Fw: Hot Topics at The Body’s “Ask the Experts” Forums

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LIVING WITH HIV/AIDS
 Which Kind of Vitamin D Should I Take?
I know that it’s important for HIVers to take vitamin D supplements if their levels are low. Are there different forms of vitamin D; and if so, which one is best at raising blood levels of this vitamin?

 Are Diet Soft Drinks Better for Me Than the Sugary Kind?
I drink a lot of water each day; however, I also consume about four 12-ounce soft drinks per day. A few years ago I switched to diet soft drinks. I lost 10 pounds from that switch, but I craved sweets and gained back the 10 pounds plus about 10 more, so I switched back to regular soft drinks. I’ve been reading about how diet drinks are bad for our bodies, and may be even worse for us HIVers. What do you think? Do you have any ideas for alternatives to soft drinks?
BODY SHAPE CHANGES & HIV/AIDS
 What Do You Know About Treatments for Lipohypertrophy?
I am dealing with a case of lipohypertrophy (fat gain). It seems whenever I research body shape changes, all I find is information about lipoatrophy treatments. Are there any successful treatments for visceral fat gain in HIVers? Wasn’t the U.S. Food and Drug Administration about to approve a drug to treat this condition? What’s going on with that?


 What Are the Challenges to Using Silicone to Treat Buttock Lipoatrophy?
As an alternative to PMMA (polymethyl-methacrylate, also known as Articol, Artefill or Metacrill) to treat my buttock wasting, my plastic surgeon suggested we use Sculptra (poly-L-lactic acid, New-Fill) with silicone — the same concoction he’s used to plump up my face three times so far, with good results. Do you see any problems with this approach?
TRANSMISSION OF HIV & HEPATITIS
 Two Poz Partners, One With Hepatitis C: What’s the Concern in Sex Without Condoms?
I’m HIV positive, and my partner has HIV as well as hepatitis C. My CD4 count is 550 and his is 540; we both have HIV-1. We’re very much in love and we’d like to have sex with no condoms, but my partner is scared of passing hep C to me. Doesn’t my having been vaccinated against hepatitis for the past eight years — and the fact that my partner’s hep C has been dormant for two years — put me at less risk of acquiring that virus?

 Are HIV Test Results Reliable While Taking PEP?
I accidentally had unprotected sex with a stripper. Though I ended up contracting a sexually transmitted disease from this encounter, I’d gone on post-exposure prophylaxis with AZT (zidovudine, Retrovir) within three hours of my exposure, and added Viread (tenofovir) within 12 hours. I had two negative PCR test results within 28 days of the exposure; and a third PCR test, along with an HIV antibody test, came back negative at 61 days. How reliable are all these test results?

Also Worth Noting: Visual AIDS
Image from the October 2010 Visual AIDS Web Gallery
“A Day in The Life,” 2001; Curtis Carman

Visit the October 2010 Visual AIDS Web Gallery to view our latest collection of art by HIV-positive artists! This month’s gallery, entitled "OSC: Obsessive Sex Collecting," is curated by Sarah Forbes.

HIV/AIDS TREATMENT & SIDE EFFECTS
 Is Truvada Truly Dangerous for HIVers’ Kidneys?
I’m about to start taking Norvir (ritonavir), Reyataz (atazanavir) and Truvada (tenofovir/FTC), but I’ve been hearing a lot lately about kidney issues with the Viread (tenofovir) in Truvada. How common are kidney issues on this med — and among HIVers in general? Is the potential damage reversible? Are there signs or symptoms to watch out for once I start Truvada? Which lab tests should I take to monitor my kidney function?

 Recent Israeli Study Involving Viral Genes: Big News for HIVers?
Can you explain a bit about the recent report by Israeli researchers studying a treatment that could potentially work alongside effective HIV meds, killing leftover viral genes inside cells once the meds have suppressed HIV? Is this big news in the treatment of HIV?

 Could My HIV Meds Cause Eczema?
I’ve been on HIV meds since 1985 and taking Trizivir (AZT/3TC/abacavir) for almost a decade. My viral load is undetectable and my CD4 count is about 300. For the last three years I’ve suffered from chronic eczema (dry skin). My dermatologist thinks my HIV meds are the cause, but my HIV doctor disagrees and won’t put me on other meds. What do you think?

More Questions About HIV/AIDS Treatment & Side Effects:

OTHER HEALTH ISSUES & HIV/AIDS
 If My HIV Is Stable, Why Am I Always Sick?
I’m 15 years old, I was born HIV positive and I take Combivir (AZT/3TC) and Sustiva (efavirenz, Stocrin). My last four lab results showed CD4 counts of 630, 580, 487 and now 502. I went from undetectable to a viral load of 620. I’m also sick a lot (colds, bladder infection, thrush, etc.). I feel like everyone tells me everything’s OK just to keep me happy but I want to know the truth: Do you think I’m becoming resistant to my meds? Why am I always sick?

 What Effect Does Testosterone Supplementation Have on the Prostate?
I’m 50 years old and I just started using testosterone gel. My friends have been telling me to be careful of prostate cancer, and now I’m afraid. What can testosterone use do to a person’s prostate?

 Knocked Out by the Common Cold: A Multiple-Choice Question
I’m 45 years old and have been HIV positive for five years. I’ve been taking Atripla (efavirenz/tenofovir/FTC) for about two and a half years, my viral load is undetectable and my CD4 count is in the low 600s. I usually feel great and only get colds and such a couple of times a year, but when I do get sick it knocks me on my butt for several days. Do you think this is a side effect of HIV, my meds, aging — or none of the above?

More Questions About Other Health Issues & HIV/AIDS:

Connect With Others The Person Who Infected Me Has Been Arrested: Should I Come Forward Too?
(A recent post from the "Gay Men" board)

Five years ago I was infected by someone who I initially had consensual sex with. After the consensual sex I was forcibly raped by this person who knew full well he was infected. I found out I was infected shortly thereafter.

Today I was reading some old news articles and saw that the person who did this to me was arrested and has been charged with knowingly infecting some other people this year.

Should I come forward? God if I came forward then could I have stopped this person? Now what good will me coming forward five years later be? … I don’t hate this person but I have anger and I’m sick that he has been doing this for five years to others. The only positive I could see of me coming forward would be to make sure this person is stopped from doing what he has been doing but maybe those who have come forward now will be enough …

I’ve come to terms with my diagnosis and I guess accepted my responsibility in the whole ordeal. I’m just really in shock right now and don’t know what to do. Can anyone offer any advice or maybe shed some light on something I haven’t seen? — livesinadream

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NEWS & VIEWS
 Why Is HIV Testing Not Required Worldwide?
As the three-month mark for my post-exposure HIV test draws near, one question’s been bugging me: Why is HIV testing not yet compulsory? Are there certain countries where it is? That method might encourage people to talk more about HIV, and it would become a more “normal” illness for people who might otherwise think they can only get HIV from having sex with “dodgy” people, as many still foolishly believe. Do you think required HIV testing would be a good approach to eradicating HIV worldwide?
STRANGE BUT TRUE
 Dangers of the Gag Reflex: Can Barf on My Penis Transmit HIV?
What are the chances of getting HIV if a female vomits on your penis during oral sex?

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Activist Central
 Women With HIV Deserve Abortion Coverage: Tell the White House!

 Join a Facebook and Twitter Campaign to Fight NY Gov. Paterson’s Rent Cap Veto!

 NIAID to Host Public Meeting on Future HIV/AIDS Research Networks

 Action Alert: Say NO to Abstinence-Only Sex Education

 President Obama: Address the ADAP Crisis!

 NMAC Asks for Your Help Ending S.B. 1070; Promoting Comprehensive Federal Immigration Reform

At the End of Your Rope?

October / November 2010

At the End of Your Rope?

by Tim Murphy

Ironically, the success of today’s antiretroviral treatments has hindered the development of new options for longtime survivors with drug-resistant HIV.

Chad Kenney, 56, was always aggressive when it came to his HIV treatment. Shortly after his 1987 diagnosis, the Denver native started a treatment newsletter, Resolute, that quickly became a survival guide for people living with HIV/AIDS in Colorado. He was always game to try to raise his CD4 levels with the latest drug (they’ve never been above the 400s), whether it was Retrovir, the first HIV med; Compound Q, a failed hope; or the very first protease inhibitor. He remembers attending a lecture in the late ’80s given by the late legendary treatment activist Martin Delaney. “[Delaney] asked, ‘If you had a diagnosis of cancer, would you wait and see if it got worse [before] you started 
to treat it?’” remembers Kenney. “So I decided that I was going to try whatever agent I could find [to fight my HIV].”

But what neither Kenney nor HIV experts knew at the time was that adding just one new drug to a failing HIV regimen is usually not enough to quash viral replication. And, doing so often leads to the rapid development of HIV resistance to one new drug after another.

An accumulation of drug-resistant mutations certainly hasn’t made things easy for Kenney. Despite using a power regimen consisting of Truvada, Isentress and Selzentry, his viral load stayed in the hundreds of thousands.

It was only when he added another new drug, Prezista, that his CD4 cell count rose to 145 and his viral load fell to 69—just above the “undetectable” viral load threshold.

He’s hoping these numbers will stick, if not improve. “I’ve lived with uncertainty for a long, long time,” he says, “so I try not to ride an emotional roller coaster.” But the scary truth is, if his viral load creeps back up, there’s no new HIV drug on the market he can add to his regimen.

Just five years ago, tens of thousands of HIV treatment veterans were in the same boat Kenney finds himself in today. The volume of people facing treatment failure was enough to spur drug companies to develop a new wave of antiretrovirals strong and innovative enough to keep drug-resistant HIV in check. Many of those drugs on the market today—including Aptivus, Fuzeon, Intelence, Isentress, Prezista and Selzentry—have lowered the number of people with HIV who are fully resistant to treatment. Based on most good accounts, there are just a few thousand such people nationwide.

Good news, unless you are a member of this large handful of people—which is expected to grow in size in the future—who still need new options. The number of patients who currently need resistance-busting antiretrovirals is so small that pharmaceutical drug companies have little financial incentive to invest the billions of dollars arguably necessary to develop new drugs, including entirely new classes of compounds.

“HIV drug development is about to come to a halt,” says Jay Lalezari, MD, a San Francisco HIV doc who works on creating new HIV drugs and says that of 1,000 patients in his HIV practice, only about 40 “are waiting for something better to come along.”

Nelson Vergel, a longtime HIV survivor in Houston, only recently got his viral load undetectable, thanks to TaiMed Biologics’ experimental drug ibalizumab (TMB-355). He has devoted his life to finding similarly situated patients and connecting them with the trial drugs they need to suppress their HIV.

During the past 15 years, new options continued to come along for survivors like himself. But today? “They’re in deep shit,” Vergel says. “I’m really angry.”

Why angry? For one thing, the current drugs keeping millions of people alive were tested on the very folks who currently need, or may soon need, new treatment options. “The drug industry owes them a big debt,” says Steven Deeks, MD, another San Francisco HIV doc who works on the issue of drug resistance. “We should not forget this generation of people living with HIV,” he says, adding that we need to provide them with new drugs as soon as possible.

The current pipeline, however, has only a few contenders. Two notable hopefuls: the aforementioned ibalizumab, which blocks a key protein on CD4 cells so HIV can’t bind to it, is gearing up for Phase III studies; and GlaxoSmithKline’s S/GSK-572, which is currently in Phase II studies and shows some promise for folks who’ve developed resistance to Merck’s first-generation integrase inhibitor Isentress.

In recent months, two other experimental HIV drugs—Avexa’s apricitabine and Myriad Genetics’ bevirimat—were shelved. Both were casualties of weak early test results and lack of a profit motive.

In a unique activist-doctor partnership, Vergel, Deeks and Lalezari are working with the developers of TMB-355 and S/GSK-572, as well as with the U.S. Food and Drug Administration, on a program to enable patients who really need new options to go on both drugs simultaneously, before the FDA approves them, to beef up the chance of success. They hope this program will launch by mid-2011.

Kenney, who takes a fistful of meds three times a day, says he’ll only sign up for the new drug program if his current regimen doesn’t hold out, but he’s hoping it does. Meanwhile, life goes on. And though he and others like him may dream of “undetectable,” their lab numbers don’t necessarily reflect how they feel day to day.

Many patients with no options left remain in good health, living functional lives despite low CD4 counts and high viral loads. The trick, it seems, is to stay on the best HIV regimen possible rather than going off HIV meds completely. (See “Safety Nets” on page 18.) Lalezari mentions a patient who’s had one CD4 cell for the past five years. “Somehow the lethality of the virus has been weakened by all the drugs he’s on,” he says, adding that lab CD4 counts are a weak marker of immune health because they detect only CD4s circulating in blood, not in lymph tissues and other compartments.

Kenney hopes to visit his boyfriend this winter in Thailand. For now, he hits the gym daily and eats healthy. And there’s love in his life in Denver. “My brother lives two blocks away, and I have friends that go back more than 20 years,” he says. And at day’s end? “My 7-year-old Lab retriever, Kasandra, sleeps on my bed. She’s very, very affectionate—and incredibly demanding!” Sounds a bit like her owner.

Safety Nets
Detectable virus doesn’t mean doom! Here’s how to survive and thrive at the end of your treatment rope while waiting for new options.

DETECTABLE? KEEP TAKING YOUR MEDS!
Research shows that people with multidrug-resistant virus and detectable viral loads do better when they stay on their “failing” HIV meds rather than going off them. Talk to your doctor about finding the best regimen possible. And it’s OK to ask for a second opinion. The indefatigable Nelson Vergel can put you in touch with an expert in your area.

SUPPRESS YOUR HERPES
If you have genital herpes (HSV-2), stick to your anti-herpes meds like acyclovir or talk to your provider about taking it. Research shows these meds also help reduce HIV viral load.

USE CONDOMS
It’s important to use condoms to avoid contracting sexually transmitted infections, because getting STIs can inflame your immune system and make your HIV viral load go up. You’ll also want to protect your partners from drug-resistant HIV.

LIVE WELL
Eat right, exercise, take quality vitamins and reduce stress with yoga, acupuncture, support groups, a pet—whatever works for you. “Keep a positive outlook,” Vergel says. He should know—he’s had detectable virus most of his 27 years with HIV, and he’s still going strong!

PLUG IN TO FUTURE RESEARCH
Connect with Vergel at salvagetherapies.org or e-mail him directly at nelsonvergel@yahoo.com. He’s your link to the latest resources for folks seeking new options.

Search aidsmeds.com and clinicaltrials.gov for the latest updates on experimental drugs ibalizumab, S/GSK-572 and other agents making their way into clinical trials. 


Fw: HIV and Aging: Advocates Push for More Research

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From: AIDSmeds <news@aidsmeds.com>
Date: Wed, 6 Oct 2010 10:09:16 -0400
To: <nelsonvergel@yahoo.com>
Subject: HIV and Aging: Advocates Push for More Research

AIDS Meds: Founded & Operated by People with HIV

Web Exclusive

Race Against Time:
Activists Call for More Research on Aging and HIV


With the ranks of HIV-positive people older than 50 growing rapidly, AIDS activists with the Coalition for HIV and Aging Research and Policy Advocacy (CHARPA) are demanding that the National Institutes of Health (NIH) devote more attention and resources to the issue of aging and HIV. Will the NIH respond, and will it respond in time? Pipeline Problems

Treatment News


October 05, 2010
NIH Licenses Generic Prezista to Medicines Patent Pool
The National Institutes of Health (NIH) has become the first patent holder to join the Medicines Patent Pool, PlusNews reports. 
Vaccine Achieves “Functional Cure” in Monkeys
The monkey version of a therapeutic vaccine by VIRxSYS Corporation achieved a “functional cure”—fully controlling simian immunodeficiency virus (SIV) production and halting disease progression in a subset of vaccinated monkeys.
October 04, 2010
Herpes Vaccine Found Ineffective
An experimental vaccine failed to protect HIV-negative women from developing genital herpes, according to a statement by the National Institute of Allergy and Infectious Diseases (NIAID), which helped conduct the clinical trial.
October 01, 2010
Recommendation: Test All HIV-Positive Men 50 and Older and All Post-Menopausal Women for Bone Loss
All post-menopausal women living with HIV and all HIV-positive men 50 or older should be screened for low bone mineral density (BMD), according to new guidelines published in the October 15 issue of Clinical Infectious Diseases (CID). The guidelines, authored by experts in the field of HIV medicine and metabolic issues, also highlight the need for aggressive workups to determine underlying causes of reduced BMD, while also providing guidance on treatment and preventive care.
September 29, 2010
New Study on Brain Disorders and HIV:
What Does it Mean?

Though neurological disorders are common in people with HIV—one in four has a disorder—and are associated with an increased risk of death, a history of an AIDS diagnosis appears to be the most important factor associated with these problems, a new study reports. What’s more, HIV-positive people can potentially avoid these problems by starting antiretroviral (ARV) treatment before their CD4 counts are depleted. These data, which also show signs of improvement with respect to certain neurological disorders in recent years, were published online August 24 in the journal Neurology.

Heard in the Blogs
Jay's BlogFrom Jay Vithalani’s Blog

First Words

Nabokov once said that Mnemosyne, the muse of memory, was a very careless girl. Which is a fancy though beautiful way of saying that memories, and the stories we tell and re-tell based on these, are notoriously prone to error. So, apply the caveats by all means; I do. Nevertheless, certain snapshots from my past are incredibly vivid to me, and it would take a pretty powerful psychic crowbar to prise them from my head. Read more and post a comment…

Click hereClick Here

Tim's BlogFrom Tim Horn’s Blog

Wishing on the "C" Word

For so many different reasons – past disappointments, scientific knowledge of HIV’s recalcitrant ways; not to mention a conspiracy theory or two – many of us have pretty much abandoned hope that HIV can, in fact, be cured. I’ve been involved in HIV/AIDS treatment education and advocacy for a lot of years and, like numerous colleagues, have found myself focusing instead on arguably less lofty accomplishments: the development of new antiretrovirals that work a bit better, are somewhat less toxic or easier to take than currently available agents; data further pinpointing the ideal time to begin or switch treatment; and public policy changes that will potentially improve access to care nationally and globally. All important, yes… but hardly the earth-shattering and epidemic-ending stuff we’ve been silently waiting for. Read more and post a comment…

Heard in the Forums

Hi all… I have been taking reyataz, truvada and norvir for about 2 years. Someone told me they can keep you awake so I switched to taking them in the am (Im a terrible insomniac) but I wonder if they are lending to some of my difficulty concentrating or memory lapses during the day. Has anyone heard of this combo causing either the insomnia or daytime fuzziness? I checked my "side effects" paperwork for the drugs but they are pages and pages. —dbsd222’s "Time of day for meds"
 

 

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Fw: Hot Topics at The Body’s “Ask the Experts” Forums

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From: “News at The Body” <update@news.thebody.com>
Date: 05 Oct 2010 12:17:12 -0400
To: <nelsonvergel@yahoo.com>
ReplyTo: “News at The Body” <update@news.thebody.com>
Subject: Hot Topics at The Body’s “Ask the Experts” Forums

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LIVING WITH HIV/AIDS
 How Can I Raise My Levels of “Good Cholesterol”?
My “bad cholesterol” (low-density lipoprotein, or LDL) is low, but so is my “good cholesterol” (high-density lipoprotein, or HDL), and it’s been that way for a while. What does HDL do, and what steps can I take to increase my HDL level?

 Why Does the AIDS Diagnosis Stick, Even When an HIVer’s Condition Improves?
If a person’s CD4 count bounces back up above 200, or they beat an opportunistic infection, they’re still considered to have AIDS. Why is that? Why, when I haven’t had an AIDS-related illness in 17 years and my CD4 count is 920, do I still have an AIDS diagnosis when I simply have HIV disease?
MIXED-STATUS COUPLES
 My Partner Loves Poppers: Are They Risky for Me?
I’m HIV positive, my partner is negative and we practice safe sex. My partner loves poppers and other inhalants. I don’t care for them but when we get “rough and tumble” he pulls them out. I figure that whatever he’s inhaling, so am I, so I’m wondering how safe inhalants are for HIV-positive folks. Do you have any information about this?


 Blow Job With Bleeding Gums During PEP: Should I Extend My Course?
I had a case of broken condom with my HIV-positive boyfriend. I immediately started on post-exposure prophylaxis (PEP) with Atripla (efavirenz/tenofovir/FTC), which is what my boyfriend takes. Ten days into PEP, he performed oral sex on me, and the next morning we discovered that his mouth was bleeding and that my penis had come in contact with his blood. Should I take PEP for 10 more days (38 total)?

Also Worth Noting: Visual AIDS
Image from the October 2010 Visual AIDS Web Gallery
“Untitled (Physician Desk Ref. #1),” 1993; Gin Louie

Visit the October 2010 Visual AIDS Web Gallery to view our latest collection of art by HIV-positive artists! This month’s gallery, entitled "OSC: Obsessive Sex Collecting," is curated by Sarah Forbes.

BODY SHAPE CHANGES & HIV/AIDS
 Does Medicaid Cover Lipoatrophy Treatments As Well As Medicare?
If treatment for facial wasting is now supposed to be covered by Medicaid, why do all my doctors say they know nothing about it?

 What’s the Next Step in Making Sure Medicare Makes Facial Fillers More Accessible?
I consulted with a trusted specialist who told me she doesn’t know of any plastic surgeons or dermatologists in our state that even accept Medicare. Why don’t doctors want to accept Medicare for facial fillers, and what would need to happen to make them more willing?
HIV TRANSMISSION & TESTING
 Now That My Partner and I Are Both HIV Positive, Do We Still Need to Use Condoms?
I was recently diagnosed with HIV, which I contracted through unprotected sex with my partner (I’ve known he was positive since before we were in a relationship). Now that we are both positive, is it still necessary to use condoms? I understand the potential risk of reinfection if I have unsafe sex with another positive person, but what if it’s the person whose virus I was initially infected with?

 Is the Blood Donation Center Telling Me I’m HIV Positive?
I donated blood earlier this year. After some time I received a letter from the blood donation center telling me that I could no longer donate blood because I had a “reactive” result on my specimen. Does this mean I’m HIV positive? What should I do next?
HIV/AIDS TREATMENT
 What’s Up With the Study of Cancer Drugs to Treat HIV?
I heard about a recent study using two cancer drugs to effectively force the HIV virus to mutate itself to death, or so the article I read said. Are there further studies in the works to see how this information could be used to treat or even cure HIV?

 Do HIV Meds Affect Digestion?
Does taking HIV meds have an effect on the way a person’s body digests food?

 Are There Any Interactions Between Cocaine and HIV Meds?
I have a client who’s taking Intelence (etravirine), Isentress (raltegravir), Norvir (ritonavir) and Prezista (darunavir) and also uses cocaine. Are there serious interactions between coke and these HIV meds? What other issues should I consider as a clinician?

More Questions About HIV/AIDS Treatment:

Connect With Others Just Diagnosed and Feeling the Need to Share
(A recent post from the "I Just Tested Positive" board)

I am positive. It’s a very terrible thing that I never ever imagined in my life. I don’t know what I should do now. I do not believe much in the treatment in my country, but I know I have to do anything I can to make my life last the longest that it could. For anyone with a project in Viet Nam, or just some kind words to help me, please answer me! I need to see the light so I can have hope. — PeacePhan

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OTHER HEALTH ISSUES & HIV/AIDS
 Never Finished My Course of Syphilis Treatment: Should I Be Worried Now?
I was infected with syphilis about a year ago. I had treatment at the time it was discovered, but I didn’t go back for my second set of penicillin shots because my symptoms were gone. Earlier this year I found out I still have it. I’ve had another set of shots, but I now have a chancre of some sort on the tip of my penis. Should I be concerned?

 Alcoholic With Liver Problems: Should I Switch Meds to Reduce Liver Damage?
I’m HIV positive and I started meds with Truvada (tenofovir/FTC) and Viramune (nevirapine) in February. I’m also an alcoholic. I’ve tried everything to control my alcoholism, from detox to Alcoholics Anonymous, but nothing’s worked; it seems I’m stuck with both HIV and alcoholism, for now at least. My last tests showed an undetectable viral load, but my CD4 count has dropped from 540 to 350 and my liver function tests were off the charts. Should I consider switching meds if my liver function continues to decline and my CD4 count doesn’t improve? What else can I do?
UNDERSTANDING HIV/AIDS LABS
 Can You Explain PCR Testing?
I’ve seen many posts on these forums referring to PCR testing for HIV. What is the purpose of the PCR test? Is there ever a reason to take a PCR test beyond the six-month mark when an antibody test would be conclusive at that point?
STRANGE BUT TRUE
 Soap and Water Reduce HIV Risk! … Right?
I had sex with the UPS man who delivers to my work. I was alone in the office one day and we ended up hooking up. It was sort of spur of the moment and we didn’t have a condom so he washed his penis with soap and water first. He told me he washed off anything unsafe. Knowing that his penis had just been cleaned, how risky was this encounter?

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Activist Central
 Join a Facebook and Twitter Campaign to Fight NY Gov. Paterson’s Rent Cap Veto!

 NIAID to Host Public Meeting on Future HIV/AIDS Research Networks

 Action Alert: Say NO to Abstinence-Only Sex Education

 President Obama: Address the ADAP Crisis!

 NMAC Asks for Your Help Ending S.B. 1070; Promoting Comprehensive Federal Immigration Reform

 Action Alert: Help Homeless AIDS Activist Get Into Housing Today

Report from the Aging and HIV Workshop- Frailty

Today was the start of the first international workshop on Aging and HIV in Baltimore.

The program was started by Dr L. Ferrucci who gave the first presentation on frailty. He works in geriatrics and presented general data from previous studies in the general aging HIV negative population. He presented compelling data that showed that people lose lean body mass (via a syndrome. called age related sarcopenia) and strength in people as they age, and those decreases are correlated to higher mortality. Also, inflammation markers like interleukin 6 increase with age, and levels of over 2.5 pg/ml in the blood have been linked to disability due to loss of muscle strength and mass. He also added that aging related inflammation can decrease brain volume and may be implicated in depression and other health issues.

Dr Joseph Margolick from the MACS Cohort presented previously published frailty data from this cohort that followed 4959 men who have sex with men since 1984 until 2006. Some of these men got infected with HIV and have been followed up before and after infection. A total of 1045 patients with HIV were followed. 75% of them had undetectable HIV viral load.

The frailty related phenotype (FRP) (i.e., the physical characteristics of frailty) was identified using 1 item selected from the questionnaires for each of the following 4 components: weight loss (answer yes to since your last visit, have you had unintentional weight loss of at least 10 pounds), exhaustion [answer yes to during the past 4 weeks, as a result of your physical health, have you had difficulty performing your work or other activities (for example, it took extra effort)?], slowness (answer yes, limited a lot to does your health now limit you in walking several blocks?), and low physical activity level (answer yes, limited a lot to does your health now limit you in vigorous activities, such as running, lifting heavy objects, participating in strenuous sports?). The assessment of weakness (ie, grip strength) was not incorporated into the MACS protocol until October 2005 and therefore could not be used in defining the FRP. A participant was considered as having the FRP at the visit if at least 3 of the 4 components were present. The FRP thus defined had a prevalence of 4.4% among MACS HIV-uninfected men aged 65 years and older, which was similar to the prevalence of frailty observed in the Cardiovascular Health Study for men of similar ages.

Frailty improved with the introduction of HAART. However, after adjusting for most important factors, frailty was still higher in HIV+ men compared to HIV- men. In fact, frailty of a 55 year old HIV+ man may be similar to that of a 65 year old HIV negative man.

Basal metabolic rate has also been found to be higher in HIV+ men compared to HIV- ones.

No therapeutic intervention data was presented to review the effect of exercise, testosterone replacement, and other factors on frailty in HIV+ men.

Blogging from the HIV and Aging Wksp

I will start blogging tomorrow from this new workshop. I am glad we will be able to discuss the issues related to the seemingly accelerated aging that some long term survivors are experiencing. Tomorrow we will be listening to presenters speaking about frailty, immunology of aging, immunosenescense, neurocognitive changes, bone loss, vitamin D deficiency and drug interactions. Stay tuned! Nelson

HIV-resistant cells work in mice. Can they help humans?

latimes.com

HIV-resistant cells work in mice. Can they help humans?

California scientists, boosted by stem cell research funding enabled by Proposition 71, are aiming for clinical trials involving gene therapy through bone marrow transplants.

By Rachel Bernstein, Los Angeles Times
6:44 PM PDT, August 21, 2010

Clad in a yellow gown, blue foot covers, hair net, face mask and latex gloves, Paula Cannon pushed open the door to the animal room. “I hate this smell,” she said, wrinkling her nose.

The stink came from scores of little white mice scurrying about in cages. Some of the cages were marked with red biohazard signs, indicating mice that had been injected with HIV.

Yet, in some of the animals — ones with a small genetic change — the virus never took hold.

Like mouse, like man? Maybe so.

In early 2007, a patient in Berlin needed a bone marrow transplant to treat his leukemia. He was also HIV positive, and his doctor had an idea: Why not use the marrow from one of the rare individuals who are naturally resistant to HIV and try to eradicate both diseases at once?

It worked. Sixty-one days after the patient’s transplant, his virus levels were undetectable, and they’ve stayed that way.

Since news of the man’s cure broke, HIV patients have been telephoning doctors to ask for bone marrow transplants. But it’s not that simple. The treatment is too risky and impractical for widespread use.

“A bone marrow transplant — it’s a horrible process you would not wish on your worst enemy unless they needed one to save their life,” said Cannon, a biology professor at USC’s Keck School of Medicine. There are grueling treatments to prepare a patient for transplant; the danger of rejecting the marrow; and the risk of graft-versus-host disease, wherein the marrow attacks the patient.

And that’s assuming the patient can find a matching donor — a difficult proposition in itself — with the right HIV-resistant genetic constitution, which is present in only about 1% of the Caucasian population.

But there could be another way.

Instead of sifting through the sands for a rare donor and then subjecting a patient to the dangers of a bone marrow transplant, Cannon and her colleague Philip Gregory, chief scientific officer at the Richmond, Calif.-based biotech company Sangamo BioSciences, began to think: They could use gene therapy instead, to tweak a patient’s own cells to resistance — and recovery.

The mouse “cure,” they say, suggests they’re on the right track.

Now, with $14.5 million from the California Institute for Regenerative Medicine, the San Francisco-based stem cell research-funding center created by 2004’s Proposition 71, Cannon, Gregory and researchers at the City of Hope cancer center in Duarte are working toward bringing the technique to clinical trials within four years.

Cannon and other HIV researchers insist that, despite cancers and deaths associated with past gene therapy trials, it’s the right way to target the disease. They cite recent successes, including treatments that cured children with the “bubble boy” syndrome and helped blind children regain their vision.

“I don’t think anyone would want to do gene therapy if there were an alternative,” said Caltech biologist David Baltimore, one of the many L.A.-based researchers pursuing gene therapy strategies to prevent or cure HIV. “I think it’s absolutely necessary. Nothing else will work.”

Since AIDS emerged in the early 1980s, development of anti-HIV medications has turned the disease from a virtual death sentence into a chronic, manageable condition.

But the clamor for a cure hasn’t quieted.

Vaccine trials have failed; drug-resistant strains are on the rise; and the meds, which can have uncomfortable side effects such as fatigue, nausea and redistribution of body fat that creates a so-called buffalo hump, cost about $20,000 a year.

A bone marrow transplant is about five times as expensive, but it would have to be done only once.

The question was, could researchers create bone marrow stem cells that — just like the marrow the Berlin patient received — lack the crucial gene, CCR5, that normally lets HIV into the key immune cells it destroys?

In 2006, Gregory asked Cannon if she was interested in testing whether a tool his company developed, called a zinc finger nuclease, could do the trick.

Zinc finger nucleases are genetic scissors, cutting DNA at a specific site — say, in the middle of the CCR5 gene. When the cell glues the gene back together, it usually makes a mistake, resulting in a gene that no longer works.

“It just jumped out at me as, ‘Oh my gosh, that’s actually something that could work,’ ” Cannon said.

The team spent about a year optimizing the procedure for treating delicate stem cells with the CCR5 snippers.

They tested the method using so-called humanized mice — ones engineered to have a human immune system — because HIV doesn’t infect normal mice. When stem cells were treated with the molecular scissors before being injected into mice, the resulting immune system lacked CCR5, exactly as the scientists had hoped.

These mice acted just like the Berlin patient — they fought off the virus.

Ready to make the leap from mouse to man, Gregory found a third leg for the team: researchers at City of Hope, who had extensive bone marrow transplant expertise.

“They brought Paula’s data to us and we said, ‘Wow, this looks fantastic,'” said Dr. John Zaia, City of Hope’s deputy director for clinical research.

Researchers there are now working toward clinical trials, optimizing every element of the treatment for safety, effectiveness and reproducibility.

On a wiltingly hot afternoon in July, lab manager Lucy Brown maneuvered a computer mouse across three screens speckled with red, yellow and green dots.

The computer was hooked to a flow cytometer — a collection of black boxes, green wires and silver knobs that can detect subtle differences between cells and separate them at a rate of 50,000 per second. This is how the scientists will separate stem cells from patients’ blood once trials are underway, to be sure that the genetic fix in the CCR5 gene was made, and kept.

Upstairs, machines with mazes of sterile tubes and pumps stood ready to prepare cells for CCR5-snipping. Here, the scientists will purify the bone marrow stem cells, increasing their numbers first to 5% of total cells, up from a measly 0.1% in the starting mixture, and then to 99%. At this point they can begin testing methods to clip the cells’ DNA.

When all is perfected, the scientists will have a precise recipe for producing batches of engineered stem cells, including exactly how long the cells should be treated, how much of each chemical needs to be added, how pure the cells need to be, and thousands of other details.

“We are literally writing the book on how you do this,” said David DiGiusto, director of City of Hope’s bone marrow stem cell therapy research.

To receive FDA approval for clinical trials — a goal they hope to achieve in three to four years — the researchers must prove that they can safely and reliably prepare the cells. Once they get the green light, the first cases will probably be people like the Berlin patient who need bone marrow transplants to treat AIDS-related lymphoma.

They’ll modify the patients’ cells in the stringently sterile manufacturing lab that DiGiusto designed with details such as cove molding and seamless floors so there are no corners or cracks to collect dust. Anyone who enters must wear a full bunny suit, much like the one Cannon wears in her mouse room, to keep from contaminating the delicate cells.

Some have advertised the effort as a quest for the elusive “C” word, but Cannon doesn’t quite see it that way.

“People say we’re trying to cure HIV,” she said. “I think of it more as, we’re just trying to make the body live quite happily and healthily with a small amount of virus.”