Dr. Thomas Kerr: Public Health Hero

January 7, 2008

Kerr is a Research Dr. Thomas Scientist with the BC Centre for Excellence in HIV/AIDS and an Assistant Professor in the Department of Medicine at the University of British Columbia. In his current role at the BC Centre, Dr. Kerr is a principal investigator of several large cohort studies involving injection drug users, HIV-positive individuals and street-involved youth.

Dr. Thomas Kerr has been called a "public health hero" for his work in a controversial area — Vancouver's Eastside medical injection site program. Dr. Kerr's research evaluating North America's first safer injecting facility, Insite, has contributed significantly to academic, public and government discussions, both nationally and internationally. He spoke on the phone with Am Johal.

Am Johal: You recently won a research award related to your work with Insite. Can you tell me about that?

Dr. Thomas Kerr: I was awarded a Canadian Health research award in the area of knowledge translation. There is now a growing pressure on researchers to make sure that their work is translated into language that people can understand and that it is transferred to appropriate people, not just other researchers, but the broader public, policy makers and others. We’ve tried to communicate our findings in a way that the broader public can understand. It’s a credit to our entire research team to have our work recognized by the national research community.

You were involved with the supervised injection site, prior to it being open. I’m wondering if you can talk to the period prior to the site being opened?

I was working as a counsellor at the Dr. Peter Centre. I was working with people living with HIV/AIDS including many injection drug users. We experienced first-hand the frustration of dealing with their challenges without being able to deal with their addictions.

There was a growing pressure to set up a pilot project. I was doing my PhD at the University of Victoria and was gaining more experience in research. A number of community-based AIDS organizations and organizations serving drug users wanted to develop a pilot study of a safe injection site. Given that I had a background in both health care and research, people thought I was an appropriate candidate. I travelled overseas, went through the literature and developed a model that would work in Vancouver.

From the outset, we wanted to implement a pilot project and evaluate it rigorously. It was always the plan to proceed cautiously. We wanted to ensure the appropriate level of scientific evaluation.

There have been well over 20 peer-reviewed articles supportive of the site in terms of what the intent was and the outcomes have been. Can you speak to that?

The main findings were that the site was having a positive effect [on] reducing public disorder, HIV/AIDS risk behaviour such as needle sharing, assisting people in getting into detox and addiction treatment. We’ve also looked at studying whether adverse effects were occurring — but we did not find that the site led to an increase in drug use, new drug users starting to inject, drug related crime or open drug use.

Have the rates related to communicable diseases tailed off?

We haven’t really looked at that closely enough yet. From an epidemiological perspective, I’m sure that’s the way to go about it. This is a tiny pilot facility. With 12 seats open 18 hours a day, we have a small pilot facility and only a small number of injections that happen every day in this neighbourhood. The site only covers about five to ten per cent of injections that happen in the neighbourhood each day.

For many, the wait is too long or the site is closed when they want to use it. The way to investigate this is not to look at the population level, but rather to look at a sub-population who uses the facility. At that level, we have some relevant examples. There have been close to 1000 overdoses and nobody’s died. We’re continuing to look at numbers like that.

A recent federal government study attempted to place conditions on your research on Insite. Can you speak to that?

Health Canada put out a request for proposals. We were offered one contract. The contract contained an intellectual property clause that stated that the researchers could not utilize the information produced under the contracts unless approved by Health Canada, and it was said that this approval was expected to be given within six months. Our lawyers at UBC and community partners had major issues with that. We contacted a lawyer at UBC, since most of the members of our research group are faculty at UBC, and we were told that as faculty we are prohibited from taking the contract. In essence, it would be taking part in research in secret. We felt it had to be undertaken in a transparent way.

We requested Health Canada make an amendment. We didn’t receive a formal reply. Our request was ignored. We never heard from Health Canada again.

Do you view this as a politicization from the previous research you were engaged in related to the supervised injection facility?

It is interference in the natural evolution of evidence-based policymaking. They were essentially putting a gag order on researchers. We could not communicate our research or speak to the media. We weren’t prepared to work under such draconian conditions.

There has been criticism from both the U.S. government and the International Narcotics Control Board regarding Insite. Can you speak to this international dimension of this debate?

The U.S. drug czar made a trip to Vancouver and called the safe injection site ‘state-sponsored suicide’ before we even opened the doors. He wasn’t prepared to take an evidence based approach or to take a look at a rigorous approach to a complex issue. It’s very unscientific.

The INCB is an archaic and irrelevant body. The international drug conventions were created long before we had the problem of HIV/AIDS. These policies are not relevant in this era of pandemics of infectious diseases. There were legal assessments carried out for the INCB by UN experts on whether supervised injection sites violated international law. Those expert lawyers said that no — there were no international law being broken here. Despite the fact that they had elicited this opinion, members of the INCB continued to state that they were in contravention, which is totally irresponsible. Making public statements that are incongruent with their own expert legal opinions is outrageous. It’s sad that a UN body like the INCB takes positions that are incongruent with the policies of UNAIDS and the World Health Organization.

Anything else?

We have a very serious public health problem here. It exists locally, nationally and internationally. This one intervention seems to be working really well. There is no debate about whether this works or not. We shouldn’t allow this issue to be politicized and allow it to overshadow the scientific evidence.

We need to disengage from this misrepresentation of the science and the research. Other jurisdictions should be allowed to move forward with their proposals. We need to end the human suffering associated with drug addiction rather than engage in these predictable debates that are distorted by politics.

Interview by Am Johal, http://www.rabble.ca

Most Gays Ruled Out As Organ Donors
Health Canada ban goes too far to guard against HIV, doctors say

January 9, 2008

A Health Canada regulation that bans most gay men from donating organs is scientifically unjustified, virtually unenforceable and could worsen critical transplant shortages, a prominent Toronto AIDS doctor says.

The regulation, which took effect in December and closely resembles blood-donor guidelines, prohibits organ donations from sexually active gay men, intravenous drug users and hepatitis victims.

Both strictures are unfair to thousands of conscientious gays, says Dr. Philip Berger, head of family and community medicine at St. Michael's Hospital.

"What about a gay monogamous couple, (Health Canada) is not going to let them donate? It's ridiculous," says Berger. "It's been known for 20 years that the risk factor is not in being gay (but) in risky sexual behaviour."

Heath Canada officials did not respond to numerous requests for interviews yesterday.

Berger says "it's what the individual does in their sexual lives, whether gay or straight, (that) puts them at risk."

"To exclude bona fide donors because they've had sex with another man ... would exclude a lot of people who are no risk at all. Zero risk."

Berger says the "unreasonable" restriction is bound to reduce the supply of transplant organs at a time when the need is growing more urgent.

But Dr. Gary Levy, head of Canada's largest organ transplant program, says the new regulation simply formalizes precautions in use across Canada for at least 10 years.

The precautions were based largely on blood donor criteria that exclude sexually active gays, says Levy, head of the transplant program at the University Health Network.

Still, Levy says, Health Canada's formalizing of the criteria was bound to cause "some anger and hostility" among many homosexuals.

And he agrees with Berger that the restrictions likely go too far in excluding all sexually active gay men.

"I personally believe someone who has been in a monogamous relationship for 30 years, regardless of the gender of their partner, is a safe situation," Levy says.

Levy says transplant physicians will likely urge Health Canada to reconsider the ban to put the emphasis on high-risk behaviour, whether promiscuous sex or illicit needle use.

In the end, however, Levy says transplant surgeons will continue to make the final decision on which organs are suitable for use.

He says many organs from known gay men have been used in his program after physicians determined from retrieval agencies that the donor's sexual behaviour did not carry a significant HIV risk.

Under the new regulation, however, surgeons will have to sign a form stating they authorized the use of an organ that would normally be excluded.

In the vast majority of organ donation cases, sexual history is assessed through interviews with relatives of the deceased. Even if a donor card has been signed, the family or the courts must give permission for harvesting in Ontario, Levy says.

But Berger says the Health Canada regulation is fundamentally flawed because the organ harvesting system depends entirely on the goodwill and honesty of donors or their families.

He adds that current HIV screening tests can confirm the infection-free status of donated organs rapidly and with virtual certainty.

The only risk would come from donors in the "so-called window period when they've been recently infected," Berger says, calling that an "infinitesimal" worry.

However, Levy says HIV can incubate for 20 days or more before becoming detectable.

By Joseph Hall, The Toronto Star

A Ghastly Disease Feeds Off a Ghastlier Oppression

January 9, 2007

Toronto - Gender inequality has become the main driver of the HIV/AIDS epidemic, especially in Africa, where 70 percent of those infected are women.

A new powerful international agency for women is needed to turn this situation around and address the growing problem of violence against girls and women, experts and advocates say.

"Rape is extremely common, especially by older men who are infected with HIV who believe that having sex with a virgin will cure them," said Betty Makoni, executive director of the Girl Child Network, a Zimbabwean non-governmental organisation.

In rural Zimbabwe, a teacher rapes 30 or 40 of his girl students and nothing is done about it, said Makoni at the International AIDS Conference in Toronto, which ended last week. "Where is the world outrage?" she asked.

The Girl Child Network has helped 30,000 girls in 500 centres across Zimbabwe, where an estimated 25 percent of the population aged 15 to 49 is believed to be HIV-positive. At the conference, Makoni was awarded the inaugural Red Ribbon Award by the United Nations Development Programme and UNAIDS.

"There is no right to life here for women and girls. They are treated as semi-slaves," she said.

Stephen Lewis, the U.N. special envoy for AIDS in Africa, agreed. "We will never subdue the gruesome force of AIDS until the rights of women become paramount in the struggle," he said at the conference. "It's a ghastly, deadly business, this oppression of women in so many countries on the planet."

The United Nations estimates that up to three million women lose their lives to gender-based violence and four million are sold into prostitution each year, while two million suffer genital mutilation. One woman in five is a victim of rape or attempted rape.

Women also make up the vast majority of illiterates in the world due to lack of educational opportunities.

To aggressively tackle these issues, Lewis has appealed to the United Nations to create an international agency to advocate for the rights of women, similar to UNICEF. The proposed agency would have a billion-dollar budget, employ thousands of staff and have widespread operational capacity on the ground where it is needed.

Lewis and his supporters say a U.N. agency for women would be able to support and fund these programmes, extract donations and make sure women are involved in development, trade, culture, peace and security.

Women in poverty face different problems than men, but development policies and programmes are not designed to meet the needs of girls and women, says Joanna Kerr, executive director of the Association for Women's Rights in Development, a Toronto-based international organisation of women's groups involved in gender equality and human rights.

Women do not earn cash salaries and are not permitted to own land or open bank accounts in many parts of the world, leaving them powerless and poor, Kerr told IPS.

"In many parts of the world, women can't even negotiate the use of a condom. HIV/AIDS cannot be effectively addressed without getting at the root causes of poverty and inequality," she said.

HIV/AIDS prevention programmes will be ineffective without programmes to reduce violence against women, especially young women. These issues are not just African but apply to Southeast Asia and Latin America, she says.

"There is no powerful voice for women at the U.N.," Kerr stated.

For example, young girls are raped every day in refugee camps, and a new U.N. agency for women with strong operational capacity could take action on the ground and ensure their safety, she said. An agency with enough staff could also make sure the needs of girls and women are addressed, such as providing sanitary napkins and ensuring proper toilet facilities are built. "Such obvious things are often not provided," the activist noted.

The U.N. currently has a small agency for women called UNIFEM -- the United Nations Fund for Women -- but with a relatively scant 40-million-dollar budget, limited mandate and few in-country staff, it is far from what is needed.

So where is the money going to come from for a U.N. women's agency? Global foreign aid is more than 100 billion dollars and is expected to reach an estimated 130 billion by 2010, Lewis told the High-Level Panel on U.N. Reform this summer.

"Is more than half the world's population not entitled to one percent of the total?" he asked.

The panel is charged with making recommendations regarding the reform of the U.N. and could recommend that the U.N. General Assembly create this new agency.

The need for such an agency is "obvious" and there is a mounting clamour for action, says Kerr.

"I see big, empty buses on the streets of Toronto and I wonder about the equitable distribution of resources," said Makoni last week. "In Zimbabwe, girls who used to walk 20 kilometres to school don't attend because they don't have sanitary napkins. They try to use sticks instead."

But it is far from certain the U.N. will create a strong and effective agency for women, Lewis readily admits. He urged those attending the Toronto conference in his final speech as U.N. envoy to "enter the fray against gender inequality."

"There is no more honourable and productive calling. There is nothing of greater import in this world. All roads lead from women to social change, and that includes subduing the pandemic," he concluded.

By Stephen Leahy, http://www.zimbabwejournalists.com

Rates of Infection Among Canada's Native People Grossly Disproportionate To Their Total Numbers

January 10, 2008

HIV rates among Canada's aboriginal community continue to rise at alarming rates – and women face the highest risk.

That's where Catherine Beaver comes in.

A wry, outspoken, slip of a woman who walks with a bit of a limp, Beaver is a public speaker with 2-Spirited People of the First Nations in Toronto, a gay, lesbian and transpositive organization that conducts HIV/AIDS outreach for the community.

"The way I look at it is, I am not ashamed or afraid of it," says Beaver, 28, who is HIV-positive. She tells her story nationwide to try to stem the epidemic spread of HIV in the aboriginal community – mostly connected to intravenous drug use.

In November, the Public Health Agency of Canada released its latest stats on the spread of HIV and AIDS in this country.

The report reveals aboriginal people (Inuit, Métis and First Nations) accounted for more than a quarter of all positive HIV tests reported in 2006, even though they only make up about 6 per cent of the total population in the 12 provinces and territories included in the stats. (Ontario and Quebec are excluded because they do not collect ethno-specific HIV data.)

And, for the third year in a row, women accounted for more than half of the positive test results among aboriginal people.

In her talks, Beaver explains how she became infected 2 -1/2 years ago through intravenous drug use. She talks about being adopted, of her isolation while living on the streets, losing custody of her two children, substance abuse and prostitution.

"You know, when the whole world just disintegrates, goes black, like in TV shows ... and you are just standing there by yourself..."

After years of treatment, she is no longer an addict but still struggles to fight the occasional setback. Beaver uses her story to make a point.

"I'm not scared of people reacting," she says, insisting not enough aboriginal people are speaking out, which is why the number of infections continues to rise.

According to the Public Health report, intravenous drug use was the main cause of HIV infection among aboriginal people, at 64 per cent. Heterosexual contact was the other main cause, at 34 per cent.

That's the reverse of the national averages for HIV-positive tests, where 74 per cent of new cases are attributed to heterosexual contact and 24 per cent to intravenous drug use.

Dr. Ahmed Bayoumi, a physician and clinical epidemiologist with the University of Toronto, says the numbers don't offer a complete picture of rates, or their root causes, within the aboriginal community.

"The delivery of effective health services to aboriginal people in this country has been a problem for many years," he says. "I think there is a legacy of mistrust and alienation."

However, he says the trends detected by Health Canada are accurate and need to be addressed.

Trevor Stratton, former president of 2-Spirited People, suggests social oppression of aboriginal people in Canada has resulted in a spiritual sickness and the oppression of women (men abusing or oppressing women because they themselves have been abused), making women extremely vulnerable.

There is also a cultural stigma around the disease within the community, which makes it difficult to talk about. Even the words they commonly use for HIV/AIDS translate to "the dirty disease" or the "dirty blood disease," which can carry tremendous stigma.

"Our leaders have to acknowledge it's an epidemic," says Doris Peltier, 51, a board member with the Canadian Aboriginal AIDS Network. "I didn't have a voice."

Peltier was infected through a partner she knew was not monogamous, but she didn't have any control in the relationship at the time.

She says her inner strength was tempered by decades of isolation, addictions and physical abuse – much of which was ignored by her community.

If the aboriginal community doesn't join together to protect its women and stem the spread of HIV, Peltier says it will endure decades of disaster and despair.

"I compare it to the sexual abuse that finally came out" at residential schools, she says.

Now she's fighting for women who can't speak for themselves. "Even though I might have that virus in my body, I'm being healed."

By Emily Mathieu, Toronto Star

HIV Vaccine Initiative Still On Drawing Board
Federal government's plan is diverting money from local AIDS groups

January 10, 2008

The federal government's $139-million AIDS vaccine program is still in the planning stages, says a senior public health official.

The program — officially known as the Canadian HIV Vaccine Initiative (CHVI) — was announced in February of last year. The Bill and Melinda Gates Foundation is contributing $28 million and the federal government is putting in $111 million, which health minister Tony Clement promised at the time would be new money.

Since then, however, the government has announced a funding cut of $1 million to local AIDS programs in Ontario and has said that it plans to cut funding in other areas of the country as well. Part of those funding cuts will be directed into the CHVI.

Steven Sternthal, the special advisor for HIV vaccines in the Public Health Agency of Canada, which will run the CHVI, says the program wants to work with local organizations.

"Under the vaccine initiative we need to work with communities," he says. "That's a critical part of how the initiative needs to be implemented.

"It's a tough situation in government where you have to balance short-term and long-term goals."

Funding for the CHVI is to be distributed over five years, in five different areas.

The plan assigns $3.4 million to cover the administrative costs of establishing and running CHVI.

There will be $22 million to augment existing vaccine research in Canada and to promote international cooperation.

"We're hoping there will be new ideas, new teams, new concepts that will be more successful," says Sternthal. "This work cannot be done in isolation. The Swiss recently launched a vaccine initiative. There's a network of African researchers. This kind of work needs to be done much more collaboratively than other areas of research."

The CHVI will give $16 million towards establishing clinical trials and expanding the capacity for such trials. Most of that work will centre around helping to establish procedures for safe clinical trials in developing countries. Sternthal says much of the work will build on that already being done by the Canadian International Development Agency.

"You have to be in countries where infection rates are high," says Sternthal. "It would take years in Canada to get sufficient numbers. You don't want to subject people to procedures that could harm them and particularly in developing countries there's not sufficient infrastructure."

The largest chunk of the money — $61.1 million from the government and all of the Gates Foundation's $28 million — will go into a project that will establish a facility in Canada capable of manufacturing potential vaccines for clinical tests.

"Clinical trial lots need to be manufactured in a way that meets all the standards," says Sternthal. "One of the things that's difficult to do is to manufacture on a small scale, say 50 doses, of a vaccine that may not succeed and may never be used again."

Sternthal says the CHVI will be seeking proposals from a nonprofit corporation to build the facility.

"We decided that because of the global nature and the common good approach that a not-for-profit corporation should receive the money," says Sternthal. "We're looking for a novel partnership with the private sector.

"The facility should be located in an environment where manufacturing is taking place. It can't be done in an apartment building and it should be well-connected to efforts going on in other countries."

The CHVI will also be designating $8.5 million to dealing with policy, community and social issues. Sternthal says this money will be spent on community involvement and information.

"HIV infection doesn't occur in a vacuum," he says. "HIV vaccine work shouldn't take place in a vacuum. You need to promote dialogue, get Canadian communities more involved in vaccine work. Where they interact is with a clinical trial. It involves members of the community and people hear about it."

Sternthal says community involvement is even more essential in clinical trials in developing countries.

"There may be more targetted campaigns with prevention workers in areas where there are clinical trials," he says. "In Africa it can be so hard to recruit people. They're literally losing people all the time to AIDS."

By Krishna Rau, http://www.xtra.ca

Court Strikes Down Regulation Limiting Growers of Medical Marijuana

January 11, 2008

Canadians who are prescribed marijuana to treat their illnesses will no longer be forced to rely on the federal government as a supplier following a Federal Court ruling that struck down a key restriction in Ottawa's controversial medical marijuana program.

The decision by Judge Barry Strayer, released late Thursday, essentially grants medical marijuana users more freedom in picking their own grower and allows growers to supply the drug to more than one patient.

It's also another blow to the federal government, whose attempts to tightly control access to medical marijuana have prompted numerous court challenges.

Currently, medical users can grow their own pot but growers can't supply the drug to more than one user at a time.

Lawyers for medical users argued that restriction effectively established Health Canada as the country's sole legal provider of medical marijuana.

They also said the restriction was unfair, and that it prevented seriously ill Canadians from obtaining the drug they needed to treat their debilitating illnesses.

In his decision, Strayer called the provision unconstitutional and arbitrary, as it "caused individuals a major difficulty with access…"

Ottawa must also reconsider requests made by a group of medical users who brought the matter to court to have a single outside supplier as their designated producer, Strayer said in his 23-page decision.

While the government has argued that medical users who can't grow their own marijuana can obtain it from its contract manufacturer, fewer than 20 per cent of patients actually use the government's supply, Strayer wrote.

"In my view it is not tenable for the government, consistently with the right established in other courts for qualified medical users to have reasonable access to marijuana, to force them either to buy from the government contractor, grow their own or be limited to the unnecessarily restrictive system of designated producers," he wrote.

Ron Marzel, a Toronto lawyer representing the group of medical users who brought the matter before the Federal Court, called the decision a "great remedy" for his clients.

"All this means is that the limit — the one-to-one ratio — it's the last nail in the coffin for that ratio," he said in an interview.

"The court has said, 'Look, unequivocally, this is unconstitutional, it's arbitrary. All the reasons you've provided us with so far for this one-to-one ratio, they don't pass muster. We don't buy it, we don't accept it."'

The provision had been struck down by the courts before, but was reinstated by the government who contracted Prairie Plant Systems Inc. in Flin Flon, Man., to provide the drug to patients.

www.cbc.ca

A Never-Ending Tale Of Political Neglect
Principals of all three levels of government have pretended for decades that one stop-gap measure is a solution

January 12, 2008

A decade and several elections ago, the three levels of government and their many and varied agencies agreed that an integrated approach was the only way to heal the problems of Vancouver's Downtown Eastside.

That was the genesis of the Four Pillars plan and the controversial decisions to provide free needles, supervised injection sites and, later this year, free mouthpieces for cocaine pipes.

In their search for solutions, politicians rather neatly neglected to acknowledge their responsibility for the perfect storm that has devastated the neighbourhood and left hundreds, if not thousands, of people dead.

Ottawa stopped funding low-income housing in the 1990s. Today, there's a housing crisis across Metro Vancouver, the most expensive urban area in Canada.

To make up for the lack of affordable housing, the B.C. government changed its rules so that welfare recipients could live in single-room occupancy hotels. That concentrated the poor in older hotels all within a very small area near the Carnegie Centre at Main and Hastings streets.

All of that coincided with closures of mental hospitals. But the provincial government failed to provide the promised alternative housing, the group homes and supervised living arrangements on which the success of de-institutionalization depended. The number of beds for people with mental health problems plummeted from 5,000 to 800.

The B.C. government closed Pender Detox, the largest residential detox program for people with alcohol and drug addictions. Other social service agencies closed in the name of deficit-fighting.

A decade later, we're still trying to make up for what was lost since 1998. And all of that would have been bad enough -- a shortage of affordable housing, lack of jobs and the ready supply of drugs and alcohol -- without HIV/AIDS. Combined, those factors resulted in an AIDS epidemic on a scale seen only in Africa, not in any other developed or developing countries of the world. By 1998, 40 per cent of the injection drug users were infected with HIV.

Syphilis and tuberculosis were also at epidemic proportions even as Vancouver began being recognized as one of the world's most livable cities (unless you're poor, addicted or mentally ill.)

The folly of governments' containment strategy -- ghettoizing the poor, the addicted, the sick and the mentally ill in cheap rooms downtown -- spilled out on to the streets and alleys that quickly turned into filthy, garbage-strewn shooting galleries, open drug markets and home to a growing survival sex trade whose workers started disappearing and nobody seemed to care.

Because of the crisis, local, provincial and federal politicians embraced the harm-reduction strategy as a stop-gap measure to keep people alive until housing, detox, treatment and recovery programs were in place. But the politicians have so heartily embraced the harm-reduction model, it's virtually all that they talk about or fund.

There's something politically appealing about being a maverick opening North America's first supervised injection site or promising free heroin. It gets you on magazine covers, in documentaries. It gets you invitations to international conferences.

Most of all, it beats the hell out of sitting through long public hearings with angry residents who don't want addiction treatment facilities in their neighbourhood whether it's on Hastings, Fraser, Dunbar or Fir Street. That's especially true if, in the end, the decision is to ignore the opposition and approve it anyway, because it's the right thing to do and the only thing that makes a stab at solving the horrific addiction problems in this city, region and province.

And that's where we find ourselves a decade on. The dramatic stuff, the headline stuff, the harm-reduction pillar has mostly been done. The epidemics have subsided. Fewer addicts overdose on the streets. There's been a reduction in other infectious diseases that require hospital stays.

All this harm reduction has kept people alive. The question is, for what? Are there decent places for them to live as they recover? Are there services available for what is a long road to recovery because everyone from addictions specialists to the Vancouver Coastal Health Authority agrees that recovery means leading a substance-free life, not swapping heroin for methadone, cocaine for marijuana or Ativan for some other pharmaceutical?

The short answer is no. But there's good news on the housing front largely because of the B.C. government and Housing Minister Rich Coleman. Politicians will have plenty sod-turnings and ribbon-cuttings to attend over the next five years because there are 3,200 units of social housing on the drawing board for Vancouver.

It's a level of production that hasn't existed since the 1990s. Among the projects are redevelopment of Woodward's, the provincial government's renovations of 10 single-room occupancy hotels in the Downtown Eastside and redevelopment of public housing sites, including one in Little Mountain.

It's the treatment pillar that lacks a champion. Coleman has talked about treatment supports being included in some of the new housing units. But so far, there's no commitment of funds.

Over the past decade, Vancouver Coastal has improved access to detox and rehabilitation facilities with little or no fanfare. It is the first city in Canada to have four levels of detox care. But when it started Canada's only fully supported, home detox program, there weren't any politicians trumpeting it to journalists.

Vancouver Coastal Health Authority estimates 5,000 people on the Downtown Eastside need treatment for addictions and mental health problems. Close to half of them need significant amounts of help and somewhere between 250 and 500 need significant and long-term addictions treatment in a residential facility.

To provide that kind of support, Vancouver Coastal recommends that, at a minimum, Vancouver needs a 30- to 60-bed facility to deal with those in the greatest need. There needs to be a shorter-term stabilization facility for 30 to 60 of those who need significant support on the road to recovery.

And that's just for the Downtown Eastside. It doesn't take into account the addicts living in other neighbourhoods or cities. Or kids. Operating money has been promised for the residential youth recovery centre that's planned for Keremeos. But, so far, there's not enough money to build it.

There's a civic election in November, a federal election that could come along any day and a provincial election in the spring of 2009.

It's not enough for the politicians to acknowledge the problems of addiction and homelessness. It's not enough for them to keep piling on more harm-reduction programs.

We need solutions. We need strong leaders willing to stand up to the Not-in-Anybody's-Backyarders and fight not just to keep people alive, but to help them make a full recovery.

By Daphne Bramham, The Vancouver Sun

Glam Reaper Ad Campaign Launched to Educate Gays on HIV/AIDS

January 8, 2007

Two decades ago, the Australian Department of Public Health launched a disturbing, yet informative, ad campaign to help educate the gay community about HIV and AIDS. With the number of new infections still on the rise over the past few years, Sydney has launched a new viral video campaign which highlights the Glam Reaper and hopes to once again highlight HIV as a disease that effects everyone.

The original Grim Reaper campaign depicted images of death mowing down a range of victims in a bowling alley. Although the ad was widely criticized at the time, it did succeed in creating widespread discussion of the epidemic.

Twenty years later, the discussion is still in the forefront of the gay community, and the new campaign hopes to resend the message that there are still concerns and ways to prevent infection.

The Grim Reaper has been brought up to date and glamorized in order to send the same message. Played by Sydney drag queen Mitzi Macintosh, and backed up by community archetypes, including Party Boy, Mr Leather, Asian Femme, DJ, Mz Butch, Miss Lippy, Mr Bear and Twinky, the campaign offers the simple message that other than abstinence, condoms are still the best way to prevent infection.

John Stanton, who has returned to lend his support to this important campaign, provided the original Grim Reaper voice over.

Filmed at the Imperial Hotel, the ad hopes to advocate safe sex in the gay community.

Campaign coordinator Ben Tart told SSONET.com, "We wanted to really take ownership of the Grim Reaper for our community and remind the community that HIV is still such a big issue for all of us. It is so important to protect ourselves, our partners and our community by continuing to use condoms."

Video may be viewed here:
http://www.youtube.com/watch?v=6A8SX1d-0_g

By Dylan Vox, http://www.gaywired.com
Also: 

Confronting Approach To HIV In Gay Community

January 10, 2008

Full-page images of men having sex will be splashed across gay newspapers in Melbourne today as part of a bold advertising campaign designed to stem rising HIV infections in Victoria.

Four advertisements — which show men having sex, with a dialogue box discussing safe sex issues covering their genitalia — will appear in Bnews and MCV newspapers as part of the Victorian AIDS Council's latest campaign to target gay men who have unprotected sex.

Executive director Mike Kennedy said the decision to use images of penetrative sex in the campaign was based on interviews with gay men about what they best responded to at a time when HIV infections in the community were rising.

"We're doing it not because we're trying to push the envelope but because the focus groups are telling us that this is what we need to do to have the conversation we need to have," he said.

"When we showed people in the focus groups words alone, they said 'nup, doesn't work for us'. But when we showed images of real people, they said 'this says to us you're fair dinkum'. It doesn't look like stuff people have seen 100 times before."

Mr Kennedy said the campaign would be accompanied by another more public campaign urging people to get tested for HIV and other sexually transmitted infections, called "The Drama Down Under".

Tea-towels showing images of men having sex alongside safe-sex messages about condom use and water-based lubricants would also be distributed at gay festivals in coming months.

He said the organisation had a proposal to State Government to be reimbursed for the $630,000 campaign, which would run for at least six months.

The campaign comes after HIV infections reached their highest level in Victoria in 20 years. The Department of Human Services was notified of 334 cases in 2006, 17% higher than the 285 in 2005 and the highest number since 1987.

The director of The Alfred hospital's infectious diseases unit, Professor Sharon Lewin, said the campaign appeared to be targeting the group responsible for rising infections — gay men in their 30s having casual, unprotected sex.

"What we know is that new infections are predominantly occurring in gay men and that unsafe sex practices are common," she said. "One of the recent lessons from NSW was that they had a very targeted and explicit safe-sex campaign … and it seemed that that was quite effective. The number of new infections has not increased in NSW, whereas they have in Victoria and Queensland."

BNews news editor Doug Pollard said the campaign followed much criticism of the Victorian AIDS Council from gay people who thought the organisation was not going hard enough.

He said staff at his newspaper decided the message was too serious to ignore.

By Julia Medew, http://www.theage.com.au

Drug Interaction Caution with Crestor and Kaletra

January 7, 2008

Kaletra (lopinavir/ritonavir) can significantly increase blood levels of Crestor (rosuvastatin)—one of the most effective drugs used to lower high cholesterol—say researchers of a study published in the Journal of Acquired Immune Deficiency Syndromes. This was an unexpected finding, as Crestor is not metabolized significantly through the liver pathway that Kaletra, and other protease inhibitors, are known to affect.

Jennifer Kiser, Pharm D, from the department of pharmaceutical sciences at the University of Colorado in Denver, and her colleagues enrolled 20 HIV-negative men and women to assess the impact of Kaletra on Crestor blood levels. The study volunteers agreed to first take 20mg of Crestor alone for seven days, then Kaletra alone for 10 days, and finally a combination of the two drugs for seven additional days. A full set of data were available on 15 of the volunteers.

Kiser’s team found that Kaletra had a significant impact on Crestor blood levels.  The total area under the curve—which measures the sum of the blood levels over time—was two times higher when Kaletra was taken with Crestor, compared with values when Crestor was taken alone. Even more significant, the peak dose of Crestor, which can impact side effects, was nearly five times higher when the two drugs were taken together. Though the severity of side effects in the study volunteers was reported as mild or moderate, it is possible that persistently high levels of Crestor in people with HIV who are also taking Kaletra may lead to more serious side effects.

The metabolism pathway responsible for the increased blood levels of Crestor could not be determined by Kiser’s team. Rather, they are calling for additional studies that combine Crestor with a number of different protease inhibitors to identify the reasons behind this drug interaction, and to determine whether a lower dose of Crestor when taken with Kaletra may be safe and effective.

http://www.poz.com

AIDS Treatment with Potential
UCCS associate professor will research how, why VGV-1 is effective

January 8, 2008

A small California company has agreed to license medical technology developed by a local biology professor to research a promising treatment for HIV and AIDS.

Under the complex agreement announced last month, Karen Newell, a University of Colorado at Colorado Springs associate biology professor, will spend about a year determining how and why a compound called VGV-1 developed by Azusa-based Viral Genetics Inc. is effective in treating some HIV and AIDS patients.

If Newell’s research is successful, it will help Viral Genetics win U.S. Food and Drug Administration approval to use the compound in U.S. clinical trials. Trials have already been conducted in Bulgaria, China, Mexico and South Africa.

The company’s Web site says the compound, which uses thymus nuclear protein in a suspension, appears to work by boosting the immune system to allow the body to fight HIV more efficiently. Studies have shown it reduced the amount of HIV in the blood of some patients.

Newell’s technology involves modulating the immune system and causing apoptosis, or the body’s process of killing harmful cells.

"This is a very important agreement for Karen, the University of Colorado and the company," said David Allen, the university’s associate vice president for technology transfer. "It is a validation of her work in this area and should advance the company’s prospects of getting its product approved by the FDA."

Under the agreement, Viral Genetics created a company called V-Clip Pharmaceuticals Inc. co-owned by University License Equity Holdings Inc., Newell, her son Evan Newell, UCCS associate biology professor Robert Melamede and Los Angeles patent attorney Robert Berliner.

Newell’s UCCS lab will receive $25,000 per quarter to complete the research into how and why the compound works. If that research is successful, Viral Genetics plans to spend up to $600,000 to complete independent tests that will verify what Newell determines about VGV-1.

Upon successful completion of her research, Viral Genetics will acquire all of V-Clip for 18.5 million shares of its stock plus options and warrants to buy an additional 31.5 million shares. Viral Genetics stock closed at 3.4 cents in over-the-counter trading Monday.

"Dr. Newell’s basic scientific research and discoveries appear to compliment (sic) the over 10 years of human clinical experience we have," Viral Genetics co-founder and President Haig Keledjian said in a news release. "The acquisition of these rights holds significant promise to finally" determine exactly how and why the compound works.

Keledjian and Dr. Harry Zhabilov began researching thymus nuclear protein in 1992 for early detection of HIV and cancer and founded the company in 1995. The company conducted its first human trial that year and went public in 2001. Zhabilov died in 2002.

Newell said the agreement came together quickly after a chance meeting in May with Monica Ord, senior vice president of corporate development and communications for Viral Genetics. Newell said they quickly discovered they were working on complementary research.

"We not only want to show how and why the compound works, but also improve the product so that it works on all of the patients rather than just some of them," Newell said.

By Wayne Heilman, http://www.gazette.com

Amino Acid Mutations In Protein Might Make HIV Vulnerable To Immune System Attack, Study Finds

January 8, 2008   

Mutations found in four amino acids in the protein that surrounds HIV might make the virus vulnerable to the immune system, according to a study published in the January issue of PLoS Medicine, ANI/Thailand News reports.

For the study, Julie Overbaugh of the Fred Hutchinson Cancer Research Center and colleagues analyzed the HIV strain of a woman living in Mombasa, Kenya, whose virus was inactivated by antibodies produced by her body. The study found that the woman's virus contained mutations in four amino acids located in HIV's outer envelope protein. Two of the amino acids when introduced to unrelated HIV strains in a laboratory setting provided sensitivity to inactivation by a number of antibodies produced by HIV-positive people, according to the researchers.

The researchers said that such mutations might cause changes in the overall structure of the envelope protein, which might result in exposure to regions of the immune system that normally are hidden from HIV. According to ANI/Thailand News, further research is needed to confirm the theory that vaccines containing envelope proteins with the mutations might be able to stimulate an antibody response to protect against HIV (ANI/Thailand News, 1/3).

http://www.kaisernetwork.org

Heart Disease (3 studies)

1. High Prevalence of Asymptomatic Heart Disease in HIV-Positive Patients

January 9, 2008

Asymptomatic ischaemic heart disease is common in HIV-positive individuals, according to a subanalysis of the SMART treatment interruption study published in the January 11th edition of AIDS. Using ECG examinations investigators found that approximately 10% of patients enrolled in the study had asymptomatic ischaemic heart disease. Older age, diabetes and high blood pressure were risk factors for the condition.

In HIV-negative patients asymptomatic ischaemic heart disease (reduced blood supply to the heart muscles) is associated with an increased risk of heart attack and death.

An increased risk of heart disease has been identified in HIV-infected patients taking antiretroviral therapy. Longer duration of antiretroviral therapy, particularly if it includes a protease inhibitor, is associated with a particular risk of heart disease.

Anti-HIV therapy can cause levels of blood fats to increase and insulin resistance and it is thought that these side-effects increase the risk of heart attack in antiretroviral-treated patients. However, traditional risk factors for heart disease including older age, male sex, smoking and high blood pressure are also significant.

The SMART study was designed to compare outcomes in HIV-positive patients who took continuous anti-HIV therapy to those who interrupted their therapy when their CD4 cell count was 350 cells/mm3. The study was stopped early when it was found that patients in the intermittent therapy arm were more likely to develop AIDS-defining illness and other serious illnesses, such as heart, liver and kidney disease.

As part of the SMART study patients had an ECG examination. These examinations provided an opportunity for investigators to assess the prevalence and risk factors for asymptomatic ischaemic heart disease in HIV-positive patients. In particular they wished to see if abnormalities detected by the ECG were associated with demographics, HIV disease characteristics, traditional risk factors for heart disease, or with the type or duration of antiretroviral therapy.

Of the 5472 patients enrolled in the SMART study 4831 had ECG readings and were included in the investigators’ analysis. The patients were recruited from over 300 HIV treatment centres in 33 countries. Mean age was 44 years, 28% were female, 30% were black, 40% were smokers, 7% had diabetes, 17% were taking therapy for high blood pressure, and 14% were taking lipid-lowering therapy. Almost all the patients (95%) had experience of antiretroviral therapy, and 89% were taking anti-HIV therapy at baseline. The median duration of anti-HIV treatment was six years.

ECG evidence of asymptomatic ischaemic heart disease was found in 526 patients (10%).

Factors associated with the condition were older age (over 60 years vs. under 40 years: OR 2.2; 95% CI: 1.5 – 3.2, p < 0.001), use of medication to lower blood pressure (OR, 1.5; 95% CI: 1.1 – 1.9, p = 0.003), geographic location (Europe vs. North America, OR, 1.4; 95% CI: 1.1 – 1.7, p = 0.004; Asia vs. North America, OR, 1.6, 95% CI: 1.0 – 2.6, p = 0.05). The investigators were unable to explain the significance of location.

Patients who reported using an NNRTI as part of their antiretroviral therapy appeared to have a lower risk of asymptomatic ischaemic heart disease (p = 0.05), but increasing duration of antiretroviral therapy seemed to attenuate the beneficial effects of NNRTI therapy (as opposed to protease inhibitor therapy), possibly because some NRTI drugs that provide the backbone of anti-HIV therapy can cause metabolic disturbances and therefore increase the risk of heart disease.

Self-reported lipoatrophy was significantly associated with asymptomatic ischaemic heart disease in univariate analysis (OR, 1.3; 95% CI: 1.0 – 1.6, p = 0.03), but not in multivariate analysis.

Diabetes was of borderline significance (OR, 1.4; 95% CI: 1.0 – 2.0, p = 0.06).

Some traditional risk factors for heart disease such as smoking, cholesterol, triglycerides and the use of lipid-lowering drugs were not significantly associated with asymptomatic ischaemic heart disease in this study.

The investigators conclude that ECG evidence shows that there was a high prevalence of asymptomatic ischaemic heart disease in the SMART study population. But they add, "the clinical significance of our data…remain to be determined." Only when patients are prospectively evaluated will it be possible to say if asymptomatic ischaemic heart disease is predictive of symptomatic heart disease or death in HIV-infected patients in the future.

Nevertheless, given the high prevalence of asymptomatic ischaemic heart disease revealed by their analysis the investigators suggest that patients with the highest risk of this condition – those who are older, or with high blood pressure or diabetes – receive "closer follow-up or more aggressive cardiovascular protective interventions."

Reference

Carr A et al. Asymptomatic myocardial ischaemia in HIV-infected adults. AIDS 22: 257 – 267, 2008.

By Michael Carter, www.aidsmap.com


2. Spanish Find Low Prevalence of Peripheral Arterial Disease In HIV-Positive Patients With Heart Disease Risks

January 9, 2008

Spanish investigators have found a low prevalence of peripheral arterial disease in HIV-positive patients with multiple traditional risk factors for heart disease. The study is published in the January 1st edition of the Journal of Acquired Immune Deficiency Syndromes and stands in contrast to a Swiss study presented to last year’s ICAAC that found that 20% of HIV-positive patients had peripheral arterial disease.

There is an increasing awareness that HIV-infected individuals have an increased risk of cardiovascular disease. Peripheral arterial disease is an indicator of hardening of the arteries and a strong predictor of an increased risk of death from heart disease. It is easy to detect peripheral arterial disease using an ankle-brachial index (ABI). This involves attaching a blood-pressure cuff to the ankle and comparing blood pressure at the ankle and at the normal measuring point on the upper arm (the brachial artery). An ABI of 0.9 or below indicates the presence of peripheral arterial disease.

Spanish investigators conducted a prospective study involving 91 HIV-positive patients with at least two traditional risk factors for heart disease. The study ran between January 2006 and January 2007.

The patients’ average age was 50 years, 80% were men, 36% had a history of injecting drug use, and 32% had progressed to AIDS. Antiretroviral therapy was being taken by 81% of patients and 63% of patients had experience of treatment with a protease inhibitor, the class of antiretrovirals most associated with a risk of heart disease. The median duration of antiretroviral therapy was seven years, 52% of patients had a viral load below 50 copies/ml and median CD4 cell count was 507 cells/mm3.

Lipodystrophy was present in 34% of patients, 69% had elevated lipids, 73% were smokers, 18% had diabetes, 57% high blood pressure and 20% a family history of heart disease.

A total of 33 patients (36%) had three or more risk factors for heart disease, and 26 (28%) four or more factors.

A low ABI was present in only four patients (4.39%). All four patients were men aged over 45 (median age, 55 years). Three of the patients were currently taking antiretroviral therapy, and all had some experience of protease inhibitor treatment. Lipodystrophy was present in three patients and two individuals had lipoatrophy. Three patients had three or more risk factors for heart disease.

Two patients had a heart attack within months of the study being conducted.

"Our results show a low prevalence of peripheral arterial damage in a cohort of HIV-infected patients with several cardiovascular risk factors", write the investigators. They note that studies in the general population have found that between 5% - 30% (depending on age and risk factors) have this disease. The investigators expect the prevalence of peripheral arterial disease in patients with HIV to increase as the HIV-infected population ages.

Reference

Bernal E et al. Low prevalence of peripheral arterial disease in HIV-infected patients with multiple cardiovascular risk factors. J Acquir Immune Defic Syndr 47: 126 – 127, 2008.

By Michael Carter, www.aidsmap.com


3. Vitamin D Insufficiency Linked to Heart Disease

January 8, 2007

Heart disease has a long list of known causes, including smoking, obesity and diabetes. But researchers in the United States now say there may be another and somewhat surprising addition to this list: vitamin D insufficiency.

Although it is well known that vitamin D is needed for good bone health, a study released yesterday found that not having enough of the sunshine vitamin is also linked to a higher risk of heart disease.

The research, based on a group of white Americans living near Boston, found that those with low levels of vitamin D in their blood were 62 per cent more likely to develop heart failure, strokes and other circulatory problems than those with more of the nutrient.

Those with both high blood pressure and low vitamin D status had about twice the risk of developing serious cardiac-related problems.

"Vitamin D deficiency is associated with increased cardiovascular risk, above and beyond established cardiovascular risk factors," said Thomas Wang, the study's lead author and an assistant professor at Harvard Medical School in Boston.

"The higher risk associated with vitamin D deficiency was particularly evident among individuals with high blood pressure."

He said the finding raises the possibility that people may be able to reduce their risk of heart disease by treating vitamin D deficiency through supplements or lifestyle changes.

The study's results could have public-health implications for Canadians, who are typically at risk of vitamin D deficiency because of the country's northern latitude. It is not possible in Canada to make the sunshine vitamin the natural way - through the exposure of naked skin to strong sunlight - for about six months a year during fall and winter, and even longer in the most northern areas. This causes nutrient levels to plunge over the winter.

"A substantial portion of people living in temperate regions are probably vitamin D deficient or insufficient," observed John White, a professor in the departments of physiology and medicine at McGill University in Montreal.

Cardiovascular disease, including stroke, is Canada's leading cause of mortality, with about 75,000 people dying annually from it, or about 32 per cent of male deaths and 34 per cent of female deaths.

The new U.S. study, which is appearing in the current issue of Circulation, the journal of the American Heart Association, was based on blood tests of 1,739 people from the Framingham, Mass., area, where the annual period during which people can't naturally produce vitamin D is about the same as in Toronto. About 28 per cent of participants were considered to have inadequate vitamin D status.

Framingham is the site of the world's longest-running research project into the causes of heart disease, and previous studies have made such path-breaking discoveries as its link to smoking and high cholesterol.

Researchers have been intrigued by a possible link between low vitamin D status and heart disease because of observations that coronary heart disease and hypertension rates rise with increasing distance from the equator, where the intense sunlight allows year-round production of high levels of the nutrient.

To test the hypothesis that vitamin D is linked to heart disease, researchers analyzed the amounts of the nutrient in blood samples taken between 1996 and 2001 from healthy individuals of an average age of 59 who didn't exhibit signs of heart disease.

Over a follow-up period of about five years, 120 participants developed heart failure and other cardiac-related problems. Those with low vitamin D status were found to be at far higher risk of these ailments.

According to the study, one possibly explanation is that vitamin D receptors are found in cells throughout the heart and in other parts of the circulatory system, including the inside lining of blood vessels. The genes in these cells may malfunction when they don't get enough of the nutrient. Low vitamin D status may also cause an increase in inflammation.

Dr. Wang said there isn't yet enough information to develop a heart disease prevention strategy using vitamin D. Further clinical studies into the effects on heart health of correcting for vitamin deficiencies would be needed to figure out whether the approach would work and what doses would be needed, he said.

Funding for the research was provided by the U.S. government and the American Heart Association.

In light of the finding, the association recommends that people try to get adequate amounts of the vitamin through diet. Vitamin D is found naturally in salmon, mackerel, sardines and cod liver oil. It is also added to milk and some other foods.

The new finding is one of many recent discoveries about the health effects of vitamin D. Last year, U.S. researchers found that taking vitamin D supplements reduced the risk of cancer. In response to the study, and other research showing the vitamin may have an anti-cancer effect, the Canadian Cancer Society began recommending people take up to 1,000 international units of the vitamin daily. A cup of milk contains about 100 IU.

By Martin Mittelstaedt, The Globe and Mail

Dutch Find No Evidence Of Superinfection In Patients Experiencing Virological Failure

January 10, 2008

The natural evolution of HIV rather than superinfection with a drug-resistant strain of HIV is usually the explanation of antiretroviral treatment failure, according to a Dutch study published in the January 11th edition of AIDS.

Transmitted drug resistance can severely limit the antiretroviral treatment choices for HIV-positive individuals. A significant proportion of new HIV infections (approximately 10% in the UK and 6% in the Netherlands) involve a strain of HIV that is resistant to one or more anti-HIV drugs. In addition, about 30 cases of superinfection with a second or drug-resistant strain of HIV have been reported worldwide.

Many gay men choose to have unprotected sex with other HIV-infected men (often called serosorting), and Dutch investigators therefore wished to see if superinfection was contributing to the virological failure of previously effective antiretroviral therapy.

The investigators examined the HIV pol sequences from 101 patients before anti-HIV therapy was started and after the virologic failure of their treatment.

Included in the study were 85 men and 16 women. Most of the men (68) were gay. Injecting drug use was the HIV risk activity for six individuals, 21 were infected through heterosexual sex, two from blood products, and the mode of HIV transmission was unknown for four patients.

Viral load fell to undetectable levels a median of four months after antiretroviral therapy was started, but then rebounded to detectable levels after a median of three months.

Half the patients were starting their first antiretroviral regimen, but eleven of these patients (23%) already had resistance to one or more anti-HIV drugs. The other 50% of patients were already treatment experienced, and 36 (72%) had drug-resistant virus.

Resistance tests performed after the emergence of virological failure showed that 81% of patients had drug-resistant virus.

Tests showed that eight individuals had virus that was significantly different after treatment failure compared to the start of anti-HIV therapy. But detailed analysis of HIV sequences from these patients showed that such differences were explained by the natural evolution of HIV. In none of the patients did the investigators find any evidence of superinfection or recombination of HIV.

This was despite the fact that significant levels of HIV risk behaviour were reported by individuals. Two injecting drug users reported sharing injecting equipment with other drug users, and one injecting drug user reported regular unprotected sex with another HIV-positive individual. In addition, four gay men reported unprotected anal sex in the period between starting antiretroviral therapy and the virological failure of their therapy.

"In conclusion", write the investigators, "in this selected subgroup of patients who experienced virological failure while still on initially successful combination antiretroviral therapy, no evidence of superinfection with resistant HIV-1 was observed."

Reference

Bezemer D et al. Combination antiretroviral therapy failure and HIV super-infection. AIDS 22: 309 – 311, 2008.

By Michael Carter, www.aidsmap.com

Proteins Found That HIV Preys On

January 10, 2008

Washington - The AIDS virus has to hijack human proteins to do its damage, but scientists until now have known only a few dozen of its targets. On Thursday, Harvard researchers unveiled a surprisingly longer list, an important first step in the hunt for new drugs.

HIV is on its face a simple virus, consisting of just nine genes. Yet it makes up for that bare-bones structure in a sinister and complex way - by literally taking over the cellular machinery of its victims so it can multiply and then destroy.

The proteins it exploits have been dubbed HIV dependency factors, and 36 had been discovered. The new research, published online Thursday by the journal Science, found 273 of these potential HIV targets.

Led by geneticist Stephen Elledge of Brigham and Women's Hospital, the team used a technique called RNA interference that can disrupt a gene's ability to do its job and make a protein. One by one, they disrupted thousands of human genes in test tubes, dropped in some HIV, and watched what happened. If HIV couldn't grow well, it signaled the protein that the gene that had failed to produce must be the reason.

It will take far more research to figure out the role each of these proteins plays in HIV's life cycle.

But most of today's AIDS drugs work by targeting the HIV virus itself. In August, the government approved sale of the first drug that works by blocking an HIV dependency factor, a cellular doorway called CCR5. The hope is that this longer list of those factors will point toward spots where similar drugs might work.

By The Associated Press, www.365Gay.com

Anti-HIV Treatment Reduces TB Incidence in Spain

January 11, 2008

Antiretroviral therapy and tuberculosis (TB) control measures have helped reduce the incidence of tuberculosis in Spain in recent years, according to data from GEMES, the Spanish Multicenter Study Group of HIV Seroconverters published in the November 30th 2007 edition of AIDS.

HIV increases the risk of TB disease through reactivation of latent infection as the immune system declines or by accelerating the progression of recently acquired infection. Therefore the availability of effective antiretroviral therapy since the mid-1990s is likely to have had an impact on the epidemiology of TB in HIV-infected individuals.

Although this are good data about the incidence of TB in resource-limited countries, there is less information about the incidence of the infection in industrialised countries.

Spain has a high incidence of HIV compared to other countries in Western Europe and intravenous drug use (IDU) has been a major route of HIV transmission. Before the HIV epidemic, Spain had the second highest TB rate of Western Europe in the general population. IDUs, irrespective of their HIV status, are also exposed to high levels of TB infection. As a result of this, Spain has seen a large overlap of both the HIV and TB epidemics leading to high rates of HIV–TB co-infection.

Using data from GEMES, an established Spanish nation-wide cohort of HIV-infected individuals with well known dates of seroconversion from the 1980s to the present day, researchers analysed the incidence and determinants of tuberculosis in HIV-seroconverters before and after the introduction of effective antiretroviral therapy. Furthermore, all HIV-infected persons with clotting disorders (PCD) from three of the largest haemophilia units in Spain were analysed.

Information on sociodemographic characteristics (age, sex) as well as clinical and immunological data (number and type of AIDS events, antiretroviral treatments prescribed, lymphocyte CD4 cell count, HIV viral load, vital status and cause of death) were collected. All transmission categories were included: IDU, men who have sex with men (MSM), heterosexuals and PCD/people with haemophilia.

Calendar year at risk was divided into three periods (before 1992, between 1992–1996 and 1997–2004) reflecting the availability of different antiretroviral therapies before the introduction potent anti-HIV therapy in Spain in 1996. Between 1992 and 1996 only AZT, ddC, 3TC, d4T and ddI were available for the treatment of HIV and AIDS. Incident tuberculosis was calculated as cases per 1000 person-years. In this study TB diagnoses were culture proven in 85% of cases.

The proportional hazard model was used to determine the factors associated with the risk of developing TB taking into account the following variables: gender, exposure category, age at seroconversion, and calendar period.

Data from 2238 HIV-seroconverters (1874 men and 364 women) between the 1980s and 2004 were analysed. Overall, 51.9% were infected with HIV via IDU, 27.4% were PCD and 20.6% were infected by sexual transmission, of which 14.7% were heterosexuals.

By December 2004, 173 (7.7%) patients had developed TB (55.5% pulmonary, 35% extra-pulmonary and 10% in both locations) giving an overall rate of 7.3 cases per 1000 person-years (95% confidence interval [CI], 6.3–8.5). TB was the first AIDS-defining condition in 147 patients (85%), second in 19 cases (11%) and third in six cases (3.5%). Median time from HIV seroconversion to TB disease was 5.6 years.

The median CD4 cell count at TB diagnosis was 80 cells/mm3, indicating a profound state of immune suppression. After the introduction of effective antiretroviral therapy, the median was 182 cells/mm3. The majority (106; 61.2%) of the patients that developed TB had not received any antiretroviral treatment and 135 out of 173 (78%) were IDUs.

Incident tuberculosis was higher in IDUs, 12.3 per 1000 person-years compared with persons infected sexually, 3.8 per 1000 person-years (P < 0.001), and persons with clotting disorders (PCD), 2.7 per 1000 person-years (P < 0.001).

Highest tuberculosis rate, 44 per 1000 person-years, were observed prior to 1997 in IDUs infected with HIV for eleven years.

A decreasing tuberculosis incidence trend was observed from 1995 in all categories. TB rates in the era of effective anti-HIV therapy (5.6 per 1000 person-years) were significantly lower than before 1997 (8.9 per 1000 person-years). TB rates before and after the introduction of potent antiretroviral therapy were 18.09 and 8.68 cases per 1000 person-years for IDUs, 8.18 and 2.22 cases per 1000 person-years for sexually transmitted HIV and 3.43 and 0 cases per 1000 person-years for PCD, respectively. The reductions in the hazard of TB for each of the transmission categories were 48%, 27% and 100%, respectively. For PCD, no new TB cases were observed after 1997.

The study showed a 69% reduction in the incidence of TB among HIV-seroconverters from all transmission categories from 1997 onwards, (RH, 0.31; 95% CI, 0.17–0.54; P < 0.001). Before 1997, the risk of tuberculosis increased with time since HIV seroconversion, whereas it remained nearly constant in the era of potent anti-HIV therapy. After 1997, TB did not increase with longer duration of HIV infection but peaked around the fifth to seventh year in the IDU and sexually transmitted HIV groups, and decreased thereafter.

Among the 65 TB cases observed since the introduction of effective anti-HIV therapy, 52 (80%) were IDU and 41of the 65 (63%) were not taking antiretroviral therapy. The remaining 24 patients developed TB despite having started anti-HIV therapy.

Women had a 38% lower risk of TB compared to men. IDUs showed a three times higher risk of developing TB and PCD had a 60% lower risk in comparison with people infected through sexual transmission.

The authors conclude, "Our results suggest that in the period between 1997 and 2004, improvements in the immune status among those receiving HAART and/or a reduction in the environmental risk of TB transmission must have taken place. Forty percent of patients from GEMES cohorts had been initiated on HAART, so it is likely that antiretroviral therapy may be responsible for a large proportion of the observed reductions in TB, as it has been for other AIDS-defining conditions."

As the decreasing trends in TB were observed just before the introduction of effective anti-HIV therapy in Spain they also note that TB control programmes may have also played a part.

Reference

Roberto Muga et al. Changes in the incidence of tuberculosis in a cohort of HIV-seroconverters before and after the introduction of HAART. AIDS 21:2521–2527, 2007.

By Rob Dawson, www.aidsmap.com

Updated Guide Shows Which Countries Restrict Entry and Residence for People with HIV

January 07, 2008

The European AIDS Treatment Group (EATG) has produced an updated edition of its guide summarising the restrictions (or otherwise) that countries place on entry for people with HIV.

This is the eighth edition of the guide, titled, Travel and Residence Regulations for People with HIV and AIDS 2007 which has been compiled by Karl Lemmen and Peter Wiessner of the German AIDS Federation and (EATG) and David Haerry (EATG).

Click here http://www.eatg.org/hivtravel to read the guide in English. PDF versions of the guide in French, German, Italian, Spanish are also available.

By Michael Carter, www.aidsmap.com