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From the Huffington Post

“The report that ushered in an epidemic 30 years ago this week was startling: Five otherwise healthy gay men in Los Angeles had come down with a rare form of pneumonia, and two of them had already died. Unnerving as this news was, none of us could have predicted the horrors ahead.

-Early studies showed that condoms were highly effective barriers to HIV infection. Mother-to-child transmission of the virus has been virtually eliminated in the developed world.

-Male circumcision has been shown to reduce the risk for males of contracting HIV through heterosexual sex.

-Last July researchers showed that a vaginal microbicide gel that women can use before heterosexual sex can sharply decrease their risk of contracting HIV.

-In November, a study showed that high-risk men who have sex with men who diligently took an ARV while HIV-negative reduced their chances of contracting the virus by more than 90 percent.

-And in May a clinical study finally confirmed what many in the scientific and medical communities have believed for years, namely that a healthy HIV-positive person on ARVs is much less likely to pass on the virus to his or her partner.

-None of these interventions alone will end the epidemic. But if used in combination and scaled up among vulnerable populations in particular, they could lead to quick, substantial and worldwide reductions in the incidence of HIV infection.

Furthermore, smart investments in HIV prevention will pay off handsomely not only in lives saved, but also in treatment costs averted.

-Ending the global AIDS epidemic will ultimately require an effective vaccine or a cure.

-Thirty years into the AIDS epidemic, we are faced with a choice. Are we content to tinker at the fringes of the epidemic, spending untold billions to treat a fraction of those in need for decades into the future? Or can we summon the political will to effectively deploy the prevention interventions that are already available to us and to make the necessary investments in research that could end this epidemic in our lifetime?

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The Washington Post reported that treating people with HIV drugs sharply cuts risk of transmission to other people. LINK to Article We’ve been discussing this in the Wednesday group for many years. Lower viral loads reduce risk of transmission. A prvious Swiss study stated that an undetetectable viral load was non-infectious and other studies have stated that viral loads less than 1,500 or even 3,500 are low risk.

HIV drugs sharply cut risk of transmission, study finds
By David Brown, Published: May 12
AIDS researchers announced Thursday that a study conducted in nine countries has proved the long-standing hunch that HIV-infected people on treatment are much less likely to transmit the virus than people who aren’t taking the drugs.

The study, which was stopped early because the results were so dramatic, found that men and women whose sexual partners were infected with the AIDS virus were almost completely protected if the partner took a combination of HIV-suppressing drugs.

The study provides evidence — useful in American cities and African villages — that getting HIV-infected people on treatment early, long before they have symptoms, may be the best strategy for slowing the 30-year-old epidemic. The District has the highest infection rate of any American city, on a par with that of Rwanda.

“This is far beyond expectation. It could completely change the way we are dealing with the epidemic,” said Michel Sidibe, head of UNAIDS, the United Nations’ AIDS program.

“This is data that you can’t ignore,” said Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, which paid for the $78 million experiment.

Condoms, behavior change, clean hypodermic needles and a safe blood supply are the chief tools for preventing HIV infection. However, since the arrival of antiretroviral therapy (ART) in 1996, there has been a lot of indirect evidence that treatment is a tool for prevention.

The reason is simple. ART, three or more drugs taken every day, prevents the AIDS virus from replicating, and it rapidly disappears from blood and other bodily fluids that are the usual vehicles for infection.

The idea that treatment could be preventive was seen in studies of “discordant” couples — one partner infected, the other not — in Kenya. Researchers observed that when an infected person was in treatment, the partner was at much less risk of becoming infected. This observation held for whole populations.

Researchers in British Columbia last year reported that the rate of new infection for the entire province declined after a policy of widespread HIV testing and early treatment was adopted.

What was missing was evidence from a randomized, controlled trial — the gold standard of medical research — that treatment had a clearly preventive effect.

The new study enrolled 1,763 couples in five African countries, as well as Brazil, India, Thailand and the United States. Nearly all were heterosexual. The researchers wanted to include large numbers of gay men but were unsuccessful in recruiting them, possibly because they were already convinced that treatment reduces transmission.

All of the volunteers had a CD4 cell count of 350 to 550 cells per cubic millimeter of blood — evidence of mild damage to the immune system.

In half of the couples, the infected person immediately went on ART. In the other half, the medicines weren’t started until the infection became more severe, as evidenced by a fall of the CD4 count below 250. All were advised to use condoms.

Over the next four years, 28 people acquired HIV from their partner. (Gene fingerprinting of the virus revealed that in 11 other cases, people became infected by someone other than their regular partner.) Of those 28 new infections, 27 occurred among couples in which the HIV-infected partner had not started taking antiretroviral drugs at the start of the study. That amounted to a 96 percent reduction in the risk of acquiring HIV in the couples in which the infected partner was on ART.

Significantly, 17 of the 27 infections occurred in couples in which the infected partner’s CD4 count was greater than 350. The World Health Organization’s guidelines call for starting ART when the count dips below 350. This study shows that having a partner whose CD4 count is above that cutoff is no assurance the person won’t transmit the virus.

The leader of the study, Myron Cohen of the University of North Carolina at Chapel Hill, said the results are “probably generalizable” to all heterosexuals. But that’s not absolutely certain.

The study marks a further swing of the pendulum back toward the once-popular and later discredited HIV treatment strategy known as “hit hard, hit early.”

Prescribing ART long before an infected person has symptoms or evidence of severe immune system damage was popular until it became clear the drugs could have serious side effects. (They can damage nerves, raise blood cholesterol and change the distribution of body fat). More recent evidence shows that putting off treatment for too long increases the risk of early death.

Although it is now clear that ART protects a person’s partner, what isn’t certain is whether ART benefits the patient when it’s started soon after infection and before the immune system is measurably damaged. A study designed to answer that question recently started but won’t be finished for several years.

Some AIDS experts fear the new study may be used to browbeat newly infected people into starting ART earlier than they might otherwise.

“I can imagine people deciding to get treatment because they are in a relationship and they want to protect the partner. But if a person has a CD4 count of 800, it is wrong to mislead people that they will benefit when we really don’t know,” said Joseph A. Sonnabend, 78, a retired physician and researcher previously affiliated with St. Luke’s-Roosevelt Hospital Center in New York City.

Like many cities with a high AIDS prevalence, the District has an aggressive policy of testing for HIV infection and urging infected people to enter care.

As of Dec. 31, 2008, the most recent year for which data are available, 16,513 city residents were living with HIV. About 3.2 percent of people older than 12 in the city are thought to be infected.

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Antabuse to flush HIV resevoir

Antabuse is a drug used to treat alcoholism. It makes people who drink alcohol become ill therefore helping them stop drinking.

There’s a new clinical trial underway to use Antabuse (disulfiram) to flush out the hidden reservoir of HIV that evades both the immune system and antiretroviral (ARV) drugs. The trial is small and isn’t attempting to cure the participants, it could be a new path to a cure.

Current HIV drug therapy only works on active cells. Inactive cells hide out in resevoirs preventing the drugs from attacking them. Antabuse not only makes people sick from alcolhol, it also activates cells which would then allow the immune system and the HIV drugs to destroy them.

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Hope Survives: 30 Years of AIDS

As the 30th anniversary of the first AIDS diagnosis approaches, Anderson Cooper will take a look at the history of the battle and the latest medical breakthroughs. Hope Survives: 30 Years of AIDS will air on CNN:
Friday, January 14th, at 9 PM EST.

In addition to Anderson Cooper’s in-depth interview with Sir Elton John about his foundation’s work to end the disease, the show will also include interviews with Academy-award winning actress Mo’nique, Project Runway’s Mondo Guerra, Phill Wilson, Founder and Executive Director of the Black AIDS Institute and co-founder of Greater Than AIDS, a new national movement developed with the Kaiser Family Foundation, and Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases. The special hour will also feature emotional clips from famous personalities on their personal “Deciding Moment” that changed how they think about the disease and inspired them to get involved, including Academy-Award winning actress Susan Sarandon, actress Sharon Stone, singer Barry Manilow, basketball legend Kareem Abdul Jabbar, comedienne Margaret Cho, Author Maya Angelou and Jeanne White Ginder, the mother of the late Ryan White.

Margaret Cho’s “Deciding Moment,” as she recalls her family bookstore in the mid-80’s and the reason it suddenly started losing business

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Sad but True

Living in our HIV bubble world, I often hear people say; how can anyone get infected today, everybody knows how HIV is spread. Well, sadly that simply is not the case. Here’s a story from TheBody of questions they got questioning how HIV could be spread; The Body .

Remember nobody has ever gone broke underestimating the intelligence of the American public.

-Steve

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Doctors Say Stem Cell Treatment Eradicates HIV in Berlin Patient

Timothy Brown, a US expat living in Berlin, is said to have been cured of HIV infection via genetically-engineered stem cells, according to reports from doctors, writes AIDSMAP:

Doctors who carried out a stem cell transplant on an HIV-infected man with leukaemia in 2007 say they now believe the man to have been cured of HIV infection as a result of the treatment, which introduced stem cells which happened to be resistant to HIV infection.

The man received bone marrow from a donor who had natural resistance to HIV infection; this was due to a genetic profile which led to the CCR5 co-receptor being absent from his cells. The most common variety of HIV uses CCR5 as its ‘docking station’, attaching to it in order to enter and infect CD4 cells, and people with this mutation are almost completely protected against infection.

The case was first reported at the 2008 Conference on Retroviruses and Opportunistic Infections in Boston, and Berlin doctors subsequently published a detailed case history in the New England Journal of Medicine in February 2009.

They have now published a follow-up report in the journal Blood, arguing that based on the results of extensive tests, “It is reasonable to conclude that cure of HIV infection has been achieved in this patient.”

Brown, who is referred to as ‘The Berlin Patient’ gave an interview to German magazine Stern:

His course of treatment for leukaemia was gruelling and lengthy. Brown suffered two relapses and underwent two stem cell transplants, as well as a serious neurological disorder that flared up when he seemed to be on the road to recovery.

The neurological problem led to temporary blindness and memory problems. Brown is still undergoing physiotherapy to help restore his coordination and gait, as well as speech therapy.

Friends have noticed a personality change too: he is much more blunt, possibly a disinhibition that is related to the neurological problems.

On being asked if it would have been better to live with HIV than to have beaten it in this way he says “Perhaps. Perhaps it would have been better, but I don’t ask those sorts of questions anymore.”

Brown’s case is obviously one of very specific traits where similar treatment would be unlikely to benefit people with HIV in other situations. More on Brown’s case history at AIDSMAP.

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Human HIV drug trial near

CD4 T-cells are one measurement of the body’s immune system. Another cell that fights infections are called Natural Killer Cells (NK). These are a kind of white blood cell that play a major role in the rejection of tumors and cells infected with viruses.

But they don’t seem to attack cells infected with HIV and that has puzzled scientists for more than two decades. This article explains how HIV produces a protein called Vpu which basically neutralizes the NK cells preventing them from attacking the infected cells.

This new drug, BIT225, targets the Vpu protein of HIV which would then allow the NK cells to do their job. Which means this would be a new class of drugs in the fight against HIV.

“An Australian biomedical research company, Biotron Ltd, already has a drug that specifically targets the Vpu protein of HIV.

The discovery has excited Australian biomedical research company Biotron Ltd which has a drug that specifically targets the Vpu protein of HIV.

The drug has passed through early safety trials, and the company hopes to implement an efficacy trial with HIV-positive patients in the near future.

“This study is really important for Biotron,” said Biotron CEO Dr Michelle Miller.

“We have been working on developing drugs to target the Vpu protein of HIV for several years and, until recently, there has been very little known about exactly how Vpu works, despite good evidence that it is critical to the process of establishing HIV infections in specific cell types.”

From their company web site:

Based on the company info for Biotron, they have an efficacy trial in the works. Looks like there should be a definitive answer in about two years, to how well the treatment might work in humans.

This is a snip from their investor PDF. Looks like their avenue of research is at least promising (not just another ARV). Given the Rush Univ publication, I would think funding will now not be a problem. Because recent studies have shown that if you are adherent to your meds, the chance of resistance is extremely low, investors no longer see new HIV drugs worth the $$$. That’s why this recent news is so important. Otherwise this trial may have come up empty looking for scarce public funding.

• First-in-class new anti-HIV drug
• New mode of action – inhibits budding of virus from infected cells
• Targets HIV in viral reservoirs in vivo
• Reservoirs are last of the holy grail in HIV
• No existing drugs target this source of HIV in the body
• Eradication of reservoirs is essential for “cure” of HIV
• Phase Ib/IIa trial protocols finalised
• 12 – 20 subject trial in HIV+ patients
•Trial designed to demonstrate proof-of-concept i.e. can reduce HIV
loads in HIV-infected reservoir cells in man
• Expected to commence once funding in place

Additional links on related information:

News releases on the drug:

New class of drug in offering

http://www.biospectrumasia.com/content/251110AUS14722.asp

International study supports Biotron’s HIV drug approach

Biotron Presentation to Investors explaining drug’s importance

We will talk about this drug in the second half of the 12-15-2010 Wednesday group meeting.

-Steve

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This Wednesday was a special tribute to World AIDS Day. 40 guys showed up and we read The History of HIV/AIDS. This is a timeline of significant events that took place in this history, OUR history. Each year was printed on a sheet of paper and we took turns reading the years chronologically, 1980-2010. 31 guys had a turn at reading a year. Some guys picked a significant year in their life to read, the year they turned positive, the year they graduated High School, etc. I think one guy picked the year he was born, damn that hurts.

What always amazes me is how well everyone reads this difficult material. Some of the words are tongue twisters(Non Nucleoside reverse transcriptase, Immunodeficiency, etc), but everyone does so well. Someone asked if we’re going to take this show on the road. Show me the road and let’s go.

I want to thank you all for indulging me in reading this work. I put this together because this is what I do for fun. I’m a geek at heart and I love doing stuff like this. I hope everyone enjoyed participating in this and learned at least one thing new.

-Steve

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Tonight, Wednesday 12-08-2010 the group’s topic is The History of HIV/AIDS in commemoration of Dec 1 AIDS Day. The room has been specially decorated for this topic with over 50 pictures and posters representing people, events, symbols and statistics that tell the story of HIV/AIDS. There is also an interactive verbal presentation that you will have the option of participating in, if you chose.

So come join us for this special interesting and educational topic.

-Steve

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18 guys showed up tonight, 12-01-2010 to discuss Why they weren’t at the Candlelight Vigil. Some were unaware of the march. One felt it was just too cold to be outside. A few felt that their main priority was to take care of themselves and felt the need to attend a support group out weighed the need to attend yet another rally, some felt that 20+ years of attending rallies had left them burned-out and some felt they made their contribution to the cause in other ways. All in all it was an interesting and revealing conversation into the many differnet views present in our community.

We then talked about the Truvada study that tested whether negative men using Truvada prevented HIV. It was pointed out that men who regularly took the drug more than 90% of the time reduced their risk by 73%. This is a good result for a first study and we should hope for more studies to see if this is another way of reducing risk of getting HIV.

We had a home-made chocolate cake, carrot cake and a special cake congratulating me on winning the Footsteps in the Sand Award. Thanks guys.

We cut the meeting short and 5 guys walked over to Alibi parking lot to attend the AIDS Day Rally and listen to the speeches.

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