When the Red Cross arrived at the Library of Congress in 1998 for its annual blood donation drive, gay library employee Charles McMoore registered, then rolled up his sleeve to perform what he felt was a civic duty.
The field of HIV prevention has its share of raging controversies, but there's one thing almost everyone agrees on — an effective HIV vaccine is desperately needed. After an embarrassing burst of optimism for a failed first-generation product in the early 1990s, vaccine research has been widely perceived as stagnant.
Compounds become useful drugs only if their beneficial qualities far outweigh any harmful or unwanted activity. But drugs can have subtle, unintended effects — both good and bad — that may remain unnoticed until after they are in widespread use.
GMHC Treatment Issues: September / October - Volume 14, Number 9/10
The 13th International AIDS Conference, which took place in Durban in July, dominated the main pages of the country's newspapers and the prime slots on TV, an indication that South Africans are becoming increasingly aware of the damage this disease, and the lack of an appropriate response to it, is causing to the social and economic fabric of this society.
One of the most important themes at the International AIDS Conference in Durban was the prevention of mother-to-child transmission of HIV (MTCT). This was very appropriate given that one in four South African women in their peak child-bearing years -- between the ages of 20 and 29 -- are HIV-positive. In addition, rates of HIV infection in prenatal clinics in sub-Saharan Africa can run as high as 43%.
Few Americans who attended the Durban AIDS meeting left without a profound of sense of transformation. AIDS activists marched through the streets of Durban, and the country's newspapers and televisions were dominated by AIDS coverage.
The mystery of change in body habitus, accumulation of fatty tissue in areas such as the trunk, the neck, the breasts and the upper back accompanied by atrophy of adipose tissue in the face (Bichat's fat pad), the limbs and the pelvis/butt, was not resolved in Durban.
GMHC Treatment Issues: Spring - Volume 14, Number 3/4
The Conference on Retroviruses and Opportunistic Infections is the most comprehensive yearly scientific meeting covering research on HIV and the treatment of HIV disease. Yet the thing that most impressed me at this year's meeting, in San Francisco, was not a data presentation or posters on an exciting new class of drugs or any other scientific breakthrough.
While in San Francisco for the Retrovirus Conference, I kept seeing wheat-pasted flyers that defaced posters for the San Francisco AIDS Foundation. "SFAF is homophobic," they said, or "HIV is a myth." It was clear to me that the AIDS denialists, those who believe that HIV is not the cause of AIDS, were experiencing a resurgence, at least in the City by the Bay.
A community meeting, Long-Term Effectiveness Clinical Trials in HIV/AIDS, met in San Francisco on January 29, 2000, the day before the Retrovirus Conference began. Approximately 50 activists met in response to the NIH's workshop on long-term studies in HIV infection that was held in Bethesda on January 12 and 13.
Despite Dr. Miles concerns that early antiretroviral therapy may be harming some patients, as noted in the Celia Farber article, he thinks that the drug bashing has gone a little too far. He is concerned that some patients who should be on treatment are quitting, and others afraid to start.
The 7th National Conference on Retroviruses and Opportunistic Infections devoted a significant part of its oral and poster presentations to lipodystrophy, which is more accurately called HIV-related adipose redistribution syndrome (HARS). This disorder, a possible long-term complication of anti-HIV therapy, has become one of the leading obstacles in the management of HIV disease.
With the passage of time and accumulation of more data, we are learning more about the nature of lipodystrophy and metabolic complications. Still, there were widely varying reports on their incidence at the Retrovirus Conference. Much depends on how the syndrome is defined, but now the question seems to be "Is it one syndrome, or many?"
Along with their new legitimacy as a potential treatment strategy, "drug holidays" are now known as structured treatment interruptions (STIs), and they are being studied in two very different contexts.
In a late-breaker, Dr. Steve Deeks presented results from a prospective study of STIs in patients who were on protease inhibitor-based therapy and who had a viral load over 2,500 copies for at least twelve months (LB-10).
Initially used in salvage regimens, dual protease inhibitor therapy is now increasingly used earlier in treatment. (For discussions of dual protease inhibitors in salvage therapy, see Treatment Issues, 'Salvage Therapy: Still More Intuition Than Data' January, 1999, and 'The Great Salvage Therapy Drug Juggle' April, 1998.)
Nelfinavir (Viracept), Agouron's protease inhibitor that was initially approved at a dose of 750 mg (three 250 mg tablets) three times each day, has become easier to take. Late in 1999, the FDA approved a dose of 1250 mg (five 250 mg tablets) twice daily.
Glaxo Wellcome has issued a warning about potential safety concerns with Agenerase (amprenavir) Oral Solution. The oral solution contains a significant amount of propylene glycol, which some people cannot metabolize sufficiently, leading to possible adverse events including seizures, stupor, lactic acidosis, rapid heart rate, kidney toxicity, and hemolysis (a loss of red blood cells).
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