People living with HIV are invited to participate in an online survey on HIV and employment in Canada. The purpose of this survey is to learn more about the education, training, employment and health needs of people living with HIV. Our ultimate goal is a national network that will provide employment support, information and advocacy opportunities for people living with HIV whether in or out of the workforce. Your responses to the survey will inform us on the employment-related issues that matter to you most.

The survey is available electronically and will take approximately 25 minutes to complete. You will be able to save survey responses and then submit the final version at a later date. If you would like to request a hardcopy of the survey please send your contact information to the address below.

You do not have to give personal information and we do not plan to publish personal information. If this plan changes, we will only do so with your agreement. You have the right to opt out of any question(s) at any point throughout the survey. You may choose to provide us with contact information if you would like to be kept updated on the progress of this project.

The link to the survey is provided below. The survey will be open for responses through Friday, March 13. This opportunity is unique to people with HIV. We look forward to your response to the survey.

http://www.surveymonkey.com/s.aspx?sm=BxPMtNFSCtrk5n1CZTiWPQ_3d_3d

March 9, 2009

Vancouver - LifeSciences British Columbia today announced the recipients of the 2009 LifeSciences British Columbia Awards. They are:

Genome BC Award for Scientific Excellence:

• Dr. Ben Koop, Centre for Biomedical Research, University of Victoria
• Dr. Willie Davidson, Department of Molecular Biology and Biochemistry, Simon Fraser University

Innovation & Achievement:

• John Babcook, AMGEN British Columbia

Leadership Awards:

• Dr. Jack Saddler, Faculty of Forestry, University of British Columbia
• Dr. Julio Montaner, BC Centre for Excellence in HIV/AIDS

Medical Device Company of the Year:

• Response Biomedical Corporation

Life Sciences Companies of the Year:

• OncoGenex Pharmaceuticals
• Nexterra Energy Corporation

These awards are presented annually by LifeSciences British Columbia to recognize individuals and organizations that have made outstanding contributions to the development of British Columbia’s life sciences industry across all sub-sectors, from biopharmaceuticals and medical devices to bioproducts and bioenergy – sectors which are critical to the economic future of the province and country.

“We all know what a challenging business environment the world is facing,” commented Karimah Es Sabar, President of LifeSciences British Columbia, “So it’s even more important during such times that we celebrate and continue to nurture these great accomplishments. These recipients have all proven over the last year and during the course of their careers that great science and the application and commercialization of that science continue to be achieved right here in British Columbia. We extend our warmest congratulations and appreciation to each of the Award recipients.”

The awards will be presented at a gala ceremony Wednesday, April 8th, 2009 in front of an audience of approximately 600 biopharmaceutical, medical device, bioproducts, bioenergy and greater life sciences community and public policy leaders at the Hyatt Regency Hotel in Vancouver. Please visit www.lifesciencesbc.ca for full details.

The LifeSciences British Columbia Awards are presented by Ernst & Young; Farris, Vaughan, Wills & Murphy, LLP; Genome British Columbia; and Rx&D (Canada’s Research-Based Pharmaceutical Companies). Media sponsor: Business in Vancouver Magazines.

About LifeSciences British Columbia:

LifeSciences British Columbia supports and represents the biopharmaceutical, medical device, bioproducts, bioenergy and greater life sciences community of British Columbia through leadership, advocacy and promotion of our world-class science and industry. Via active facilitation of partnering and investment into the life sciences sector, British Columbia is fast becoming a global life sciences leader. LifeSciences British Columbia is a not-for-profit, non-government, industry-funded association.

http://www.businesswire.com

March 12, 2009


“The law is not what I want it to be,” says Glenn Betteridge. “It is what it is.”

A former lawyer and policy advisor with an extensive background in fields related to HIV/AIDS, Betteridge was in Vancouver Mar 1 for a public forum on the criminalization of HIV nondisclosure.

In 1998, the Supreme Court of Canada ruled that you could be charged with aggravated assault for failing to disclose your HIV-positive status to a sex partner prior to having unprotected sex.

Since then, an increasing number of HIV-positive people, including many gay men, are being charged with, and convicted of, violent offences ranging from aggravated sexual assault to murder.

About 25 people attended the Vancouver forum; many brought questions about the grey areas surrounding HIV disclosure laws.

The forum was part of a Canada-wide tour hosted by the Canadian AIDS Treatment Information Exchange (CATIE), in conjunction with the Canadian HIV Legal network and local AIDS organizations.

“The law places really onerous, heavy obligations on people living with HIV,” says Betteridge.

Asked how he feels about these legal obligations, Betteridge is reluctant to comment further. He says he’d rather not express his personal views on the subject while he’s moderating the forums, so that he can continue to act as a more impartial facilitator.

In a recent interview with Xtra West’s Toronto sister paper Xtra, Betteridge noted that there are disparate viewpoints within the gay community about the best way to handle failure to disclose allegations.

“We almost talk about those things in a utopian aspirational way,” he said. “The idea that people living with HIV can have unprotected sex and face no consequences because the other parties should be looking out for themselves, asserting that as a human right, is tenuous.”

He said he hasn’t yet made up his mind about criminalizing non-disclosure.

“I am not sure,” he told Xtra. “It’s an issue I struggle with. I need to have my viewpoint more informed by those people who are feeling this profoundly to decide where I think the truth lies in this.”

For now, Betteridge advises people who have tested positive to clearly disclose their status to potential sex partners before the first fly is unzipped — and to keep evidence to prove they disclosed.

For example when meeting online for face-to-face hookups, keeping a clearly worded email disclosure and its reply — stating that the person understands the risks associated with sero-divergent sex — can mean less worry about future legal fallout.

Similarly, speaking openly and directly about one’s HIV-positive status in the company of friends and a new date makes those friends witnesses to the disclosure, Betteridge explains.

Vice-chair of the British Columbia Persons With AIDS Society (BCPWA) Ken Buchanan agrees that these are good ideas.

With increasing numbers of people finding casual sex partners on websites, he remarks, email is a practical way of keeping records of disclosure.

Consistently practicing safer sex doesn’t eliminate the need to disclose, either, Betteridge told the Vancouver forum.

When it comes to an individual’s obligation under the law in this country, Betteridge bluntly states, “a condom doesn’t cut it.”

Though courts in some countries, including Canada, have made judgments based on rates of infection for certain sexual acts, viral load, and the use of condoms, there is to date no definitive legal ruling that practicing safer sex belies the need for open dialogue about HIV status.

Counting only those charges that went to trial, about 75 criminal prosecutions for non-disclosure have taken place in Canada since 1989, the majority of which consisted of complaints by one or more women against HIV-positive men.

One such case, that of Charles Mzite, ended in a BC Supreme Court conviction only hours after Betteridge’s presentation in Vancouver. Mzite was found guilty on four counts of aggravated sexual assault for having unprotected sex with women who testified that they did not know he had the virus.

Betteridge says disclosure can be a factor even between HIV-positive individuals.

Although the courts have yet to see such a case, the risks associated with drug-resistant strains of HIV, which can be passed to someone with a currently manageable strain, means disclosure may be required there too.

At the core of this whole issue is the continued stigmatization of HIV, says Buchanan.

“I know people who’ve had the disease for years, [and] people they work with, their families don’t know. There’s very few of us that are the public faces of HIV or AIDS.”

This stigma, and possible legal worries, he says, can discourage people from being tested regularly.

Be open and honest with all sexual partners and get tested regularly, Buchanan advises. Despite what may sometimes feel like a slow pace of change, after 25 years of activism, he says, “we have to just keep at it.”

Discuss this story here

By Patty Comeau, http://www.xtra.ca

March 12, 2009

The Save St Paul’s Coalition is celebrating a victory this week after its ongoing efforts to keep the West End hospital’s programs intact garnered unanimous support from city council’s Planning and Environment committee.

Councillor Geoff Meggs introduced a motion to back the hospital’s renewal and retain its key specialized programs at the committee’s Mar 5 meeting.

“This is to put on record our commitment to the renewal of St Paul’s as a critical healthcare facility for the province, but also a major economic generator for our city,” Meggs said.

The motion urges the provincial government to consider the economic, ecological, medical and social benefits of keeping the West End hospital’s key programs and services intact.

The motion was unanimously supported by all councillors present at the committee meeting: Meggs, David Cadman, Andrea Reimer, Heather Deal, Kerry Jang and Ellen Woodsworth. Mayor Gregor Robertson voted in favour as well.

BC health minster George Abbott says he’s not opposed to the motion. Given its age and structure, St Paul’s is in need of renewal and revitalization, he acknowledges.

But whether that revitalization will occur on the existing Burrard St site or on the proposed False Creek Flats site is still undetermined, Abbott says.

Abbott calls the part of the motion that refers to the provincial government’s potential dismantling and transferring of the hospital’s key programs to other hospitals “premature and misleading.”

“The province has made no decisions in regard to taking services away from St Paul’s,” he maintains.

However, he confirms that talks with BC’s health authorities are taking place.

“A planning process is currently underway involving the health authorities and the ministry regarding the utilization of acute care facilities well into the 21st century,” Abbott reveals.

The government is looking at how programs at Vancouver General Hospital, Surrey Memorial, Royal Columbian and St Paul’s are best utilized, Abbott says.

Asked if his ministry has seen any business case from St Paul’s operator Providence health care regarding the hospital’s relocation and renewal, Abbott says he has not.

“The spirit of the motion is something we all would support,” says Providence spokesperson Shaf Hussain, who says the hospital still needs major investment and renewal.

Meggs’ motion follows a Jan 30 letter sent by senior hospital staff to Premier Gordon Campbell.

“We know there is extensive planning underway within the Ministry of Health to develop strategic plans to address BC’s growing long-term health care needs. We support the need for such planning,” the letter reads. “However, 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.”

Prior to the committee’s vote, Brent Granby, chair of the Save St Paul’s Coalition, urged councillors to put pressure on the province to make a decision regarding the hospital’s future. St Paul’s has been in a state of limbo long enough, Granby told the committee.

“St Paul’s Hospital renewal plans have been languishing for more than seven years,” he claimed. “The lack of significant investment in capital spending in renewing and extending the hospital has left many speculating on what the long-term plans for the hospital are.

“The fear now is not that it will move, but that it will be hollowed out from within,” he said. “The province should make good on its commitment to assist on the capital cost of this project.”

“The idea of moving discrete programs from St Paul’s Hospital to another hospital is unrealistic,” Dr Peter Dodek, chair of the Critical Care Working Group at the hospital’s Centre for Health Evaluation and Outcome Sciences, told the committee.

“Each of the key programs at St Paul’s Hospital is intricately related to many other programs and services and the success of these programs depends on this synergy,” Dodek said. “I believe that we can meet these needs through incremental renewal on our existing site, not the creation of an entirely new building on another site.”

“The idea that you can take pieces out and move them willy nilly here or there and still protect the health services is wrong,” Meggs agreed.

“By passing this motion in council we make it very clear to all the stakeholders and the province that we’re prepared to look at this proactively, renewing St Paul’s and generating for the province the medical benefits that will come,” Meggs said.

“Using what has already been built and expanding on the current site is more cost effective, more ecologically sustainable and more in line with the historic context of the location,” Granby said.

“The economic impact of St Paul’s is huge in the West End,” added Little Sister’s co-owner Jim Deva. “If St Paul’s were to move, you would see For Rent signs and For Lease signs up and down Davie and Burrard and Denman Sts. It would be a disaster economically. If we could have a renewal of St Paul’s hospital, I think we could have a renewal of the West End.”

Jennifer Breakspear, executive director of The Centre on Bute St, pointed out that the West End’s queer community, including its seniors, uses St Paul’s services on a regular basis. “The people that need the services are in the West End. Let’s keep the services in the West End,” she urged.

The hospital is also vital for the many HIV-positive people who live nearby and rely on its services, Breakspear added. “So many of the folks living with HIV/AIDS are living in the West End. It would be a travesty to deny those people that most need the services access to them for various financial, economic or profiteering motives.”

“It’s an issue that’s emotional. It’s technical. It’s community-based. It covers all kinds of different issues,” acknowledged councillor Heather Deal.

“It’s an urban hospital in a very urban setting. It’s within the fabric of the neighbourhood and the grid and transit. If every service that is there now were moved down to the proposed site it would become a suburban hospital,” Deal said. “It would become the kind of hospital that would be quite cleaved off from the community it serves.”

By Shauna Lewis, http://www.xtra.ca

March 9, 2009

Nobel Prize-winning French researcher Luc Montagnier - credited as co-discovering HIV - is being accused of stealing the intellectual property rights to a revolutionary electromagnetic technique that may be used to combat HIV and other diseases sucha s Parkinson's and Alzheimer's.

According to the article, Montagnier is engaged in a legal battle with inventor Bruno Robert, who approached him in May 2005 with his work on electromagnetic waves. The following November, Robert registered a patent for a process that would pinpoint illnesses by their electromagnetic signature and potentially block or neutralize them with an opposing signal. A month later, Montagnier requested a patent for the exact biochemical process. The case went to court March 3.

Robert’s lawyer alleges that Montagnier has already admitted that he did not come up with the discovery, adding that the virologist had signed a contract to use Robert’s electromagnetic technique in 2005 in exchange for an annual payment of 100,000 euros per year over a five-year period. Robert says he received no such payment. Montagnier’s lawyer affirms that his client had only signed a “protocol agreement,” which is not legally binding.

http://www.poz.com

March 6, 2009

The doors opened this week on the S. Mark Taper Foundation Center, a 2,500-square-foot one-stop shop of vital services for persons living with HIV/AIDS.

Founded by the non-profit AIDS Project Los Angeles, the new facility, located on the campus of the former Martin Luther King Jr.-Harbor Hospital, includes a full-service dental clinic with three operatories, a waiting room, a one-on-one consultation room, a lab, a sterilization room, a kitchen for food demonstrations and a food pantry.

The new center will complement the nearby OASIS Clinic HIV/AIDS Program, which provides medical care such as hormone therapy and care management, and the Drew Center for AIDS Research, Education and Services (Drew CARES), an affiliate of the adjacent Charles Drew University of Medicine and Science created to provide outreach services to the community.

“I always had a fear of dentists [because of] the health of my teeth,” said Wanda, a client and 55-year-old Los Angeles Unified School District retiree who would not disclose her full name but says she sexually contracted the disease from her late partner, an intravenous drug user. “Then I had a phobia because at the time people didn’t understand HIV and AIDS so I was afraid to tell the dentist not knowing that they know [just by] looking in your mouth,” she said. “I was afraid that they might sue me or I might get in trouble because of the bleeding. I didn’t know the complexity of the HIV [disease] itself. I was still learning. So, I just started letting my teeth go because I was scared to go to the dentist, not realizing the infection that I was causing myself.”

As a result she suffered from complications with eating and upset stomach due to tooth abscesses. After a long, painful wait, her physician at the OASIS Clinic, recommended AIDS Project L.A. Dental Services near downtown Los Angeles.

“I felt more cared about. They talked to me to calm my fears and walked me through every procedure,” she added. “We talk about different things like where I’m at with the virus and how I feel. … They make me feel good, like somebody loves me. You know, like I’m not out here by myself.” According to APLA, “more than 70 percent of HIV-positive people in L.A. County need dental care, but fewer than 10 percent receive it,” due to financial hardship, lack of transportation, and the fear of letting their status being known.

But APLA Executive Director Craig Thompson, who has worked for the organization for almost 12 years, added that many who attempt to get dental services from normal dental clinics are turned away. “In the early days the discrimination was against the fear of HIV. Now, we have universal precautions. …

So, no one should be worried about that but they still are,” he said. “The bigger issue really for most [dentists] is that HIV dentistry takes longer because [the] HIV disease has oral manifestations and it actually complicates normal dental procedures.”

For a patient without HIV, he said, a typical visit or procedure can take 30 minutes. For someone with HIV, it may take 45 minutes or more. “So dentists don’t [particularly] want to serve people with HIV because they don’t get paid anymore and it takes twice the time. There has been a significant economic disincentive for them to do it.”

Dr. Steven Vitero, a medical director at APLA Dental Services who previously owned his own private practice for 18 years, said that during his practice “There was so much that was unknown and private dentists didn’t want to treat patients anymore. They were afraid of the unknown, there were even classes on how to legally get rid of patients.”

Even today, Vitero said, he talks to new clients who say they have been turned away, sometimes from dentists they’ve gone to for several years.

Some oral conditions include fungal infections, chronic gum disease, shingles and intraoral herpes, but Kaposi’s Sarcoma — dark lesions — remains the most frequent oral malignancy.

In rare cases, “we will see certain lesions that are rare in the general population with a person with a poor immune system. We’ll see warts, we’ll see fungal infections … but they’re rarely seen, usually those are indicators that the T-cells are down, that the immune system is not working as well as it should be,” Vitero added.

This is why, he said, dental care is just as vital to those living with HIV/AIDS as is medical care and nutrition.

The new center’s Necessities of Life Program food pantry will coincide with the work they do at the facility.

“Proper nutrition is a powerful tool for the successful management of HIV disease,” said a statement from APLA. “People living with HIV often have deficiencies in essential vitamins and minerals needed by the immune system to fight off infection.”

Based on a 2,000-calorie diet, every Thursday from 10:30 a.m. to 4 p.m., clients in the program will receive free pre-bagged groceries with dairy products, frozen meats, whole grains, fresh fruits and vegetables, canned and dry goods as well as personal hygiene products and cleaning products donated by vendors. Each person can access any of the organization’s nine food pantries a maximum of four times a month — equivalent of up to 16 bags of groceries. The pantry is expected to service 400 people annually.

One of those clients will be a 65-year-old retired labor worker, who was diagnosed with HIV in 1997. She volunteers at many of the food pantry sites as does she make her own four monthly visits. Receiving a small check each month for disability, she says, she wouldn’t be able to afford medication and food without the help of the program.

“They give you good nutritional food so you stay healthy,” she said.

NOLP program manager Tonya Hendricks said people line up at some of their other sites three hours before opening. “For many of our clients, we are their primary source of food,” she said. “In our program, we think of ourselves as trying to take away the struggle of ‘Do I buy food for my family or do I get my medications this week?’”

In addition to an income screening, eligibility is contingent on each person seeing a dietitian or participate in a number of nutritional classes that focus on such things as diabetes, high blood pressure, food-water safety and how to understand food labels.

APLA Dental Services, established in 1985, was the nation’s first community-based dental clinic exclusively for people with HIV/AIDS and serves an average of 2,500 clients between its two already-established facilities and expects to service up to an additional 500 people at its new Watts/Willowbook facility.

Fees and co-pays are also based on income, but “the reality is that 95 percent of the people that will use the dental clinic will be poor enough that they have no co-pay or they will have denti-cal,” said Thompson. Their income cannot exceed more than $1,395 per month. “The other five percent typically have a small co-pay.”

Most of their operating expenses will be covered by a grant from the L.A. County Public Health Office of AIDS Programs and Policy, which also helps fund their mobile dental clinic.

The dental clinic at the facility will operate three days, Tuesday and Thursday — the last day has yet to be finalized — a week from 7:30 a.m. to 4 p.m. Vitero anticipates that the clinic will be open full time within the next year or two once it has grown its client base.

The construction of the facility/clinic, as well as the equipment inside, costs approximately $900,000.

The S. Mark Taper Foundation, to which it is named after, gave APLA a $300,000 grant, the rest was gathered through public and private partnerships — one being the M.A.C. AIDS Fund.

The land on which it was built on was donated by the County of Los Angeles. Thompson credits former 2nd District county Supervisor Yvonne Braithwaite-Burke’s involvement for the facility’s completion.

Burke’s successor, Supervisor Mark Ridley-Thomas said dental care for people with HIV/AIDS has been identified as one of the “most-needed” services by people living with HIV/AIDS in L.A. County.

“That’s why I’m thrilled that this [new] AIDS Project Los Angeles [facility] is … conveniently located near this area’s largest provider of HIV/AIDS services, the OASIS HIV/AIDS Clinic.”

This is the second time the S. Mark Taper Foundation provides funds to APLA. In 2004, the foundation donated approximately $25,000 to fund an APLA mobile clinic.

By Leiloni De Gruy, http://news.newamericamedia.org/

March 10, 2009

Norway has become the latest country targeted in a growing global movement to eliminate HIV criminalization laws, many of which have been attributed to promoting stigma surrounding the virus and, therefore, discouraging people from seeking testing and treatment.

An anonymous nonprofit Norwegian AIDS activist group called HIV Manifesto distributed an international call-to-action on January 9. The group was seeking signatures of support to convince the Norwegian Parliament to abolish Section 155 of its Penal Code, which the group believes unfairly criminalizes people living with HIV.

The section states, “Any person who has sufficient cause to believe that he is a bearer of a generally contagious disease that is hazardous to public health, willfully or negligently infects or exposes another person to the risk of infection shall be liable to imprisonment for a term not exceeding six years if the offence is committed willfully and to imprisonment for a term not exceeding three years if the offense is committed negligently.*”

It continues, “Any person who aids and abets such an offense shall be liable to the same penalty. If the aggrieved person is one of the offender’s next of kin, a public prosecution shall be instituted only at the request of the aggrieved person unless it is required in the public interest.”

The effects of vague, uninformed HIV criminalization are far-reaching, and they undermine prevention and treatment efforts around the world. In sub-Saharan Africa, more than 10 countries enforce criminal laws concerning HIV in their alleged attempt to prevent the spread of the virus. One such law levies criminal charges against women who don’t take measures to prevent transmission of the virus to their offspring, while numerous churches in Nigeria have adopted a “no test, no marriage” law by which potential brides and grooms are required to take HIV tests before they can wed.

Even in the United States, men and women are charged for potential HIV exposure in circumstances where transmission is not possible. In May 2008, Willie Campbell, an HIV-positive homeless man in Dallas, was arrested for drunk and disorderly conduct after spitting in the face of the arresting officer. He was sentenced to 35 years in prison for harassing a public servant because his saliva was deemed a “deadly weapon,” despite the U.S. Centers for Disease Control and Prevention’s (CDC) assertion that saliva has never resulted in HIV transmission.

The Norwegian manifesto is in direct response to the Justice Advisory Group of the Norwegian Parliament’s recently proposed revision of the Penal Code. According to HIV Manifesto, while the revision is “less strict” and has “slightly modified” Section 155, “the criminalization of HIV will continue.”

The group asserts this is because the Penal Code, which was introduced in 1902 to prevent the spread of infectious diseases, as of late has been applied only in cases specifically concerning HIV and is often referred to as the “HIV paragraph.” Section 155 has never been documented as a preventative measure. On the contrary, the number of reported HIV infections in Norway has increased from 238 to 299 since 2003, when the maximum penalty was increased from three to six years.

Accordingly, Norwegian Parliament member Anette Trettebergstuen said, “The Penal Code is not efficient as a means of reducing HIV infections. Statistics show us clearly that the numbers of new diagnoses have increased in recent years since the criminalization was initiated. Information and knowledge are the right way to go, not threats of criminal prosecutions.”

Likewise, South African Supreme Court Judge Edwin Cameron called the manifesto an “important, well-written, informative, inspirational piece of work.” In a recent interview with advocacy group HIV Norway, Cameron went on to state, “Stigmatization is the driving force behind these laws. And the laws are themselves further increasing the stigma. The Norwegian paragraph clearly is discriminating against HIV-positive people. It claims to regulate several diseases, but in reality it is only being used against HIV. The government’s suggested revision will not make any significant change or improvement.”

Consequently, HIV Manifesto believes that revising Section 155 is not enough; instead, it wants the section completely removed from Norway’s Penal Code to prevent any future revisions from targeting HIV-positive Norwegians.

“To our knowledge,” stated HIV Manifesto, “this is the first time anyone has produced a manifesto aimed at abolishing the criminalization of HIV. We are working toward a goal bigger than removing this paragraph: toward a reality, a future, where HIV is considered a medical diagnosis. Period. One that comes without stigma and all the social burdens we see in various cultures today. It was not so long ago that cancer was considered a shame, and people withered and died at home behind drawn curtains. Today, the stigma has vanished from that diagnosis. In a not so distant future, we are convinced, the same will be the case regarding HIV. We want to accelerate this process. It has been going on too long and has caused, and still causes, immense suffering, from gay men to housewives to African mothers.”

In light of HIV-criminalization issues such as those addressed by HIV Manifesto, questions arise as to when punishment is in fact appropriate. Where should a government draw the line ethically? Does it have a fiduciary duty to punish for willing intent, or only after that willing intent results in infection? Perhaps the Norwegian manifesto will inspire other governing bodies to at last resolve such persistently unsettling dilemmas.

To learn more about the manifesto, please go to hiv-manifesto-norway.blog.com.

*Translation provided by Inger-Lise Hognerud of behalf of HIV Norge.

by Nick Fowler, http://www.poz.com

March 10, 2009

A noninvasive method for determining liver damage, called transient elastography, is nearly as accurate as a liver biopsy in people with hepatitis C virus (HCV) infection, according to a study published in the April 1 issue of Clinical Infectious Diseases.

A liver biopsy, which involves inserting a large needle through the back into the liver to collect tissue, can be quite painful and sometimes results in internal bleeding and other side effects. Biopsies can also, due to the small amount of tissue taken, underestimate the amount of liver damage a person living with hepatitis actually has.

Because of this, too many people infected with HCV avoid having biopsies in the United States. Nevertheless, biopsies are the gold standard for diagnosing liver damage in people infected with HCV and assessing the urgency for HCV treatment.

Elastography—which uses an ultrasound machine to detect the elasticity or stiffness of the liver—has proved in some studies to be quite effective. The stiffer the liver, the more likely it is to have damage. This noninvasive method has gained increasing acceptance in Europe, but it is not yet widely available in the United States outside research settings. Elastography has not, therefore, been tried in significant numbers of African Americans or in people coinfected with HCV and HIV.

To determine the method’s accuracy in a U.S. population of people infected with HCV, Gregory Kirk, MD, PhD, from Johns Hopkins University in Baltimore, and his colleagues enrolled 192 HCV-infected patients participating in two Maryland cohorts to compare elastography and biopsy results. Most of the patients were male, African American and coinfected with HCV and HIV.

Kirk and his colleagues found that elastography results matched the results of liver biopsies about 85 percent of the time. In the remaining cases where there was disparity in the results, most people had an elastography score indicating more liver damage than was found in the biopsy.

The authors conclude that elastography could be useful in large clinical studies and that the technology could one day achieve greater accuracy. In the interim, they encourage physicians to be cautious about interpreting a single test result, whether from elastography or biopsy, particularly when the result indicates little to no liver damage while other tests—such as elevated liver enzymes—suggest that liver damage is likely.

http://www.aidsmeds.com

Researchers have estimated that there were about one million infections and a half a million deaths from HIV-related cryptococcal meningitis worldwide in 2006. The findings published in the February 20^th edition of the journal AIDS also show that sub-Saharan Africa had the highest global burden of cryptococcal meningitis among people living with HIV.

The scientists (led by Benjamin J. Park of the US Centers for Disease Control) did the study because although although cryptococcal meningitis is one of the most widely reported HIV-related opportunistic infections, the global burden is unknown

In regions with higher HIV burdens, particularly sub-Saharan Africa, cryptococcal meningitis has been reported to be on the increase (more than any other type of meningitis).

Studies from Zimbabwe, Rwanda, Central African Republic, Kenya and Tanzania have all shown increased incidence of cryptococcal meningitis as an AIDS-defining illness and a leading cause of AIDS mortality. Away from Africa, similar reports have emerged from India, Thailand and Asia-Pacific (see the December 2007 edition of HATIP, a clinical review on meningitis, for more information)..

The investigators said that understanding the burden of cryptococcal meningitis is an important public health goal that would enable adequate planning and prioritisation of resources to enable effective prevention of the disease.

The investigators carried out a systematic review of all available literature published in English after 1996. Articles were selected if they used prospective or retrospective cohort study design, reported incidence among PLHIV or reported results which could allow calculation of incidence among PLHIV. The researchers found 19 studies which met eligibility criteria.

The scientists used the 2007 United Nations Programme on HIV/AIDS (UNAIDS) estimates for adult and children prevalence as the global HIV estimates. They used median incidence rates from available studies to estimate region-specific cryptococcal incidence. For those regions where data were not available, the investigators imputed the rates using medians from regions of geographic proximity and similar economic development level.

The researchers estimated the regional cryptococcal burdens by multiplying the median incidence rate by the 2007 UNAIDS population prevalence estimate for each region. They then got the sum of all regional estimates to get the global burden of cryptococcal meningitis.

Due to variations in regional mortalities, the investigators estimated the deaths by using case-fatality rates from clinical trials conducted in high and middle-income countries. They also reviewed case series, surveillance reports, reports on outcomes of cryptococcal meningitis and consulted with clinical experts. The scientists assumed a 10-week case fatality rate of 9% among infected people in high-income countries and 55% for middle and low-income countries, except sub-Saharan Africa where the estimate was 70%.

The investigators found cryptococcal incidence ranged from 4% to 12% per year in the the reports. They had at least one eligible report per region except for Eastern Europe and Central Asia, North Africa and the Middle East, and the Caribbean. The incidence for Eastern Europe and Central Asia, and North Africa and Middle East were estimated at 1.7% per year (same as East Asia). For the Caribbean, the researchers assumed an incidence of 3.4% per year (same as Latin America).

The scientists estimated 957,900 (range 371,700-1.54 million) cases of cryptococcal meningitis in 2006. Sub-Saharan Africa had the highest numbers of infection (720,000; range 144,000-1.3 million) followed by South and South-East Asia (120,000; range 24,000-216,000). Oceania had the fewest estimates (100 cases) followed by Western and Central Europe (500 cases). The researchers said these estimates of both infections and deaths will be useful for public health efforts to prevent, diagnose and treat the disease.

The researchers further estimated about 624,725 (range 124,956-1.2 million) cryptococcal meningitis deaths in 2006. Again sub-Saharan Africa had the highest (504,000; range 100,800-907,200) and Oceania had the fewest (9) death estimates.

When the scientists compared the death estimates for sub-Saharan Africa with other diseases other than HIV, they found that cryptococcal deaths were higher than tuberculosis (350,000) which has received greater public health attention: and were closely comparable to childhood cluster diseases combined (530, 000), diarrhoeal diseases (708,000) and malaria (1.1million).

The researchers acknowledged that their estimates were restricted by limited available studies and the limitations of the available studies themselves. They also noted that provider-based cohort studies may be limited by incomplete follow-ups.

However, they felt the estimates are fairly accurate (particularly for sub-Saharan Africa) because their estimates are consistent with possible calculations from HIV cohort and natural history studies which have reported that about 13 to 44% of AIDS deaths in the region result from cryptococcal meningitis.

Although most of the estimates in their study were determined prior to antiretroviral roll-out efforts, the researchers said the expansion of treatment is not likely to impact on the global burden soon because access to treatment is not yet universal and in some cases (such as South Africa) the rates of cryptococcal meningitis have actually gone up despite increased access to treatment.

Acknowledging that access to treatment can substantially reduce the disease among PLHIV, the scientists noted that the introduction of antiretroviral therapy has led to a drop in incidence of cryptococcal meningitis mainly in North America and Western Europe.

The researchers said their findings emphasise the growing and future need for attention to the problem in regions with higher HIV burden. They suggest the expansion of accurate and simple to implement diagnostic technologies, further research into the disease and expansion of treatment options .

In his commentary, Thomas S. Harrison of St. George’s University, London, acknowledged that despite study biases, there is little doubt that HIV-related cryptococcal mortality in Africa has been underestimated over the years..

He further said that the current study is important in stressing the need to address the problem of cryptococcal disease. Apart from fluconazole prophylaxis, he suggested pre-emptive fluconazole therapy for those who screen positive for cryptococcal antigen before starting antiretroviral treatment, suggesting that such strategy would prevent one third of cases that present after starting antiretroviral therapy.

He concluded that many patients in Africa simply present too late for current antifungal therapy to be effective. He also called for efforts to facilitate earlier diagnosis and treatment and trials to compare amphotericin B-based and oral antifungal regimens as well as to determine the best time to start anti-HIV treatment for those diagnosed with cryptococcal infection.

References
Harrison TS. The burden of HIV-associated cryptococcal disease (Editorial comment). AIDS, 23:531-532. 2009

Park BJ et al. Estimation of the current global burden of cryptococcal meningitis among persons living with HIV/AIDS. AIDS, 23: 525-530, 2009

By John Owuor, http://www.aidsmap.com

By Hayden Eastwood, http://www.aidsmap.com

March 11, 2009

March 11, 2009

In a collaborative study with the World Health Organization and seven other laboratories, researchers at the School of Medicine have compiled a list of 93 common mutations of the AIDS virus associated with drug resistance that will be used to track future resistance trends throughout the world.

The researchers analyzed data from about 15,220 patients across the globe to develop an updated and accurate list of the most common, resistance-related mutations of the virus. The list was published March 6 in the online journal PLoS-One.

"The epidemic is changing, especially as new drugs are being developed," said Robert Shafer, MD, associate professor of infectious diseases and geographic medicine at Stanford and the senior author of the paper. "To effectively track the spread of drug resistance, particularly transmitted drug resistance, you need a sensitive and specific list that's considered standard and is adopted by all the surveillance studies."

The list is important, he said, as it helps countries gauge the effectiveness of their HIV medication programs. But assembling such a list can be a challenge, particularly with a virus that has so many resistance-related variants.

On the one hand, if the list is too liberally defined, then HIV drug funders and providers may believe resistance is more widespread than is the case. "That will cause problems in countries. They may be concerned about whether their drugs will work," Shafer said.

On the other hand, if the list is too restrictive, there is a risk of underestimating the actual extent of resistance, Shafer said. "So there is a real challenge to using the right number of mutations," he said.

In 2007, Shafer and his colleagues published a similar list of 80 HIV mutations that has since served as the basis for global AIDS surveillance work. However, with the scale-up of antiretroviral drug programs in the last two years and the introduction of new medications, resistance patterns have changed. So there was a need for a newly updated reference, he said.

The data used in the study was derived from a publicly available, searchable database that Shafer and his colleagues began at Stanford in 1998. Known as the Stanford HIV RT and Protease Sequence Database, it includes information on the two key proteins targeted by HIV drugs: reverse transcriptase and protease. More recently, the researchers have begun gathering resistance data on integrase inhibitors, the latest class of antiretroviral drugs to be introduced. However, this data was not included in the study, as these drugs are not yet in wide use, particularly in developing countries.

To compile the latest list, the researchers added data from other laboratories in Europe, Canada and the United States to include more than 15,000 sequences from untreated individuals, double the number available in 2007. To ensure geographic diversity, information was included for eight different subtypes of the virus, as these vary from one region of the world to another.

The researchers scoured the data to ensure they included only those mutations that were clearly recognized as causing or contributing to resistance. They excluded polymorphisms, or variants of the virus that can arise naturally, as well as drug-related mutations that occur rarely.

The result was that 16 new mutations were added to the 2007 list, while three were dropped. Shafer said it was reassuring to find minimal changes were needed.

"It shows the first list was quite good," he said.

Shafer's Stanford colleagues in the study are Mark Kiuchi, Tommy Liu, Soo-Yon Rhee and Jonathan Schapiro, MD. The research was funded by the National Institutes of Health.

By Ruthann Richter, http://news.stanford.edu

March 12, 2009

Professors Eddy and Gail Ferstandig Arnold Gail Ferstandig Arnold and Eddy Arnold may have turned a corner in their search for a vaccine against HIV – the virus responsible for AIDS. In a paper published in the Journal of Virology, the husband and wife duo and their colleagues reported on their research progress.

With the support of the National Institutes of Health, the Arnolds and their team have been able to take a piece of HIV that is involved with helping the virus enter cells, put it on the surface of a common cold virus, and then immunize animals with it. They found that the animals made antibodies that can stop an unusually diverse set of HIV isolates or varieties.

While researchers previously had been able to elicit effective antibodies, they usually only acted against a very limited number of HIV types. With HIV’s known propensity to mutate, antibodies developed against one local strain may not recognize and combat mutant varieties elsewhere. The challenge is to find a broad spectrum vaccine capable of protecting against the HIV varieties.

The Rutgers team identified a part of the AIDS virus that is crucial to its viability – something it needs in order to complete its life cycle – and then targeted this Achilles heel. In this case, the part plays a role in the ability of HIV to enter cells and is common to most HIV.


The Arnolds are members of the Center for Advanced Biotechnology and Medicine, a joint research institute of Rutgers and the University of Medicine and Dentistry of New Jersey. Also, Gail Ferstandig Arnold is a research professor and Eddy Arnold is a professor, both in Rutgers’ Department of Chemistry and Chemical Biology.

While most vaccines are actually made from the pathogen itself, employing weakened or inactivated organisms to stimulate antibody production, HIV is just too dangerous to use as the basis for a vaccine vehicle. Instead, they used the relatively innocuous cold-causing rhinovirus and attached the target portion of the HIV. This must be done in a way that maintains the HIV part’s shape so that when the immune system sees it, it will actually mount an immune response as it would to the real HIV.

Using recombinant engineering, the research team developed a method to systematically test millions of varied presentation of the HIV segment with the rhinovirus. They tried millions of different variations on how to graft (or splice) one on to the other, creating what are called combinatorial libraries.

“The really exciting part is that we were able to find viruses that could elicit antibodies against a huge variety of isolates of HIV. That is an immense step and a very important step,” said Gail Ferstandig Arnold.

“However, we need to be careful to not overstate things because the quantity of response is not huge, but it is significant,” added Eddy Arnold. “This is actually the first demonstration of this particular Achilles heel being presented in way to generate a relevant immune response. It is probably not potent enough by itself to be the vaccine or a vaccine, but it is a proof of principle that what we are trying to do is a very sound idea.”

Contact: Joseph Blumberg
732-932-7084 ext. 652
E-mail: blumberg@ur.rutgers.edu

By Michael Carter, http://www.aidsmap.com