Thursday, February 28, 2008

New journal received in the library: AIDS Patient Care& STDs, Vol. 22, no 1, January 2008

In this issue:

Case Report: Bilateral Renal Aspergillosis in a Patient with AIDS: A Case Report and Review of Reported Cases
A.W. Oosten, H.G. Sprenger, J.T.M. van Leeuwen, N.E.L. Meessen, S. van Assen
pp. 1-6.
Abstract

Viro-Immunologic Response to Ritonavir-Boosted or Unboosted Atazanavir in a Large Cohort of Multiply Treated Patients: The CARe Study
Maria Mercedes Santoro, Ada Bertoli, Patrizia Lorenzini, Adriano Lazzarin, Roberto Esposito, Giampiero Carosi, Giovanni Di Perri, Gaetano Filice, Mauro Moroni, Giuliano Rizzardini, Pietro Caramello, Renato Maserati, Pasquale Narciso, Antonietta Cargnel, Andrea Antinori, Carlo Federico Perno, the CARe Study Group
pp. 7-16.
Abstract

Concurrent HIV/AIDS Diagnosis Increases the Risk of Short-Term HIV-Related Death among Persons Newly Diagnosed with AIDS, 2002–2005
David B. Hanna, Melissa R. Pfeiffer, Lucia V. Torian, Judith E. Sackoff
pp. 17-28.
Abstract

Prior Illicit Drug Use and Missed Prenatal Vitamins Predict Nonadherence to Antiretroviral Therapy in Pregnancy: Adherence Analysis A5084
Susan E. Cohn, Triin Umbleja, Joseph Mrus, Arlene D. Bardeguez, Janet W. Andersen, Margaret A. Chesney
pp. 29-40.
Abstract

Predictors of the Initiation of HIV Postexposure Prophylaxis in Rhode Island Emergency Departments
Roland C. Merchant, Kenneth H. Mayer, Bruce M. Becker, Allison K. Delong, Joseph W. Hogan
pp. 41-52.
Abstract

A Qualitative Study Among Injection Drug Using Women in Rhode Island: Attitudes Toward Testing, Treatment, and Vaccination for Hepatitis and HIV
Michelle A. Lally, Sydney A. Montstream-Quas, Sara Tanaka, Sara K. Tedeschi, Kathleen M. Morrow
pp. 53-64.
Abstract

Vaccination in Brazilian HIV-Infected Adults: A Cross-Sectional Study
Yeh Li Ho, Thatiana Enohata, Marta Heloisa Lopes, Sigrid De Sousa Dos Santos
pp. 65-70.
Abstract

Self-Reported Adherence to Antiretroviral Treatment among HIV-Infected People in Central China
Honghong Wang, Gouping He, Xianhong Li, Aiyun Yang, Xi Chen, Kristopher P. Fennie, Ann Bartley Williams
pp. 71-80.
Abstract

Letter to the Editor: Medical Care of HIV-Infected Individuals in Poland: Impact of Stigmatization by Health Care Workers
Dorota Rogowska-Szadkowska, Alicja Małgorzata Ołtarzewska, Jolanta Sawicka-Powierza, Sławomir Chlabicz
pp. 81-84.

Contact the library to request copies of articles.

New approach stops HIV at earliest stage of infection

Source: Science Daily

ScienceDaily (Feb. 28, 2008) — Researchers at The Scripps Research Institute have developed a new two-punch strategy against HIV and they have already successfully tested aspects of it in the laboratory.

Their study, which appears in the online Early Edition of the Proceedings of the National Academy of Sciences, may re-energize attempts to create a preventive/therapeutic vaccine against HIV, say the authors. To date, more than a dozen candidate vaccines, which have attempted to raise immunity against the spiky proteins on the viral envelope, have all failed in clinical testing.

The investigators have created devices they call glycodendrons that are designed to do two things at once: inhibit the transport of HIV from where it traditionally enters the body, preventing it from moving deeper inside where it can infect immune cells; and set up an immune antibody response to a unique carbohydrate structure on the surface of the virus.

"This paper is about a new direction in HIV vaccine design," said the study's lead investigator, Scripps Research Chemistry Professor Chi-Huey Wong. "Results we have so far are very promising."

To date, he says the devices have been able to stimulate the immune system of mice to induce antibodies against HIV surface glycoprotein, and, in laboratory studies, have been able to block the virus from infecting immune cells. (...)

Click here to read the complete article.

Monday, February 25, 2008

B.C. study shows 40 per cent of HIV sufferers died without getting treatment

Source: The Canadian Press

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

"And they have no general practitioner. That's another nightmare," she said.

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

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

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

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

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

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

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

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

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

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

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

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

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

Monday, February 18, 2008

Study: Gel Fails to Stop HIV Infection

Source: The Associated Press

The first anti-AIDS vaginal gel to make it through late-stage testing failed to stop HIV infection in a study of 6,000 South African women, disappointed researchers announced Monday.

The study was marred by low use of the gel, which could have undermined results, they said. Women used it less than half the number of times they had sex, and only 10 percent said they used it every time as directed.

Scientists are still analyzing the results to see if this made a difference. They also plan more tests on a revamped gel containing an AIDS drug that they hope will work better.

The gel used in the current study did prove safe, however, and researchers called that a watershed event.

But for now, the effort is the latest disappointment in two decades of trying to develop a microbicide — a cream or gel women could use to lower their risk of getting HIV through sex. A female-controlled method is especially needed in poor countries where women often can't persuade men to use condoms.

A year ago, scientists stopped two late-stage tests of a different gel after early results suggested it might raise the risk of HIV infection instead of lowering it. (...)

Click here to read the complete article.

Wednesday, February 06, 2008

Test Detects Sensitivity to HIV Drug

Source: US News & World Report

Test Detects Sensitivity to HIV Drug Could be first step toward personalized medicine, experts say
By Randy Dotinga

WEDNESDAY, Feb. 6 (HealthDay News) -- New research suggests that an expensive blood test could help a small minority of HIV patients discover whether they should avoid a common AIDS drug that can sometimes cause serious side effects.

The test detects sensitivity to the medication abacavir by checking to see if a patient's genetic makeup is linked to poor reactions to the medicine.

"This is very important news in relation to the great hopes from the work with the Human Genome Project," said Magnus Ingelman-Sundberg, a professor at Karolinska Institutet in Sweden, who wrote a commentary about the research. The genome project aims to analyze the genetic blueprint of humans.

At issue is the AIDS drug abacavir, also known by the brand name Ziagen, which is found in compound drugs known as Trizivir and Epzicom. The drug is known as a nucleoside reverse transcriptase inhibitor and works by preventing the AIDS virus from going through the motions of multiplying.

About 8 percent of patients suffer from hypersensitivity to the drug, said study author Simon Mallal, a researcher at Murdoch University & Royal Perth Hospital in Australia. His report on the results is published in the Feb. 7 issue of the New England Journal of Medicine. The problems typically occur within the first six weeks that patients use the drug, he added.

According to the study, the side effects include fever, rash, gastrointestinal symptoms and other problems.

By testing patients for a genetic trait that was found in 5.6 percent of 1,956 female and male patients, the researchers found they could spot potential cases of sensitivity to abacavir.

The test's use could allow doctors to do a better job of personalizing drugs for individual patients, Mallal noted. (...)

Click here to read the complete article

Drug Helps Prevent Breast-Feeding Moms From Passing on HIV

Source: US News and World Report

6 weeks of nevirapine greatly reduced infant infections in Africa, India, study found
Posted 2/6/08

WEDNESDAY, Feb. 6 (HealthDay News) -- The antiretroviral drug nevirapine greatly reduces the risk that HIV-infected mothers will pass the virus to their babies during breast-feeding, according to a study conducted in Africa and India.

Nevirapine is already in widespread use in developing countries to prevent HIV-positive women from infecting their newborns during childbirth, note researchers at Johns Hopkins University, in Baltimore.

In this study, the Hopkins team and colleagues in Ethiopia, India and Uganda gave daily doses of the drug to breast-feeding infants when they were 8 to 42 days old.

By the time they reached 6 weeks of age, the rate of HIV infection among infants who received the drug daily was about half that of infants who received a single dose of nevirapine at birth, which is the current standard of care.

After six months, the infants who'd received the six-week drug treatment were almost a third less likely to suffer HIV infection or death than those given the single dose at birth.

The study included about 2,000 infants and was conducted from 2001 to 2007. It's one of the first randomized controlled trials to show that a drug can prevent HIV transmission in infants being breast-fed by HIV-infected mothers.

The findings were presented Monday at the Conference on Retroviruses and Opportunistic Infections, in Boston.

Breast-feeding is a major cause of HIV infection in the developing world. Each year, about 150,000 infants are infected with HIV through breast-feeding, according to the World Health Organization.

Moms Pre-Chewing Food Gave HIV to Kids

Source: The Associated Press

By MIKE STOBBE

ATLANTA (AP) — For the first time, health officials report that the AIDS virus can be spread by a mother pre-chewing her infant's food, a practice mainly seen in poor, developing countries.

Three such cases were reported in the United States from 1993-2004, government scientists said Wednesday in a presentation in Boston at a scientific conference.

It's blood, not saliva, that carried the virus because in at least two of the cases the infected mothers had bleeding gums or mouth sores, according to investigators at the U.S. Centers for Disease Control and Prevention.

CDC officials say more study is needed. But they are asking parents and caregivers with HIV not to pre-chew infants' food, and are trying to educate doctors about this kind of transmission.

Health officials believe chewed-food transmission is rare in the United States, where such behavior is considered unusual. In some countries, mothers do it because they have no access to baby food or a means of pulverizing food for toothless infants.

"But even one case is too many," said the CDC's Dr. Ken Dominguez, who helped investigate the U.S. cases. (...)

Click here to read the complete article.

Tuesday, February 05, 2008

Circumcising HIV positive men may increase HIV infections in female partners, but fewer STIs seen

Source: AIDSMAP - 15th Conference on Retroviruses and Opportunistic Infections, Boston USA - February 2008

There was a trend towards higher HIV incidence in the wives of HIV positive men who were circumcised compared with wives of men left uncircumcised, in the latest prevention study conducted in Rakai province, Uganda, investigators revealed at a press conference on the opening day of the Fifteenth Conference on Retroviruses and Opportunistic Infections in Boston.

In 2006, a randomised trial of circumcision in Rakai reported that circumcision led to an almost 50% reduction in a man’s risk of acquiring HIV through heterosexual sex. The impact of male circumcision on transmission of HIV to the female partner remains unknown, and the study reported today set out to examine the effects.

In the Gates Foundation-funded study, 1015 HIV positive men were randomised either to immediate circumcision or circumcision delayed by two years. Of these 770 were married and were asked to invite their wives into the study; 566 wives enrolled of whom 245 (43%) were HIV-negative and therefore in a serodiscordant relationship.

The annual HIV incidence rate in the wives of the men who were circumcised was 14.4% over two years of follow-up compared with 9.1% in women whose partners remained uncircumcised. This result may be due to chance as it was not statistically significant, but was described as “unexpected and somewhat disappointing” by lead investigator Maria Wawer of Johns Hopkins University, Baltimore. It was not due to behavioural disinhibition; condom use was the same in both arms.

Wawer said that these results were an additional challenge to the rolling-out of mass circumcision programmes in Africa, which are expected following the positive results from three randomised controlled trials of circumcision in HIV negative men, one of them conducted within the Rakai community.

She said: “It is inevitable that some HIV positive men will seek circumcision. It is the only HIV prevention modality that leaves a mark, and no one wants to be the only guy in the village who is uncircumcised if it becomes regarded as a mark of HIV.” (...)

Click here to read the rest of the article.

New Issue of JANAC received: Vol. 19, no 1, Jan/Feb 2008

The Journal of the Association of Nurses in AIDS Care covers the spectrum of nursing issues in HIV/AIDS: education, treatment, prevention, research, practice, clinical issues, awareness, policies and program development. This peer-reviewed journal is a forum for nurses and other health care professionals whose focus is the care and treatment of individuals infected and affected by HIV/AIDS.
The Journal of the Association of Nurses in AIDS Care offers the latest information in the areas of health care delivery, program implementation and research analysis and application.

In this issue:

Editorial
Women and HIV Infection
Lucy Bradley-Springer
pages 1-2

Features

Low-Income HIV-Infected Women and the Process of Engaging in Healthy Behavior
Tracy A. Riley, Brenda M. Lewis, Mary Pat Lewis, Joseph L. Fava
pages 3-15
Abstract

Adaptation of an HIV Prevention Curriculum for Use With Older African American Women
Judith B. Cornelius, Linda Moneyham, Sara LeGrand
pages 16-27
Abstract

African American Women's Experience of Infection With HIV in the Rural Southeastern United States
Caroline Mallory
pages 28-36
Abstract

Health Concerns of Mature Women Living With HIV in the Midwestern United States
Maithe Enriquez, Nancy Lackey, Jacki Witt
pages 37-46
Abstract

Women's Voices: The Lived Experience of Pregnancy and Motherhood After Diagnosis With HIV
Lorraine B. Sanders
pages 47-57
Abstract

Improving Women's Adjustment to HIV Infection: Results of the Positive Life Skills Workshop Project
Carol Bova, Tobey Nestor Burwick, Maritza Quinones
pages 58-65
Abstract

The Centers for Disease Control and Prevention Revised Recommendations for HIV Testing: Reactions of Women Attending Community Health Clinics
Joe W. Burrage, Gregory D. Zimet, Dena S. Cox, Anthony D. Cox, Rose M. Mays, Rose S. Fife, Kenneth H. Fife
pages 66-74
Abstract

Promoting Adaptive Coping by Persons With HIV Disease: Evaluation of a Patient/Partner Intervention Model
Betsy L. Fife, Linda L. Scott, Naomi S. Fineberg, Beth E. Zwickl
pages 75-84
Abstract

Contact the library to request copies of articles.

Friday, February 01, 2008

Judge’s ignorance of AIDS draws fire

Source: The Toronto Star

Witness with HIV forced to wear a mask in court, groups complain

An Ontario judge is at the centre of a misconduct investigation after insisting a witness who is HIV-positive and has Hepatitis C don a mask while testifying in his courtroom.

Three groups have complained to the Ontario Judicial Council about the conduct of Barrie judge Justice Jon-Jo Douglas, who later moved the case to a bigger courtroom in order to create more distance between the witness and the bench. The judge refused to accept Crown counsel Karen McCleave's entreaties there was no need for such measures.

"The HIV virus will live in a dried state for year after year after year and only needs moisture to reactivate itself," Douglas insisted, according to a transcript of the Nov. 23 trial proceedings.

"This is outlandish," Bluma Brenner, an assistant professor at the McGill AIDS Clinic at McGill University in Montreal, said yesterday. A drop of human immunodeficiency virus drying on the floor "would be inactivated within 20 minutes," Brenner said in an interview.

But Douglas, a former Crown attorney appointed to the Ontario Court of Justice 10 years ago, was not prepared to continue the trial until he was satisfied "the safety and integrity of this courtroom" was protected.

"I mean, he speaks within two feet of me with two serious infectious diseases," Douglas told McCleave. "Either you mask your witness and/or move us to another courtroom or we do not proceed." (...)

Click here to read the article.

HIV rate soars among Vancouver's native drug users

Source: The Globe & Mail

Startling new research reveals that aboriginal drug users living in Vancouver's Downtown Eastside are contracting HIV-AIDS at twice the rate of non-aboriginal users.

Over the four-year study, 18.5 per cent of aboriginal men and women who injected such drugs as cocaine and heroin became HIV-positive, compared with 9.5 per cent of non-aboriginal intravenous drug users.

"This is a tragedy," Evan Wood, a research scientist at the B.C. Centre for Excellence in HIV/AIDS, said in an interview. "Many people in the aboriginal community are reaching out for care and the care isn't there."

Dr. Wood, the lead author of the research, said the higher rates of infection among natives are not due to biological factors but rather to patterns of social networking: The fact that aboriginal people interact principally with other aboriginals heightens their exposure and speeds the spread of HIV-AIDS.

Better social programs tailored to aboriginals could help alleviate that situation, he said.

In fact, even before researchers started tracking new infections, they found that the proportion of aboriginal drug users with HIV-AIDS was already higher - 25.1 per cent versus 16 per cent for non-aboriginals. (...)

The entire article is available here.
Click here for an abstract of the research article.

Briton sentenced to 14 years in prison for infecting women with HIV in Sweden

Source: The Canadian Press

STOCKHOLM, Sweden - A British man was sentenced Friday to 14 years in prison for infecting two young women with HIV and putting 13 more at risk of infection.

News agency TT reports that thirty-two-year-old Christer Aggett, also convicted of six counts of having sex with minors, was ordered to pay more than $428,000 in damages. The two HIV-infected women will receive the equivalent of about $134,000 - each. Aggett was charged in October with two counts of aggravated assault for allegedly infecting two girls during sex without telling them he was HIV-positive.

Solna District Court in November had found Aggett guilty of the charges but him to undergo psychiatric examination before sentencing. He also was charged with aggravated assault, or "exposing others to danger," by having unprotected sex with more than a dozen other women between 2001 and 2006 - six of them under the age of 15. They were not infected with HIV.

He confessed to most of the charges, but not to having had sex with underage girls, saying he was unaware they were so young. Aggett's lawyer, Jonas Granfelt, said his client is likely to appeal the ruling. Police suspect that Aggett had been in contact during the five-year period with at least 130 women he met via Internet chat rooms.