Tag Archives: AIDS

“Turning the Tide” on HIV/AIDS

In advance of the upcoming XIX International AIDS Conference, the International AIDS Society and the University of California, San Francisco, have issued the “Washington D.C. Declaration,” a nine-point action plan aimed at broadening global support for “Turning the Tide” of the AIDS epidemic.

Everyone is urged to sign the Declaration.

It calls for:

1) An increase in targeted new investments;
2) Evidence-based HIV prevention, treatment, and care in accord with the human rights of those at greatest risk and in greatest need;
3) An end to stigma, discrimination, legal sanctions, and human rights abuses against those living with and at risk for HIV;
4) Marked increases in HIV testing, counseling, and linkages to services;
5) Treatment for all pregnant and nursing women living with HIV and an end to perinatal transmission;
6) Expanded access to antiretroviral treatment for all in need;
7) Identification, diagnosis, and treatment of tuberculosis;
8) Accelerated research on new tools for HIV prevention, treatment, vaccines, and a cure;
9) Mobilization and meaningful involvement of affected communities.

Turning the Tide is the theme of this year’s biennial conference, which will take place July 22-27 in Washington.  It is expected to draw 25,000 attendees, including HIV professionals, activists, politicians, and celebrities. Sir Elton John will open the conference and Bill Clinton will close it. A large delegation of U.S. members of Congress will participate, and Bill Gates will moderate a session. An enormous “Global Village” outside the D.C. Convention Center will be open to the public. “If you haven’t been, it’s a conference like no other,” conference cochair Dr. Diane V. Havlir said at a press briefing.

The recent optimism regarding HIV/AIDS stems from major advances in knowledge regarding prevention of partner transmission with early patient treatment, pre-exposure prophylaxis, and male circumcision as HIV infection prevention (new data will be released at the meeting), all of which are viewed as breakthroughs  in the fight against HIV/AIDS. “So we have now in our hands the tools. The question is how do we combine those tools together, and how do we roll them out,” said Dr. Havlir, professor of medicine at the University of California, San Francisco, and chief of the HIV/AIDS division at San Francisco General Hospital.

Dr. Diane V. Havlir / Photo by Miriam E. Tucker

Monday’s plenary session will include an address from Dr. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, on “Ending the HIV Epidemic: From Scientific Advances to Public Health Implementation.” Other plenary topics during the week will include viral eradication, vaccines, TB and HIV, and HIV/AIDS in specific populations including minorities, women, youth, and men who have sex with men. On Friday, there will be a plenary talk that may be of particular interest to the primary care community, “The Intersection of Noncommunicable Diseases and Aging in HIV.”

Plenaries and other conference sessions will be webcast at http://globalhealth.kff.org/aids2012.

-Miriam E. Tucker (@MiriamETucker on Twitter)

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Cardiologists Challenged

The opening scientific session at the annual American College of Cardiology meeting kicked off with a glitzy video montage that would have made Hollywood proud. I half expected to see a reminder to visit the concession stand crawl across the big screens. But just as the hype was beginning to overwhelm, Dr. James Orbinski rose to deliver the most scorching presidential lecture in memory.

Image courtesy TheSilentPhotographer at en.wikipedia (CC)

The internationally acclaimed physician and humanitarian challenged the audience to get involved in global heath and to tackle issues that most people write off as hopeless causes. He pointed out that the $13,000 price of antiretroviral drugs to combat AIDS was once a virtual death sentence for all but the wealthy.

With vocal outrage from humanitarian groups including Dignitas International, which he cofounded with James Fraser, however, the price tag has dropped to just $64 per year for generic therapies, and somehow, Big Pharma did not collapse, as was prophesied, he said.

Dr. Orbinski didn’t shy away from politics, which at most medical meetings is politely veiled in talk of pending legislation.

As Chief of Mission to Rwanda with Médecins Sans Frontières during the genocide, he recalled a young girl brought to his care who avoided being hacked to death as her mother had been by hiding in a latrine. He scolded France for supplying arms to the Habyarimana regime, and the global compliancy exhibited by countries including the United States despite overwhelming evidence of genocide.

Dr. Orbinski, who collected the Nobel Prize on behalf of MSF for its work in Rwanda, spoke of the need for ongoing research of neglected tropical illnesses and the growing threat that West Nile virus and Dengue fever pose to even the most well-heeled Americans. He spoke about climate change and the political unrest caused by hunger, now experienced by one in seven persons across the globe.

He reminded us that 43 years ago today when Dr. Martin Luther King Jr. was assassinated in Memphis, no one would have dreamed that it was possible for a black man to become president of the United States.

The lecture was nothing like I’ve ever heard before.

Dr. Ralph Brindis

When he finished, the packed ballroom was silent and still. Many rose to give Dr. Orbinski a standing ovation, but some did not. So when outgoing ACC president Dr. Ralph Brindis rose to speak, there was something of a sense of relief in the air. It was short lived.

Dr. Brindis cited the recent ICD-registry study by Dr. Sana Al-Khatib and colleagues that found that 22.5% of 111,707 patients received nonevidence based ICD implantations for the primary indication of sudden cardiac death between January 2006 and June 2009.

Dr. Brindis said he has been disappointed in physician participation with the National Cardiovascular Data Registry, despite its ability to provide greater understanding of physician practice as well as local and national trends in socioeconomic disparity.

“The NCDR data are your clinical data,” said the mild-mannered Dr. Brindis, while pointing his finger squarely at the audience. “You are responsible for the accuracy of the information, and you should strive to take advantage of these reports to discover opportunities to improve the care of your patients.”

This reporter tips her hat to the ACC for selecting New Orleans for its annual meeting and for being bold enough to challenge its members. Thinking outside the box beats Hollywood any day.

—Patrice Wendling from New Orleans

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Dr. Fauci Talks about AIDS with Stephen Colbert

Dr. Anthony Fauci (NIAID photo)

In case you missed it, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, was a guest on the March 29, 2011 episode of Comedy Central’s “The Colbert Report.”

Early in the interview host Stephen Colbert asked Dr. Fauci to forecast the next “hot, newest” infectious disease. “I want to get my graphics department working on the next thing that’s going to scare the poop out of these people,” Mr. Colbert said, as the studio audience chuckled in the background. “Turkey herpes? What’s it gonna be?”

Then the discussion turned serious, with Mr. Colbert suggesting that the public attention on AIDS treatment and prevention has waned in recent years. He asked Dr. Fauci: “Why aren’t we talking about it if it’s no big deal?”

Dr. Fauci said that AIDS remains a “serious problem” in the United States, with 56,000 newly diagnosed cases each year. “It’s been that way for the last 10 or 15 years,” he said.

“Why are so many people getting it? Because we have abstinence education…” Mr. Colbert asked.

“That rarely works,” Dr. Fauci said, noting that the majority of Americans practicing high risk behavior lack access to AIDS education campaigns and to good health care. In 2010, he added, about half of new AIDS infections in the United States were among African Americans.

To view the entire interview, click here.

— Doug Brunk (on Twitter@dougbrunk)

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My Pick for Best Medical Story of 2010

Image via Flickr user Patrick Hoesly's Photostream by Creative Commons License.

With the close of 2010 just weeks away, it’s a good time to reflect on the notable medical stories of the year. We can’t forget the historic passage of health care reform by Congress. Or the invasion of bed bugs from coast to coast. Or the spotlight shone on concussive injuries sustained in football and other contact sports.

What about the most important medical development of 2010? For this my vote goes to a study published online in Science on July 20, which found that 1% tenofovir gel used before and after sexual intercourse reduced the rate of new HIV infections in women by 39% and cut the rate of transmission of HSV-2 infections by 50% (Science doi: 10.1126/science.1193748). A full story about the study was reported by my colleague Mitchel L. Zoler from the 18th International AIDS Conference in Vienna, where the findings were unveiled.

More studies of tenofovir are needed, to be sure, but this was the first study to prove that 1% tenofovir gel can stop HIV transmission in its tracks. The clinical implications of the findings are significant, especially in sub-Saharan Africa, where an estimated 22.5 million adults and children live with AIDS.

“Is it good enough? No,” reproductive infectious diseases expert Sharon L. Hillier, Ph.D., said at this summer’s annual meeting of the Infectious Diseases Society for Obstetrics and Gynecology in Santa Fe, N.M. “Do we need something that’s 80% effective? Absolutely. But I have to tell you: from working in the microbicide field for 15 years, this was a startling and wonderful finding. Many of us were not surprised by the results, but so thrilled that finally there was something that looked like it was working.”

— Doug Brunk (on Twitter@dougbrunk)

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Video of the Week: New HIV Treatment Guidelines

The increased efficacy of antiretroviral therapy for HIV has changed the nature of HIV infection, according to Dr. Melanie A. Thompson. In response, treatment guidelines now call for treatment to begin earlier.  Our reporter, Mitchel Zoler, talked with Dr. Thompson about these changes at the 18th International AIDS Conference.

We now feel that the risks of untreated infection are tipping the scales toward earlier therapy.

Dr. Thompson is the principal investigator of the AIDS Research Consortium of Atlanta and chairwoman of the panel that wrote the new recommendations. You can read Mitch’s story at Internal Medicine News.

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Medical Meeting as Performance

The medical meetings I cover are mostly academic exercises, with researchers reporting new data and other experts mulling the data over and trying to decide what it means. But there is another aspect to many meetings, especially the big ones with thousands or even tens of thousands of attendees, that has a decidedly theatrical element. I even know some people who insist on calling these meetings shows, although that’s mostly their exhibit-hall orientation.

No other medical meeting I’ve covered, easily more than 400 in my career, incorporates as much theater and performance as the International AIDS Conferences, which began in 1985 and have been held every other year since 1996. The AIDS Conferences are where conventional meeting science and discussion collides with demonstrations, passions, and flamboyant displays.

At the eighteenth International AIDS Conference, held this week and wrapped up today in Vienna, my vote for the most attention-grabbing and creative theatricality was the Condomize! display that maintained an expansive presence in the middle of the main traffic corridor all week. Volunteers from The Condom Project created condom mosaics on corridor columns, worked beneath billboard-sized condom murals along with a display of air-filled condoms (the better to see the variety of sizes), and had tables laden with thousands of condoms for distribution and for the creation of condom pins.

Other theatrical elements included the Haitian solidary demonstration that took over the podium and launched one morning’s plenary session.

Where else but at the AIDS Conference would you find Annie Lennox co-chairing a plenary session.

all images by Mitchel Zoler

And then there was the most electrifying and anticipated report at this year’s session, last Tuesday afternoon, when researchers from Caprisa reported results from their proof-of-principle clinical study that showed a tenofovir vaginal gel used by women before and after sex cut the rate of new HIV infections by a relative 39% (see my report here). During the course of the hour-long report, the large, packed audience greeted the exciting results with four separate outbursts of applause, ending with a standing ovation at the end of the talk.

Nothing gets more theatrical than a performance received like that.

—Mitchel Zoler (on Twitter @mitchelzoler)

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HAART Rules

Liberal use of highly active antiretroviral therapy for HIV infections, the kind of regimen that makes the virus undetectable in an infected patient, has been the mantra of the International AIDS Conference in Vienna this week. It’s been promoted as a strategy to both help HIV-infected patients as well as to help those who are not yet infected and wanting to stay that way.

image by Mitchel Zoler

The revised HIV treatment recommendations from the International AIDS Society-USA, released July 18, reset the threshold for starting HAART in asymptomatic patients from 350/mcL CD 4 cells to 500/mcL, as well as provided a list of eight special situations that also warranted treatment in asymptomatic patients. Even more aggressively, it said starting treatment could be considered for any asymptomatic patient, regardless of CD 4 cell count, saying that no contraindication existed for treating HIV infection at any CD 4 cell level.

But it was hard to see treatment of these patients as merely a consideration when the chairwoman of the recommendations panel, Dr. Melanie A. Thompson, said that “at any CD 4 count the body takes a hit from uncontrolled HIV infection,”  that’s believed to show up later as cardiovascular, renal, and hepatic complications, as well as cancer. She also said that one of the major, prior reasons to wait on starting treating–to avoid possibly wasting one or more of a limited panel of drug treatment options–has become much less of a concern because now more drug options exit, and the new options have good tolerability and potency. Here is my full report on the treatment recommendations.

But there is more to like about widespread, and early HAART: It also helps the community as a whole avoid HIV infections, Dr. Julio S.G. Montaner said in a talk on July 21 and in a paper that appeared last week in The Lancet. He assessed the impact of HAART on HIV transmission rates in British Columbia, Canada, and found a strong link between an increased number of HIV-infected patients on effective HAART and a substantial drop in new HIV infections. The way this works is if HIV-infected patients are on HAART and have an undetectable viral load they are much less likely to pass the infection on to someone else.

In his analysis, Dr. Montaner found that for every 100 additional HIV-infected patients on HAART the number of new HIV infections in British Columbia dropped by 3%, and that for each 10-fold drop in the “community viral load” of HIV the number of new infections fell by 14%.

Of course, many challenges remain, such as identifying people infected with HIV when they’re asymptomatic and still have high CD 4 cell levels, and paying for all this HAART.

—Mitchel Zoler (on Twitter @mitchelzoler)

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