September 13, 2006

•  COMPLICATIONS OF HIV & HIV MEDS

The Diarrhea Diaries: Treatment Trauma With No Umbrella
"I can now say with complete confidence that I have, at the tender and vulnerable age of 40, experienced the most humiliating, degrading event of my life," writes Jim Pickett. "And hon, there's plenty of embarrassing competition for that honor." After a lengthy treatment interruption, Jim recently restarted his HIV meds -- and when he did, the old side effects came rushing back. Literally. In public. Here is his graphic story.

Have your own story to tell about embarrassing side effects of HIV meds? Stop in at The Body's "HIV Treatment" bulletin board and spill the beans.

Also be sure to check out The Body's special report on dealing with "gut" side effects of HIV medications; it includes personal stories and advice from experts and people who have dealt with side effects such as diarrhea, nausea and heartburn.


Scientists Believe a Test Could Help Doctors Spot Nevirapine Liver Risk
Wouldn't it be amazing if doctors could know what side effects you were likely to experience before you actually started taking HIV meds? Well, we may be taking baby steps toward making that a reality. Two new U.S. studies suggest that a test may be able to predict who will experience severe liver problems after starting nevirapine (Viramune). The studies show that people who have a modified version of a specific enzyme in their body are much less likely to have a potentially life-threatening liver reaction, which occurs in 1 percent to 5 percent of people after they start taking nevirapine. (Web highlight from aidsmap.com)


Frequently Asked Questions About Metabolic Problems in HIVers
Doctors use the word "metabolic" to describe a whole host of different health problems that are common among people with HIV, including body fat changes, high cholesterol/triglycerides, high blood pressure and insulin resistance. What do you need to know about these complications? In this informative article, a dietician and a physician provide a primer on metabolic problems in HIVers, and offer advice on how you can prevent or treat them.

For much more information on metabolic problems in HIV-positive people, read through The Body's special report on metabolic complications! It includes overviews, treatment advice, diet tips and first-person stories from other HIVers.

•  LIVE FATIGUE/ANEMIA CHAT WITH DR. BOB FRASCINO, SEPT. 27

Submit Questions Now for The Body's Live Fatigue/Anemia Chat With Dr. Bob Frascino!
Fatigue is one of the most common health problems that people with HIV experience. It can have any number of causes, including HIV medications, anemia, depression and HIV itself. The good news is that, whatever the cause, there are several different ways to prevent, diagnose and treat fatigue in HIV-positive people. At 6 p.m. Eastern Time (3 p.m. Pacific) on Wednesday, Sept. 27 (that's two weeks away), Dr. Bob Frascino, one of The Body's most popular, loveable, huggable online experts and an HIV-positive person himself, will answer questions from HIVers who are dealing with, or worried about, fatigue, anemia and related health issues. Click here to register for an e-mail reminder before the chat begins, or to presubmit a question you'd like Dr. Bob to answer!

•  NEWS & VIEWS

Exclusive Podcast: One-on-One With David Scondras, Passionate AIDS Advocate
"The disease called AIDS is not a medical issue," says David Scondras, the head of the AIDS organization Search for a Cure and an AIDS activist for more than 20 years. "It is a religious, cultural, societal, economic issue. It's a germ that threw a spotlight on the inequities, the human rights abuses, the lack of uniform availability of medicines and infrastructure for dealing with illnesses. ... To solve this problem requires solving all these other problems, right down to prejudice, right down to the whole issue of sex workers, the issue of sexuality itself." In this captivating interview with The Body (available as both a transcript and a podcast), Scondras talks about the purpose of the recently concluded XVI International AIDS Conference in Toronto, the effect of free-trade agreements on access to HIV treatment, studies on tenofovir (Viread) for HIV prevention, and what a Martian would say about the global HIV pandemic.

For many more podcasts and transcripts of interviews with HIV-positive people, advocates and researchers from around the world, visit Podcast Central at AIDS 2006!

•  HIV TREATMENT

The Verdict Is Still Out on "CD4-Guided" HIV Treatment Interruptions
If you think the ill-fated SMART trial was the last word on structured treatment interruptions, think again: Although SMART was a landmark trial that seemed to shoot down the concept of "CD4-guided" interruptions (in which HIV treatment is stopped and then restarted after a person's CD4 count reaches a specific number), it may just be that SMART let people's CD4 counts fall too low before restarting them on treatment. In this extensive review, The Body's Gerald Pierone Jr., M.D., takes a close look at SMART and another trial, Staccato, that seems to contradict the negative SMART findings.


Five-Year Study Finds Similar Success for NNRTI-Based and PI-Based Regimens
When HIVers first start treatment, they almost always receive a combination of meds from two different drug classes. One of those classes is NRTIs; the other is either an NNRTI or a protease inhibitor (PI). This raises an interesting question: Which works better, NNRTIs or PIs? In one of the largest randomized studies ever to compare first-line treatment regimens, researchers found that it didn't seem to matter much either way: Although there do appear to be differences in terms of side effects and viral load suppression, they found little difference when it comes to the things that really matter: risk of death, progression to AIDS or low CD4 count. Simon Portsmouth, M.B.Ch.B., reports for The Body from the XVI International AIDS Conference.

For much more news and research from last month's XVI International AIDS Conference -- as well as exclusive podcasts and our engrossing photojournal -- check out The Body's AIDS 2006 home page!


Researchers Try to Turn Chinese Herb Into HIV Medication
Researchers are currently developing a drug, known as bevirimat (PA-457), which is derived from a Chinese herb. If approved by the U.S. Food and Drug Administration, bevirimat would be the first in a new class of HIV meds called maturation inhibitors, which interfere with the way HIV infects human cells. Maturation inhibitors cause these infected cells to produce harmless, undeveloped copies of HIV that the body's immune system could destroy. In early clinical trials, bevirimat has been shown to reduce viral load by as much as 90 percent. That's good news for HIVers with multidrug resistance; unfortunately, the new drug is at least three years away from being available to the general public.


NNRTIs, Like Boosted Protease Inhibitors, May Be More "Forgiving" of Low Adherence
There's no denying that the best way to keep your viral load down is to take all of your HIV medications on time at least 95 percent of the time. But researchers are finding that some HIV meds are more "forgiving" than others when it comes to missing doses. Case in point: efavirenz (Sustiva, Stocrin) and nevirapine (Viramune), part of the drug class known as non-nucleoside reverse transcriptase inhibitors (NNRTIs). A 110-person study by University of California-San Francisco researchers compared people who took an NNRTI as part of their regimen to people who took a single protease inhibitor as part of their regimen. They found that, among people who missed between a quarter and half of their doses, those who took NNRTIs were much more likely to keep their viral loads below 400 than those who took a protease inhibitor. They noted, however, that 95 percent adherence still gives a person the best chance of maintaining a low viral load. (Web highlight from aidsmap.com)

In a study presented last month at the XVI International AIDS Conference, researchers examined the impact of poor adherence on people taking "boosted" protease inhibitors, in which a protease inhibitor is taken with a small dose of ritonavir (Norvir). As The Body's Paul Sax, M.D., reports, the study found that "boosted" protease inhibitors were also more forgiving of less-than-ideal adherence than unboosted protease inhibitors.

•  LIVING WITH HIV

Dating, Youth and HIV: Interviews With Teens on Both Side of a Mixed-Status Relationship
At the age of 16, Raven Lopez and Aaron Parker have both experienced their first kiss and first relationship. However, unlike many of their peers, they've had to overcome a hurdle larger than bad breath, sweaty palms or an early curfew: Each has been part of a serodiscordant couple. Raven was born HIV positive, and has to decide if, when and how to disclose her status to friends and partners: "I do get scared, because I don't know how they're going to react," she says. Aaron, meanwhile, is HIV negative, but has dated an HIV-positive girl (he knew about her status before they started dating): "I talked to some of my friends [about my girlfriend's HIV status], but it's not really my business to share with them what she has," he says. "[We] have some of the same friends and some of them know. ... They understood how hard the whole thing was for us."

•  HIV TRANSMISSION & PREVENTION

Women at Risk: HIV-Positive Hetero Men Often Don't Have Protected Sex, Studies Find
We're 25 years into the United States' HIV epidemic, and many people still believe it's not a heterosexual disease. But as most of us know all too well, it most definitely is: One out of three people who get HIV in this country get it through heterosexual sex. One major reason may be that many HIV-positive men aren't being as responsible as they should be about safer sex, which puts their female partners at risk. Recent studies published in the Journal of Urban Health show that between 21 percent and 41 percent of HIV-positive men reported unprotected sex with a woman whose status was unknown or who was HIV negative. This might be one of the many reasons why HIV rates among women have grown so steadily over the past decade.


New Bill Aimed at Black Epidemic Would Require Prisons to Provide HIV Tests
Fact: Half of all new HIV diagnoses in 2004 were made among African Americans. Another fact: More than 50 percent of U.S. prison inmates are estimated to be African American. Given those alarming numbers, it's easy to see why many people think that one of the keys to addressing the U.S. HIV epidemic is to focus on African Americans in prison. To this end, U.S. Congresswoman Maxine Waters (D-Calif.) introduced a bill last week that would require federal prisons to provide opt-out HIV tests for inmates at the beginning and end of their incarcerations. Waters said that under her bill, more prisoners would be tested, receive better care in prison and be directed to community support services upon release -- all of which would help prevent HIV from continuing to spread among African Americans.

•  HIV OUTSIDE THE UNITED STATES

George Soros Pledges $50 Million to Fight HIV, Poverty in Africa
2006, it seems, is the year for the world's billionaires to put their money where their mouth is when it comes to HIV. First came Bill Gates' announcement that his foundation, the richest in the world, would make fighting HIV its number-one priority. Then Warren Buffett announced a $30 billion donation to Gates' foundation. Now, financier and philanthropist George Soros has declared he is donating $50 million to the Millennium Villages project, which aims to fight poverty and diseases such as malaria and HIV in villages throughout Africa.


Church of England Appoints Gay, HIV-Positive Priest
For the first time in the history of the Church of England, a bishop has knowingly appointed a priest who is HIV positive. The unnamed priest said he is adhering to church rules that prohibit gay priests from engaging in sexual activity. Some opponents of gay and lesbian clergy say the appointment threatens the unity of the worldwide Anglican community; however, little opposition is expected from parishioners. Although this marks the first appointment of a known HIV-positive priest, 25 to 30 of the church's clergy members are thought to have died from AIDS-related illnesses in the past 15 years.