 |
|
|
|
The
HIV/AIDS eNews is published by the British Columbia Persons With AIDS
Society. This publication is a compilation of various articles
collected from numerous news sources. Opinions and information
expressed are those of the individual authors and not necessarily those
of the Society.
|
|
|
|
 SUITS
Join us for the kick-off of our new monthly networking event for professional, gay HIV+ men!
Where: Milestones Yaletown (1109 Hamilton Street)
When: January 26, 2009, 5.30-8pm
RSVP: (required) 604.893.2258
For more information call 604.893.2200 |
|
|
|
HIV: CHRONIC DISEASE?
Join us for this free community forum exploring HIV as a manageable chronic disease.
Where: Sands Best Western Hotel (1755 Davie)
When: January 19, 2009, 5.30pm
RSVP: (required) 604.893.2274 or zorans@bcpwa.org |
|
|
|
Volunteer at BCPWA
Volunteer Event Organizer
Do you enjoy talking and meeting new people?
Some Responsibilities:
- Assist with the coordination of the Annual Volunteer Recognition Event in April
- Securing door prizes from local sponsors
- Strong communication skills to call and meet people
- Providing administrative support to the Coordinator
* 6 month Volunteer commitment required (1 position) start December
Please see Marc Seguin-Coordinator Volunteer Services BC Persons With AIDS Society, for more information; marcs@bcpwa.org 604-893-2298
|
|
|
|
Activists push AIDS funding
Feds urged to form 'catastrophic drug program'
December 26, 2008
The federal government must
maintain the current levels of funding for HIV/AIDS -- especially
during this time of economic hardship, according to activists.
"Now, more than ever, we need
to continue funding health care. We can only have a healthy economy if
we keep our citizens healthy, including those with chronic diseases
like HIV/AIDS. That's why we need the federal government to take the
lead in establishing a national catastrophic drug program," said Louise
Binder, an HIV-positive woman and chairman of the Canadian Treatment
Action Council (CTAC).
CTAC argues a catastrophic
drug plan is a necessity for working Canadians who don't have private
insurance to cover the high costs of medication for HIV, as well as
other life-threatening diseases.
In Canada, there are 56,000
people living with HIV/AIDS and the disease is on the rise among women,
aboriginals and young gay men. Many in those groups don't have private
insurance.
"Job security is on
everyone's mind. For people living with HIV/AIDS or other diseases that
require access to high cost drug therapies, the prospect of maintaining
your health and your job can be equally onerous," said Ron Rosenes,
vice-chairman of CTAC. Representatives from CTAC also say more needs to
be done to stop the spread of the disease.
In addition to those already
diagnosed with HIV/AIDS, are 15,000 HIV-positive people who don't know
their status, added Patrick Cupido, a board member with CTAC.
"Especially during difficult
economic times, Canada needs to continue to strengthen its efforts to
curb the spread of HIV by doing more to provide access to testing,
prevention, treatment and support needed for those living with HIV/AIDS
and those who are co-infected with HCV/HBV (hepatitis C and B virus,"
said Cupido.
There is no cure or vaccine for HIV/AIDS.
"Prevention and timely treatment are the only tools we have to stop this disease," Binder said.
Since 1985, there have been 27,621 HIV cases in Ontario and 60% of those have been in Toronto.
By Kevin Connor, http://www.torontosun.com
|
Health teams tackle mountain of woe
AFRICAN AID MISSION: Climbing Kilimanjaro will help raise funds for the medical clinic they're supporting
December 30, 2008
A London doctor is headed to Africa to climb a mountain -- literally and figuratively.
On Jan. 11, Dr. Louise Moist, a kidney specialist and researcher, will
leave for Tanzania in East Africa to climb Mount Kilimanjaro.
But first, Moist will tackle a mountain of medical misery in the hope
of shoring up a new medical clinic aimed at improving the lives of
women and children, many stricken or threatened by AIDS.
"It's really to promote proper health care and provide HIV care and
primary care for women and children. It's a significant issue," said
Moist, the mother of two children, seven and 10, and a 22-year-old
stepchild.
"We'll be teaching the community about health and women and children about proper diets based on what's available to eat."
Moist will be joined by 27 other health-care professionals, teachers
and administrators from across the country, who will each carry
22-kilogram bags of aid, including medical supplies, personal health
and hygiene products, school and office supplies and more.
Queen's University physician Karen Yeates and Kingston businessperson
Carol Bisaillon founded Prevention Through Empowerment, a project of
the Canada Africa Community Health Alliance, in the hopes of improving
basic health and HIV prevention among Tanzanian women.
Yeates, a friend of Moist, helped build the Pamoja Tunaweza Women's
Centre in the Mount Kilimanjaro area staffed by Tanzanian women with
training in human rights and HIV/AIDS-related issues. The centre's aim
is to improve knowledge and access to women's health care.
After spending two weeks at the clinic, the team will spend four days
climbing Mount Kilimanjaro and two days descending as part of a
fundraiser for the clinic. They return to Canada Feb. 2.
Each team member was to find $6,000 in sponsors for the climb. It costs $2,000 a month to keep the clinic operating.
Moist said she's never climbed a mountain, but is training daily in preparation.
The 52-year-old doctor, who also is a trained pharmacist and family
doctor, quotes a Bible passage, -- Luke 12:48, "For unto whomsoever
much is given, of him shall be much required" -- to explain her
motivation.
"It's to contribute to improved health care and education for women and children in deprived countries," she said.
"We're privileged to be born in Canada. Just lucky."
By Joe Belanger, http://lfpress.ca
|
Court Orders Schwarzenegger Administration to Enforce HIV/AIDS Law, Says AHF
Superior Court Judgment Commands California Department of Health to
Comply with Landmark 2002 Law Providing Care for HIV-Infected
Individuals, Compels State to Report Within 120 Days on Actions Taken
December 23, 2008
Los Angeles -- The Superior Court of California, County of Los Angeles
has entered a judgment and will issue a writ ordering California's
Department of Health Care Services (DHCS) to implement a landmark 2002
law intended to extend Medi-Cal (Medicaid) coverage to HIV-positive
Californians. In addition to detailing specific steps that must be
taken in order to be considered in compliance, the Court has issued a
writ commanding the Department to "...make and file a return to this
writ within 120 days of issuance, setting forth what you have done to
comply."
Earlier this month, the Court ruled that the state's Department of
Health Care Services (DHCS) "...arbitrarily failed to meet its
statutory duties..." in implementing the 2002 legislation. The ruling
came in a case (#BS 108234) filed by AIDS Healthcare Foundation (AHF)
which sought to compel the Department of Health Care Services to comply
with legislation intended to extend Medi-Cal coverage to HIV-positive,
non-disabled individuals who would otherwise qualify for Medi-Cal.
Prior to the passage and signing of the legislation (California
Assembly Bill 2197) only such individuals who had advanced to a
diagnosis of AIDS were considered eligible for Medi-Cal enrollment and
coverage.
"Despite an excellent record on AIDS issues, Governor Schwarzenegger
has been ill-served by his administration which for six years has
failed to enact this crucial--and ultimately cost-saving--health care
legislation," said Michael Weinstein, President of AIDS Healthcare
Foundation, the US' largest HIV/AIDS organization, which operates AIDS
treatment clinics in the US, Africa, Latin America/Caribbean and
Asia--including 12 clinics in California. "We thank the court for this
judgment which compels the state to do its job by implementing this
important legislation passed by the state's representative government
and signed into law by the Governor."
In the judgment, the Court orders the state to:
- "1. Conduct all outreach and awareness activities necessary
to encourage the voluntary enrollment into Medi-Cal managed care of
persons who are disabled as a result of AIDS pursuant to Welfare and
Institutions Code 14149.3, subdivision (g);
- 2. Determine the savings generated by the increased
voluntary enrollment into Medi-Cal managed care of persons who are
disabled as a result of AIDS pursuant to Welfare and Institutions Code
14149.3, subdivision (f) (1);
- 3. Establish capitation rates to be paid to Medi-Cal
managed care plans for services provided pursuant to Welfare and
Institutions Code 14149.3, subdivision (e);
- 4. Seek the appropriate federal waiver under Section
1115 of the Social Security Act (42 U.S.C. Sec. 1315) to implement the
expansion of eligibility provided for pursuant to Welfare and
Institutions Code 14149.3, subdivision (j); and
- 5. Take any further action specially enjoined on them by
the law. Nothing in this judgment or in that writ shall limit of
control in any way the discretion legally vested in respondents."
The Need for Care for HIV-infected Individuals in the Early Stages of the Disease
AB 2197 came about in part in response to a call by the federal centers
for Medicare and Medicaid Services for states to seek waivers to extend
healthcare services to low-income individuals in the early stages of
HIV. As written and signed into law back in 2002, AB 2197 directs
California's Department of Health Services to, among other things:
- Determine whether, under applicable Federal law, the
federal government will contribute financially for the enrollment and
maintenance of these beneficiaries in the Medi-Cal program;
- Seek from the federal government a waiver of
requirements for the Medi-Cal program, such that California may
implement this program;
- Actively encourage Medi-Cal recipients with AIDS to voluntarily enroll in Medi-Cal managed care programs;
- Utilize the savings generated by such enrollments to fund the
coverage of otherwise eligible persons with HIV into the Medi-Cal
program.
History of California Assembly Bill 2197
In 2002, California Governor Gray Davis signed Assembly Bill 2197. The
bill, which had been introduced twice before in the California
legislature in various versions as far back as 1997, honored a campaign
pledge Davis made during his first California gubernatorial campaign.
At the time of its passage, AB 2197's author, Assembly Member Paul
Koretz (D, West Hollywood--retired), said, "This bill is a win-win for
the state and for persons living with HIV. It will provide access to
more reliable, stable health care for these individuals at no
additional cost to the state. The strong bi-partisan support this bill
has received is testament to the fact that it is a very sensible,
cost-effective approach to improving access to health care."
AB 2197 had been the highest priority that legislative year for
California's leading AIDS organizations--including the Southern
California HIV Advocacy Coalition (SCHAC), (the sponsor of the bill)
representing 10,000 individuals throughout the Southland, and AIDS
Healthcare Foundation (AHF), the nation's largest specialty provider of
HIV/AIDS medical care with clinics in Southern and Northern California.
AB 2197 extends Medi-Cal eligibility to Californians who are HIV
positive, but do not yet have an AIDS defining illness. Previously,
only Californians with an AIDS diagnosis (those who have progressed
clinically from being HIV positive to having an AIDS defining illness)
could be considered for Medi-Cal eligibility. As a result, many
HIV-positive Californians had to progress to an AIDS diagnosis--in
essence get sicker, in order to then access care--via Medi-Cal. Sadly,
because of the state's failure to comply with AB 2197 almost five years
after its passage, this still largely remains the case today.
About AHF AIDS Healthcare Foundation (AHF) is the nation's largest
non-profit HIV/AIDS organization. AHF currently provides medical care
and/or services to more than 93,000 individuals in 21 countries
worldwide in the US, Africa, Latin America/Caribbean and Asia.
Additional information is available at www.aidshealth.org
|
Drug-injection facility still sparks debate in San Francisco
December 27, 2008
San Francisco is about to create the first legal drug-injection
facility in the country — a place where users could bring in drugs
obtained on the street, get clean needles and shoot up in a medically
supervised room.
A year ago, the San Francisco Public Health Department, the Alliance
for Saving Lives and a consortium of community members gathered to
discuss the idea of opening a legal injection facility.
San Francisco's Tenderloin district — home to many drug users, as well
as families and children — has been identified by officials as the most
likely location of the Safer Injection Facility. But residents are
concerned about the impact of a state-sanctioned center for drug use in
their neighborhood.
The resistance doesn't surprise Capt. Gary Jimenez of the Police Department's Tenderloin station.
"I do know that on the issue of a safer injection facility, many people
in the community are saying, 'Good, but not in my neighborhood,'"‰" he
said.
While Jimenez concedes that the Tenderloin would be an ideal site
because of its high rates of injection-drug use and lethal overdose, he
would rather see the center elsewhere.
"But I think the folks in Pac Heights and Bay View would say 'No thank you,'"‰" he said.
Some Tenderloin residents have suggested incorporating the facility into existing social service programs.
"Instead of creating an entirely separate institution, there already
The Tenderloin district is home to some 3,500 children, some who are
frequently exposed to drug use near their schools and playgrounds.
According to Jimenez, the injection facility would alleviate that
problem by providing a sanctuary for those who inject on the city's
streets and alleys, as well as a safe place to dispose of syringes.
"None of us want to shoot out here in front of kids," said Adam Archie,
of San Francisco, a homeless drug user. "If we had a place to shoot,
then we'd also have a place to put our dirty needles, which is a
problem out here."
Supporters point to the success of injection facilities that have
operated in Europe and Australia for more than 20 years, starting with
Switzerland in 1986, and most recently in Vancouver, British Colombia,
where the Insite facility was established in September 2003.
"Studies in Vancouver show that people are more likely to engage in
other services once they've used the injection facility," Enteen said.
"We've seen less public injection, fewer fatal overdoses, less public
disposal of syringes and more people trying to get clean. You just
can't argue with Vancouver's findings."
The Canadian facility consists of three levels: the first floor is a
safe injection center, the second a detoxification center, and the
third a rehabilitation center. The idea is that clients will move up in
the center, entering as drug users and eventually leaving clean.
According to figures presented at last year's symposium, hundreds of
overdoses have occurred at the Insite facility yet resulted in no
fatalities because medical staff were standing by. Additionally, users
of the facilities aren't allowed to share needles, reducing the spread
of hepatitis C and HIV.
The city of Oakland has funded the Casa Segura Needle Exchange program for 17 years, but hasn't discussed an injection facility.
"We'd probably wait to see what happens in San Francisco, and then
there will be a precedent set," said Joy Rucker, executive director of
Casa Segura. "Oakland just isn't as progressive as San Francisco in
terms of looking at a public health model for injectors."
Dr. Paul Quick, a physician involved in the care of homeless people in
San Francisco, said many of the city's homeless drug users suffer from
underlying mental illnesses. For these individuals, the injection
facility not only would address their addictions but also their mental
health needs.
"When you have a facility that people can use safely, you stand on
better moral ground as a community to demand that people not use on the
street." Quick said. "It's simply not acceptable for society to let
addicts use on the street and die."
By Philip Hoover, http://www.insidebayarea.com
|
AIDS skeptic Christine Maggiore dies at 52
December 30, 2008
Los Angeles - Christine Maggiore, an activist who vehemently denied
that HIV causes AIDS, declined to take anti-AIDS drugs and sued Los
Angeles County for stating that her 3-year-old daughter succumbed to
AIDS-related pneumonia, has died. She was 52.
Maggiore died at her Van Nuys home on Saturday. She had been treated
for pneumonia in the past six months, but the official cause of her
death was pending, county coroner Assistant Chief Ed Winter said
Tuesday.
He said it was unclear if her death was AIDS-related. She was diagnosed with human immunodeficiency virus in 1992.
A call to her home seeking comment from her husband, Robert Scovill,
was not answered, and no message could be left because the recording
mailbox was full.
Supporters told the Los Angeles Times on Monday that they doubted she died of AIDS.
"Why did she remain basically healthy from 1992 until just before her
death?" asked David Crowe, a former board member of the nonprofit group
Rethinking AIDS, which advocates for the "scientific reappraisal of the
HIV/AIDS hypothesis."
Others said she may have benefited by following standard treatments for AIDS.
"It's just really sad that she never could understand and never could
trust the medical community, unlike the rest of the world," said Craig
Thompson, executive director of AIDS Project Los Angeles.
For a year after her diagnosis, Maggiore was a volunteer at AIDS shelters and spoke about the risks of the virus
However, she began to change her views in 1993 when she had more HIV
tests that gave contradictory results, some negative and some positive.
"My desire to learn finally led me outside the confines of the AIDS
establishment," she wrote on the Web site of her nonprofit
organization, Alive & Well AIDS Alternatives.
"The more I read, the more I became convinced that AIDS research had
jumped on a bandwagon that was headed in the wrong direction," she said.
She was heavily influenced by University of California, Berkeley,
biology professor Peter Duesberg. In conflict with generally accepted
scientific views, Duesberg argues that AIDS is caused not by HIV but
from long-term consumption of recreational drugs or even AZT, the
compound used in AIDS treatment.
Maggiore founded her nonprofit organization, which challenges
mainstream medical views about the causes and treatment of AIDS. She
wrote a book, "What If Everything You Thought About AIDS Was Wrong,"
and appeared on national television to promote her view that pregnancy,
alcoholism, drug use and even common viral infections could cause false
positives on HIV tests.
She contended that people were at risk of AIDS because of factors that
lowered the immune system, including malnutrition, drug use, chronic
anxiety and lack of sleep.
Maggiore believed that AZT was both ineffective at preventing AIDS and
toxic to healthy cells. She refused to take anti-retroviral drugs.
For pregnant HIV-positive women who didn't want to take the drugs, she
recommended alternatives such as homeopathic medicine, vitamins, herbs,
acupuncture, mental "imagery" to boost the immune system and
"cleansings" of the body's toxins through such methods as "colon
hydrotherapy" and juice fasts.
Maggiore breast-fed both her children, despite the accepted view that it increased the risk of spreading HIV.
In 2005 her daughter, Eliza Jane Scovill, died at age 3. The girl never
had an HIV test. The county coroner's office concluded she died of
pneumonia related to an advanced case of AIDS. Police reviewed the
death to determine if negligence or child endangerment was involved.
The county district attorney's office in 2006 declined to file criminal
charges, noting that the girl's parents had taken her to several
doctors.
Maggiore retained a toxicologist who served on her group's advisory
board to review the autopsy results. He concluded the girl died as a
result of an allergic reaction to an antibiotic.
Maggiore sued the county last year, contending that the conclusion of
the autopsy lacked proper medical and scientific evidence. The case is
pending.
Maggiore's death was an "unmitigated tragedy," said Jay Gordon, a
pediatrician consulted by Maggiore and her husband when her daughter
was sick.
"There are medications that enable people who are HIV-positive to lead
healthy, normal, long lives," said Gordon, who believes HIV causes AIDS.
In addition to her husband, Maggiore is survived by a son, Charles. Both have tested negative for HIV.
By The Associated Press, http://www.mercurynews.com
|
Catholic Leader Claims Pope's Homophobic Outburst "misrepresented"
December 30, 2008
Cardinal Murphy-O'Connor said that the pope "wasn't condeming
anyone or any person" with his comments
Cardinal Cormac Murphy-O'Connor, head of the Catholic Church in England
and Wales and Archbishop of Westminster, has defended Pope Benedict
XVI's controversial comments about gay people.
The pope said at his end of year address to the Curia that the
existence of gay people threatens humanity as much as the destruction
of the rainforests does, and that "blurring" genders through acceptance
of transgender people would kill off the human race.
During an interview on this morning on Radio 4's Today programme,
Cardinal Murphy-O'Connor said that the pope "wasn't condeming anyone or
any person" with his comments.
The cardinal went on to say that the pope was only trying to emphasise
the importance of the family, and the responsibility on humans to
procreate.
He also said that Pope Benedict's comments were "quite difficult to
interpret" and as a result of this that he had been "very much"
misrepresented in the media.
The Pope said behaviour beyond traditional heterosexual relations is "a destruction of God's work."
He also said man must be protected "from the destruction of himself"
and urged respect for the "nature of the human being as man and woman."
"The tropical forests do deserve our protection. But man, as a creature, does not deserve any less."
The comments caused outrage within the gay community.
London Gay Christian Movement chief executive Rev Sharon Ferguson said:
"There are still so many instances of people being killed around the
world, including in western society, purely and simply because of their
sexual orientation or their gender identity.
"When you have religious leaders like that making that sort of
statement then followers feel they are justified in behaving in an
aggressive and violent way because they feel that they are doing God's
work in ridding the world of these people."
The UK based gay humanist charity the Pink Triangle Trust has described the Pope's statement as clear evidence of paranoia.
"This must be the most ourtrageous and bizarre claim yet made by the
Pope who has already got a well-deserved reputation as one the most
viciously homophobic world leaders on a par with Mahmoud Ahmadinejad of
Iran and Robert Mugabe of Zimbabwe," said PTT secretary and trustee
George Broadhead.
"The Vatican has already reinforced its anti-gay reputation by strongly
opposing a UN declaration calling for an end to discrimination against
gays, but this latest Papal outburst is clear evidence of an obsession
about homosexuality which is tantamount to paranoia."
Gay equality activist Peter Tatchell wrote on PinkNews.co.uk:
"The suggestion that gay people are a threat to human survival is
absurd and dangerous. It is poisonous propaganda that will give comfort
and succour to queer-bashers everywhere."
By Rachel Charman, http://www.pinknews.co.uk
|
Leaving Platform That Elevated AIDS Fight
December 30, 2008
Fred Merz for the New York Times
RAISING THE ALARM Dr. Peter Piot, the director of the United Nations AIDS program for all of its 13 years, is retiring.
Dr. Peter Piot, the only head of the United Nations AIDS program in its 13-year history, is retiring on Wednesday. He is
credited as the person most responsible for making heads of state
understand the political, economic and social ramifications of a
pandemic that rivals the worst in history.
Although the toll
of infected people and deaths grew during his tenure, Dr. Piot, 59,
said in an interview that he had achieved a number of successes. He
attributed them to basing policy recommendations on scientific evidence.
He said his program had raised global public concern about AIDS; vastly
increased the money spent to try to blunt the pandemic; lowered the
price of life-extending antiretroviral drugs for millions of infected
people in poor countries; and gave a voice to socially marginalized
groups like gay men and injecting drug users, who are at great risk for
AIDS yet had virtually no say in poor countries.
Dr. Piot (pronounced PEA-ott) recalled that when he became executive
director in 1996, about $250 million was spent that year in developing
countries on the disease.
“Trying to fix a global epidemic with that kind of money is impossible, but that is what we were expected to do,” he said.
The current figure is about $10 billion, and Dr. Piot said that “if we
had the kind of money that we have today 10 years ago, we would have
never had an epidemic so out of control.”
Dr. Piot’s program was born in part out of widespread frustration with a lack of coordination among United Nations agencies concerned with AIDS — particularly the World Health Organization,
which was responsible for monitoring the disease’s global reach. In the
early to mid-1990s, the health organization’s leadership was widely
criticized for a seeming inability to cope with a pandemic of the
dimensions and social complexities of AIDS.
So member
governments created a program to coordinate the United Nations’ role in
defeating AIDS. The program now has 10 co-sponsors, all of them part of
the United Nations system.
Dr. Piot, who helped discover the Ebola virus and was one of the first
scientists to study AIDS, was named executive director by Boutros Boutros-Ghali, then the United Nations secretary general.
“When we started, AIDS was definitely not on the world’s political
agenda, and now it is,” said Dr. Piot, speaking by telephone while
participating in AIDS meetings in Africa, where the disease has taken
its greatest toll.
Dr. Piot helped the United Nations characterize AIDS as a global security issue and make the disease the focus of the General Assembly’s first session ever devoted to any health issue. And he helped add AIDS to the agendas of world economic forums.
As executive director, he said, he soon came to realize that scientists
alone could not defeat AIDS. Success would also require strong
political support from government leaders and civic groups.
The United Nations offered him a rare platform and access to the
world’s top leaders. He traveled the world — 23 countries in 2008
alone, and countless more over his tenure. Through moral suasion, his
scientific expertise and his experience as a student political activist
in his native Belgium, he was able to sway the views of many heads of
state.
His position requires a palette of skills, he said. The director needs
sound scientific knowledge of the viral disease and its sociological
ramifications; appreciation of the economic and political realities of
rich and poor countries; and the diplomatic skills to talk to a pope,
pharmaceutical industry executives and AIDS activists, among many
others.
Dr. Piot said he was confident that his deputy and successor, Michel
Sidibé of Mali, had the skills to keep AIDS a top global health issue.
Critics contend that the United Nations should not have created a
separate program devoted to a single disease, even a pandemic, because
a narrow focus can diminish the attention to other health problems.
Dr. Piot replies that without his program’s efforts, millions more
people would have died. While a separate agency may not seem the most
rational approach, he said, “it works, and that is what matters.” He
added that “well-focused organizations have much greater impact than
those with broader mandates.”
AIDS has highlighted the difficulty of delivering antiretroviral drugs
to patients in poor countries, thereby focusing world attention on the
underlying cause: a lack of effective health care infrastructures.
That understanding has had an unexpected benefit, Dr. Piot said:
“attracting more money to strengthen these health systems.” Indeed, in
many cases AIDS financing has been the only investment those systems
have received.
A turning point in the direction of the United Nations AIDS program
took place in Dr. Piot’s first year as executive director: the
marketing of powerful drug combinations that can allow many people with
H.I.V. to live near-normal lives.
The drugs, too expensive even for many patients in rich countries, were
far beyond the reach of the tens of millions of infected people in the
developing world.
At first, Dr. Piot said, “the development agencies and the traditional
public health communities were dead set against making access to
treatment available in poor countries.”
Although he was skeptical at first about negotiating with industry to
lower the drugs’ cost in poor countries, he encouraged more optimistic
staff members to try it anyway, “because no one else was doing it.”
Negotiating lower prices was “largely Unaids’s work until the Clinton
Foundation came in and shaved off the last bits to further lower the
costs,” Dr. Piot said.
Dr. Piot has endured criticism, including for having published inflated
estimates of the number of people infected with H.I.V. in the early
years.
“We were wrong; we overestimated the potential of the epidemic in Asia,
particularly in India,” he replied. “But we underestimated in several
African countries, and we definitely underestimated in Eastern Europe,
where we had not seen that epidemics were building up in Russia and
Ukraine.”
But he denied as “absurd” the accusation from some critics who
contended that he deliberately inflated the figures to raise the
profile of AIDS. “We have review panels, which include top
epidemiologists from the world’s top academic and research and public
health institutions,” he said. “Every estimate involves hundreds of
people, and any of them would have denounced efforts to distort the
figures.”
Current estimates are that 33 million people are living with H.I.V. and
20 million have died since the disease was first recognized in the
United States in 1981.
Working with political leaders was a constant challenge, Dr. Piot said.
Because member states run the United Nations, criticizing any of them
can be ticklish, if not impossible.
As H.I.V. ravaged South Africa, Thabo Mbeki,
its president for much of Dr. Piot’s tenure, virtually denied that the
virus caused AIDS. Dr. Piot could not convince him otherwise.
Similarly, Dr. Piot said he wished he could have persuaded Russia to
permit methadone substitution therapy for injecting drug users, who are
fueling a growing AIDS epidemic. “Are these mistakes?” he said. “Well,
they certainly are failures, let us put it that way, in the sense that
I have not been able to convince the leadership there to go for a
scientific approach.”
On the other hand, he went on, in China “the top leadership did change
completely their policy on injecting drug use, and that was in 2005.”
In an ideal world, Dr. Piot said, he would have leaders create large
nationwide and worldwide campaigns to prevent AIDS. That effort would
require sustaining AIDS awareness; using marketing efforts to promote condom use; creating incentives for people to be tested for H.I.V.; organizing circumcision clinics for males in some countries; and encouraging scientists to work
more closely and share data in the effort to develop an H.I.V. vaccine.
|
 |
 |
|
| |
Yiorgos Karahalis/Reuters
GLOBAL MISSION An artwork depicting AIDS awareness ribbons in 2005 in the Athens subway. |
“It is not the ‘what’ that is lacking in preventing AIDS,” he said. “It is the ‘how to organize it’ that is key.”
In May, Dr. Piot will move to Imperial College London to create an
institute of global health. An aim is to nurture a younger generation
of students to apply the lessons of the AIDS battle to other diseases,
including chronic and noninfectious ones like heart disease, which are
not well studied in the developing countries. Despite the financial
difficulties of starting a new program at this time, he said, “there is
so much interest in global health that I am quite optimistic.”
By Lawrence K Altman, MD, http://www.nytimes.com
|
Iran Asked to Free AIDS Doctors Held for Six Months on Illegitimate Charges
December 22, 2008
Cambridge, MA -- On the sixth-month anniversary of Iran's detention of
Dr. Arash Alaei and Dr. Kamiar Alaei -- Iranian brothers who are known
worldwide as HIV/AIDS physicians -- international NGOs, academic
institutions, and medical leaders from across the globe are asking Iran
to free them immediately.
The doctors have been held in Tehran's notorious Evin prison since late
June 2008. They were indicted this month on charges of communicating
with an "enemy government" according to their attorney, Masoud Shafie.
Iran should drop these illegitimate and politically motivated charges,
the groups and leaders said.
In an exclusive interview with the International Campaign for Human
Rights in Iran, Shafie said that the brothers have been indicted under
article 508 of the Islamic Penal Code, which states that anyone found
guilty of communicating with an "enemy government" shall be sentenced
one-to-ten years in prison.
Bringing this charge against the Alaeis is likely to have a chilling
effect on the Iranian medical community's ability to share their work
and learn from global experts, which could undermine the health of the
Iranian people.
The brothers have already been detained two months longer than Iranian
penal code allows. According to Shafie, Articles 30-34 of the Code of
Penal Procedure of the Islamic Republic of Iran allow for detentions
but require that the investigating judge issue such detention orders
for one month at a time and for no longer than four months.
The brothers are also legally eligible for bail, but the judge in the case has not issued bail nor held a bail hearing.
Over 3,100 people from more than 85 countries have signed an online petition demanding their release, which can be viewed at IranFreeTheDocs.org.
Several of the world's most accomplished HIV/AIDS and health experts --
including the Global Fund executive director, Professor Michel
Kazatchkine; the Partners in Health co-founder, Dr. Paul Farmer; Wafaa
El-Sadr, MD, 2008 MacArthur Foundation Fellow MPH; Hossam E. Fadel, MD,
of the Islamic Medical Association of North America; a 1993 Nobel
laureate in medicine, Sir Richard Roberts PhD, FRS; and the Ugandan
AIDS pioneer Dr. Peter Mugyenyi, have signed a letter urging the Alaei
brothers' release.
Dr. Kamiar Alaei is a doctoral candidate at the SUNY Albany School of
Public Health in Albany, New York and was expected to resume his
studies there this fall. In 2007, he received a master of science
degree in Population and International Health from the Harvard School
of Public Health in Boston.
Dr. Arash Alaei is the former director of the International Education
and Research Cooperation of the Iranian National Research Institute of
Tuberculosis and Lung Disease. Since 1998, the Drs. Alaei have been
carrying out HIV/AIDS treatment and prevention programs, particularly
focused on harm reduction for injecting drug users.
In addition to their work in Iran, the Alaei brothers have held
training courses for Afghan and Tajik medical workers and have worked
to encourage regional cooperation among 12 Middle Eastern and Central
Asian countries. Their efforts expanded the expertise of doctors in the
region, advanced the progress of medical science, and earned Iran
recognition as a model of best practice by the World Health
Organization.
http://www.thebody.com
|
Doctor sees ripples of hope in the gene pool
Canadian's research, training and philanthropic efforts have helped
doctors around the world map the genetic causes of grave illnesses
December 22, 2008
When Michael Hayden was named Canada's "researcher of the year" by the
Canadian Institutes for Health Research last month, it was hardly a
surprise.
He is, after all, one of the world's most renowned geneticists, having
identified the genes responsible for a number of disorders - including
Huntington's disease, amyotrophic lateral sclerosis (ALS or Lou
Gehrig's disease), Type 2 diabetes and pain - and the founder of three
successful biotechnology companies.
But it is what Dr. Hayden, director of the Centre for Molecular
Medicine and Therapeutics at the University of British Columbia, did
with the $500,000 prize money that surprised and inspired his
colleagues: He donated the entirety to a charity that will train
aspiring doctors and researchers, particularly those from Africa.
"At first, I wasn't aware money came with the prize," Dr. Hayden said
in an interview. "But when I found out there was half a million
dollars, I decided that I have to be a curator, I have to use this to
honour the opportunities that have been given to me and help provide
opportunities to others."
Using the prize as seed money (and having raised almost $3-million more
in the past six weeks), he has created a foundation called Ripples of
Hope.
The foundation will bring trainees to Canada to study in four areas:
global health (HIV-AIDS and tuberculosis in particular), mental health,
rare diseases and biotechnology and entrepreneurship.
"Each of these awards reflects an aspect of my past and encompasses the future," Dr. Hayden said.
Dr. Hayden was born and raised in apartheid-era South Africa. His
parents were divorced and he lived, in modest circumstances, with his
mother, though his father paid for his private-school education. "I was
the only kid in my school whose family didn't have servants, or a car,"
he said.
On June 6, 1966, he skipped school, jumped on his mother's Vespa
scooter and headed to the University of Cape Town. The then-15-year-old
waded into the crowd and listened to a speech by U.S. senator Robert
Kennedy, in which he said: "Each time a man stands up for an ideal, or
acts to improve the lot of others, or strikes out against injustice,
they send forth a tiny ripple of hope, and crossing each other from a
million different centres of energy and daring those ripples build a
current which can sweep down the mightiest walls of oppression and
resistance."
The words, Dr. Hayden said, remained with him his whole life and served as an inspiration for the Ripples of Hope Foundation.
After graduating at the top of his class in medical school at the
University of Cape Town, Dr. Hayden began working as a clinician. His
mentor ran a health clinic for "coloreds" - the term used to describe
those of mixed race in the apartheid era - and one of his patients had
Huntington's, a devastating neurological disorder that causes a mixture
of physical, developmental and mental health problems. At the time, it
was believed that Huntington's was unique to Europeans, but Dr. Hayden
undertook a research project in which he scoured psychiatric
institutions in South Africa and discovered numerous Huntington's
patients. It would be the beginning of a lifelong quest to unravel the
mysteries of the disease.
His work attracted the attention of Marjorie Mazia, the wife of
folk-singing legend Woody Guthrie, who died of Huntington's in 1967. It
also led to a research job at Harvard University.
But in February of 1983, Dr. Hayden visited UBC, which was aggressively
courting young faculty. The visit was marked by five glorious days of
sunshine (only later would he learn that it actually rains in
Vancouver) that were reminiscent of his native South Africa.
But even more impressive, he said, was the "glorious welcome" he
received from researchers at the university, as well as patients with
the disease and their family members.
"There was this spirit of camaraderie and openness that was
remarkable," Dr. Hayden said. He was sold immediately on UBC and has
been there for 25 years, despite lucrative job offers from around the
world.
Alain Beaudet, president of the CIHR, the principal financier of health
research, said Canada is blessed to have a researcher of Dr. Hayden's
stature.
In addition to his scientific discoveries, he said one of Dr. Hayden's
notable achievements is his reaching out to younger researchers. He has
trained close to 100 researchers from 30 countries and that pace will
accelerate with the new foundation. He is also known for his
philanthropic work, including the construction of a community centre
for children and youth with HIV-AIDS in Cape Town.
Dr. Hayden said: "I have been blessed as an immigrant to be able to
live and work in this great country, and I want to give back." He
points, for example, to the Canadian Genetic Disease Network, a
cross-country collaborative effort that was able to "discover more
genes than any other organization in the history of the world."
Dr. Hayden said he sees this kind of success time and time again in Canadian science, and it never ceases to inspire him.
"Our colleagues around the world are amazed that this is possible.
Elsewhere, people cannot subsume their individual goals for the greater
good, but it happens routinely in Canada."
It is in that spirit, Dr. Hayden said, that he created the new
foundation and the awards for trainees, the first of which will be
handed out in early 2009.
"Every day in Canadian science is a lesson in nation-building," he said. "It's a lesson we need to share with the world."
By Andre Picard, The Globe and Mail
|
Starting HIV treatment doesn't increase neuropathy rate in Thai study
December 19, 2008
A small Thai study has found identical rates of neuropathy between
patients taking HIV treatment and those yet to start antiretroviral
therapy. The study is published in the December 1st edition of the Journal of Acquired Immune Deficiency Syndromes.
Most of the patients being treated with antiretroviral drugs were taking d4T (stavudine, Zerit), making this finding surprising.
There are two major causes of neuropathy in patients with HIV. The
first is a weak immune system and it is estimated that 30% of
HIV-positive individuals will develop neuropathy unless they receive
treatment with antiretroviral drugs. However, neuropathy can also be a
side-effect of some nucleoside reverse transcriptase inhibitors
(NRTIs), most notably d4T, a drug that is widely used in
resource-limited settings. Previous research in Thailand suggested that
7% of patients taking a d4T-containing regimen developed neuropathy
within two years of starting HIV treatment.
To gain a better understanding of the prevalence and risk factors of
neuropathy, investigators from the Phramongkutkloa Medical Centre in
Bangkok designed a cross-sectional study involving 100 HIV-positive
patients, 63 of whom were taking HIV treatment. Recruitment took place
between January and July 2006.
Information was obtained from their medical records about the presence
of other illnesses, history of AIDS-defining illnesses, use of
antiretroviral drugs, CD4 cell counts and viral load.
A number of tests were conducted to see if patients had sensory
impairment associated with neuropathy and neuropathy-associated
symptoms such as numbness and pain.
Median CD4 cell count was 132 cells/mm3 and 37% of patients had been diagnosed with an AIDS-defining illness, the most common being tuberculosis (19%).
Of the 63 patients taking antiretroviral therapy, 61 were taking a d4T-containing regime.
Unsurprisingly, patients taking antiretroviral therapy had a higher CD4 cell count (213 cells/mm3 vs. 44 cells/mm3, p < 0.01) than treatment-naive patients, and a higher body mass index (21 vs 19.7, p = 0.04).
Symptoms suggestive of neuropathy were present in an identical
proportion of treatment-experienced and treatment-naive patients (35%).
However, none of the treatment-naive patients reported neuropathic pain
but this symptom was reported by seven of the patients taking anti-HIV
drugs.
Further more, a similar proportion of patients taking HIV treatment
(28%) and treatment-naive patients (32%) had possible sensory
impairment associated with neuropathy. When the investigators used the
strictest-possible definition of sensory impairment they once again
found that a similar proportion of treatment-experienced and
treatment-naive patients had this condition (9.5% vs 10.6%).
A lower CD4 cell count was associated with an increased risk of neuropathy overall.
“It is interesting to note a lack of divergence in probably
HIV-associated sensory neuropathy rates by antiretroviral status,”
write the investigators. They add, “this finding is unexpected
considering the high frequency of dNRTI use (94%), a factor expected to
increase rates of antiretroviral toxic neuropathy.”
The investigators hypothesise that in their cohort “the tendency for
dNRTI to induce neuropathy may have been outweighed by the favorable
effects of immunologic benefit with potent antiretroviral therapy,
particularly because our cohort had severe immunosuppression.”
An association between a low CD4 cell count and a higher risk of
neuropathy in antiretroviral-treated patients has also been found in
other research. The investigators therefore suggest “immunologic
parameters continue to be important as a risk factor for HIV sensory
neuropathy after use of potent antiretroviral medications.”
They conclude by calling for more research to determine rates of neuropathy after the initiation of antiretroviral regimens.
Reference
Sithinamsuwan, P. et al. Frequency and characteristics of HIV-associated sensory neuropathy among HIV patients in Bangkok, Thailand. J Acquir Immune Defic Syndr 49: 456-58, 2008.
By Michael Carter, www.aidsmap.com
|
CD4 cell counts may not be accurate marker of treatment failure for resource-poor HIV care
December 23, 2008
Clinicians treating people with HIV in
resource-limited settings should be cautious when making treatment
switches based solely on CD4 cell counts, say a group of researchers
including International AIDS Society president, Julio Montaner. Writing
in the December 15th issue of the Journal of Acquired Immune Deficiency Syndromes,
the team reports that the practice, recommended in large parts of the
world where viral load testing is not available, may not accurately
identify treatment failure, leading clinicians to delay switching from
a failing regimen or causing them to switch away from a still effective
regimen.
Antiretroviral therapy suppresses viral replication
in people living with HIV, slowing disease progression and maintaining
health. In resource-rich settings, the effectiveness of antiretroviral
therapy is monitored by viral load tests, which measure the level of
HIV in the blood. WHO guidelines suggest that when viral load tests are
not available, CD4 cell counts should be used to evaluate whether or
not antiretroviral therapy is effectively suppressing viral
replication. This is common in many resource-limited parts of the world
where HIV is prevalent.
Antiretroviral regimens are changed if monitoring reveals that the
virus is not suppressed. With viral load tests, a detectable viral load
is taken as a sign of treatment failure. In the absence of viral load
tests, the WHO guidelines recommend that a person change their drug
regimen if either their CD4 cell count returns to levels seen before
starting antiretrovirals or their CD4 cell count falls to less than 50%
of its peak value.
There is limited clinical evidence in resource-limited settings that
CD4 cell counts are accurate indicators of viral suppression on
treatment. To address this question, a team of US and Canadian
researchers undertook an analysis of the relationship between
immunologic and virologic markers among a group of people initiating
treatment in the African country of Uganda.
The Home-Based AIDS Care Project, based in eastern Uganda, is studying
the impact of different monitoring strategies on disease progression.
In this analysis, participants with a CD4 cell count below 250 cells/mm3 or signs of advanced disease were offered the fixed regimen of 3TC
(lamivudine), d4T (stavudine) and nevirapine. Blood samples were
collected every three months and tests performed to determine viral
load and CD4 cell counts.
Using time points up to 24 months,
investigators grouped data according to whether viral load was
detectable or not (using a range of cut offs: 50, 500, 1000, 5000
copies/ml) and then compared three factors between the two groups:
absolute CD4 cell count; median change in CD4 cell count from baseline;
and percentage showing no change or a decline in CD4 cell counts.
The proportion of participants failing at each time with each
definition varied between 1.5% and 16.4%. For each time point, the
absolute CD4 cell count and change in CD4 cell count was lower in
patients with a detectable viral load, and differences were larger when
a more stringent definition of undetectable was used. However, not all
differences were statistically significant, indicating that some of the
time CD4 cell counts do not distinguish between successful and
unsuccessful treatment.
To better quantify the ability of CD4 cell counts to detect treatment
failure accurately, investigators calculated the sensitivity and
positive predictive value of several possible CD4 cell count measures.
Sensitivity is the proportion of people with a condition who are
identified by the test, while the positive predictive value is the
proportion of people with a positive test who actually have the
condition.
For a definition of treatment failure similar to that in the WHO
guidelines, that is: “no increase in CD4 cell count or an at least 50%
drop in CD4 cell count at twelve months”, the calculated sensitivity
was 0.08, meaning only eight of 100 people failing treatment would
actually be identified. The investigators point out that not
identifying all people failing treatment could increase the risk of
disease progression and drug resistance within a population.
The positive predictive value for this definition was 0.11, meaning of
100 people identified as failing treatment according to CD4 cell
counts, only eleven would actually be failing and 89 would have
suppressed virus. “If the current WHO guidelines were applied to these
patients,” the investigators write, “they would have been mistakenly
identified as failing ART and prematurely switched from their primary
antiretroviral regimen which was effectively controlling viral
replication.”
The investigators acknowledge that the value of their analyses is
limited by the small number of participants with treatment failure in
their study (between 2% and 16%) and may underestimate the predictive
power of CD4 cell counts. In defence, they point to other data that
support their finding, and say that even in a scenario where 30% of
people were failing treatment, the positive predictive value would be
only 0.64.
While CD4 cell counts may not be an accurate marker of treatment
failure, the investigators remark that both CD4 counts and viral load
are independently associated with disease progression. CD4 cell counts,
they propose, have other benefits in monitoring patient health,
including the need for prophylaxis against opportunistic infections.
Also, “CD4 counts could be used as a screening test to identify those
persons who require VL testing, potentially reducing the demand for
viral load testing in situations where it is available,” they propose.
In a strongly worded conclusion the investigators say, “immunologic
parameters do not seem to accurately identify individuals receiving
antiretrovirals with unsuppressed viral loads or virologic failure.
Guidelines for monitoring individuals on antiretroviral therapy in
resource-limited settings should be adapted to recognize this
limitation.” They caution, “In the interim, clinicians should be
cautious in initiating therapy changes based solely on CD4 cell count
criteria.”
Reference
Moore DM et al. CD4+
T-cell count monitoring does not accurately identify HIV-infected
adults with virologic failure receiving antiretroviral therapy. J Acquir Immune Defic Syndr 49: 477 – 484, 2008.
By David McLay, www.aidsmap.com
|
Thiamine 'reverses kidney damage'
December 29, 2008
Diabetes UK advised against seeking vitamin supplements at this stage
|
Doses of vitamin B1 (thiamine) can reverse early kidney disease in people with type 2 diabetes, research shows.
The team from Warwick University tested the effect of vitamin B1,
which is found in meat, yeast and grain, on 40 patients from Pakistan.
The treatment stopped the loss of a key protein in the urine, the journal Diabetologia reports.
Charity Diabetes UK called the results "very promising" - but said it was too early for any firm conclusions.
The latest findings build on earlier work by the Warwick University
team, showing that many diabetes patients have a deficiency of
thiamine.
According to the researchers, this cheap and readily available
supplement could benefit most people with diabetes - both type 1 and
type 2 - as between 70% and 90% of people with diabetes are thiamine
deficient.
In diabetes the small blood vessels in the body can become damaged.
When the blood vessels that supply blood to the kidneys are
involved, the kidneys stop working correctly and important proteins,
such as albumin, are lost from the blood into the urine.
A third of the patients in the study saw a return to normal urinary
albumin excretion after being treated with high dose (300mg) thiamine
taken orally each day for three months.
The experts say thiamine works by helping protect cells against the
harmful effects of the high blood sugar levels found in diabetes.
Lead researcher Professor Paul Thornalley said: "This is the first
study of its kind and suggests that correcting thiamine deficiency in
people with diabetes with thiamine supplements may provide improved
therapy for early-stage kidney disease."
They plan more work to confirm their findings.
Dr Iain Frame of Diabetes UK said: "Diabetes UK hopes a large
clinical trial will be possible as results so far are very promising.
"However, we would like to stress that it's still too early to come
to any firm conclusions about the role of vitamin B1 and we would not
advise that people look to vitamin supplements to reduce their risk of
kidney complications at this stage."
A person should be able to get all the thiamine they need from a normal healthy diet.
http://news.bbc.co.uk
|
Study finds smaller CD4 response to successful antiretroviral therapy following treatment interruptions
December 29, 2008
HIV-positive people who stop taking
antiretroviral therapy and then start again are likely to see smaller
CD4 cell count increases than they did when they first went on
antiretrovirals, according to a study in the December 15th edition of the Journal of Acquired Immune Deficiency Syndromes.
The poorest immunological responses were seen in study participants who
were older and whose CD4 counts were lower during treatment
interruption.
The observational study used data from CASCADE,
a large European research network that is monitoring the health of more
than 17,000 HIV-positive individuals. Investigators identified a cohort
of 216 CASCADE participants who had stopped taking antiretroviral
regimens after an initial treatment period of at least 90 days, then
started again after a break of at least 14 days.
The most striking finding was that when people resumed antiretroviral
therapy, CD4 cell counts initially increased about as much as they had
during the first treatment period, but then increased at a slower rate
after three months. In other words, there were smaller long-term CD4
cell count gains following treatment interruption.
The median duration of treatment interruption was 6.2 months, and CD4
cell counts were available for a median (IQR) of 19.4 (8.5-37.8) months
following treatment resumption.
When investigators compared the rate of CD4 increase per month in the
first treatment period to the rate in the second, they found the
equivalent of median increases of 106 (88 to 123) cells/mm3 at the three-month mark during the first treatment period versus 99 (74 to 119) cells/mm3 at the same point after treatment resumption; then, respectively, 119 (101 to 137) versus 107 (88 to 127) cells/mm3 at six months; 145 (126 to 165) versus 125 (105 to 144) cells/mm3 at twelve months; 200 (170 to 230) versus 160 (135 to 185) cells/mm3 at 24 months; and 258 (213 to 302) versus 197 (162 to 231) cells/mm3 at 36 months (all 95% confidence interval [CI]).
Investigators also looked at rates of CD4 increase following treatment
interruption in relation to CD4 cell count levels during treatment
interruption. They found that only people who had CD4 cell count
measures of more than 500 cells/mm3 during treatment interruption could be expected to attain nearly normal CD4 cell count levels within three years.
People older than 40 had smaller CD4 increases during their first three
months back on antiretroviral therapy, as did people who returned to
the same antiretroviral regimens.
Virologic responses during the two treatment periods were comparable,
with viral loads dropping to less than 500 copies/ml for 82% of people
newly initiating antiretroviral therapy and for 87% of people resuming
antiretroviral therapy after treatment interruption. During the first
treatment period, a median time of 13.6 (11.9 to 16.2) weeks was
required for the viral load to go below 500 copies/ml, and during the
second treatment period, a median time of 12 (11 to 15) weeks was
required.
The researchers attribute the initial steep climb in CD4 cell counts
after resumption of antiretroviral therapy to the release of CD4 cells
that were sequestered in the lymph nodes when viral load was high. The
same mechanism accounts for large early increases in CD4 cell counts
when people first begin antiretroviral therapy. It takes longer for new
CD4 cells be formed, and thus a slower rate of increase can be expected
after three months.
However, the researchers note, “The underlying biological mechanism for
the observed differences in these subsequent rates of CD4 increase
during [treatment resumption] … is mostly unknown.” They do not believe
that previously undetected viral resistance from the first treatment
period could account for their outcomes because even people who had
sustained virologic responses to both rounds of treatment saw poorer
CD4 responses after treatment interruption.
Many researchers began to investigate the effects of planned treatment
interruptions, also known as structured treatment interruptions, after
a 1999 case study raised the possibility that people might continue to
see the benefits of antiretroviral therapy while taking time off from
the medicines. However, large clinical studies of various treatment
interruption strategies have not only failed to confirm their efficacy
but also raised safety concerns.
While it seems unlikely that planned treatment interruptions will ever
be medically advisable, the complexity and toxicity of antiretroviral
regimens lead many HIV-positive people to discontinue treatment. The
authors of the CASCADE treatment interruption study advise careful
clinical monitoring of treatment interruptions in people who are above
age 40 and have had low CD4 cell count levels in the past.
Reference
Touloumi G et al. Rates
and determinants of virologic and immunological response to HAART
resumption after treatment interruption in HIV-1 clinical practice. J Acquir Immune Defic Syndr 49: 492 – 498, 2008.
By Kelly Safreed-Harmon, www.aidsmap.com
|
Ring, Ring: Cell Phones That Test for HIV?
December 23, 2008
Scientists from the University of California in Los Angeles converted
an ordinary mobile phone into an inexpensive portable blood analyzer
that can detect diseases such as HIV and malaria, reports Science Daily. The device could possibly save lives in poorer countries that can’t afford expensive testing equipment.
Aydogan Ozcan, PhD, MS, BS, a UCLA researcher, developed the software
that allows blood samples to be analyzed with off-the-shelf camera
sensors and a filtered light source. The key is the software’s ability
to analyze thousands of blood cells at once, providing accurate results
in minutes.
“This technology will not only have great impact in health care
applications, it also has the potential to replace cytometers in
research labs at a fraction of the cost,” said Ozcan.
Blood analysis usually involves large and expensive machinery or a
trained technician to manually examine the material. Neither necessity
is accessible to remote areas in Africa or other Third World countries.
http://www.poz.com
|
Looking Back, Moving Forward: The Year in Treatment News
A
new non-nuke, the apparent cure of an HIV-positive patient receiving a
bone marrow transplant and the possibility of earlier antiretroviral
treatment for all make the top 10 list of treatment research
developments for 2008.
December 30, 2008
A new
non-nuke, the apparent cure of an HIV-positive patient receiving a bone
marrow transplant and the possibility of earlier antiretroviral
treatment for all make the top 10 list of treatment research
developments for 2008.
Now more than 25 years since the 1983 discovery of HIV as the cause of
AIDS, research continues at a steady clip in pursuit of sound
prevention strategies, better treatments and—with a little bit of
luck—a cure. While 2008 wasn’t exactly a year of earth-shattering
discoveries, there were advances, setbacks and a few telltale hints of
interesting things to come in 2009.
What follows is a review—including updated insight from some leading
HIV activists— of the top 10 treatment research developments that made
us sit up straight in 2008. Have additional news items to add to the
list? New observations or experiences of your own to share? Let us know
by posting a comment at the end of this article.
New Numbers
After months of speculation, the U.S. Centers for Disease Control and Prevention (CDC) released new data in early August confirming thousands more annual HIV cases than was
previously believed. The numbers—56,300 new HIV infections in 2006,
compared with the 40,000 estimate—sent prevention and treatment
activists scurrying for answers and solutions to the
instantly-ballooned U.S. epidemic.
The CDC was quick to point
out that the number of new infections has remained fairly stable during
the past decade, albeit many more than was originally thought.
Activists, however, still had difficulty stomaching the new estimate.
“The incidence figures, labeled by the CDC as evidence of a ‘stable’
epidemic, actually reveal an unabated rise in the number of new
infections among gay men, particularly young gay men of color,”
explains Julie Davids, senior consultant of the prevention-focused
Community HIV/AIDS Mobilization Project (CHAMP) in New York and
Providence.
“It’s clear that we need a national AIDS strategy that spans treatment and prevention, and that specifically addresses
the urgent need for prevention innovation,” Davids adds. “This must
include an investment in research as well as measures that challenge
and change the root causes of HIV—such as homophobia and mass
imprisonment—that fuel marginalization.”
When to Start
“From colds to cancer, it is almost always better to treat a disease
earlier rather than later; HIV is no exception,” says Washington,
DC-based biomedical journalist Bob Roehr, referring to three recent
studies indicating that antiretroviral (ARV) therapy should be started
sooner than later. A 2,000-patient Spanish study, the 1,400-patient FIRST trial and the U.S. and Canadian NA-ACCORD study,
all reported in 2008, suggest HIV-positive people initiating ARV
treatment with CD4s above 350 face a reduced risk of AIDS- and
non-AIDS-related health problems and deaths compared with those
starting with CD4s below 350—the current green light for commencing
therapy.
Arguments against early therapy, many contend, are
also losing ground. “The hang-up with HIV has been side effects,
including nausea, lipodystrophy and damage to cell mitochondria,” Roehr
says. “New treatments are more powerful at suppressing the virus and
have fewer side effects, so it is no surprise that the trend is to
starting treatment earlier.”
While many experts agree that it’s only a matter of time before the
official Department of Health and Human Services (DHHS) HIV treatment
guidelines are amended to promote early treatment, Roehr argues that
individualized care—based on a patient’s specific risk factors, needs
and limitations—must take precedence over cookie-cutter approaches to
care. “Treatment HIV is not a static formula,” he says. “It remains a
medical art; it is a dance between doctor and patient where a good
partnership is crucial.”
Introducing Intelence
The year began with excellent news when the FDA approved Tibotec’s twice-daily Intelence (etravirine). Not only was it the first
new non-nucleoside reverse transcriptase inhibitor (NNRTI) in 10 years,
but studies also confirmed its effectiveness for HIV-positive patients with resistance to
first-generation NNRTIs, such as Viramune (nevirapine) and Sustiva
(efavirenz). Study results also emerged suggesting that Intelence may be potent enough, used once a day, for those starting treatment for the first time.
“Intelence comes with the baggage of hope,” says Bob Huff, editorial
and antiretroviral project director of the New York-based Treatment
Action Group. “Intelence made its mark by helping people with long and
troubled treatment histories achieve viral suppression for perhaps the
first time in their lives.”
The arrival of Intelence has also opened up promising possibilities.
One potential option to explore in future studies, explains Huff, is
using nucleoside analogue-sparing regimens for first-line therapy,
“perhaps combining Intelence with unboosted Reyataz for a clean and
durable twice-daily combination.”
“For all the promise,” Huff adds, “Intelence is still young and
relatively fragile when it comes to combating resistance. In 2009,
results from dozens of studies examining the drug’s potential will
begin to reveal whether these hopes are more than wishes.”
Epzicom Woes
It was a frustrating year for Epzicom, GlaxoSmithKline’s two-in-one
tablet containing the nucleoside reverse transcriptase inhibitors
abacavir and lamivudine. The D:A:D study and SMART trial linked abacavir to a higher risk of heart attacks, whereas the AIDS Clinical Trials Group study 5202 ( ACTG 5202)
reported a higher rate of treatment failure among Epzicom-treated
patients starting therapy with viral loads above 100,000 copies. These
findings not only resulted in the DHHS demotion of Epzicom as a preferred treatment option for first-time treatment takers, but
also left those already using the drug—many without any signs of
trouble—scrambling to determine whether a switch was necessary.
While GSK and independent research teams continue to make neither heads
nor tails of the data, experts stress that Epzicom is an effective
treatment option for many people living with HIV. “The need for the
Epzicom option could outweigh potential risks, as with any drug
combination and medical history and clinical status,” says Ken
Fornataro, executive director of the AIDS Treatment Data Network in New
York. “Obviously a high viral load is going to put pressure on a
treating physician to avoid using it in that case, but it’s all about
what options exist and what it is combined with. There could be
competing concerns of potential side effects with another recommended
combination. This is one of those cases that reinforce the need for
patients to discuss their past, present and future treatment options
with their doctors.”
Pipeline Problems
Activist circles were abuzz with ominous speculation regarding the
state of HIV treatment research and a dearth of promising compounds in
the pipeline after receiving word that pharmaceuticals giant Roche had terminated its in-house HIV research.
“The search for better AIDS meds seems to have paused after a flurry of
new drug approvals in the past year and a half,” explains TAG’s Huff.
“Some companies say they’ve tried but haven’t been able to top their
current best sellers. Others have gained approval for innovative new
HIV drugs, only to see them languish in the marketplace.”
Some argue that the Roche’s decision isn’t necessarily a sign of
trouble ahead. “More isn’t necessarily better; better is better,” says
Roehr, the biomedical journalist. “Scientifically, it has become very
difficult to make better HIV drugs because those now available use so
many different mechanisms of action and have such good tolerability and
durability. The rough economy reinforces this scientific message.”
Huff, however, says there is much room for improvement with ARVs. “Too
many HIV physicians appear content to ‘set it and forget it’ with one
pill once a day,” he points out. “Such complacency is misguided and may
be misleading the pharmaceutical industry to believe that there is no
urgency to finding better HIV drugs. We may be in a trough between new
drug approvals, but the need for AIDS treatment is not over.”
Undetectable = Uninfectious?
In January, the Swiss Federal Commission for HIV issued a surprising
statement: People living with HIV with undetectable viral loads and no
other sexually transmitted infections (STIs) are not “sexually infectious.” This claim, however, has since been the subject of much debate.
Few experts deny data confirming a low risk of HIV transmission by
positive people with low viral loads and, as a result, that ARV therapy
is a key player in HIV prevention efforts. What irks some, however, is
the black-and-white tenor of the Swiss Statement, especially when it is
based on a handful of studies that only enrolled HIV-discordant
heterosexual couples in sexually monogamous relationships.
“We know that oral sex has, at best, a very low risk of HIV
transmission but that it will be very difficult or impossible to prove
that it is no risk,” says CHAMP’s Davids. “Similarly, there are major
methodological challenges to proving the veracity of elimination of
transmission risk among those who are undetectable and STD-free. The
Swiss Statement is a challenge to prevention experts who need to
provide information that is not only accurate to the best of their
knowledge, but also offers practical tools for decision making across
the lifespan of people living with HIV.”
Staph Troubles
While not considered an AIDS-defining illness, drug-resistant staph infections have become a serious concern among HIV-positive people and the care providers who treat them. A
handful of 2008 studies confirmed that methicillin-resistant
Staphylococcus aureus (MRSA) is not only more likely to occur in people living with HIV compared with their negative counterparts but also more likely to recur after treatment.
“We’ve started seeing MRSA more and more frequently in the last few
years, and unfortunately, it’s on the rise and not going away any time
soon,” explains Chicago-based Jeff Berry, editor of Positively Aware
magazine. “Studies show that many of these infections are sexually
transmitted and that those with a lower CD4 count are more at risk.
Being on HIV treatment reduces your risk, but it’s still a very real
threat, and some of the MRSA treatments interact with certain HIV meds.”
Berry cautions that MRSA can be disfiguring and easily spread, “so if
you think you may have it, seek treatment immediately.” He also spells
out a few prevention strategies:
“Use a harm-reduction approach by limiting your sexual partners, not
sharing needles, using clean towels at home and at the gym, using good
hygiene, and using a condom—although even that is no guarantee, since
it is transmitted via skin-to-skin contact.”
Transplanting Hope
Not every remarkable HIV treatment discovery makes the front page of the morning papers. Take, for example, the apparent eradication of HIV from an HIV-positive patient in Berlin undergoing a bone marrow
transplant to treat his leukemia, first reported at the 15th annual
Conference on Retroviruses and Opportunistic Infections (CROI) in
Boston earlier this year. Only recently has the report made headlines,
renewing the biggest question of them all: Can HIV be cured?
The man’s transplant team used stem cells from a donor with a rare
genetic mutation that prevented his CD4 cells from producing CCR5
receptors and, thus, rendered him virtually immune to HIV. Even if the
patient turns out to have beat back HIV permanently—further analysis of
his blood and tissue samples is still needed—it is unlikely that stem
cell transplants are going to become a routine treatment. For starters,
patients must first undergo whole-body radiation or high-dose
chemotherapy to make space for the transplanted cells, both of which
come with a high risk of serious side effects and death.
Will this intriguing case pave the way for similar—yet kinder and gentler—curative approaches, such as therapies to “turn off” genes responsible for producing CCR5 on CD4 cells? “It may be evident that
reducing HIV reservoirs and enhancing the resistance of CD4 cells can
lead to a functional cure,” says Richard Jefferys, coordinator of the
Treatment Action Group’s Michael Palm Basic Science, Vaccines and
Prevention Project. “But scientists need to figure out how to achieve
this outcome using different, safer approaches. I think the case offers
encouragement to researchers already pursuing these goals, but I’m not
sure it will help achieve them any faster.”
Awakening an Exhausted Immune System
It seems as if a day doesn’t go by without an interesting report from
laboratory scientists claiming to cast additional light on HIV’s wily
ways in the human body and potential methods to stop it in its tracks.
One of the most notable of 2008 involved a protein called programmed death-1 (PD-1)—and the
fact that blocking it had some miraculous effects in monkeys infected
with SIV, a simian version of HIV.
Two years ago, researchers reported an overabundance of PD-1 proteins on CD8 cells in people with HIV that
causes essential virus-fighting components of the immune system to
become fatigued and listless. The latest research, testing an anti-PD-1
antibody in nine monkeys, found both significant reductions in viral
loads and an apparent survival advantage.
“The results of the
SIV experiment were not as straightforward as some of the stories made
it sound, but it was still an important study,” says TAG’s Jefferys.
“Reviving exhausted virus-specific T-cell responses has always sounded
like a nice idea in theory, but this experiment is the first hint that
it may actually be possible.”
Fat Buster to the Fore
When it became clear in 2007 that EMD Serono’s Serostim (recombinant
human growth hormone) was unlikely to be approved for the treatment of
HIV-related body fat accumulation, all eyes focused on the development
of tesamorelin. Theratechnologies’ injectable compound jump-starts the
natural production of fat-busting growth hormone, but without the side
effects seen in studies of Serono’s agent.
This year saw the successful completion of not one, but two,
Phase III tesamorelin studies. And in a deal to put the Montreal-made
product into the hands of U.S. residents, Theratechnologies struck a deal with EMD Serono to market and sell the drug.
When asked where things stand regarding the pending availability of
tesamorelin, Nelson Vergel, director of Program for Wellness
Restoration, expressed frustration. “It is not yet approved by the FDA
pending additional data,” he says, although it is expected to get the
thumbs up from the FDA sometime in 2009. “Theratechnologies has not
committed to providing the drug through a pre-approval expanded access
program, despite frequent demands by activists.
“Visceral fat accumulation can not only affect self image in people
with HIV, but also increase cardiovascular risks and belly discomfort,”
Nelson adds. “I really hope that Theratechnologies and EMD Serono work
together to provide this drug to people who need it before and after
FDA approval.”
By Tim Horn, http://www.aidsmeds.com
|
|
|
We would not advise that people look to vitamin supplements to reduce their risk of kidney complications at this stage 