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Archive for February, 2008

GayHealth.com docs disagree with Swiss HIV study

Posted by pozlife on February 29, 2008

Swiss AIDS experts stunned researchers in Europe and North America recently by publishing a shocking study concluding that some people with HIV who are on stable treatment can safely have unprotected sex with non-infected partners.

The Swiss National AIDS Commission said patients who meet strict conditions, including successful antiretroviral treatment to suppress the virus and who do not have any other sexually transmitted diseases, do not pose a danger to others.

“I think this is an extremely dangerous path to go down … without a large trial to prove that this is safe.”

However, Dr Stephen Goldstone and Dr. Susan Ball, Medical Directors of GayHealth.com, both strongly disagree with the Swiss proposal, published recently in the Bulletin of Swiss Medicine:

Said Dr. Goldstone: “I think this is an extremely dangerous path to go down especially without a large trial to prove that this is safe. I would hate for knowingly positive men to abandon condoms and not disclose their status to a partner thinking that they can’t infect him or her anyway. We must advocate safe sex until we know much more.”

Said Dr. Ball: “We definitely do not agree with the Swiss version and Dr. Roy Gulick, head of the AIDS Clinical Trial Unit at Cornell, is aware of written reports indicating confirmed HIV transmission from partners who had low viral loads. All would agree that low or undetectable viral loads pose less risk but no one here would support infected patients having unprotected sex.”

The Swiss reported that other studies had also found that patients on regular anti-AIDS treatment did not pass on the virus, and that HIV could not be detected in their genital fluids.

The Swiss scientists took as their starting point a 1999 study by the U.S. Centers for Disease Control and Prevention, which showed that transmission depends strongly on the viral load in the blood.

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NIAID Modifies HIV Antiretroviral Treatment Study – The Body

Posted by pozlife on February 29, 2008

 

NIAID Modifies HIV Antiretroviral Treatment Study

Combination Therapy That Includes ABC/3TC Found Less Effective in Subgroup of Antiretroviral-Naive Individuals

February 28, 2008

An independent Data and Safety Monitoring Board (DSMB) met recently to review data from a clinical trial examining the safety, tolerability and effectiveness of four different antiretroviral treatment regimens in HIV-infected adults who had never taken anti-HIV drugs before. The trial, sponsored by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, involves a randomized comparison of the HIV drug efavirenz (EFV) with atazanavir boosted with ritonavir (ATV/r), and a double-blind, randomized comparison of co-formulations of emtricitabine/tenofovir disoproxil fumarate (FTC/TDF) with abacavir/lamivudine (ABC/3TC). The DSMB has recommended changes to the study on the basis of new findings in a subset of participants who have been receiving ABC/3TC.

This study is being conducted by the NIAID-funded AIDS Clinical Trials Group (ACTG) and is known as ACTG 5202. The trial is important for examining initial HIV treatment regimens because existing regimens may vary both in their ability to suppress the level of HIV in the blood (viral load) and in the side effects with which they may be associated.

Investigators enrolled 1,858 eligible men and women into the Phase III efficacy study between September 2005 and November 2007 at 64 sites in the United States. Participants were divided into two groups based on HIV levels at the time of screening: those with high viral loads (100,000 or more copies of HIV RNA per milliliter of blood) and those with lower viral loads (fewer than 100,000 copies/mL). Each volunteer was assigned at random to one of the four treatment groups:

  1. EFV, FTC/TDF, and placebo for ABC/3TC.
  2. EFV, placebo for FTC/TDF, and ABC/3TC.
  3. ATV/r, FTC/TDF, and placebo for ABC/3TC.
  4. ATV/r, placebo for FTC/TDF, and ABC/3TC.

All regimens effectively reduced the amount of virus in most participants. However, the DSMB found that among participants with high viral loads at the time of screening, treatment combinations that included ABC/3TC were not as effective in controlling the virus as those on regimens containing FTC/TDF. This was the DSMB’s primary concern. Secondarily, the DSMB found that among participants with a high viral load at screening, those receiving ABC/3TC experienced a shorter time to developing non-specific side effects, such as body aches, and laboratory test abnormalities, such as elevated cholesterol and triglyceride levels, than those receiving FTC/TDF. In general, these side effects were obvious to participants or the study physicians and would have been readily managed or treated.

The DSMB had no safety concerns regarding EFV or ATV/r and recommended that study participants in the lower viral load group who were taking ABC/3TC should continue with their assigned treatment regimen.

Based on its findings, the DSMB recommended that all participants who had high viral loads at screening be told which treatment regimen they are receiving and stop taking their placebo pill. The DSMB also recommended that those participants receiving ABC/3TC who had high viral loads at screening be counseled on what the DSMB findings might mean for them and possibly be shifted to another regimen, if appropriate. Finally, the DSMB recommended that the remainder of the study continue as originally designed. NIAID concurred with the DSMB’s recommendations.

ACTG has notified the site investigators and the affected study participants of the DSMB’s recommendations. In consultation with the site study teams and their physicians, these participants may continue taking ABC/3TC, switch to FTC/TDF or switch to alternative antiretroviral combinations.

NIAID Modifies HIV Antiretroviral Treatment Study – The Body

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Agreement Reached On AIDS Bill

Posted by pozlife on February 27, 2008


by The Associated Press

Posted: February 27, 2008 – 1:00 pm ET

(Washington) A House committee on Wednesday voted to more than triple spending for a global AIDS program that has proven to be one of the Bush administration’s most successful and popular foreign policy initiatives.

The Foreign Affairs Committee’s voice vote on the plan to approve spending of an average $10 billion annually over the next five years came hours after lawmakers and the White House reached a compromise on some of the policy issues, including spending on abstinence programs, that had held up action on the legislation.

The bill extends the President’s Emergency Plan for AIDS Relief, which authorized spending of $15 billion total for five years for prevention and care programs in sub-Saharan Africa and other regions hit by the epidemic. That act, passed in 2003, expires in September.

Every day another 6,000 people are infected by HIV, said committee chairman Howard Berman, D-Calif. “We have a moral imperative to act decisively.”

While the program has wide bipartisan support, the White House and many Republicans objected to the original Democratic-crafted draft because it removed a provision requiring that a certain amount be spent on abstinence programs and bolstered links between AIDS treatment and family planning. Some Republicans said that would open the way for family planning groups to spend money on abortions.

The compromise worked out in late-night negotiations Tuesday does eliminate the clause requiring that one-third of all HIV prevention funds be spent on abstinence, instead directing the administration to promote a “balanced” prevention program in target countries. The administration must issue a report if programs focusing on abstinence and fidelity do not receive half of funds devoted to the prevention of sexual transmission of HIV, a smaller pot.

The agreement also allows the use of AIDS funds for HIV/AIDS testing and counseling services in those family planning programs supported by the U.S. government.

Rep. Ileana Ros-Lehtinen, R-Fla., top Republican on the committee, said the compromise maintained core values important to both sides. “Many of us in this room concluded that a collapse of the political consensus on this issue would do irreparable damage to what is arguably the most successful U.S. foreign assistance program of the last half century.”

President Bush was hailed during his recent trip to Africa for a program that has resulted in 1.4 million people receiving drugs to fight the virus and has cared for nearly 6.7 million, including 2.7 million orphans.

The bill was named after two former chairmen of the committee, Reps. Henry Hyde, R-Ill., and Tom Lantos, D-Calif., Hyde, who died last November, and Lantos, who died earlier this month, sponsored the 2003 bill. Lantos was the sponsor of the new bill.

“This historic agreement will save millions of lives,” said Dr. Paul Zeitz, executive director of the Global AIDS Alliance. He welcomed the increase in funds for tuberculosis and malaria while expressing concerns that the compromise retains limitations on AIDS funding for family planning.

The White House on Wednesday also repeated that the president’s proposal to double spending to $30 billion, rather than the $50 billion in the House bill, was more appropriate. “We believe … that $30 billion is the right amount of money that could be effectively used by these governments to tackle the HIV-AIDS problem,” White House Press Secretary Dana Perino said. “We don’t think it’s smart to send additional American taxpayer dollars that will sit there and not be used, or be used ineffectively.”

But Josh Ruxin, assistant clinical professor at Columbia University and a resident of Rwanda where he heads the Access Project, said that while the first five years of the program have been “extraordinary… simply continuing to implement the same policies and practices over the next five years will be inadequate to address this tidal wave” that is engulfing Africa.

He noted that investing more in such areas as running water and electricity for health centers and training medical personnel increases the capacity of programs to spend more to combat the disease.

The new bill adds 14 Caribbean countries to the 15 mostly African nations that have been the focus of the program. It also retains a provision in the 2003 act that requires organizations receiving funds to oppose prostitution and sex trafficking.

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40% Of AIDS Deaths In Canadian Province Untreated

Posted by pozlife on February 27, 2008


by The Canadian Press

Posted: February 26, 2008 – 5:00 pm ET

(Vancouver, British Columbia) Forty per cent of the people who died of HIV-AIDS in British Columbia never accessed life-saving treatment even though it was free, according to a new study.

The study by the B.C. Centre for Excellence in HIV-AIDS looked into more than 1,400 HIV-related deaths in the province between 1997 and 2005.

In that period of time, a total of 567 people died without ever receiving the highly effective antiretroviral treatment.

“We have a problem,” said Dr. Julio Montaner, director of the centre. “The treatments are available for free but something is wrong because the people that most need the treatment, they’re not always accessing the treatment.”

Low income was strongly associated with the delay in starting therapy and the ensuing high mortality rate.

Residence in a poor neighborhood was associated with an increased risk of mortality among HIV patients, Montaner said.

“Factors such as a lack of housing or transportation, mental illness, illegal activity and language barriers play a role in an individual’s ability to access treatment,” he said.

Twenty-five per cent of those infected with HIV in Canada are not aware of their infection, according to the centre.

The centre distributes the cocktail of antiretroviral medications to all eligible British Columbians, free of charge, through the provincewide Drug Treatment Program, funded by Pharmacare.

Yet ensuring access to the treatment remains an elusive goal, he said.

“We have found that over the last several years there is a persistent number of people dying with HIV in our midst, where treatment and health care is supposed to be readily available,” Montaner said.

Typical examples are single mothers who don’t have the resources to get a babysitter or a homeless, mentally ill drug addict who lives on the Downtown Eastside and doesn’t even know he’s HIV-positive, he said.

And it’s not just Vancouver, Montaner said. It’s a problem right across the country and the percentage could even be worse in smaller communities where fewer resources are available.

Ann Livingston, spokeswoman for the Vancouver Area Network of Drug Users, called the study shocking.

Four in 10 people in Vancouver’s Downtown Eastside live outside and many among them are sick with AIDS, she said.

Some live in substandard hotels that are often infested with cockroaches and unsafe but people stay there because welfare payments don’t provide enough money for decent housing for those who are too ill to work, Livingston said.

“And they have no general practitioner. That’s another nightmare,” she said.

Ken Buchanan, of the British Columbia Persons with AIDS Society, said the long-term solution is to bring some stability to the lives of HIV-AIDS sufferers.

“For a person who is homeless, taking medications, even free medications, is pretty low in their priorities,” he said.

Buchanan warned that access to medication isn’t enough. A person who begins treatment and doesn’t maintain the proper dose regime will build up a resistance to the drugs and end up more likely to die.

“You can’t take them for a few days and then stop for a few days,” he said. “If your life is chaotic … you don’t have the ability or the need or the desire to take your meds.”

The centre has a proposal before the provincial government to form outreach teams that would take rapid-response testing to the most vulnerable and offer treatment.

But “free health care is not necessarily enough to address this problem,” he said.

“We need to bring the treatments to the people and we need to create the programs that are going to help these individuals to take the treatment,” he said.

It is not only the ethical and human thing to do, he said, it’s also better for society at large because it reduces HIV-related illnesses that drain the health care system.

“By treating these people we’re doing what is right for them, we’re doing what is right for the system and we’re also going to decrease HIV transmission,” Montaner said.

“This is the right thing to do both in an ethical sense and also in a business sense.”

Previous research by the centre and by researchers in Taiwan showed a 50 per cent reduction in new HIV cases that they felt was due to access to the highly active antiretroviral therapy.

The treatment consists of three or more antiretroviral drugs on a daily basis for life and it requires a very high level of adherence in order to be fully effective.

It has been the standard of care for the treatment of HIV-AIDS since 1996.

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Drug-Resistant TB Spreading Fast

Posted by pozlife on February 27, 2008


by The Associated Press

Posted: February 26, 2008 – 5:00 pm ET

(London) Drug-resistant tuberculosis is spreading even faster than medical experts had feared, the World Health Organization warned in report issued Tuesday.

The rate of TB patients infected with the drug-resistant strain topped 20 percent in some countries, the highest ever recorded, the U.N. agency said.

“Ten years ago, it would have been unthinkable to see rates like this,” said Dr. Mario Raviglione, director of WHO’s “Stop TB” department. “This demonstrates what happens when you keep making mistakes in TB treatment.”

Though the report is the largest survey of drug-resistant TB, based on information collected between 2002 and 2006, there are still major gaps: Data were only available from about half of the world’s countries.

In Africa, where experts are particularly worried about a lethal collision between TB and AIDS, only six countries provided information.

“We really don’t know what the situation is in Africa,” Raviglione said. “If multi-drug resistant TB has penetrated Africa and coincides with AIDS, there’s bound to be a disaster.”

Raviglione said it was likely that patients – and even entire outbreaks of drug-resistant TB – were being missed.

Experts also worry about the spread of XDR-TB, or extensively drug-resistant TB, a strain virtually untreatable in poor countries. When an XDR-TB outbreak was identified in AIDS patients in South Africa in 2006, it killed nearly every patient within weeks. WHO’s report said XDR-TB has now been found in 45 countries.

Globally, there are about 500,000 new cases of drug-resistant TB every year, about 5 percent of the 9 million new TB cases. In the United States, 1.2 percent of TB cases were multi-drug resistant. Of those, 1.9 percent were extensively drug-resistant.

The highest rates of drug-resistant TB were in eastern Europe. Nearly a quarter of all TB cases in Baku, Azerbaijan, were drug-resistant, followed by about 20 percent in Moldova and 16 percent in Donetsk, Ukraine, WHO said.

High rates of drug-resistant TB were also found in China and India, the world’s two most populous nations that together are home to half the world’s cases.

Drug-resistant TB arises when primary TB treatment is poor. Countries with strong treatment programs, like the U.S. and other Western nations, should theoretically have very little drug-resistant TB.

That is not the case in China, however, where the government says 94 percent of TB patients complete their first TB treatment.

“There’s a huge, gross discrepancy there if they are then reporting 25 percent of the world’s multi-drug resistant TB cases,” said Mark Harrington, executive director of Treatment Action Group, a public health think tank. “They are clearly nurturing a multi-drug resistant TB epidemic and failing to report XDR-TB at all.”

With growing numbers of drug-resistant TB patients, there is concern some national health systems will soon be overwhelmed.

“We are totally off track right now,” said Dr. Tido von Schoen-Angerer, executive director of Medecins Sans Frontiere’s Campaign for Access to Essential Medicines. He said only 30,000 multi-drug TB resistant patients were treated last year.

Experts said new drugs are needed if the outbreak is to be curbed, along with new diagnostic tests to identify drug-resistant TB strains faster – current tests take about a month for results.

WHO said a new diagnostic test able to provide results within a day is being tried in South Africa and Lesotho. If successful, the test could be introduced across Africa in a few months, though new labs would be needed to run the tests.

“Multi-drug resistant TB is a threat to every person on the planet,” Harrington said. “It’s not like HIV, where you are only infected through specific actions. TB is a threat to every person who takes a train or a plane.”

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Massachusetts Court of Appeals Rules MassHealth Must Review Payment Denial for Teenager’s HIV-Related Surgery

Posted by pozlife on February 27, 2008

three-judge panel of the Massachusetts Court of Appeals on Tuesday ruled that MassHealth, the state’s Medicaid provider, must review its decision to deny a claim filed in 2004 on behalf on a 15-year-old HIV-positive girl who underwent surgery to remove a growth on her neck caused by antiretroviral drugs, the Boston Globe reports (Ellement, Boston Globe, 2/20).
MassHealth denied authorization for the procedure shortly before it was performed on the girl, Ashley Shaw, even though her doctors said the procedure was medically necessary. According to the AP/Worcester Telegram, the growth caused abnormal posture, difficulty swallowing, back and neck pain, headaches and an inability to sleep without medication. Shaw’s, mother Elizabeth Shaw, decided to proceed with the operation and appealed the denial to MassHealth. MassHealth in a hearing later said the procedure was not a “covered procedure,” did not “meet medical necessity criteria” and was denied because it was a “(r)etroactive (r)equest.”
The court in its ruling said Elizabeth Shaw had no choice but to proceed with the operation after MassHealth’s initial denial because “no timely and reasonable alternative” was available. The court also said the case could not be considered retroactive because the initial request was made prior to the procedure and a decision was pending (LeBlanc, AP/Worcester Telegram, 2/19).
In addition, the court said the main issue in the case was not the time the request was made but whether the procedure was medically necessary and ordered MassHealth to decide the case on those grounds. Judge Elspeth Cypher in the opinion said the panel rejects MassHealth’s “view that the review of Ashley’s claim may be terminated because the procedure had been performed without authorization.”
Jennifer Kritz, a spokesperson in Massachusetts’ Executive Office of Health and Human Services, said MassHealth is reviewing the ruling and declined to comment further (Boston Globe, 2/20). Janson Wu — an attorney with Gay & Lesbian Advocates & Defenders, which argued the case on behalf of the Shaws — said the ruling is the “first time” a Massachusetts court “has ruled that MassHealth is misapplying their prior authorization regulation in this way,” adding that the agency “ignore[d] the purpose” of the regulation in denying the original request (AP/Worcester Telegram, 2/19).

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Antiretrovirals Becoming More Profitable for Pharmaceutical Industry, Los Angeles Times Reports

Posted by pozlife on February 27, 2008

 

February 22, 2008

Antiretroviral drugs are becoming a "growing profit center" for the pharmaceutical industry as treatment for HIV-positive people worldwide improves, the Los Angeles Times reports.
According to the Times, sales of antiretrovirals for Gilead Sciences, which sells antiretrovirals to about one half of all HIV-positive people taking drugs nationwide, reached $3.14 billion in 2007, an increase of 48% from 2006. Sales of all antiretrovirals are expected to increase from $6 billion in 2007 to $11 billion by 2015, according to Datamonitor.
The increase in antiretroviral profits is fueled in part by longer life expectancies for people living with HIV/AIDS and earlier treatment of the virus. HIV vaccine development has stalled and HIV/AIDS rates are increasing in some communities after being stabilized for years, the Times reports. In addition, once-daily antiretrovirals such as Truvada and Atripla have made the virus easier to treat and have helped increase treatment adherence.
According to the Times, Gilead’s success in the antiretroviral market in part is because of its "foresight" in developing once-daily medications. Atripla — which was introduced in 2006 and combines Gilead’s antiretrovirals Viread and Emtriva with GlaxoSmithKline‘s antiretroviral Sustiva — is the most prescribed medication for HIV-positive people beginning treatment in the U.S. The drug — which costs about $1,300 monthly — is expected to reach $1 billion in sales this year.
Gilead CEO John Martin said that many pharmaceutical companies were "scared off" from developing HIV treatment because of "political and assumed financial pressure." In addition, many companies did not believe antiretrovirals would be profitable because two-thirds of HIV-positive people live in developing countries in Africa, the Times reports. Homayoon Khanlou, a Los Angeles-based HIV expert, said once-daily antiretrovirals are a "milestone because of how easy they are to use." Martin added that Gilead "recognized" a "significant unmet medical need" in making HIV treatments easier to follow.
Some doctors have expressed concern that once-daily antiretrovirals could be responsible for a recent increase in cases as more people begin to view HIV/AIDS as a manageable, chronic illness. Khanlou said public health experts and the pharmaceutical industry should continue to warn people about the virus, adding, "We’ve made too much progress to start going back" (Costello, Los Angeles Times, 2/21).

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HIV and AIDs

Posted by pozlife on February 19, 2008

AIDS stands for acquired immunodeficiency syndrome, a disease that makes it difficult for the body to fight off infectious diseases. The human immunodeficiency virus known as HIV causes AIDS by infecting and damaging part of the body’s defenses against infection — lymphocytes, which are a type of white blood cell in the body’s immune (infection-fighting) system that is supposed to fight off invading germs.

HIV can be transmitted through direct contact with the blood or body fluid of someone who is infected with the virus. That contact usually comes from sharing needles or by having unprotected sex with an infected person. An infant could get HIV from a mother who is infected.

Though there are treatments for HIV and AIDS, there are no vaccines or cures for them. But there are things you can do to prevent you and your child from getting the disease.

What Does HIV Do to the Body?

The virus attacks specific lymphocytes called T helper cells (also known as T-cells), takes them over, and multiplies. This destroys more T-cells, which damages the body’s ability to fight off invading germs and disease.

When the number of T-cells falls to a very low level, people with HIV become more susceptible to other infections and they may get certain types of cancer that a healthy body would normally be able to fight off. This weakened immunity (or immune deficiency) is known as AIDS and can result in severe life-threatening infections, some forms of cancer, and the deterioration of the nervous system. Although AIDS is always the result of an HIV infection, not everyone with HIV has AIDS. In fact, adults who become infected with HIV may appear healthy for years before they get sick with AIDS.

How Common Are HIV and AIDS?

The first case of AIDS was reported in 1981, but the disease may have existed unrecognized for many years before that. HIV infection leading to AIDS has been a major cause of illness and death among children, teens, and young adults worldwide. AIDS has been the sixth leading cause of death in the United States among 15- to 24-year-olds since 1991.

In recent years, AIDS infection rates have been increasing rapidly among teens and young adults. Half of all new HIV infections in the United States occur in people who are under 25 years old; thousands of teens acquire new HIV infections each year. Most new HIV cases in younger people are transmitted through unprotected sex; one third of these cases are from injection drug usage via the sharing of dirty, blood-contaminated needles.

Among children, most cases of AIDS — and almost all new HIV infections — resulted from transmission of the HIV virus from the mother to her child during pregnancy, birth, or through breastfeeding.

Fortunately, medicines currently given to HIV-positive pregnant women have reduced mother-to-child HIV transmission tremendously in the United States. These drugs (discussed in detail in the Drug Treatments section of this article) are also used to slow or reduce some of the effects of the disease in people who are already infected. Unfortunately, these medicines have not been readily available worldwide, particularly in the poorer nations hardest hit by the epidemic. Providing access to these life-saving treatments has become an issue of global importance.

How Is HIV Transmitted?

HIV is transmitted through direct contact with the blood or body fluid of someone who is infected with the virus.

The three main ways HIV is passed to a very young child are:

  1. while the baby develops in the mother’s uterus (intrauterine)
  2. at the time of birth
  3. during breastfeeding

Among teens, the virus is most commonly spread through high-risk behaviors, including:

  • unprotected sexual intercourse (oral, vaginal, or anal sex)
  • sharing needles used to inject drugs or other substances (including contaminated needles used for injecting steroids and tattooing and body art)

In very rare cases, HIV has also been transmitted by direct contact with an open wound of an infected person (the virus may be introduced through a small cut or tear on the body of the healthy person) and through blood transfusions. Since 1985, the U.S. blood supply has been carefully screened for HIV.

Signs and Symptoms of HIV

Although there may be no immediate physical signs of HIV infection at birth, signs of the infection might appear within 2 to 3 months after a child is born. Kids who are born with HIV can develop opportunistic infections, which are illnesses that can develop in weakened immune systems, such as Pneumocystis carinii pneumonia (PCP). A child with HIV may also get more severe bouts of other common childhood infections, such as Epstein-Barr virus (EBV) infection, which generally causes mild illness in most kids. In developing countries, tuberculosis has been a particularly common problem and often the cause of death of children and adults.

A baby born with HIV infection most likely will appear healthy. But sometimes, within 2 to 3 months after birth, an infected baby may begin to appear sick, with poor weight gain, repeated fungal mouth infections (thrush), enlarged lymph nodes, enlarged liver or spleen, neurological problems, and multiple bacterial infections, including pneumonia.

Teens and young adults who contract HIV usually show no symptoms at the time of infection. In fact, it may take up to 10 years or more for symptoms to show. During this time, they can pass on the virus without even knowing they have it themselves. Once the symptoms of AIDS appear, they can include rapid weight loss, intense fatigue, swollen lymph nodes, persistent diarrhea, night sweats, or pneumonia. They, too, will be susceptible to life-threatening opportunistic infections.

Diagnosing HIV Infections and AIDS

Every pregnant woman should be tested for HIV to have a better chance of preventing transmission to her unborn child.

If a woman knows she is HIV-infected and already has children, it is recommended that all of her children be tested for HIV. Even if she has older children and they seem healthy, they could still have an HIV infection if she was HIV-positive at the time they were born. A blood test is needed to know for sure.

However, when a new baby is born to an HIV-infected mother, there is no immediate way to know whether the baby is infected with the virus. This is because if the mother is infected, an ELISA test (which checks for HIV antibodies in the blood) will almost always be positive, too. Babies will have their HIV-infected mother’s antibodies (which are passed to the baby through the placenta) even if they are not truly infected with HIV. These babies may remain HIV-antibody positive for up to 18 months after birth, even if they are not actually infected.

Infants who are not actually infected with the virus (but are born to HIV-positive mothers) will not make their own antibodies; the HIV antibodies that came from their mothers will gradually disappear from their blood before they reach 2 years of age. Any blood tests performed after this point will likely be HIV-negative. Infants who are infected with HIV from their mothers will begin to make their own HIV antibodies and will generally remain HIV-positive after 18 months of age.

The most accurate diagnosis of HIV infection in early infancy comes from tests that show the presence of the virus itself (not HIV antibodies) in the body. These tests include an HIV viral culture and PCR (polymerase chain reaction), a blood test that looks for the DNA of the virus.

Older children, teens, and adults are tested for HIV infection by an ELISA test to detect the presence of HIV antibodies in the blood. Antibodies are specific proteins that the body produces to fight infections; HIV-specific antibodies are produced in response to infection with HIV. Someone with antibodies against HIV is said to be HIV-positive. If the ELISA test is positive, it is always confirmed by another test called a Western blot. If both of these tests are positive, the patient is almost certainly infected with HIV.

Can Young Children Spread HIV?

Across the United States, there have been only a handful of reported cases where HIV infection was contagious from a child to another person. All of those cases involved direct blood contact within a household. The typical baby secretions (urine, drool, spit up, vomit, feces, etc.) do not seem to transmit the virus, so routine care of babies with HIV is considered safe.

Despite widespread concerns, there are no reported transmissions of HIV within a school or child-care setting. Because the danger in transmitting HIV involves direct contact with blood, personnel at schools and child-care programs should routinely use gloves when any child has a cut, scrape, or is bleeding.

Transmission of HIV Among Teens

Among teens, HIV is spread mostly through unprotected sex with an infected person or sharing intravenous drug needles. Education of children and teens is vitally important to help prevent sexual transmission of HIV, as well as other sexually transmitted diseases (STDs), including chlamydia, genital herpes, gonorrhea, hepatitis B, syphilis, and genital warts. Many STDs cause irritation, sores, or ulcers of the skin and mucous membranes that the virus can pass through. Having an STD, such as genital herpes, for example, has been proven to increase a person’s risk of getting HIV if he or she has unprotected sex with someone who is HIV-positive.

HIV is not spread through:

  • casual contact, such as hugs or handshakes
  • drinking glasses
  • sneezes
  • coughs
  • mosquitoes or other insects
  • towels
  • toilet seats
  • doorknobs
Opportunistic Infections

Opportunistic infections (infections that take advantage of a person’s weakened immune system) are the most common complication of HIV/AIDS. Sometimes adults with HIV/AIDS can get an infection from germs that do not normally cause illness in a healthy person (like cryptococcus). People with AIDS (especially children) can get a severe version of a more common infection, such as salmonella (a type of diarrhea-causing bacteria) and chickenpox.

In kids with HIV, the following opportunistic infections and conditions can frequently occur:

  • viral infections like a form of chronic walking pneumonia called lymphoid interstitial pneumonia (LIP), herpes simplex virus, shingles, and the cytomegalovirus infection
  • parasitic infections such as PCP, a pneumonia caused by Pneumocystis carinii, a microscopic parasite that can’t be fought off due to a weakened immune system, and toxoplasmosis
  • serious bacterial infections such as bacterial meningitis, tuberculosis, and salmonellosis
  • fungal infections such as esophagitis (inflammation of the esophagus), and candidiasis or thrush (yeast infection)
Other Complications

Children with HIV are also at higher risk for some forms of cancer because of their weakened immune systems. Lymphomas associated with Epstein-Barr virus (EBV) infection are more common in older kids with HIV.

The most difficult conditions to treat in kids who have HIV or AIDS are the wasting syndrome (the inability to maintain body weight due to long-term poor appetite and other infections related to HIV disease) and HIV encephalopathy (due to HIV infection of the brain that causes swelling and then damage to the brain’s tissues over time). HIV encephalopathy results in AIDS dementia, especially in adults. Wasting syndrome can sometimes be helped with nutritional counseling and daily high-calorie supplements, but preventing HIV encephalopathy remains extremely difficult.

Treating AIDS and HIV

Two major advances in the treatment of HIV/AIDS have occurred over the last 20 years. One is the development of drugs that inhibit the virus’s growth, preventing or delaying the onset of AIDS and allowing people living with HIV to remain free of symptoms longer. The other is the development of medications that have proven very important in reducing the transmission of the virus from an HIV-infected mother to her child.

Drug Treatments

As medical understanding about how the virus invades the body and multiplies within cells has increased, drugs to inhibit its growth and slow its spread have been developed. Drug treatment for HIV/AIDS is complicated and expensive, but highly effective in slowing the replication (reproduction) of the virus and preventing or reducing some effects of the disease.

Drugs to treat HIV/AIDS use at least three strategies:

  1. interfering with HIV’s reproduction of its genetic material (these drugs are classified as nucleoside or nucleotide anti-retrovirals)
  2. interfering with the enzymes HIV needs to take over certain body cells (these are called protease inhibitors)
  3. interfering with HIV’s ability to pack its genetic material into viral code — that is, the genetic “script” HIV needs to be able to reproduce itself (these are called non-nucleoside reverse transcriptase inhibitors [NNRTIs])

Because these drugs work in different ways, doctors generally prescribe a “combination cocktail” of these drugs that are taken every day. This regimen is known as HAART treatment (HAART stands for highly active antiretroviral therapy). Doctors may also prescribe drugs to prevent certain opportunistic infections — for example, some antibiotics can help prevent PCP, especially in kids.

Although a number of medicines are available to treat HIV infection and slow the onset of AIDS, unless they are taken and administered properly on a round-the-clock schedule, the virus can quickly become resistant to that particular mix of medications. HIV is very adaptable and finds ways to outsmart medical treatments that are not followed properly. This means that if prescribed medicines are not taken at the correct times every day, they will soon fail to keep HIV from reproducing and taking over the body. When that happens, a new regimen will need to be established with different drugs. And if this new mix of medicines is not taken correctly, the virus will likely become resistant to it as well and eventually the person will run out of treatment options.

Aside from the difficulty of getting young children to take their medication on a timed schedule, the medications present other problems. Some have unpleasant side effects, such as a bad flavor, whereas others are only available in pill form, which may be difficult for kids to swallow. Parents who need to give their child these medications should ask the doctor or pharmacist for suggestions on making them easier to take. Many pharmacies now offer flavoring that can be added to bad-tasting medicines, or your doctor may recommend mixing pills with applesauce or pudding.

Because the number of drugs described above is still limited, doctors are concerned that if children fail to take their medicines as prescribed (even missing just a few doses), the virus could eventually develop resistance to existing HIV drugs — making treatment difficult or impossible. It is then doubly important that kids take their medications as directed. One of the most important home treatment messages for any parent or caregiver that the child should take all medications consistently, at the time the prescription indicates. This can be difficult — but many HIV/AIDS family support groups and experienced medical providers can help families with practical suggestions to help them be successful with the many day-to-day challenges they face.

Many of the new medications that fight HIV infection are expensive. One of the major challenges facing individuals, families, communities, and nations is how to make these medications easily available to all that need them.

Preventing Mother-to-Child Transmission of HIV

When a pregnant HIV-infected woman receives good medical care early and takes antiviral medications regularly during her pregnancy, the chance that she will pass HIV to her unborn baby is dramatically reduced.

It is important that any pregnant woman who knows she is HIV-positive start prenatal care as soon as possible to take full advantage of such treatments. The sooner a mother receives treatment, the greater the likelihood her baby will not get HIV.

An HIV-infected mother can receive medical treatment:

  • before the birth of her baby: antiviral treatments given to the mother in the third trimester can help prevent HIV transmission to the baby
  • at the time of birth: antiviral medications can be given to both the mother and the newborn child to lower the risk of HIV transmission that can occur during the birth process (which exposes the newborn to the mother’s blood and fluids); in addition, the mother will be encouraged to formula-feed rather than breastfeed because HIV can be transmitted to her baby through breast milk
  • during breastfeeding: because breastfeeding is discouraged among HIV-infected mothers, this type of transmission is rare in the United States. However, in places in the world where formula is not readily available, both the mother and child can be treated with medication to lower the risk of the HIV infection to the breastfeeding child.

In the past, before antiviral medicines were routinely given, almost 25% of children born to HIV-infected mothers developed the disease and died by 24 months of age. Recent studies have shown that mothers with HIV or AIDS who get good prenatal care and regularly take antiviral drugs during their pregnancy now have less than a 5% chance of passing HIV to their babies. If these babies do get the HIV virus, they tend to be born with a lower viral load (less HIV virus is present in their bodies) and have a better chance of long-term, disease-free survival.

Long-Term Care of Kids With HIV/AIDS

Cases of HIV infection and AIDS in children are complicated and should be managed by experienced health care professionals. Kids will need to have their treatment schedules closely monitored and adjusted regularly. Any infections that could become life threatening must be quickly recognized and treated.

Medicines are adjusted in relation to the child’s viral load. The child’s health is also monitored by frequent measurement of T-cell levels because these are the cells that the HIV virus destroys. A good T-cell count is a positive sign that medical treatments are working to keep the disease under control.

Children will need to visit their health care providers often for blood work, physical examinations, and discussions about how they and their families are coping socially with any stress from their disease. Some immunizations during routine visits may be slightly different for infants or children with HIV/AIDS. A child whose immune system is severely compromised will not receive live virus vaccines including measles-mumps-rubella and varicella (chickenpox). All other routine immunizations are given as usual, and a yearly influenza vaccine (flu shot) is recommended as well.

If a family seeks health care in a hospital emergency department, parents should be sure to tell the nurse who registers the child that the child has HIV. This will alert medical caregivers to look closely for any signs of diseases from opportunistic infections and provide the best possible treatment.

Outlook for HIV and AIDS

There is no known cure for HIV or AIDS. Children who acquire HIV at birth develop AIDS sooner and tend to have more serious complications than adults with the virus.

Although all children, teens, and adults with HIV will eventually become sick, recent medical advances have significantly improved their chance for survival. Drug treatments can allow people living with HIV to remain free of symptoms for longer and can improve quality of life for people living with AIDS.

Preventing HIV and AIDS

Prevention of HIV remains of worldwide importance. Despite much research, there is no vaccine that will prevent HIV infection. Only the avoidance of risky behaviors can prevent HIV infection. Among U.S. teens and adults, HIV transmission is almost always the result of sexual contact with an infected person or sharing contaminated needles. Infection can be prevented by never sharing needles, and abstaining, or not having oral, vaginal, or anal sex.

Risk can be substantially reduced by always using latex condoms for all types of sexual intercourse, and avoiding contact with the blood, semen, vaginal fluids, and breast milk of an infected person.

Avoidance of alcohol and drugs is also key in preventing the spread of HIV — not because a person can get HIV directly from drinking and doing drugs, but because drinking and drug use often leads to risky behaviors that are associated with an increased risk of infection (such as having unprotected sex and sharing needles).

The most important means of preventing HIV/AIDS in infancy is to test all pregnant women for the virus. If the result is positive, treatment can immediately begin before the baby is born to prevent HIV transmission.

Talking With Kids About HIV and AIDS

Talking about HIV and AIDS means talking about sexual behaviors — and it’s not always easy for parents to talk about sexual feelings and behavior with their kids. Similarly, it’s not always easy for teens to open up or to believe that issues like HIV and AIDS can affect them.

Doctors and counselors suggest that parents become knowledgeable and comfortable discussing sex and other difficult issues early on, even before the teen years. After all, the issues involved — understanding the body and sexuality, adopting healthy behaviors, respecting others, and dealing with feelings — are topics that have meaning at all ages (though how parents talk with their children will vary according to the child’s age and ability to understand). Open communication and good listening skills are vital for parents and kids.

Schools can help. Every state requires schools to provide age-appropriate information about HIV/AIDS that has been designed to educate kids about the disease. Studies show that such education makes a tremendous difference in stopping risk-taking behavior by young people.

Parents who are well informed about how to prevent HIV and who talk with their children regularly about healthy behaviors, feelings, and sexuality play an important part in HIV/AIDS prevention.

Reviewed by: Cecilia DiPentima, MD
Date reviewed: October 2007

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AIDS Symptoms : Symptoms of AIDS

Posted by pozlife on February 19, 2008

HIV virus causing AIDS enters the blood and quickly penetrates white cells. Then they program the white cells, after which there is often little or no trace of the AIDS virus at all. This situation usually lasts for six to twelve weeks. During this time the person is free of HIV or AIDS symptoms and antibody tests for AIDS and HIV are negative.

First Symptoms of AIDS Illness (HIV Infection)
First thing that starts developing in a flu like illness, which may look like glandular fever with swollen glands in the neck and armpits. At this stage the blood test will usually become positive as it picks up the tell-tale antibodies. Most people do not realise what is happening, although when they later develop AIDS they look back and remember it clearly. Most people have produced antibodies in about twelve weeks.

Latent infection
The person in this stage has a positive HIV test. The virus often seems to disappear completely from the blood again. At least nine out of ten who see these HIV and AIDS symptoms will develop further problems.

San Francisco studies show that in developed countries, without use of the latest therapies:

  • 50% with HIV develop AIDS in ten years
  • 70% with HIV develop AIDS in fourteen years
  • Of those with AIDS, 94% are dead in five years

The next HIV AIDS symptoms stage begins when the immune system starts to break down. This is often preceded by subtle mutations in the virus, during which it becomes more aggressive in damaging white cells. Several glands in the neck and armpits may swell and remain swollen for more than three months without any explanation. This is known as persistent generalised lymphadenopathy (PGL).

Early HIV Virus Progression
As the HIV disease progresses, the person starts showin up other AIDS symptoms. A simple boil or warts may spread all over the body. The mouth may become infected by thrush (thick white coating), or may develop some other problem. Dentists are often the first to be in a position to make the diagnosis. People may develop severe shingles (painful blisters in a band of red skin), or herpes. They may feel overwhelmingly tired all the time, have high temperatures, drenching night sweats, lose more than 10% of their body weight, and have diarrhoea lasting more than a month. No other cause is found and a blood test will usually be positive. Some used to call this stage ARC, or AIDS related complex.

Late HIV Illness – The AIDS Symptoms
The final stage is AIDS. Most of the immune system is intact and the body can deal with most infections, but one or two more unusual infections become almost impossible for the body to get rid of without medical help, usually intensive antibiotics.

These infections can be a nightmare for doctors and patients. The desperate struggle is to find the new germ, identify it, and give the right drug in huge doses to kill it. The germ may be hiding deep in a lung requiring a tube (bronchoscope) to be put down the windpipe into the lung to get a sample. The person is sedated for this. It may be hiding in the fluid covering the brain and spinal cord, requiring a needle to be put into the spine (lumbar puncture). It may be hiding in the brain itself. It may hide in the liver or gall-bladder or bowel. It can hide anywhere.

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San Diego Health Officials Launch Ad Campaign to Stem Rise in Syphilis, Other STIs

Posted by pozlife on February 19, 2008

 

February 15, 2008

San Diego County health officials on Thursday launched a radio and television ad campaign that aims to stem the rise of syphilis and other sexually transmitted infections, the San Diego Union-Tribune reports. According to CDC, the number of new syphilis cases recorded in the county increased 800% from 2001 to 2006, compared with the national increase of just 60% during the same time.
The county’s annual number of new syphilis cases increased from 23 in 1997 to 312 in 2007. According to county health officials, the annual number of chlamydia cases also increased from 10,249 in 2003 to 12,796 in 2007. The number of annual gonorrhea cases increased from 1,972 to 2,403 during the same time frame. According to the Union-Tribune, it is unclear what caused the increases. County and federal health officials in November 2005 discussed the possibility that the increase in STIs might be caused by a practice called “serosorting,” in which HIV-positive men have unprotected sex with other HIV-positive men.
Health officials also said that complacency might be a variable among men who have sex with men who have unprotected sex. “A possible explanation for the increase … could be that patients are not forthcoming about their sexual practices, making it difficult for their health providers to order appropriate tests,” county health officials said in a statement released Wednesday. According to 2005 statistics, about eight in 10 syphilis cases in San Diego County were among MSM, compared to about six in 10 nationally (Clark, San Diego Union-Tribune, 2/14).

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