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Thursday, March 31, 2011

Parent-Based Intervention to Reduce Sexual Risk Behavior in Early Adolescence

The current study evaluated the efficacy of a parent-based sexual risk reduction intervention targeting young Latinos and African Americans in New York City. Mothers received the program while waiting for their adolescent child to complete an annual physical examination.

The randomized controlled trial involved 264 mother-adolescent dyads. Adolescents were study-eligible only if they were African American or Latino and ages 11-14, inclusive. Dyads completed a short baseline survey and then were randomly assigned to one of two conditions: (1) a parent-based intervention (n=133), or (2) a "standard care" control group (n=131). Nine-month follow-up assessed outcomes, including whether the adolescent had ever engaged in vaginal intercourse, the frequency of sexual intercourse, and oral sex frequency.

"Relative to the control group, statistically significant reduced rates of transitioning to sexual activity and frequency of sexual intercourse were observed, with oral sex reductions nearly reaching statistical significance (p<.054). Specifically, sexual activity increased from 6 percent to 22 percent for young adults in the 'standard of care' control condition, although it remained at 6 percent among young adults in the intervention condition at the nine-month follow-up," the study's results showed.

A parent-based intervention involving mothers waiting for their child at a pediatric clinic "may be an effective way to reduce sexual risk behaviors among Latino and Africa-American middle-school young adults," the investigators concluded.

The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals and empowering people to make healthy choices to prevent the spread of the HIV virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.


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African Girls Getting World Bank Cash Deters Sex with Sugar Daddies

Young women in sub-Saharan Africa have HIV infection rates up to three times higher than their male peers, largely because of relationships with older "sugar daddies" who give them money in exchange for sex. The phenomenon contributes significantly to HIV's spread, said Ester Etkin of loveLife, South Africa's largest anti-AIDS group.

A World Bank study in Malawi examined cash incentives among approximately 3,800 females ages 13-22. One group received roughly $10 a month and payment for school fees if they regularly attended class, while the control received no incentives. HIV infection rates at 18-month follow-up were 60 percent lower among girls who were given cash: 1.2 percent, compared with 3 percent. The study also showed a delay in the start of sexual activity among beneficiaries and a decline in the number of partners among those who were sexually active.

Though the study's results are being assessed by a peer-reviewed journal, plans are underway to repeat the experiment elsewhere in Africa, said Mayra Buvinic, director of gender and development at the World Bank. "The potential could be huge to reduce HIV rates in teenage girls," she said.

But some experts question whether cash payouts are an appropriate strategy. "We could end up creating an environment of dependency that cannot be sustained," warned Peter Lamptey, a Family Health International physician practicing in Ghana. "Paying people to influence their sexual behavior won't solve the wider problems of abuse, esteem, neglect and inequality that cause them to get HIV," said Sophie Harman, a senior lecturer at London's City University who has studied World Bank AIDS policies.

The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals and empowering people to make healthy choices to prevent the spread of the HIV virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.


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More Support Needed to Reverse HIV/AIDS Epidemic in Asia

Asia is still falling short in terms of HIV prevention and treatment access needed to reverse the epidemic, delegates from 24 Asia-Pacific nations heard at a UN regional AIDS conference in Bangkok this week. From 2001 to 2009, HIV infection rates fell 25 percent in India, Nepal and Thailand; however, they rose more than 25 percent in Bangladesh and the Philippines. An estimated 5 million people in the region have HIV.

Just 30 percent of adults and 44 percent of children in the region have access to antiretroviral therapy, said Anupama Rao Singh, regional director of UNICEF in East Asia and the Pacific.

"HIV prevention services still fall short of the level required to reverse the course of HIV in the most populous part of the world," Singh said. "The larger issues of stigma and discrimination, outmoded legislations, inadequate domestic resource commitments and policies that do not adequately take account of equitable access, will remain barriers to effective prevention, treatment, care and support if they are left unaddressed."

Laws in Asia that criminalize same-sex relations, drug use and sex work undermine prevention and treatment programs and place more people at risk of HIV, UNAIDS said. Nineteen regional countries outlaw same-sex relations, and 16 limit the free movement of people with HIV.

"Long-term financing for the international HIV response is a major concern," said Murray Proctor, Australia's ambassador for HIV. "In 2009, funding for HIV actually fell globally for the first time since 2002."

The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals and empowering people to make healthy choices to prevent the spread of the HIV virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.


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US Jury Rejects Glaxo Antitrust Claim vs. Abbott

In Oakland, Calif., on Wednesday, a 10-member federal jury rejected GlaxoSmithKline's (GSK) antitrust claim that Abbott Laboratories had quadrupled the price of its HIV drug Norvir in order to preserve the sales growth of its HIV drug Kaletra.

Norvir is used in drug cocktails because it can boost the effectiveness of other HIV medications. Abbott's combination pill Kaletra includes Norvir as a component. GSK maintained that Abbott raised the price of Norvir 400 percent in 2003 to hurt the sales of competing drugs that are typically administered with Norvir.

The jury did award GSK $3.4 million for its breach of contract claim, but Abbott spokesperson Adelle Infante said the company may appeal that judgment. "However, the jury's awarding of $3.4 million in damages, instead of the $571 million that GSK was asking for, confirms our view that GSK's alleged damages were inaccurate and inflated," she said.

GSK spokesperson Marc Meachem said the company was disappointed but accepts the verdict. "We continue to believe that Abbott did not act in the best interest of those living with HIV," Meachem said.

Several retail chains, including CVS Caremark and Safeway, had been trying the case with GSK but accepted undisclosed settlement offers from Abbott during the trial.

The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals and empowering people to make healthy choices to prevent the spread of the HIV virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.


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Volunteers Needed for HIV Trials

Vanderbilt University's HIV Vaccine Trials Unit is encouraging high-risk, HIV-negative men ages 18-45 to enroll in a trial testing a new HIV vaccine strategy.

Nashville is one of 12 sites chosen by the National Institutes of Health for the HVTN 505 trial, which will test a prime-boost vaccine approach against HIV. Sponsored by the National Institute of Allergy and Infectious Diseases, the trial is being conducted by the NIAID-supported HIV Vaccine Trials Network.

Researchers aim to sign up at least 60 men for the Nashville arm of the study. Kyle Rybczyk, director of the Vanderbilt unit, wants to enroll even more than 60, as the study began accepting volunteers in 2009 and total national enrollment was only 883 as of mid-March of this year. To determine efficacy, the trial needs at least 1,350 volunteers.

Researchers are hoping to learn whether this particular vaccine regimen could decrease the viral load of people who become infected with HIV. Usually, the lower the viral load, the longer it can take to progress to AIDS, according to the network. A lower set point may delay illness and help lower transmission.

Participants will get a series of three immunizations with a recombinant DNA-based vaccine over eight weeks, followed by a single recombinant booster at week 24, or placebos. The DNA priming shots, as well as the adenovirus serotype 5 booster, contain more pieces of HIV DNA than the earlier STEP trial. In addition, the ad5 virus has been weakened more than the STEP trial version, expressing less adenovirus genes while still carrying HIV gene segments to the immune system, the network said.

Efficacy data should begin to develop two years into the study, said Dr. Spyros Kalams, a Vanderbilt immunologist. Those interested in volunteering can telephone 615-322-HOPE.

The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals and empowering people to make healthy choices to prevent the spread of the HIV virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.


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Teens Spread Word on Sex Education; Peer Education Group Gives Girls Information at Whitehall-Yearling

Fifteen Columbus girls who have undergone training and education on STDs and teen pregnancy are providing leadership on these topics for their peers. Members of the Whitehall Peer Education Group (WPEG) are answering questions from classmates and holding discussions and demonstrations in health classes.

The goal, according to the girls, is to encourage young females to respect themselves and be self-confident. Sophomore and WPEG member Michaela Jones said, "No one tells them that they are beautiful, and they feel they have to have sex" to feel that way.

WPEG is now in its second year. It is run by Planned Parenthood of Central Ohio and receives $35,000 from the Columbus Foundation and the Women's Fund of Central Ohio. Though Planned Parenthood has been a frequent target of conservative groups, Whitehall-Yearling Principal Carl Svagerko said he knows of no pushback from the community regarding WPEG's activities.

Members were selected through an application and interview process. They then received five two-hour training sessions throughout the year covering key topics, including being an effective educator. The girls also attended leadership workshops last summer.

"Kids really open up to their peers," said Lynn Feils, who helps run WPEG. "When peer educators give an opinion, the [students] get it, and they understand how it's relevant to their life."

"We know that in the teen years, their peers are an incredibly strong influence in their thinking and in their choices. This is normal adolescent behavior to move away from parental advice," said Barbara Huberman, director of education and outreach for the Washington-based Advocates for Youth, a reproductive health group.

"You have to let kids have that dialogue, have those adult conversations," Svagerko added.

The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals and empowering people to make healthy choices to prevent the spread of the HIV virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.


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Association of Aging and Survival in a Large HIV-Infected Cohort on Antiretroviral Therapy

The authors undertook the prospective observational study to determine whether there is a "significant difference in survival between elderly (>50 years) and nonelderly adult patients receiving combination antiretroviral therapy [ART] in Uganda between 2004 and 2010."

Patients enrolled in the AIDS Support Organization Uganda HIV/AIDS national program were evaluated for time to all-cause mortality. The investigators applied a Weilbull multivariable regression.

Of the 22,087 patients in the analyses, 89.0 percent (19,657) were ages 18-49 and 11.0 percent (2,430) were age 50 or older. "These populations differed in terms of the distributions of sex, baseline CD4 cell count and death. The age group 40-44 displayed the lowest crude mortality rate (31.4 deaths per 1,000 person-years; 95 percent confidence interval 28.1, 34.7) and the age group 60-64 displayed the highest crude mortality rate (58.9 deaths per 1,000 person-years, 95 percent CI 42.2, 75.5)," the results showed. Nonelderly patients had better survival than elderly patients (P<0.001), per Kaplan-Meier survival estimates. Adjusted Weilbull analysis indicated that elderly age status was significantly associated (adjusted hazard ratio 1.23, 95 percent CI 1.08-1.42) with mortality, after controlling for sex, baseline CD4 cell count and year of ART initiation.

"As antiretroviral treatment cohorts mature, the proportion of patients who are elderly will inevitably increase. Elderly patients may require focused clinical care that extends beyond HIV treatment," the study authors concluded.

The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals and empowering people to make healthy choices to prevent the spread of the HIV virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.


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ACLU Lawsuit Claims Alabama Discriminates Against HIV-Positive Inmates

In a federal lawsuit filed Monday on behalf of 10 HIV-positive inmates, the American Civil Liberties Union claims that Alabama's correctional system discriminates against prisoners with the virus by separating them from others
and excluding them from some programs.

The lawsuit - filed in the Middle District of US District Court in Montgomery - asks the court to find that the policy violates sections of the Americans with Disabilities Act and the Rehabilitation Act. The suit seeks class-action status on behalf of all HIV-positive state inmates, and it asks the court to order an end to the practice of segregating these inmates.

The plaintiffs claim they have been subjected to harsh punishments because of the policy. One inmate was allegedly punished for eating in an area with HIV-negative prisoners; another reportedly was told certain jobs, such as food preparation, were off-limits.

"Prisoners diagnosed with HIV are segregated from all other prisoners and cannot keep their HIV status confidential," the lawsuit says. "Every male prisoner who tests positive for HIV is required to wear an armband publicly identifying him as a person with HIV."

According to the lawsuit, Alabama limits its approximately 250 HIV-positive inmates to certain prisons, meaning they cannot take part in programs offered in other prisons. Alabama and South Carolina are the only states that segregate all inmates with HIV, the suit says.

The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals and empowering people to make healthy choices to prevent the spread of the HIV virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.


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Wednesday, March 30, 2011

New Viramune Tablet Approved for Once-Daily Use

Viramune XR—an extended-release version of nevirapine, a non-nucleoside reverse transcriptase inhibitor (NNRTI)—has been approved by the U.S. Food and Drug Administration (FDA), according to a March 28 announcement from the agency. The new Viramune formulation allows for once-daily dosing, an option that hasn’t been recognized by the FDA until now.

According to Jennifer Soares, a Boehringer Ingelheim spokesperson, Viramune XR will likely be available from pharmacies the third week of April.

Immediate-release Viramune, one 200 milligram (mg) tablet taken twice daily, has been the approved dose in the United States since the drug was first approved in 1996. While clinical trials have explored once-daily dosing using the original formulation—two 200 mg tablets once a day—results have been conflicting. Yet, once-daily Viramune is prescribed “off label” by some U.S. health care providers, and it has long been a popular option in other countries.

With the development of Viramune XR (400 mg nevirapine), manufacturer Boehringer Ingelheim set its sight on once-daily approval of the drug in the United States. Approval has now been granted, based on the results of two clinical trials: the VERxVE study, comparing Viramune XR with immediate-release Viramune in first-time treatment takers, and TRANxITION, a study exploring the safety and efficacy of transitioning patients from twice-daily Viramune to once-daily Viramune XR.

VERxVE

This Phase III study randomized 508 treatment-naive individuals to the standard Viramune group (200 mg taken twice daily) and 505 to the Viramune XR group, with patients in both groups also receiving Truvada (tenofovir plus emtricitabine). The average age of participants entering the study was 38, and about 85 percent of the study volunteers were men. About 250 patients were enrolled in the study through European research centers; about 150 were enrolled in the United States; and the remaining patients were enrolled through sites in Latin America or Africa.

Viral loads at study entry were about 50,000 copies, and CD4 counts averaged 228 cells.
Of note, all patients enrolled in the study began treatment with a 14-day lead-in period in which they took one 200 mg tablet of standard Viramune once a day, before starting full dosing—a common practice to reduce the risk of Viramune toxicity upon commencing treatment.

After 48 weeks, a viral load below 50 copies was maintained in 75 percent of patients in the standard Viramune group, compared with 80 percent of patients in the Viramune XR. Virologic failures, including viral load rebounds, were documented in 13 percent of those in the standard Viramune group compared with 11 percent of those in the Viramune XR group.

In patients with pre-treatment viral loads greater than 100,000 copies, according to data presented at the XVIII International AIDS Conference last summer in Vienna, the response rate was 73 percent in the Viramune XR group, compared with 71 in the standard Viramune group. Among patients with pre-treatment viral loads at or below 100,000 copies, the response rate was 79 percent in the standard Viramune group, compared with 86 percent in the Viramune XR group.

The rate of discontinuations due to adverse events in the Viramune XR group was 6.3 percent, compared with 8.9 percent in the standard Viramune group. Symptomatic liver problems were documented in 1.6 percent of Viramune XR–treated patients, compared with 2.8 percent of those taking standard Viramune. Rashes developed in about 8.5 percent of all patients, with no discernable differences between the two groups.

After 48 weeks of treatment, CD4 counts increased an average of 191 cells among those receiving standard Viramune, compared with a 206-cell gain among those receiving Viramune XR.

TRANxITION

Another Phase III study, TRANxITION evaluated the safety and efficacy of switching 443 patients—all with undetectable viral loads—from standard twice-daily Viramune to once-daily Viramune XR. About half the study volunteers were also using Truvada, with the remaining subjects using either Epzicom (abacavir plus lamivudine) or Combivir (zidovudine plus lamivudine). About half the subjects had been using twice-daily Viramune for at least three years.

Two thirds of the patients were switched to once-daily Viramune XR; the remaining third remained on twice-daily standard Viramune.

Twenty-four weeks after transitioning, 94 percent of patients who remained on twice-daily Viramune, compared with 95 percent of patients who switched to Viramune XR, maintained viral loads below 50 copies.

Viramune XR Dosing

There is an increased risk of liver problems in certain people using Viramune when starting HIV treatment for the first time. These liver problems are more likely to occur in women (including pregnant women) with CD4 cell counts greater than 250 at the time of starting treatment. As for men, liver problems are more likely to occur if their CD4 cell count is greater than 400 at the time of starting treatment. In turn, neither standard Viramune nor Viramune XR should be used in patients who meet these CD4 cell criteria.

Even with the approval of Viramune XR, taking the drug remains a two-step process. For the first two weeks (14 days) of treatment, the dose is one 200 mg tablet once a day, which is possible using the standard formulation of Viramune. Two weeks after starting treatment, the dose of Viramune is increased to one Viramune XR tablet once a day.

Following this schedule—which you should do under your doctor’s guidance—can reduce the chance of developing a rash or other side effects.

The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals and empowering people to make healthy choices to prevent the spread of the HIV virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.


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Pooled Trial Results Suggest Capsaicin Patch Relieves Neuropathy Pain

The pooled results of two clinical trials suggest that a skin patch with the chili pepper–derived chemical capsaicin could relieve HIV-related neuropathy pain by about 30 percent. These trial results, presented at the annual meeting of the American Academy of Pain Medicine (AAPM), were reported by the website Medpage Today.

Chili peppers and mustards have been used for centuries in topical balms to treat chronic pain. Only during the past few decades, however, have scientists figured out how capsaicin—the chemical that gives chilies their pungency—works as an analgesic: It depletes a neurochemical called substance P responsible for transmitting pain.

NeurogesX, based in San Mateo, California, has spent several years testing capsaicin in skin patches to treat a variety of chronic pain conditions. The company now has a skin patch made up of a gel containing 8 percent capsaicin, called Qutenza, which is approved by the U.S. Food and Drug Administration (FDA) to treat pain from shingles and from diabetic neuropathy. Qutenza is applied for one hour in a single application, and the pain-relief lasts for about three months.

NeurogesX has also conducted trials of Qutenza to treat HIV-related distal sensory polyneuropathy (neuropathy), a condition marked by nerve damage, which can cause pain, tingling and numbness in the extremities and sometimes lead to permanent disability.

“To date, medications used to treat neuropathic pain have yielded disappointing results in large randomized controlled studies among HIV-associated neuropathy,” Steven Brown, MD, from the AIDS Research Alliance in Los Angeles, told Medpage Today.

Brown, who presented the results of the two trials at the AAPM conference, also noted: “The only substances that have shown any impact on the pain appear to be the [Qutenza] patch, smoked cannabis and recombinant human nerve growth factor, but none of these treatments has yet been approved by the FDA for that use.”

Two clinical trials of Qutenza for HIV-related neuropathy conducted before 2008 had mixed results, with one showing improvements in neuropathy pain and another finding that Qutenza wasn’t significantly better than a gel patch containing a miniscule amount of capsaicin. A 2009 article in Wired magazine detailed how the placebo effect—whereby patients’ symptoms can significantly improve just by thinking they are getting a real medicine, even if they receive only a sugar pill—is particularly strong in trials of pain medication. This means that a medicine often has to be quite potent to show a statistical difference.

At the recent AAPM conference, Brown presented data on an analysis that pooled the results of two newer studies. The studies compared 239 people who received a single application of Qutenza (8 percent capsaicin) with 99 people who received a single application of a control patch containing only 0.04 percent capsaicin.

Brown and his colleagues found that those receiving Qutenza had a 27 percent decrease in their neuropathy pain compared with a 15.7 percent decrease in those who received the control patch. The improvement was highly statistically significant, meaning that the difference between Qutenza and the control was too large to have occurred by chance.

What’s more, when Brown’s team looked at those who received a higher degree of pain relief—a 30 percent or more reduction in pain scores—36 percent of those on Qutenza saw this higher level of relief compared with 22 percent on the active control.

The three-month improvement in neuropathy pain doesn’t come without side effects, however. David Walk, MD, of the University of Minnesota in Minneapolis, who has used Qutenza for non-HIV pain care, told Medpage Today, “This treatment can be painful. Even with the lidocaine that is delivered before the patch is applied, patients report some pain associated with the patch for as long as a week afterward, so we usually send them home with analgesia to cover that period.”

NeurogesX reports on its web site that it is still working to seek FDA approval for Qutenza for HIV-related neuropathy.

The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals and empowering people to make healthy choices to prevent the spread of the HIV virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.


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Another Study Finds No Heart Attack Risk From Abacavir

People taking abacavir (found in Ziagen, Epzicom and Trizivir) had no greater risk of having a heart attack than people not taking abacavir, according to an analysis of six AIDS Clinical Trials Group (ACTG) studies reported in the April 1 issue of Clinical Infectious Diseases. Though the studies predominantly involved people with low cardiovascular disease (CVD) risks, the ACTG analysis joins other reports in challenging the conclusions of studies suggesting that abacavir treatment increases the risk of CVD among people living with HIV.
Three major studies have now found an increased risk of heart attacks associated with abacavir. These include two cohort studies—the Data Collection on Adverse events of Anti-HIV Drugs (D:A:D) cohort and the French Agence Nationale de Recherches sur le SIDA (ANRS) cohort—and a study comparing delayed or interrupted treatment with continuous treatment, called Strategies for Management of Antiretroviral Therapy (SMART). The three studies have significantly different designs, populations and methods, yet all indicated at least some degree of increased heart attack risk among people taking abacavir.

Meanwhile, analyses conducted by ViiV Healthcare (formerly GlaxoSmithKline) and the U.S. Food and Drug Administration of multiple controlled clinical trials involving abacavir found no increased risk—they also failed to find any biological explanation or hint for why the other studies did. Though this has remained a controversy, current antiretroviral (ARV) guidelines recommend that people with high CVD risk factors do not use abacavir.

To add to the knowledge base on abacavir and cardiovascular disease risk, Heather Ribaudo, PhD, from the Department of Biostatistics at the Harvard School of Public Health in Boston, and her colleagues from the ACTG A5001/ALLRT Protocol Team, analyzed data on more than 5,000 HIV-positive people drawn from six ACTG studies.

Most of the participants were younger than 45, and most were male, though the cohort was racially diverse. One-year follow-up data was available for 92 percent of the participants, and six-year follow-up data was available for 22 percent.

Over the course of the study, there were 36 heart attacks, roughly two thirds of which occurred between the second and sixth year on ARV therapy.

Based on several different types of analysis, Ribaudo and her colleagues could find no additional heart attack risk in those taking abacavir. In fact, the only factor that predicted a heart attack were older age and traditional heart attack risk factors, such as smoking and a history of cardiovascular disease.

No study of abacavir and heart attack risks is going to be perfect, and Ribaudo and her team acknowledge that their own analysis has limitations. For one thing, the total number of heart attacks was low, and it is possible that a difference might have emerged with larger numbers. Also, three of the studies directly randomized people to abacavir or another similar drug, while three did not randomize their treatments this way. This could also have affected the study outcomes. Finally, clinical trials such as those included in the ACTG analysis tend to exclude individuals with underlying health problems, such as high blood pressure or very high cholesterol or triglyceride levels. In other words, people in the ACTG studies may have been at a lower risk of a heart attack before starting abacavir, compared with those in the “real world” D:A:D and ANRS cohorts.

Nevertheless, the authors cite one potential strength not present in the studies that have thus far found an increased heart attack risk: The randomized ACTG trials were able to reduce the chance that people with higher heart attacks risks were preferentially put on abacavir, as was possibly done in the earlier cohort studies because providers at that time felt abacavir was more heart “friendly”—less likely to causes lipid increases, etc.—than other regimens. If this kind of “channeling” bias was in effect, it could go a long way toward explaining the increased heart attack risk found in those earlier studies.

“We found no evidence of an increased risk of [heart attack] or serious CVD associated with the use of abacavir as part of initial treatment over the first year of [ARV therapy] and the longer term that was consistent in [several types of analyses],” the authors conclude. “Classic CVD risk factors were the strongest predictors of [heart attacks] and serious CVD events and should be the main focus in assessing CVD risk among HIV-1 infected individuals.”

The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals and empowering people to make healthy choices to prevent the spread of the HIV virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.


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Reyataz May Be Safe for HIV-Positive People With Severe Liver Disease

People with HIV who have severe hepatitis C virus (HCV)-related liver disease (cirrhosis) may be able to safely take Reyataz (atazanavir) without worsening their liver condition, according to a study published online March 17 in the journal AIDS.
Reyataz is one of the best tolerated protease inhibitors (PIs) available, and though it can cause significant elevations in a liver enzyme called bilirubin, it does not appear in clinical trials to negatively affect the liver in other ways—certainly no more so than other PIs.

While Reyataz is commonly used in people with milder forms of liver damage, some providers have expressed concerns about using it in people with cirrhosis. This is because advanced liver disease—just like Reyataz—can raise bilirubin levels. Adding Reyataz, therefore, might make it difficult to know whether a person’s increased bilirubin is being caused by Reyataz, and therefore harmless, or if the increased bilirubin is a sign of worsening disease.

To help shed light on this situation, Jose Rodriguez, MD, and his colleagues from the Hospital Ramón y Cajal in Madrid examined the medical records of 92 people coinfected with both HIV and hepatitis C virus (HCV) who had cirrhosis, 34 of whom were prescribed Reyataz at some point.

The majority were treatment experienced and had undetectable HIV levels when starting Reyataz. Roughly three quarters had a milder form of cirrhosis, and the other 26 percent had more severe cirrhosis. Most of the study participants (76 percent) used Reyataz in conjunction with low-dose Norvir (ritonavir). Only one person stopped taking Reyataz because of increases in other liver enzymes. The average length of time on Reyataz was about 15 months.

Though Reyataz did cause bilirubin elevations, the authors state that the elevations—surprisingly—were no greater than those seen in people without liver disease. Also, though people with more severe cirrhosis had higher bilirubin elevations than those with less severe cirrhosis, the difference was not large.

This finding had two practical implications. First, contrary to previous concerns, adding Reyataz did not make it difficult to determine if a person’s increased bilirubin levels were due to the drug or to worsening liver disease. Secondly, because the bilirubin increases were of a relatively small and predictable size, they did not significantly worsen a person’s model for end-stage liver disease (MELD) score, which is used to determine the urgency with which someone should receive a liver transplant.

Rodriguez and his colleagues concede that because their study did not randomly assign people to either Reyataz or another antiretroviral medication, it isn’t possible to say with certainty that it is always safe in this population, or to pinpoint those individuals who should not use it. They do state, however, that Reyataz can be safely used in at least some people with more severe liver disease.

“Atazanavir did not worsen hepatic function in more than 500 patient-months of follow-up. According to this data, [Norvir-] boosted and unboosted atazanavir could be considered a safe option in patients with cirrhosis in the clinical setting,” they conclude.

The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals and empowering people to make healthy choices to prevent the spread of the HIV virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.


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Tuesday, March 29, 2011

Cellular Proteins Responsible For Viral Replication Identified To Help Develop New Therapeutics For HIV/AIDS

Worldwide over 30 million adults and 2.5 million children are infected with the human immunodeficiency virus (HIV) that causes acquired immune deficiency syndrome (AIDS). HIV infection in humans is considered pandemic by the World Health Organization (WHO), and this year alone an additional 2.6 million people will be newly infected. Without treatment, HIV infected individuals develop AIDS and have a life expectancy of less than five years. To date, more than 25 million people have died of AIDS, and two million more are expected to die this year. With recent setbacks in the development of vaccines, the high mutation rate of HIV and new multi-drug resistant strains of the disease appearing with growing frequency, there is an urgent need to develop new drugs. Massimo Caputi, Ph.D., associate professor of biomedical science in the Charles E. Schmidt College of Medicine at Florida Atlantic University, has received a competitive grant of $433,500 from the National Institute of Allergy and Infectious Diseases of the National Institutes of Health to further his research on identifying novel therapeutics for HIV.

HIV is a virus that causes AIDS by damaging the immune system cells until the immune system can no longer fight off other infections that it would usually be able to prevent. HIV cannot reproduce on its own, and instead infects the cells of a living organism in order to replicate.

"Antiretroviral drugs used today to treat HIV infected individuals cannot completely eliminate the virus, and the majority of these drugs target viral proteins," said Caputi.

HIV uses a multitude of host cellular proteins to replicate efficiently. Caputi and his colleagues are focused on the identification and characterization of these cellular factors, and have already identified more than a dozen cellular proteins that are required by the virus in order to replicate efficiently. Because cellular therapeutic targets do not undergo a high rate of mutation, the emergence of resistant viral strains is unlikely. Identifying these cellular factors provides hope for developing new therapeutics.

"We are testing the possibility of obstructing the activity of these proteins to limit viral replication, and also exploring a novel set of technologies to further characterize the mechanism by which HIV replicates within human cells," said Caputi.

HIV is transmitted through unprotected sexual intercourse, contact with an infected person's blood, from mother to child, use of infected blood products, and injecting drugs. The majority of people with HIV live in the developing world where AIDS is the leading cause of death. The total number of people living with HIV continues to rise in high-income countries as well. In the U.S., AIDS is the fifth leading cause of death among all adults aged 25 to 44. Urban areas with lower socioeconomic standards are hit the most by this epidemic. South Florida with the metropolitan areas of Miami, Fort Lauderdale and West Palm Beach has the highest infection rate in the country.

The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals and empowering people to make healthy choices to prevent the spread of the HIV virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.


TOGETHER WE REMAIN STRONG!

Test Children for HIV?

Over the past decade, advocacy and awareness of HIV and AIDS prevention has gained momentum in decreasing stigmas associated with the infections.

However, certain stigmas still exist, especially when it comes to screening minors, who have always had low screening rates, according to the Texas Tech University Health Sciences Center of the Permian Basin. Questioning the historically low rates, Texas Tech researchers wanted to know if parental attitudes served as potential barriers for screening minors.

“We were speculating what would cause a parent to be willing and not willing (to have their child screened),” Dr. Stephanie Caples said. “We wanted to know what parents think.”

In a survey conducted at the school’s Family Health Clinic, the researchers found that 57 percent of 78 parents questioned agreed or strongly agreed to screen their child for HIV. Forty-four percent said the optimum screening age should be 11 to 15 years old.

The results are part of an ongoing study conducted by Caples and other principal investigator Dr. Jamal Islam that assesses parental attitudes and knowledge on HIV. During June 2010, Caples and Islam surveyed parents who used the Texas Tech Family Health Clinic and who have children between the ages of 10 and 24 years.

Parents were given a questionnaire that asked their age, gender, ethnicity, dwelling, number of children and if they themselves have been screened. Parents were also tested on their knowledge of HIV.

Caples said that even though the parents were asked about subjects that might have a potential influence on their decision, such as income and ethnicity, neither of those issues seemed to be a predictor of the resulting answers.

Two influential factors were the parents’ fear that their child might get HIV or their child is possibly at risk of acquiring the virus. Of the 57 percent who agreed or strongly agreed to screen their child, 72 percent said it was out of fear their child could get HIV.

“There’s not a clear indication if their child was sexually active,” Caples said. “But that might seem like a motivation.”

Midland-Odessa Area AIDS Support associate director Renue Batula said she was impressed with the results, because parents need to start realizing the possibility that their kids could be sexually active.

“Unfortunately (minors) are becoming sexually active younger and younger, and there needs to be testing. It’s something that needs to be closely looked at to really stress that kids need to be tested,” Batula said. “I think it’s awesome that parents are willing to realize that and are on board with kids being tested.”

If their children are sexually active, Batula said, the fear of HIV screening or the stigmas associated with it shouldn’t be a deterrent to a virus that grows more harmful the later it’s diagnosed.

“Parents need to be aware that the possibility is there that their children may be having sex. If the possibility is there, wouldn’t you want to know that your child has got something potentially deadly,” Batula said. “If that child did have (HIV), you would not want to find out 10 or 12 years down the road when that child has AIDS and is dying of it.”

Only 20 percent of parents disagreed or strongly disagreed to screen their child. Twenty-three percent had no opinion. Caples said with awareness and education, those parents with no opinion on the issue might be swayed into agreeing to screen their children.

“My hope would be that if the doctors spoke with them, they would agree,” Caples said. “I hope what we could do is bring awareness of having HIV screening in children’s well check. More primary care centers will ask parents to consent regularly. I think that could be implemented.”

Education remains the key to prevention for Batula and MAAS founder Judy Warren. Warren, whose brother died of AIDS in 1990, often speaks to schools, churches and businesses of her brother’s struggle and the importance of AIDS awareness.

Batula said most people don’t know much about HIV and AIDS until they or someone close to them gets infected. For Batula, it was her son, who was diagnosed with HIV in 2007 when he was 19 years old, just after his graduation from Midland Lee High.

“I was devastated at first, extremely devastated. I didn’t know anything about HIV. Once I came to MAAS, I got more educated,” Batula said.

Batula’s son was diagnosed early enough to prevent the development of AIDS within his body longer.

“I’m thankful my son got tested, because he did have it. I’m thankful we caught it as early as we did,” Batula said. “Just because he has it doesn’t mean he’s going to die from it. He’s keeping it under control with medication.”

Parents should also have an open communication with their children, Caples said.

“When a child is under the age of 18, parents have to inform themselves,” Caples said. “They can talk to their family physician; they can call resources like the CDC or World Health Organization in order to learn to speak to their child about it.”

Wendy Rathbun, a parent to nine-year-old and 11-year-old boys and a 14-year-old girl, said she prefers to talk with her children when they’re at an adolescent age, around 13 or 14 years, to make sure they’ve reached a mature age to discuss sexual education.

“I initiate (conversation) if there’s something I heard in the news or something she needs to know,” Rathbun, who is also a nurse, said about discussions with her daughter. “Usually, if she has a question about what she sees on TV or something they discussed at school, I let her bring it up.”

Rathbun said if parents don’t have that communication with their child, they might learn their sexual education from more unreliable sources like their peers.

“If they don’t ask the parents or someone with knowledge, they’ll go by myths and what their friends perceive, and they’ll get misinformation,” Rathbun said. “It could be detrimental to their health.”

The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals and empowering people to make healthy choices to prevent the spread of the HIV virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.


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Gates Stops HIV/AIDS Funds to India

Bill Gates has wrapped up his high-profile visit to India, and with that, the massive funding for the country's HIV/AIDS programmes through the Gates Foundation has also officially ended. Gates cited the fact that HIV/AIDS infection rates have declined in the country."The Avahan initiative has been a phenomenal success. I should note though that the Government of India has been together on this on every step of the way. In fact in the years ahead most of the ongoing work on prevention would be funded by the Government," said Bill Gates.What this means is almost $338 million less to fight the HIV/AIDS epidemic in India after 2012, an amount committed by the GATES Foundationn's initiative Avahan, in the year 2009.

"$200 million is not a small change. We are always struggling for funding- health is an ever expanding horizon of needs. They have done a great job. Now its over to us- the ministry to build it and make then into sustainable projects," said former Health Secretary Sujatha Rao.

Avahan-supported schemes used to reach nearly 2 lakh female sex workers and 80,000 patients in the MSM community and the transgender community.

This work will now be taken over completely by the National AIDS Control Organisation while the Gates foundation will redirect its funds into other public health programmes like research or drug and vaccine and cheaper drugs.

The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals and empowering people to make healthy choices to prevent the spread of the HIV virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.


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California State University-Long Beach Professor Fights Ignorance About HIV/AIDS with Research

Years ago in Tennessee, a cousin's diagnosis with HIV set Thomas Washington on a quest to learn more about the disease and to help those affected. Washington said his family had been sheltered from knowing much about HIV/AIDS, and so were community youths.

"It was alarming," said Washington, now an associate professor of social work and CSULB research fellow. He can remember people developing AIDS rapidly losing weight and having a stricken appearance. His cousin died 10 years after diagnosis.

"There were countless people being alienated from their family members because of the fear and the ignorance surrounding HIV," Washington said. "They didn't know how it was spread necessarily - whether they could catch it from sitting on the toilet seat after the person or drinking from the same cup." Washington began volunteering for support organizations including Memphis-based Friends for Life.

In HIV/AIDS work, Washington said a major problem continues to be "gaining access to the minority community." Many researchers visit a community, conduct their studies, and depart never to be seen again, he said. As a result, Washington said he has "to build the rapport to help them understand that I am not just about collecting data."

Washington said the most rewarding aspect of his work is being invited to speak about HIV, engaging people's attention, and getting them involved. "If I can help prevent one new exposure, then I can see that my job - my work - can make a difference," he said. He is also encouraging people to volunteer for HIV vaccine studies.

At the recent 2011 National African-American Men Who Have Sex with Men Leadership Conference, Washington won the Gerald Ludd Award in recognition of his work on HIV/AIDS and other health disparities affecting African-American MSM.

The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals and empowering people to make healthy choices to prevent the spread of the HIV virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.


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University of Pennsylvania Pioneers HIV Gene-Therapy Trial

University of Pennsylvania researchers are still recruiting HIV-positive participants for a trial of a gene therapy approach intended to block HIV from entering human immune cells. The trial's initial results, presented at the recent 18th Conference on Retroviruses and Opportunistic Infections in Boston, were promising.

In the study, launched in July 2009, Penn scientists remove T-cells from HIV-positive patients' blood, genetically alter them to lack a receptor HIV uses to infect the cells, and re-inject the cells into their donors.

"We separate the cells in the lab, and the protein in the membrane of the cell where the HIV virus uses to enter the cells is taken out," Dr. Pablo Tebas said. "So we remove that particular gene from the cells and then monitor the patients to see if the HIV continues to expand or not."

"We've seen that it is doable," Tebas said. "We can take cells and genetically modify them and re-infuse them and it's safe, nothing bad has happened to the patients. The cells are alive when they go back into the patient and, while we don't have all the data yet, the cells have expanded so far as normal cells as we can tell, which means that they are protected from HIV infection."

Despite the good results, scientists are a long way from freeing HIV patients from the need for life-long antiretroviral therapy, Tebas said. "In order for there to be an actual cure, we'd need all cells in the patient to have this gene removed, and we can't do that yet - we've only removed a small fraction."

For more information about the study, telephone Penn's AIDS Clinical Trials Unit, 215-349-8092.

The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals and empowering people to make healthy choices to prevent the spread of the HIV virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.


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Integrated Behavioral Intervention to Improve HIV/AIDS Treatment Adherence and Reduce HIV Transmission

The current study concerns an integrated behavioral intervention designed to enhance the use of HIV treatment as prevention by improving medication adherence, reducing risks for other STDs, and minimizing risk compensation beliefs. The authors conducted a randomized clinical trial to evaluate the intervention.

A total of 436 persons with HIV/AIDS participated in the trial, which compared the intensive behavioral intervention with an attention control condition. The researchers used unannounced pill counts to monitor adherence to antiretroviral (ARV) therapy. Computerized interviews were used to assess risk behaviors.

The findings indicated that the intervention demonstrated increased ARV adherence and less unprotected sex with nonseroconcordant partners at three- and six-month follow-ups, and fewer new STDs diagnosed over the nine-month follow-up period (adjusted odds ratio=3.0; P<.05; 95 percent confidence interval=1.01, 9.04). In addition, the intervention decreased behavioral risk compensation beliefs.

"A theory-based integrated behavioral intervention can improve HIV treatment adherence and reduce HIV transmission risks," the authors concluded. "HIV treatment as prevention should be bundled with behavioral interventions to maximize effectiveness."

The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals and empowering people to make healthy choices to prevent the spread of the HIV virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.


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Senate Plan Would Not Pay for New HIV Patients

On Thursday, a state Senate finance subcommittee approved a budget proposal under which the Texas HIV Medication Program for low-income patients would be unable to afford new clients. However, Lt. Gov. David Dewhurst (R), president of the Senate, said later that he expects "lifesaving drugs will be included" in any final budget.

The subcommittee's chair, Sen. Jane Nelson (R-Flower Mound), tasked budget writers with ranking items by three levels of priority, with the first category the most important. The proposal approved would restore $4.5 billion to state-supplied health services. The HIV program was listed as a second-tier priority.

Sen. Judith Zaffirini (D-Laredo) asked the Department of State Health Services commissioner what would happen if HIV/AIDS patients could not access treatment.

"The natural progression, without any medications, would be that they die," replied Dr. David Lakey.

"And this is in priority two, which is really a wish list?" asked Zaffirini. "It is my belief that when we vote on a priority like this we are basically making a decision regarding who lives and who dies."

Prompted by Nelson, Lakey explained that one-time federal funds for the program were only for the last budget cycle. Those funds are not on the table this cycle. The program provides treatment to 14,000 HIV/AIDS patients, Lakey said.

"I simply cannot vote for this proposal," Zaffirini said. "I believe it is wise to add $4.5 billion, but that is not enough. And I doubt items in priority two will be funded at this time."

"There are too many Texans that need our help that will be hurt if we only do the $4.5 billion," said Sen. Kevin Eltife (R-Tyler).

Dewhurst pledged the HIV program would be funded, without offering details. "I've made sure that happened before," he noted.

The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals and empowering people to make healthy choices to prevent the spread of the HIV virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.


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Friday, March 25, 2011

Improving Adherence and Clinical Outcomes Through an HIV Pharmacist's Interventions

The assistance of an HIV clinical pharmacist can benefit patients in terms of regimen complexity, adherence and immunologic and virologic outcomes, the authors of the current study report.

Though antiretroviral therapy (ARV) can effectively suppress HIV and boost immunologic response, most patients struggle with adherence, the authors noted. While previous studies showed that clinical pharmacists contribute to management of HIV patients, variability in the pharmacist's responsibilities and study limitations have hampered a thorough evaluation.

In this retrospective study, an HIV clinical pharmacist's interventions included suggesting regimens to suppress HIV, improve immunologic response, minimize adverse events, and optimize adherence by reducing pill burden and/or dosing frequency. Ma and colleagues assessed the efficacy of these interventions on pill burden, frequency, adherence, and patient clinical outcomes. The study took place at the Kaiser Permanente Medical Care Program, Vallejo, Calif., from September 2006 to September 2008.

From a cohort of 75 patients, mean daily pill number and dosing decreased from 7.2 pills/day and 2.0 times a day in the control phase to 5.4 pills/day and 1.5 times/day during the study, respectively (p<0.001.) Adherence increased from a mean of 81 percent to 89 percent (p=0.003).

"Clinical outcomes measured by CD4+ cell count and CD4 percent were statistically improved, and more individuals achieved undetectable HIV viral loads post-intervention (p<0.001)," the authors found. "In conclusion, HIV clinical pharmacists may play an important role in reducing pill burden and dosing frequency, increasing medication adherence, and improving clinical outcomes."

The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals and empowering people to make healthy choices to prevent the spread of the HIV virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.


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Health Scare Haunts HIV/AIDS Patients in Ukraine

Advocates and patients allege Ukraine's Interior Ministry is cracking down on drug substitution therapy, a World Health Organization, and UN-backed method of treating opioid addiction. The country adopted drug substitution programs in 2004 as way to combat injecting drug use (IDU) and HIV. More than 5,000 Ukrainians are currently registered in programs, and plans are for as many as 20,000 to be enrolled by 2014.

But during the past year, police have stepped up the questioning and harassment of program participants and the groups that help them, activists say. Some experts speculate that corrupt police may be working with illegal drug suppliers to halt the programs. Others wonder if Russia, which bans drug substitution therapy, is exerting its influence to sway policy.

Ukraine has up to an estimated 300,000 IDUs, and in major cities as many as a quarter are believed to be HIV-infected. The country also has one of Europe's highest adult HIV prevalence rates, 1.1 percent in 2009. By comparison, the United Kingdom's is 0.2 percent.

Last January, Prime Minister Mykola Azarov issued what AIDS experts at the time called a "bold and far-reaching" directive to boost drug substitution efforts. But Interior Minister Anatoly Mogilev has repeatedly described such initiatives a "mistake."

In a letter sent to Azarov last month, Mogilev asked the prime minister to "consider prohibiting the use of methadone in substitution maintenance therapy, as well as to commission scientists working in the area of pharmacology to develop a 'softer' drug for use in substitution therapy ... manufactured by the domestic pharmaceutical industry."

Ted Nierras, head of the International AIDS Alliance's Eastern European team, said the crackdown "does not help in reducing HIV infection and AIDS."

The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals and empowering people to make healthy choices to prevent the spread of the HIV virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.


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Lord Fowler Calls for More HIV Awareness

Most Britons over 30 can remember the 1987 televised warning, "Protect yourself. If you ignore AIDS, it could be the death of you, so don't die of ignorance." The transition from a sustained general awareness campaign to the more targeted campaigns of today, however, could be leaving other at-risk residents in the dark, says the former health secretary who backed that initial £90 million (US $145.4 million) campaign.

"We are in a position in this country where almost 100,000 people are living with HIV," said Lord Nathan Fowler, who has set up a committee to investigate current HIV/AIDS prevention efforts. "It's a big issue, but it's not necessarily a popular issue with politicians at the moment," he said during a fact-finding visit to Brighton, which has one of the UK's highest HIV rates.

Most UK HIV prevention efforts today focus on immigrants from sub-Saharan Africa and on men who have sex with men, groups with higher HIV rates, rather than on the general population.

"The way it works these days is that we have very targeted campaigning, which is often a shorthand way of saying we are not going to spend much money on it," Fowler said. "I'm all for trying to have a bigger impact on areas of the country and the population, but it's good if it's seen by the population generally. We need a wider sense of sexual education. That's a bit lacking at the moment."

"Campaigns in this area have changed. The important thing is you need to continue to have a campaign," Fowler said.

Spending on HIV awareness this year is expected to be £3 million (US $4.8 million), said professor David Harper of the Department of Health. "It's not about spending less money for the sake of spending less money," he said. "It's about getting more effect from what we spend."

The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals and empowering people to make healthy choices to prevent the spread of the HIV virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.


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United Kingdom National Health Service Makes HIV Test Routine for Patients Living in Worst-Hit Areas

General practitioners in areas of high HIV prevalence should routinely offer and recommend HIV testing for new patients and anyone having a blood test, according to the National Institute for Health and Clinical Excellence. The NICE guidelines issued Wednesday apply in areas where more than two in 1,000 adults have been diagnosed with HIV.

The guidelines aim to boost testing and earlier HIV diagnosis and treatment, and to reduce the stigma of testing by making it a part of routine health care. They are the result of advice from health professionals and the Health Protection Agency and effectively endorse British HIV Association policy.

"Currently, almost half of the people in the UK who are diagnosed as HIV-positive are diagnosed late," NICE said.

The initiative will cost nearly £16 million (US $25.6 million) a year and affect 37 National Health Service primary care trusts: 26 in London and PCTs in Blackpool, Brighton and Hove, Birmingham, Leicester, Manchester, and Milton Keynes.

"We urge anyone having sex with different partners to make regular HIV testing a priority," said Ben Tunstall of the Terrence Higgins Trust. "These guidelines need to be put into practice to combat onward transmission of HIV and reduce the unacceptably high levels of undiagnosed HIV that we're still seeing in the UK."

"The later people are diagnosed with HIV the more difficult and expensive it is to treat them, the poorer their outcome may be and the more likely they are to have transmitted the infection," said Keith Radcliffe, president of the British Association for Sexual Health and HIV.

The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals and empowering people to make healthy choices to prevent the spread of the HIV virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.


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Sexual Risk Behaviors Among Teens at an Urban Emergency Department: Relationship with Violent Behaviors and Substance Use

Noting that "data regarding sexual risk behaviors among adolescent patients presenting to urban emergency departments (EDs) are lacking," the authors undertook a study of the rates and correlates of these behaviors among youths screened in an urban ED.

During a one-year period, 1,576 patients ages 14-18 (57.6 percent female, 59.3 percent African-American) completed a self-administered computerized survey. Among the 60 percent who reported being sexually active, 12 percent reported four or more partners. Of these, 45.3 percent reported consistent condom use, and 14.7 percent reported substance use prior to sex.

Regression analyses were used to examine correlates of sexual risk behaviors on the basis of demographics, violence, and substance use. Adolescents with poor grades were more likely to have had sex and have used substances before sex, and were less likely to report condom use. Participants reporting dating violence were more likely to have had sex and less likely to have used condoms, while youths reporting peer violence and weapon carriage were more likely to report substance use prior to sex. Binge drinking and marijuana use were associated with all sexual risk behaviors.

"The visit to an urban ED may provide an opportunity to deliver interventions to address sexual risk behaviors among adolescents," the authors concluded.

The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals and empowering people to make healthy choices to prevent the spread of the HIV virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.


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Taylor Was Early and Tireless AIDS/HIV Advocate

The HIV/AIDS community is mourning Wednesday's passing of Elizabeth Taylor, who was as well known for her work on the epidemic as she was for her acting.

Taylor co-founded the American Foundation for AIDS Research (amfAR), which has funneled more than $300 million toward related research. In 1991, the actress started the Elizabeth Taylor AIDS Foundation, which has distributed more than $12 million to US organizations that provide direct care and services to people with AIDS.

"She was profoundly instrumental in helping us identify the resources which have led to the research that has improved and extended the lives of those with HIV and AIDS," said Kevin Robert Frost, CEO of amfAR.

"There have been a lot of incredible warriors in the fight, but she will stand for history on a podium above everyone else," said Craig Thompson, executive director of AIDS Project Los Angeles, a group that benefited from Taylor's early support.

When Taylor came to Capitol Hill in the early 1990s to testify about AIDS, "Every senator showed up," Thompson said. "Because Elizabeth Taylor was talking about it, people like my mother were reading about HIV and AIDS."

"At a time when most Americans thought of HIV/AIDS as something that didn't affect them, her commitment to the issue and considerable star power helped to take the fight against HIV/AIDS right into the mainstream of American society," said Don Blanchon, head of the D.C.-based Whitman-Walker Clinic, which named its central facility after Taylor.

"She earned our adoration for her stunning beauty and for being the very essence of glamorous movie stardom," said AIDS advocate and entertainer Elton John. "And she earned our enduring love and respect for her compassion and her courage in standing up and speaking out about AIDS when others preferred to bury their heads in the sand."

The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals and empowering people to make healthy choices to prevent the spread of the HIV virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.


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National Organization Adds Voice Against HIV-Specific Criminal Laws

The National Alliance of State & Territorial AIDS Directors (NASTAD) is voicing its opposition to the HIV-specific criminal laws on the books in 34 states and two US territories.

"HIV criminalization has often resulted in egregious human rights violations, including harsh sentencing for behaviors that pose little to no risk of HIV transmission," said a statement by NASTAD, which is composed of top state and territory public health officials who are tasked with addressing the epidemic.

NASTAD said that as a member of the Positive Justice Project, initiated by the Center for HIV Law & Policy (CHLP), it is committed to the following:
*Supporting HIV testing and medical record confidentiality as a way to encourage testing and treatment efforts.
*Identifying and sharing best practices related to successes in repealing criminalization laws that are not grounded in public health science.
*Promoting public education and understanding of the stigma and negative health consequences of criminalization laws and prosecutions.
*Providing strong public health leadership on the relative transmission risks and the dangers that punitive responses pose to the epidemic.

NASTAD's members "are the public health professionals who are close to the epidemic, and they know first-hand how powerfully stigma drives HIV transmission, and they recognize how HIV criminalization drives stigma," said Sean Strub, the founding publisher of POZ magazine and senior fellow at CHLP. "Their statement will send a powerful message to legislators, prosecutors and others who, whether out of ignorance, fear, ambition or vengeance, promote HIV criminalization."

To view the full statement, visit: http://www.nastad.org/Docs/highlight/2011311_NASTAD%20Statement%20on%20Criminalization%20-%20Final.pdf.

The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals and empowering people to make healthy choices to prevent the spread of the HIV virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.


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Wednesday, March 23, 2011

HIV Tests Come to South Africa's Schools

At a high school in Mtubatuba, some students recently underwent HIV testing at a mobile clinic brought in by Mpilonhle (Zulu for "good health"). Since 2007, the charity has sent teachers, social workers, and nurses to local schools. However, it is one of just a handful of organizations that offer school-based HIV testing in South Africa.

By age 16, half of South African youths have experienced sex, and 9 percent have acquired HIV by age 20. In February, the government endorsed expanded HIV testing for all students older than 12, even though some advocates worry that children will feel coerced and be emotionally unprepared for an HIV-positive diagnosis.

"We underestimate adolescents' knowledge," said pediatrician Michael Bennish, who founded Mpilonhle. "All adolescents, by definition, have elements of maturity and immaturity. With proper support and good counseling which is friendly to them, they can make a mature decision."

"I feel happy, I am able to tell my mum," said Nkosi Minenhle, 15. "And I know how to behave to remain negative."

About one-quarter of students declined Mpilonhle's rapid-testing offer.

"I am afraid," said one 17-year-old at Madwaleni high school, who has had sex with an older man and fears she has HIV. "Once I know that I am positive, my school work will be affected."

"You can't pretend that these teenagers are not sexually active, when they are," said Gugu Zulu, Mpilonhle's top educator. "They are no longer innocent angels."

"Because most parents are unemployed, to get things the kids will go out with sugar daddies to get money from them," said Andile Zulu, a Mpilonhle social worker. Of 12th-graders tested, 6 percent of females were HIV-positive, compared with less than 3 percent of boys.

The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals and empowering people to make healthy choices to prevent the spread of the HIV virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.


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South Carolina HIV Patients Fear Loss of Vital Drugs

Some 7,400 South Carolinians are diagnosed with HIV/AIDS, according to Kaiser Family Foundation figures, and 2,262 people rely on the state AIDS Drug Assistance Program to access their medications. But as lawmakers struggle to balance a budget with a $700 million shortfall, there is little support for adding funds to eliminate ADAP's waiting list.

According to the S.C. Department of Health and Environmental Control, 527 state residents, who earn less than three times the federal poverty level but do not qualify for Medicaid, are now on that list. CDC data show that 72.3 percent of HIV-positive South Carolinians are African-American.

South Carolina's ADAP currently is funded with $16.8 million from the federal government and $1.9 million from the state. In 2008 and 2009, a one-time infusion of $2.4 million in state money reduced the waiting list. It has grown again, however, since 2010, when the Legislature cut the state's ADAP contribution by 60 percent.

In a report on expanding HIV/AIDS services, Harvard University's Health Law and Policy Clinic recommended that South Carolina apply for a waiver to permit Medicaid coverage of people with HIV. So far, the state has not taken that step.

"I think we have an obligation to not have these medicines be so cost-prohibitive that people are dying because they are poor," said Julia Craft, a nurse who lives in Lexington County. "It's not a problem that's exclusive to South Carolina."

Meanwhile, "The disease is spreading, spreading, spreading," said Craft, who has cared for eight patients who died of AIDS. She worries that, in part because of Magic Johnson's successful response to treatment, "no one's afraid of this disease" these days.

The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals and empowering people to make healthy choices to prevent the spread of the HIV virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.


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Study Shows High Satisfaction and Success With Internet-Based HIV Care

A group of HIV-positive people who received their health care via the Internet from a Barcelona HIV clinic felt that their care was comparable with—and potentially superior to—standard in-person care. These findings, published January 21 in the online journal PLoS One and reported March 21 on the website Computerworld, could offer hope to select patients in rural settings who must often travel great distances to receive specialty HIV care.

By necessity, providers in resource-poor nations have been quick to adopt electronic communications as ways to provide health care. In countries where people are sometimes more likely to have access to a cell phone than running water or transportation, and where they must sometimes travel 100 miles or more to see a doctor, “e-medicine” has significantly expanded the reach of traditional health care.

Developed countries, including the United States, have been much slower to adopt these new technologies, partially because of concerns that e-medicine would result in poorer care, along with legal concerns about patient privacy. Recent positive experiences with using the Internet and telephones to extend and improve care for people with chronic diseases, such as diabetes, are beginning to tear down the walls that have kept e-medicine from wider implementation.

To determine whether e-medicine could be used in caring for people with HIV, Agathe León, MD, from the University of Barcelona, in Spain, and her colleagues set up a virtual hospital system in 2005 to help streamline care for patients in their HIV clinic. During the first two years of operation, León’s team tested its Internet-based system involving 83 HIV-positive people who were in stable health and had CD4s over 250. The study did not require participants to have an undetectable viral load or to be on antiretroviral (ARV) therapy—though about half were. All participants had a home computer and broadband Internet access.

Over the first year of the study, half of the group received their HIV care, pharmacy consultations, psychological care and appointments with social workers over the computer, while the other half received traditional in-person service. After one year, the groups switched their mode of receiving care. Participants went into local laboratories for any necessary lab work.

León’s team conducted detailed surveys of the participants throughout the study to assess their satisfaction with the care, their psychological health and their quality of life. Each participant’s CD4 count and viral loads were also recorded.

León and her colleagues found that patient satisfaction was high and that overall health and well-being—including CD4 counts and viral loads—were no different between those receiving care through the virtual hospital and those being seen at the clinic. This held true despite the facts that 7 percent started antiretroviral (ARV) therapy during the course of the study and 28 percent switched therapy. In fact, 85 percent reported that the Internet-based system actually made it easier for them to access the care they needed from their providers.

León reported that 200 people with HIV have now been followed through the virtual hospital.

“This program allows patients to continue their treatment without altering their routine. Medication is sent to their home, or other locations specified by the patient,” representatives for León’s clinic stated. “Telemedicine is emerging as a service appropriate for this treatment, and [the virtual hospital] as a safe and effective tool.”

It remains to be seen whether, or how, systems like these could be used with difficult-to-reach populations such as those with less access to modern technology, but experiments to test this are ongoing, especially in rural settings where access to quality health care is more challenging for people with HIV and other chronic illnesses.

The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals and empowering people to make healthy choices to prevent the spread of the HIV virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.


TOGETHER WE REMAIN STRONG!

Support the Right of HIV-negative People to Choose Which Methods They Will Use to Remain Uninfected!

The Friends of AIDS Foundation is deeply troubled by an advertising campaign being run by the AIDS Health Care Foundation (AHF) opposing the efforts of pharmaceutical manufacturer Gilead to obtain Food & Drug Administration (FDA) approval of Truvada for use in the prevention of HIV. We find AHF’s campaign to be anti-science and ethically problematic.

We urge you to sign on to a community statement supporting FDA review of Gilead’s request for licensing of this potentially powerful new prevention tool. The sign-in statement may be accessed by visiting: http://salsa.democracyinaction.org/o/1837/p/salsa/web/common/public/signup?signup_page_KEY=5897.

The iPrEx study, conducted among 2,499 gay and bisexual men at high risk for HIV-infection in the US, South Africa, South America and Thailand, reported extremely hopeful results about the effectiveness of taking the antiretroviral Truvada daily, in combination with safe sex and condom use counseling, to prevent HIV infection. Overall results showed that 44 percent fewer men - 35 actual people – avoided becoming infected with HIV while taking Truvada than those taking a placebo. AHF says that the 44 percent result is not strong enough to warrant any consideration by the FDA of licensing of Truvada for HIV prevention. But this represents a simplistic view of the iPrEx data.

Here are some important facts. It is true that fifty percent of study participants did not take Truvada daily or even at all. But 52 percent fewer men who reported that they sometimes had unprotected receptive anal intercourse (URAI), the highest risk activity for acquiring HIV, and who did take Truvada drug 50 percent of the time or more avoided becoming infected. Men who took Truvada daily at least 90 percent of the time were between 70 and 90 percent less likely to become infected with HIV than those not taking it. Many of the men who reported that they were not taking Truvada daily also reported that they were not having sex, and therefore did not see the reason for taking the pill. But among participants who were having regular sex, and particularly among those having URAI, adherence to daily Truvada was much higher. So, too, was PrEP effectiveness.

We have a simple question for AHF. What would they say to the 35 men in the iPrEx study who could still be HIV-negative today if they had been receiving Truvada instead of a placebo? That they should not be given a choice to take it? If a young gay male saw one of AHF’s doctors and said that, despite his best intentions to use condoms when bottoming during anal intercourse, depression and substance use were making it impossible and he wanted to consider PrEP, would they refuse him the opportunity?

Not to prescribe PrEP if asked to by someone who could clearly benefit from it and who indicates that they can adhere to a regimen of daily pill use and ongoing safe sex counseling would, in our opinion, be unethical given the strong results of iPrEx. (In coming years when data are reported from trials now underway among heterosexuals and injection drug users, PrEP might also help others in their sometimes difficult efforts to remain HIV-negative, too.)

The Friends of AIDS Foundation and others are working to assure that PrEP can eventually be paid for by all public and private insurers. In order for PrEP to be available to some of the people who most need it – particularly low-income gay and bisexual men of color who obtain health insurance as a result of health care reform - Medicaid programs across the country will require FDA licensing of Truvada or any other antiretrovirals eventually shown to be effective for PrEP. And so, AHF’s actions threaten to harm the very people who could most need and could benefit from PrEP.

There is no "one size fits all" method to HIV prevention. We feel it is well past the time that the 30,000 new cases of HIV infection that occur each and every year among gay and bisexual men in the United States were eliminated. We are working to support the development of a new set of responsible options for people at risk for HIV to choose from in order to avoid becoming infected, rather than block them. We hope you will support us in these efforts by signing the statement at: http://salsa.democracyinaction.org/o/1837/p/salsa/web/common/public/signup?signup_page_KEY=5897

The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals and empowering people to make healthy choices to prevent the spread of the HIV virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.


TOGETHER WE REMAIN STRONG!