Study: HIV may lead to decreased cognitive function

by Alex Schoenfeld

A recent study has found that individuals who test positive for HIV may suffer from premature aging of the brain, either due to the infection itself or the treatment used to control it.

Researchers at the Washington University School of Medicine used magnetic resonance imaging scanners to study the brain of 26 patients with HIV and 25 uninfected subjects. They found that brain blood flow values were considerably reduced in HIV patients compared to control respondents.

The cognitive function of subjects infected with the virus was equivalent to readings seen in uninfected individuals who were 15 to 20 years older.

“Brain blood flow levels decline naturally as we age, but HIV, the medications we use to control it or some combination of the two appear to be accelerating this process independent of aging,” said lead author Beau Ances.

Researchers discovered that declining brain function was perceptible in young, newly infected patients as well as older individuals who have been dealing with the virus for some time. Previous studies related to the long-term health of HIV patients have indicated that the virus adversely affects the liver, heart, kidneys and endocrine system.

Herpes Medication Does Not Reduce Risk of HIV Transmission, Study Finds

ScienceDaily (Jan. 25, 2010) — A five-year international multi-center clinical trial has found that acyclovir, a drug widely used as a safe and effective treatment taken twice daily to suppress herpes simplex virus-2 (HSV-2), which is the most common cause of genital herpes, does not reduce the risk of HIV transmission when taken by people infected with both HIV and HSV-2.

The results of the study are published in the New England Journal of Medicine.

Up to 90% of people with HIV infection also have HSV-2 infection. Most people who are infected with HSV-2 do not know they have the virus because symptoms can be mild or absent. HSV-2 infection can cause recurrent sores and breaks in the skin of the genital region, which can be mild and often go unnoticed. HSV-2 infection also attracts immune cells called CD4 T-cells to the genital region, which HIV uses to establish or pass infection.

Multiple studies have shown that frequent genital herpes recurrences increase the amount of HIV in the blood and genital tract. The HIV virus is also shed from genital herpes ulcers and persons with such ulcers transmit HIV to others more efficiently. Five preliminary studies showed that it is possible to decrease the amount of HIV in the blood and genital tract through treatment to suppress HSV-2, but these studies did not measure whether this translated into a reduction in HIV transmission. Researchers had hoped that acyclovir’s ability to suppress the herpes virus, which causes symptomatic genital sores and breaks in the skin but also frequently is active without symptoms, could reduce the likelihood of sexual transmission of HIV from a person with HIV and HSV-2. The study is the first to determine whether twice daily use of acyclovir by individuals who are infected with both HSV-2 and HIV reduced the transmission of HIV to their sexual partners. The authors conclude that daily acyclovir therapy did not reduce the risk of transmission of HIV, in spite of the fact that acyclovir reduced plasma HIV RNA by a ¼ log and the occurrence of genital ulcers due to HSV-2 by 73%.

Led by the University of Washington in Seattle and funded by the Bill & Melinda Gates Foundation, the Partners in Prevention HSV/HIV Transmission Study was conducted among 3,408 African HIV serodiscordant couples, in which one partner had HIV and the other did not. In all the couples, the partner who had HIV also had HSV-2 infection. The study took place at 14 sites in seven countries in eastern and southern Africa (Botswana, Kenya, Rwanda, South Africa, Tanzania, Uganda and Zambia). In sub-Saharan Africa, the majority of new HIV infections occur among heterosexual HIV discordant couples, many of whom are in stable partnerships and unaware that one partner has HIV and the other does not. Genital herpes is thought to be a factor in a substantial proportion of new HIV infections in Africa.

The study began recruitment in Nov. 2004 and ended follow-up of participants in Oct. 2008. Results were first announced in May 2009 and were presented at the International AIDS Society (IAS) meeting in Cape Town, South Africa, on July 22, 2009.

In the primary analysis of HIV transmissions determined by laboratory testing to have occurred within the couple and not acquired from an outside partner, there were 41 infections in the acyclovir arm and 43 in the placebo arm — not a significant difference. Of the partners who were infected with HIV, 68 % were women. Acyclovir suppressive treatment did show significant reductions in the frequency of genital ulcers (by 73%) and the average amount of HIV in the blood (by 0.25 log10 copies/milliliter, a reduction of 40%), compared to the placebo arm.

“As is often the case with large efficacy trials, you learn to expect surprises,” said Dr. Connie Celum, the leader of the study and a UW professor of Global Health and Medicine in the Division of Allergy and Infectious Diseases. “We found that, in spite of a significant reduction in plasma HIV levels and genital ulcer disease with acyclovir suppressive therapy, there was no reduction in HIV transmission. This was a disappointing finding, but a critical outcome of this study is the understanding that interventions must achieve a bigger reduction in HIV levels in order to reduce HIV transmission, especially among persons with high HIV levels. This will be important in informing future interventions to reduce HIV infectiousness.”

Celum said the study is a direct assessment of the impact of herpes suppression on HIV transmission and is the most direct way to see if it’s possible to make a person less infectious and less likely to transmit HIV to their partner. Although the primary outcome of reducing HIV transmission was not observed, Celum said the study achieved many significant mile¬stones that will help to inform HIV prevention research in a number of ways. Among these were HIV testing of approximately 55,000 couples of unknown HIV serostatus, screening of more than 6,500 HIV serodiscordant couples, and enroll¬ment of 3,408 couples in which the HIV- infected partner was dually infected with HSV-2 and not eligible for antiretroviral therapy, based on national guidelines. Adherence to twice daily acyclovir was high, with 88% of doses dispensed (the drug was not dispensed during pregnancy or if visits were missed), and 96% of dispensed doses taken, as measured by pill counts. Retention of study participants at 24 months of follow-up was 92% for HIV infected partners and 84% for HIV uninfected partners.

The Partners in Prevention HSV/HIV Transmission Study is the first clinical trial to directly test whether suppressing HSV-2 infection in HIV-infected persons could reduce rates of HIV transmission and HIV disease progression. The study was randomized, placebo-controlled and double-blinded, meaning that both participants and the care providers did not know which treatment the participants were receiving. Both the placebo and treatment groups received standard HIV prevention services, which included being supplied with condoms, treated for other sexually transmitted infections, and provided care for HIV infection. All participants received extensive counseling, both individually and as a couple, throughout the study period, on how to reduce the risk of HIV infection.

“This was an ambitious study, and I applaud our collaborators at the University of Washington, the investigators and study teams in Africa, the study participants, and the communities where the study was done, for their dedication over the past five years,” Celum said. “We will continue to learn from this study about risk factors for HIV transmission, which will bear fruit for both the HIV prevention and the vaccine fields for years to come.”

Medicare now covers HIV tests

Washington — The Centers for Medicare & Medicaid Services announced Dec. 8 that Medicare will cover HIV screening services, effective immediately.

Testing will be covered for Medicare beneficiaries who are at increased risk for HIV, as well as for those who request the service.

Under the Medicare Improvements for Patients and Providers Act of 2008, lawmakers gave CMS the flexibility to add to Medicare’s list of covered preventive services. Before MIPPA, Medicare could cover additional screenings only when Congress authorized it to do so.

According to the Kaiser Family Foundation, the number of Medicare beneficiaries with HIV increased by 80% between 1997 and 2003, from 42,520 to 76,500. In fiscal year 2008, Medicare spending on HIV totaled $4.5 billion, representing 39% of federal spending on HIV care.

The decision was hailed as a milestone by Health and Human Services Secretary Kathleen Sebelius. “Beginning with expanding coverage for HIV screening, we can now work proactively as a program to help keep Medicare beneficiaries healthy and take a more active role in evaluating the evidence for preventive services.”

The Centers for Disease Control and Prevention estimates 1.1 million people in the U.S. have HIV, with about 25% not realizing they’re infected. Without treatment, AIDS generally develops within eight to 10 years.

In 2006, the CDC called for widespread HIV screening, and the American Medical Association recommends that physicians routinely test adult patients.

At its Annual Meeting in June, the AMA also called for the development and adoption of a single, national plan to address the HIV/AIDS epidemic. Under a resolution adopted at the meeting, the AMA will work with the White House’s Office of National AIDS Policy and other relevant bodies to develop such a program.

“Every adult should know their HIV status,” said Howard K. Koh, MD, HHS assistant secretary for health. “This decision by Medicare should help promote screening and save lives.”

Don’t hang HIV carriers; educate them

Wednesday, 23 December 2009 08:18 By Ariel Rubin

Hardly a day goes by in Uganda without a case of defilement making the rounds in newspapers and media outlets. From the lurid tales spewed out daily by the Red Pepper tabloid to disheartening articles in the Daily Monitor and New Vision of allegations of police defiling rape victims and young women killing attempted rapists, these stories are garnering more and more attention. But why? No other country seems to be as focused on defilers as Uganda. Indeed, one of the major justifications for the controversial “Anti-Homosexuality Bill 2009” is that the proposed law is a necessary measure to counteract the increasing amount of sexual abuse being perpetrated by homosexuals throughout the country.

According to a recent report by the African Network for Prevention against Child Abuse and Neglect (ANPPCAN) Uganda Chapter, 16 children were sexually abused daily in the first six months of this year in Uganda. A total of 9,480 child-abuse related cases were reported to various sources and of these, around 2,600 were defilement. According to Anselm Wandega, the national coordinator for research, information and advocacy at ANPPCAN, the number of child abuse cases in Uganda is “unacceptably high.” He blamed the high incidences of defilement on breakdown in the family system. 

This “breakdown of the family” and the fear it has engendered in Ugandans is one of the major pillars of Bahati and company’s arguments for further marginalising and criminalising Uganda’s gay community. This sentiment was echoed by Topher Mugumya, then-programme coordinator for research, information and advocacy at the ANPPCAN Uganda Chapter, who noted in 2007 that the widespread myth that having sex with a young child can “cleanse” one of HIV had led to a spike in child rape by HIV-positive men. This blanket statement, without any substantial qualification, is all that supporters of the anti-gay bill need to further stoke the fire. A quick glance at comments on Andrew Mwenda’s November 10th op-ed piece in this magazine shows just how many visceral, fear-driven reactions there are.

Instead of a nuanced and intelligent debate about the legality and ethicality of such a bill, the discourse revolves around a sinister cabal of homosexuals fiendishly preying upon innocent school children. Perversely, this renders the two terms synonymous, thus permitting proponents of the Anti-Homosexuality Bill to stifle opposition by calling any supporter a homosexual and thus invariably a defiler of small children. Even though the Penal Code Act already includes provisions which criminalise rape and defilement, Pastor Martin Ssempa can still vehemently argue that, “For too long we have had a problem that boys are raped and sodomised in school settings. Now when we deal with aggravated homosexuality, we are trying to provide equal protection before the law.”

 Unfortunately much of the debate over the Anti-Homosexuality Bill 2009 and the serious problem Uganda faces regarding child abuse seem to have become confused, allowing those like Ssempa to articulate that this deeply unfair bill is one that promotes equality. Indeed, ANPPCAN’s numbers pose a serious problem to Ugandan society but the spurious and offensive notion of a massive homosexual recruitment and rape drive is not the reason why. The difference between pedophilia and homosexuality must be elucidated so that the real reasons behind this bill can be understood and the appropriate responses to child abuse can be generated.

Ultimately, it would be prudent to investigate just how many cases of child rape by HIV-positive men are occurring as this is the kind of claim which can (and given the popular support for the bill, clearly has) stoke serious and often spurious biases against one small segment of the population. It is worth noting that according to one World Vision survey, 60% of girls reported sexual abuse while the number for boys was only 13%, indicating that heterosexual defilement is still a significantly bigger issue than same-sex abuse. As Dr Sylvia Tamale noted in a recent speech at Makerere University, “Over 50% of child sexual abuse reports involve children below 10 years of age, and the perpetrators are heterosexual men who are known to the victim.”  However, no one is tabling an “Anti-Heterosexuality Bill” in Parliament. 

There is no doubt that sexual abuse of minors poses a serious problem but it must not be conflated with the practice of consensual homosexual relations between two adults. The two issues have to be separated and dealt with accordingly. Instead of spending so much time and money advocating the execution of those with HIV/AIDS, the government would be wise to start educating.

Travis McCoy Premieres Solo Track To Support HIV/AIDS Activists

 

Travis McCoy premiered a new solo track titled “One at a Time” Wednesday night at a charity event in New York City’s Lower East Side. The single is meant to reflect Travis’ time spent touring the globe with MTV’s Staying Alive Foundation — a nonprofit organization that aims to support young people working to prevent the spread of HIV and AIDS in their community.

 

 

 

As Gym Class Heroes frontman traveled to South Africa, India and the Philippines, meeting young HIV/AIDS activists, he was encouraged to put his experience to music.

 

“That was kind of the catch of the trip,” Travis told MTV News. “I had to write a song that encompassed everything I saw and felt on the trip … and also gives the listener an idea of what they can do.”

 

“One at a Time” showcases a more serious and contemplative side we don’t often get to see from McCoy. When asked about a specific message in the new track, Travis started reciting some of the lines: “I feel like my generation complains about things we don’t have/ But if you think about it, we ain’t got it so bad / Trust me, I know bad, and I’ve met worse / And it’d be so sad to sit and let it get worse.”

 

McCoy’s experiences abroad are also being turned into a documentary, “Travis McCoy’s Unbeaten Track,” which will air on MTV networks around the world on World AIDS Day, December 1. Talking to the singer, it’s clear that he is proud of the film, and hopes that viewers will tune in and gain something from seeing the work of the many young people he met.

 

“If there was one thing I would want people to take away from my experiences with this documentary, just educate yourself and be aware,” he said. “You know, awareness is the key to knowing what’s going on, for one, and also finding out what you can do to help the situation.”

 

You can find out more about Travis’ trip at TheUnbeatenTrack.com, and the charity single will be available as a digital download on iTunes starting on December 1. All proceeds from the sale of the single will go to the projects supported by the Staying Alive Foundation.

 

 

 

 

 

 

 

 

 

 

Bill Clinton: Health care reform vital to HIV/AIDS patients

Former President Bill Clinton said homeless HIV/AIDS patients are in dire need of health care reform in a speech at a benefit Wednesday for the Chicago House & Social Service Agency, a nonprofit providing housing and support for people with HIV and AIDS.

“There’s still an increasing number of homeless people with HIV/AIDS, and a lot of that is because of the health care crisis,” he told an audience of about 1,000 donors at the downtown Palmer House Hilton Hotel.

The event raised an estimated $400,000 for the charity, which helps 1,160 Chicagoans with HIV/AIDS and their family members find housing, medical care and emotional and spiritual support.

The homeless are three to nine times more likely to have HIV or AIDS than people with stable housing, according to a 2004 study by the Centers for Disease Control and Prevention and the Department of Housing and Urban Development. In his speech, Clinton attributed this fact to the high cost of medications and treatments and said public health care could curb homelessness for those with the virus.

Health care reform is not only morally right, but because reform would encourage preventive care, it would save money in the long run, Clinton said.

“The government will have to provide a health care program not just to be as healthy (as other countries) but also to be economically competitive,” he said.

The Rev. Stan Sloan, CEO of Chicago House, said the former president was his first choice to speak at the benefit because he started the Clinton HIV/AIDS Initiative, which helps developing countries provide treatment and prevention. Clinton’s work overseas mirrors Chicago House’s work here, Sloan said.

“We hope you leave here inspired,” Sloan said.

Clinton closed his talk with a story about a 15-year-old HIV-positive boy in Rwanda whose parents already had died of AIDS. The Clinton HIV/AIDS Initiative built him and his sister a new home. Clinton knelt down to talk to the boy, who had only made it to the third grade because of his illness.

“I said: ‘I hope you’re not discouraged to go to school,’ ” he said.

The boy earnestly replied “no,” that he planned to study hard, go to medical school and become a doctor to help other sick children.

“We’ve got to create a world of positive interdependence,” Clinton said. “We’re in this together.”

PR group tests syringe vending machine for addicts

SAN JUAN, Puerto Rico — A needle exchange program in Puerto Rico is testing a vending machine that provides drug users with clean syringes after-hours to fight the spread of HIV and hepatitis C.

Dr. Jose Vargas Vidot is the founder of Community Initiative, the U.S. island territory’s only needle-exchange group. He says a single machine will make clean syringes available at night outside the group’s office in Hato Rey.

Vargas said Tuesday that drug counseling offices that distribute syringes are open only during daylight hours.

The vending machine program targets young addicts reluctant to seek help.

Drug users can get syringes, cookers, cotton filters, gauze and sterile water to prepare drugs for injection by inserting a special card.

Proposed legislation to end written consent for HIV testing in Mass. sparks controversy

Two bills pending in the Massachusetts Senate that would eliminate informed, written consent before administering HIV tests continue to stir debate. Supporters say the proposed legislation would increase the chances of treating the virus in its early stages. Opponents, on the other hand, maintain written consent is crucial in building trust between doctor and patient.

The Centers for Disease Control issued a non-binding recommendation in 2006 that written consent for HIV testing is no longer needed. The CDC concluded general consent for medical care should be considered sufficient.

Only eight states currently still require written consent before a patient undergoes an HIV test. Besides Massachusetts, they are Alabama, Michigan, Nebraska, New York, Pennsylvania, Rhode Island and Wisconsin.

The Massachusetts bills, sponsored by state Sens. Patricia Jehlen and Robert O’Leary, both Democrats, would replace written consent with requirements health care providers verbally discuss the test, outline treatment options if it comes back positive, recommend patients who test negative but remain at-risk undergo periodic testing in the future and advise them they have the right to decline the test.

O’Leary’s bill also would require the state’s Department of Public Health to undertake a study on how to best reach those who are at increased risk for contracting the HIV virus, but are not getting tested.

In making the case for eliminating written consent, Jehlen’s office reported 20 percent of Massachusetts residents with HIV/AIDS are unaware of their status because they have not been tested. It also
referenced the fact HIV testing rates at San Francisco General Hospital rose by 44 percent after administrators eliminated its written consent regulation. The number of positive test results increased by 67 percent.

The Boston Globe recently endorsed the proposed legislation in an editorial. And many healthcare providers and activist organizations support it. They include Gary Daffin, executive director of the Multicultural AIDS Coalition.

Fenway Health, a Boston-based provider that treats LGBTs and has been at the forefront of HIV/AIDS treatment and prevention since the early days of the epdemic, also maintains believes it is time to end what many believe is an outmoded policy.

“We’re very supportive of moving in this direction,” Fenway president Dr. Stephen Boswell told EDGE in a phone interview.”The goals of the CDC are to help identify as many of the people who are HIV positive in the country, but don’t know it, as possible. Study after study has shown that the current testing paradigm for HIV is interfering with making testing readily available in some of the sites where the largest number of people who are positive, but don’t know it, are going for care.”

But some Massachusetts LGBT and HIV/AIDS service organizations remain opposed the bill. Gay & Lesbian Advocates & Defenders opposed it during a state house hearing last week. The AIDS Action Committee also remains opposed..

Bennett Klein, director of GLAD’s AIDS Law Project, testified before the Joint Committee on Public Health on Oct. 6 he feels written consent provides important protections to those HIV/AIDS. He further argued there is no evidence to suggest it is a barrier to people getting tested.

“Solving this problem requires a comprehensive public health solution, including determining how to reach populations, such as the homeless or immigrants, who may not make contact with the traditional healthcare system,” Klein told the panel. “If we could solve a difficult social and public health problem by simply getting rid of a piece of paper, we would be very lucky. But that is not the case.”

In a phone interview, Klein further contended the bills leave open the possibility some people will be tested without knowing it or without believing the test was voluntary and that they were in control of the situation.

“There are also larger repercussions in terms of the public response to the epidemic, such as creating a sound and trusting relationship between provider and patient, and patients being able to talk frankly about risk behaviors,” he explained. “This is particularly important in adherence to medication. If people are distrustful of the healthcare system, you are much less likely to ensure that there is a patient-provider relationship that can address those issues.”

The AAC told EDGE in a statement that while it welcomes efforts to eliminate barriers to HIV testing and supports the goals of the proposed legislation, it cannot endorse the bills as they currently are written.

The organization said it could support proposals that required documentation of verbal informed consent and imposed enforceable penalties for failure to document consent and for violations of patient confidentiality.

AIDS Action further called for a statute to require a funded study of the reasons people with HIV often enter treatment late and to propose solutions.

“Because written informed consent is perceived to be a barrier to testing in medical settings, moving to verbal consent with appropriate documentation and confidentiality protections can be an important first step toward increasing the number of HIV tests offered and ensuring routine HIV testing in medical settings,” the statement read.

The organization added it feels the full integration of routine HIV testing in medical practices will help reduce the stigma still associated with the virus because of its association with sex and drug habits.

“HIV/AIDS disproportionately impacts gay men and women of color,” AIDS Action said. “People at risk for HIV should not have to seek out extra services or special sources of care to be screened for a medical condition that disproportionately impacts them. HIV screening and testing should be available everywhere in the Commonwealth.”

The Massachusetts Department of Public Health has not taken a position on the legislation, but it noted in a statement it has long supported routine screening.

Among its initiatives are pilot routine screening projects in urban areas, a public information campaign promoting knowledge of HIV status and guidance to providers about how to reduce the administrative burden of obtaining consent under current law.

“We are invested in reducing barriers to HIV screening for both patients and providers while preserving the strict confidentiality of individual medical information,” Kevin Cranston, director of the agency’s Bureau of Infectious Disease, said.

H1N1 vaccine trials in HIV-infected people

BETHESDA, Md., Oct. 12 (UPI) — The first clinical trial of the H1N1 influenza vaccine in human immunodeficiency virus-infected pregnant women has begun, U.S. officials said.

Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, said a similar trial will begin in HIV-infected children and youth next week.

“These studies are important because HIV infection and pregnancy both increase the risk for a poor immune response to the normal 15-microgram dose of seasonal influenza vaccine given to the general population,” Fauci said in a statement. “Moreover, children, young people and pregnant women are at higher risk for more severe illness from the 2009 H1N1 influenza virus than other groups, and HIV-infected individuals in these populations may be particularly vulnerable.”

One trial will enroll 130 HIV-infected pregnant women ages 18-39, who are in their second or third trimester of pregnancy. The other trial will enroll 140 children and youth ages 4-24 infected with HIV at birth.

The Catholic church’s Lazarus complex over HIV-Aids

 More talk about the Catholic Church and condoms. 

So here we are again, talking past one another on the subject of condoms, Aids and Africa. Tanya Gold says the pope’s got it all wrong. Giuseppe Caramazza defends the pontiff, under the headline “the condom is no cure for Aids in Africa“.

Let’s get some facts straight. Condoms prevent HIV. And if we prevent HIV, then we prevent Aids, without having to put millions into the bank accounts of pharmaceutical companies. Caramazza toes the papal line, implying that African countries with higher rates of condom use have higher rates of HIV, and that condoms therefore don’t work in preventing HIV. Well, more people use insecticide-treated bed nets in west Africa than they do in Britain, and west Africa has far higher rates of malaria. Proof, by Caramazza’s logic, that treated bed nets don’t work as protection against malaria.

He also holds up the example of Uganda as a country that has promoted abstinence and seen HIV infections fall. I must correct him. Uganda aggressively promoted condoms as well as abstinence and fidelity from the early 1990s until the early 2000s. People began to wait on average a year longer before becoming sexually active. Once active, they were more faithful to their chosen partners, and used condoms much more frequently with the casual partners they did have.

All of this in combination did, indeed, cut the number of new infections. Then, around five years ago, Uganda started to receive vast slabs of money under the US government’s Pepfar (President’s Emergency Plan for Aids Relief) programme, which was driven by rightwing Christians. A good proportion of the money was spent on the abstinence-only sex prevention programmes, which have failed so miserably in the United States. Shortly afterwards, the slow slide in new HIV infections that we had measured in rural areas over the previous decade stopped, and there are indications that new infections are actually rising again.

The Ugandan data has been so badly tortured by both promoters and opponents of condoms that it has confessed to just about anything asked of it, so it’s not Caramazza’s confused interpretation that upsets me. What I object to (as a Catholic, and one who has worked, like him, in Kenya) is the Catholic church’s distorted approach to compassion, which his words shine a light upon. He rightly points out that “the church cares for the victims of Aids”, that many of the organisations caring for those infected and their families are Christian. Half of all Aids projects in Africa are run by Catholics. I’m prepared to bet that almost all of them deal with “victims”.

It seems it is absolutely fine to show compassion for people once they’ve become infected with HIV, to care for them, to provide fabulously expensive drugs to raise them off their deathbeds. But this Lazarus complex seems to me only half-Christian. Why can’t we extend our compassion to those who are not yet infected, and provide them with all the information and tools they need to stay uninfected? Whether the pope likes it or not, those tools include condoms.