HIV Treatment Info

Holiday periods and how we're feeling

2010-12-15T11:07:00.000-08:00

As what is considered a holiday season approaches, so many people are (as they say) "in the spirit" and yet, at the same time, some are not. Both groups of persons may be experiencing stress for any number of reasons - on top of what people consider a normal amount. This increase may be related to expectations, rushing around and other events which the crowded calendar adds to our regular living activities. The added stress, however, cannot be good for our overall physical and mental health: Stress is shown to actually make our bodies more vulnerable to illness.

What can we do?

If we program ourselves - however it works - to stop, momentarily, once-in-awhile... To reflect, to count blessings (hard as they may be to find, sometimes) and if we have something occurring and bothering our minds and / or bodies, to remind ourselves to seek professional assistance where possible... and not put that off. Maybe the appointment isn't available immediately but some peace-of-mind may come from knowing we at least enquired and made a date to see somebody about what's bothering us. Putting it off may not be the wisest course.

Remembering that our stress levels can rise in certain times is a big step toward trying to reduce that stress and increase our overall health.

Testing

2010-11-02T15:12:00.000-07:00

Fairly soon, now, you may be able to get a test to detect the presence of HIV (as now: due to the presence of antibodies) at your walk-in clinic, at your dentist, in the hospital and at your primary care provider...

Yes - everybody will soon be able to have testing... MAYBE even without asking for it: It COULD be that folks will automatically have an HIV test unless they specifically ask not to have that included with regular laboratory blood work.

Is that the face of the future? Is that the right direction in which to move forward? Is the balance of society's larger need great enough that people should be subjected to a test that may occur without their realizing it because for the greater good, it's better that we all know... Or is that a step too far?

Guidelines for Starting Treatment

2010-09-28T11:16:00.000-07:00

Isn't it fascinating that a group of almost-equally and well-educated plus extremely well-versed physicians, scientists and other researchers can get together and examine the virtually identical body of double-blinded, peer-reviewed, placebo-controlled evidence (in some cases) in Europe, Britain, the US, Australia and British Columbia, yet come up with somewhat different suggestions as to when and what to use in treating HIV?

It seems to follow that certain guidelines will likely come into effect in one place as will occur elsewhere since the same bases are used to determine what evidence has merit and what does not. However, there is room for interpretation, and where one group of experts will discount an element of a study because (for example) it didn't control for an important factor or compounder, still another group will excuse the omission and choose to weigh that evidence more heavily and - therefore - change their recommendations based upon it.

There is no particular body of evidence to which this blog post refers; it is simply a note that the wider body of all evidence is - particularly in this current age of instant / worldwide / electronic communication and publication - easily available to us all... and it forms the basis for all these decisions; yet, there is some discrepancy (look no further than the BHIVA recommendations that suggest ATRIPLA is the first-line regimen most highly recommended, whereas US-IAS and US DHHS recommendations suggest several different preferred regimens in slightly older guidelines of the same era).

Some considerations are (of course) given to the cost-benefit analysis that is part of whether a province (or other jurisdiction) places something on the drug formulary and for what considerations / indications, and some other consideration goes into first-line versus treatment-experienced patient treatment... Still, it makes one wonder...

Do you agree?

Potential Co-morbidities & challenges with HIV

2010-09-13T09:49:00.000-07:00

Much has recently been made of the damage that the human immunodeficiency virus (HIV) does - not only to a person's CD4 cell count, but also to the entire body - via an inflammatory process which engages when the body's own defense mechanism is activated by the HIV.

What we have long known and are beginning to understand more about, now, is that cardiac (heart); cerebral (brain); osteo (bone); and other body systems are affected - though age at infection, length of time from infection to testing & detection, general overall health, treatment and other factors seem to influence the outcomes to varying degrees - as might logically be expected with any difference in disease progression from person to person.

Some people take special precautions, particularly if closely monitored by healthcare professionals and / or they are on treatment: These can include taking such things as statins (lipid-lowering agents that help fight higher-than-appropriate values in LDL-C and triglycerides: markers of cholesterol imbalance that can lead to heart disease); calcium and vitamin D supplements to help fight bone mineral density (BMD) decreases, which are not uncommon in HIV-positive persons, etc...

What other treatments - whether specifically suggested by healthcare professionals or not - are people using / taking / considering for overall healthy organ and system health in light of HIV infection?

Let us all know!

Groups of people surviving long-term with HIV

2010-08-03T11:28:00.001-07:00

Many years ago, at the outset of the HIV epidemic as now know it (i.e., back in the early 1980s) we knew so very little about what was happening: Researchers, physicians, HIV-positive individuals - we were all in the dark. Slowly - as studies and work progressed and we first identified the virus, found some initial but toxic treatments and then continued to fight for greater information and better regimens that actually worked and produced fewer, liveable side-effects - we ended up with groups of people for whom we couldn't work fast enough to help save; then groups of people whom we were saving but with so many difficult-to-live-with issues; and that was with (oftentimes) large numbers of pills to take and many side effects, some of them irreversible.

Now, as we live in an era whereby some folks are eligible for and actually only take one pill once-per-day, have we yet a third group of folks who are living with HIV? Is this yet another clear distinction as we progress toward cures and vaccines? Is this another major group in the long fight that we're all so embattled with? What is the next step, after progressing from losing so many folks through keeping so many around but with such difficulty, to such relatively simple and easy pill burdens and quality-of-life issues, nowadays (at least compared with before)?

Does this make is ever-more hopeful that there are few steps left because the next group (or cohort, if you will) must be something even better than just such a simple regimen as we now have?

What are your thoughts?

A D H E R E N C E

2010-06-28T13:01:00.000-07:00

Not many years ago, much was made of the fact that roughly 95% (or better) adherence was needed in order for antiretroviral treatments to remain successful in the face of a constantly mutating (often said to be “sloppy”) virus which, if offered the chance for a breakthrough through reduced adherence, would become resistant to the medications being taken. Obviously, the serious worry was over a reduction in successful treatment options.

In more recent times, there appears to be less made of this adherence figure (without saying that it isn’t still a target, as there is some evidence and, thus, there are some in the community who admit that 95% may be higher than needed); however, acknowledging that at least some high level of adherence is required, what supportive measures can we expect / provide as expanded HAART programs target the more disadvantaged populations in this province in a testing and treatment campaign? The rock and the hard place, on this one, appear to be that either we do or we do not need such strict “take these medications at the time and in the manner directed” instructions, always without fail… and that this is dependent to some degree upon the specific medications and the frequency of dosing (just as it also is an individualized biological issue). Is every individual going to have a different threshold? How is that communicated? The message, here, may seem inconsistent, but in fact we’re aiming for as high an adherence as possible – period. The higher and (to some degree) the lower levels of adherence (in numbers) appear to be better than an irregular off-and-on strategy. In other words, if you’re going to miss, they say it’s better to miss all the time than to hit-and-miss a lot.

What are your thoughts?

Holidays half over; treatment plans intact?

2009-12-29T08:49:00.000-08:00

Many people are aware that current treatment plans involve a lifetime committment. This means whether once-per-day or twice, whatever combination of medicines is prescribed needs to be taken in the same way at the same time, daily, as instructed.

This can be very challenging during holiday periods: There may be travel involved (which may include time-zone changes); there could be guests visiting or being visited (which might mean a change in how, where and to what degree the prescription-taking is visible to others, and to whom); there may be changes in eating and also drinking patterns (possibly involving parties, dinners, get-togethers and other things) and this combination needs to be accounted for in our holiday planning.

While a great majority of the "rush" of the season is now behind us all, there are still a few more days (almost a week, in fact) when many people are still away, or otherwise not yet returning to normal routines, be they work, school or whatever.

How are you coping? Has it been a challenge? Was there some adjustment? Did it all go well? Were there some rough patches?

Nobody is perfect, for if we were, how "human" would we be? Still, where possible, we must try to give the research and team of healthcare professionals who are literally working on our behalf the best possible outcome they've worked for - and this is not to mention our own selves... for we deserve it - by trying to account for these holiday-period changes and recognizing the challenges, where possible, ahead of time. Planning for that, and doing what we need to do to accommodate these differences in our daily routines, will go a tremendously long way toward the success of our treatment plan and toward better health outcomes for us!

Here is hoping that 2010 is the year when it all comes together, if it hasn't; and here's also hoping that the gains of 2009 improve while the pains lessen in this coming year. To whatever extent we have control over these issues, here's hoping we'll take that control and use it wisely, and that to whatever extent it's out of our hands, we are favoured with nothing but the best!

The Season

2009-12-21T15:19:00.000-08:00

At a time in the year when people's thoughts turn to holidays of one kind or another, whether travelling or hosting, whether near or far; regardless of religion or not, and with the emphasis on getting it all done, no matter what that may be (even just stocking up on supplies when things are closed down for so long): How do people cope? How does anyone cope with the rush, the demands, and the resulting stress that is seasonally ours - subscriber or not?

For some, it may be just turning to those they regularly seek out and are with; others may find comfort in finding long-ago (even recent) folks who've moved, been less involved or are otherwise distant. Reducing stress is shown to be of benefit in healthcare settings of all kinds, whether just helping to reduce blood pressure or helping with behaviour changes that reduce risk and include harm reduction measures. Friends, family and even strangers may have it in them to help, but we have to let them or seek it, or at least actively engage. Whatever way one does it, make sure that this holiday season, there is something in your stockings (whether hung or worn) that really helps take stress levels down as much as one can. You'll feel and be better for it!

So, what reduces your stress?

Most important considerations in choosing a regimen?

2009-12-18T12:38:00.001-08:00

Anti-retroviral medications have improved, over time, with fewer (and sometimes better-managed) side effects, reduced numbers of required pills and less-frequent dosing.

Choosing the right medication combination is a very personal thing, and even each HIV specialist differs in their approaches: Some will choose a regimen that is very defensible while others prefer different choices. The choice often rests on the individual patient's priorities: Does the number of pills really seem important? For some, even many, it will. Is there any difficulty with varying day-to-day schedules (work, sleep, travel, etc...) making dosing schedules an important consideration. Are there certain other medications already (or likely to be) used to control such things as diabetes, high blood pressure, cholesterol issues (particularly triglycerides)? Interactions with certain medications is an issue. Is there a co-infection with hepatitis B or hepatitis C? This can influence the choice of medication and even the decision to start treatment or not. Is it likely that food will always be available at the specific time when one needs it for the medication (if the medication requires food)? For those who travel and who don't generally eat breakfast, this may influence once-a-day dosing scheduling as well as help decide whether or not once- or twice-a-day is best. And that can also lead to influencing decisions regarding which medication to choose as, for example, efavirenz (Sustiva) is often taken at nighttime in order to help manage certain possible side effects; however, there may be reasons to avoid that medication, so a different one may be needed.

For those folks being recommended to start treatment, these are among the questions that need to be thought out. If they are considered ahead of your appointment with the HIV specialist, a fuller discussion can be had and the result will be a better-tailored medication regimen that will work and that you can adhere to, which is the greatest single factor within our control that can prevent resistance developing by the virus to the medications... and obviously, that will lead to better health outcomes.

Starting Treatment & Patient-centred care

2009-12-08T13:40:00.000-08:00

The question about when to start treatment has been a hotly-debated one, and over time, the target has been moving back-and-forth between lower and higher numbers of CD4s as a base for recommending the beginning of antiretroviral use. However, the decision remains a personal one that each individual must make in connection, and after discussion, with his or her healthcare provider. Gone are the days where one simply presents to a doctor with an illness and whatever is handed for treatment is taken without question. Patient-centred care is not only a valid buzzword but also a most necessary part of decision-making: When medications no longer have side effects, when food no longer needs to be taken, when housing and other necessities of life are fully assured, then there might be every reason to follow the doctor's advice without question, but still: You have a choice. Things must be carefully weighed and balanced, both medical considerations as well as personal ones, and the decision remains an individual one. If you need help making such a lifelong committment to treatment, you're not alone; there is support, and there are professonals to speak with who may be able to help with the reasoning process, and other important actions, as well. The take-home message is that one doesn't simply take a strong medical recommendation and follow it blindly without thinking about what it means. It has to be a balanced and thoughtful approach toward treatment. What do folks think about this?

World AIDS Day

2009-12-01T10:07:00.000-08:00

Today is World AIDS Day. You may be hearing about funding cuts to HIV community based organizations in the Vancouver area today. How does this affect your health? Programs and services are needed for HIV-positive individuals as each year sees approximately 200-300 new HIV-positive results. What do you think of this? Share your thoughts on this.

HIV and Belly Fat

2009-11-23T10:16:00.000-08:00

Belly fat is an issue for HIV-positive individuals (also known as lipodystrophy) and is a side effect of some HIV medications. As individuals age, they may also develop body fat especially with poor diet. Diet and exercise are increasingly important to reduce body fat. Some individuals have used alternative treatments to reduce fat levels. Tesamorelin is a new drug used for belly fat that has shown promising results so far. What have you been doing? Are you concerned about belly fat and what do you wish to know?

Naturopathy and HIV

2009-11-12T10:12:00.000-08:00

BCPWA Treatment Information Program has started up an HIV Complementary Care Clinic which runs every Wednesday evening. This is a partnership with the Boucher Institute of Naturopathic Medicine in which naturopath students provide treatments under the supervision of a naturopath. Some of the naturopathic treatments available include: acupuncture, vitamin & mineral supplementation, nutritional counseling, homeopathy and botanical medicine. Have you used such treatments and what has been your experience? Share with us.

Cancer and HIV - News

2009-11-03T10:28:00.000-08:00

There was a recent journal article from Lancet reporting that both non AIDS related and AIDS related cancer can occur earlier for HIV-positive individuals with low CD4 counts - by as much as 20 years earlier! This is another argument for starting treatment earlier to get your CD4 counts high and viral load to undetectable. What do you think of this?

H1N1

2009-10-27T15:22:00.000-07:00

We've been away for a while and now back. The big news of this fall season is H1N1 (or also called swine flu). Flu risk is highest from November to March and this year, we expect both regular flu and H1N1. People with chronic conditions, like HIV, are at greater risk & the H1N1 vaccine is now available. Ask your doctor if you should be vaccinated. Do you have any questions for us? What do you wish to know about H1N1 & we'll try our best to answer. Also, if you have experienced H1N1, let us know on here how you managed.

2009 INT'L AIDS SOCIETY CONFERENCE - SOUTH AFRICA - FINAL DAY

2009-07-23T10:16:00.001-07:00

Here is the final summary of some main events occurring in Capetown, South Africa, at the International AIDS Society’s 2009 5th Conference on HIV Pathogenesis, Treatment and Prevention. The Conference concludes on Wednesday, July 22nd.

Again, please remember that it is always difficult, and is a necessarily subjective process, to cull from various sources and limit the detail while offering such coverage.

Once more, the official sources for this information (as suggested by the Conference organizers) are:

- The Live Conference Blog
- News Releases
- Facebook
- twitter
- Clinical Care Options
- Rapporteur summaries

For more in-depth information on these and other subjects arising from this Conference, please visit: http://www.ias2009.org/

I HOPE THE MATERIAL, THIS WEEK, HAS BEEN OF INTEREST.

CANADA’S OWN STEPHEN LEWIS
(earlier this week)

Darunavir/ritonavir monotherapy does well

Two separate studies have shown that treatment with ritonavir-boosted darunavir (Prezista) monotherapy may be a viable option after a person has first suppressed their viral load to undetectable levels using conventional triple-drug HIV therapy.

The first of the studies (MONET) involved 256 patients in Europe. All had suppressed their viral load to below 50 copies/ml for at least six months using a combination of three drugs that included darunavir/ritonavir.

Half the patients were randomised to continue taking triple therapy, whereas treatment for the others consisted of darunavir/ritonavir only.

After a year equal proportions of patients (approximately 85%) maintained an undetectable viral load.

The second study (MONOI) was conducted in France and involved 225 patients. This also demonstrated the non-inferiority of darunavir/ritonavir monotherapy to standard three-drug treatment.

[I think this was reported on Wednesday – but this shows more detail, today.]

Boosted and unboosted atazanavir both effective

A two-year study has shown that atazanavir (Reyataz), regardless of whether it is boosted by ritonavir, is effective at suppressing viral load to undetectable levels when used as part of triple-drug antiretroviral therapy.

After 84 weeks of follow-up, 86% of those taking unboosted atazanavir had a viral load below 50 copies/ml, compared to 81% of those treated with the boosted version of the drug.

Gains in CD4 cell counts were comparable, but the research showed that individuals taking unboosted atazanavir were less likely to develop the side-effect hyperbilirubinaemia than those taking atazanavir/ritonavir (4% vs 10%). Furthermore, cholesterol fell in those taking the unboosted drug, but it increased in those treated with the ritonavir booster.

Aciclovir reduces risk of HIV disease progression and death
Twice-daily treatment with the anti-herpes drug aciclovir significantly reduced rates of HIV disease progression and death, a study has shown.
The study involved 3408 HIV-positive patients. They were randomised to take either twice-daily doses of aciclovir (400mg) or a placebo.
Patients taking the anti-herpes drug were 19% less likely to need to start HIV treatment, a finding that was of borderline significance. Moreover, they were significantly less likely to experience a fall in their CD4 cell count to below 200 cells/mm3.
Although treatment with the drug reduced the risk of HIV transmission to a negative partner by 17%, this finding was not significant.

Successful treatment for hepatitis C improves liver damage in co-infected patients

Individuals co-infected with HIV and hepatitis C who have a successful response to hepatitis C treatment with pegylated interferon and ribavirin experience an improvement in their liver fibrosis and, in some cases, cirrhosis, according to new research.

The study involved 294 patients. All had a liver biopsy and were assessed after 44 months after completion of hepatitis C therapy using FibroScan.

An improvement in fibrosis was observed in 36% of individuals who had a sustained response to this treatment. There were even cases of cirrhosis improving.

Statistical analysis showed that successful hepatitis C treatment was the only factor significantly associated with an improvement in fibrosis.

Anal cancer

US research has shown that new diagnoses of anal cancer in HIV-positive men are increasing.

The rate of anal cancer increased from 11 per 100,000 before HIV treatment became available in 1996, to 55 per 100,000 between 1996 and 2008.

An AIDS diagnosis and a low nadir CD4 cell count were significantly associated with the risk of developing the malignancy.

A second study showed that 53% of HIV-positive men with anal human papilloma virus were not infected with the strains of the virus most associated with a high risk of anal cancer.

This finding suggests than many HIV-positive individuals could benefit from receiving the new vaccines that offer a very high level of protection against the strain of human papilloma virus most associated with genital cancers.

Three ART Combinations Lower MTCT Rate During Breastfeeding to 1%
Author: Mark Mascolini

--------------------------------------------------------------------------------

22 July 2009

Three antiretroviral therapy (ART) combinations taken before and after delivery by women in Botswana all controlled viral replication in the women and kept mother-to-child transmission rates at 1% throughout breastfeeding—the lowest rate yet recorded during breastfeeding by HIV-infected women.

The study involved 730 HIV-positive women, 560 of them with a CD4 count above 199 cells/µL randomized to coformulated abacavir plus zidovudine plus lamivudine or to lopinavir/ritonavir plus coformulated zidovudine/lamivudine. The 170 women with a CD4 count below 200 cells/µL took nevirapine plus coformulated zidovudine/lamivudine.

HIV RNA suppression in women did not differ significantly between the two randomized arms at delivery (96% with abacavir versus 93% with lopinavir, P = 0.18) or throughout breastfeeding (92% versus 93%, P = 0.98). The nonrandomized nevirapine group also had high viral suppression rates at delivery (94%) and throughout breastfeeding (95%).

MTCT rates were low at delivery and during breastfeeding in all three treatment groups and did not differ significantly between the two randomized groups. Among women taking abacavir, 3 had infants infected in utero and 2 infected their infants during breastfeeding (1.8% total). Among women taking lopinavir, only 1 HIV transmission occurred, in utero (P = 0.53 versus the abacavir group). Among women taking nevirapine, 1 transmitted HIV in utero. The overall transmission rate was 1%.

Only 2% of women taking abacavir or lopinavri had treatment-limiting side effects, compared with 11% taking nevirapine. But the higher side-effect rate in the nevirapine group could reflect their more advanced HIV infection when the study began.

Overall, 71% of women breastfed for more than 5 months, but fewer than 1% continued beyond 6 months. Infant mortality was 2% in the abacavir group, 3% in the lopinavir group, and 4% in the nevirapine group.

Abstract WELBB101

IAS HALL

IAS HALL

Track B
Daily summary
22 July (Wednesday)

Today [Wednesday, July 22nd] was the last day of the conference and without doubt the most important one. The CIPRA HT 101 study was presented. This study demonstrated that starting patients on antiretroviral therapy while their CD4 is between 200 and 350 cells/mm3 both decreases mortality and the incidence of tuberculosis. This study ends the discussion on when to start antiretroviral therapy in the developing world, and should have a profound impact on antiretroviral policies around the globe. If you have to take 1 presentation from the whole meeting this should be the one. I have no doubts that you will see this study published in the New England Journal very soon. The main question now is how we implement these changes in recommendations for the initiation of antiretroviral therapy in a world in the middle of a huge economic recession.

VA Cohort: Nonsignificant Association of Abacavir Exposure With Acute MI, Further Reduced by Controlling for Chronic Kidney Disease
Posting Date: July 22, 2009

Retrospective cohort study

Summary of Key Conclusions:

Cumulative abacavir exposure associated with marginal nonstatistically significant increase in risk of acute myocardial infarction (AMI) and cerebrovascular accidents (CVA).

Association further attenuated by adjusting for presence of chronic kidney disease prior to therapy initiation or traditional cardiovascular risk factors
No association found between inclusion of abacavir in last regimen and AMI and CVA events.

Chronic kidney disease associated with significant increase in AMI and CVA
Abacavir use more common in patients with chronic kidney disease

- N = 19,424 patients enrolled
- Mean age at study entry: 46.2 (± 10.2) years
- Total patient follow-up: 76,376 patient-years
- Mean: 3.93 years/patient (range: 0-9)
- Antiretroviral exposure ≥ 30 days: 80%
- Mean antiretroviral therapy duration: 1.93 years (range: 0-8.64)

Substudy Finds No Antiretroviral Class Effect on Long-term Changes in Bone Mineral Density
Posting Date: July 22, 2009

Substudy of randomized SPAR trial

Summary of Key Conclusions:

No significant differences in changes in bone mineral density (BMD) through 144 weeks between patients assigned to a NRTI-sparing regimen or a PI-sparing regimen.

BMD declined during first 24-48 weeks after initiation of HAART, stabilized thereafter.

Investigators suggest that initial BMD decline possibly associated with delayed reversal of bone loss prior to HAART and/or may reflect a transient state between bone resorption and bone formation.

Low baseline CD4+ cell count significant predictor for early BMD loss at spine and hip.

For more detailed info (cut-and-paste):

http://www.clinicaloptions.com/hiv/conference%20coverage/cape%20town%202009.aspx

SUBMISSIONS / QUESTIONS: paulk@bcpwa.org / (604) 646-5309

2009 INT'L AIDS SOCIETY CONFERENCE - SOUTH AFRICA - DAY 3

2009-07-22T12:56:00.001-07:00

Genetic Test Predicts Response to Maraviroc in Treatment-Experienced HIV Patients
Vancouver, British Columbia, Canada, July 22 2009 – A genetic approach to determining HIV tropism can be used to effectively identify patients who will respond to treatment with the CCR5 antagonist maraviroc, according to new data presented today at the 5th International AIDS Society (IAS) Conference on HIV Pathogenesis, Treatment and Prevention in Cape Town, South Africa.
Using screening samples from patients enrolled in the maraviroc treatment-experienced clinical trial program, results of this retrospective analysis showed that changes in HIV viral levels and the percentage of patients who achieved undetectable viral loads were comparable between those patients tested with HIV V3 Genotyping and Trofile™ (the recombinant-phenotypic assay originally used in the clinical trial program), indicating comparable accuracy of both tests at identifying treatment-experienced patients that will respond to treatment with maraviroc.
“HIV V3 Genotyping shows promise as a significantly faster and more cost-effective way to correctly identify patients who would benefit from CCR5 antagonists like maraviroc,” said Richard Harrigan Ph.D., lead investigator and Director of Research Laboratories, B.C. Centre for Excellence in HIV/AIDS, Vancouver, Canada. “Since the genotypic test is based on methods that are already widely used through the same labs that provide HIV drug resistance testing, this approach could become broadly available and conducted at the same time as resistance testing to determine susceptibility to all drugs, including maraviroc.”

____________________________________________________________________-

22 July 2009, Cape Town, South Africa –
The International AIDS Society (IAS) today announced the selection of Rome, Italy as host of the world’s largest open scientific conference on HIV/AIDS – the 6th IAS Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2011) – to be held from 17 - 20 July 2011 at the Auditorium Parco della Musica. The event will be organized by the IAS, in partnership with Istituto Superiore di Sanità (Italian National Institute of Health), which is the leading technical and scientific body of the Italian National Health Service.

High-risk genital wart strains increase HIV risk
Infection with one or more of the strains of human papilloma virus (HPV) associated with anal and cervical cancer increases the risk of contracting HIV.

Researchers from the Orange Farm circumcision study gathered information on the HPV infection status of 1683 men.

They found that the men infected with high-risk HPV strains were 4.5 times more likely than men without HPV to contract HIV.

Infection with low-risk HPV strains was not, however, associated with an increased risk of infection with HIV.

Once-daily Kaletra safe and effective in treatment-experienced patients

Previously treated patients can achieve good outcomes with once-daily lopinavir/ritonavir (Kaletra), and boost their adherence.

Kaletra is approved for once-daily dosing in combination with other antiretrovirals for individuals starting HIV treatment for the first time.

Researchers wanted to see how well this treatment strategy performed in patients with previous experience of antiretroviral therapy.

The study involved 600 people currently taking HIV treatment, but with a viral load above 1000 copies/ml. They were randomised into two equal groups, one taking the standard twice-daily dose of Kaletra (lopinavir/ritonavir 400/100mg), the other a once-daily dose (lopinavir/ritonavir 800/200mg).

After 48 weeks, equal proportions of patients in the two arms (52% vs 55%) had an undetectable viral load (below 50 copies/ml), the goal of antiretroviral therapy. Increases in CD4 cell count were also comparable between the two groups.

An advantage of once-daily dosing was better adherence.

New integrase inhibitor looks good in early clinical trials

Glaxo SmithKline’s experimental second-generation integrase inhibitor GSK-572 has performed well in early clinical trials.

In a phase 2a, ten-day, study, 35 HIV-infected, treatment-naive people were randomised to receive either monotherapy with the drug or a placebo.

Significant falls in viral load were observed in patients taking all doses of the drug. Within 2 weeks, a 2.46 log drop in viral load, from baseline, was seen in this monotherapy arm. As well, there appears to be a significantly long half-life. To this point, there appears to be no cross-resistance with raltegravir or elvitegravir.

Especially good results were achieved by individuals taking the 5mg dose, with 70% having a viral load below 50 copies/ml at the end of the study, and 90% a viral load below 400 copies/ml.

The most commonly reported side-effects were diarrhoea, tiredness and headache. With the exception of headache, these were more common in the placebo arm.

The 50mg dose will be studied in a 24-week phase IIb trial starting later this month, followed, hopefully, by a phase III trial.

5 abstracts, either oral or poster, were to be presented at this Conference.

Science has paid insufficient attention to gender identities
(masculinities and femininities) and as a result has failed to
consider the meanings and social context underlying risky
sexual practices. Dr. Jewkes is Director of the Medical
Research Council’s Gender and Health Research Unit in
Pretoria, South Africa. Dr. Jewkes’ ethnographic and epidemiological
research on gender and sexuality includes the
evaluation of Stepping Stones, an HIV prevention programme
that aims to improve sexual health by using participatory
learning approaches to improve knowledge, risk awareness
and communication skills. The research shows reductions in
new herpes simplex type 2 (HSV-2) infections and men’s use
of violence against women. According to Dr. Jewkes, the
consideration of sexual practices within a broader context of
gender identities may help explain why efforts to change
isolated sexual behaviours (such as promoting consistent
condom use) have met with resistance, and may also explain
the relatively greater success of interventions that have
sought to change gender norms.

Have HIV Programmes
Strengthened Health Systems?

Yes. At a two-day pre-conference meeting, one-hundred
health systems and HIV researchers examined existing
evidence on this crucial question and found that HIV
scale-up has enhanced and strengthened key components
of health systems:

1. Health expenditures have increased.
2. The overall health workforce has become more
innovative.
3. Human rights, social determinants and issues of
equity are now at the forefront of primary health care.
4. There is global solidarity around the need for
strengthened health systems.
5. Accountability and effectiveness of public health
programmes and services has improved.

While scale up of HIV treatment has enabled the building
of emergency systems to put large numbers of people on
antiretroviral therapy, HIV programmes must now evolve to
allow for management of HIV as a chronic health condition.
Building integrated health services for broader health
outcomes for people living with HIV is also crucial. Participants
agreed that health systems research can demonstrate
how to improve social health insurance, programme
effectiveness, and build up and retain the health workforce.

Track B
Daily summary
21 July (Tuesday)
________________________________________
Under the title of “Old Doors Closing, New Doors Opening” important new data from clinical trials was presented today. We will particularly highlight the 96-week follow-up data from the MERIT study (as observed at Week 48, when patients were reclassified according to the enhanced tropism assay, maraviroc virologic response was non-inferior to the comparator arm) , the next generation once-daily integrase inhibitor from GSK (following a 10-day administration in ART-naïve subjects, there was a significant dose-response effect, with 70% of patients becoming undetectable with the highest dose of 50 mg) , and the MONET trial (treatment simplification from Truvada/Darunavir to Darunavir alone achieved equivalent virologic response to Truvada/Darunavir continuation), this strategy could be associated with significant cost savings. A more detailed summary of these important studies, some of which have the potential to change practice, can be found in the corresponding reports of the session.
Another session highlighted significant differences in the spectra of causative microbiologic organisms in bacterial infections between HIV-positive and HIV-negative populations in both high- and low-income countries. For instance, unlike HIV-negative patients, Streptococcus pneumoniae appears to be a significant cause of bloodstream infections in Spain and of pulmonary infections with high rate of drug resistance in Uganda.
There was a very good symposium on antiretroviral resistance that discussed recent data from the resistance meeting that took place in Florida in June. Another presentation did an update on resistance from the developing world and the different pathways of resistance that the different clades of the virus can take; an issue that can become relevant in the management of patients with HIV in the South. Finally Dr. Boup made a presentation about the peculiar patterns of resistance of HIV-2.

Community
Daily summary
21 July (Tuesday)
________________________________________
Daily Summary
Tuesday July 21 2009
Dr Wafaa El-Sadr from the US expressed her major concern that countries of the North are starting to think that HIV is not an emergency anymore when only one third of the people who need treatments are getting it. HIV is a chronic disease that requires major adaptation to the health systems of countries to treat it effectively but here will be gains in treating other infectious diseases and other diseases generally if we provide enough resources to get HIV right. It is unacceptable to reject HIV-positive pregnant women who arrive at clinic needing care, or to reject HIV-positive children when it known that the chances of their dying without treatments will be around 50%.
The community engagement tour has been a highlight of the Conference for me so far. MSF plays a wonderful role in these health care settings despite huge obstacles. They provide integrated care for thousands of people living with HIV and TB who attend the daily clinics here. The challenges they face though are enormous with a scarcity of human resources caused by the difficulty to retain clinical staff on such low salaries: as someone explained to me some of the health care workers could receive higher wages working in an hotel in Cape Town than they can at their facilities. But many do the work because of the huge need and the knowledge that they are helping to keep people alive by delivering the best clinical care that is possible. It was confronting to see the numbers of children being cared for by their grandmothers and aunts as they have lost their parents to HIV.

________________________________________________________________
A mathematical model from the Harvard School of Public Health, based on the population of Washington, DC has found that recalling every adult for annual HIV screening and treating every HIV-positive person with antiretrovirals as soon as they were diagnosed would result in a 30% decline in the proportion of the HIV positive population who had non-suppressed viral loads (defined as over 500 copies/ml in this study), in the event of realistic takep of tests and treatment.
________________________________________________________________
Two studies using new methods to detect changes in arteries that could give rise to cardiovascular disease have generated differing results.
In one, a study using a sensitive ultrasound test found that long-term HIV infection was independently associated in men with an impairment of the artery’s ability to expand, with higher systolic blood pressure as the result. However, this impairment was only seen in men who had had HIV for more than 15 years.
In the other study, researchers found an apparent effect on heart function in patients who had only been on antiretroviral therapy for a month. They used a sophisticated series of PET and CT scans to map coronary perfusion – blood flow through the coronary arteries and into the heart muscle. They found there was a 31% reduction in coronary blood flow in patients taking HIV therapy when subjected to maximum cardiac stress.
________________________________________________________________________
Track B
Session summary
WESY2, Challenges in Treatment and Care
________________________________________
Powderly discussed the issue of when to start ART in patients with advanced disease and opportunistic infections. Citing the ACTG A5164 study and the SAPiT study of the optimal timing of ART in the treatment of TB, as well as an observational study of critically ill patients in Brazil that was presented in Mexico City, he noted that there is growing evidence of a benefit of ART as soon as is possible and logistically feasible to ensure adherence and access to an unbroken drug supply in people with advanced disease and acute opportunistic infections. He noted that more data will be forthcoming on the optimal timing of ART and TB initiation, and that there may be important differences between individual OIs that require further study; for example, a small uncontrolled study of ART in cryptococcal meningitis from Zimbabwe from CROI 2009 showed a higher mortality when ART was introduced earlier.
Dr. Gallant summarized approaches to second-line antiretroviral therapy by discussing when to switch therapy. Earlier switches are associated with better outcomes, as resistance develops in the face of even low level HIV replication. In resource rich settings the typical sequential treatment algorithm for patients with virologic failuare after starting on 2 NRTIs and an NNRTI is to switch to a second line regimen constructed around a boosted PI. Data suggests that a boosted PI alone may be potent enough for many patients. Continued use of 2 NRTIs is most commonly used, but there are options to use a new agent such as raltegravir, maraviroc, or etravirine. For patients initiated on a boosted PI combination, a single M184 mutation is the most likely resistance pattern that would be encountered with virologic failure. Second options for such patients include continued boosted PI therapy and other NRTIs with enhanced adherence recommendations, or a boosted PI with another active drug in the NNRTI, CCR5 inhibitor, or integrase inhibitor classes. In the developing world second line options differ. The response to the initial combination is similar in developed and developing countries. However, the use of CD4+ count or clinical monitoring to gauge when to switch therapy will likely result in a delay in treatment modification until a time when the virus has more resistance than what would typically be encountered in the developed world. Many patients failing first line therapy in the developing world have virus that is so resistant there may not be remaining NRTI options. The typical second approach is to use two other NRTIs, that have not been used previously, plus a boosted PI. An important change to ART treatment patterns in the developing world should include avoidance of thymidine analogs because of toxicities and the propensity to develop cross resistant virus after failure. The availability of viral load monitoring is essential to make wise decisions. Finally, in a general context there is a need to bridge the gap between patterns of therapy in the developed and developing world.

Track B
Session summary
WELBB1, Late Breaker B

Dr. Squires presented the 84 weeks results of a simplification trial to test the effectiveness of an unboosted PI regimen in patients with virologic suppression. Subjects (n=515) who entered the trial started on ABC/3TC + boosted ATV, were treated for 36 weeks, and were randomized to continue therapy (n=209) or drop the RTV and continue on ABC/3TC + ATV (n=210) if their viral load was <50 c/mL prior to week 36. The primary endpoint was the proportion of subjects with VL<50 c/mL at week 84 by TLOVR analysis. Subjects were predominantly White (63%) and men (84%), with a median viral load of 5.05 log and CD4+ count of 200. At week 84, 86% of subjects on ATV and 81% on ATV/r had viral loads <50 c/mL (-5%; 95% CI -1.75, 12.48, p=0.140). Similar results were seen in subjects with baseline viral loads < or >100.000 c/mL. CD4+ count changes were similar in both groups. There were a total of 8 virologic failures, 1 in the ATV group and 7 in ATV/r group, and treatment emergent mutations was seen in the one failure in the ATV group (M184) and no mutations in the ATV/r group. Treatment related adverse events included grade 2-4 hyperbilirubinemia (14% in the induction phase and 4% in the maintenance phase in the ATV arm versus 12% in the induction phase and10% in the maintenance phase in the ATV/r arm. Decreases in total and LDL cholesterol and triglycerides were observed following discontinuation of RTV in the unboosted ATV arm. In conclusion, unboosted ATV had comparable activity with less hyperbilirubinemia and a more favorable lipid profile than continued boosted ATV.
________________________________________________________________________

Dr. Gandhi's study examined the potential of treatment intensification to reduce low level, detectable viremia in patients with quantifiable viral loads <50 c/mL to determine if this low level viremia represents replicating virus or virus release from latent reservoirs. Subjects received raltegravir or placebo for 12 weeks, and then crossed over to the alternative experimental arm and followed until week 24. The study included subjects with baseline VL >100,000 c/mL and had a screening VL>1 c/mL. 125 subjects screened 60% with detectable VL, 53 were enrolled, and 49 contributed data. The median viral load of subjects was 1.7 c/mL. There were no differences between the absolute or change in viral load between the two groups or following the switch to the alternative treatment. There was a trend towards a higher CD4+ count following the addition of raltegravir that reversed after its withdrawal. These data argue against the hypothesis that ongoing cycles of replication are the main source of residual plasma viremia.

Community
Session summary
TUSY3, New Strategies and Controversy in HIV Testing and Surveillance
________________________________________
TUSY3 New strategies and controversy in HIV testing and Surveillance
Tuesday 21 July 14.30 – 1600

HIV testing and surveillance issues are becoming an increasingly critical aspect to many of the emerging debates about not only testing and treatments access, but also the appropriate focus of service delivery. Covering the increasing use of surveillance surveys – not just for collection of prevalence data, but also now including a number of other features such as CD4 levels, and incidence data, the question was repeatedly posed as to whether the cost and data burden of these large country wide survey programmes are really going to be measured as justifiable or cost effective.

The speakers agreed that current tools are not only imperfect, but as has been spoken about in other sessions at this meeting, it is also apparent that we often do not have the right tools to know if interventions being rolled out are working. As Maestro from the US observed, the most critical measure of a HIV epidemic – the incidence of HIV – is the target for many efforts from the WHO and others to develop new tools that can guide the next billions of dollars to be spent in the HIV response.

Lo from Germany also spoke to the data we do have which shows what large behavioural impact there is when people who receive counseling and testing know their status. She pointed to data that underlined this not only for those who are HIV positive, but also those in serodiscordant relationships.The power of community based interventions to increase testing, but that are linked to treatment and care services, and target also the decreasing of discrimination, were highlighted.

Finally, Amon from Human Rights Watch in New York gave a powerful overview of the the testing issues for those “hard to reach populations”. In his opening remarks it was framed that there was really no easy group, but that clearly marginalized populations were a focus – highlighting MSM, prisoners, and migrants. The criminalization of sexuality, the segregation and neglect of many in prison settings, and the discriminatory laws and policies in place around the world that deny rights to migrant populations were all described. Amon argued that unless human rights were set as the context for these problems then structural barriers for testing and treatments would continue. Government leadership and cross sectoral responses beyond only the health sector were emphasized as the only way forward.

Track B
Session summary
WEBS1, Hepatitis B and C
Pointing out that the availability of the HCV replicon has made it easier to identify HCV treatment target and assess responses, Bhagani first gave an overview of the substantial HCV drug pipeline which includes protease inhibitors (the closest to the market being telaprevir and boceprevir), polymerase inhibitors, entry inhibitors and others such as immune modulators. He however pointed out that many questions remain including how the findings apply to HIV-infected patients (as no study involved HBV/HIV co-infected patients), potential emergence of resistance and drug-drug interactions. He then drew attention to the new epidemic of acute HCV infection among MSMs which has spread beyond Europe. In concordance with what Lewin discussed earlier, he pointed that progression to end-stage liver disease has improved in the HAART era, but remains significantly higher in HIV/HCV than HCV-only patients. Also, better control glucose metabolism is associated with improvement in liver fibrosis in HIV-infected patients.
The speaker then went on to outline factors predictive of clinical response to HCV, including acute infection, low viremia, younger age, lack of stage ¾ fibrosis or steatosis, ethnicity, low BMI, high CD4 and lack of insulin resistance. Finally he discussed potential strategies to maximize treatment response. We’ll highlight that longer duration of undetectability on treatment increases chance for SVR, which is why the current guidelines total duration of HCV treatment depends on the speed of achieving undetectability. Increasing the interferon dose did not alter the response rate.
Finally, regarding HBV, he highlighted the importance of lamivudine resistance on disease progression, and the caution about the efficacy of entecavir on HIV replication.

Rapporteur report

Track B report by Ian Frank, Pablo Tebas, Renslow Sherer and Roger Bedimo

In a substudy of the GRACE trial of boosted darunavir in antiretroviral naïve women, changes in immunological markers following therapy were described in 19/32 virologically suppressed subjects. CD4 counts increased 195 cells/mm3 at week 48. Decreases in percent CD38+DR+CD4+ and %CD38+DR+CD8+, markers of immune activation towards, but not to control levels seen in an HIV uninfected control group were seen. Functional recovery, as assessed by capacity to proliferate and the expression of intracellular cytokines by CD4+ cells, was observed.
The TRIO study evaluated open label raltegravir, boosted darunavir, and etravirine in highly treatment experienced patients. 103 subjects were enrolled with a baseline viral load of 4.0 log10 c/mL, a median CD4+ count of 255, and 13 years of treatment experienced. The proportion of subjects with viral loads <50 copies/mL at weeks 24 and 48 were 90% and 86% respectively, demonstrating the durability of the response.
Trottier and colleagues analyzed the contribution of NRTIs to a salvage combination in highly treatment experienced patients who received raltegravir, maraviroc, etravirine, and NRTIs. There were no active NRTIs by genotype. There was an inverse correlation between number of NRTIs prescribed and probability of achieving a viral load <50 c/mL. [This information was presented similarly at CAHR 2009 – Vancouver]

IAS 2009: The Numbers

• 5,80+ participants
• 360 volunteers
• 1,000+ Facebook fans
• 123 countries represented
• 197 scholarship recipients
• 299 media representatives
• 2,400+ abstracts submitted,
with 1,550+ accepted
• 59 total sessions
• 12 plenary speeches
• 5 special sessions
• 49 exhibits
• 35 satellite meetings
• 6 scientific awards

2009 INT'L AIDS SOCIETY CONFERENCE - SOUTH AFRICA - DAY 2

2009-07-21T15:18:00.001-07:00

As promised, here – again – is a summary of some main events occurring in Capetown, South Africa, at the International AIDS Society’s 2009 5th Conference on HIV Pathogenesis, Treatment and Prevention. The Conference concludes on Wednesday, July 22nd.

It is always difficult, and is a necessarily subjective process, to cull from various sources and limit the detail while offering such coverage.

Today’s Newsletter is longer; however, please note it contains more scientific content… The opening day’s content is more announcement-like.

Again, the official sources for this information (as suggested by the Conference organizers) are:

- The Live Conference Blog
- News Releases
- Facebook
- twitter
- Clinical Care Options
- Rapporteur summaries

For more in-depth information on these and other subjects arising from this Conference, please visit: http://www.ias2009.org/

This Newsletter summary will continue daily through and including Thursday, July 23rd.

MAIN HALL

MAIN HALL (CLOSE UP OF STAGE)

PLENARY HALL

Biomedical Prevention – Microbicides, Vaccines, Circumcision and PrEP

In his plenary presentation, Dr. Ronald Gray summarized the results of the 28 completed biomedical HIV prevention trials of STD control, microbicides, pre-exposure prophylaxis (PrEP), HIV vaccines and male circumcision. Of these trials, only four, including three of male circumcision, have reported significant efficacy. According to Dr. Gray, one of the
1 2
conclusions to be drawn from positive and negative results is that phase III prevention trials are difficult, expensive and time-consuming. Ultimately, according to Dr. Gray, researchers will need to more carefully screen candidate interventions prior to trials and may need to conduct fewer trials, but with a greater investment in rigor and quality. Dr. Gray is Robertson Professor of Reproductive Epidemiology in the Department of Population, Family and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health.

ELITE CONTROLLERS
People with AIDS may have viral loads of several hundred thousand copies per milliliter. In contrast, the viral loads of elite controllers range from a scant 50 down to levels so small that even the most sensitive tests can't detect them. Doctors know these people have the virus only because separate tests have revealed the presence of antibodies to HIV in their systems. In other words, elite controllers aren't HIV-free; they may still be able to pass the virus to others, in whom it may be deadly.
Early on, researchers discovered that elite controllers aren't infected with a less virulent strain of the disease. But little else about their condition is certain.
Since 2006, Walker and his colleagues have been organizing an international contingent of more than 250 researchers and more than 200 physicians who have elite controllers as patients. Initially funded by a gift from the Mark and Lisa Schwartz Foundation and recently boosted by a $22 million grant from the Bill & Melinda Gates Foundation, the International HIV Controllers Study is working to identify elite controllers, collect samples of their blood and DNA, and distribute the samples to labs for analysis.
Vaccines normally work by introducing a dead or harmless piece of virus that stimulates the adaptive immune system to attack. In that way, the body builds defenses capable of destroying the real virus. But AIDS has resisted every effort to develop a vaccine.
The MIT team wants to know whether the T cells in elite controllers have special properties. The answer will require a much more detailed understanding of how T cells function. So the team has developed a system to trap a single T cell along with a single cell infected with HIV. That allows researchers to watch T cells attacking infected cells and to compare the action of elite controllers' cells with those of patients whose HIV has progressed into AIDS.
One clue may already have emerged. In the Dec. 19 issue of the journal Immunity, researchers at the National Institute of Allergy and Infectious Diseases concluded that the killer T cells of elite controllers killed 68 percent of infected cells in an hour, compared with just 8.1 percent for those with AIDS.
One theory about elite controllers holds that they possess special genetic traits, beyond any differences in their immune systems, that better equip them to battle AIDS. Geneticist Paul de Bakker of Brigham and Women's Hospital in Boston is combing through the human genome to find those characteristics. It's a daunting endeavor. The genome comprises 3 billion coded pieces of information that determine who a person is. Some 99.9 percent of these pieces are the same in all people, but there are points of difference known as single nucleotide polymorphisms (SNPs, pronounced "snips").

GRACE Shows Similar Treatment Response Rates in Women and Men on Prezista Treatment
July 20, 2009
By Tim Horn
Long-awaited 48-week data from the Gender, Race and Clinical Experience (GRACE) study indicate that Norvir (ritonavir)–boosted Prezista (darunavir) can be used in women and men with similar safety and efficacy outcomes. Reported by Kathleen Squires, MD, of Jefferson Medical College in Philadelphia and her colleagues on Monday, July 20, at the Fifth International AIDS Society (IAS) Conference on HIV Pathogenesis, Treatment and Prevention in Cape Town, GRACE also documented higher rates of study discontinuation among women, underscoring the need for further investigation into ways to better retain women in clinical trials.

Prezista, combined with low-dose Norvir, has been approved in the U.S. as a protease inhibitor option for treatment-experienced patients, as well as first-time treatment takers and HIV-positive children between the ages 6 and 17.

About 66 percent of the women enrolled were black, compared with 51.4 percent of the men. Hispanics/Latinos accounted for 20.9 percent and 25.4 percent, respectively. The average length of infection upon entering the study was about 11 years; in addition, 58.5 percent of the women and 64.8 percent of the men had used at least two protease inhibitors before enrolling in GRACE. Average CD4 counts at study entry were 210 cells in the women, compared with 175 cells in the men.

The rate of treatment discontinuation was higher in women (32.8 percent) compared with men (23.2 percent). This difference was statistically significant, meaning it was too great to have occurred by chance. The primary reasons for study discontinuation were loss to follow-up and side effects; however, there were no trends toward a specific type of side effect driving discontinuations in either group.

Men experienced a slightly better CD4 cell recovery compared with women after 48 weeks in the ITT analysis: gains of 89 versus 68 cells, respectively. But in the less stringent analysis, women faired better with a 131 CD4 cell gain, compared with a 104 cell gain among men.

The number of men and women who developed new HIV resistance mutations while participating in GRACE was small, according to data still being analyzed. Two (7.4 percent) women, compared with two (1.2 percent) men, were found to have a new major protease inhibitor-resistance mutation after experiencing virologic failure.

Overall, 90.2 percent of the women and 83.1 percent of the men experienced at least one adverse event, the majority of which were mild-to-moderate in severity. In total, 46.7 percent of women and 43.0 percent of men experienced at least one adverse event considered by Squires’s group to be at least possibly related to the use of Prezista/Norvir.

The most common side effects were nausea (24.4 percent of the women versus 14.1 percent of the men), diarrhea (16.4 versus 22.5 percent, respectively), upper respiratory tract infections (11.1 versus 7.7 percent, respectively) and vomiting (11.5 percent versus 6.3 percent). Interestingly, serious adverse events were less common among women compared with men: 16.4 percent versus 22.5 percent, respectively.

In conclusion, Squires pointed out that the GRACE study successfully enrolled a high proportion of women and is, to date, the largest North American study to assess sex-based differences in the efficacy and safety of an ARV regimen. Overall, she said, the data reported suggest that Prezista/Norvir can be used in women and men with similar safety and efficacy outcomes.

DART study

A major study has shown that HIV treatment can be successful in resource-limited settings without laboratory monitoring.

The DART study involved over 3300 adults in Uganda and Zimbabwe. All were starting HIV treatment for the first time.

Half the patients were randomised to change to second-line antiretroviral therapy if their CD4 count fell, the others switching if they developed a serious HIV-related illness.

Similar proportions of patients in the clinical monitoring arm (87%) and laboratory monitoring arm (90%) were alive after five years.

There were no differences in toxicity rates between the two arms.

Direction of Obama government HIV policy

Presentations from senior US HIV officials have given some clues about the priorities of the Obama administration.

These include:

Continued PEPFAR funding
Earlier HIV treatment
Exploring the concept of 'treatment as prevention'.

Abacavir and heart attack: debate continues

Two new studies have found no connection between treatment with abacavir (Ziagen, also in the combination pills Kivexa and Trizivir) and an increased risk of heart attack.

The first study involved over 19,000 US veterans with various HIV treatment histories. The first set of results showed that abacavir was associated with a modest 17% increase in the risk of heart attack. But when the researchers controlled for other risk factors, this association was weakened.

Of note, the investigators found that patients with kidney disease, which can increase the risk of cardiovascular disease, were more likely to be given abacavir. They believe that this could be an explanation for the association between treatment with the drug and heart attack.

A second smaller study was conducted in Spain. It involved 300 patients and showed that treatment with abacavir did not affect levels of bio-markers that can predict an increased risk of heart attack.

'Treatment as prevention' must not violate human rights
A plenary session at the conference was told that expanded HIV testing and treatment as prevention must not be coercive or violate human rights.

Mathematical models have predicted that increasing the number of individuals diagnosed with HIV and on antiretroviral therapy has the potential to significantly slow the pace of the epidemic.

But human rights organisations said that testing for HIV must not be coercive. They also emphasised the importance of having properly trained counsellors, and linking testing to treatment and education.

MORE DETAILS ON A STORY QUOTED YESTERDAY:
South Africa begins AIDS vaccine trial, cuts funds

AP – Dr Danielle Crida, left, demonstrates how a new Aids vaccine is administrated on a trail subject, Wanda …
By MICHELLE FAUL, Associated Press Writer Michelle Faul, Associated Press Writer – Mon Jul 20, 5:26 pm ET
CAPE TOWN, South Africa – South Africa launched a high-profile trial of an AIDS vaccine created by its own researchers Monday, a proud moment in a nation where government denial, neglect and unscientific responses have helped fuel the world's worst AIDS crisis.
After a government official lauded the project at a ceremony at Cape Town's Crossroads shantytown, the scientist leading the research said state funding had been halted.
The contrast between Monday's hopeful vaccine launch and the revelation of funding cuts raised questions about whether the government was backsliding on its pledge to combat AIDS.

Anna-Lise Williamson, an AIDS researcher at the University of Cape Town, told The Associated Press the clinical trial would continue with U.S. money. But she said South Africa's Department of Science and Technology had pulled its funding in March, while the project's other sponsor, the state electricity utility Eskom, did not renew its contract when it expired last year.

Neither government spokesmen nor Eskom immediately returned calls seeking comment about funding cuts.

The South African vaccine was developed at the University of Cape Town and targets the specific HIV strain that has ravaged South Africa. It is also undergoing safety tests at a trial involving 12 volunteers in Boston that began earlier this year, said Sarah B. Alexander, spokeswoman for the HIV Vaccine Trials Network at the Fenway Institute, an AIDS treatment center where the trial is under way.

The safety trials started in the U.S. to allay any criticism the United States was collaborating on an AIDS vaccine that might be seen as using Africans as guinea pigs, she said.

In its vaccine initiative, the government decided it was important to target the HIV subtype C strain that is prevalent in southern Africa "and to ensure that once developed, it would be available at an affordable price," said Anthony Mbewu, president of South Africa's government-supported Medical Research Council, which shepherded the project.

Some 250 scientists and technicians worked on the vaccine's development.
Dr. Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Disease and a leading AIDS researcher, was in South Africa for the trial launch and said the South African scientists received more money from his institute's research fund than any others in the world, outside the United States. The U.S. also paid to produce the vaccine.

He called it "the most important AIDS research partnership in the world."
But, he warned: "There are extraordinary challenges ahead," referring to the years of testing needed now that South Africa has reached the clinical trial stage.
Monday's launch was put on by the South African AIDS Vaccine Initiative, the lead program of the government-backed Medical Research Council. The deputy ministers of health and science were both at the event and praised the initiative.

Aaron Motsoaledi, a medical doctor who became health minister in May, has promised to try to strengthen AIDS prevention campaigns that were weakened for years by red tape and mixed messages from policy makers.

Getting people onto treatment, not earlier treatment, must be priority, conference warned
Monday, July 20, 2009 2:00 AM
Filed under: Conference news, Starting treatment news, IAS 2009
Debates about whether to start treatment at a CD4 count of 350 in developing countries ignore the fact that current programmes are doing very badly at retaining patients in care after diagnosis or starting people on treatment before they become seriously ill, Dr Francois Venter, President of the South African HIV Clinicians Society told the Fifth International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention on Monday.
Speaking during a conference symposium on when to start treatment, Dr Venter pointed out that the current average CD4 count at which patients start treatment in South Africa is 87 cells/mm3.
Despite a huge increase in the number of people who undergo HIV testing – up to one-quarter of South African adults took a test in the past year, according to 2009 research by the Human Sciences Research Council – the average CD4 count at which patients in his Johannesburg clinic start treatment has not moved above 80 to 100 cells since 2004, Dr Venter said.
“We are still doing a terrible job of retaining patients in care, and we need to start looking harder at retention in care,” he said. “Are you delivered into a package of care that looks after you [after diagnosis]?” he asked.
A large number of patients were dying while waiting for the results of diagnostic tests and while undergoing treatment-preparation counselling, or during acute opportunistic infections.
He also expressed concern about the implications of recent findings on the inflammatory effects of HIV infection for developing countries. “Cardiovascular disease is not usually seen as an African problem, but death-certificate analysis in South Africa recently revealed that diabetes and hypertension were among the most frequent causes of death.”
Similarly, South Africa is seeing overlapping epidemics of HIV and obesity. Potent cardiovascular risks may lead to a high rate of cardiovascular disease in people with HIV, Dr Venter argued. He also drew attention to the high rate of liver disease and hepatitis virus infection in the developing world, to data showing that uncontrolled HIV replication exacerbates liver damage, and to the high frequency of kidney disease in African-Americans with advanced HIV infection (people of African origin appear to have a high risk of HIV-associated kidney damage).
“The thing that filled me with fear [looking at the data on inflammation and HIV] was renal disease. Kidney transplants, dialysis, even prophylactic drugs to deal with proteinuria are difficult to obtain and expensive in this region.”
Eighty-four per cent of maternal deaths and 47% of postnatal infant infections occur at CD4 counts below 350, he noted.
“… one of the major obstacles to early treatment in the developing world is the current reliance on d4T (stavudine) in first-line treatment.
Starting treatment in the developed world
In the developed world national US, British and European guidelines now concur that treatment should be recommended to all patients with CD4 counts below 350.
While US cohort data suggest benefits to starting treatment before the CD4 count falls below 500, another major cohort analysis did not find an additional benefit to starting treatment at CD4 counts above 400, and an international randomised trial called START is currently recruiting patients to determine whether starting treatment at a CD4 count above 500 results in less death and illness than starting at the currently recommended threshold.
Dr Jose Gatell of Hospital Clinic, University of Barcelona, highlighted that current European AIDS Clinical Society treatment guidelines state that antiretroviral treatment should be considered for all diagnosed patients.
He warned “We cannot wait until completion of the START study to make decisions.”
But to achieve an extended period of healthy life, normalisation of CD4 counts needs to be achieved. Professor Gatell pointed to research showing that normalisation of CD4 counts for at least five years above 500 cells is necessary in order to eliminate the difference in mortality between people with HIV and the general population.
Nevertheless, a substantial proportion of patients continue to fail to reach this CD4 level with current treatment due to late initiation of treatment, he noted. Therefore all patients with a CD4 count below 350 should be offered treatment unless there is a specific contraindication.

RAPPORTEUR:
Track B
Session summary
MOAB2, Cardiovascular Disease: to HAART or not to HAART
________________________________________
Not surprisingly the session started with presentations related to the presumed role of abacavir in increasing the risk of cardiovascular events in patients with HIV infection, a topic that has been in the mind of clinicians, patients, and researchers since the original presentation of this data by the DAD group in 2007.

Bedimo et al. presented a large epidemiological study of the VA cohort that included more than 19000 participants. In this cohort the use of abacavir was marginally associated with an increased cardiovascular risk, and the association disappeared after adjusting for traditional risk factors, renal function (the main reason ABC is used instead of tenofovir) and HCV. Importantly, renal dysfunction was an additional strong predictor of cardiovascular risk.

RAPPORTEUR:

Track B
Session summary
MOSY3, Current Issues in Pharmacology and Toxicology
________________________________________
Carr gave an update on changes of body composition (fat and bone) and their importance in the management of HIV infected individuals. The discontinuation of thymidine analogs consistently (and slowly) improves lipoatrophy, one of the most feared toxicities of HIV treatment. Tesomorelin decrease fat in patients with fat accumulation, but its benefits are transient. Bone is affected probably by all ART regimens, with bone loss after the initiation of therapy that is greater with some drugs (TFV). Although tenofovir appears not to decrease kidney function at the population level, once renal problems appear in a particular individual, they are only partially reversible. Hyperlipidemia and insulin resistance are also very common in HIV infected individuals and that was the focus of Dr. Currier who discussed different lipid lowering therapies, ART switch, and intensification strategies to manage it. She also discussed the effects of HIV infection itself, and of different classes of drugs, on insulin resistance and lipids. She noted that it is necessary to address both problems to decrease the incidence of cardiovascular disease

RAPPORTEUR:

Track B
Session summary
MOPDB1, Update on Diagnosing and Monitoring
________________________________________
In this symposium on advances in point of care diagnostic testing, Wee presented an elegant micro-fluidic system which is the size of a credit card for the quantification of HIV1 cDNA for neonatal diagnosis. With a 30 minute throughput, the data correlated well with a standard table top analyzer, with an R2 value of 0.997, and is well positioned for large scale testing.
In order to improve the accuracy and precision of viral load testing in reservoirs, Fiscus et al studied the Abbott m2000 RealTime HIV-1 viral load assay, which is standardized for plasma, in breast milk, dried blood spots (DBS), seminal plasma, and cerebrospinal fluid, and compared the results to plasma. Linear results were obtained for all fluids, and, compared to blood, recovery was near 100% for semen, CSF, and DBS, and roughly 50% for breast milk.
In contrast to the earlier presentations, an independent review of various rapid tests in 20 HIV negative and 200 HIV-1 individuals specimens by Payle et al result in high rates of false negative results with oral fluid and blood specimens. The highest false negatives were seen with the Oraquick oral fluid (11.9%), with false negative rates of 3-4% for Oraquick blood and Determine rapid blood tests, and the lowest rates with the Vikia and INSTI blood tests (<2%). The authors urged awareness of this variability and caution in the interpretation of these results.

Community
Session summary
MOSY1, When to Start
________________________________________
When to Start?
Monday July 20 11am

Josep Gatell from the University of Barcelona: The data on years of survival for people on HAART who started below 350 was acceptable (at 35 years) but patients needed to be above 500 T-cells for at least 4 years to have the same life expectancy as the rest of the population. Two thirds of Gatell’s cohort start below 350 T-cells and only half of that (53%) reach more than 500 after 3 years.

(NB: Elsewhere, Gatell is quoted as saying “… at least 5 years…”)

There is also now more evidence of higher risks of AIDS defining events for those who start under 350 and more results about the role the virus itself plays in chronic inflammatory responses in people with HIV. Viral replication is a main predictor of non-AIDS events. Evidence is mounting that people should start earlier when their T-cells are less than 500. This was particularly true for people with other health issues such as a higher cardiovascular risk, Hepatitis B or C and pregnancy.

Nevirapine May Be Option for Some Kids After Single Dose for MTCT
Author: Mark Mascolini
________________________________________
20 July 2009
Children exposed to single-dose nevirapine (sdNVP) for prevention of mother-to-child transmission (MTCT) of HIV may be able to replace lopinavir/ritonavir with nevirapine in a first regimen after that regimen gets HIV replication under control, according to results of a randomized trial presented at the 5th IAS Conference on HIV Pathogenesis, Treatment and Prevention.

The investigators caution that more work must be done to confirm the findings and define which children may safely swap lopinavir/ritonavir for nevirapine. But if the results hold, the strategy would be a plus in low-income countries where many children are exposed to sdNVP and still become infected with HIV. Nevirapine is cheaper and easier to use than the protease inhibitors (PIs) lopinavir/ritonavir because it is formulated into a single pill with other antiretrovirals. Nevirapine may also have fewer long-term side effects than lopinavir/ritonavir.

http://www.clinicaloptions.com/HIV/Conference%20Coverage/Cape%20Town%202009.aspx

2009 INT'L AIDS SOCIETY CONFERENCE - SOUTH AFRICA - DAY 1

2009-07-21T15:07:00.000-07:00

As promised, here is a summary of some main events occurring in Capetown, South Africa, at the International AIDS Society’s 2009 5th Conference on HIV Pathogenesis, Treatment and Prevention. The Conference had a number of ancillary events held prior to its official opening ceremonies on Sunday, July 19th. The Conference concludes on Wednesday, July 22nd. More than 5,000 researchers, clinicians and community leaders are expected to attend the conference.

It is always difficult, and is a necessarily subjective process, to cull from various sources and limit the detail while offering such coverage.

The official sources for this information (as suggested by the Conference organizers) are:

- The Live Conference Blog
- News Releases
- Facebook
- twitter
- Clinical Care Options
- Rapporteur summaries

For more in-depth information on these and other subjects arising from this Conference, please visit: http://www.ias2009.org/

This Newsletter summary will continue daily through and including Thursday, July 23rd.

OPENING HIGHLIGHTS:

HAART as Prevention

“The added preventive benefit of antiretroviral therapy represents a compelling new rationale for the re-invigoration of HIV treatment roll-out and gives further urgency to the need to avert disruptions in access to life-saving medicines,” said IAS President Dr. Julio Montaner, who is IAS 2009 Chair and Director of the BC Centre for Excellence in HIV/AIDS in Vancouver, Canada. “By reducing HIV transmission, as well as morbidity and mortality, treatment scale up is not only the right the thing to do for humanitarian and public health reasons; it is also a cost averting intervention, which makes fiscal sense in these difficult times.”

In addition to these remarks, above, Dr Montaner also said the following:

"Earlier this month, another G8 Summit came and went. HIV/AIDS was indeed the elephant in the room. In 2009 the eight most powerful economies in the world left HIV off their priority agenda. They parted with no progress report on HIV, and they even failed to renew their prior commitments to the goal of universal access to HIV, prevention, care and treatment by 2010. This is totally unacceptable. This is a tragedy."

"HAART is no longer viewed as just a cost-effective intervention that prolongs the life of a person living with HIV or AIDS. HAART is now additionally viewed as an essential tool to curb the growth of the epidemic."

Importantly too, Montaner re-emphasised the importance of not compromising human rights (and protections for marginalised communities such as MSM, IDU and sex workers) in the process of providing treatment and care to people with HIV.

In his plenary remarks, Dr. Reuben Granich, Medical Officer for HIV/TB in the HIV/AIDS Department of the World Health Organization (WHO), examined the significant promise of the use of HAART as part of a combined approach to HIV prevention that includes behavioral, structural and biomedical prevention interventions. Dr. Granich outlined the context and basic assumptions regarding this emerging strategy, including when to start ART for maximal clinical and prevention benefit. He also highlighted the essential roles of human rights, dignity and community engagement in the use of HAART for prevention and discussed the outstanding biological, feasibility, impact and cost issues related to research in this arena [emphasis added].

HIV and Host Genetics

Dr. Amalio Telenti discussed the relatively new field of HIV and host genetics, examining the role of host genetics in susceptibility to HIV-1 disease, plasma drug levels and treatment toxicity. Dr. Telenti, Professor of Medical Virology and Director of the Institute of Microbiology at the University Hospital Center of the University of Lausanne, Switzerland noted that despite some false starts, there is now solid data in this arena, including a thorough understanding of the role of common human genetic variation in HIV disease progression and drug toxicity. He said that we can now explain 22% of population variance in viral load by genetics, population effects, gender and age. He thought that it won’t be long before there are useful predictive pharmaco-genomic strategies to predict toxicities of certain antivirals and to allow for the creation of optimal treatment regimens for individuals [emphasis added].

Prevention of Mother-to-Child Transmission

Dr. Louise Kuhn called for a mobilization of political will to implement the latest knowledge on prevention of mother-to-child transmission (PMTCT), highlighting data on breakthroughs in PMTCT strategies during breastfeeding, including lactation support and counseling, continuation of maternal HAART after delivery, and extended infant prophylaxis with nevirapine. According to Dr. Kuhn, the urgency of implementing these interventions is underscored by accumulating data on negative impacts of avoiding or shortening the duration of breastfeedign [emphasis added].

The issue of treatment as prevention is set to be a major discussion topic at this Conference and it is important one for community to monitor. Dr Reuben Granich, from the United States, began the plenary saying that if there was universal testing and immediate ART, combined with other prevention interventions, there would be a 95% reduction in HIV cases in 10 years and the incidence would be reduced from 15-20 000 to 1000 cases per million. Prevalence (or the number of people with HIV) would become less than 1% by 2050. Initial resources would be higher but this approach may provide cost savings.

Some interesting quotes:

Hoosen (Jerry) Coovadia (IAS 2009 Local Co-Chair, Chairman of Dira Sengwe and Scientific Director of the Doris Duke Medical Research Institute at the University of KwaZulu-Natal):

"HIV is the hand-maiden to tuberculosis."

Kgalema Motlanthe (South African Deputy President):

"Unless we redouble our efforts to conquer this disease it will define the 21st century for sub-Saharan Africa."

Françoise Barré-Sinoussi (2008 Nobel Laureate and IAS Governing Council):

Viral reservoirs constitute the major obstacle to eliminating HIV from the body. Prof. Barré-Sinoussi was expected to explain how HIV – hidden mostly in subpopulations of latently infected resting memory CD4+ T cells – persists by distinct mechanisms in patients treated with highly active antiretroviral therapy. In her remarks, she was to pose some of the most vexing questions facing AIDS scientists and clinicians today, including: What are the main reservoirs of HIV in the body? What are the mechanisms responsible for the establishment and persistence of these reservoirs? Which strategies can be proposed accordingly?

"There is still a very long way to go" in controlling HIV reservoirs.

Stephen Lewis (AIDS Free World Co-Director):

"When, as now, there's a backlash against funding for AIDS, with
mindless charges against AIDS exceptionalism, you should find a way collectively to shoot down the pinched bureaucrats and publicity-seeking academics who advocate exchanging the health of some for the health of others."

"We must never allow them to play one part of the health sector against the other...HIV/AIDS, for all the horrendous human consequences, has objectively strengthened health systems."

"When the G8 won't renew its 2005 commitment to universal access...then it's time for science to speak with one powerful voice of accusation."

"An ugly homophobic culture is a threat to public health that
inevitably serves to spread the virus."

Events which occurred prior to, but that are connected with, the Official Conference Program included:

IAS 2009: 5th IAS Conference on HIV Pathogenesis, Treatment and Prevention – Treatment Action Campaign sponsored a march and rally calling for the resources needed to meet the South Africa National Strategic Plan's targets for HIV/TB treatment and prevention just prior to the opening of the conference on 19, July 2009. One of the loudest cheers went up for a doctor in the public health service who explained why doctors had found it necessary to go on strike about the lack of health care workers to do the tasks required to care for plhiv.

Viyuseka Dabula, General Secretary of Treatment Action Campaign:

“When I need second-line treatment I want a guarantee I can get access to it, “she said. “If we don’t increase the resources available, 90% of the current monies will be needed for second line treatment by 2012.”

Some photographs taken during the first few days include:

Dr Montaner – wearing the Rally shirt “HIV-POSITIVE” – signs a petition

South African Health Minister Dr. Aaron Motsaoledi asks for, and then puts on, an HIV Positive t-shirt in solidarity with activists demonstrating for increased resources for HIV and health services.

Médecins Sans Frontières (MSF) reported on disruptions in supplies of antiretroviral (ARV) drugs in six African countries. Citing the catastrophic consequences of drug shortages on new patients and those already in care, the MSF report called on national governments, donors and their partners to take swift action to address the funding gaps and supply distribution problems hampering access to lifesaving drugs. The six countries cited were the Democratic Republic of Congo, Guinea, Malawi, South Africa, Uganda and Zimbabwe.

US Global AIDS Coordinator Eric Goosby and NIAID Director Anthony Fauci spoke at an IAS 2009 special session entitled, Global HIV Research and Policy and Programme Implementation under the New United States Administration. The session was on Monday, 20 July, from 1:00 – 2:00 pm (local time) and it was chaired by Global Fund Executive Director Michel Kazatchkine.

This is the first major international AIDS conference for Ambassador Goosby, in his role as Coordinator of the President’s Emergency Plan for AIDS Relief (PEPFAR), the US government’s multi-billion dollar global AIDS programme. Dr. Fauci, who has spoken at previous IAS conferences and is always a big draw, discussed US government-funded HIV research. The session was expected to attract a standing room only crowd eager to hear details of the Obama Administration’s plans. Those unable to watch in person can access a free webcast of the session on the conference website.
Dr Fauci:

"Sure" US #HIV travel ban will be lifted. Everyone I have talked to in the Obama Admin supports lifting ban.

Yogurt Promotes Gut Health

2009-07-15T12:31:00.000-07:00

Yogurt, or more specifically the bacteria in it, seems to have a positive effect on both CD4 counts, and may protect against some HIV related diseases.

A recent article in the journal Nature Magazine explores the connection between yogurt consumption and gastrointestinal health. The gut is home to over 100 trillion microorganisms that help with immunity and digestion. HIV Researchers have known since the early days of the pandemic that HIV can wreak havoc in the gut which is home to an abundance of CD4 cells (helper T-cells). It has also been known for some time that probiotics can aid in the treatment of fungal infections such as thrush.

The verdict is still out, and researchers continue to explore the symbiotic relationship that the probiotic bacteria may have. In the mean-time, Canada’s food guide suggests 2-4 servings of dairy per day, try making a yogurt with “live bacterial culture” part of your diet.

Do you experience many “gut” problems due to HIV? What do you find helps?
Until next week…be well!

Touch me in the Morning! A Breakfast Conversation About Research On Gay Men’s Sex.

2009-07-08T22:12:00.001-07:00

As part of the Treatment Information Program at BC Persons With AIDS, this week’s blog is to invite you to an upcoming, informal discussion of HIV research, taking place during PRIDE.

Wednesday, July 29th from 8 to 10am.

HIV Research Cafés bridge the worlds of community and academia through casual and respectful plain language conversations about HIV research articles which we send to you in advance. Read as much or as little as your time, energy and interest permits.

It’s like friends gathering over breakfast to chat. No group presentations mentioning HIV, no talking heads, no signs saying “HIV Research”, no minutes and no recordings. Open to all interested.

We’d love to hear your input and questions regarding sex, or sex as an HIV positive individual. Do you have a hard time discussing your HIV status with your potential partners, or what other concerns may you have? Please drop us a note as they are monitored daily. Until next week…be well!

This Breakfast is by registration only!

Register with Glen Eatly at the following: cafeguest@bcpwa.org .

An event hosted by the Community Based Research Program housed at BC Persons With AIDS Society.

Treatment Side-effects; Skin Disorders

2009-07-01T10:47:00.000-07:00

Individuals with HIV can develop minor skin complications when they start HAART. The most common reaction is a rash, or dry patches anywhere on the body. These problems will usually resolve themselves after your body gets used to the treatment medications.

However, there are a couple of things to keep and eye out for:

If the rash is accompanied by a fever, nausea or coughing, speak with your doctor; go to emergency if symptoms rapidly worsen, or if you have difficulty breathing.

After starting HAART, as our immune system becomes reconstituted (stronger), flare-ups of skin disorders are common, with eosinophilic folliculitis being one of the most common issues.

As dry skin can also be a problem, topical creams containing oatmeal, calendula (marigold), silicone or Vaseline should all help. Apply at least once daily, particularly after you shower.

Do you have any questions about treatment side-effects? Please drop us a note. Until next week...be well!

Treatment Side-effects: Sleep Disorders

2009-06-24T16:01:00.001-07:00

Sleep is an essential process needed by the body as “down time” in order to rest and repair from the day. With person’s with HIV, side-effects of treatment may create sleeping disorders. If you are not able to get regular, good quality sleep, either in the long or short term, your ability to think, speak and concentrate will be reduced. You can become more irritable and have slower reactions, and your memory and judgment will be affected.

Try these few tips first to try and improve your sleeping, if the problem persists, please contact your health care provider.

Take a hot bath before bed
Have a cup of herbal (chamomille) tea or warm milk
Make your room a quiet and comfortable refuge; only use it for sleeping in
Try to get some exercise every day
Get into a routine where you go to sleep and wake up at the same time each day

As I mentioned, if sleeping disorders persist, you should contact your doctor as he will be able to help. What are your tips for helping to get to, or to stay asleep? We always love to hear from you. Until next week…be well!

Treatment Side-effects; Nausea

2009-06-17T08:14:00.000-07:00

Most antiretrovirals, as well as many other drugs used to treat infections in those of us with HIV, list nausea and vomiting as some of the most-likely side-effects. Besides making it difficult to go “out and about”, nausea and vomiting can in the long-term cause serious problems such as dehydration and malnutrition. Here are a few tips for dealing with nausea:

-Eat small, more frequent meals
-Avoid greasy, fat, fried or spicy foods
-Herbal teas, especially peppermint, chamomile and ginger will help
-Over-the-counter drugs such as dimenhydrinate (gravol)
-Don’t lie flat for at least an hour after eating or drinking
-Eat cold food, warm food can worsen nausea

What works for you in decreasing nausea and vomiting, or is it not an issue for you? Until next week…be well!

Treatment Side-effects: Diarrhea

2009-06-11T08:36:00.000-07:00

Diarrhea is one of the most common side-effects of HAART, and has a huge impact on our ability to go about our days. The good news is that this side-effect does respond to treatment and can usually be managed.

Diarrhea is an increase in the water content, frequency, and volume of bowel movements. It can become a serious problem if left untreated, leading to dehydration and nutritional problems. If diarrhea has just become a problem, it may become serious, please check with your doctor if it does not clear up within a few days.

If Diarrhea is a problem, there are various ways of trying to clear it up. Over-the-counter medications such as loperamide (Imodium) may help, or prescription medications will usually do the job as well.

Another way to attack the problem is through your diet. Stay away from coffee and other caffeinated beverages, as well as spicy or fried food. The BRAT diet really helps, it consists of Banana’s, Rice, Apple juice and Toast or tea.

Do you experience many side-effects that are attributed to treatment? How do you manage them? If you have any questions regarding side-effects, please ask and we’ll do our best to answer. Until next week, be well!

HIV and Swine Flu (H1N1)

2009-06-08T03:01:00.000-07:00

What is Swine flu and is its occurrence relevant to individuals with HIV? Swine flu is only a new strain of the flu virus that has yet to have been in contact with humans. As we have never been exposed to this flu, we do not have any antibodies to it which makes us a little more vulnerable.

Generally taking the same pre-cautions which we usually use, should avoid contracting this flu. The singular most important thing that we can do is hand washing. Other precautions involve of course staying away from those infected, and if the flu is showing up in your area, avoiding crowded places if possible.

If you develop any flu symptoms and you suspect it could be swine flu, DO NOT go to your doctor’s office as this may contribute to the spread. Instead, call your doctor and they will tell you what to do.

How has the Swine flu outbreak affected you? Are you staying in more, or avoiding busier places? How about your tips to help avoid infection? Be well.

Smoking Is Even More Dangerous To Individuals With HIV Than Those Without

2009-05-27T16:26:00.000-07:00

If you have HIV and are a smoker, you now have another reason to quit. In recent research done by Syed Kadri at Ohio State University Medical Centre, patients with HIV were found to be twice as likely to experience a decrease in lung function.

The immediate effects of quitting smoking are:
*Within 8 hours, carbon monoxide levels drop in your body and oxygen levels in your blood increases.
*After 2 days, your sense of smell and taste begin to improve.
*Within 2 weeks to 3 months, your lungs work better making it easier to breathe.
*After 1 to 9 months, coughing, sinus congestion, tiredness and shortness of breath improve.

An excellent resource for those who would like to quit, as well as for those who don’t, is the Canadian Cancer Society

How do you feel about being positive and continuing to smoke? Is more information or support needed to assist you break the habit? Be well!

Interpretating Your Lab Results, Viral Load

2009-05-06T15:51:00.000-07:00

Viral load is the term used to describe the amount of virus in your blood ( # of HIV RNA copies per millilitre). The more HIV viruses that are in your blood, the faster your CD4’s will be depleted and your risk of disease and illness will increase.

When first infected with HIV (sero-converting), your viral load may be around 100,000 or more. This will soon drop to around 10-30 thousand until you start HAART. If your HAART regime is working, your viral load should fall to “undetectable” within approximately 3-6 months. This means that you have less than 40 HIV RNA copies per ml of blood. One of the goals of HAART is to keep that viral load at “undetectable”. You can expect to have lab tests anywhere from every 1-6 months once your viral load has stabilized.

We’d love to hear your questions about your viral load, or any other lab results that you may receive. Until next week, be well!

Interpretating Your Lab Results, CD4 Percentage

2009-04-29T16:19:00.000-07:00

This is the second in a four-part series on understanding you lab results.

CD4 percentage answers the question of what percentage of all blood cells are CD4’s? A normal CD4 percentage is approximately 40%, a CD4 percentage of 20% or less is an indicator that HAART should be initiated. Some doctors believe that CD4 percentage should be used in place of CD4 as it is potentially more active, although not as perceptive to smaller changes . In Canada, our doctors receive the CD4 percentage on the same lab form as the CD4 so we do have access to both.

Do you keep track of your lab results? If so, how do you do it? Next week we’ll discuss viral load. Until then, Be well!

Interpretating Your Lab Results, CD4

2009-04-22T17:26:00.000-07:00

This is the first in a four-part series on understanding you lab results.

“CD4 cells” (“T-helper cells”), are white blood cells which initiate the immune systems response to bacterial, fungal and viral infections. The CD4 count is the number of CD4 cells in a cubic milliliter of blood. (CD4 cells/mm3). A normal CD4 count is anywhere from 500-1,600. After being infected with HIV, our CD4 count will generally drop by approximately 100 cells annually. When your CD4 count is lower than 350, your immune system is weaker and you may get opportunistic infections, current treatment guidelines now suggest starting HAART by this time.

We'd be happy to answer any questions you may have about your lab results. Please drop us a note. Next week we’ll talk about CD4 percentage. Be well!

Coping With HIV

2009-04-15T15:36:00.000-07:00

A recent study done in the UK found that the top four needs of HIV positive individuals were all related to mental health. Anxiety/depression, self-esteem, sleep and sex, pose the largest problems to the most people. The study also found that the largest and most often used resources for these problems were friends and family.

Living with HIV is for most people one of the hardest things that they will do in their life. Thanks to science and research, we can now expect to live pretty much as long as those without HIV, but it does take some work. Doctors and clinicians can help with mental health problems, but most of us can get significant help and support from our friends and family.

How do you cope with mental health issues due to being HIV positive? Your friends are always a great place to start.

HIV and HPV

2009-04-08T13:31:00.000-07:00

Genital Human Papillomavirus or HPV is a common virus which is spread by skin to skin contact. There are over 100 different strains of the virus, and at least 30 strains have been directly related to cervical cancers and anal warts. Transmitted during sexual contact, HPV can take years to show symptoms, and sometimes no symptoms will develop. The most identifying symptom is a cauliflower-like growth on the genitals, anus or vagina.

HPV in not a curable illness, but treatment can relieve discomfort, and when infected, a person should take note of any new sores as they appear and bring it up with one’s doctor. Evidence suggests that HIV infection may play a role in the outcome of HPV infections because of immunosuppression. A vaccine has been developed and is currently only approved for HPV prevention in younger females. The vaccine has so far only been proven to help prevent HPV from becoming cervical cancers, but as studies progress, and further research is done, the vaccine may be approved for more use in both females and males.

Do you have any questions or concerns about HPV? We’d love to hear from you!

Working with Your Doctor

2009-04-01T13:18:00.000-07:00

The following is a quick reference for working with your doctor from Living Positive Magazine.

• Schedule regular visits with a doctor whom you are comfortable with.
• Keep a list of questions and concerns for your appointments.
• Get a copy of your blood test results and learn what they mean.
• It’s okay to take a friend to appointments with you to help you remember.
• Ask for options to be explained, you can always refuse any treatment if you wish.
• If you are having a problem, talk to someone. BCPWA has advocates here for you.

Do you have any tips on working with your Doctor, or on creating a healthy relationship with them?

Complementary Therapies and HIV

2009-03-25T10:13:00.000-07:00

Many individuals with HIV find that adding non-western therapies to their treatment assists in reducing symptoms from both HIV disease and HAART. Other benefits realized may include a reduction in stress and treatment side-effects, pain relief and boosting the immune system.

These are just a few of the more common complementary therapies; Homeopathy, Naturopathy, Traditional Chinese Medicine and Acupuncture, Herbal Therapy and Juicing. Many of these therapies are simple and affordable, making them available to most.

Do you use complementary therapies? Or have you had an experience where complementary therapies have had a positive effect on your health? We’d love to hear what works for you.

More Information

Questions To Ask Your Doctor When Starting Treatment

2009-03-19T12:55:00.000-07:00

Current anti-HIV drug treatment is called HAART, or Highly Active Anti-Retroviral Therapy. If you are HIV positive, at some point as the disease progresses, your Doctor will want prescribe this for you. You’ll be required to take in a lot of information, but there are a few questions that you will definitely want answered.
Keep a copy of this list to ask and take them to your Doctor appointments with you to ensure you get the knowledge and answers that you need.

• What is my CD4+ count and has it changed?
• What is my viral load and has it changed?
• What are the names of the medications that I will be taking?
• What should I do if I miss a dose of medication, or if I am too nauseous to take my medication?
• When do I take which medications?
• What are the side-effects?
• What can I do to help relieve any side effects?
• Should I take the medications with a full or empty stomach?

These are some of the more important questions that you want the answers to. We’d love to hear of other questions that you feel are important as well, drop us a comment.

We Want Your Input

2009-03-11T15:53:00.000-07:00

The Treatment Information Program (TIP) at the British Columbians Persons with AIDS Society (BCPWA), is conducting a research project to assess the HIV/AIDS treatment information needs in BC. The research is being conducted through a survey and we are asking all HIV positive individuals in BC to please take part. Participation must be completely voluntary and involves completing the online survey.

For more information, please click on the link below. We appreciate you taking the time to give us your input. This information will be used to recommend alternatives for TIP at BCPWA to consider as it plans future programming.

Take Survey

Food and Water Safety for HIV Positive Individuals

2009-03-04T10:26:00.000-08:00

There are many infections that can be easily avoided using a few precautions regarding food and water storage and preparation. These illnesses include Salmonella, Campylobacter, Listeria and Cryptosporidium. These may cause nausea, diarrhea, upset stomach, vomiting, stomach cramps, fever, headache, muscle pain, meningitis and encephalitis. Precautions to take include:

• Meat, poultry (such as chicken or turkey), and fish can make you sick if they are raw, undercooked, or spoiled.
• Wash all fruits and vegetables well before cooking or eating raw.
• Don’t drink water straight from lakes, rivers, streams, or springs.
• Keep hands and counters clean, don’t cross contaminate with raw food such as meats or poultry.

Proper storage and preparation of food and water will decrease your chances of having to deal with these infections and is an important part of your preventative health care.

Do you have any questions regarding food and water safety? We’d love to hear from you.

HIV Treatment Adherence

2009-02-18T09:20:00.000-08:00

Treatment adherence (or compliance) refers to the HIV positive individual’s ability to stick to the prescribed method of treatment. This includes such things as taking your pills on time, not missing a dose, and following any recommended food guidelines.

Adherence is important for two reasons:

1.) If you miss even one dose, the levels of medication in your blood drop, allowing faster replication of the HIV virus.
2.) Drug resistance develops much faster when you miss even one dose. This means that the drugs that you are currently taking may not continue to work, including some drugs that you may have not even tried yet! You will have fewer options for treatment in the future.

An excellent way to make sure that you never miss a dose is to use a scheduler on your computer that you can set up to prompt/remind you when to take your medication. Others may find marking it on a calendar may be a quick and easy way to keep track.

What are your tips for ensuring personal adherence to your HIV treatment? We’d love to hear your suggestions.

HIV and Selenium

2009-02-11T06:14:00.000-08:00

Selenium is a mineral that has been in the news over the last year for its apparent beneficial results in HIV positive people. Selenium is an essential micronutrient; its dietary sources are nuts, cereals, meat, fish and eggs. Selenium deficiency is apparent in HIV disease, and predicts an increased risk of death. Current studies are finding promising results from selenium supplementation, and it should be considered as part of your supplementation program.

Daily supplementation with 200μg (mcg) of selenium has been shown to help stabilize viral load, and modestly increase CD4 counts in patients on antiretroviral therapy. These findings suggest selenium supplementation as a simple and inexpensive complimentary therapy for people with HIV. 1000μg is the upper tolerance, and selenium becomes toxic above this daily level.

Have you been taking selenium as part of your supplementation? We would love to hear what your experiences are.

HIV and Vitamin D Deficiency.

2009-02-04T09:56:00.000-08:00

Vitamin D deficiency results in impaired bone mineralization, leading to diseases such as osteomalacia (bone softening) and osteoporosis. Vitamin D also plays an important role in maintaining organ systems. The Canadian Food Guide recommends a minimum of 200 IU daily for healthy individuals, with the upper daily tolerance around 2000 IU. The only significant natural dietary sources are oily fish and egg yolks, but it is not possible to intake enough through these foods alone. 15-20 minutes sun exposure, twice weekly will produce enough Vitamin D as it is synthesized through the skin, or a daily supplement can be taken.

Are you getting enough vitamin D through your diet and supplement program? Your doctor can test you to see if you’re deficient or not. Is vitamin D deficiency a concern to you? Do you take a vitamin D supplement already? If not, would you consider supplementing or not, and why do you feel that way?

Health Canada, Vitamin D.

HIV and Disclosure

2009-01-28T09:41:00.000-08:00

When reviewing cases where a person with HIV is believed to not have informed a sexual partner of their HIV status, judges currently use Canada’s Currier decision (1998) which states “A person has a legal duty to disclose his or her HIV-positive status to sexual partners before having sex that poses a “significant risk” of HIV transmission.” This includes anal or vaginal sex without a condom. What else it includes is not fully clear.

Do you disclose to all of your partners, or only those whom you place at “significant risk”, and how do you determine whether the risk is significant or not? What are your thoughts on the Currier Decision? Is it clear enough, or do we need a list of what can or can’t be done, with or without disclosure? HIV is a disease, not a crime, perhaps clearer laws would help. We’d love to hear your thoughts on this.

Canadian HIV law

Monitoring Your Immune System, Emphasis on Your!

2009-01-21T10:14:00.000-08:00

You may be great about going in and getting your blood work done as recommended…but do you know what those results mean? What’s a CD4 count? Should it go up or down? Or what’s your Viral Load? Is a high number good or bad? And what’s this ratio that always comes up? If we are knowledgeable regarding this disease, we can actively participate in our own treatment.

Do you know the answers to these questions? More importantly do you know what the answers mean? How closely do you monitor your immune system and how do you do it, or do you? We’d like to hear your ideas on how to monitor your own immune system; perhaps your ideas can help someone else. Please tell us your thoughts.

More evidence continues to be found proving the dangerous effects of crystal meth, particularly for those who are at risk for or who have HIV.

2009-01-14T11:23:00.000-08:00

With many HIV positive individuals battling issues such as depression, lack of energy, low self-confidence and anxiety, it’s easy to see how this drug has become a popular release from the stresses of living with HIV as it promises to temporarily erase or gloss over these concerns. Crystal meth may sound like a great cure for the woes of PHA’s, but Scientists continue to find more evidence of the dangerous and possible deadly results of its use, including the fact that meth can interfere and negate the effects of HAART, leading to a more rapid progression of HIV. Meth also causes permanent changes in the physical structure of the brain, possibly changing a person’s psychology and ability to think clearly.

What do you think? Is the risk worth the fun? Some feel that they can choose to use crystal meth occasionally; for example to enhance or prolong sexual pleasure, and then not think of the drug until the next party. Is this a healthy attitude? Or should we all be scared shitless of the fact that this drug will kill you (possibly), and never even be tempted by it? We want to know what you feel. What do you see out there? Tell us your thoughts.

2008-12-09T13:39:00.000-08:00

Our treatment blog is currently in hiatus and will return in January 2009. In the meantime, please let us know what your areas of interest are. We notice there are many “hits” on the blog so many of you are reading, however there aren’t many comments made on the entries we make.

You can make comments by clicking comments section after this entry and then typing in your comment where it says leave your comment. You can click anonymous at the bottom of your comment if you wish to remain anonymous, and then click publish comment.

Please let us know what you think of our blog, what you want to know more about, and what your areas of interest are. Ask us a question. This will help us in generating more discussion of importance to you. See you in 2009!

Can We Cure HIV Using Stem Cells?

2008-11-25T17:18:00.000-08:00

You are HIV+. The virus is undetectable from the use of HAART. Is it possible to cure HIV from the body? Physicians from Germany appear to have done so. They describe a 40-year-old man—an American working in Berlin—whose HIV had been under good control for several years using a typical cocktail of drugs known as HAART. Then he developed acute leukemia. In an attempt to cure the leukemia, he underwent a course of radiation therapy and chemotherapy in preparation for a stem cell transplant. The patient's stem cell transplant was a success. Furthermore, now off HAART for almost two years, the patient shows no detectable signs of HIV in his blood, bone marrow, lymph nodes, intestines, or brain. This patient represents a functional cure. Is this the future of HIV therapy? Are stem cells the answer to HIV/AIDS? Are we finally at the door to a cure? What are your thoughts? What do you think of this?

Raw or Wrapped? Is Barebacking a Concern?

2008-11-18T06:08:00.000-08:00

You are HIV+ and Undetectable. Are you jeopardizing your health because you think it’s ok to play raw? Unsafe sex isn't worth the risk. You are risking your health. For PHA’s unsafe sex places both individuals at risk for a wide array of STDs. STDs can behave differently in PHA’s. Hepatitis, Syphilis, HPV and many others can have far more serious consequences for PHA’s than for those with intact immune systems. HIV reinfection (dual infection, superinfection) can also occur early in the course of infection. Safe sex does protect against many blood-borne infections that are major causes of life-threatening diseases and death in people with HIV. What do you think? Is it condom fatigue or wishful thinking? How are you playing?

HIV+ In Today's World. So Many Possibilities!

2008-11-04T09:13:00.000-08:00

You are HIV+. Taking your medications has stabilized your health. But has living with HIV stopped you from living a full life? Has your world become a smaller place because of instability or your needs not being met? Is anyone listening? Do you require more than just medical appointments, doctors and meds? HIV treatment includes living with the virus and awareness to mental/physical needs. Is it time to be ‘pro-active’ in your own life? There are many resources available to you for assistance and guidance as a PHA in today's world. Connecting with peers may be a way to open your life to new avenues while continuing the fight to remain healthy. What are some positive steps you are taking to remain active? Is there something we can help you with? Perhaps you can share ideas that have helped you.

Bones and HIV. Do you have that aching feeling?

2008-10-23T17:44:00.000-07:00

As people living with HIV take medications over time, a growing list of conditions has become a concern for those who try to manage their overall health. One of the concerns is painful, aching bones. As the body is weakened by HIV the increase in pain can be difficult to live with. Bone is living tissue and is in constant change during your life. People with HIV face more bone loss than HIV-negative people of the same sex and age. Increased risk for developing thin bones (osteoporosis) and bone damage such as fractures are just some of the problems. Supplements can help support your body’s ability to stop and reverse bone loss. It is suggested to refer to your doctor for information on the need for bone-building nutrients such as calcium, magnesium and vitamins C and D. What do you do to ensure healthy bones? Please share your thoughts.

HIV and METH. A deadly game. Are you playing it?

2008-09-10T21:26:00.000-07:00

Methamphetamine, or Crystal, is a synthetic stimulant that is similar in chemistry to adrenaline, a central nervous system hormone that stimulates the body's responses. The drug is used recreationally for sexual enhancement and stimulation, to initiate more sex and to prolong the encounters. Methamphetamine (Meth) and HIV do not mix well together. Meth suppresses killer T cells, causes hypertension, chest pain, increased heart rate, abrasions in the mouth and rectum, damages blood vessels in the heart and brain and more importantly reduces effectiveness of antiretroviral therapy, thus increasing viral replication. Meth use and HIV infection might significantly alter the size of a person's brain structure and lead to cognitive function impairments such as difficulties learning or processing information. Younger Meth users who are HIV+ were more affected in some areas of the brain than older Meth users who are HIV+. Meth and HIV also causes personality changes, paranoia, anorexia, weight loss, irritability, memory problems, depression, sleep disorders and physical aggression. Are you playing with Meth and your health? Do you experience any of these problems? What are your thoughts?

Nutrition & HIV. Are you maintaining the balance?

2008-09-04T14:59:00.001-07:00

Good nutrition is very important for people with HIV. However, this can be a problem for many PHA’s. When your body fights HIV, it uses more energy and you need to eat more than normal. You need to increase the amount of food you eat and maintain your lean body weight. A moderate exercise program will help your body turn your food into muscle. Having extra muscle weight will help you fight HIV. Make sure you eat plenty of protein and starches, with moderate amounts of fat and plenty of vegetables, fruits and whole grain foods. Supplements can help you maintain your body weight and get the vitamins and minerals you need. Drinking enough liquids is very important when you are on HAART and can help reduce some side effects like dry mouth and constipation. What are your thoughts? Are you having a difficult time eating? Do you have any information on nutrition to share with others?

Women & HIV. What Are The Challenges Women Face on Treatment?

2008-08-28T10:28:00.000-07:00

After more than 25 years and 25 million deaths, the world has yet to realize that HIV isn't just a man's problem. HIV has quietly become the third most-deadly disease for women, after heart disease and cancer. The single most significant fact that separates female PHA’s from male PHA’s is that more than 60% of women are caring for at least one child under the age of 16. Female PHA’s are also different from male PHA’s physically, psychosocially and emotionally. There is now information that states female PHA’s develop AIDS at a lower viral load than men, and in fact at a viral load below the recommended level for treatment with HAART, which makes it extremely important to treat early. The most noticeable side effects from HAART have been metabolic -- the so-called fat-redistribution syndromes, which in a woman translates to significantly enlarged breasts and abdomen. Menstrual irregularities, like amenorrhea (no menstrual periods), polymenorrhea (periods come too often) and oligomenorrhea (periods don't come often enough). Sexual function changes: decreased sexual interest, delayed or difficult orgasm. Obese women over 40 are more likely to develop lactic acidosis, which has been linked to mitochondrial toxicity due to reverse transcriptase inhibitors. Have you experienced similar or different side effects? Tell us your thoughts.

Human Growth Hormones + HIV Meds = Healthier Living?

2008-08-20T11:14:00.000-07:00

Human growth hormone could reduce fat deposits caused by HIV treatment. Low doses of human growth hormone can reverse some of the abnormal fat distribution and lower the risk of cardiovascular disease, caused by HIV treatment. 40% of males and 16% of females who take antiretroviral drugs develop visceral fat in the stomach, neck and cheeks, which is associated with higher levels of cholesterol and triglycerides and can increase the risk of heart attacks and stroke. A Harvard Medical School doctor said the hormone produced good results but would have to be used carefully to avoid inducing diabetes. The hormone could increase the risk of side effects in people who have early stages of diabetes. Previous studies using higher levels of the hormone produced "unacceptable" side effects, including tissue swelling and joint pain. Another AIDS expert suggested that although there were fewer side effects with lower doses, the results of the study were "disappointing" and states hormone injections at best have limited use for treating fat abnormalities associated with HIV. Can this be the threshold for more positive results toward healthier living with HAART? What are your thoughts?

Have we won the AIDS battle? Are the years of fighting over?

2008-08-13T16:52:00.000-07:00

Doctors have presented information which may end the painful years we know as AIDS. New HIV treatment guidelines issued at the International AIDS Conference in Mexico urge starting ARV therapy sooner. The goal is to achieve maximum suppression of the HIV/AIDS virus, with minimal toxicity, and maximum simplicity. Initiation of ARV therapy in PHA’s within the 200 to 350 CD4 cell count range should be strongly considered. Recommendations? Start ARV therapy in PHA’s that have less than 200 CD4 cell count. Doctors are encouraged to evaluate the whole patient, not just the status of HIV disease, but all coexisting conditions. What are the key areas of ARV management? When to start therapy, choice of HAART regimen, PHA monitoring and how best to approach treatment options. The hope is that the AIDS virus will be completely contained as ‘undetectable’ in the body of the PHA. Is it that simple? Can we finally conquer the AIDS virus? What are your thoughts?

Hep C and HIV coinfection in B.C. Is it out of control? An epidemic?

2008-08-07T14:20:00.000-07:00

Hepatitis C and HIV coinfection is a reality growing out of control in British Columbia. Hep C (HCV) makes the HIV disease worse. HCV is transmitted through infected blood. HCV damages the liver. About 15% to 30% of people clear HCV from their bodies without treatment. The other 70% to 85% develop chronic infection, and the virus stays in their body unless it is successfully treated. For PHA’s, HCV can be more serious and make it harder to take ARVs. HCV and HIV coinfection slows down the rate of increase in CD4 cell counts during HIV treatment. A doctor who treats patients with HCV is criticizing the B.C. government for denying lifesaving treatment in what he terms a full-blown epidemic. “At best, I can say it is indifference to an epidemic of huge proportion. It is one of the most serious epidemics we are facing in our community today." B.C. Health Minister George Abbott disagrees. "I don't think its fair to say it's an epidemic," Abbott said. "Certainly Hep C is a very big challenge — that is why we are expending about $100 million annually in identifying preventing and treating Hep C when it occurs." Do you think B.C. is doing enough? Should we do more? What are your thoughts?

Have you been to an AIDS Conference before? Want to go to Mexico? Watch coverage of the International AIDS Conference via satellite!

2008-07-30T18:00:00.000-07:00

Come and watch the Opening Ceremonies of the World AIDS Conference. Live from Mexico! Via satellite the BCPWA Society will be presenting various workshops ranging from “Responding to the HIV epidemic among men who have sex with men” to “ARV therapy in 2008—Current Issues & Controversies in Optimal ARV Therapy”. This is open to persons living with HIV and any other interested participants. Some snacks and refreshments will be provided. The location is the AIDS Vancouver Training Room @ 1107 Seymour Street on the ground floor. For further information and to RSVP, please email zorans@bcpwa.org or phone 604.893.2239. We hope to see you there. IF YOU HAVE BEEN TO AN AIDS CONFERENCE BEFORE WHAT DID YOU THINK ABOUT IT? Please tell us your thoughts.

HIV and smoking. What is all the fuss about?

2008-07-23T12:20:00.000-07:00

Smoking accelerates progression of HIV infection to AIDS. If you have HIV, you're more likely than an HIV-negative person to be a smoker. Yet cigarettes are especially dangerous for PHA’s, who already face a higher risk of heart problems than HIV-negative people. Smoking causes lung cancer and increases the risk of stroke and heart attack especially for PHA’s. Smoking also causes respiratory tract infections, sinusitis, bronchitis, pneumonia, etc. These, in turn, can send your HIV viral load up and worsen your HIV disease. PHA’s are at much greater risk of negative health outcomes related to smoking than those without the virus. A recent study showed that up to 66 percent of people with HIV are lighting up. Even if you’ve been smoking for most of your life, you can still quit and reverse much of the damage that smoking has caused to your body. What are your feelings about smoking and being HIV+? Is it a concern to you? Tell us your thoughts.

Is the future of HIV drug therapy the “one pill” option?

2008-07-16T15:49:00.000-07:00

HIV medication treatment may begin to favour the ‘once-a-day’ pill called Atripla. More doctors are choosing Atripla as the HIV drug therapy for their patients and many think it will be a great boon to simpler HIV care. It contains three different HIV medications from two classes of HIV medications: Viread, Emtriva & Sustiva. Atripla can be taken alone as a complete treatment regime. Atripla almost certainly will continue to suppress your virus and be easier to take. Side effects may include nervous system symptoms, headaches, diarrhea, nausea, vomiting, rash, fatigue, itching, abdominal pain and inflammation of the pancreas. Note that it is powerful and will be generally well tolerated. However, if you are doing well with no side effects on your current HIV meds and your regimen is already once a day, albeit with more pills, there may be no reason to change it. Remember that your doctor and health care team are always your most important source of information about your health and your treatment. Have you had experience with Atripla? Are they positive? Negative? Has it proved to work well for you? Tell us your thoughts.

Beyond HIV medications. Why is Complementary Therapy important to PHA’s?

2008-07-09T15:04:00.000-07:00

Complementary Therapies are an effective addition to the HIV medication regime you may be taking. With the introduction of HAART as an effective way to manage HIV infection, complementary therapies are now being used by PHA’s to improve general well-being, reduce symptoms and manage side effects. Touch Therapy, including Reiki & Therapeutic Touch modify imbalances in the energy field within you by redirecting that energy. Yoga is a great way to achieve longevity, rejuvenation and self-realization through mental, emotional and physical aspects. Massage Therapy is the movement and stimulation of body tissues by a therapist. These are just some of the many complementary therapies available to you. Have you experienced some of these before? Was the experience effective for you? Please share your thoughts.

Overweight? On meds? Bad diet? High cholesterol?

2008-07-02T10:46:00.000-07:00

Are you on HAART and overweight with high cholesterol? If you are on HIV meds and have increased fat in unacceptable areas– you could be doing more harm to yourself if you are not willing to change your nutritional habits. Obesity can cause high cholesterol putting you at risk for other health related problems, e.g. diabetes. Diet is where you can start. The best diet for cholesterol and triglyceride elevation is one low in saturated (animal) fats, with plenty of omega-3 fats (fish, canola and flax oil, flax seeds) and loads of fresh fruit and vegetables and plenty of fibre. Skimmed milk is preferred. Bread and rice or potatoes are good. You could look at an exercise program to keep fit which will help keep your weight in the 'normal' range. Smoking is certainly not a healthy thing to do if you are living with HIV/AIDS. What is your health and weight like while on HAART? Tell us your thoughts.

Have you used Herbal Therapy in your HIV regime?

2008-06-26T13:05:00.000-07:00

Using Herbal Therapy can be a wonderful compliment to your HIV therapy. Simple uses for skin problems or immune cell building are available through the proper use of Herbal Therapy. Ginger is the root of an herb plant grown throughout the tropics and may be used to combat nausea and other gastrointestinal problems. Garlic has been used by people with HIV to treat fungal conditions like thrush and also parasites which may cause diarrhea. Astragalus is a bone marrow stimulant and has shown increases in immune cells for people live with HIV. Aloe Vera may be used to treat skin problems associated with HIV and anti-HIV meds causing dry skin and other skin blemishes. Andrographis Panicilata is a weed found primarily in India, Thailand and Indonesia which can be beneficial to the immune system helping to increase your cd4 count and possibly decrease in your viral load. It is strongly recommended to speak with your doctor and pharmacist first before trying any of the Herbal Therapies available. Some Herbal Therapies may interact negatively with your HIV medications. Have you used any of these Herbal Therapies? Do you have any suggestions regarding Herbal Therapy which may help other people living with HIV?

Questions about HIV treatment? Need to talk about it? Come on in!

2008-06-18T21:12:00.000-07:00

We recently opened our ‘new’ Multi Purpose Room located on the 2nd floor of the BCPWA building at 1107 Seymour Street in Vancouver. The room will, among other things, provide Treatment Information to you Monday to Friday from 10am – 12pm. Our aim is to help you find answers to the overwhelming questions you may have concerning your HIV treatment. Available to you are the most recent articles on medications, HIV & aging, mental health, alternative health options, side effects and things to ask your doctor. Treatment Information in our 'new' Multi-Purpose Room gives you access to printed materials and online readiness. We will sit down with you and help you find the information pertaining to your needs and what you want to know. This is your health and your body, so come in and check out the “new” Multi-Purpose Room. Are you ready to learn more? Please give us your comments and feedback about this new venture.

Can PEP reduce mother-to-child transmission of HIV?

2008-06-12T08:45:00.000-07:00

Recent studies may offer hope to many HIV+ mothers with newborns. Effective strategies are urgently needed to reduce mother-to-child transmission of human immunodeficiency virus through breast-feeding. Post-Exposure Prophylaxis is using antiretroviral drugs to stop the transmission. Studies now may offer hope using single-dose Nevirapine plus 1 week of Zidovudine or extended Nevirapine or extended Zidovudine until the age of 14 weeks. This may significantly reduce postnatal HIV infection in 9-month-old infants. Or will HAART be a concern with the onset of side effects? Should we place the already vulnerable newborn at more risk? What are your thoughts?

Are you experiencing lingering side effects with the facial filler polyalkylimide?

2008-06-04T20:38:00.000-07:00

Facial lipoatrophy is the loss of subcutaneous facial fat due to HIV or aging and is not uncommon in individuals on HAART. Facial lipoatrophy appears as facial lines increase with folds and depressed scars leaving pronounced cheekbones, sunken cheeks and loss of facial volume. Polyalkylimide is sold in Canada as Bio-Alcamid. It is a permanent filler that is a popular option for the treatment of HIV-associated facial lipoatrophy. It is an injectable, water-based gel containing 4% polyalkylimide. Polyalkylimide has become one of the most promising and widely-used facial fillers used in treating facial lipoatrophy. However, people who have injections of the facial filler polyalkylimide may have immune-related side effects many months after the injections. Side effects range from tender nodules, headaches, fever and immune inflammation. Are you experiencing any side effects from polyalkylimide? Please let us know here.

Does peripheral neuropathy affect you? Are you on HAART?

2008-05-28T22:48:00.000-07:00

Some people living with HIV will develop a disease of the nerves called peripheral neuropathy, or PN. People living with HIV are at a much higher risk due to a history of PN, low cd4 counts, high viral loads, medications that have damaged nerve cells, poor nutrition, diabetes and abuse of alcohol. HIV itself can cause PN by infecting the nerve cells, while some medications may contribute to the nerve damage in the later stage of HIV disease. The newer medications have not shown the risk for PN, though it may take several years before evidence of this side effect appears. It is important to talk with your doctor to help reduce further damages to your nerves. Talking to your doctor sooner rather than later will improve your diagnosis and outcome. Has PN affected your health living with HIV? Please tell us your thoughts.

HIV? On medications? Has your quality of life improved?

2008-05-22T12:12:00.000-07:00

Has it been a difficult road while coping with HIV? Are you experiencing challenges due to the drug therapy you were prescribed? Come to an open discussion with experts on HIV therapy and ask questions related to your progress. A forum and panel discussion on HIV & medication side effects called Has your quality of life improved? will be presented by BCPWA. Tuesday, June 3rd @ 6pm in the Best Western Chateau Granville. (corner of Granville & Helmcken) Open to persons living with HIV and any other participants. Dinner provided. Please RSVP by June 1st to 604-893-2274 or email zorans@bcpwa.org.

Using marijuana? Are you HIV positive? Are you harming yourself?

2008-05-14T15:18:00.000-07:00

Some people feel smoking marijuana offers relief from depression if you are HIV+, while others say it is harmful to your system. It's important for you to consider possible health risks before using marijuana. Immune function, lung complications, mental well-being, the worsening of asthma and possible increase of lung cancer over and above smoking tobacco are some of the harmful effects from smoking marijuana for someone HIV+. Marijuana may also increase your risk for certain infections, including herpes and a variety of other bacterial, viral and fungal infections. Smoking marijuana has become a popular treatment for HIV related weight loss improving the appetite and weight maintenance. Other studies show the use of marijuana does not increase the HIV disease progression or loss of CD4 cell counts. It has been the drug of choice for many who are living with HIV. The benefits to some offer immense relief from the day to day struggles of this disease. So, ask yourself the question. Is using marijuana worth the risk for you? Or is it an added ingredient to your wellness? Does the usage of marijuana affect your HAART therapy regime? What are your thoughts?

Abacavir. Part of your HIV therapy? Experiencing hypersensitivity?

2008-05-07T16:24:00.000-07:00

Abacavir is a nucleoside reverse-transcriptase inhibitor with activity against HIV, available for once daily use in combination with other antiretroviral agents. It has shown positive results, few drug interactions, and a favorable long-term toxicity profile. Abacavir hypersensitivity reactions occur in 3% to 8% of patients starting the drug. Allergy to abacavir is strongly associated with the presence of the HLA-B*5701 gene, and a test has been developed to monitor patients for its presence. Symptoms of hypersensitivity reaction to abacavir include combinations of fever, rash, gastrointestinal and respiratory symptoms that become more severe with continued dosing. A test to predict who will develop a severe allergic reaction to the anti-HIV drug abacavir is said to be accurate and found in the April 1st edition of Clinical Infectious Diseases. What is the alternative to taking this drug if you are experiencing hypersensitivity? Have you experienced hypersensitivity reaction? Did you need to switch medications? Give us your thoughts.

Will there ever be an AIDS vaccine? Or are we chasing a ghost?

2008-04-30T08:00:00.000-07:00

It is now years later! About 33 million people in the world are infected with HIV and some 26 million have died of AIDS since the pandemic began. Is there ever going to be an AIDS vaccine? Or is HAART a better solution? With HAART, you can recover from HIV/AIDS and live with HIV for a very long time. Putting funding and belief toward HAART may be saving lives rather than the waiting and false hope of a vaccine. A substantial minority of scientists admit that an HIV vaccine may never be developed. Some say it will take another 20 years of research before one is discovered. Others believe that a vaccine against HIV is further away than ever and admit that effective immunization against the virus may never be possible. A mood of deep pessimism has spread among the international community of AIDS scientists after the failure of a trial of a promising vaccine at the end of last year. It just was the latest in a series of setbacks in the 25-year struggle to develop an HIV vaccine. However, we do know HAART is an effective way to control the HIV spread and allow people infected to live longer and healthier. Should all efforts be put into prevention? What are you thoughts?

MRSA. What is it? Does having HIV affect MRSA risk?

2008-04-23T08:50:00.001-07:00

The HIV community is watching carefully as MRSA breaks out among ‘men having sex with men’ and ‘injection drug use’. What is MRSA? MRSA , "methicillin-resistant Staphylococcus aureus", is a bacteria commonly carried on the skin or in the nose of healthy people. If the skin is cut or broken, the bacteria are given the opportunity to infect. MRSA looks similar to a large pimple or boil. MRSA can cause a wide variety of infections ranging from mild skin infections to serious infections such as pneumonia or sepsis. People with a weakened immune system should follow the same preventive measures to prevent being infected, including washing their hands frequently, covering wounds with bandages, and refraining from sharing personal hygiene items. Treatment is by incision and drainage of the wound. Then antibiotics may be used for up to ten days. Have you known about MRSA? Is it the next health problem for people living with HIV?

Can you talk to your doctor? Does he provide the care you need?

2008-04-16T08:43:00.000-07:00

Do you have a doctor who does not listen to you? Do you feel you are caught in the middle of a medical world not interested in your needs? Finding the right doctor is of great concern to people living with HIV. It is a matter of expecting the right care and knowing your doctor will provide it. Empowered communication with your doctor is personal and important. Perhaps you have encountered problems and need information pertaining to the things ‘your’ care should involve. A community forum called “Doctor Visits: Are yours what they should be?” is being presented by the BCPWA Society in the Best Western Chateau Granville (corner of Granville & Helmcken) at 6pm on Tuesday, April 22. Open to persons living with HIV & other interested participants. Free dinner included. If you wish to attend this you need to rsvp to paulk@bcpwa.org by april 17th. If you have any comments or share experiences, please do so on this blog.

Could HAART treatment strategy reduce HIV?

2008-04-09T17:45:00.000-07:00

A new strategy to battle HIV might reduce the epidemic of HIV/AIDS. Dr. Julio Montaner, of the B.C. Centre for Excellence, suggests using HAART as treatment for HIV could lower the number of cases around the world. HAART reduces viral loads of HIV in the patient's blood until it is undetectable, and as a result they become less infectious. A patient going on HAART soon after testing positive to HIV lessens the transmission of the virus. Montaner adds, "It's time that we start talking about it, and the Center would like to lead that discussion because if that is the case between better prevention and strengthening of our treatment programs we may be able to, at least in the short term, control the spread of HIV." Convincing people who have already tested positive to HIV is a very heavy task. Why would you want to take medications when you are not sick? Is this one more way of prevention? Or is it suggesting something else?

Swiss study states: no virus? = no infection?

2008-03-26T11:17:00.000-07:00

Professor Bernard Hirschel, MD, of the University Hospital, Geneva, Switzerland, declares that HIV-positive people with undetectable viral loads cannot transmit HIV. Stated at the 15th Conference on Retroviruses and Opportunistic Infections (CROI) in Boston, MA, and based on an analysis of several studies over a long period of time, Hirschel’s bold statement has rocked the HIV community. There’s a lot of discussion on both sides of the debate. Hirschel, along with two other co-author’s, has disclosed the findings for several reasons including a series of court trials in Switzerland where HIV positive people have been accused of endangering others, who are HIV negative, through sexual relations. Hirschel argues that an HIV infected person on HAART (highly active antiretroviral therapy), with an undetectable viral load is not technically infectious. Others say that the absence of a risk can never really be proven. Does Hirschel’s study send the wrong message? Does it give hope? How do you feel about this statement?

HIV/AIDS and working life

2008-03-19T17:08:00.000-07:00

Are you living with HIV and working? In the cover story of the current issue of living+ magazine, there is a feature entitled Back to Work: living and working with HIV. We have noticed a trend these days that as more people are becoming healthier, they are also returning to work. Stable antiretroviral drug regimens may be contributing to people’s health however there are still challenges in living with HIV. One person states that having HIV and working are accompanied by unique concerns not faced by the average worker. What are your experiences? If you have gone back to work recently, how have you managed? Share your experiences with others.

Facial Wasting and HIV/AIDS

2008-03-12T16:09:00.000-07:00

Facial wasting/lipoatrophy is a serious medical condition that plagues many people living with HIV/AIDS. It can cause disfigurement and make people feel stigmatized. There are treatments for it, however, people with HIV have to pay out of their own pocket if they wish to have the necessary treatment procedures – which we say just isn’t right!
The BCPWA Society has been actively advocating to get medical services coverage for treatments used to correct facial lipoatrophy for people living with HIV/AIDS. We are now in discussions with the Ministry about this issue and awaiting an answer. In the meantime, we have organized a community forum on facial lipoatrophy. It will take place on Wednesday, March 26th at 6 pm at the Best Western Chateau Granville (corner of Granville and Helmcken). If you wish to attend this you need to rsvp to zorans@bcpwa.org If you have any comments or share experiences, please do so on this blog

HIV/AIDS & kidney problems

2008-03-05T09:41:00.000-08:00

Kidney problems can occur amongst HIV-positive individuals and that some HIV medications may cause kidney-related side effects. Recent research shows that HIV treatments can help improve the health of kidneys in people with low CD4 counts. The results of this study showed that there are improvements in kidney function in people who started HIV medications with a CD4 count below 200, and whose viral load falls below 400 when they started HIV treatment. Researchers are implying that HIV may cause kidney problems for people with weak immune systems even before starting treatment. Do you think this is true? Are kidney problems caused by HIV medication side effects or is it HIV itself? What is your experience?

HIV Drugs and Heart Conditions

2008-02-27T13:48:00.001-08:00

Do you take abacavir? At the Conference on Retroviruses and Opportunistic Infections abacavir and DDI were associated with an increased risk of heart attack. Do you take abacavir and are you worried about this? Do you have any questions? The researchers who conducted this study believe that its findings have the greatest implications for those persons with HIV who may already have diabetes, a family history of heart disease or those who smoke. Now that more HIV-positive people are getting older, there is an increased the risk for cardiovascular problems.

HIV/AIDS & hospital stays

2008-02-20T11:54:00.000-08:00

When was the last time you stayed at a hospital? Did you have a good or bad experience? In the current issue of the living+ magazine, there is an article on how to make your hospital stay a more pleasant one. This involves knowing what to expect, what to bring with you when going to the hospital and knowing how to advocate for your rights. Let us know your experiences and what questions you may have about hospital stays.

Smoking Room at BCPWA

2008-02-13T09:29:00.000-08:00

Did you know that the smoking room at British Columbia Persons With AIDS Society lounge may close on March 31, 2008? A new regulation in the BC Provincial Tobacco Sales Act may force BCPWA to close the smoking room. At the Society’s Annual General Meeting a few years ago, the majority of the membership voted in favour of keeping the smoking room, so the Board of Directors has written a letter to the Ministry asking for an exemption to this new regulation. We will have to see how the government responds. There are statistics that show that 60-80% of persons living with HIV smoke, which is significantly higher than the general population at 20-30%. There are pros and cons to closing the smoking room. What do you think about this? Do you think the smoking room should close? What do you think the smoking room should be used for?

BCPWA Complementary Health Fund

2008-02-06T11:08:00.000-08:00

Are you using the BCPWA complementary health fund (CHF)? It’s a unique service for people living with HIV/AIDS in Canada. What complementary health products have helped you address your HIV or AIDS symptoms or related conditions? In the new issue of living+ magazine, our society Chair has written an editorial about the complementary health fund and the fact that it hasn’t been used to its full capacity by eligible HIV-positive members of the Society. There are many medications and services that are not covered by private and public insurance plans, so the Society’s complementary health fund subsidizes things such as traditional Chinese medicine, acupuncture, massage and even gym memberships. As we all know, there are numerous side effects associated with HIV medications, so complementary and alternative medicine can benefit. Are you taking advantage of the complementary health fund? What do you use it for? Do you know how to access it? Share your experiences and thoughts with us on this blog

Treatment Access Denied?

2008-01-30T08:34:00.001-08:00

Would you like to learn more about how government policies and systems affect your access to drugs and other therapies? Do you want to better understand government cost containment strategies, and if they put your health at risk? Do you think BC should cover the cost of treatments for facial lipoatrophy for those who can’t afford it? There’s a workshop and panel discussion on treatment access issues in BC for persons with HIV/AIDS on February 7th at the Best Western Chateau Granville (in Vancouver) starting at 9:30 am. It’s free to attend and is hosted by the Canadian Treatment Action Council along with several other community groups. Let us know what your concerns are about healthcare in BC

Bacteria Strain Hits Gay Men

2008-01-23T10:02:00.000-08:00

Have you heard about the new bacteria strain affecting gay men? Last week, researchers in San Francisco and Boston reported upon a new highly drug-resistant strain of flesh-eating MRSA bacteria spreading among gay men. The bacteria is easily shared through anal intercourse, and can also be spread through casual skin-to-skin contact and touching contaminated surfaces. The infections can cause skin ulcers and abscesses, and are difficult to treat because the bacteria is resistant to many of the antibiotics used to treat earlier strains. If you notice anything unusual with how you are feeling or with your skin, you should check with your doctor. Let us know if you have any questions about this new bacteria.

International AIDS Conference

2008-01-16T09:02:00.000-08:00

This year the International AIDS Conference will take place in Mexico City in early August. You can click www.aids2008.org for more information. Have you ever attended such a conference? There is usually lots of information that comes out of this event on new drug developments, clinical research, and international issues. In 2006, over 25, 000 people attended the International AIDS Conference in Toronto. If you attended past conferences please share your experiences with other blog readers.
On January 24, the treatment information program will provide information about the 2008 International AIDS Conference, how to apply for a subsidy to get there, and how to submit a workshop proposal. The information sessions starts at noon at BCPWA and everyone is welcome to attend.

Stigma and Discrimination

2008-01-09T10:01:00.000-08:00

Welcome to 2008. In the last blog posting we asked for your ideas. Someone discussed whether your mind can control HIV. What about those people who have been HIV-positive for a long time, and don’t take HIV medications? How do they stay healthy? How do they handle stigma and discrimination? Do they tell others about their HIV status or live in secrecy? Although we are into a New Year, there are unfortunately some things that haven’t changed, such as the stigma and discrimination associated with HIV. What are we going to do about it?

Your Ideas for the HIV Treatment Blog

2007-12-19T11:46:00.000-08:00

Earlier this year, the treatment information program launched this HIV treatment blog. Since then we have posted 27 new topics and there have been about 41 comments made to these topics. Over 1600 hits have been made on the blog (blog has been seen 1600 times). We try to post topics that are relevant to those people with HIV and need your ideas for 2008. What do you want to see discussed on this blog? What do you think about this blog? Why do you go on this blog? Let us know as we try to decide what to do in 2008. In the meantime, we wish you a happy New Year and look for us in 2008

B12 Low in HIV-positive folks!

2007-12-12T11:48:00.000-08:00

Are you getting checked for your B12 levels? Many persons with HIV have low B12 levels in their blood. B12 is important because it helps to maintain nerve cells and red blood cells. It can be found in food products with high protein such as fish, meat, poultry, eggs, milk and milk products. B12 deficiency is associated with an increased risk of peripheral neuropathy (nerve damage causing numbness, burning or tingling feeling in the toes, feet, hands or arms), decreased ability to think clearly, and even anemia. Persons with HIV with low B12 levels may feel very tired and have low energy. You should ask your doctor to check your blood levels. If you have low B12 levels, you should get B12 supplements. Have you experienced low B12? Have you tried any other complementary health products to increase your energy? What other health issues are you faced with?

AIDS Vaccine

2007-12-05T09:33:00.000-08:00

What is happening with the AIDS vaccine? There have been over 38 million people infected with HIV worldwide in the last 26 years and yet there hasn’t been an HIV vaccine created. Recently, yet another AIDS vaccine study was stopped when it was discovered that in was not effective in preventing HIV infection. There were actually more people infected with HIV in the vaccine study compared to those who were not in the vaccine study. The virus mutates (changes shape) so quickly that it has been difficult to find the right vaccine. Despite this latest setback, scientists are still working on the development of an AIDS vaccine, however one wonders how much longer do we have to wait? What do you think about all of this?

Sleeping Problems?

2007-11-14T14:50:00.000-08:00

Do you suffer from sleep problems? We hear about lots of people having trouble falling asleep or waking up in the middle of the night and unable to sleep. This is defined as insomnia. This could be a side effect of certain HIV medications at least in the initial stages when you are first starting on HIV meds. Some people need to take so called sleeping pills to battle insomnia, however there’s debate as to whether this is beneficial. Other ways may include drinking hot milk or chamomile tea before bedtime, and to limit caffeine and sugar, especially in the evening hours. So how do you deal with sleeping disorders?

Depression

2007-11-07T09:14:00.000-08:00

Do you suffer from Depression? Do you know if it is caused by HIV, your medications or you? Depression is very common amongst HIV-positive individuals and can arise for a number of reasons. Decreased interest in daily activities, tiredness and fatigue, trouble sleeping or too much sleep, loss of appetite, difficulty concentrating, feelings of worthlessness and guilt are some of the symptoms of depression. Some people need to take antidepressants to manage their depression. What do you know about depression and how do you cope? Next Wednesday, November 14th, the BCPWA treatment information program will host a community forum on this topic. It will be presented by a local psychiatrist. By attending, you will learn more about depression and HIV. Check out our website for more information about this event.

New Drug Developments

2007-10-31T10:03:00.000-07:00

There’s lots of activity going on in development of HIV medications. During the month of October 2007, there have been two new drugs approved in Canada and one new drug approved in the United States. Atripla is now available in Canada. It becomes the first once-daily single tablet formulation (contains Sustiva, Tenofovir and Emtricitabine all in one pill). Maraviroc, also approved in Canada, is a new entry inhibitor. Raltegravir, an integrase inhibitor, has gained approval in the U.S. and is expected to be given approval in Canada soon. This is all good news, giving those who are developing drug resistance hope for the future. What are your thoughts on new drug developments? Have you had experience with any of these new drugs through clinical trials?

Treatment Fatigue

2007-10-24T09:40:00.000-07:00

Do you ever think about stopping HIV medications? In the current issue of the living+ magazine, there’s an article about treatment fatigue. Some people with HIV are just plain tired of taking their medications and chose to stop. Is this a way of ignoring your HIV? There has been data showing that those who take drug holidays may have an increased risk for cancer. Treatment fatigue may be a sign of the times just like condom fatigue. Based on the empowerment model, BCPWA continues to hold the position that any HIV-positive person has the right to refuse treatment, even it that places the person’s life at risk. What are your thoughts on your HIV meds? Are you getting tired of them? How do you manage?

Complementary and Alternative Therapies

2007-10-17T08:59:00.000-07:00

Do you use complementary and alternative therapies? Many persons living with HIV use complementary and alternative therapies to manage the disease as well as some of the side effects associated with HIV medications. Unfortunately, physicians aren’t always knowledgeable on such therapies and may not even be supportive of them. They say such therapies are not supported by typical medical testing. What have been your experiences with complementary and alternative therapies? What do you use that helps you? For your information, the BCPWA Treatment Information Program will have a 6-week workshop series on complementary and alternative therapies each Thursday evening in November + on December 1st - at the BCPWA lounge (starting @ 6pm). This is open to anyone wanting to learn more about complementary and alternative therapies. Some interesting people will be presenting. You might want to come... so hope to see you there!

St. Paul's moving?

2007-10-10T09:06:00.000-07:00

Is St. Paul’s Hospital moving? In the current living+ magazine, there’s an article about the possibility of St. Paul’s moving from the west end. Providence Health Care is looking at how to expand St. Paul’s currently limited facilities in the future. Some land was purchased on False Creek Flats (north of the rail station by Main Street), and Providence holds an option to use that land. If this happens, how will it affect the many persons living with HIV in the West End? BCPWA will be meeting with Providence officials this fall to discuss what is going on. What do you think about all of this?

Syphilis Alert

2007-10-03T09:00:00.000-07:00

Do you know that syphilis is rising in BC at an alarming rate? We have written about syphilis before on this blog, however the importance of this sexually transmitted infection warrants another blog entry. Recently, the British Columbia Centre for Disease Control reported that in the past 5 years, there has been a steady increase in the number of syphilis infections among men who have sex with men (MSM). In 2006, 46.5 percent of new syphilis infections in BC occurred in MSM of all ages. 64.5 percent of these MSM were HIV-positive individuals who are more likely to present with later stages of syphilis. Syphilis is detected by a blood test and is available at most clinics. MSM, both positive and negative, with an active sex life should get tested regularly. Have you had experience with syphilis and taken treatments for it?

Side Effects and HIV medications

2007-09-26T10:27:00.000-07:00

How do you cope with diarrhea? HIV medications come with side effects, and diarrhea is a common and unpleasant side effect of many HIV meds. One way to manage this is through a BRAT diet (bananas, rice, applesauce, toast). What other side effects are you experiencing and how have you been managing them? Do you ever think about stopping your meds because of unpleasant side effects?

Remembering to Take Medications?

2007-09-19T17:01:00.001-07:00

HIV medications – not something to forget… but people do miss taking them: Side effects, busy schedules, drug fatigue, etc. But, skip too many and you can develop resistance – the drugs won’t work. Then, you have to switch to other HIV drugs. How do folks remember? Pill boxes? Alarm reminders? We’ve heard that “HIV drugs suck, but HIV sucks worse.” How do you remember taking your drugs?

HIV/AIDS & Funding

2007-09-12T10:01:00.000-07:00

Where is AIDS funding going? In 2004, the government announced an increase of funding to the national HIV/AIDS strategy, however little of that funding has even shown up at community based AIDS organizations. As a result, these organizations, which provide direct services to PWAs, have experienced significant hardships in the past couple of years. Many have had to cut services and programs which has impacted the health and well-being of persons living with HIV. BCPWA has joined forces with AIDS service organizations across the country to lobby members of parliament to pressure the federal government to meet its commitment to improve services for people living with HIV/AIDS. What do you think about this? What can you do?

Housing, Security and HIV

2007-09-05T10:47:00.001-07:00

Lack of affordable housing is a big issue in Vancouver. Though there are condos being built just about everywhere, most are unaffordable. Rent is ever increasing as is the cost of living (food/grocery prices are on the rise now too). A number of studies suggest that a high percentage of people living with HIV are also living in poverty, often on the streets. One thing is for sure, for those living in the lower income brackets, the rising cost of living in Vancouver is becoming increasingly challenging. How can a person living with HIV/AIDS even think about their well being when they lack basic needs, such as affordable housing and adequate food? What are our priorities these days? What are your thoughts on this important issue? Is anyone doing anything about this?

Your Testing in the United States?

2007-08-29T09:40:00.000-07:00

How do you feel about having your blood work sent to the United States?

Maraviroc is a new HIV drug that will soon be made available. However, in order to qualify for this drug, you will need to do something called a tropism test. The tropism test will check to see if you have R5 or R4 receptors on your CD4 cells as Maraviroc will only work on R5 receptors (to prevent the virus from attaching to the CD4 cell). Right now, this test can only be conducted in California, as Canada doesn’t have this technology. Does having your blood sent to the States worry you? What are the issues and concerns, if any?

Is it Age or HIV....?

2007-08-22T09:32:00.000-07:00

Is it age or is it HIV? As people with HIV are now living longer, treatment of HIV has become more complex. Health conditions such as cardiovascular disease, diabetes, osteoporosis and depression can be attributed to both HIV and age. Some drug companies may like us to think aging causes some of these health conditions in order to minimize the associated side effects of their drugs. What do you think? What do you think about as you're aging with HIV?

HIV Drugs - Start Early or Later......?

2007-08-15T11:07:00.000-07:00

Do you remember the days when “hit hard hit early” were the norm. It wasn’t that long ago that HIV-positive individuals were told to start taking HIV medications right away. Due to side effects and resistance, we re-examined this and learned that you didn’t need to start drugs so quickly. Now the trend seems to be to start earlier again. There are a lot of new drugs coming down the pipe, however we still don’t know what the long term side effects will be from these drugs. There’s also a theory that expanding access to antiretrovirals may help curb the growth of the HIV epidemic (by getting everyone undetectable). A lot of research going on, but are we revisiting the past? Two steps forward, one step back? What do you think about all of this?