Friday, December 30, 2016

CRISPR Helps Find Three New Targets for Potential HIV Treatments

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Because these targets are human genes, therapies that go after them would be less 
susceptible to drug resistance.

December 30, 2016


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Researchers have used the cutting-edge CRISPR/Cas9 gene-editing technology to identify five potential targets for HIV treatments, including three new discoveries. Because these targets are all human genes, treatments that go after them are likely less likely to give rise to drug resistance compared with existing antiretrovirals (ARVs) that target proteins crucial to the rapidly mutating virus’s life cycle.

Publishing their findings in the journal Nature Genetics, researchers used CRISPR to screen a cell line taken from human CD4 cells, which HIV targets. They found five human genes that when switched off, protected the CD4 cells from infection with the virus without affecting the cells’ survival.

The two previously identified genes were the CCR5 gene, responsible for the coreceptor on the surface of CD4 cells to which most HIV attaches in order to infect the cell, as well as the CD4 gene itself.

The researchers also identified two enzymes, known as TPST2 and SLC35B2, that modify the CCR5 coreceptor in order to facilitate the virus’s effort to bind to it. The other new gene they identified is known as ALCAM, which helps CD4 cells stick to one another, which facilitates the transmission of HIV from cell to cell.

To read a press release about the study, click here.

To read the study abstract, click here.

Read more articles from POZ, here.

$1M in New Grants to Explore Bold Ideas in Cancer and HIV Research

Thinkstock (Model(s) used for illustrative purposes only)

Immunotherapy and an HIV vaccine are among the first round of grants from Fred Hutch’s Evergreen Fund.

December 30, 2016


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The newly established Evergreen Fund is awarding a total of $1 million to eight projects focused on accelerating research in cancer and HIV, according to a press release from the Fred Hutchinson Cancer Research Center, which launched the fund.

“The Evergreen Fund is an innovative, bold initiative by the Hutch to promote commercialization of its latest research into lifesaving therapies for cancer and other diseases,” said Gary Gilliland, PhD, president and director of Fred Hutch. “We firmly believe it will lead to new ventures and partnerships that will significantly improve outcomes in the battle to defeat cancer and other diseases. It’s a new chapter in our ongoing commitment to creating enterprises that will be game-changers for global health.”

Among the grantees is Andrew McGuire, PhD, who “is working on a novel approach to elicit broadly neutralizing antibodies to trigger an immune response that will ultimately lead to development of an effective HIV-1 vaccine,” according to the press release.

Also related to HIV is the work of Hans-Peter Kiem, MD, PhD, whose research involves a method to purify and gene-modify stem cells for therapeutic use. The press release states: “Worldwide millions of people suffer from malignant, genetic or infectious blood diseases such as leukemia and HIV/AIDS. The Kiem lab has identified a stem cell population using preclinical small and large animal models to demonstrate this population of cells can quantitatively predict engraftment and repopulation of blood cells. The goal of the proposal is to translate this into clinical practice and overcome major barriers that limit the broad utilization of gene-modified hematopoietic stem cell transplants.”

Other grant recipients are studying the enhancement of T-cell immunotherapy and ways to measure components of the immune system. For a complete list, click here.

In related news, HIV has been officially listed as a cancer hazard to humans.
  
Read more articles from POZ, here. 

H.I.V. Cases Surpass a Million in Russia, but Little Is Done

Volunteers from the Andrey Rylkov Foundation distributing free needles, condoms and other supplies from a truck in Moscow. Credit Max Avdeev for The New York Times
ST. PETERSBURG, Russia — Quietly, the number of Russians who have received a positive H.I.V. diagnosis passed the one million mark this year. There is, however, little indication that the government will commit adequate resources to stem the acceleration of the virus from high-risk groups into the general population.

About 850,000 Russians carry H.I.V. and an additional 220,000 have died since the late 1980s, said Vadim Pokrovsky, the longtime head of the Moscow-based Federal AIDS Center, who estimated that at least another 500,000 cases of H.I.V. have gone undiagnosed.

Although the label “epidemic” prompts denials from some senior officials, experts on the front lines like Mr. Pokrovsky are calling it just that. The overall estimate of victims constitutes about 1 percent of Russia’s population of 143 million, enough to be considered an epidemic, they argued. Beyond that, they said that heterosexual sex would soon top intravenous drug use as the main means of infection.

“This can already be considered a threat to the entire nation,” Mr. Pokrovsky said, noting that the caseload is increasing by about 10 percent a year. In 2016, 100,000 new infections are anticipated, about 275 daily. It is the largest H.I.V. epidemic in Europe and among the highest rates of infection globally.

Despite the grim milestone, experts do not expect much change in Russia, where victims still face the kind of stigma prevalent in the 1980s in the West and where continuing trench warfare between the Kremlin and independent nongovernmental organizations saps collective efforts. In addition, some prominent voices push “family values” as the ideal prevention program.

In many ways, Russia’s fight against H.I.V. is a case study in the constant tension between civil society and a Kremlin under President Vladimir V. Putin; public activity outside government control is considered inherently suspect. Tensions heightened this year after the Justice Ministry blackballed a number of bantam N.G.O.s involved in combating H.I.V./AIDS as “foreign agents” because they received grants from abroad.

Anton Krasovsky, a prominent talk show host fired in January 2013 after coming out as gay on air, says he has spent his personal savings building an N.G.O. that tries to bridge that divide.

“Since we are not talking about fighting Putin, but fighting a virus, people have to understand that they can fight this virus only if they are on the same side as Putin,” Mr. Krasovsky said. “It is impossible to change the situation without coming to some kind of an agreement.”


Volunteers for the Andrey Rylkov Foundation must attach the label “foreign agent” to the plastic bags they distribute. Credit Max Avdeev for The New York Times

The president has remained largely silent on H.I.V. Over all, activists said, the combination of indifference toward victims, government financial austerity, hostility toward foreign funds and a powerful camp of AIDS deniers all amounts to the lack of a coherent national effort.

Experts criticized a new, rather vague Russian government strategy on fighting H.I.V. that was released in October for lacking a plan of execution or any new money.

Despite that, both sides in the H.I.V. battle agree that Russia has made some progress. The fact that a national strategy exists — as well as an advertising program promoting H.I.V. tests backed by Svetlana Medvedeva, the wife of the prime minister — at least implies some high-level interest.

In St. Petersburg, one married couple, Dr. Tatiana N. Vinogradova and Andrei Skvortsov, straddles the government-N.G.O. divide on the issue.

Dr. Vinogradova, slim beneath her white coat, with bobbed brown hair and beige stilettos, is a third-generation H.I.V. warrior. Her grandmother, an infectious-diseases specialist, treated one of the first patients in St. Petersburg in the late 1980s and pushed the city to establish an AIDS Center. Dr. Vinogradova’s mother ran it, and she herself is now its deputy head of scientific research.

Mr. Skvortsov, wiry, scrappy and H.I.V. positive — a reformed drug addict and ex-convict — runs a small N.G.O. called Patients in Control. It was founded in 2010 to try to cajole, pressure and embarrass both federal and local governments into providing government-guaranteed treatment.

At the St. Petersburg AIDS Center, Dr. Vinogradova, 41, has seen the prevalence among drug addicts shrink while cases among heterosexual couples soar.

“Calling it an epidemic would be akin to admitting that the government let the problem get out of control over the past 30 years,” she said, explaining why the government avoids the term. But she uses the national strategy and any official statements she can find to try to wring more money out of politicians. “This is Russia, so everything has to be top down to get anything done.”

The couple has tried to use their marriage to help break the stigma that the disease is an untreatable plague limited to drug addicts, homosexuals or others likely to die anyway.


Dr. Tatiana N. Vinogradova and Andrei Skvortsov, who is H.I.V. positive, have used their marriage to help break the image of H.I.V. as untreatable. Credit Max Avdeev for The New York Times

“I watch people jump back a meter when he says he is living with H.I.V.,” Dr. Vinogradova said, with older medical professionals particularly still fearful despite the raft of evidence that anyone taking antiviral drugs is not infectious. “Now whenever I hear about H.I.V. discrimination, I take it as a personal offense.”

When her husband needed an operation last year to repair with a metal implant a collarbone broken in a motorcycle accident, the surgeon refused after discovering his H.I.V. status. Mr. Skvortsov, 37, recently appeared on a talk show with Evgeniya Prokhoda, an H.I.V. activist in the southern city of Krasnodar, and one of the first Russians to speak about carrying the virus on national television without hiding her face.

She detailed the gantlet of fear and discrimination she had faced, including when authorities put her son in an orphanage for about a year after her own mother sued to have him removed from home. The day after she appeared on television, Mrs. Prokhoda was fired.

Activists and experts always come back to the lack of government support as the root problem.
Under World Health Organization guidelines, to reduce the spread of the disease, at least 90 percent of H.I.V.-positive patients should receive antiviral drugs.

In Russia, a little more than 37 percent receive such treatment, according to government statistics. “The prevention programs are not working, the coverage is not sufficient to break the curve,” said Vinay P. Saldanha, the Unaids regional director for Eastern Europe and Central Asia.
Russia is among five countries that account for almost half the new infections globally; the others are South Africa, Nigeria, India and Uganda, according to Unaids figures, although in some of them, a much higher percentage of the overall population is infected.

Most of the $338 million annual Russian federal H.I.V. budget is spent on medicine, and almost nothing goes to preventive education. Veronika Skvortsova, the health minister, has repeatedly called expanding treatment programs a government priority. (The minister is not related to Andrei Skvortsov.) After a deep recession, however, little new money has materialized.

At the same time, the Russian Orthodox Church and some politicians promote “conservative values” as the best way to combat H.I.V.

Patriarch Kirill called for “moral education,” stressing that the “establishment of family values, ideals of chastity and marital fidelity” should be at the forefront of curbing the virus.


A poster of Dr. Vinogradova and Mr. Skvortso in St. Petersburg encouraging people to get tested for H.I.V. “I know that there are no barriers to my love,” the poster reads. Credit Max Avdeev for The New York Times

Both the government and the church staunchly oppose sex education for children. One senior government official stated that classical literature was the best teacher.

The state also adamantly opposes methadone for drug addicts, sometimes denigrated as a “narcoliberal” scheme. In other countries, methadone programs are used both to treat and to monitor patients infected by intravenous needles.

The emphasis on traditional values dismays those fighting the disease. “Traditional values just means leaving everything as it is,” Mr. Pokrovsky said. “If we have traditional values and do nothing, the epidemic will keep spreading.”

Compounding the problems, the federal government has tried to silence organizations that challenged its policies, labeling them “foreign agents” for receiving grants from abroad, forcing some to close.

The Andrey Rylkov Foundation for Health and Social Justice, which hands out free needles and condoms in southern Moscow, now has to staple a small label to its plastic bags saying “Foreign Agent” as required by law. Recipients said they could not care less, but it means that the foundation cannot work with government organizations.

“H.I.V. is not a personal problem, it is a social problem, and it should be solved as a social problem,” Elena Plotnikova, who works for the foundation, said as she handed out supplies. “The basic attitude of the government is: You made a bad decision and we are not going to help you.”
N.G.O.s are considered crucial to reaching populations that avoid government contact, including drug addicts, prostitutes and gay men. Help varies widely from city to city. St. Petersburg is perhaps the most enlightened, treating all comers to its clinic and sponsoring an advertising campaign.

Dr. Vinogradova and Mr. Skvortsov appear together on one poster encouraging people to get tested. The couple is startlingly open about their sex life, stressing that his being on antiviral drugs means that she remains H.I.V. negative even though they do not use condoms.

In the poster, wearing navy blue shirts, they stare into each other’s eyes. “I know that there are no barriers to my love,” reads the text. “H.I.V. is not an obstacle to creating a family; it’s possible to live a long life with H.I.V.”
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Oleg Matsnev contributed reporting from St. Petersburg, and Sophia Kishkovsky from Moscow.

Thursday, December 29, 2016

Hep C Drug Sovaldi May Interact Harmfully With HIV Drug Viread



Sovaldi, included in Harvoni and Epclusa, may affect a key liver enzyme that activates the HIV drug Viread.
December 28, 2016


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Sovaldi (sofosbuvir)-based hepatitis C virus (HCV) regimens may negatively affect the body’s ability to process the commonly prescribed HIV antiretroviral (ARV), Viread (tenofovir disoproxil fumarate, or TDF), Healio reports.


Sovaldi is included in the fixed-dose combination hep C regimens Harvoni (ledipasvir/sofosbuvir) and Epclusa (sofosbuvir/velpatasvir) and is also used in combination with other stand-alone tablets such as Daklinza (daclatasvir) and Olysio (simeprevir).


Viread (tenofovir disoproxil fumarate, or TDF) is included in Truvada (TDF/emtricitabine), Atripla (efavirenz/TDF/emtricitabine), Stribild (elvitegravir/cobicistat/emtricitabine/TDF) and Complera (rilpivirine/TDF/emtricitabine).


Publishing their findings in the Journal of Hepatology, researchers studied small portions of cells known as microsomes taken from the liver cells of 20 people and the kidney cells of 12 people. 
They found that Sovaldi inhibited the chemical breakdown, or hydrolysis, of both liver and kidney microsomes and that the drug inhibited the enzyme carboxylesterase-2 (CES-2).


CES-2 is known for its detoxification effects and is found in great quantities in the liver and kidney. It normally breaks down through hydrolysis and activates Viread.


The researchers believe that the Sovaldi-prompted inhibition of the enzyme may have implications for Viread-related kidney toxicity. They recommend that people take these two drugs at different times or administer them in different ways, i.e., not both as oral drugs, until clinical trials can fully analyze the risks of combining them.


To read the Healio article, click here.

To read the Journal of Hepatology letter, click here.

Read more articles from POZ, here.



Gay Bars That Offer Free Water May Lower HIV Risk in Patrons

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Readily available hydration may cut down on drunkenness, which itself may increase the likelihood of risky sex.

December 29, 2016


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By offering free self-serve water, gay bars may reduce drunkenness among their patrons and in turn men’s risk of contracting HIV, SF Weekly reports. Alcohol intake may impair an individual’s judgment and lead to sex that poses a greater risk of HIV transmission.

Researchers from the University of California, San Francisco and the San Francisco AIDS Foundation conducted a study in which they placed cups and water pitchers at two gay bars in San Francisco. They conducted Breathalyzer tests on patrons leaving these bars as well as on those departing two control gay bars that did not have free water stations.

The investigators found that the men in the two bars with the water stations left the establishments less intoxicated than those who left the control bars.

There’s no word yet on whether bar owners would be keen on a scheme that would reduce the number of drinks patrons order.

To read the SF Weekly article, click here.

Read more articles from POZ, here.  

Single Shot at Doctor's Office May Be Future of HIV Prevention

HIV, the virus that causes AIDS BSIP/UIG Via Getty Images
Truvada, the other "little blue pill," is taken daily to prevent HIV and has been touted as a miracle drug responsible for lowering HIV rates across the United States. But soon, the daily pill may be overshadowed by an even simpler method—a single flu shot-like injection at the doctor's office, once every two months. 

The National Institutes of Health (NIH) announced last week that it was entering the first-ever global clinical trial of an injectable HIV-prevention drug called cabotegravir. The trial is taking place in eight countries across three world regions—the Americas, Africa and Asia—and researchers are enrolling 4,500 gay and bisexual men along with transgender women, pulling from groups with the highest rates of new infections. 

"The annual number of new HIV infections among young people, especially young men who have sex with men and transgender women who have sex with men, has been on the rise despite nearly flat HIV incidence among adults worldwide," said Raphael J. Landovitz, the Protocol Chair for the study. 

In the U.S., the Centers for Disease Control reported new HIV diagnoses have declined by nearly 20 percent—mostly among white gay and bisexual men. But HIV rates are on the rise for men of color and transgender women, as well as youth. Data suggests the disparity might be due to Truvada itself: A 2016 study found 74 percent of Truvada users were white, and the number of black users dropped between 2012 and 2015. 

RELATED: Black Gay, Bisexual Men Have 50 Percent Risk of HIV
 
Patients participating in the new study will be randomly assigned to receive Truvada pills or cabotegravir injections, to compare the injectible drug's efficacy with the established PrEP pill. Currently, Truvada is the only commercially available pre-exposure prophylaxis (PrEP) medication, and the only FDA-approved HIV-prevention method, period. 


Bottles of antiretroviral drug Truvada are displayed at Jack's Pharmacy on November 23, 2010 in San Anselmo, California. Justin Sullivan / Getty Images

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases at the NIH, told NBC Out the hope is the injectable PrEP drug will work as well as Truvada—which currently has a roughly 99 percent rate of success in preventing transmission of the HIV virus.
"The ultimate reason for the trial is that many people who take Truvada have difficulty with having to take a pill every single day," Fauci said. "That really becomes prohibitive, and sometimes people don't adhere really well." 

Fauci explained that while it would be ideal for patients to only have a shot once a year, for example, the 8-week period is how long cabotegravir stays in the system inhibiting the virus from taking hold. If the current trial is successful, he predicted, researchers will likely begin to tweak the drug's chemical makeup in an effort to make it last longer. 

Full results of the trial are expected by 2021 but could come even sooner. A related trial testing the injections on cisgender young women is slated to begin in 2017. 

RELATED: New Study Shows HIV Epidemic in New York in 1970
 
The stunning efficacy rates of Truvada have launched a race to expand the market. Researchers are currently studying an HIV vaccine that uses antibody injections, a microbicide gel that can be used as a sort of HIV-prevention lube and a slew of other HIV drugs for treatment and prevention.
Damon Jacobs, an HIV-prevention specialist who moderates the 15,000-member Facebook group PrEP Facts: Rethinking HIV Prevention and Sex, told NBC Out the plethora of future prevention methods looming on the horizon is "wonderful." 

"It's not going to be one size fits all," he said. "Just like with birth control: some women take the pill, some get an IUD. I'm glad we're going in that direction for PrEP as well." 

According to Jacobs, the PrEP race in medicine is happening because of Truvada's runaway success. While the studies showed Truvada prevents HIV transmission at near-total rates, it's only over the course of the past couple years that the wider effects have been seen. Truvada was introduced commercially in the U.S. after its FDA approval in 2012—since then, New York City has announced new HIV rates fell below 2,500 for the first time since the epidemic exploded in 1981. Jacobs said PrEP was largely responsible for the decline.
 

 



"We're seeing how well it works for communities when there's wider implementation and access," Jacobs added. "We're looking at areas where the use of PrEP is being validated by local governments—subway ads, newspaper ads, doctors being supportive of it." 

There are still kinks to be worked out when it comes to PrEP. Truvada is expensive, and some communities—particularly gay and bisexual black men, who are at the highest risk for new infections—report frustrating experiences with doctors reluctant to offer PrEP medication. And within the gay community, critics suggest some men may be overly reliant on PrEP alone, rather than using condoms in addition to the drug. 

RELATED: AIDS Activists Still Fight Stigma
 
But Jacobs said condoms and PrEP aren't an either-or scenario. Truvada, he said, is filling the space that was left empty years ago in terms of HIV prevention. 

"Even when the consequences of not using condoms was death, people weren't using them," he said. "Why would you think they're going to start using them now?" 

New drugs like cabotegravir are poised to fill even more gaps. One early study of Truvada (the "iPrex" trial) showed that while 93 percent of study subjects reported taking the daily pill, only 51 percent actually kept up the regimen. For patients who don't adhere well to daily medication, a shot every two months is a highly desirable alternative. 

For Jacobs, who works as a marriage and family therapist in addition to educating people about PrEP, the expansion of HIV-prevention methods is a boon not only to the health of Americans, but also to their emotional and sexual wellness. 

"People are having sex for pleasure, to experience intimacy and connection with a partner," Jacobs said. "These studies are beautiful, because they will allow more people to connect in meaningful ways." 





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Read more articlecs from NBC, here

Gates Foundation to Invest Up to $140 Million in HIV Prevention Device

An Intarcia factory in Hayward, Calif., last year. Photo: Jason Henry for The Wall Street Journal

Intarcia Therapeutics is developing implantable pump which holds six or 12 months’ supply of medicine
 
Dec. 29, 2016


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The Bill & Melinda Gates Foundation is investing up to $140 million to support development of a tiny implantable drug pump it believes could help prevent people in sub-Saharan Africa and elsewhere from becoming infected with HIV, the virus that causes AIDS.

The matchstick-size pump is being developed by Intarcia Therapeutics Inc., a closely held Boston-based biotechnology company. It can hold six or 12 months’ supply of medicine and is designed to deliver micro doses continuously to patients, ensuring they stay on the treatment for up to a year.

The new investment, which Intarcia is announcing Thursday, comes amid a flurry of fresh efforts to develop HIV prevention strategies.
Last week, for instance, the National Institute of Allergy and Infectious Diseases announced the launch of a global 4,500-patient clinical trial to test whether injections every eight weeks of an experimental HIV drug, cabotegravir, from U.K.-based ViiV Healthcare is effective in preventing HIV infection. Last month, the first efficacy study of an HIV vaccine in seven years was launched in South Africa.

This is “one of the most exciting years ever in HIV prevention,” said Mitchell Warren, executive director of AVAC, a global HIV advocacy organization supported by the Gates Foundation.

Progress is needed. Despite major gains against HIV and AIDS in the past two decades, some 1.9 million people become infected with the virus each year, the Joint United Nations Programme on HIV/AIDS estimates. The majority are in resource-poor regions such as sub-Saharan Africa, where the epidemic’s toll has been especially severe.

Experts worry that without effective prevention efforts, an emerging generation of young people are at risk of becoming infected.

“If we don’t find a way to prevent infection, we’re going to wind up with more people infected in that part of the world than we have now,” said Emilio Emini, director of the HIV program at the Gates Foundation.

Using the pump in this manner would fit a prevention strategy called pre-exposure prophylaxis, or PrEP.

Gilead Sciences Inc.’s daily pill Truvada, the only drug regulators have approved for PrEP, has been shown in clinical trials to reduce risk of HIV infection by more than 90%.  It is becoming available in generic versions in some African countries.


Bill and Melinda Gates in February. Mr. Gates visited Intarcia’s Boston headquarters in June. Photo: Shannon Stapleton/Reuters

But “its real-world effectiveness is much lower than that because you have to take a pill” every day and getting healthy people to do so is difficult, Dr. Emini said. That’s what makes Intarcia’s pump so attractive, he said. “You put it in and you forget it,” he said, likening it to long-acting forms of contraception. “You can immediately imagine how it could be applicable.”

Under terms of the agreement, the foundation will take a $50 million equity stake in the company and provide up to $90 million more in grants, pegged to certain research milestones toward development of the device.

The money comes from a $1.5 billion fund the foundation has set aside apart from its larger grant-funding operation to make investments in technologies being developed in the private sector. The goal of the fund isn’t to generate a financial return but to back ideas with equity, loans and other financing that advance the foundation’s charitable mission, Andrew Farnum, the foundation’s director of program-related investments, said in an interview.

The Intarcia deal is one of about 50 such investments the foundation has made since 2009. The pump would likely find a market in the U.S. and other wealthy countries, but “the ultimate goal is developing an HIV prophylaxis device that will save lives in the developing world,” Mr. Farnum said.

Intarcia has already developed a version of the pump loaded with the diabetes drug exenatide as a treatment for patients with Type 2 diabetes. The company filed an application with the U.S. Food and Drug Administration last month to market the device, called the ITCA650. If all goes well, it could be on the market by the end of 2017.

It took a decade to develop. The challenge the company faced was to come up with a formulation of exenatide that would remain stable at body temperature for at least a year and that was potent enough to be effective at the micro doses delivered by the pump. The company mounted several phase 3 clinical trials, which demonstrated its efficacy in controlling blood sugar.

“We’re going to basically take that same approach” with an HIV drug, said Kurt Graves, Intarcia’s chairman, president and chief executive officer.

The $50 million in equity is part of a larger round of new financing for Intarcia totaling $206 million, Mr. Graves said.

The foundation, which considers prevention a critical component of its efforts to combat HIV, first heard about the Intarcia pump about a year ago while searching for technologies with the potential to provide long-term protection against the virus.

As part of the due diligence, Bill Gates visited Intarcia’s Boston headquarters in June, where he and Mr. Graves discussed the technology for nearly two hours.

The company and the foundation haven’t decided which HIV drug to put in the pump, but Mr. Graves said initial tests indicate “we have a very good probability of success” in coming up with an effective formulation.  It will likely take several years before the pump reaches the market.
If they are successful, the agreement is intended to make sure the pump available and affordable to poor populations in the developing world.

Write to Ron Winslow at ron.winslow@wsj.com

Read more articles from The Wall Street Journal, here.
 

People With Well-Treated HIV Still Have Nearly Double the Risk of Heart Attack

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The virus itself appears to be the primary driver, likely due to the chronic inflammatory state it prompts.

December 28, 2016


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Even when people’s HIV is well treated with antiretrovirals (ARVs), their risk of heart attack is apparently nearly double that of the general population.

This risk is likely driven by the chronic inflammatory state to which HIV gives rise, even when the virus is suppressed to undetectable levels. Lifestyle factors such as smoking, which is more common among the HIV population, also likely play a role.

Researchers also found that a standard calculator for estimating the risk of heart attack and stroke underestimates the risk for those living with HIV.

Publishing their findings in JAMA Cardiology, researchers studied a multicenter clinical cohort of people receiving care at one of five Centers for AIDS Research Network of Integrated Clinical Systems sites in the United States.

The scientists looked at data on 19,829 people who had received inpatient and outpatient care since 1995. Ultimately, they narrowed the cohort to 11,288 people with sufficient data.

The study authors found that even when members of the cohort had an undetectable viral load, they still had about a 1.5- to 2-fold increased risk of heart attack or stroke compared with the general population. The risk of heart attack and stroke was also about 50 percent higher than predicted by a common algorithm used to predict such risk in the general population.

The researchers believe that scientists should develop a new cardiovascular disease–predicting algorithm specifically for HIV-positive people.

Among the HIV-positive cohort, the rate of heart attack per cumulative 1,000 years of follow-up was higher for black men (6.9) and black women (7.2) compared with white men (4.4) and white women (3.3). The rates per cumulative 1,000 years of follow-up were also higher for people age 40 and older (7.5) compared with those younger than 40 (2.2) and for those who were not virally suppressed (6.3) compared with those who were virally suppressed (4.7).

To read the study abstract, click here.

To read a press release about the study, click here.
  
Read more articles from POZ, here

Op-Ed: Why AIDS.Gov Is Changing Its Name


 
December 29 2016


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Why the name change?

We write frequently about our commitments to following the science, tracking data, gathering user feedback, and responding to the community’s needs—and our name change honors those commitments. We want our program to reflect today’s science, as well as the terms most of our visitors use to tell their stories about HIV or to search for information about HIV and AIDS on our website.

As we prepare for this name change, we’ll share updates and feedback we receive. After the changeover, our program, which is funded through the Secretary’s Minority AIDS Initiative Fund, will automatically redirect users who search for “AIDS.gov” to the new URL (or web address).
We look forward to sharing more with you soon! For more details about our name change, read below. And we look forward to your feedback.

What factors are driving the change?

For more than a year, we’ve been listening to how people talk about HIV and AIDS, and we asked our partners and users for their input on the name change. We’ve also been watching how the terms are used on other websites and social media, and we assessed how they’re used on our site. Here’s what we found:

Science is advancing: In the beginning of the epidemic, the term “AIDS” became implanted in the public’s mind because it was used in the popular press before researchers identified the cause of AIDS and an international committee of scientists named it the Human Immunodeficiency Virus (HIV).

Today, people with HIV who are diagnosed early, linked to care, start antiretroviral therapy (ART), and take it as prescribed, can achieve life-long viral suppression that prevents HIV infection from progressing to AIDS. Viral suppression improves health outcomes for people living with HIV (PLWH), reduces HIV-related deaths, and prevents transmission of the virus to others.
AIDS has not gone away. People in the United States and around the world still develop AIDS and die from its complications. But as our ability to treat HIV infection has improved again and again over the years, AIDS is no longer an expected outcome of having HIV. Today, stopping the progression of the disease before AIDS develops by suppressing the virus to very low or undetectable levels is the primary aim of HIV medical care. Effective ART means that almost everyone living with HIV can achieve viral suppression, including many of those who had been diagnosed with AIDS in the past.

There are other reasons for focusing now on HIV rather than AIDS. Since 2010, a string of major scientific advances have dramatically improved our ability to prevent HIV transmission. Key studies showed that early treatment of PLWH could reduce transmission of the virus to HIV-negative partners by 93 percent over extended follow-up [through TasP] (HPTN 052), and that taking a daily pill containing HIV drugs [PrEP] significantly lowered the risk of an HIV-negative person contracting the virus (iPrEx study, the TDF2 Study, and the Partners PrEP trial ).

Searches are changing: Today, twice the number of people who come to our website from internet searches use the term “HIV” rather than “AIDS.” In addition, the majority of the social media conversations we participate in focus on the term “#HIV.” Changing our name to HIV.gov will improve our ability to help our users find the information they need.

Stories are evolving: In the early days of the epidemic, the public often referred to “AIDS victims.” But many people living with AIDS pushed back against that [phrase] because they did not see themselves as “victims.” They asked to be called “people with AIDS,” and this marked the beginning of a movement by those with HIV to define themselves on their own terms.

Now many of the people living with HIV with whom we work across the nation use the term “HIV” more often than “AIDS” to discuss themselves and the wider HIV community.

We see this in the personal stories shared by those who are HIV-positive in our Positive Spin digital storytelling initiative and in our Black Voices blog series, as well as in other resources by and for the community.

What did our partners say?

Our partners tell us that the pending name change reflects the progress we’ve made over 35 years of the epidemic and reinforces that it’s now possible for individuals to live long and healthy lives with HIV.

Our partners also noted that the term “AIDS” continues to make it difficult to serve key populations at risk for/living with HIV infection. “A big reason youth from communities of color and the LGBT community don’t come into the healthcare system is because they experience more stigma associated with AIDS. Talking about HIV in its current state and that it’s not a death sentence helps people come into my clinic, get on treatment, and be able to live life. I think other physicians would also welcome the chance to get out of the AIDS mindset and help people live,” said Michelle Collins Ogle, at the Warren-Vance Community Health Center, Inc.

“So many people have worked so hard and fought for so long to get us to this place. I started doing this work in 1985 when the reality of living with HIV was so very different than it is today. I cannot tell you how happy I am about the progress that has been made, but our work is far from over,” said Dr. Richard Wolitski, director of the Health and Human Services Office of HIV/AIDS and Infectious Disease Policy. “Now people with HIV can live just as long as their HIV-negative peers. I’ve been living with HIV for more than 20 years, and I don’t expect to ever develop AIDS.”

Wolitski noted: “This change focuses all of us more clearly on ending HIV, whether that’s stopping transmission or preventing the destructive effects of HIV on the body. It represents all of us who are dedicated to stopping HIV transmission and improving HIV care, as well as those of us who are living with HIV, regardless of whether we have been diagnosed with AIDS. We will continue working to address the needs of all people who are at risk for, or living with, HIV. We understand that the experiences and needs of people living with AIDS can be different from those of other people living with HIV and that we all need to take this into account in the work that we do. Together we’ll continue to work toward our dream of seeing the end of this epidemic. It is within our grasp, but our work is not over yet.”

MIGUEL GOMEZ (pictured above), is the director of AIDS.gov, and senior communications advisor of the Office of HIV/AIDS and Infectious Disease Policy, U.S. Department of Health and Human Services. This piece previously ran on AIDS.gov.
 

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Wednesday, December 28, 2016

Doctors Strongly Disagree Over Trump’s Pick for Health Secretary

U.S. Representative Tom Price of Georgia                                                        District Office of Tom Price / CC-BY-SA-3.0

Tom Price wants to dismantle Obamacare and Medicaid expansion, so why did the American Medical Association endorse him to lead HHS?
December 28, 2016


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When President-elect Donald Trump tapped physician and U.S. Rep. Tom Price as secretary of the Department of Health and Human Services (HHS), the selection earned a speedy endorsement from the American Medical Association. But apparently, the AMA does not speak for most doctors—not even those in its organization. As The New York Times reports, thousands of doctors oppose Price in that role.

For Price to lead the HHS, he will have to be confirmed after a Senate hearing, which will take place in January. The Times says the growing dissent among doctors is not likely to harm Price’s confirmation.

What is the controversy? Price wants to dismantle the Affordable Care Act, or ACA (a.k.a. Obamacare), and transform Medicare and Medicaid, programs for older Americans and low-income people, respectively. Doing so, one doctor told the Times, would mean that vulnerable patients would lose insurance benefits and be put at risk. Other doctors criticized Price’s record on women’s health (he wants to cut off funds for Planned Parenthood).

So why would the AMA, which boasts about 235,000 members, endorse Price? As one doctor told the Times: “Pocketbook issues—the economic well-being of physicians—may well be a factor contributing to the AMA’s endorsement.” The Times writes that “physicians have long been a focus of Mr. Price’s legislative efforts. He led the push to fix widely recognized flaws in Medicare’s formula for paying doctors and supported changes in malpractice laws that could make it easier for doctors to defend themselves. He supported changes in Medicare that would allow doctors to get around fee limits by signing contracts with patients. He has also backed changes in antitrust law that would enhance doctors’ bargaining power in negotiations with insurance companies.”

Other doctors remain staunch supporters. Patricia Harris, AMA chairwoman, said that Price is “a longtime member, he’s a delegate. For us, he has always been accessible. He listens, and he really knows how policies impact the delivery of care and the physician-patient relationship.”
  
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Tuesday, December 27, 2016

AIDS Activist George Michael Dead at 53


 
December 26 2016


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Gay pop star George Michael has passed away at the age of 53, BBC reports. Michael, who found fame in the 1980s as the lead singer of Wham! later launched a successful solo career, becoming one of the biggest pop stars of the late 20th-century, selling over 100 million albums. Michael He came out in 1998 after being arrested for soliciting sex with an undercover police officer in Beverly Hills, California.

It's not clear the cause of Michael's death, but the BBC says he "passed away peacefully at home." As rumors began about whether his death was related to HIV, fans took to social media to condem the idea as "ugly," homophobic, and biased. As Heavy notes, one of Michael's partners, the designer Anselmo Feleppa, passed away from AIDS-related complications. The British singer’s song “Jesus to a Child” was reportedly a tribute to Feleppa.

Michael had been an active supporter of those with HIV since the early days of the AIDS epidemic and contributed widely to charities.  According to the Elton John AIDS Foundation, Michael donated over £1 million from his tour for the album Symphonica to EJAF which, "enabled the Foundation to set up a special fund commemorating the AIDS-fighting work of Elizabeth Taylor."  The singer also performed in numerous fundraising concerts like Live Aid, and the World Aids Day concert. And, "In recent years, he staged a charity performance at the Palais Garnier Opera House for France’s biggest AIDS charity Sidaction."

Born in London, Michael would pair up with childhood friend Andrew Ridgeley to form Wham!. The band broke through with their second album, Make It Big, released in 1984 and featuring hits like "Wake Me Up Before You Go-Go" and "Careless Whisper."

His 1987 solo album, Faith, was a phenomenon, featuring the hit title track, along with the controversial, "I Want Your Sex." The album won numerous accolades, including Album of the Year at the Grammys. His follow-up, Listen Without Prejudice, Vol. 1, was a more somber affair. Eschewing his past image as a sex symbol, Michael released videos like the iconic "Freedom! '90" that didn't feature him.

Though he continued to release albums and participate in philanthropic efforts throughout the 1990s, Michael's career was in decline when he was arrested in Beverly Hills. He would soon come out and even mock the bathroom incident in his video for the single "Outside."





Michael struggled with drugs during the past decade and was arrested several times for possession or driving under the influence. The singer's health was also suffering; he had a severe case of pneumonia in 2011 and suffered a head injury after falling out of his car in 2013. 


 

 


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