February 16, 2009

An HIV-positive stripper who was jailed for three years for infecting her ex-husband has been deemed a danger to the public and ordered to remain in jail until her deportation to Thailand.

Suwalee Iamkhong, 39, of Toronto, will likely go underground and fail to show up for a flight home, a Federal Court of Canada has ruled.

The court killed a bid last month by Iamkhong's brother-in-law and friend to have her released on $23,000 in cash and performance bonds.

Mr. Justice Michel Shore said there's no guarantee Iamkhong won't have unprotected sex again.

"If the respondent reoffends by having unprotected sex, this would result in irreparable harm for a victim," Shore said in a Jan. 21 decision.

Iamkhong "was alleging that she did not know about her HIV infection" at an immigration hearing in prison.

Percy Whiteman, who was married to Iamkhong from 1997 to 2004, said his life has been ruined by the disease and has started a self-help group "Positive Survivors Living with HIV/AIDS" at www.positivesurvivors.ca.

"What she did to me was wrong," Whiteman said yesterday. "Nobody in life should have to go through what I am going through."

Whiteman said he never knew of Iamkhong's sexual escapades or that she was HIV positive. He wasn't told of her disease until she collapsed in 2004 and had to be hospitalized.

"I never knew she was a prostitute in Hong Kong before coming to Canada," he said. "Everything came out in court."

Iamkhong was charged by Toronto police and sentenced in August 2007 to three years in jail for criminal negligence causing bodily harm for infecting Whiteman.

He has launched a $30-million lawsuit against the Canada Border Services Agency and the Zanzibar Strip Club in Toronto in connection with the case.

Whiteman said Iamkhong was sexually active with others while they were married.

"I know of other men that I think she infected, as well," he said. "She was dating other people all along."

Iamkhong was interviewed last Thursday by officials from the Thai Consulate in Toronto.

Whiteman sponsored Iamkhong and -- according to immigration laws -- is financially responsible for her until 2011.

By Tom Godfrey, http://www.torontosun.com 

February 17,  2009

Hamilton -- The often delayed case of a man charged with murder in two HIV-related deaths has been further postponed until Friday in Hamilton.

Johnson Aziga has pleaded not guilty to two counts of first-degree murder and 11 counts of aggravated sexual assault.

The Crown wrapped its case two months ago and the defence was granted a delay to allow an expert witness time to complete his report.

The defence was to begin presenting its case Tuesday, but while the report was ready, the judge told the jury the opening remarks would not go ahead.
Instead, that will happen on Friday.

The Crown alleges the 52-year-old man had unprotected sex with several partners without telling them he was infected with the virus that causes AIDS.

Seven women became infected and two died of related illnesses.

The Canadian Press

February 18, 2009

Margaret Atwood

Novelist Margaret Atwood has announced she will not attend the Emirates Airline International Festival of Literature in Dubai after organisers decided to ban the launch of a book with a gay character.

The author of The Handmaid's Tale will not be among the more than 60 top authors who are attending the cultural event.

In a letter to organisers she wrote:

"I know you have put an enormous amount of work into it, I can imagine how many difficulties have had to be overcome, and I am very sad about the regrettable turn of events surrounding The Gulf Between Us.

"I was greatly looking forward to the Festival, and to the chance to meet readers there; but, as an International Vice President of PEN — an organisation concerned with the censorship of writers — I cannot be part of the Festival this year."

While Dubai likes to present itself as a tolerant and Westernised Gulf state, homosexuality is banned. Punishments range from jail to deportation and the death penalty.

The majority of its 5.6 million residents are foreigners and in recent months EU citizens have been jailed for conducting gay and lesbian relationships.

Last year there was a crackdown on "immoral" activities that led to wave of deportations.

Festival organisers feared the country's censors may have taken offence at Geraldine Bedell's The Gulf Between Us.

Penguin had planned to launch the book, which is set in the Gulf region, at the literature festival.

A minor character, a gay sheikh with an English boyfriend, led organisers to tell Ms Bedell to stay away.

Isobel Abulhoul, director of the fesitval, said: "I knew that her work could offend certain cultural sensitivities.

"I did not believe that it was in the festival’s long term interests to acquiesce to her publisher’s request to launch the book at the first festival of this nature in the Middle East."

The festival website claims Dubai "is regarded as the most tolerant and progressive country in the region."

Gay rights campaigner Peter Tatchell accused the organisers of "collusion" with "Middle Eastern homophobia."

"We should support liberal and progressive people throughout the Middle East who are striving for an open and free society," he said.

"The banning of this book is a betrayal of their heroic efforts. It shows that Dubai still has a long way to go to secure freedom of expression."

British authors due to attend the event later this month include Kate Adie, Anthony Horowitz, Wilbur Smith, Philippa Gregory, Louis de Bernieres and Victoria Hislop.

http://www.pinknews.co.uk

February 18, 2009

The staff at Vancouver's St. Paul's Hospital is raising an alarm over the future of the historic facility and the possible downgrading of its specialized programs.

The hospital's executive sent a letter to Premier Gordon Campbell expressing concerns that the health ministry and the local health authority are contemplating changes that would gut several key programs at the aging downtown Vancouver hospital.

"We have received messages from our peers in the Lower Mainland health authorities that these organizations and the Ministry of Health are contemplating options and developing plans that would, in our opinion, critically damage St. Paul's Hospital's key provincial programs and the hospital's international reputation as a centre of research, teaching and care excellence," said the letter, dated Jan. 30.

The letter, which was signed by hospital president Dr. Dara Behroozi and other members of the executive, goes on to say that staff want assurance that the hospital will not be dismantled.

"Any process that begins with contemplating a downgrading of St. Paul's is inherently flawed and naive. We believe the beginning point should be how to add to St. Paul's current levels of expertise and human potential, not subtract from it," said the letter.

Health Minister George Abbott office also reportedly received a copy of the letter, but neither he nor the premier were available for a response.
Hidden plans revealed: NDP critic

A report issued in 2000 found that the then-88-year-old building was leaking, that pieces of the aging structure were falling off, that it was too small to accommodate demands for emergency and psychiatric services, and that the old brick building would collapse in a major earthquake.

In April 2007, local residents and staff expressed concern when Providence Health Care, which runs the facility for Vancouver Coast Health, floated a possible plan to build a replacement on the shores of False Creek.

NDP Health critic Adrian Dix says the Liberal government broke its 2002 promise to redevelop and expand St. Paul's and has since supported the preparation of plans to downgrade the facility.

"This is just the latest evidence that the Campbell government, while publicly refusing to disclose St. Paul's fate on the eve of an election, continues to work behind the scenes to dismantle it," Dix said in a release Tuesday.

As an internationally recognized acute care, academic and research hospital, St. Paul's has established several acclaimed programs that provide care to residents from Vancouver and across B.C, said Dix.

Its cardiac care centre performs 33 per cent of all cardiac surgeries in B.C., including more than a quarter of the province's most complicated and life-threatening cases, he said.

"It takes decades to build the high caliber clinical care teams and expertise St. Paul's currently has," said Dix.

Metro Vancouver is still struggling with past acute-care cuts, and Vancouver Coastal Health projects that the Lower Mainland's current shortage of acute care beds will rise to 750 beds by 2010, he said.

The November 2003 closure of Saint Mary's hospital, another Catholic acute-care hospital, also offers a harbinger of St. Paul's future, he said.

"St. Paul's current situation shares many parallels with Saint Mary's. The Campbell government first hollowed out its acute-care services, and reduced its specialty programs and budget. Announcement of its permanent closure followed a few months later," said Dix.

http://www.cbc.ca

February 19, 2009

Advocates in Vancouver, Canada, in a Feb. 10 letter said that the city police department's 2009 business plan to increase drug enforcement for the Downtown Eastside area also could increase the spread of HIV, the Vancouver Courier reports. The letter -- signed by seven not-for-profit organizations and scheduled to go before the police department board on Wednesday -- was sent to Police Chief Jim Chu and Mayor Gregor Robertson. It said the plan to increase patrols, street checks and ticketing in an area "whose population is disproportionately disabled, aboriginal, HIV-positive and hepatitis C-positive" could increase the spread of HIV and hepatitis C, as well as "limit access to critical health services and will not achieve its desired goals." The Courier reports that the business plan also calls for a priority on seizing drugs rather than prosecuting people for simple drug possession. The letter was signed by directors of AIDS Vancouver, the Positive Women's Network, the Canadian HIV/AIDS Legal Network, the YouthCO AIDS Society, the Asian Society for the Intervention of AIDS, the B.C. Civil Liberties Association and the British Columbia Person with AIDS Society.

The concerns expressed in the letter are based on 2005 research conducted by the British Columbia Centre for Excellence in HIV/AIDS, the Courier reports, adding that the research was conducted after the police department increased anti-drug efforts in 2003. The Centre found that during that time period, injection drug users would utilize used needles rather than visit a supervised injection site or a needle-exchange program out of fear of being arrested by police. The advocates in the letter said that they "strongly urge you to reconsider what appears to be an illegal and inappropriate response to core issues of poverty and homelessness in Vancouver." They added that they "especially urge you to resist the temptation to clear the streets and parks of the Downtown Eastside of their longtime residents to address the imagined perceptions of the international community in 2010," when the Winter Olympics are scheduled to be held in Vancouver. According to the letter, the provincial and federal governments should increase resources for treatment and affordable housing programs (Howell, Vancouver Courier, 2/18).

The letter is available online (.pdf).

http://www.kaisernetwork.org

February 16, 2009

The UK's leading gay rights organisation has called on the National Blood Service to end the ban on blood donations from men who have had sex with men.

Stonewall also accused the National Health Service of "passing the buck" on the issue.

Opposition to the ban has been rising for several years.

A petition on the issue is being considered by the Scottish Parliament and the National AIDS Trust formally came out against it last year.

A Stonewall spokesperson told PinkNews.co.uk that they held a series of meeting with the NBS before speaking out.

"Stonewall has spent two yeats reviewing this policy with the greatest care," he said.

"The safety of the blood supply is of course paramount, but it is our genuine belief that exclusion should be expressed in terms of risky behavour, not sexual orientation."

The NBS insists it targets sexual behaviour and not sexual orientation, but in effect virgins are the only gay men whose blood will be accepted for donations.

There is increasing pressure for the ban to be lifted in favour of more sophisticated models.

"Stonewall now urges the National Blood Service to change its current restrictions to reflect risk behaviours," said chief executive Ben Summerskill.

"As it stands, a heterosexual person who has consistently put themselves at risk of exposure to HIV is not given the same lifetime ban as that of a gay man, who has had protected sex just once.

"People wanting to donate blood should be asked the same questions – irrespective of their sexual orientation - that accurately and fairly assess their level of risk of infection. The current system fails to do this.

"Instead, it stigmatises gay men by perpetuating the offensive myth that they cannot be trusted in matters of sexual health.

"In the course of our policy review, Stonewall has been perplexed by the buck-passing in the NHS on this matter.

"We’ll be urging ministers to encourage senior health professionals to take this matter seriously and to fall in line with current practices in Spain, Italy, Australia and New Zealand – none of whom now have a lifetime blanket ban on gay men.

"We’re also mindful that the Anthony Nolan Trust has recently lifted their own ban on bone marrow donations by gay men."

Last week Health minister Dawn Primarolo told MPs:

"Current policy excludes men who have ever had sex with men, whatever their sexual orientation, from blood donation.

"The United Kingdom adopts a highly precautionary approach to blood safety.

"The guiding principle is that if the best available evidence shows that there are reasonable grounds to believe that a course of action will improve the safety of the blood, this action should be taken.

"The Department is committed to regularly reviewing this evidence, and has asked its expert advisory committee on the Safety of Blood, Tissues and Organs to do this in 2009."

The NBS has said that while safer sex through the use of condoms does reduce the transmission of infections, it cannot eliminate the risk altogether.

"The reason for this exclusion rests on specific sexual behaviour rather than the sexuality of the person wishing to donate," the NBS told PinkNews.co.uk.

"The policy would only be changed on the basis of clear evidence that patients would not be put at jeopardy. In addition, scientific advances in virus testing and inactivation are monitored."

By Tony Grew, http://www.pinknews.co.uk

By Liz Highleyman & Michael Carter, http://www.aidsmap.com

By Gus, Cairns, www.aidsmap.com

February 19, 2009

A new human immunodeficiency virus prevention strategy is making waves in the medical community.

A. David Paltiel, a professor at the School of Public Health, and his team of researchers have published a study showing that the HIV prevention model — called pre-exposure prophylaxis, or PrEP — could reduce an individual’s lifetime HIV infection risk from 44 percent to 25 percent and could increase his or her overall life expectancy by eight-tenths of a year. Despite the study’s results, however, some professionals said they remain skeptical of the PrEP approach. (PrEP is an HIV prevention strategy based on giving antiretroviral drugs to high-risk populations before they contract the disease in order to reduce their risk of infection.)

The study, which simulates the health outcomes of middle-aged homosexual men, also found that if PrEP’s effectiveness is higher than the model estimates, lifetime infection risk would be even more significantly reduced. Namely, if the drug was 90 percent effective instead of the proposed 50 percent, the risk of infection would drop from 44 percent to 5.8 percent.

“If there was a pill that you could take once a day that could prevent HIV infection,” Paltiel asked, “how much would you be willing to pay?”

For logistical and ethical reasons, Paltiel said, the researchers had to resort to a mathematical model to investigate decisions about the disease.

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, the institute that co-funded Paltiel’s project, said he decided to fund the proposal because of its powerful implications.

“PrEP is a promising area of research that potentially could have significant public health value in preventing HIV infection,” he said.

The study’s assumption that PrEP would be effective in preventing HIV 50 percent of the time is a relatively high figure in the world of chronic disease, said Robert Levine, professor of Internal Medicine at the Yale School of Medicine.

“If you look at the cancer field, 50 percent effectiveness would be something that we truly celebrate,” he said.

But the study has also caused dissent among researchers.

For instance, Levine took issue with PrEP’s proposed cost — $9,000 annually — which he said makes the model an unfeasible option for foreign countries, and particularly for developing nations.

Gregg Gonsalves, a HIV/AIDS activist and student in the Eli Whitney Program, said the study does not take into account the benefits of social education and therapy, which might be a more cost-effective way to combat rising infection rates at this point.

“Right now we have an exploding epidemic among young, black gay men and young gay men more generally, so we desperately need to figure out a way to reduce infections among these young guys,” he said. “PrEP may be one strategy, but dealing with substance use, depression, violence in these men’s lives might also offer a way to reduce their risk.”

Martha Dale SPH ’80, executive director of Leeway, an HIV/AIDS care facility in New Haven, agreed that communities need an aggressive social marketing campaign to make younger people more aware of the risk of contracting the virus.

But Dale said she is not opposed to the possibility of a successful drug-related prevention scheme. “Everything we can do for this population, I think we should do,” she said.

A cure may be a distant reality for HIV/AIDS, which has killed an estimated 25 million people in the past 20 years. As a result, Paltiel’s study is evidence of the focus among clinicians on ways to improve treatment strategies and reduce the side effects and toxicity of HIV drugs, assistant professor of medicine Krystn Wagner said.

“There is no belief right now that a patient who is infected will eradicate the disease,” she said. “So now it’s not only about HIV control, but also about looking at the long-term effects of those drugs and how they interact with other medical conditions.”

By Ilana Seager, http://www.yaledailynews.com 

February 18, 2009

Interrupting antiretroviral (ARV) therapy has a rapid unfavorable effect on “good” HDL cholesterol levels, significantly increasing the risk of cardiovascular disease (CVD). This was an additional finding from the SMART trial, reported by Daniel Duprez, MD, of the University of Minnesota and his colleagues at the 16th Conference on Retroviruses and Opportunistic Infections (CROI) last week in Montreal. According to the researchers, HIV-positive people not on treatment experienced a high rate of serious coronary-related problems.

Previous data from SMART indicated that treatment interruption is associated with drops in both HDL cholesterol and “bad” LDL cholesterol. But even with a decrease in LDL levels—typically a favorable outcome—there were still disproportionately more CVD problems in the treatment interruption group, compared with those who remained on treatment throughout the study.

By way of background information, Duprez explained that HDL is one of the five major groups of lipoproteins—the other four are chylomicrons, VLDL, IDL and LDL—that help fats such as cholesterol and triglycerides move through the water-based bloodstream. Because HDL removes cholesterol from fatty deposits in artery walls (atheromas), it is widely considered “good” cholesterol. When HDL levels fall below 40 milligrams per decaliter (mg/dL), the risk of CVD increases, as there isn’t enough of the lipoprotein to halt or reverse thickening of the arteries.

Duprez also noted that not all HDL lipoproteins are created equal. For example, two individuals of similar ages and total HDL levels can have different amounts of small HDL particles—studies suggest these more accurately reflect protective action—in relation to medium and large HDL particles. (HDL particle concentrations are measured using sophisticated assays, such as electrophoresis and nuclear magnetic resonance spectroscopy).

To better understand the protective role of HDL, Duprez’s group measured lipoprotein concentrations in stored samples from 218 patients who discontinued treatment and 233 patients who remained on treatment in SMART. In addition, lipoprotein particles at study entry were measured in 248 SMART participants diagnosed with CVD and in 480 age-, region- and gender-matched SMART participants who remained free of coronary disease.

The average age of the patients included in the analysis was 49 years. About 19 percent in both groups were women, and nearly 40 percent were black.

Most lipoprotein levels—including total cholesterol, LDL and VLDL—were similar between those who developed CVD (cases) and those who did not while participating SMART (controls). Total HDL levels, however, were significantly lower in the cases compared with controls at baseline: 38 mg/dL vs. 42 mg/dL, respectively. Total HDL particle concentrations were also lower among cases vs. controls—28.4 micromol/L vs. 30.2 micomol/L, respectively—suggesting that lipoprotein particle size is also directly related to the risk of CVD.

In the comparison between those off and on treatment in SMART, one month after entering the trial, both small and medium HDL particles fell significantly in the interruption group compared with those who remained on therapy. Concentrations of large HDL particles remained similar in both groups.

In concluding his talk, Duprez reiterated that lower total HDL levels—especially small HDL particles—can predict cardiovascular events in people living with HIV. Discontinued or intermittent therapy, he added, is associated with a decrease in HDL, when compared with continuous treatment. He recommends that additional studies, notably randomized clinical trials, be conducted to better understand the long-term effects of both ARV and lipid-altering therapies on HDL and HDL particles.

By Tim Horn, http://www.poz.com

February 18, 2009

New research at Oregon Health and Science University's Vaccine and Gene Therapy Institute suggests vaccines that specifically target HIV in the initial stages of infection -- before it becomes a rapidly replicating, system-wide infection -- may be a successful approach in limiting the spread of the disease.

The research is published in the early online edition of the journal Nature Medicine and will appear in a future print edition.

The researchers used a vaccination method that involves creating and maintaining resistance by programming a portion of the body's immune system -- effector memory T cells -- to look out for HIV at the site of infection.

"HIV appears to be vulnerable when it is first introduced into mucosal surfaces in the body," Louis Picker, MD, associate director of the institute and director of its vaccine program, said in a press release. "However, once HIV spreads throughout the entire body, it replicates very rapidly and becomes difficult -- if not impossible -- to control. Our approach is to attack during this early period of vulnerability. The approach is similar to that of a homeowner who sprays their house with water before sparks land on the roof. This approach can prevent the roof from catching fire and, in the case of HIV, prevent the spread of the virus."

To determine whether they could proactively "educate" the immune system, scientists used a monkey model of AIDS -- simian immunodeficiency virus, the monkey counterpart to HIV. They introduced an altered monkey form of cytomegalovirus programmed to express SIV proteins and trigger specialized effector memory T cells to look for and attack SIV in its early stages.

In total, 12 rhesus macaque monkeys at the Oregon National Primate Research Center were vaccinated using this method. When the animals were later infected with SIV, one third were protected.

The next step for the research team is to try to determine why only a portion of the monkeys who are vaccinated using this method are responding. The researchers also hope to expand the number of subjects to better determine the success rate of the therapy.

The research was funded by the National Institute of Allergy and Infectious Diseases and by the Bill and Melinda Gates Foundation.

Oregon Health and Science University is the state's only health and research university and Oregon's only academic health center.

http://www.hivplusmag.com

February 11, 2009

Listen to Audio (6 min.) Download Audio Please note: These files can be quite large. Allow some time for them to download.

I'm David Bangsberg, at Massachusetts General Hospital and Harvard Medical School. This study is based on a group of people who are homeless or marginally housed in San Francisco, who are on antiretroviral therapy.¹ We're measuring their adherence with random home pill counts, which we have found to be a very objective and reliable measure of adherence -- much better than self-report.

We follow these people over time and we ask the question: Among those patients who are virologically suppressed, what is the risk of virologic failure -- rebound -- as a function of the duration of prior suppression?

The basic question is: Do you need the same level of adherence to keep your virus suppressed 12 months into therapy as you do the first few months of therapy? We hypothesized that the level of adherence required to sustain viral suppression would decline with time, possibly because the reservoir of latently infected cells declines with suppression.

David Bangsberg, M.D., M.P.H.

Has this question ever been asked before?

Not that I know.

We used a statistical approach, followed marginal structural models, to look at each patient every month, look at their level of adherence, and look at the risk of virologic rebound. Then we stratified that as a function of how long someone had been suppressed. You can see that we have a population which is largely people of color, on diverse antiretroviral therapy. There's a high prevalence of injection drug use, crack use and alcohol use. So this is a population at risk for incomplete adherence.

As we looked at them, we broke adherence down into four different levels, and found that, at least for levels of adherence above 50 percent, the risk of virologic failure at any given level of adherence declines with time. Here are people who are taking 50 to 74 percent of their medications. This graph [on our poster] looks at the probability of virologic failure as a function of the number of months of prior viral suppression. Early on, you have about a 50 percent chance of virologic suppression with this level of adherence, and this declines to quite low as you maintain 12 months of viral suppression.

The interpretation is: The goal remains the same. The goal is to achieve as perfect adherence as possible. And the better the adherence, the better the chance of durable viral suppression.

What's the "magic" percentage?

There is no magic number, but with currently available therapies most patients can achieve reliable viral suppression at more modest levels of adherence -- 70 to 80 percent adherence. I want to just be clear that the goal is perfect adherence, but with more potent therapies, the window of adherence that can lead to viral suppression has opened up a bit. What this data suggests is that this window opens up a little bit further. It changes as someone gets deeper into, or has more extended duration of, full viral suppression.

Was this known before?

No.

Is this percentage difference because of the strength of the newer medications?

I think the more potent regimens have opened up this window of adherence, such that you can achieve virologic suppression within a window [of adherence] that's wider than 95 to 100 percent. How does the risk of virologic rebound change over time on a particular regimen? We're controlling for the type of regimen.

What does this mean for short-term interruptions of therapy?

We think that interruptions of treatment appear to be bad, in that you have low-level virologic replication, immunologic stimulation; and I think interruptions should be minimized.

Interruptions early into therapy may have more damage and lead to a greater risk of virologic suppression than interruptions later into therapy. But still, the more interruptions, the greater the risk of virologic rebound.

Are you going to continue following this population?

We are still following this population, and we'll continue to follow this population at least for another year, depending upon our funding.

Were you surprised by the results?

I think that we hypothesized that this would be the case, based on what we know about HIV in latently infected memory cells, and that that population [o cells] declines over many months to years on treatment. Given that declining population, we hypothesized that you might have more of an adherence cushion late into viral suppression than early into viral suppression.

http://www.thebody.com

February 10, 2009

There's nothing like hearing the results of studies directly from those who actually conducted the research. In this interview, you'll meet one of these impressive HIV researchers and read his explanation of a study he presented at CROI 2009. After his explanation, he then answers several questions from the audience.

My name is Vivek Jain. I'm an infectious disease researcher at the University of California-San Francisco. This is an analysis of patients who have acute and early HIV infection, which is a special population of patients.¹ It's an analysis of patients who have acquired HIV that is drug resistant. This is a major public health problem because patients who acquire drug-resistant virus are at risk of having antiretroviral failure if that drug resistance is not accounted for.

Vivek Jain, M.D.

This project is simply a look at the epidemiology of that trend. We had previously published some trends, going from 1996 to 2002. We now are reporting trends from 2003 to 2008. What we found is that overall, the transmission of drug-resistant virus seemed to increase from 2003 to 2007, to the point where, in San Francisco in the year 2007, 28 percent of all new cases of HIV were resistant to at least one drug.

 

Adapted from Vivek Jain et al. CROI 2009; abstract 673.

What's interesting is that that following year, in 2008, we had a large drop in that resistance. And this is an interesting trend that we're going to look at now to see what led to that drop.

Wow. So this was a surprising result, wasn't it?

Somewhat, yes. But I think there are several theories as to why that resistance has gone down. I think one of the possibilities that we're starting to think about is that in the second half of 2007 and in early 2008, we had the addition of several new powerful drugs into our armamentarium, and we wonder whether we took a lot of patients who were previously resistant to all the classes of antiretrovirals and got them on these new, more powerful suppressant drugs, eliminated the viremia in those patients; and we're wondering if it's possible that is what led to less transmission among the networks in our city. That's a theory at this point, but it's something we're interested in looking at.

I see that NRTI resistance was more common than NNRTI resistance in 2008. That's sort of a surprise.

Yes. I think, again, the numbers are a little bit on the small side. Some of the years, it's the opposite trend. And I'd say in many of the years they are similar. But I would agree.

How many patients did you have?

This is a total of 266 patients who entered our cohort from 2003 up through the end of 2008. This is one of the largest groups studying patients with acute and early HIV.

We don't know if 2008 is a blip or a trend, right?

We don't yet know because the data from 2008 just finished, as of December 31. We're going to be monitoring the data from 2009 pretty closely, and we will see over time. Time will tell whether these trends hold up. Hopefully, the transmission of drug resistance will be at lower levels. Because this is a major public health problem.

Did you already report the data? Did we already know that it was so high from 2003 to 2007?

That has not been reported yet; we are just about to report that. Part of being here at the conference is to share that data with everybody.

So, there's the good news and there's bad news. The good news is about today, and the bad news was about yesterday.

I think you could put it that way. Again, I'd point out a caveat: This is our experience in one cohort, in one city of San Francisco. But we do have a big problem with drug resistance in San Francisco, so a lot of trends are seen in San Francisco that then are seen in other cities. Hopefully, these results are useful to other clinical groups.

This transcript has been lightly edited for clarity.

By Bonnie Goldman, http://www.thebody.com/