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 31, 2009

A member of a popular Victoria marimba band has been sentenced to 10 years less three days for having unprotected sex with four Greater Victoria women without telling them he was HIV positive.

On March 2, Charles Kokanai Mzite, 37, was convicted of four counts of aggravated sexual assault between May 2001 and November 2005. Today, B.C. Supreme Court Justice Robert Johnston told Mzite he had committed offences that could only be described as “profoundly selfish.”

“You infected one woman and exposed three others to very serious risk to satisfy your own needs for intimacy and sexual gratification,” said Johnston.

“Each of the complaints would have refused to have sexual intercourse with Mr. Mzite if she’d known he was HIV positive. Each of the cases occurred in the context of a relationship. ... Each of the victims felt safe because he denied he was HIV positive.”

Johnston sentenced Mzite to four years for the woman he infected with HIV, the virus that causes AIDS, and two years less a day for each of his other three victims. The sentences are to be served consecutively.

Mzite, who was been in custody since September 2007, was credited with 37.5 months time served. This means he must serve a further six years and 10 months in prison.

Mzite, a dancer and musician who used to perform with the Jambanja group on the streets of downtown Victoria, must also comply with the National Sex Offender Registry and provide a DNA sample. The judge did not impose a weapons prohibition as requested by Crown prosecutor Nils Jensen.

Defence lawyer Martin Allen indicated to the court that his client might appeal his conviction.

Mzite, who appeared in court with his head shorn, chose not to address the court before Johnston passed sentence upon him. He sat impassive, slumped in a corner of the prisoners’ dock. None of his victims were present in the courtroom.

Johnston acknowledged the sentence will affect Mzite’s immigration status. Mzite came to Canada from Zimbabwe in 2001. He has been a convention refugee since his application was accepted in 2001 and is a protected person under the Immigration and Refugee Act.

“I have evidence, that as a result of these convictions, Mr. Mzite will, in all likelihood, be ordered deported from Canada,” said Johnston.

Although, with a sentence of four years, Mzite has lost his right of appeal to the Immigration Appeal Board, he will not be deported automatically, said Johnston. As a protected person, he has a right to appeal directly to the Minister of Citizenship and Immigration.

“The minister will be called upon to balance the risk to the Canadian public if Mr. Mzite is allowed to remain in Canada against the risk Mr. Mzite will be persecuted, tortured or subject to cruel or unusual punishment if he is removed to Zimbabwe.”

Johnston also noted Mzite’s health would be at risk if he is deported. Treatment for HIV is much more advanced in Canada than in Zimbabwe.

“I do conclude that without the kind of treatment available here, Mr. Mzite’s infection will almost inevitably progress much faster and lead to his death much sooner. But Mr. Mzite will have an opportunity to be heard in the deportation process,” said Johnston.

Johnston noted that Mzite applied himself well in custody, taking courses in respectful relationships, substance abuse management and peer education to help in harm reduction.

By Louise Dickson, Times Colonist

March 28, 2009

Calgary - Calgary Catholic teachers have cancelled a fundraiser for AIDS relief in Africa after a local bishop spoke out against a prominent Canadian and his foundation’s AIDS prevention programs, which include promoting condoms.

But with the Stephen Lewis Foundation donating hundreds of thousands of dollars annually to several church-run AIDS programs in Africa, Lewis said that the bishop’s efforts to “excommunicate” the charity are only going to hurt Catholics there.

“The bishop didn’t stop to think, when you say to teachers you can’t raise money for a foundation that is directly supporting Catholic projects in Africa, then you are discriminating against those projects. You are harming your own people,” Lewis said.

Teachers at the Calgary Catholic School District have been passing the hat around among themselves during Lent for the past five years to raise money for the Stephen Lewis Foundation’s AIDS work in sub-Saharan Africa.

Last year, teachers raised $45,000 through personal and matching donations, said Calgary Catholic Teachers’ Association president David Cracknell.

But in December, a parishioner approached Calgary Bishop Fred Henry with questions about teachers raising funds for an organization that uses condoms in its AIDS prevention programs, he said.

Henry met with Cracknell to discuss the issue, then sent a letter to the teachers’ association encouraging members to focus their fundraising efforts on other organizations in Africa.

“For me, it’s been a difficult issue,” said Cracknell.

“I understand the commitment our teachers have toward helping people in Africa with AIDS. I understand the fact Stephen Lewis is a very prominent Canadian, and people are very committed to his charity. But I also understand the bishop is our moral guide.”

In a letter to the editor of the Calgary Herald, Henry said the Christian virtues of chastity, abstinence and fidelity are “the most effective means of primary HIV prevention,” and should not be pushed aside as valid prevention options in favour of passing out condoms.

When asked about his opposition to the Stephen Lewis Foundation, Henry said teachers do have other options in supporting AIDS charity efforts in Africa.

“If you have two businesses or organizations, one that doesn’t support your values and mission statement and another that does, which one are you going to support? I think that the answer is obvious,” Henry told the newspaper in an e-mail.

The Calgary Catholic Teachers’ Association is evaluating whether it will organize fundraisers for Lewis’s foundation in future.

By Sarah McGinnis, www.theherald.canwest.com

March 28, 2009

Regina -- Saskatchewan says it will hire up to 15 new workers over the next several years to deal with what medical officials are calling an alarming increase in HIV cases.

The province recorded 170 new cases last year - a 40 per cent increase - which is about twice the national average. Dr. Moira McKinnon, the province's chief medical health officer, says more than half of the cases are women under the age of 30 and most of the cases involve intravenous drug use.

About 65 per cent of the people are aboriginal, including two girls who are under 15. Seven babies were also born HIV positive.

"It is alarming," she says. "We're having women turn up who have had no pre-natal care and delivering babies and they're HIV positive. These people aren't accessing the health system."

McKinnon says most of the new cases involve people who live in poor urban areas.

"Most of the cases are reported in Saskatoon, Regina and Prince Albert, but because the population is transient, it may be that they also have community homes and they're only disclosing their urban addresses. So we have some work to do in that area."

She says the province is also looking at bolstering testing and early treatment of HIV, the virus that leads to AIDS.

"Diagnosing people early and getting them on treatment is one of the most effective ways of preventing transmission," she says.

The Canadian Press, http://www.ctv.ca

March 30, 2009

Summerside, PEI  – Anonymous HIV/AIDS testing is needed on P.E.I., according to Mark Hanlon. And it’s something the AIDS P.E.I. executive director plans to push government for.

“Right now we are the only province in Canada, yet again, that doesn’t have anonymous testing, which is a big problem,” said Hanlon. “If you don’t provide anonymous testing people are wary of getting tested.”

Islanders wanting to be tested for HIV/AIDS do so through their doctor via nominal testing, where their name is on the request, or non-nominal testing.

“People can go to their doctor, their doctor knows who they are and there’s a code submitted to government,” Hanlon said, explaining non-nominal testing.

With anonymous testing, a subject doesn’t provide their name or other personal information. Only the person tested knows they were tested and is privy to their results.

Hanlon said AIDS P.E.I. could potentially be a test site.

“They could go in on a Monday, get tested, and on Friday, they just come in, give a number. We have the numbers for the tests and they get the test results back,” he added. “If they want to come back and talk to us about a positive result or they want to talk about a negative result and how they can avoid problems then we can do that.”

But providing anonymous testing would require government’s help.

“We need somebody on site. It doesn’t mean they have to give us any money. They could provide a nurse,” said Hanlon. “One-day-a-week testing and having the nurse come back later in the week to distribute the results would be great. That way there’s no face-to-face contact with other health professionals besides that nurse.”

The Province currently isn’t looking at introducing anonymous testing.

“We have not had a request from anyone to do it anonymously or a proposal from anybody who would do it. We would take it on and look at it if a request came,” said Dr. Lamont Sweet, deputy chief health officer. “It does require that a physician be responsible for requesting the test. So, if a physician wanted to apply to do that anywhere, then we would have to look at that.”

Since 1985 46 people have registered as having HIV or AIDS.

Hanlon said AIDS P.E.I.’s goal is to eventually provide anonymous testing “in each corner of the province.”

“We’ve kind of had it on our radar for awhile,” he added. “It certainly would be a fantastic thing.”

Four types of HIV testing in Canada:


By Nancy MacPhee, http://www.journalpioneer.com

March 31, 2009

Patients with HIV/AIDS are not getting the special care they require, the Newfoundland and Labrador AIDS Committee says.

The only infectious disease specialist in the province recently moved away, and out-of-province physicians now provide sporadic services every five weeks.

Chris Pickard, executive director of the AIDS committee, said a regular clinic has been suspended because its nurse-practitioner is on leave until at least mid-April, and a social worker assigned to it is available for just over a day each week.

He said people living with HIV/AIDS are feeling abandoned.

"We're not about trying to create panic, but I think we have to make sure that this kind of goes to the highest level, that this is a critical health issue," Pickard told CBC News Tuesday.

"People right now don't know what to do. They're calling into the clinic, leaving a message, and hopefully, someone is getting back to them," said Pickard, adding patients are optimistic that a new infectious diseases specialist will soon be hired.

In a statement, Eastern Health said Tuesday it hopes to resume its clinics by late April.

The clinics will continue until August, or until a new infectious disease specialist is on duty. Until then, internal medicine specialists will provide consultations with patients.

"Eastern Health would like to emphasize that these are interim contingency measures, designed to ensure care for our infectious disease patients until a full-time specialist is in place," the authority said.

Eastern Health said it hoped to finish negotiations with a new specialist "in the very near future."

Last week, patients and their supporters held a rally at Confederation Building to raise awareness about the lack of regular treatment.

http://www.cbc.ca

March 30, 2009

A couple of years ago, I did a documentary on AIDS in the aboriginal community in Saskatchewan. I called it The Hidden Plague. Today, it's not so hidden. It's a crisis.

When I first looked at HIV/AIDS in the province, the problem was serious and experts expected it to worsen. Saskatchewan now leads Canada in new cases of HIV per capita, with double the national rate.

Last year, Saskatchewan had 174 new cases of HIV. This was up 40 per cent from the previous year, when there were 124 new cases. The number is expected to rise this year and next.

Even more alarming is the fact that one-quarter of the HIV-positive babies born in Canada are in Saskatchewan. Of the 23 HIV-positive babies born across Canada last year, seven were in this province.

These may seem like small numbers when we look at a provincial population of about a million people, but the incidence of AIDS is located in pockets and includes a disproportionate number of aboriginal people.

A virulent new strain of HIV has emerged that does not respond well to existing medication. AIDS is a long-term disease that can take years to take hold and can be controlled for years after that.

But this new strain takes about two years to move from an HIV infection to full blown AIDS. This means that in the future we will see increased costs and stresses on the medical system.

So what is the reason behind this epidemic? There is a shallow answer and a deeper one.

First, HIV/AIDS most often is a product of a high-risk lifestyle. Intravenous drug users and sex trade workers are the groups most at risk.

The drug of choice in Saskatchewan for many people is injection cocaine, and 60 per cent of the new cases were associated with injection. This addiction can lead up to 20 needles per day.

Drug addiction and prostitution go hand in hand. Most sex trade workers are on the street because of a drug addiction. Many are slaves to their pimp, who keeps them high in return for cash. HIV-positive sex trade workers pass it on to the johns, who spread it throughout the population.

This is reflected in the fact that almost one-third of the new HIV cases are women under age 29, with the youngest 15 years old. Many of these women are aboriginal.

The next question is: Why are aboriginal people most likely to be in a high-risk lifestyle?

Poverty plays a huge part. Lack of opportunity, poor education and related depression all play a role. But social issues are a symptom of a greater problem.

The root of the problem lies in history and societal factors.

For most of the 20th century, generations of our people were placed in residential schools.

This experience sapped our self-esteem, destroyed our social system and ruined our parenting skills. The results are still with us.

Since this is a crisis on several levels, it needs to be attacked the same way. We need more education about the dangers of intravenous drug use; where the problem already exists, we need to practise harm reduction. This means more needle exchange programs and the establishment of safe injection sites.

A lot of people see harm reduction as a stamp of approval or encouragement, but I see it as facing reality and treating people with respect.

Addicts are now treated as criminals. We need to move beyond a revenge mentality and treat addiction as a health issue.

The same goes for AIDS, which many people consider a less worthy disease because of how it is spread. In the end, it's a fatal disease just like many others.

At one time, AIDS was seen as a disease of gay men. Now it's a disease of poverty.

It has taken root in the inner cities in the United States, the slums of Asia and villages in Africa. It has also found fertile ground in the aboriginal slums of Western Canada.

The growing incidence of AIDS is moving to a crisis and there is no end in sight. The root problems that lead to drug use and prostitution continue to exist. Our people are living in grinding poverty and its damage is evident.

Until governments and individual address the root causes, there will be no letup in the AIDS crisis.

By Doug Cuthand, Saskatoon StarPhoenix, The Victoria Times Colonist

1. Research May Support Pope's Comments Against Condom Use in Africa, Opinion Piece Says

March 30, 2009

Pope Benedict XVI "set off a firestorm of protest" earlier this month when he commented that condom distribution "isn't helping, and may be worsening" the spread of HIV/AIDS in Africa, but "in truth, current empirical evidence supports him," Edward Green, a senior research scientist at the Harvard School of Public Health, writes in a Washington Post opinion piece. The condom has become a "symbol of freedom and -- along with contraception -- female emancipation," Green writes, adding that those who "question condom orthodoxy are accused of being against these causes." Members of the HIV/AIDS and family planning communities "take terrible professional risks if we side with the pope on a divisive topic such as this," Green writes, noting that his comments "are only about the questions of condoms working to stem the spread of AIDS in Africa's generalized epidemics -- nowhere else."

According to Green, several research articles published in peer-reviewed journals such as the Lancet, Science and BMJ "have confirmed that condoms have not worked as a primary intervention in the population-wide epidemics of Africa." He adds that condom promotion "has worked" in countries such as Cambodia and Thailand, where HIV is transmitted primarily through commercial sex. "In theory, condom promotions ought to work everywhere," Green writes, adding that this is "not what the research in Africa shows."

Green writes that "people think they're made safe by using condoms at least some of the time" and they "actually engage in riskier sex." In addition, many people in Africa rarely use condoms in stable relationships "because doing so would imply a lack of trust," Green continues, adding that it is "those ongoing relationships that drive Africa's worst epidemics" where most HIV cases occur in general populations rather than high-risk groups like commercial sex workers, men who have sex with men or injection drug users. "And in significant proportions of African populations, people have two or more regular sex partners who overlap in time," creating an "invisible web of relationships through which HIV/AIDS spreads," Green writes. What has proven effective in Africa are "[s]trategies that break up these multiple and concurrent sexual networks -- or, in plain language, faithful mutual monogamy or at least reduction in numbers of partners, especially concurrent ones," Green writes, adding, "'Closed' or faithful polygamy can work as well."

Green says that he is "not anti-condom," adding, "All people should have full access to condoms, and condoms should always be a backup strategy for those who will not or cannot remain in a mutually faithful relationship." In addition, "liberals and conservatives agree that condoms cannot address challenges that remain critical in Africa such as cross-generational sex, gender inequality, and an end to domestic violence, rape and sexual coercion," Green continues, concluding, "Surely it's time to start providing more evidence-based AIDS prevention in Africa" (Green, Washington Post, 3/29).

http://www.kaisernetwork.org

2. Medical Journal Slams Pope’s Condom Lie

March 29, 2009

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During the pope’s first trip to Africa earlier this month, he said HIV is a “tragedy that cannot be overcome by money alone, that cannot be overcome through the distribution of condoms, which can even increase the problem.”

“The Catholic Church’s ethical opposition to birth control and support of marital fidelity and abstinence in HIV prevention” are “well known,” states The Lancet’s editorial, which some criticized as “virulent.” “But, by saying that condoms exacerbate the problem of HIV, the pope has publicly distorted scientific evidence to promote Catholic doctrine on this issue,” said the editorial.

“The governments of Germany, France, and Belgium released statements criticizing the pope’s views,” as did aid agencies, The Lancet said. “The Joint United Nations Programme on HIV/AIDS, the U.N. Population Fund, and the World Health Organization released an updated position statement on HIV prevention and condoms, which said that “the male latex condom is the single most efficient, available technology to reduce the sexual transmission of HIV.”

“Whether the pope’s error was due to ignorance or a deliberate attempt to manipulate science to support Catholic ideology is unclear,” said the editorial. “When any influential person, be it a religious or political figure, makes a false scientific statement that could be devastating to the health of millions of people, they should retract or correct the public record. Anything less from Pope Benedict would be an immense disservice to the public and health advocates, including many thousands of Catholics, who work tirelessly to try and prevent the spread of HIV and AIDS worldwide.”

The editorial is titled “Redemption for the Pope?”

http://www.hivplusmag.com

March 30, 2009

Although former President George W. Bush "made an ambitious new commitment to the global fight against AIDS," and Congress in 2008 "authorized billions in new spending," lawmakers and philanthropists "will retreat" as the current economic recession continues, a Providence Journal editorial says. So it "comes as a rare bit of good news" that Phillip Ragon -- founder of the software company InterSystems Corp. -- is "giving $100 million of his own to the quest for an AIDS vaccine," the Journal says. Ragon "will allocate his gift in $10 million annual installments over 10 years" to the newly formed Ragon Institute -- a collaboration between Massachusetts General Hospital, the Massachusetts Institute of Technology and Harvard University -- the Journal continues, adding that the three groups will "join in an effort to find new approaches" to an HIV/AIDS vaccine.

A vaccine for HIV/AIDS "has been the holy grail of AIDS research" but has proven difficult to find because the disease "has shown an uncanny ability to alter its makeup and elude destruction," the editorial says. The Ragon Institute aims "to find new ways of deploying the immune system against a variety of diseases, not just AIDS," the Journal writes, adding that the "hope is that, for example, MIT engineers can lend new perspectives to the medical doctors, biologists and others who have already spent years tilling this hard soil." The Journal says that "[p]hilanthropists everywhere are cutting back on or suspending charitable contributions," but a 2007 visit to South Africa "convinced [Ragon] there was no time to waste." Ragon's "inspiring example may encourage others leery of giving. May the Ragon Institute succeed," the editorial concludes (Providence Journal, 3/27).

http://www.kaisernetwork.org

March 31, 2009

Bangkok - The most heartbreaking moment for doctors and nurses treating people with HIV/AIDS in Myanmar is the arrival of a new patient. Running short of funds and medications, clinics have started turning dying people away.
“They continue to knock on our doors, even though we can’t take in most of them,” said Joe Belliveau, operations manager of the international aid group Médecins Sans Frontières.

The 23 clinics run by the group, also known as Doctors Without Borders, are the primary dispensers in Myanmar of the antiretroviral drugs that can prolong the lives of those infected with HIV., the virus that leads to AIDS. So most of the people it cannot treat are likely to die.

The people of Myanmar, a country that seems to have been marked for suffering, receive little foreign assistance — the country ranks among the lowest per capita for such aid in the world. The same is true for assistance for people with HIV/AIDS.

Médecins Sans Frontières estimates that 240,000 people are currently infected with H.I.V. in Myanmar and that 76,000 are in urgent need of antiretroviral drugs. Every year, about 25,000 people with the virus die.

The group’s clinics have been providing 11,000 people with the antiretroviral drugs that keep them alive. The longer they live, the more treatment they need. The group says it is unable to increase its budget there without taking money away from people in need elsewhere.

Last year it made the difficult decision to stop accepting any new patients in order to continue treating the old ones. It has opened its doors a little bit this year, accepting 3,000 new patients, still a fraction of those in need.

“When we stopped last July it was devastating for the staff,“ Belliveau said. “They couldn’t even treat the ones dying on their doorsteps.”

This year, the United Nations-backed Global Fund To Fight AIDS, Tuberculosis and Malaria has applied for government permits to bring antiretroviral drugs into Myanmar, and the number of people receiving treatment is likely to rise.

But that will only be one step. Fewer than 20 percent of those who need the drugs receive them, either from international groups or, in very small amounts, from the government, Médecins Sans Frontières said in a report released in November.

When a photographer visited a clinic a few months ago, he found anguish and fatalism among the people who had not received the drugs.

“I can only live longer if I have ART,” said one 28-year-old woman, referring to the antiretroviral treatment she needs. “Most of the money and possessions I had are already gone. My family sends me food from the village, but they cannot support my treatment. If I get ART I will be able to live, if not, I will die.”

In one room the photographer found a 49-year-old man, gaunt and weak, sitting on the side of a bed. He had no family, and because of the stigma of the disease he was ashamed to tell his friends or co-workers about it.

“The worst thing for me is the loneliness,” he said.Two weeks after his picture was taken, he was dead.

http://global.nytimes.com/

1. HIV Before Hep C? Be Careful!

March 30, 2009

At a San Francisco forum titled “Could You Survive HIV Only to Die From Hepatitis C?” presenters talked about the growing number of hepatitis C virus infections found among HIV-positive men who have sex with men.

The Conant Foundation’s Dr. Marcus Conant said outbreaks of hepatitis C apparently linked to sexual activity began appearing among MSM in London and continental European cities around 2002. University of California, San Francisco, researcher Dr. Brad Hare said 42% of HIV-positive men in UCSF’s Positive Health Program now have HCV.

Recent acute HCV coinfections among HIV-positive men appear to represent “a new 21st century clinical syndrome,” said Dr. Daniel Fierer of New York’s Mount Sinai School of Medicine. Previous studies of monogamous HIV-negative heterosexuals indicated a sexual HCV transmission rate of less than 5% -- suggesting sexual transmission is rare. Though specifics vary among studies, the recent acute HCV outbreaks among MSM have been linked to unprotected anal sex, fisting, group sex, sharing sex toys, coinfection with other STDs, and the use of noninjected recreational drugs.

The process whereby HCV destroys the liver typically takes years or decades. But Fierer said his analysis of a small but growing number of coinfected MSM in New York suggests acute HCV infection in a person already infected with HIV leads to unusually rapid liver damage. He has theorized that existing HIV infection may predispose patients to accelerated liver fibrosis if they are subsequently infected with HCV. This rapid disease progression is not common in coinfected injection-drug users, who typically acquire HCV before HIV.

Fierer’s findings are controversial, since U.K. and European researchers have not reported similar rapid disease progression. However, they have tended to use noninvasive methods, not the more accurate liver biopsies employed by Fierer’s team, to evaluate liver damage.

Fierer added the good news that if HCV treatment is begun during the acute phase of infection, there is a good chance of both eliminating HCV and improving liver damage.

http://www.hivplusmag.com


2. Hepatitis C has no impact on CD4 cell recovery in patients taking HIV treatment

March 27, 2009

Patients co-infected with HIV and hepatitis C virus whose HIV treatment is suppressing their viral load to undetectable levels have comparable CD4 cell count increases to those seen in patients who are only infected with HIV, investigators report in the April 15th edition of the Journal of Acquired Immune Deficiency Syndromes.

It is estimated that there are 2 million HIV-positive individuals co-infected with hepatitis C virus in the European region. Earlier research has provided conflicting information on the effect of co-infection on CD4 cell recovery in individuals taking HIV treatment. Differences in adherence to HIV treatment or the potency of antiretroviral regimens were a potential limitation of this studies. Furthermore, they defined hepatitis C-co-infection as the presence of antibodies to the virus and did not investigate the influence of either hepatitis C replication or genotype.

Investigators from the EuroSIDA cohort therefore designed a prospective study to assess the influence of chronic hepatitis C-co-infection and genotype on CD4 cell recovery in HIV-positive patients whose HIV treatment achieved and sustained the suppression of viral load to undetectable levels (below 50 copies/ml).

Patients with antibodies to hepatitis C virus and at least two consecutive undetectable HIV viral loads after starting HIV treatment were eligible for inclusion in the study. The investigators calculated the annual change in CD4 cell count for these patients and then compared them to those observed in patients only infected with HIV whose antiretroviral therapy had suppressed viral load to undetectable. Further analyses were then performed to determine the impact of hepatitis C genotype and replication on CD4 cell recovery.

A total of 4208 patients were included in the investigators’ analyses. The first of these showed that there was no significant difference in the annual CD4 cell count increase seen in the co-infected patients (36 cells/mm3, 95% CI, 27.2-43.9) and the patients only infected with HIV (38 cells/mm3, 95% CI, 34.8-41.9).

These results did not change when the investigators adjusted for hepatitis C genotype. Nor were they altered by adjusting for nucleos(t)ide combinations, third antiretroviral drug, age, time since starting antiretroviral therapy, time to initial viral suppression, or whether an individual was treatment-naïve or treatment experienced when they started combination HIV therapy.

Taking into account ongoing hepatitis C replication did not significantly affect the results. Nor did the hepatitis C genotype influence CD4 cell recovery in these patients with ongoing hepatitis C replication. Finally the investigators compared changes in CD4 cell counts according to co-infected patients’ hepatitis C viral load. This showed that although annual CD4 cell gains (43 cell/mm3) were higher amongst patients with a hepatitis C viral load below 1 million iu/ml than those with a hepatitis C viral load above this level (35 cells/mm3), the difference was not significant (p = 0.43).

“In this large prospective cohort study, we provide evidence that hepatitis C virus coinfection does not influence the CD4 cell recovery in HIV-1-infected patients who are persistently maximally HIV suppressed…compared with HIV-monoinfected patients”, write the investigators.

Nor did they find any differences in CD4 cell gain when comparing patients who were hepatitis C “viremic vs. aviremic patients with hepatitis C virus antibodies, and between distinct hepatitis C virus genotypes among viremic patients.”

They do however conclude that co-infected patients may benefit from starting HIV treatment earlier than otherwise recommended “because studies have shown that combination antiretroviral therapy may slow fibrosis progression.” They also note the benefits of hepatitis C treatment for co-infected patients as “hepatitis C virus eradication will lower the risk of hepatotoxicity induced by antiretroviral drugs and progression of liver disease.”

Reference

Peters, L. et al. Hepatitis C virus coinfection does not influence the CD4 cell recovery in HIV-1-infected patients with maximum virologic suppression. J Acquir Immune Defic Syndr 50: 457-63, 2009.

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

Drug-resistant forms of HIV can be spread between individuals who have not received antiretroviral treatment, according to Deenan Pillay of University College, London, and the Health Protection Agency, speaking at the Society for General Microbiology meeting in Harrogate, England.

Antiretroviral therapy is a major advance in the treatment of HIV, and there are currently over 25 drugs available. It is known that the virus can mutate, reducing its susceptibility to treatment, and that these resistant viruses can be transmitted between individuals. Professor Pillay found that drug resistant viruses could also circulate between individuals who have not received antiretroviral drug treatments.

"Our findings show that assuming that drug-resistant HIV was only passed on from individuals receiving drug treatment may mean the number and size of the reservoirs of drug resistant virus…have been underestimated," said Pillay. "Our results indicate that although the incidence of drug resistance has been declining, this might not continue -- which could have implications for planning and management of treatment programs".

http://www.hivplusmag.com