Dr Vincent Marconi talks about his study “Evaluating the Safety and Tolerability of Ruxolitinib in Antiretroviral-Treated HIV-Infected Adults” which is currently looking for volunteers. For more information about the study or how to join it, call us at 206-744-8883 or email us at email@example.com https://clinicaltrials.gov/ct2/show/N…
Dr Vincent Marconi received his MD at the Johns Hopkins School of Medicine in 2000. He then received training in Internal Medicine and Infectious Diseases at the Brigham and Women’s Hospital and the Massachusetts General Hospital of Harvard Medical School. Currently, he is Professor of Medicine for the Division of Infectious Diseases and Professor of Global Health at the Rollins School of Public Health. In 2014, he became the Director of Infectious Diseases Research at the Atlanta Veterans Affairs Medical Center. Dr Marconi sees patients at both the Infectious Disease Program Ponce Clinic (part of the Grady Health System) as well as the Infectious Disease Clinic of the Atlanta VA Medical Center. He has co-authored over 90 scientific articles.
FOR BACKGROUND INFORMATION ON JAK INHIBITORS IN HIV:
To read the transcript of this interview, click here
In the United States, the rate for anal cancer in the general population is 1 case per 100,000 people; among HIV-negative men who have sex with men the rate increases to 35 cases per 100,000 people.
For HIV-positive gay and bisexual men, the rate is estimated to be between 75 to 115 cases per 100,000 people. It seems to affect those of us who have lived longer with HIV, have had detectable HIV viral load for a few years, have had anal warts (debatable) and/or had lower CD4 cells in our HIV infection.
There is good evidence that HPV causes many cases of anal cancer. More than 100 subtypes of HPV have been found. The subtype known as HPV-16 is often found in anal cancer lesions and is also found in some anal warts. Another type, HPV-18, is found less often. Most anal warts are caused by HPV-6 and HPV-11. Warts containing HPV-6 or HPV-11 are much less likely to become cancerous than those containing HPV-16. Some reports show that many HIV+ long term survivors have been exposed to many HPV genotypes, including the oncogenic (cancer producing) ones.
There are really no guidelines yet about how to diagnose and treat anal dysplasia. The University of California in San Francisco is leading the way in studying different methods of detection. They are researching three forms of tests: an anal Pap smear (where the doctor swabs an area of the anus to remove surface cells), a high resolution anoscopy (where a doctor uses a special microscope to look at the anus), and a biopsy (where the doctor scrapes away an area of the anus to remove surface cells).
The good news is that a 5-year study designed by Dr. Joel Palefsky and his team is now enrolling patients to study the long term effect of performing high resolution anoscopies (HRA) and infrared coagulation (IRC) in HIV+ men and women with dysplasia versus not performing the IRC to determine if IRC is an effective way to prevent progression to cancer.
I had the pleasure and honor to interview Dr. Palefsky, one of the world’s experts on HPV infection in HIV+ people, and Jeff Taylor, the nation’s top HPV/HIV activist. I think everyone will agree with me that this video includes most of the information needed to proactively prevent and/or treat HPV related anal cancer as we age with HIV. You can also find out information on how to volunteer to be monitored in Dr. Palefsky study.
Nelson Vergel from PowerUSA.org interviews Dr Steven Grinspoon from Harvard Medical School about what we know about HIV lipodystrophy associated fat accumulation. Dr Grinspoon covers potential causes and treatments. For more information please refer to the closing image at the end of the video.
QUESTIONS FOR DR GRINSPOON’S INTERVIEW:
1. Please give our audience background information on what HIV lipodystrophy is.
2. What causes HIV lipodystrophy? How is HIV lipodystrophy different than other lipodystrophies?
3. What types of fat tissue does the body have? What are their metabolic functions, if any?
4. Why is visceral fat and dorsocervical accumulation not just a cosmetic issue?
5. Talking specifically about visceral fat (VAT), have we learned about what makes someone more or less prone to having increased VAT before and after starting antiretrovirals? Is increased VAT driven by HIV as much as ART? Inflammation?
6. Are some antiretrovirals “better” than others when it comes to avoiding excessive VAT increase? Can switching HIV regimens improve VAT?
7. What kind of hormonal, lipids and glucose issues have you seen in your research with HIV+ patients experiencing increased VAT?
8. What is growth hormone pulsatile release and how does it differ in HIV lipodystrophy patients?
9. Are there any ways to predict who may have more increased VAT when starting HIV ARVs?
10. VAT then and now- Is increased VAT as common now as it was back in the 90’s and early 2000’s? If not, why? is current lipodystrophy being hidden by the aging of the HIV population? Is our perception of a decrease in prevalence being affected by the increase of fat tissue due to aging? Does current day LD look different and how?
11. What treatments are approved to manage adipose tissue accumulation in HIV? How effective is it?
12. How can we predict if someone will be a good responder to the therapy? When someone responds what should they expect? Does something happen metabolically before the response happens?
13. Can exercise and diet work in synergy with the adipose tissue treatment? How about any synergy with Metformin?
14. How does liver fat affect someone’s health? Do we experience more liver fat in HIV lipodystrophy?
15. Can you tell us how VAT can affect carotid intima thickness, coronary calcium, hypertension, neurocognitive, and mortality?
16. Follow up, will a reduction in VAT improve these? What about SAT?
17. Why has leptin not been studied further?
18. Your team recently published a puzzling study on DICER deficiency in HIV lipodystrophy patients. Can you elaborate on your findings and what they may mean clinically?
19. Why does it seem that a lot of the HIV lipodystrophy research interest has decreased in the last few years? What can patient advocates do to advance more research?
Cristobal Plaza, director of ActionforSolidarity.org, talks about the medication shortages in Venezuela and how you can help while the situation is resolved one day.
Action for Solidarity is a United States established and active 501 (c) (3) Non-profit Organization. We will ensure that your donation will get to the people who need these medicines by using the extensive distribution network of our sister organization Accion Solidaria in Caracas. Several Venezuelan non-profit organizations are currently petitioning the government to facilitate the importation and aid process so that the current medication shortage is resolved. However, this process will take some time which makes your donation the onlyLIFE–SAVING option many people have in the present.
Be a Hero- Send your unused medications to Venezuelans in need.
Interview with Cristobal Plaza, Director of ActionforSolidarity.org
Nelson Vergel: Hello everybody. This is Nelson Vergel with Program for Wellness Restoration. It is my honor to have Cristobal Plaza with us today. He is the director of Action for Solidarity (actionforsolidarity.org), a non-profit organization based in Miami, Florida which works mostly in helping Latin American countries that have very little access to HIV medications particularly Venezuela since that country is going through a humanitarian crisis right now. Thank you so much, Cristobal for joining us today. Let us know, how can we help people in Venezuela right now?
Cristobal Plaza: First of all, Nelson thank you so much for having me here today and for giving us the opportunity to record this short video which, I am sure, will help us a lot. I feel very honored to be here talking to you. I would like to start Nelson, by addressing the two words you just mentioned; “Humanitarian Help.” That is what we are really needing right now. Venezuela is in a very deep health crisis that is particularly afflicting people living with HIV.
Action for Solidarity (established in 1997) has been helping Venezuela by sending medications donated in the United States to our health center in Caracas. Our Caracas’ Health Center is led by Feliciano Reyna who is the President of Action for Solidarity in Venezuela and here in the United States. We have a system in which we can get donations from people all over the United States with no shipping costs thanks to our partnership with the United States Postal Services (USPS). We have a prepaid shipping label which I can actually show you here. This is what we send to people through an email once they make a first contact.
Nelson Vergel: How can people contact you?
Cristobal Plaza: They can contact us through our website (www.actionforsolidarity.org or through our social networks: actionforsolidarity in Instagram, ActionforSolidarity in Tweeter and Action for Solidarity, Inc in Facebook. They can email us at firstname.lastname@example.org.
Once we establish contact with people who wants to donate their medication, we send them a prepaid shipping label and they can mail the medication through the USPS at no cost if the package weights 10 ponds or less. If it’s over 10 pounds they need to take it to the post office and pay for the shipping. The USPS will send the donations directly to our center here in Miami.
Nelson Vergel: Tell us a about the medications needed right now
Cristobal Plaza: We need all antiretrovirals. There is a list in our website www.actionforsolidarity.org) The health crisis In Venezuela is so generalized that it’s not only affecting HIV people. We are receiving medications, especially antiretrovirals, from people living with HIV. We need Over-the-Counter and prescribed medications specially medications for opportunistic infections. There are not medications for opportunistic infections right now in Venezuela. There still are some antiretrovirals left, but the shortage of medications, is so big and it has been constantly happening in Venezuela that right now in September 2016 there are 14,000 people without treatment.
There are many factors involved in this situation.
This all started back in 2009. Actually, let me go back a little bit more. Back in 1999 there was not a program established by the government to provide treatment for people with HIV. The program began in the year 2000, but we were already helping people with HIV since 1996 providing medications.
We really need antiretrovirals, opportunistic infections and any kind of over the counter medications for any kind of health condition as well. Again, there are not just people with HIV suffering, the entire Venezuelan population, and specifically the more vulnerable population which are children and elder people, are suffering with this crisis.
Nelson Vergel: Why is this happening? Why is the world not helping Venezuela?
Cristobal Plaza: Well, two of the most important reasons are, of course, the negligence of the government of Venezuela and the lack of administrative funds. They have not managed or administered the funds correctly. Of course, corruption is involved. The Venezuelan Minister of Health, Luisana Melo doesn’t seem to have enough knowledge of the issue so that is why they at the government don’t understand the importance of antiretroviral treatment and the importance of adherence. (Adherence means that people needs to take their medications every day as prescribed by their doctors or their prescriber).
Antiretroviral medications are prescriptions that, once you start taking them, you have to take them for the rest of your life. This shortage of medications have caused that people have had to stop their treatment for months. Right now many people have been off medications for over 3 months, I would say, since June. The government made a purchase of medications in June through a private company in India. We finally received the medications but The Pan American Health Organization has not released the medications from their office because the government owes them about $2 million. It is very disturbing and very worrying what is happening in Venezuela.
Nelson Vergel: Are Venezuelans doing anything about it? I understand there is a referendum trying to be passed. Without getting into too much detail, because it’s a long story, I just want to make sure that people understand that we’re seeking help from everybody around the world, but Venezuelans are also actively trying to fix the situation themselves.
Cristobal Plaza: Yeah, there are numerous organizations in Venezuela working specifically for people with HIV doing a lot of work. It has been very tough for them. They have tried to get attention by denouncing the shortage of medication throughout the years. Again, this started back in 2009 and it’s been going on since then. Last November, the Health Ministry should have placed a purchase order for medications for HIV, but it didn’t. That’s when all these huge problems started.
Right now, I repeat, there are more than 14,000 people not taking medications. We really need to help those people because ,based on what we are seeing, the Venezuelan government is not going to solve this issue anytime soon.
We need help from people all over the world.
We have received many donations that we have sent from the United States through our organization. I also know through Feliciano, the President of Action for Solidarity, that they have received other donations in huge quantities from other countries in the world. The government insists in saying that they do not need help, and there is not a health crisis in Venezuela, so what can you say …
Nelson Vergel: Some propaganda…so basically you know…anyways… Yeah… Without getting into it, if somebody doesn’t have medications but wants to help anyways, can she/he donate funds for helping with your shipping costs and operating expenses?
Cristobal Plaza: Yeah. It costs us a lot of money to keep this motor going. Again, people can send us medications and can send us monetary donations through our Charity Certified PayPal Account that has our name, Action for Solidarity. If you look it up on PayPal you will see that once you type our name, Action for Solidarity, it will show up as a certified charity, non-profit organization [crosstalk 00:11:13] All donations are …etc.
Nelson Vergel: Tax deductible, then, yeah. You know, I think … Closing up, we made this video so people can help. People can actually go to your website donating the funds or medications and contact you directly if they have any questions.
Cristobal Plaza: I don’t know if you can see the phone number in there …
Nelson Vergel: No, I don’t see it.
Cristobal Plaza: They can contact us through the email, email@example.com, through our website actionforsolidarity.org, or through our phone number 786-307-3857. That’s the number for the office.
Nelson Vergel: I really hope that we can get some help from everybody watching this video. This situation, hopefully, eventually will get better, but before we get there we need a lot of help. Look at your bathroom cabinets, look at the medications that are sitting there that may not have expired, that you may not have used in a while or you have switched from. A lot of people are switching from one medication to another. If you go to a store, Walmart, Target or any other store and you buy Ibuprofen, Tylenol or any other over-the-counter medicine it would be great as well. If you don’t have any medications you can always make, as Cristobal said, a tax-deductible donation through his website. Thank you so much Cristobal.
Cristobal Plaza: Thank you, Nelson.
Nelson Vergel: Don’t lose steam. I know it gets frustrating and tiring. Especially us that get a lot of emails and calls from Venezuela from desperate people that really need help.
We get those day after day after day. Thank you for sticking with the cause and for having a big heart to help others survive this illness regardless of all the political changes Venezuela is going through. Thank you so much and stay tuned for the next video from the Program for Wellness Restoration. Thank you so much, and talk to you guys soon.
Nelson Vergel from the non-profit Program for Wellness Restoration ( www.PoWeRUSA.org ) interviews Dr Luis Casavantes about his experience with PMMA filler for HIV-related facial/buttock wasting reconstruction. He also shares his experience on the use of PMMA for penile girth enlargement. For more info visit www.AvantiDerma.com. You can also find more info on PoWeR’s site www.FacialWasting.org
Nelson Vergel, director of Program for Wellness Restoration, interviews Dr Pierone about his long experience treating patients with HIV facial lipoatrophy and his upcoming study for patients with HIV related abdominal fat accumulation. His website is www.FacialRejuvenationFL.com You can also ask him questions on TheBody.com. You can also find more info on PoWeR’s site www.FacialWasting.org
Dr. Gerald Pierone Jr. has performed over 20,000 procedures with dermal fillers that include Bellafill® (Artefill®), Sculptra®, Radiesse®, Restylane®, Belotero®, Voluma® and Juvederm®. Dr. Pierone is the leading injector of Bellafill® in the United States and is a nationally recognized trainer and researcher. He has also achieved Black Diamond Elite status with Allergan – Juvederm®, Voluma®, and Botox® – the top 1% of all doctors. Dr. Pierone is also a member of the prestigious Liquid Face Lift Association – reserved and restricted to physicians who have performed thousands of dermal filler procedures while demonstrating excellence with facial fillers. He also serves as a panel expert for facial fillers, facial rejuvenation and facial wasting.
Dr. Pierone trained at The Mount Sinai Medical Center in New York and received his medical degree from University of Florida. He is board certified in internal medicine and infectious disease. In 1990, he relocated to Vero Beach, Florida to establish a medical practice. In 2005, he learned how to inject facial fillers to treat HIV-related lipoatrophy. Since then, he has developed an active private practice focused on facial rejuvenation with facial fillers, PDO threads and energy-related aesthetic treatments.