts. Levin shares this concern, asking, “Are we going to be seeing more Parkinson’s disease? Are we going to be facing increasing [incidence of] Alzheimer’s? Are we going to be facing more dementia?”

To date, studies evaluating the effect of age on cognitive functioning in HIV-positive adults have yielded mixed results. Though some have found an increase in cognitive problems in HIV-positive people as they get older at least one study failed to detect differences in cognitive disorders between older HIV-positive and HIV-negative people.

Researchers have observed one profound difference, however, between the mental health of aging HIV-positive adults and their negative counterparts: Whereas people in the general population tend to complain less often of depression as they age, those living with HIV have rates of depression that remain elevated into older age.

In fact, the ROAH study found 52 percent of the older HIV-positive New Yorkers they surveyed suffer from symptoms of depression, with 26 percent categorized as “seriously depressed.” The study’s principal author and director of research at ACRIA, Steve Karpiak, PhD, admits to being surprised by such high rates of depression, particularly in a group of people who were, on the whole, receiving very good health care. “There’s a depression that occurs post-diagnosis, and we understand that,” says Karpiak. “And granted, there’s substance use here too. But why [are the rates of depression here] so high?”

Deeks has observed a similar phenomenon in his patients. He says: “For reasons that remain unclear, many individuals who have been on long-term [HIV] therapy have persistent fatigue, malaise, pain and difficulty concentrating. Most of these symptoms are vague and most are often blown off as depression. Many are symptoms common in other chronic illnesses, particularly those associated with autoimmunity [diseases of the immune system]. Because these are difficult issues to quantify, many researchers are afraid to tackle the issue.”

While depression, when diagnosed correctly, is a highly treatable condition, other conditions found in the ROAH study that affect people’s emotional well being can’t be handled with a pill and a smile.

The Need for a Strong Social Network

According to the study, 70 percent of HIV-positive New Yorkers surveyed are living alone—more than double the percentage of elderly HIV-negative New Yorkers. The study also uncovered fairly high rates of social isolation, fear of HIV disclosure and loneliness among the participants. Such problems are likely to have a profound impact on people’s lives, particularly if they are simultaneously dealing with other age-related health issues.

Emlet explains the consequences of social isolation by saying: “As we get older, we know from years of gerontological research that one’s social network is going to change. It’s going to change because of loss [of friends and family to death] and it’s going to change functionally by access. If you’ve got some very close people in your social network but you’re too ill to get to them, or they’re too ill to get to you, it’s going to impact [your life].”

People whose social networks are already small or fragile are likely to have an increasingly difficult time as they get older. Emlet urges people to ask themselves, “What skills do you have or not have as an individual that you take into older age that might either positively or negatively impact your ability to maintain and even construct social networks?”

As people age and develop a greater need for informal care—which can range from having people run errands for them to more hands-on care like administering medications or help with bathing—their social networks become increasingly important. It is estimated that the amount of informal caregiving provided by average Americans each year to their family, friends and neighbors would cost more than $300 billion if it had to be provided by professionals. And, if people living with HIV remain socially isolated, their growing needs as they age will likely have to be provided by a social service system that is already stretched to the breaking point in many parts of the country. With an ever growing population of people with HIV over 50, advocacy is imperative to ensure that vital caregiving services are there when people need them.

In addition to advocating for increased funding, Emlet says both the gay and the mainstream community need to confront the tendency to devalue older people. He comments: “There was a great quote from a man in a study I did a couple of years ago, and he said, ‘Ageism. It’s a far mightier sword than HIV.’ He talked so eloquently about how incredibly ageist the gay community is and [how he struggled] with loss of physical health and physical beauty and maintaining one’s self worth in the midst of that.”

In addition to advocating for increased services and fighting our communities’ ageist attitudes, we must also help people strengthen their existing social networks and build new ones. Emlet says, “I’ve had a lot of older clients say to me, ‘You can’t teach an old dog new tricks,’ and that’s absolutely untrue! Given the [right] support and skills, people can make changes in their lives.”

So, Can HIV-positive People Look Forward to Aging Gracefully?

Levin says that changes on every level—medical, social and personal—will be needed to address the age-related crisis he feels is looming large on the horizon, especially for people with HIV. He was glad to see that the article in the Times “raised peoples’ eyebrows,” but he cautions: “I think that [it] actually underestimates the problem.”

At this point, based on existing research, it’s difficult to estimate just how big a problem age-related illness is going to be for people living with HIV. Karpiak points to a recent study of HIV-positive veterans that found, when it controlled for a number of factors like age, lifestyle and immune system status, that men with HIV have more liver and kidney problems than HIV-negative men. Other studies have found higher risks for heart disease in people living with HIV, despite the success of antiretroviral therapy.

Deeks says: “The only thing we know for sure is that individuals whose virus is suppressed on long-term HAART generally do well, as long as their CD4 counts [rise] into the normal range. Those individuals whose T-cell counts do not normalize appear to be at risk for complications that are typically seen in much older individuals. This includes [the incidence of] cancer and heart disease.”

Vail, however, takes a slightly more optimistic view, saying: “I think that as we learn more, people will continue to age better. The more information we have, and the more awareness we have of this issue, then I think it’s not an inevitability that people will have a bad aging process.” She adds: “Let me tell you, I have two patients who are eighty and two patients in their seventies. Yes, they’ve got some problems. They’ve got a little bit of arthritis, a little bit of diabetes and a little bit of high blood pressure, but they’re actually living well and doing well.”

Karpiak says that when he was recruiting people for the ROAH study, “For every sick person that we found, we’d find four other people who were healthy.”

Whether or not you take an optimistic view of how well we’ll deal with an aging HIV-positive population probably depends largely on where you sit. Those who’ve already suffered from early onset of heart disease, bone problems or other age-related diseases have good reason to suspect there is a growing problem. Those in good health, despite growing older with HIV, may be more inclined to agree with Vail and believe we’ll learn to handle at least some of what we need to, in order to soften the combined blows of old age and HIV.

The one thing that the ROAH study urgently revealed was, regardless of how well a person is doing medically, dealing with life on your own is going to be that much harder as you age. And so, as it has been with many other issues over the course of the epidemic, the best hope for a brighter future will probably lay in the bonds that HIV-positive people form with each other—bonds that, over the years, have brought thousands through sickness and uncertainty and changed policies and society in ways many thought impossible. Emlet agrees, saying, “I think that what ends up happening is that people find a lot of strength in connecting and talking to other people that are in the same boat they are, and they should find and use venues [like support groups and online forums] to support each other.”

By David Evans, http://www.aidsmeds.com

Swiss Experts Say Individuals With Undetectable Viral Load and No STI Cannot Transmit HIV During Sex

January 30, 2008

Swiss HIV experts have produced the first-ever consensus statement to say that HIV-positive individuals on effective antiretroviral therapy and without sexually transmitted infections (STIs) are sexually non-infectious. The statement is published in this week’s Bulletin of Swiss Medicine (Bulletin des médecins suisses). The statement also discusses the implications for doctors; for HIV-positive people; for HIV prevention; and the legal system.

The statement, on behalf of the Swiss Federal Commission for HIV / AIDS was authored by four of Switzerland’s foremost HIV experts: Prof Pietro Vernazza, of the Cantonal Hospital in St. Gallen, and President of the Swiss Federal Commission for HIV / AIDS; Prof Bernard Hirschel from Geneva University Hospital; Dr Enos Bernasconi of the Lugano Regional Hospital; and Dr Markus Flepp, president of the Swiss Federal Office of Public Health’s Sub-committee on the clinical and therapeutic aspects of HIV / AIDS.

The statement’s headline statement says that “after review of the medical literature and extensive discussion,” the Swiss Federal Commission for HIV / AIDS resolves that, “An HIV-infected person on antiretroviral therapy with completely suppressed viraemia (“effective ART”) is not sexually infectious, i.e. cannot transmit HIV through sexual contact.”

It goes on to say that this statement is valid as long as:

The article begins by stating that the Commission “realises that medical and biologic data available today do not permit proof that HIV-infection during effective antiretroviral therapy is impossible, because the non-occurrence of an improbable event cannot be proven. If no transmission events were observed among 100 couples followed for two years, for instance, there might still be some such events if 10, 00 couples are followed for ten years. The situation is analogous to 1986, when the statement ‘HIV cannot be transmitted by kissing’ was publicised. This statement has not been proven, but after 20 years’ experience its accuracy appears highly plausible.”

It then states that the evidence for the Commission’s current assertion about the relationship between treatment and sexual HIV transmisson is much more informed than what was available in 1986 regarding the transmission of HIV through kissing.

For example, they note, Quinn and colleagues found that in sero-discordant couples the risk of transmission depended on the viral load of the HIV-positive partner, and refer also to a prospective study of 393 heterosexual sero-discordant couples from Castilla and colleagues found that there were no infections among partners of persons on antiretroviral therapy, compared to a rate of transmission of 8.6% among partners of untreated patients. They also note that transmission from mother to newborn also depends on the maternal viral load, and can be avoided by taking antiretroviral therapy.

They go on to assert that effective antiretroviral therapy eliminates HIV from genital secretions. They say that HIV RNA, measured in sperm, declines below the limits of detection on antiretroviral therapy, and that HIV RNA is also below the limits of female genital secretions is, as a rule, during effective antiretroviral therapy. “As a rule,” they write, “it rises after, not before, an increase in plasma viral load.”

They also assert that although cell-associated viral genomes are present in genital secretions, even on antiretroviral therapy, these are not infectious virions since “HIV-containing cells in sperm lack markers of viral proliferations such as circular LTR-DNA.”

They note that the concentration of HIV RNA in sperm correlates with the risk of transmission and that “transmission risk declines towards zero with falling sperm viral load. These data indicate that the risk of transmission is greatly decreased by antiretroviral therapy.”

They add, however, several exceptions and caveats to the above statements:

They conclude the scientific part of the article by saying that: “During effective antiretroviral therapy, free virus is absent from blood and genital secretions. Epidemiologic and biologic data indicate that during such treatment, there is no relevant risk of transmission. Residual risk can not be scientifically excluded, but is, in the judgment of the Commission, negligibly small.”

Implications for Doctors

The Commission then discusses the implications for doctor-patient discussions. It says, "the following information aims to communicate to doctors criteria allowing them to establish whether or not a patient can sexually transmit HIV. HIV cannot be transmitted sexually if:

Implications for HIV-Positive People

The Commission states that an HIV-positive person in a stable relationship with an HIV-negative partner, who follows their antiretroviral treatment consistently and as prescribed and who does not have an STI, is "not putting their partner at risk of transmission by sexual contact."

"Couples must understand," they write, "that adherence will become omnipresent in their relationship when they decide not to use protection, and due to the importance of STIs, rules must be defined for sexual contacts outside of relationship."

"The same goes for people who are not in a stable relationship," they add. However due to the importance of STIs, use of condoms is still recommended.

They add that heterosexual women will have to consider eventual interactions between contraceptives and antiretrovirals before considering stopping using condoms.

They also say that insemination via sperm washing is no longer indicated when "antiretroviral treatment is efficient."

Implications for HIV Prevention

The Commission says that it "is not for the time being, considering recommendations that HIV-positive individuals start treatment purely for preventative measures." Aside from the cost involved, they argue, it cannot be certain that HIV-positive people would be sufficiently motivated to follow, and apply to the letter, antiretroviral treatment on a long-term basis without medical indications. They note that poor adherence is likely to facilitate the development of resistance, and that, therefore, antiretroviral therapy as prevention is indicated only in "exceptional circumstances for extremely motivated patients."

The Commission also says that their statement should not change prevention strategies currently taking place in Switzerland. With the exception of stable HIV-positive couples where HIV-positivity and the efficacy of antiretroviral therapy can be established, measures to protect oneself must be followed at all times. "People who are not in a stable relationship must protect themselves," they note, "as they would not be able to verify whether their partner is positive or on efficient antiretroviral therapy."

Implications for The Legal System

Finally, the Commission says that courts will have to take into account the fact that HIV-positive people on antiretroviral treatment and without an STI cannot transmit HIV sexually in criminal HIV exposure and transmission cases.

They conclude by stating that the Commission thinks that unprotected sex between a positive person on antiretroviral treatment and without an STI, and an HIV-negative person, does not comply with the criteria for an “attempt at propagation of a dangerous disease” according to section 231 of the Swiss penal code nor for “an attempt to engender grievous bodily harm” according to section122, 123 or 125.

Reference

Vernazza P et al. Les personnes séropositives ne souffrant d’aucune autre MST et suivant un traitment antirétroviral efficace ne transmettent pas le VIH par voie sexuelle. Bulletin des médecins suisses 89 (5), 2008.

By Edwin J. Bernard, www.aidsmap.com

Virtual Human in HIV Drug Simulation, UK

January 30, 2008

The combined supercomputing power of the UK and US 'national grids' has enabled UCL (University College London) scientists to simulate the efficacy of an HIV drug in blocking a key protein used by the lethal virus. The method - an early example of the Virtual Physiological Human in action - could one day be used to tailor personal drug treatments, for example for HIV patients developing resistance to their drugs.

The study, published online in the Journal of the American Chemical Society, ran a large number of simulations to predict how strongly the drug saquinavir would bind to three resistant mutants of HIV-1 protease, a protein produced by the virus to propagate itself. These protease mutations are associated with the disease's resistance to saquinavir, an HIV-inhibitor drug.

The study, by Professor Peter Coveney and colleagues at the UCL Department of Chemistry, involved a sequence of simulation steps, performed across several supercomputers on the UK's National Grid Service and the US TeraGrid, which took two weeks and used computational power roughly equivalent to that needed to perform a long-range weather forecast.

The idea behind the Virtual Physiological Human (VPH) is to link networks of computers across the world to simulate the internal workings of the human body. The VPH - mainly a research initiative at present - allows scientists to simulate the effects of a drug and see what is happening at the organ, tissue, cell and molecular level.

Although nine drugs are currently available to inhibit HIV-1 protease, doctors have no way of matching a drug to the unique profile of the virus as it mutates in each patient. Instead, they prescribe a course of drugs and then test whether these are working by analysing the patient's immune response. One of the goals of VPH is for such 'trial and error' methods to eventually be replaced by patient-specific treatments tailored to a person's unique genotype.

Professor Peter Coveney says: "This study represents a first step towards the ultimate goal of 'on-demand' medical computing, where doctors could one day 'borrow' supercomputing time from the national grid to make critical decisions on life-saving treatments.

"For example, for an HIV patient, a doctor could perform an assay to establish the patient's genotype and then rank the available drugs' efficacy against that patient's profile based on a rapid set of large-scale simulations, enabling the doctor to tailor the treatment accordingly.

"We have some difficult questions ahead of us, such as how much of our computing resources could be devoted to helping patients and at what price. At present, such simulations - requiring a substantial amount of computing power - might prove costly for the National Health Service, but technological advances and those in the economics of computing would bring costs down."

For the moment, Professor Coveney's group is continuing to look at all the protease inhibitors in a similar way. The VPH initiative, now underway with 72 million euros of initial funding from the EU, will boost collaboration between clinicians and scientists to explore the scope for patient-specific medical treatments based on modern modelling and simulation methods.

About UCL

Founded in 1826, UCL was the first English university established after Oxford and Cambridge, the first to admit students regardless of race, class, religion or gender, and the first to provide systematic teaching of law, architecture and medicine. In the government's most recent Research Assessment Exercise, 59 UCL departments achieved top ratings of 5* and 5, indicating research quality of international excellence.

UCL is in the top ten world universities in the 2007 THES-QS World University Rankings, and the fourth-ranked UK university in the 2007 league table of the top 500 world universities produced by the Shanghai Jiao Tong University. UCL alumni include Marie Stopes, Jonathan Dimbleby, Lord Woolf, Alexander Graham Bell, and members of the band Coldplay.

http://www.medicalnewstoday.com

Ugandan Pharmaceutical Plant Begins Production of Generic Antiretrovirals

January 30, 2008

A pharmaceutical plant in Uganda this week will begin production of generic antiretroviral drugs following an order from the Ugandan government for drugs worth 17 billion Ugandan shillings, or about $10 million, the East African Business Week reports (Etyang, East African Business Week, 1/28).

Ugandan President Yoweri Museveni in October 2007 commissioned the 15-acre pharmaceutical plant, which will produce triple-therapy combination antiretroviral and first-line malaria treatments. Ugandan pharmaceutical importer Quality Chemical Industries and Indian pharmaceutical company Cipla will produce the drugs. The factory will manufacture the antiretroviral combination therapy Triomune, which contains lamivudine, stavudine and nevirapine. In addition, the factory will produce the first-line antimalarial combination treatment Lumartem, which contains artemisinin and lumefantrin (Kaiser Daily HIV/AIDS Report, 11/26/07).

According to the Business Week, Uganda's Ministry of Health and other government agencies are covering the cost of the initial batch of drugs with 8 billion shillings, or about $4.7 million, and 9 billion shillings, or about $5.3 million, respectively, for the first quarter. The government is expected to spend 68 billion shillings, or about $40 million, during the first year of the project. Donor organizations also will cover a portion of the cost, Emmanuel Otaala, minister of state for primary health care, said. He added that the government has inserted an HIV/AIDS category into its budget to cover its portion of the cost and to fund other HIV/AIDS services.

Emmanuel Katongole, managing director of the plant, said the cost for a monthly supply of antiretrovirals produced at the plant will be about 30% less expensive than imported drugs currently available in the country, adding that the final cost will be $9 for a one month's supply. Katongole said the plant initially will "focus on addressing the problems of scarcity and affordability of drugs" in an effort to expand antiretroviral access.

During the project's first phase, the plant will produce two million antiretroviral and malaria drugs daily. The plant initially will provide antiretrovirals only to the Ugandan government but will then begin supplying drugs to the private sector and other African countries. The plant is expected to begin exporting drugs to Rwanda and Tanzania by the end of 2008, Katongole said.

According to the Business Week, about 100,000 Ugandans currently have access to no-cost antiretroviral treatment, but about 238,000 people in the country are expected to need the drugs by 2012. In 2005, about 42% of people in need of antiretrovirals had access to them, according to statistics (East African Business Week, 1/28)

http://www.kaisernetwork.org

High Rate of Bone Problems in French HIV Patients

January 30, 2008

French researchers have found rates of serious bone weakness in HIV-positive patients, particularly HIV-positive men, to be many times higher than in the general population’s, according to a new study published in the January 30 issue of AIDS.

Charles Casanave, MD, of the Fédération de Maladies Infectieuses et Tropicales in Bordeaux, France, and his colleagues enrolled 492 patients from a larger group of HIV-positive people being followed in southwestern France known as the Aquitaine Cohort. Seventy-three percent of the patients were men, 70 percent were active smokers—a risk factor for poor bone health—and less than 8 percent took supplemental calcium. The average age was 43 years for men and 41 years for women.

Body mass index (BMI), which is calculated based on a person’s height and weight, was available for 482 participants, 24 percent of whom had a BMI of less than 20, which is considered low and is a further risk factor for poor bone health. The vast majority of participants, 93 percent, were on combination antiretroviral therapy.

In order to diagnose osteopenia—a moderate reduction in bone mineral density—and osteoporosis—a more severe reduction in bone mineral density that can increase the risk of a serious fracture—Casanave’s team conducted dual energy X-ray absorptiometry (DEXA) scans on the participants’ spines and femurs, the large leg bone that links to the hip.

Fifty-five percent of the men in the study and 51 percent of the women were diagnosed with osteopenia. Thirty-four percent of the men and 8 percent of the women were diagnosed with the more serious osteoporosis. Other studies of bone health in people living with HIV have found rates of osteoporosis of 15 percent, which is almost four times higher than in similar people who are HIV negative.

Factors associated with osteopenia and osteoporosis in men included having acquired HIV through sex with other men and having an undetectable viral load. Men whose CD4 counts had ever been particularly low, known as the CD4 nadir, were also at greatest risk of osteopenia. The authors theorized that rates may have been higher in gay men because of higher rates of substance use in this community and higher rates of infection with herpes virus type 8 and Kaposis sarcoma, which can affect bone health.

In women, older age and low CD4 nadir were associated with a greater risk of having osteopenia or osteoporosis.

When measured directly, antiretroviral therapy was not associated with an increased risk for either disorder. Casanave’s team reasoned, however, that an undetectable viral load and low CD4 nadir both occur most commonly in people who’ve been on antiretroviral therapy and thus may point to some contribution of the meds on people’s bone health.

Casanave’s team also explains that the extremely high rates of osteoporosis found among the men in the study may be at least partially explained by the fact that the DEXA scans of the men had to be compared to samples from men in the United States, who on average consume more calcium than French men. The team is calling for more research to accurately determine how prevalent bone problems are in people living with HIV and what risk factors most contribute to those problems.

http://www.poz.com

Selzentry May Hold Promise for HIV Prevention

January 30, 2008

Pfizer announced today that it is offering the International Partnership for Microbicides (IPM) a royalty-free license to develop the antiretroviral drug Selzentry (maraviroc) as a microbicide to prevent HIV transmission.

Selzentry, an HIV entry inhibitor, is currently approved to treat HIV-positive people who have tried and failed other antiretroviral drugs.

For HIV to infect an immune system cell, it must first attach to collections of proteins, known as receptors, on the surface of the cell. One of the key receptors on CD4 cells is called CCR5, and Selzentry works by binding to the CCR5 receptors on a person’s CD4 cells and thus blocks entry of the virus.

Researchers hope that Selzentry may also work to stop transmission of HIV if used as a microbicide, which is typically a gel, film or slow-release device that can be put into the vagina or anus before sex.

Jack Watters, MD, a vice president at Pfizer says, “Given maraviroc's mechanism of action blocking entry of HIV into the CD4 cells, the possibility for use in a microbicide is exciting. In addition to developing new drugs to treat AIDS, we are committed to searching for ways our drugs can be used to slow down or stop this epidemic.”

IPM has similar licensing agreements with a number of other pharmaceutical companies, which would allow them to develop other promising compounds as microbicides

http://www.poz.com

Scientists Study How HIV Hides in Body

February 1, 2007

Washington - The AIDS virus has hideouts deep in the immune system that today's drugs can't reach. Now scientists finally have discovered how HIV builds one of those fortresses — and they're exploring whether a drug already used to fight a parasite in developing countries just might hold a key to break in.

Researchers have long struggled unsuccessfully to attack what they call reservoirs of dormant HIV, and the new work is in very early stages.

But University of Rochester scientists say it may be fairly straightforward to attack one of these reservoirs, blood cells called macrophages that HIV hijacks and turns into viral hideaways.

The new discovery shows the exact steps that HIV takes to do that — and found that some existing drugs, including a long-used treatment for leishmaniasis called miltefosine, can block the main step and thus cause these cells to self-destruct.

"It's a very smart virus," said lead researcher Dr. Baek Kim. "They have to have a very good fence to protect their house for a long time. ... Get rid of the fence, and now their house is gone."

Today's drugs have turned HIV from a quick death sentence into, for many, a chronic infection. Yet those drugs don't eliminate HIV because they can't reach the two known pools of cells where the virus can lie dormant, ever ready to resurface.

So-called memory T cells form one such pool. As the name implies, these are the cells that ensure if you get, say, measles as a child, you're forever immune. They live for years, even decades, making them a logical HIV hideout, and one that scientists have repeatedly sought to dismantle to no avail.

Macrophages, another type of immune cell, form the second pool. They roam the body looking for invaders like bacteria to gobble up. If they get harmed, such as becoming infected by a virus, they're supposed to commit suicide. But HIV instead keeps them alive long past their normal lifespan.

"Up to now, nobody has really thought about how to eliminate the macrophage reservoir," said Dr. Kuan-Teh Jeang, an HIV specialist at the National Institutes of Health. "The imagination now has turned toward, 'How do we eliminate reservoirs?' ... The best way to address our problem is to simply kill those cells."

The Rochester team found that HIV produces a protein that turns on a particular cell-survival pathway. After a multistep process, it ultimately activates an enzyme called Akt that in turn prevents cell suicide, the researchers reported Thursday online in the journal Retrovirology.

That was good news, Kim said, because the Akt pathway is a culprit in certain cancers — meaning oncologists have been trying to target it for some time. So Kim put human HIV-infected macrophages in lab dishes and started adding drugs known to block the Akt pathway, to see if any killed the cells.

He had luck: Miltefosine and a cousin named perifosine both rapidly killed the macrophages, thus depriving HIV of this hideout.

Perifosine is currently being studied as a possible cancer drug. But miltefosine is known to be safe through its use in leishmaniasis patients. So Kim's goal is to rapidly study the already available miltefosine in animals, to see if it truly targets infected macrophages well enough to then test in HIV patients.

"The evidence they show is in fact pretty good," said NIH's Jeang, who says the next step should be a test of miltefosine in monkeys infected with SIV, the monkey version of the AIDS virus.

By Lauran Neergaard, The Associated Press

From David's Blog on Poz/AIDSmeds: Hot Metal Hubris

As you may have read in the first blog entry, “28 Years to Life”, I’ve had HIV for 28 years. HIV is no picnic in the park. Had I been less fortunate over the years, if my only accomplishment was surviving, it might even be enough. But I’ve done more. Much more. If I could share the things I’ve done in the last 28 years with the world, it would make for a great story in itself. We’re talking tabloids here. But not just yet.

As one my HIV positive friends said yesterday, there are so many amazing stories out there, so many people who have suffered so much for so long, yet still walk through the fire today, that whatever I have accomplished in my life pales by comparison. It’s downright humbling. This is my invitation to you all. I want to read your comments. I want to smile and laugh and cry at all of the incredible things we have done, and the astonishing stories of survival and spirit that make us who we are. Post them with your own name or post them with another one. It doesn't matter...

http://blogs.poz.com/david/archives/2008/01/hot_metal_hubri.html