It's not really a stretch of the imagination to predict that Uganda's recently approved anti-gay law will have anything less than a calamitous effect on the rate of HIV transmissions within that poor African nation. The legislation, signed into law by Ugandan President Yuwari Musaveni (pictured) on February 24, allows for the life imprisonment of gay Ugandans, as well as prison sentences for any citizen not reporting gay individuals.
It's not unfair to question whether we have already begun to see the impact of the law on HIV transmissions insofar as Uganda is the only nation in all of Central and East Africa to have an increase in the number of HIV infections. The latest incarnation of the law is, in fact, only an extension of government's previous legislation, which had allowed for the imprisonment of gay Ugandans for up to 14 years.
Ugandan Health Cabinet Minister James Macharia has already admitted that HIV-positive men who have sex with men (MSM) are regularly defaulting on antiretroviral treatment for fear of public disclosure. Currently, of the 100,000 new HIV infections reported in Uganda each year, 33% can be attributed to MSM transmissions.
We have to admit we were somewhat startled last week by news that lopinavir, the key agent in the HIV protease inhibitor-class drug Kaletra, is apparently able to wipe out pre-cancerous cells associated with the development of cervical cancer.
It was one of those "wow" moments, whereby a potential breakthrough in research is shown to be right there in front of you without you even knowing it.
Invasive cervical cancer, or cancer that has spread beyond the surface of the cervix, has been considered an AIDS defining condition since 1993. In the U.S. alone, around 12,400 cases of invasive cervical cancer are estimated to be diagnosed this year, with just over 4,000 women expected to die.
Ian and Lynne Hampson, a husband and wife research team from the University of Manchester, discovered that lopinavir has the ability to eradicate pre-cancerous cells in 19 of 23 women with high grade cervical dysplasia, while two of the women reverted to low grade disease.
One of the reasons we were so taken with Josh Robbin's activist blog, @imstilljosh, was the short video he posted on his homepage, whereby he films himself preparing to receive his HIV test results and soon after gets the news that he is, in fact, HIV positive.
No matter how numbed or apathetic one might be to HIV in 2014, it would take one hard heart not to respond to that video, or relive his or her own experiences through it.
It is why sharing stories is so important to changing attitudes about HIV, providing those newly infected with the disease (or less able to cope) a sense of encouragement, while alleviating the stigma that prevent thousands from getting tested every year.
Healthline, the San Francisco-based health information network, recently launched the You've Got This initiative in support of the Timothy Ray Brown Foundation (TRBF), designed to encourage people with HIV to video their experience about what it was like to first hear that they were HIV positive.
Just a year ago it was said that the timely and informed use of combination antiretroviral therapy (cART) could increase HIV life expectancy rates in many developed countries to near-normal levels. That's not necessarily true any longer.
According to a new study published in the medical journal PLOS|ONE, if cART is initiated at a CD4 count above 350 cells/mL, many people with HIV can now enjoy a life expectancy equal to or even greater than that of the general population.
In the comprehensive eight-year review, which looked 22,937 HIV-positive people in the U.S. and Canada from 2000 to 2007, life expectancy for a 20-year-old male just starting cART was estimated to be around 77 years, while a 20-year-old female could live to the age of 82.
By contrast, the average life expectancy for all men and women in the U.S. is 75 and 81 years, respectively.
While impressive gains in life expectancy have been made in the past decade among people living with HIV, mortality rates continue to paint a somewhat different picture. A number of recent studies have compared mortality rates in the "middle years" (between the ages of 35-70) of HIV-infected people versus those of the general population.
One of the most compelling pieces of research, published in the January 14 issue of AIDS, was conducted as part of the long-standing Multicenter AIDS Cohort Study (MACS) and the Women's Interagency HIV Study (WIHS). It included a total of 6,669 HIV-positive participants who were on combination antiretroviral therapy (cART) and observed from as early as 1985 through 2010.
When compared to matched cohort of HIV-negative people, the annual mortality rate among those with HIV were seen to be seven times greater (0.37% versus 2.32%). During the entire course of the study, 540 out of 2,953 people with HIV had died (18.2%) compared to only 165 out of 3,854 HIV-negative people (3.4%).
There is no question that the daily use of the antiretroviral drug, Truvada, can significantly reduce the risk of infection in HIV-negative individuals in a serodiscordant relationship (i.e., where one partner is HIV-positive and the other is HIV-negative). The strategy, known as pre-exposure prophylaxis (or PrEP), has been shown to reduce transmission risk by anywhere from 62% to 75% if taken with consistent, uninterrupted adherence.
From a scientific viewpoint, those are amazing figures which support the use of PrEP as part of an overall HIV prevention strategy. However, from a real-life perspective, the numbers may not be all that convincing, with the words "consistent, uninterrupted" presenting potential barriers to those who might otherwise sign up.
In fact, according to industry research, only 1,774 people in the U.S. have filled prescriptions for Truvada for PrEP between January 2011 and March 2013. That's a startlingly low number, given the 50,000 new HIV infections we are seeing in the U.S. every year.
In the U.S., it has long been known that, even when advised of the benefits of early antiretroviral therapy (ART), a large proportion of patients qualified for treatment will turn it down. In fact, according to the U.S. Centers for Disease Control and Prevention (CDC), of the 902,000 Americans diagnosed with HIV, only 363,000 were actively on ART in 2012.
It was largely assumed that a lack of patient readiness and/or understanding was at the heart of this statistic. However, a recent study from the University Hospital Zurich has shown that the reluctance to initiate ART extends not only to patients, but to their doctors, as well.
The study, which was conducted in 34 sites across Europe and Australia, surveyed patients who had been diagnosed with HIV and were under a doctor's care for at least 180 days. Of the patients in the cohort, 67% were diagnosed from one to four years ago, while 28% had been diagnosed five or more years previous.
Among the surveyed physicians, 78% had five or more years experience treating HIV, while 90% had more than 50 HIV-positive patients in their care.
February has been designated as National Condom Month, designed to bring greater awareness to the effectiveness of condoms in preventing unwanted pregnancies and the transmission of sexually transmitted infections, including HIV.
While the rates of chlamydia, gonorrhea and syphilis continue to rise in the U.S., condom usage among singles has stalled to only 1-in-3 per sex act. That's an alarming statistic.
So, with Valentine's Day just around the corner, we could think of no better way to prepare for romance than with some the best (and most memorable) condom articles from the archives of About.com:
- Step-by-Step Guide to Proper Condom Use
- About.com's Condom Quiz Challenge
- Condom Size/Fit Chart
- How to Use a Female Condom
- Novelty Condoms for All Occasions
- Innovations to Watch: the Origami Condom
- Inventions That Missed: Spray-On Condoms
- Why People (Really) Don't Use Condoms
Photograph © Tomizak used under a Creative Commons license at http://www.flickr.com/photos/48329209@N03/4430804547.
It is well documented that the risk of heart disease among people with HIV is greater than that of the general population. In fact, a recent study by the Division of Research at Kaiser Permanente Northern California, which looked at 22,018 HIV-positive patients in care from 1996 to 2009, concluded that the overall risk of heart disease was 44% greater than in non-infected individuals.
While none of this information is particularly new, what the report does reveal is the striking correlation between a person's lowest, historic CD4 count -- known as the "nadir" -- and the risk of heart attacks.
Generally speaking, immunodeficiency is indicated when a person's CD4 count drops below 500 cells/mL. What the study found was that, for every drop of 100 cells, the risk for heart disease increases by some 12%. By the time it drops to below 200 cell/mL, the risk for heart attack is said to have increased to a startling 74%.
While we were among many who lauded the FDA's approval of Gilead's revolutionary hepatitis C (HCV) drug, Sovaldi (sofosbuvir), we couldn't help but raise an eyebrow when we finally got word of the wholesale price: $84,000 for a 12-week course, or an astonishing $1,000 per pill.
The news sparked immediate debate among bioethicists and healthcare advocates, with some like the Michael Foster of the AIDS Healthcare Foundation declaring "outrage, pure and simple" at the Gilead announcement.
Gilead was quick to respond, asserting that the cost reflects what they believe to be "a fair price for the value that we're bringing into the health care system and to the patients."
So the question is whether it's "fair" that a drug therapy which, by most estimates, costs around $250 to produce should be priced nearly 350 times that amount.
As with all things that related to the pharmaceutical industry, there is no simple "yes" or "no" answer. Read More...