In a fast moving and wide ranging talk at the International AIDS Conference, Dr. Anthony Fauci, the head of National Institute of Allergies and Infectious Diseases at the NIH, gave new hope and energy to the defining call of AIDS activism, ‘Until There is a Cure.’ While necessarily short of details, the vision that Dr. Fauci presented points the way forward for both the research community and the activist world.
The ongoing and deepening controversy surrounding abacavir was one of the main stories at this year’s International AIDS Conference. The ‘late breaker’ sessions, often the venue for the most interesting research data, included four full presentations debating two important questions about this widely used HIV drug: whether abacavir increases the risk of heart attack, and does it work as well as other drugs for people with high HIV levels. While it’s fair to say that controversy remains, Project Inform can’t help but note a growing cloud of questions surrounding this important HIV treatment.
With well over 20 drugs from 6 classes available to treat HIV, there’s growing interest in using novel drug combinations. Studies of class-sparing regimens are particularly important. While many new drugs have been developed over the past decade, the basic model of HAART — 2 NRTIs plus a potent drug from another class — has remained largely unchallenged. Results from a study presented at the International AIDS Conference may provide a boost for people seeking to investigate different ways of using HIV drugs.
Data from a study called the ‘Mexican 5142 study’ were presented August 5 at the International AIDS Conference. The study, a head-to-head study of Sustiva (efavirenz) vs. Kaletra (lopinavir + ritonavir) in people with CD4 counts below 200 who start first line HIV therapy, showed Sustiva to be more potent than Kaletra in this group.
Data were presented August 4 at the International AIDS Conference on a head-to-head study comparing the integrase inhibitor Isentress (raltegravir) to Sustiva (efavirenz) in people taking HIV drugs for the first time. The study found that Isentress proved equally potent and durable to Sustiva, the most widely used drug in first line treatment.
In a late-breaker session at the International AIDS Conferenc, Abbott announced progress on their long-delayed heat stable form of their booster, Norvir (ritonavir). Now several years after their successful development of a heat stable form of Kaletra (lopinavir + ritonavir), this news is welcomed.
In a presentation perhaps most notable for what wasn’t said, data on Tibotec’s experimental first line NNRTI, rilpivirine, were presented August 5 at the International AIDS Conference. The results showed that rilpivirine was equally potent and well tolerated as Sustiva (efavirenz) when taken as part of first line therapy. While the results presented were promising, the lack of forthrightness regarding questions on resistance and adverse events left many, including Project Inform, shaking their heads.
Data on the experimental NRTI, apricitabine, were presented August 5 at the International AIDS Conference, showing it is well tolerated when taken by people with experience taking HIV drugs. The results add to earlier research which showed that it might prove to be a good treatment option for people whose HIV has grown resistant to the NRTIs Epivir (lamivudine/3TC) and Emtriva (emtricitabine/FTC).
The NNRTI class has long been dominated by Sustiva. It is good news to see several new drugs with promising properties, like good potency and tolerability. These two drugs are very early in development, so much more research will be done before we know whether either will be a good option for people with HIV. Nonetheless, with the pipeline as thin as it is, all good news on new HIV drugs is welcome.
Taking drugs for both TB and HIV at the same time can be challenging for many. As well, the risk for developing TB within the first 3 months on HIV therapy is quite high. Therefore, using IFN-g in people who haven’t started HIV therapy may eventually provide another option for those faced with a TB diagnosis. Longer-term studies will need to be conducted to assess how durable this response remains over time.
A growing area of concern in the health of people living with HIV is the role that the human papillomavirus (HPV) plays in causing cervical and anal cancers. Expanding research over the past two years has helped bring this concern closer to the forefront of the community’s attention. Research is showing higher rates of HPV infection and disease in HIV-positive people than originally believed.
Globally, diagnosing and treating tuberculosis (TB) in people living with HIV is becoming more difficult, as multi-drug resistant and extensively resistant strains become more common. This difficulty is often worsened by the lack of testing resources, access to drugs, and health care infrastructures. In spite of these complex issues, it's becoming more imperative to properly screen and treat individuals at risk for TB disease. Several studies on TB/HIV co-infection reported results at the International AIDS Conference.
Some studies have suggested a possible link between using some types of anti-depressant medications to a heightened risk of cancer. There is also evidence that certain anti-depressants might lower the risk of some cancers. Understanding the possible link between anti-depressants and cancer is particularly important for people wit HIV, because they experience higher rates of cancer than the general population, and they have a high rate of anti-depressant use.
Those co-infected with HIV and hepatitis C (HCV) can face significant challenges with sustaining their liver health. This is due to how the two viruses affect the liver over time as well as the ongoing side effects from taking drugs that treat the two diseases. For these and other reasons, there’s an urgent need to find methods of improving liver function for people co-infected with HIV/HCV.
Results from a study of IL-2 (interleukin-2) garnered substantial interest from a full audience August 6 at the International AIDS Conference. Though IL-2 is the most studied immune based therapy, its usefulness as an adjunct for HIV therapy mostly hasn’t panned out, except as an experimental drug for discreet use in a select group of people. However, these results are quite exceptional and have the potential to offer a person to take extra time before starting HIV therapy.
In part of a small but interesting session focused on immune based therapies, Dr. R. Gandhi of Massachusetts General Hospital presented data comparing two immune based approaches in people interrupting HIV treatment. The study compared injections of dendritic cells (DCs) alone vs. DCs + canarypox (CP) virus in people with undetectable HIV levels while on potent HIV treatment but undergoing a treatment interruption.
These figures are yet another wake-up call for community activists and the federal government to plan and implement a national strategy to effectively end the transmission of HIV in the US. Project Inform continues to work in coalition with organizations and individuals from the community, government and industry to implement the National AIDS Strategy. We also continue to provide leadership around exploring the value of interventions such as PrEP and microbicides.
At the August 4 session, Vaccines and Microbicides: Where Do We Go from Here?, several panelists expressed their dogged resolve to continue HIV vaccine research. This comes after a mixed bag of advances and setbacks in prevention. On the positive side, male circumcision is now shown to prevent transmission. On the negative, most of the microbicides in study have failed and two major vaccine studies were recently cancelled.
In light of the recent cancellation of two major vaccine studies, unique ideas are desperately needed to resolve the global AIDS crisis. The answer to this scientific riddle may lie in a group of people who naturally control HIV infection on their own, without help from HIV therapy. These elite controllers, or long-term non-progressors (LTNPs), represent less than 1% of all people with HIV.
At the August 4 session, Vaccines and Microbicides: Where Do We Go from Here?, Zeda Rosenberg updated the state of research into microbicides. Her presentation spoke of renewed hope that the current pipeline of experimental drugs could, in a year or two, result in strong candidates for protecting women against HIV infection. This tone was in marked contrast to the general sense of disappointment that has permeated this important field for the past few years.
In January 2008, the Swiss AIDS Commission issued a controversial Statement on the transmission of HIV in heterosexual mixed status couples. It stated that HIV is not likely to be passed on when the positive partner fully adhered to a potent HIV regimen, had undetectable viral load for at least six months, and did not have any other sexually transmitted infection (STI) during that time, even despite sex without condoms.
The last few years have seen tremendous progress in treating people with advanced and drug-resistant HIV. Four powerful drugs became available that either overcame drug resistance (Prezista [darunavir, TMC-114], Intelence [etravirine, TMC-125]) or were from entirely new classes [Selzentry (maraviroc), Isentress (raltegravir)].
Washington, DC—The HIV Medicaid and Medicare Working Group criticized Congress today for failing to fix a major flaw in Medicare legislation that leaves people with HIV/AIDS stuck in the Part D “donut hole” and at risk of going without essential medications.
The last seven years have been trying for agencies like Project Inform that strive to reduce the impact of HIV in the United States. On one hand, the Bush administration has increased funding to address the global HIV crisis, resulting in substantial growth in access to care and prevention for millions of previously ignored individuals. But on the other hand, years of flat-funding of domestic HIV programs have resulted in substantial gaps in our nation's response to this continuing and grave problem.
When all chances of passing health care reform legislation died in 1993, political experts said it would be at least 15 years before the issue would again be seriously considered. It is now 15 years later, and health care reform is clearly back on the country's priorities. Health care consistently ranks in the top issues of American's concerns and many Presidential candidates have made their health care proposals a key component of their campaign. It is increasingly clear that addressing the health care crisis will be a major focus for the next President and Congress.
In a stunning setback, Project Inform has learned Koronis Pharmaceuticals has stopped the only ongoing study of their experimental drug, KP-1461. This decision was based on unexpected results from lab tests and not on safety concerns. Those participating in these studies have been told of these developments.
Get ready, San Francisco! Project Inform's annual fundraiser debuts its newest look as it takes the runway at the fabulous new InterContinental Hotel in San Francisco.
On April 9, 2008, 42 leaders in the domestic response to HIV/AIDS met at the Ford Foundation in New York City to discuss development of a National AIDS Strategy (NAS) for the United States. Dana Van Gorder, Project Inform's Executive Director, participated in the meeting. The NAS effort was initiated by the AIDS Action Council, AIDS Foundation of Chicago, Balm in Gilead, Black AIDS Institute, Community HIV/AIDS Mobilization Project, Gay Men's Health Crisis, and the San Francisco AIDS Foundation.
These two events will bring together key leaders in the HIV/AIDS community, long-time friends of Marty's and of Project Inform, to pay tribute to the countless lives Martin has improved and saved since 1985. A night of cocktails, culinary delights, tributes and gallery style retrospective of Marty's past 23 years.
On May 19, 2008, Project Inform will join hepatitis advocates around the globe in recognizing “World Hepatitis Awareness Day.” This day will highlight the severity of the hepatitis epidemic around the world through media campaigns, rallies, and educational events. We will also call on elected and administrative officials to take bold action in creating hepatitis education, prevention, diagnosis, care, and treatment programs.
The California HIV Alliance is a coalition of California's largest HIV/AIDS providers and advocates, including San Francisco AIDS Foundation, Bienestar, Project Inform, AIDS Healthcare Foundation, AIDS Project Los Angeles, AIDS Services Foundation of Orange County, LA Gay & Lesbian Center and Sacramento CARES.
In many parts of the world, May 1 is celebrated as International Workers Day, which observes the struggle of workers for a better life. In that spirit I celebrate activism — specifically the first generation of AIDS activists who forged a monumentally successful movement in the crucible of fear, stigma, illness and death. This early movement was one of the first times when a group of sick people and their allies consciously organized themselves to take on the government, scientific establishment and pharmaceutical industry.
The global tuberculosis (TB) epidemic is in enormous need of newer ways to combat the disease. Each year, 9 million people develop TB and about 2 million die. Newer drug resistant and multi-drug resistant strains are complicating treatment efforts worldwide, especially in resource-poor nations and when combined with treating HIV disease. Now, results from a recent British study looking at how tuberculosis (TB) survives during transmission have uncovered “fat and lazy” bacteria, which may present a new avenue for prevention and treatment.
More than three years ago, Project Inform kicked off a campaign to refocus the attention of the patient, activist and research communities on the need for a true cure for HIV disease. The success of combination therapy and treatment simplification seemed to have created a wave of complacency and a sense that, except for side effects, HIV treatment was finally “good enough.” Project Inform has challenged this view ever since. Though the effort was sometimes ridiculed as naïve, a number of influential groups and researchers have now joined the campaign.
In February 2008, Pfizer invited a substantial group of Executive Directors of the nation's HIV/AIDS agencies to gather at their Research & Development headquarters in Groton, Connecticut. The meeting had two principal goals: for us to hear from Pfizer about the hope and challenges that characterize the search for increasingly effective treatments for HIV infection; and to consider how the United States will continue to finance the cost of HIV care and treatment.
For the last three years, Project Inform has spearheaded a renewed call for research that seeks to find a real cure for HIV disease, rather than settling for lifetime maintenance therapy on drugs. A case study from the Medical University of Berlin reported at CROI 2008 offered intriguing results from a stem cell transplant, an approach that was tried before but without success.
In early 2007, the DHHS Guidelines panel met and agreed to a complete review and update of the guidelines. Members of the panel, which include treating physicians, researchers, government officials and community members, were assigned to various subcommittees to review the document and recommend changes to the full panel. Two sets of updates have been issued: one in December 2007 and one in January 2008. This article reviews the changes thus far.
The Conference on Retroviruses and Opportunistic Infections is the most important annual science conference in the US covering HIV/AIDS. This year's meeting was held in Boston, MA and included presentations ranging from vaccines to microbicides and experimental HIV drugs to opportunistic infections. This article reviews the research on approved anti-HIV drugs presented at CROI 2008.
Compared to the recent fast pace of new HIV drug development, the next couple of years look relatively quiet. In just over two years, five new drugs were approved by the FDA, including ones from two new classes. While most people — including those with extensive treatment experience — are now able to build potent regimens, there remains a need for new drugs.
This year at CROI, many studies covered a variety of topics related to HIV-related infections and conditions, such as tuberculosis, herpes and hepatitis. Some revealed modest advances, some exposed sobering news, while others provided us with a better understanding of how treating some infections impact HIV therapy. Some studies report possible advances in diagnostic tools that could better manage these infections and improve the lives of people living with HIV.
Nearly one-third of the world's population is infected with Mycobacterium tuberculosis (TB). Each year, about 9 million develop the active disease and about 2 million die. Globally, it's also the leading cause of death in people with HIV. Over the years, TB has developed resistance to several of the antibacterial drugs used to cure it. World health personnel are scrambling for answers as they now face multi-drug resistant (MDR) and extensively drug resistant (XDR) strains of TB.
One of the most interesting reports from CROI 2008 described new types of drug delivery using “nano-technology.” While scientists have been experimenting with such approaches for a number of years, presentations at CROI showed that this technology is much closer than previously believed.
This information is designed to support, not replace, the relationship that exists between you and your doctor.