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Archive for March, 2007

HIV Transmission Risk Highest Early in Infection

Posted by pozlife on March 11, 2007

Canadian researchers said Monday that a genetic analysis of newly HIV-infected patients showed that almost half of the infections occurred when their partners were also newly infected.
“The early infection stage can be entirely asymptomatic,” said study leader Dr. Mark Wainberg of Montreal’s McGill AIDS Center. “This is why people who are recently infected may not know it, and will probably often test negative by conventional antibody screening.”
“Hence, we must do a much better job of identifying recently infected people if we are to be able to counsel them to modify high-risk sexual behavior and desist from transmitting the virus,” Wainberg said.
Wainberg and colleagues from several Canadian hospitals and health centers studied HIV transmission among infected patients in Quebec through phylogenetic analysis. This analysis recorded viral mutations to help map out a family tree of the virus and provide an estimated time of infection. Based on the viral strains’ limited mutations, the study found that 49 percent of the early infections were clustered in a way suggesting transmission by people who were themselves in the early stages of HIV infection.
Because newly infected people have many copies of HIV in their blood, or a higher viral load, they have a higher risk of forward transmission.
The study, “High Rates of Forward Transmission Events After Acute/Early HIV-1 Infection,” was published in the Journal of Infectious Diseases (2007;195:951-959).
[This summary provided by the CDC National Center for HIV, STD, and TB Prevention | Reuters | March 5, 2007]

Source: HIV Plus

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POZ – News : LA Bathhouses Lose Lawsuit

Posted by pozlife on March 11, 2007

Los Angeles city health officials have ruled that nine area bathhouses must comply with safer sex and HIV testing regulations. The venues are now each required to pay annual regulatory fees of more than $1,000, promote safer sex, and allow quarterly inspections by health officials and providing on-site HIV testing. Last year, the sites sued the city, claiming the regulations were illegal and discriminatory.

Source: POZ – News : LA Bathhouses Lose Lawsuit

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POZ – News : Unsafe Sex in the Big Apple

Posted by pozlife on March 11, 2007

About 18% of adult New Yorkers, roughly 1 million people, partake in risky sexual or drug-use behavior—but 92% of them think they’re not at risk for HIV, according to a new study by the city’s Department of Health. About 1.4% of New Yorkers are HIV positive, compared to .37% of adults nationally.

Source: POZ – News : Unsafe Sex in the Big Apple

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Equally Speaking

Posted by pozlife on March 6, 2007

Tuesday, March 6, 2007

First up on HRC’s daily webcast, the GLBT community loses a hero. Bob Hattoy broke new ground in the fight to combat HIV and AIDS in his prime-time speech on the disease at the 1992 Democratic Convention. Bob passed away over the weekend but will always be remembered for the way he changed how millions of Americans viewed people living with HIV/AIDS.

Turning to some state news, Iowa Governor Chet Culver signed a strong anti-bullying bill into law yesterday. After a tumultuous path through the Legislature, students are now protected from bullying in schools based on sexual orientation, gender, race and age.

Last year the Arkansas Supreme Court ruled that the state’s ban on gay and lesbian foster parents was unconstitutional. Now a state lawmaker has introduced a bill to ban any gay or lesbian person from serving as a foster or adoptive parent even if they are related to the child. Perhaps showing it’s not just gay people he doesn’t like, the bill would ban unmarried, cohabitating straight people from adopting or fostering unless they are related to the child.

The New York City Council’s lesbian speaker Christine Quinn is heading to Dublin this St. Patrick’s Day to march in their parade there. Organizers of New York’s parade bar GLBT people from marching openly and Quinn will continue her tradition of boycotting the New York event.

The church of Reverend Ted Haggard has seen its contributions fall significantly since Haggard stepped down amid allegation of drug use and relations with a male escort. Forty-four people have been laid off – 12 percent of the 14,000-member church’s staff.

Finally, Sydney, Australia’s famed Gay and Lesbian Mardi Gras wrapped up this week. The parade, with 8,000 participants and 120 floats, drew more than 350,000 spectators.

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BBC NEWS | Health | Scientists expose HIV weak spot

Posted by pozlife on March 3, 2007

 

Scientists expose HIV weak spot

Image showing the antibody b12 (green) contacting a critical target (yellow) on HIV (red). Picture: NIAID

Antibody (green) locks onto a key site on the virus

Scientists have shown what happens when an infection-fighting antibody attacks a gap in HIV’s formidable defences.

The National Institute of Allergy and Infectious Diseases-led team say the work could aid HIV vaccine development.

They have published an atomic-level image in Nature showing the antibody, b12, attacking part of a protein on surface of the virus.

HIV avoids attack by constantly mutating, but this protein segment is a weak spot because it remains stable.

This is certainly one of the best leads to come along in recent years

Dr Gary Nabel,
National Institute of Allergy and Infectious Diseases

Dr Elias Zerhouni, director of the US National Institutes of Health (NIH), said: “Creating an HIV vaccine is one of the great scientific challenges of our time.

“NIH researchers and their colleagues have revealed a gap in HIV’s armour and have thereby opened a new avenue to meeting that challenge.”

Slippery foe

Developing a vaccine for HIV has proved extremely difficult.

The virus is able to mutate rapidly to avoid detection by the immune system, and is also swathed by a near-impenetrable cloak of sugary molecules which block access by antibodies.

But certain parts of the virus must remain relatively unchanged so that it can continue to bind to and enter human cells.

A protein, gp120, that juts out from the surface of the virus and binds to receptors on host cells, is one such region, making it a target for vaccine development.

Previous analysis of the blood of people who have been able to hold HIV at bay for long periods has revealed a rare group of antibodies – including b12 – that seem to fight HIV with a degree of success.

The latest study has revealed the detailed structure of the complex, which is formed when b12 docks with gp120.

Until now this has proved impossible, because of the flexible nature of some of the chemical bonds involved.

But the NIAID team were able to stiffen up the key protein enough to capture a picture of the complex.

They hope that revealing the structure of this bond in such precise detail will provide clues about how best to attack HIV.

Challenge ahead

Researcher Dr Gary Nabel said the work had revealed a “critical area of vulnerability on the virus”.

He said: “This is certainly one of the best leads to come along in recent years.”

Keith Alcorn, editor of the aidsmap.com website, said vaccines based on antibodies had so far failed to produce promising results.

“These findings are very important because they show what sort of antibodies are likely to be most successful in neutralising HIV.

“Now the challenge is to develop vaccine products that can be tested in humans.”

Source: BBC NEWS | Health | Scientists expose HIV weak spot

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Group challenges feds on medical pot – Yahoo! News

Posted by pozlife on March 3, 2007

 

By LISA LEFF, Associated Press Writer Wed Feb 21, 2:27 PM ET

OAKLAND, Calif. – Armed with a new study showing the drug can ease pain in some HIV patients, medical-marijuana advocates sued the federal government Wednesday over its claim that pot has no accepted medical uses.

The lawsuit, filed in federal court by Americans for Safe Access, accuses the government of arbitrarily preventing “sick and dying persons from seeking to obtain medicine that could provide them needed and often lifesaving relief.”

The Food and Drug Administration‘s position on medical marijuana “is incorrect, dishonest and a flagrant violation of laws requiring the government to base policy on sound science,” Joe Elford, said chief counsel for Americans for Safe Access.

California is one of 11 states that have made marijuana legal for people with a doctor’s recommendation. But because the U.S. government does not recognize pot’s medical benefits, patients can still be arrested by federal authorities.

Last week, researchers from the University of California at San Francisco reported in the journal Neurology that a test involving 50 HIV patients showed that those who smoked pot experienced much less pain than those given placebos

Source: Group challenges feds on medical pot – Yahoo! News

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India: Repeal Colonial-Era Sodomy Law (Human Rights Watch, 11-1-2006)

Posted by pozlife on March 3, 2007

 

India: Repeal Colonial-Era Sodomy Law

Entrapment, Arrests Harm AIDS Prevention Efforts

(Delhi, January 11, 2006) – New arrests of gay men in Lucknow, India—the scene of a case in 2001 that drew worldwide protests—show that India’s colonial-era sodomy law continues to threaten human rights and encourage the spread of HIV, Human Rights Watch said today in a letter to Prime Minister Dr. Manmohan Singh.

" Lucknow police have a shameful record of harassing gay men as well as non-governmental organizations that work with them. They are able to do so because India’s government clings to the criminalization of homosexual conduct, which only prevents people from coming forward for HIV/AIDS testing, information, and services. "

Scott Long, director of Human Rights Watch’s Lesbian, Gay, Bisexual, and Transgender Rights Program

Related Material

Epidemic of Abuse: Police Harassment of HIV/AIDS Outreach Workers in India
Report, June 1, 2002

India
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Letter to Indian Prime Minister Singh
Letter, January 11, 2006

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On January 4, Lucknow police arrested four men on charges of operating a “gay racket” on the Internet, as well as of engaging in “unnatural” sex. Police claim they seized the men while having a picnic in a public place, and accused them of belonging to an “international gay club” centered around the Internet website guys4men.com, on which gay men can place personals and engage in Internet chat. Reports received by Human Rights Watch indicate that undercover police, posing as gay on the website, entrapped one man, then forced him to call others and arrange a meeting where they were arrested.  
“Lucknow police have a shameful record of harassing gay men as well as non-governmental organizations that work with them,” said Scott Long, director of Human Rights Watch’s Lesbian, Gay, Bisexual, and Transgender Rights Program. “They are able to do so because India’s government clings to the criminalization of homosexual conduct, which only prevents people from coming forward for HIV/AIDS testing, information, and services.”  
In July 2001, Lucknow police, apparently spurred by an informer, raided the local offices of two nongovernmental organizations (NGOs) working on HIV/AIDS prevention, the Naz Foundation International (NFI) and Bharosa Trust. Four staff members were jailed for 47 days in deplorable conditions, accused of running a gay “sex racket.” Police declared the HIV/AIDS-related information materials seized in the raided offices “obscene.” They charged the men under India’s sodomy law, criminal conspiracy, aiding and abetting a crime and the sale of obscene materials. After international condemnation of the detention of the “Lucknow Four,” the case was eventually dropped.  
In a 2002 report, Epidemic of Abuse, Human Rights Watch documented how India’s sodomy law has been used to harass HIV/AIDS prevention efforts, as well as sex workers, men who have sex with men, and other groups at risk of the disease. Section 377 of the Indian Penal Code, titled “Of Unnatural Offences,” punishes “carnal intercourse against the order of nature” with up to ten years’ imprisonment. It was introduced by British rulers in the nineteenth century.  
A challenge to section 377’s constitutionality was brought was brought before the Delhi High Court in 2001 by the Naz Foundation India, asking the court to declare the law should no longer apply to consenting adults. In response, the then government stated that “The purpose of section 377 of IPC is to provide a healthy environment in the society by criminalising unnatural sexual activities.” The case ended indecisively, and litigation is still pending.  
“Section 377 strikes at the basic right to privacy,” said Long. “This case shows how it is used against rights to free expression and to meeting in a public place. It casts a pall over public health efforts.”  
Human Rights Watch said that India’s constitution protects the right to equality, freedoms of speech and assembly and right to personal liberty. The International Covenant on Civil and Political Rights (ICCPR), to which India acceded in 1979, guarantees freedom from discrimination. In the case of Toonen v. Australia in 1994, the United Nations Human Rights Committee held these protections against discrimination in all areas of rights should be understood to include sexual orientation.

Source: India: Repeal Colonial-Era Sodomy Law (Human Rights Watch, 11-1-2006)

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Treatment News : Fewer Side Effects with Videx/Epivir vs. Combivir

Posted by pozlife on March 1, 2007

 

Fewer Side Effects with Videx/Epivir vs. Combivir
(AIDSmeds.com)

by Tim Horn

A team of Spanish researchers is finding that, when combined with Sustiva® (efavirenz), Videx® EC (didanosine capsules) matched with Epivir® results in fewer treatment discontinuations due to side effects than Combivir® (zidovudine plus lamivudine).  The 24-week data from the 48-week GESIDA 3903 study also suggest that once-daily Sustiva/Videx/Epivir is comparable to Sustiva/Combivir with respect to viral load outcomes, with a possible CD4 cell count advantage.

According to the U.S. Department of Health and Human Services, in its Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents, only Combivir and Truvada (tenofovir plus emtricitabine) are considered “preferrednucleoside reverse transcriptase inhibitors (NRTIs) to combine with either a non-nucleoside reverse transcriptase inhibitor (NNRTI) or a protease inhibitor (PI) for HIV-positive patients starting therapy for the first time.  Videx EC combined with Epivir, prescribed separately but approved for once-daily use, is an “alternative” DHHS recommendation.  The reason for the more limited support of Videx EC and Epivir as a possible NRTI “backbone” to combine with suggested NNRTIs and PIs is a lack of data comparing this dual-NRTI combo to current leading NRTI pairings (e.g., Combivir).

GESIDA 3903 randomized 369 HIV-positive patients, none of whom had used antiretroviral therapy in the past, to Videx EC (400 mg) and Epivir (300 mg) once daily or Combivir twice daily, with both NRTI pairings taken with a standard dose of Sustiva (600 mg). 

The average viral load at study entry was 100,000 copies and the average CD4 count was approximately 210.  Approximately 7% of patients in the Videx/Epivir group and 3% of patients in the Combivir group had chronic hepatitis B virus infection; approximately 20% in both groups had active hepatitis C virus infection.

In the strict intent-to-treat analysis, which included everyone enrolled in the study even if they discontinued their treatment due to limited effectiveness or side effects, 71% of those in the Videx/Epivir group and 66% of those in the Combivir group had viral loads below 50 copies (undetectable) after 24 weeks.  In the more liberal on-treatment analysis, which only included the patients who completed 24 weeks of treatment, 82% of those in the Videx/Epivir group and 85% of those in the Combivir group had undetectable viral loads.

The differences between the two groups with respect to undetectable viral loads at week 24, in the intent-to-treat and on-treatment analysis, were not statistically significant, meaning they could have been due to chance.

CD4 count gains were significantly greater in the Videx/Epivir group compared to the Combivir group.  After 24 weeks, CD4 counts increased by an average of 128 cells (compared to study entry numbers) in the Videx/Epivir group, compared to a 110 CD4 cell count increase in the Combivir group.  This difference – along with differences in CD4 cell count increases at week 4 and 12 – were statistically significant. 

As for side effects, significantly more patients in the Combivir group (21%) discontinued treatment early due to side effects, compared to those in the Videx/Epivir group (13%).  Hematologic problems requiring treatment discontinuation, notably anemia and neutropenia, were much more common among those taking Combivir (6%) compared to Videx/EC (0.5%). 

There were no statistically significant differences between the two groups with respect to moderate-to-severe side effects like rash and central nervous system problems (caused by Sustiva), liver enzyme increases, or lipid (blood fat) level increases.

While these data are encouraging and support the use of Videx combined with Epivir as a worthy NRTI backbone pairing among patients starting therapy for the first time, the full 48-week data are required to draw any firm conclusions.

Source:

Berenguer J, Ribera E, Domingo P, et al. Didanosine, lamivudine, and efavirenz vs zidovudine, lamivudine, and efavirenz, for initial treatment of HIV infection: planned 24-week analysis of a prospective randomized non-inferiority clinical trial, GESIDA 39/03 [Abstract 504]. 14th Conference on Retroviruses and Opportunistic Infections, Los Angeles, 2007.

Source: POZ – Treatment News : Fewer Side Effects with Videx/Epivir vs. Combivir – by Tim Horn

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Treatment News : Once-Daily Viramune Strikes Out

Posted by pozlife on March 1, 2007

 

Once-Daily Viramune Strikes Out
(AIDSmeds.com)

by Tim Horn

For several years, Boehringer Ingelheim and independent researchers have been looking into the possibility of once-daily Viramune® (nevirapine) dosing, to help simplify its use in the treatment of HIV.  However, new research presented at the 14th Conference on Retroviruses and Opportunistic Infections (CROI) suggests that the approved twice-daily schedule will remain the necessary dosing option, especially for those starting therapy with high viral loads, based on a significantly greater number of virologic failures seen in a French study comparing the two dosing schedules.

The DAUFIN study randomized 71 HIV-positive patients to one of two treatment groups.  In the first group, 36 patients took once-daily Viramune (400mg), Viread® (tenofovir; 245 mg), and Epivir® (lamivudine, 300 mg).  In the second group, 35 patients took twice-daily Viramune (200 mg) and Combivir® (zidovudine plus lamivudine).  All patients were treatment-naïve – new to treatment at the start of the study – and the men had to have CD4 counts below 350, whereas the women had to have CD4 counts below 250 (to reduce the risk of Viramune-related hypersensitivity). 

The average viral loads at study entry were 71,500 in the once-daily group and 80,282 in the twice-daily group.  Pre-treatment CD4 counts average 208 cells in both groups. 

The study began in May 2005, with a planned target enrollment of 250 patients.  However, by May of 2006, early virologic failure was documented in seven patients – all in the once-daily group – leading to early termination of the study.  The data presented at CROI reflected results for 71 patients enrolled in the trial before it was discontinued.

In total, eight individuals – again, all in the once-daily group – experienced early virologic failure, defined as a viral load that failed to drop more than 2 log by week 12 or a greater than 1 log rebound in viral load by week 12.  Two additional patients experienced virologic rebound later in the study, one in each study group.

It was not initially clear why patients in the once-daily group were much more likely to experience virologic failure compared to those in the twice-daily group.  Trough concentrations of Viramune – a measure of the drug in the blood – were somewhat lower in the once-daily group, but not significantly so. 

Two factors that did seem to play a role in early virologic failure were high viral loads and low CD4 counts at the time of study entry.  The average pre-treatment viral load among those who maintained virologic control was 51,189.  Among those who experienced virologic failure, the average pre-treatment viral load was 262,747.  As for pre-treatment CD4 cells, the average count among those who continued to respond well to treatment was 223, vs. an average pre-treatment count of 110 among those who experienced virologic failure.  These differences were statistically significant.

While discontinuation due to side effects was slightly more common among individuals in the twice-daily group compared to the once-daily group, the difference was not statistically significant.

Source:

Rey D, Schmitt MP, Hoizey G, et al. Early virologic non-response to once daily combination of lamivudine, tenofovir, and nevirapine in ART-naive HIV-infected patients: preliminary results of the DAUFIN study [Abstract 503]. 14th Conference on Retroviruses and Opportunistic Infections, Los Angeles, 2007.

Source: POZ – Treatment News : Once-Daily Viramune Strikes Out – by Tim Horn

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Pirates of the Caribbean: Walking the Plank for HIV Care in Puerto Rico

Posted by pozlife on March 1, 2007

 

Pirates of the Caribbean: Walking the Plank for HIV Care in Puerto Rico

by Nicole Joseph

Jose F. Colon has spent the last six weeks fighting what he calls an “unbearable crisis” in the Puerto Rican AIDS community. The 54-year-old activist has met with local politicians. He has spoken to newspaper reporters. He even fasted for 33 hours. All from his bed at the Hospital Auxilio Mutuo in downtown San Juan.
“I decided to work from the hospital,” says Colon. As a sick man with both AIDS and diabetes, he says, the grim truth about Puerto Rico’s HIV care emergency has been staring him in the face. “I feel horrified. I feel like it’s 1980.”
You don’t need to check into the hospital to see that financial negligence and mismanagement are pushing Puerto Rico’s AIDS care to the brink. Earlier this month, two AIDS clinics shut down for lack of funds, cutting loose 1,500 HIV positive patients. An estimated 130 people are going without treatment on a waiting list and many more are in need; at least 10,000 Puerto Ricans are believed to be living with HIV.
But now a coalition of furious activists, including several groups from heavily Puerto Rican New York City, are saying enough is enough. They are insisting on federal action—or at least some acknowledgement of responsibility—and wondering whether a crisis of these proportions would be allowed to continue unchecked in any of the states on the U.S. mainland.
Puerto Rico, a U.S. “commonwealth territory” where locals are deeply divided over their relationship with Washington (many call for statehood instead or complete independence), got $58.4 million in HIV care funding last year from the federal Ryan White CARE Act. The average Puerto Rican is less and less likely to see those services, however. The funds’ distribution to local health clinics and Community Based Organizations (CBOs) has gotten painfully slow.
Funds or no funds, many clinics have stayed open anyway—sometimes without working bathrooms, telephones, air conditioning or adequate staff. Some have scraped together cash on their own and invoiced the Puerto Rico Department of Health and the San Juan AIDS Task Force. But with reimbursement now sometimes stretching to as many as nine months, more and more clinics have been forced to go out of business.
“This is something that has been going on for many years, but it has gotten critical in the last three,” says Anselmo Fonseca, co-founder and vice president of Pacientes de SIDA Pro Politica Sana. “Peoples’ lives are in danger, and too many key players either lack competence or…don’t give a damn.”
Last month, Fonseca and other local activists directly invited the feds to intervene. They sent a letter to the government official in charge of Ryan White distribution in Washington, DC: Dr. Deborah Parham Hopson, associate administrator of HIV/AIDS at the Health Resources and Services Administration (HRSA).
The activists recommended that a “third party” step in to dole out the money. The idea would be to put the funds in the hands of a “competent and trustworthy local agency such as the Puerto Rico Certified Public Accountants Chapter, or the office of a federal judgeship.”
In a statement to POZ, HRSA officials said that was one option among several they are considering, and that they are working in conjunction with the San Juan office of Mayor Jorge Santini to “improve the local situation as quickly as possible.”
Members of the New York-based Puerto Rican community who are monitoring the crisis hope that is exactly what’s in store—and have put their weight behind the request for federal help. The Latino Commission on AIDS (LCOA) wrote a second letter to Parham Hopson and also joined representatives of the National Minority AIDS Council and other groups at a February 9th meeting with the Congressional Hispanic Caucus in D.C. Then last week, the Caucus issued a third letter: this one to Michael O. Leavitt, Secretary of the U.S. Department of Health and Human Services, urging “prompt and decisive action to ensure that patients receive the care that Congress intended.”
The question is: How many more letters will be written before somebody steps up to the plate?
The situation is grave, with the CDC reporting that the island’s rate of infection for 2005 was 26.4 per 100,000, nearly twice the rate for the rest of the U.S. (Most Puerto Ricans are infected through injection drug use.)
“Our goal is to get HRSA to take this seriously,” says Dennis de Leon of the LCOA. “Some groups haven’t been paid in the last nine months —that part of the problem [will] be corrected whenever someone decides to correct it.”
This isn’t the first time Puerto Rican leaders have come under fire for mishandling AIDS money. In 1999 and 2000, several former officials of the San Juan AIDS institute were convicted of stealing more than $2 million of federal AIDS funds for personal and political gain. Last December, the FBI, the IRS and the Human Services Office of the Inspector General turned up the heat again by raiding several AIDS program offices in the municipality of San Juan, confiscating thousands of files and copying hard drives.
The San Juan division of the FBI declined to comment on what was found, or whether or not any charges will be filed, but advocates are concerned that the absence of those files might further delay the delivery of federal funds to the island’s increasingly needy CBOs.
To get directly involved, contact the LCOA.

Source: POZ – Special Reports : Pirates of the Caribbean: Walking the Plank for HIV Care in Puerto Rico – by Nicole Joseph

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