Category Archives: HIV Care

Can HIV accelerate age-related conditions?

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From MedicalExpress.com…

To answer that question, researchers at the UCLA AIDS Institute and Center for AIDS Research and the Multicenter AIDS Cohort Study investigated whether the virus induces age-associatedepigenetic changes—that is, changes to the DNA that in turn lead to changes in expression of gene levels without changing the inherited genetic code. These changes affect biological processes and can be brought on by environmental factors or by the aging process itself.

In a study published online in the peer-reviewed journal PLOS ONE, the researchers suggest that HIV itself accelerates these aging related changes by more than 14 years.

“While we were surprised by the number of epigenetic changes that were significantly associated with both aging and HIV-infection, we were most surprised that the data suggests HIV-infection can accelerate aging-related epigenetic changes by 13.7 to 14.7 years,” said Beth Jamieson, professor of medicine in the division of hematology/oncology at the David Geffen School of Medicine at UCLA and one of the study’s senior authors. “This number is in line with both anecdotal and published data suggesting that treated HIV-infected adults can develop the diseases of aging mentioned above, approximately a decade earlier than their uninfected peers.”

Read the full article.

Free AIDSINFO drug app: HIV-Related drug information for health care providers and consumers

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From AIDS.gov…

Healthcare providers and consumers need HIV-related drug information and, increasingly, they depend on mobile devices to access that information. AIDSinfo is meeting both needs with the release of the AIDSinfo Drug App. Using data from theAIDSinfo Drug Database, the drug app provides information on more than 100 HIV-related Food and Drug Administration (FDA)-approved and investigational drugs. The AIDSinfo Drug App—provided free from the National Library of Medicine at the National Institutes of Health—is available for iOS and Android devices.

The information on the AIDSinfo Drug App, offered in English and Spanish, is tailored to meet the needs of both healthcare providers and consumers. The app works offline, ensuring that healthcare providers and consumers can access vital drug information anywhere—even in healthcare facilities that may not have an Internet connection.

The AIDSinfo Drug App pulls FDA labels from Daily Med for approved HIV-related drugs. The app also integrates information on drug nomenclature and chemical structure from ChemIDplus. Information from the labels is condensed in easy-to-understand summaries in English and Spanish for consumers.

Users can also access information on HIV-related drugs under investigation via the AIDSinfo Drug App. The investigational drug summaries, which are developed from the latest clinical trial results, are tailored by audience: technical, more detailed summaries for healthcare providers and less complex summaries in English and Spanish for consumers.

Users can also personalize the AIDSinfo Drug App. According to their needs, users can set pill reminders, bookmark drugs, or add personal notes:

  • Set pill reminders: Medication adherence is crucial to successful HIV treatment, and the app’s medication reminder can help those taking HIV medicines stay on schedule. Choosing from a menu of alarms, app users can set pill reminders for any time of the day and any day of the week.
  • Bookmark drugs: Busy users can bookmark frequently referenced drugs. No more searching for the same drugs again and again.
  • Add notes: App users can also customize drugs with personal notes. For example, patients can add notes during medical visits; healthcare providers can add relevant information useful at the point of care.

Stay tuned as AIDSinfo updates the app with additional features. Visit AIDSinfo to download the drug app to your iOS or Android device. And keep us posted on your experience with the app. We welcome your questions and comments at ContactUs@aidsinfo.nih.gov.

Study finds H.I.V. drugs priced out of reach

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From the New York Times…

Drugs to treat H.I.V. and AIDS are being priced out of reach for many patients enrolled in insurance plans through the new health care exchanges, despite warnings that such practices are illegal under the Obama administration’s health care law, according to a new analysis by Harvard researchers.

The study, to be published on Wednesday in an article in The New England Journal of Medicine, looked at 48 health plans in 12 states and found that a quarter of the plans showed evidence of what researchers called “adverse tiering,” or placing all of the drugs used to treat H.I.V. in a specialty tier where consumers are required to pay at least 30 percent of the cost of the drug.

The financial impact can be drastic, the researchers found: A patient taking a common H.I.V. treatment, Atripla, would pay about $3,000 more a year in a restrictive plan compared with someone enrolled in a more generous plan, even after accounting for the fact that the more restrictive plans tended to charge lower monthly premiums.

“That’s really a large cost difference, and really is a very significant financial constraint for those with chronic conditions, particularly H.I.V.,” said Douglas B. Jacobs, the lead author of the study, who is pursuing degrees in public health at the Harvard T. H. Chan School of Public Health and medicine at the University of California, San Francisco.

Continue reading on The New York Times.

10 questions to ask yourself before you begin HIV treatment

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puzzle man_white backgroundFrom thebody.com…

An HIV diagnosis comes with its very own set of questions to ask yourself and decisions to make. Among the biggest is: When should you start treatment? It’s a Russian nesting doll of a decision, with many other questions tucked inside. Here, in no particular order, are 10 of the most important questions to ask yourself before you begin taking HIV medications.

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US guidelines on “prevention with positives” now emphasize engagement with care, HIV treatment and social factors

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From aidsmap.com…

The American public health agency, the Centers for Disease Control and Prevention (CDC) has published new recommendations on the HIV prevention interventions and advice that should be offered to people who are HIV positive.

The CDC last issued guidelines on what is sometimes called ‘prevention with positives’ in 2003. Those guidelines ran to 24 pages and emphasised screening for behavioural risk factors and sexually transmitted infections, one-to-one prevention counselling and advice delivered by clinicians, other behavioural interventions, and partner notification.

All those elements remain but the scope of the new guidelines is much broader, with the recommendations now running to 240 pages. Whereas previous guidelines were clearly focused on the individual’s knowledge and behaviour, the new recommendations take greater account of social and structural factors as well as the profound impact that antiretrovirals have on HIV transmission. For example, an individual may need support with poverty, mental illness, substance use or unstable housing in order to be able to fully engage with medical care and adhere to HIV treatment.

Continue reading on aidsmap.com.

Smoking doubles risk of death for patients taking HIV therapy

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From aidsmap.com…

Smoking doubles the mortality risk for people with HIV taking antiretroviral therapy, a study published in AIDS shows. Smokers had an increased risk of death from cardiovascular disease (CVD) and non-AIDS-related cancers, and the life expectancy of a 35-year-old man with HIV was reduced by almost eight years due to smoking. “Smoking was associated with a two-fold increase in mortality,” comment the authors. “More than a third of all non-AIDS related malignant deaths were from lung cancer and all deaths from lung cancer were in smokers.”

The benefits of not smoking were clear. HIV-positive non-smokers who were doing well on antiretroviral therapy had a similar life expectancy to non-smokers in the general population.

With the right treatment and care, people living with HIV can have a normal life expectancy. However, mortality rates remain higher among people with HIV compared to the background population. The reasons for this are unclear, but important causes of death among people with HIV now include smoking-related diseases such as heart and lung complaints and non-AIDS-related malignancies.

Investigators therefore wanted to determine the association between smoking and mortality risk among people taking HIV therapy.

Continue reading on aidsmap.com.

26th World AIDS Day: Get in there, do something, change things

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From Huffington Post…
by

red ribbonPre-exposure prophylaxis (PrEP) and treatment as prevention (TasP) have successfully returned sexual health to the national and international headlines. Not since the early years of the HIV epidemic has there been so much constructive dialogue, progress, and involvement by the public.

Long-term survivors, HIV organizations, scientists, public-health experts, and the generation that never knew a world without HIV joined hands on the 26th World AIDS Day in an effort to educate and advocate in commemoration of those we have lost to HIV and the people living with the infection today.

While a few still wage a lonely and wasteful fight against science and progress itself, it is time to acknowledge that we finally have the opportunity to move on from a monotonous, one-way conversation and use these new tools as catalysts for serious and much-needed change.

Of course, it doesn’t help when one of our favorite Star Trek actors throws all logic overboard and simply dismisses today’s generation as lazy, complacent and irresponsible, but it certainly shows that we haven’t progressed much since President Reagan’s infamous call to abstinence 27 years ago.

Six of the estimated 39 million people we lost worldwide to HIV were my friends and mentors. All six would have agreed with Meryl Streep’s Margaret Thatcher when she says in The Iron Lady, [I]f something’s wrong, they shouldn’t just whine about it. They should get in there and do something about it. Change things.”

Keep reading on Huffington Post.

U.S. HIV ‘Treatment Cascade’ stats dismal among western nations

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From AIDSmeds.com…

Compared with other high-income Western nations, the United States fares remarkably poorly in getting people with HIV diagnosed, into stable care, on treatment and to an undetectable viral load, aidsmap reports. Researchers conducted an analysis of the “treatment cascade” figures for Australia, British Columbia (statistics for all of Canada were not available), Denmark, France, the Netherlands, the United Kingdom and the United States. Results were presented at the HIV Drug Therapy Glasgow conference in Scotland.

The estimated rates of HIV diagnosis among the countries ranged from a low of 71 percent in British Columbia to a high of 86 percent in Australia, with the United States at 82 percent. The United States had the lowest rate of linkage to care, at 66 percent, and Denmark had the highest at 81 percent. The United States had by far the lowest rate of HIV-positive people retained in care at 37 percent, with British Columbia the next lowest at 57 percent. Australia’s 76 percent care-retention rate was the highest. 

Because of the United States’ low retention figures, the remainder of the nation’s figures were also markedly lower than the other countries’. The U.S. rate of people with HIV taking antiretrovirals was 33 percent. The high for that figure was the United Kingdom’s 67 percent. The rates of viral suppression were as follows: the United States, 25 percent; British Columbia, 35 percent; France, 52 percent, the Netherlands, 53 percent, the United Kingdom, 58 percent; Denmark, 59 percent; and Australia, 62 percent.

To read the aidsmap story, click here.

To read the conference abstract, click here.

Gay-rights organization endorses the use of a once-a-day pill to prevent HIV infection

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From ABC News online…

Some doctors have been reluctant to prescribe the drug, Truvada, on the premise that it might encourage high-risk, unprotected sexual behavior. However, its preventive use has been endorsed by the Centers for Disease Control and Prevention, the World Health Organization, and many HIV/AIDS advocacy groups

The Human Rights Campaign, which recently has been focusing its gay-rights advocacy on same-sex marriage and anti-discrimination issues, joined those ranks with the release of a policy paper strongly supporting the preventive use of Truvada. It depicted the drug as “a critically important tool” in combatting HIV, the virus that causes AIDS. “HRC does not take this position lightly,” the policy paper said. “We recognize there is still ongoing debate … and that there are those out there who will disagree with our stance.”

Truvada has been around for a decade, serving as one of the key drugs used in combination with others as the basic treatment for people with HIV. In 2012, the Food and Drug Administration approved it for pre-exposure prophylaxis, or PrEP — in other words, for use to prevent people from getting sexually transmitted HIV in the first place. “Today, there is an unprecedented chance to end the HIV/AIDS epidemic, in part through PrEP’s aggressive prevention of new HIV infections,” said Chad Griffin, president of the Human Rights Campaign. “There is no reason — medical or otherwise — to discourage individuals from taking control of their sexual health and talking to their doctor about PrEP.”

The CDC says studies have shown that Truvada, when taken diligently, can reduce the risk of getting HIV by 90 percent or more. Research discussed at the International AIDS Conference in July found that use of the drug does not encourage risky sex and is effective even if people skip some doses.

As part of its announcement, the Human Rights Campaign called on insurers, regulators and Truvada’s manufacturer to take steps to reduce costs, raise public awareness, and make the option available to all medically qualified individuals who could benefit from it, regardless of ability to pay.

The cost of Truvada varies widely; a New York State Health Department fact sheet gives a range of $8,000 to $14,000 per year. The manufacturer, California-based Gilead Sciences Inc., has a program that provides assistance to some people who are eligible to use Truvada but cannot afford it.

The Human Rights Campaign urged all states to emulate Washington state, which implemented a program earlier this year offering assistance in paying for PrEP. The preventive option also was endorsed by New York Gov. Andrew Cuomo when he announced initiatives in June aimed at ending the state’s AIDS epidemic by 2020.

The HRC called on state insurance regulators to take action against any insurers who deny legitimate claims from patients who’ve been prescribed PrEP by their doctors.

A prominent provider of services to HIV-positive people, the Los Angeles-based AIDS Healthcare Foundation, remains a vocal critic of the preventive use of Truvada. In an ad campaign launched in August, the foundation says many gay men fail to adhere to Truvada’s once-a-day regimen and describes government promotion of the drug as “a public health disaster in the making.”

Less than half of HIV-pos U.S. Hispanics getting proper care

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From U.S. News and World Report …

Even though Hispanics in the United States become infected with HIV at rates triple those of whites, less than half of Hispanics with the virus are receiving adequate treatment, a new report finds. The report, based on 2010 U.S. government health data, finds that while 80 percent of HIV-infected Hispanics do receive care soon after their diagnosis, only about 54 percent continue that care and only about 44 percent receive the virus-suppressing drugs they need to stay healthy.

The researchers, led by epidemiologist Zanetta Gant of the U.S. Centers for Disease Control and Prevention (CDC), also found that only 37 percent of the more than 172,000 HIV-positive Hispanic adults in the United States have the virus under control. HIV is the virus that causes AIDS. The findings “underscore the need for enhanced linkage to care, retention in care, and viral suppression for Hispanics or Latinos,” Gant’s team writes in the Oct. 10 issue of the CDC journal Morbidity and Mortality Weekly Report.
Continue reading on U.S. News and World Report.

The treatment cascade in the United States – good in Ryan White programmes, but overall picture for gay men is poor

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From aidsmap.com…

People living with HIV in the United States who receive their care through the Ryan White HIV/AIDS Program have good rates of retention and virological suppression, investigators report in the online edition of Clinical Infectious Diseases. Of the patients seen at least once in 2011, some 82% were retained in care and 73% achieved virological suppression.

These outcomes dwarf those seen for most people living with HIV in the US – previous reports have estimated that as few as 40% were retained in care and 19% had achieved virological suppression.

A second new report focuses on gay, bisexual and other men who have sex with men, demonstrating that outcomes continue to be unacceptably poor in this group. Of those who have ever been diagnosed with HIV, 51% were retained in care and 42% achieved virological suppression.

However, both new studies found that outcomes were poorer in younger people, African American people and some other ethnic groups.

Continue reading on aidsmap.com

Kaiser Family Foundation releases new alarming report reflecting gay and bisexual men’s attitudes, knowledge, and experiences with HIV/AIDS

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From Gay Men’s Health Crisis…

On Thursday, September 25, 2014, the Kaiser Family Foundation released a new alarming report reflecting gay and bisexual men’s attitudes, knowledge, and experiences with HIV/AIDS and new HIV therapies in the United States. Their survey on HIV/AIDS in the lives of gay and bisexual men in the United States reports that 56% of gay and bisexual men are not personally concerned about HIV or AIDS affecting them and 30% have never been tested for HIV.

“HIV/AIDS might not be a death sentence anymore, but there are still 50,000 new infections in the United States every year-and gay and bisexual men are still among those most at risk,” said GMHC CEO Kelsey Louie. ” The Kaiser Family Foundation study is a needed wake-up call that communicating the correct information about HIV and AIDS to the public has never been more critical. We must do more to educate our gay and bisexual men about how HIV and AIDS can affect them, and how life-saving medications like PrEP and PEP can help them prevent HIV infections and stay healthy.”

Additional Background:
Eight out ten gay and bisexual men surveyed also said that they have heard a little or nothing about PrEP, a life-saving medication that can prevent HIV-infections. Additional findings from the survey can be found here. The Foundation’s survey comes on the heels of a new CDC report showing that 58% of gay and bisexual men diagnosed with HIV are not virally suppressed.

HIV Treatment Works national communication campaign for people living with HIV

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he Centers for Disease Control and Prevention’s (CDC) HIV Treatment Works national communication campaign for people living with HIV features the stories of individuals living with HIV talking about how sticking to treatment helps them stay healthy, protect others, do what they love, and live a longer, healthier life. Visit the campaign website for resources and free materials: http://www.cdc.gov/HIVTreatmentWorks. More than 1.1 million people in the United States are living with HIV.

HIV + patients more likely to be untreated for early-stage cancer

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From Oncology Nurse Advisor…

Life expectancy for HIV-infected people is now similar to uninfected people, but survival for infected patients who develop cancer is not. Many studies have attempted to understand why HIV-infected cancer patients have worse outcomes; however, this new study, the largest of its size and scope, examined differences in cancer treatment as one potential explanation. It was conducted by researchers in Penn Medicine’s Abramson Cancer Center in Philadelphia, Pennsylvania, and the National Cancer Institute (NCI), and published in the Journal of Clinical Oncology (2014; doi:10.1200/JCO.2013.54.8644).

For early stage cancers that have the highest chance of cure with appropriate treatment, those with HIV were twice to four times as likely to not receive appropriate cancer treatment, the researchers found. HIV-infected people with lymphoma, lung cancer, prostate cancer, and colorectal cancer were almost twice as likely to be untreated for cancer, even after considering differences in age, gender, race, and stage.

Continue reading.

Newer, safer antiretrovirals an option for majority of HIV patients

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From aidsmap.com…

The majority of patients taking antiretroviral therapy (ART) that includes drugs associated with long-term side-effects may have the option of switching to a novel regimen that uses newer and safer anti-HIV drugs, according to Australian research published in PLOS One. The single-site study showed that up to 89% of patients had the option of changing to a combination that includes three active newer agents with improved safety and side-effect profiles.

The drugs associated with long-term side-effects evaluated in this study comprise the core antiretroviral drugs prescribed to the majority of people taking antiretroviral treatment today. But the authors acknowledge “most of the regimens considered as ‘viable’ in this study have not been rigorously tested in clinical trials and might be regarded as unconventional.” Nevertheless, they stress “the growing interest in testing novel combinations of ART agents, which exclude nucleoside(tide) and older non-nucleoside reverser transcriptase inhibitors (N(t)RTIs and NNRTIs, respectively), as well as ritonavir (booster dose).” Most patients taking HIV therapy have an excellent life expectancy. However, there is concern about the safety and tolerability of many routinely used anti-HIV drugs.

Investigators at St Vincent’s Hospital, Sydney, Australia, called these the “RATE” drugs: ritonavir (Norvir), which is associated with drug interactions, diarrhoea and lipid disturbances; abacavir (Ziagen), which can involve a hypersensitivity reaction, has reduced potency at higher viral loads and may involve a risk of cardiovascular disease; tenofovir (Viread), which can cause bone and kidney problems; and efavirenz (Sustiva), associated with neuropsychiatric side-effects and increased lipids. Moreover, these drugs are usually used in combination, compounding their toxicity profiles.

Continue reading here.

Smoking and HIV – One man’s story

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Smoking is especially dangerous for people who are living with HIV, the virus that can cause AIDS. Brian learned that lesson the hard way, when he had a stroke—a brain attack—at age 43. In this video, Brian talks about surviving HIV-related medical problems—then nearly losing his life because of smoking.  See All Brian’s videos.

And from LOGO online…

Smoking now leads to more deaths in the LGBT community than HIV according to the Centers for Disease Control, which also reports that while 20.5% of heterosexuals smoke, 30.8% of  gay people use tobacco products. “We know that approximately one million LGBT people [in the U.S.] will die early from tobacco-related causes,” says Dr. Scout from the Network for LGBT Health Equity. “We want to save those lives instead.”

I you’re HIV-positive and smoke, the combination can take even more years off your life: According to the Network for LGBT Health Equity, being HIV-positive takes an average of 5.1 years off one’s life, but people who smoke and have HIV die 12.3 years earlier on average. Yet the smoking rate is two to three times higher among adults who are HIV-positive than in the general public.

 

HIV drug may boost suicide risk

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From philly.com…

sustiva 3A medication commonly used to treat HIV appears to double the risk that patients will develop suicidal thoughts or take their lives, new research contends. The finding concerns the anti-HIV drug efavirenz, which is marketed as Sustiva. Prior investigations indicated that efavirenz might boost suicide risk because of a negative impact on the central nervous system. The new investigation is the first to pinpoint a link to suicidal thoughts, attempts and completion, the researchers said.

“Efavirenz is a very important and effective antiretroviral medication that is the foundation for much of HIV therapy worldwide,” said study co-author Dr. Joseph Eron, of the University of North Carolina Center for AIDS Research at Chapel Hill. “Our study demonstrated a clear association between efavirenz and suicidality,” he said.

Although that risk seems very small, he said, it appears to be persistent, lasting as long as patients take the drug.sustiva 2 Antiretroviral treatment typically is lifelong, helping people with the AIDS-causing virus live healthier lives. “Clinicians should be aware of this ongoing risk, and talk to their patients to assess suicidality,” Eron added. That means looking for any history of depression or suicidal thoughts or attempts, the study noted.

Continue reading on philly.com.

 

 

 

Study shows promise for those struggling with mental health and HIV treatment adherence

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From thebody.com…

A clinical review published in the peer-reviewed journal LGBT Health in early June by Jaclyn M. White, M.P.H., Janna R. Gordon, and Matthew J. Mimiaga, Sc.D., M.P.H., from Harvard and the Fenway Institute in Massachusetts, indicates that there may be relief at hand for HIV-positive gay men struggling with added mental health and substance abuse issues that can add difficulty to sticking to an HIV medication regimen. White et al concluded that interventions that combine both adherence counseling with standard cognitive behavioral therapy have made some headway with participants in several recent intervention trials.

Mental health issues, as well as substance use, can lend comorbidity to HIV — that is, an additional condition that compounds the effect of a primary disease. These factors can make adherence to medication more difficult than normal, though this connection is not yet well established.

White et al pointed out that concentration problems and feelings of worthlessness and hopelessness behave as barriers to self-care behavior patterns that are required for optimal outcomes on antiretroviral therapy (ART). Optimal outcomes are measured by self-efficacy efforts; those who believe in their ability to manage their own condition are more likely to approach the 80%-plus adherence level required to thrive while living with HIV, according to White et al.

Continue reading on thebody.com.