|Fuzeon should be used when CD4 counts are above 100m cells per liter: panel
Source : AIDS 2004;18:1137-1146. 2004-06-22
|NEW YORK (Reuters Health) – The fusion inhibitor enfuvirtide (Fuzeon) should optimally be started when CD4 cell counts are above 100 million cells per liter and virema is below 100,000 copies/mL, according to a panel of HIV-treating physicians with knowledge and experience in using the anti-HIV agent.|
Where options for an effective background antiretroviral regimen are few, enfuvirtide "should still be considered" as a means of "buying time" for new agents, the panel recommends in the consensus statement, published in the May 21st issue of AIDS.
The introduction of enfuvirtide represents "an important advance" in the management of highly treatment-experienced, HIV-infected patients, Dr. Bonaventura Clotet, of the Hospital Universitari Germans Trias i Pujol, Badalona, Spain and panel members note in the report. "However, parental self-administration and the advanced disease and antiretroviral experience of patients currently most needing enfuvirtide introduce unique considerations."
Principally a "salvage" medication at present, enfuvirtide has been shown to provide clinically meaningful improvements in CD4 cell counts and reductions in HIV viremia across "all subgroups of treatment-experienced patients," according to the panel.
The panel also recommends the use of resistance testing, when available, to guide the selection of background antivirals. "For preference, enfuvirtide should be used in those for whom sufficient residual drug activity remains to construct a background regimen that allows full virological response," they recommend.
The panel acknowledges that "more information is needed on enfuvirtude resistance, particularly the genotypic and phenotypic correlates of enfuvirtude response." However, it is their opinion that "until such data are available, and until potentially cross-resistant new agents advance through development, enfuvirtide resistance considerations should not influence clinical management."
Among the panel’s other recommendations are to provide ongoing training and support to enfuvirtide-treated patients to prevent "injection fatigue," boost adherence, and curb injection site reactions, which are common with enfuvirtide. "An initial investment in establishing such procedures can be expected to yield significant returns in patient confidence and benefit on enfuvirtide," the authors write.
|Minor HIV protease mutations point to antiretroviral failure
Source : J Infect Dis 2004;189:1983-1987
|NEW YORK (Reuters Health) – Minor mutations of 36I and 101/V in HIV protease can predict the appearance of a mutation associated with resistance to protease inhibitors (PIs), European researchers report in the June 1st issue of the Journal of Infectious Diseases.|
Dr. Carlo Federico Perno of the University of Rome Tor Vergata and colleagues, who note that 36I is seen in about 25% of HIV clade B and more than 80% of non-clade B viruses, came to this conclusion after studying 93 previously drug-naive patients who experienced failure of their first PI -based antiretroviral regimens.
The 90M primary mutation is associated with different levels of resistance to all current PIs, say the investigators, and identifying factors associated with its appearance "is particularly relevant from the clinical standpoint."
The findings, Dr. Perno told Reuters Health, could be eventually used in developing therapeutic strategies as well as "implementation of the diagnostic algorithms that are used in clinical practice for a better utilization of the inhibitors of HIV replication."
He and his colleagues conclude that if their results are confirmed, "use of resistance testing in chronically-infected drug naive patients before initiation of therapy should become the rule."
|Mugabe appeals for private sector help in AIDS war (2004-06-16)|
|HARARE (Reuters) – Zimbabwe President Robert Mugabe urged the private sector on Wednesday to help his cash-strapped government provide essential drugs to combat an AIDS pandemic he described as one of the greatest challenges facing the country.|
Official figures show that 24.6 percent of Zimbabwe’s adult population is infected with the HIV virus that causes AIDS, one of the highest rates in the world. The number of HIV/AIDS cases in Zimbabwe rose to about 1.8 million in 2003, 18 years after the first AIDS sufferer was detected in 1985.
"There is no doubt that HIV and AIDS is one of the greatest challenges facing our nation. The disease does not respect status, it does not respect colour… It is a war that belongs to all of us," Mugabe told Zimbabwe’s first national conference on the pandemic.
Mugabe’s government, presiding over the country’s worst economic crisis since independence from Britain in 1980, has allotted Z$15 billion ($2.8 million) this year for the procurement of anti-retroviral drugs for AIDS patients in public hospitals but at current prices this can only benefit some 10,000 patients.
"We appeal for the greater participation of the private sector. I believe there is scope for (the) government and the pharmaceutical companies to work together so as to bring the prices of the drugs down and enable more of our people to benefit," Mugabe said.
Health ministry officials say up to 3,000 people in Zimbabwe die of AIDS-related illnesses each week, and figures released at the first day of the conference on Tuesday showed that 135,000 succumbed to the pandemic last year alone.
About 166,000 new HIV infections were recorded in 2003, while 138,000 new cases of full-blown AIDS were reported.
The disease has added on to the woes of a country grappling with its worst economic crisis since independence, manifesting itself in chronic shortages of foreign currency, fuel and food, high inflation and unemployment, and collapsing health services.
Mugabe’s government denies accusations it has lacked the political will to effectively deal with the AIDS crisis and last month began distributing cheaper, locally manufactured anti-retroviral (ARV) drugs to combat the disease. Prior to the programme, only Zimbabwe’s elite could access imported drugs.
Mugabe’s government rejects critics’ charges that it has mismanaged the country over the past 24 years, and argues that opponents of its controversial seizure of white-owned farms for landless blacks have sabotaged the economy.
|Counseling about negative aspects of unsafe sex cuts HIV risky behaviors
Source : AIDS 2004;18:1179-1186 (2004-06-15)
|NEW YORK (Reuters Health) – In motivating HIV-infected patients to reduce behaviors that may transmit the virus, brief counseling about the negative consequences of unsafe sex is more effective than discussing the positive outcomes of safer sex, according to a new study.|
The findings, which appear in the May 21st issue of AIDS, are based on a study of 585 sexually active subjects who attended clinics emphasizing either of these risk reduction approaches or to control clinics that only stressed adherence to antiretroviral therapy.
With the positive consequence approach, the subjects were told "safer sex protects you from other STDs and from other strains of HIV." By comparison, subjects in the negative consequence group were told "unsafe sex may expose you to other STDs and other strains of HIV." Moreover, the counseling sessions, which lasted 3 to 5 minutes, either emphasized engaging in safer sex or avoiding unsafe sex.
Among subjects with at least two sex partners at baseline, the negative consequence approach reduced the incidence of self-reported unprotected anal or vaginal intercourse by 38% (p < 0.001). In contrast, the positive consequence approach produced no change in UAV.
Compared with the control group, the negative consequence group was 58% less likely to report unprotected intercourse at follow-up, lead author Dr. Jean L. Richardson, from the University of Southern California at Los Angeles, and colleagues state. The negative consequence approach had no effect on subjects with only partner or one main partner at baseline.
"Additional research is needed to find ways to counsel those with one partner and, among those who are not currently sexually active, to maintain abstinence or safer sexual behavior in the future," the authors conclude.
|Zimbabwe holds first national meeting on AIDS crisis
|HARARE (Reuters) – Zimbabwe opened its first national AIDS conference on Tuesday, spotlighting a health disaster that critics of its government say has been overshadowed by mounting economic and political problems.|
According to official figures, 24.6% of Zimbabwe’s adult population is infected with HIV, one of the highest rates in the world. The number of HIV/AIDS cases in Zimbabwe rose to about 1.8 million in 2003, 18 years after its first case was reported in 1985.
Health ministry officials say up to 3,000 people in Zimbabwe die of AIDS-related illnesses each week, and figures released at Tuesday’s conference showed that 135,000 succumbed to the pandemic last year alone.
About 166,000 new HIV infections were recorded in 2003, while 138,000 new cases of full-blown AIDS were reported.
The figures were below official projections of 294,000 new HIV infections and 252,000 new AIDS cases provided last August. Officials had no immediate explanation for the drop, but have pointed to changes in behavior and AIDS awareness prompted by a national publicity campaign.
This week’s conference is aimed at giving officials, health workers and community groups a chance to draw up plans for fighting the disease, an increasing threat to societies and economies across southern Africa.
AIDS has exacerbated the plight of Zimbabweans amid the country’s worst economic crisis since independence in 1980, shown in chronic shortages of foreign currency, fuel and food, high inflation and unemployment, and collapsing health services.
In a statement on Tuesday, the United Nations office in Zimbabwe, which is co-sponsoring the conference, said while new HIV infections appeared on the decline, economic hardships had led people, particularly women, to take sexual risks.
"Risky sexual behavior, including unsafe sex in exchange for cash, food, tillage (of fields) and agricultural inputs, jobs or other basic necessities, persist," the U.N. said.
President Robert Mugabe’s government denies accusations it has lacked the political will to effectively deal with the AIDS crisis and last month began distributing cheaper, locally manufactured antiretroviral drugs to combat the disease.
Prior to the program, only Zimbabwe’s elite had access to imported drugs, which were priced beyond the reach of the poor majority. Health Ministry officials estimated 5,000 people are on ARV drugs in the country and said the government hopes to expand the program around the country in the next six months.
|Un appello perché ci sia "una politica della salute più intelligente e rispettosa delle forze in campo" in Mozambico è stato rivolto dalla Comunità di Sant’Egidio, durante una conferenza stampa, a Maputo.
Alla conferenza, a cui hanno partecipato quasi tutti gli organi di comunicazione mozambicani, Andrea Riccardi ha parlato del rapporto "intimo e storico" che unisce la Comunità di Sant’Egidio con il Mozambico, della ricchezza che rappresentano le istituzioni di questo paese, e soprattutto dei numeri di DREAM, il programma globale di lotta contro l’HIV/Aids in cui è impegnata la Comunità da più di due anni.
Facendo riferimento ai dati del Rapporto DREAM di Marzo 2004, Andrea Riccardi e la coordinatrice DREAM Mozambico, Paola Germano, hanno sottolineato l’importanza che il programma svolge per la formazione:"il Mozambico – è stato detto – ha grandi risorse umane che DREAM sta valorizzando".
I numeri di DREAM in Mozambico, a marzo 2004, indicano 8000 persone che hanno fatto il test volontario, 2000 in triterapia antiretrovirale, 413 bimbi nati sieronegativi da madri sieropositive in trattamento di prevenzione verticale.
Particolare interesse ha suscitato il rapporto della Comunità con i responsabili della Sanità pubblica, rispetto al programma DREAM. A questo proposito, Andrea Riccardi ha affermato che "le dimensioni del nostro impegno dipendono da quello che ci permettono di fare".