INTERNATIONAL AIDS CONFERENCE UPDATE
I was not there. They had memorial activities for those lost in the plane shot down over the Ukraine. I have heard Joep Lange speak and run conferences before; I mourn the loss and setback to efforts of HIV control and cure.
ANTI-GAY LAWS MEAN POOR HEALTH FOR GAYS
76 countries, mainly in Africa, have anti-gay laws and through a web survey of 4020 gay men, the researchers found that 1 out of 12 respondents had been arrested. Being under increased attention by the authorities makes finding HIV health care difficult. Access to mental health, condoms, HIV testing, and sexually transmitted infections was less overall and worse for those who have been arrested–they are afraid to do anything that might trigger gaydar. It was hard for patients to be honest with their providers, making health care difficult. Prevention programs are seeing a great drop off of participants since the new laws were passed in Nigeria. They fear persecution, extortion, and blackmail.
New Orleans, Louisiana has only one needle exchange program for such a large city, open 2 hours a week. This program receives no funding. Condoms are confiscated from sex workers putting them and their partners at risk. Sadly, biomedical advances are outpacing human rights reforms. These backward laws promote transmission of sexual diseases, including HIV. The South of the United States has more HIV and it is difficult to make a dent in number of new cases due to poor human rights issues.
DRUG RESISTANT TB
A new medication, PaMZ has been shown to be effective once daily against resistant TB and the treatment only lasted 4 months instead of a year or more. Only two other drugs were given with it. Usually 5-7 drugs over 2 years are needed to control resistant TB. Great news! This study was conducted in multiple African countries.
Even though this baby had undetectable virus for many months, we learned that very early treatment is still quite helpful. Many are pursuing very early treatment for babies born to HIV positive mothers with poor viral control.
There is some action with the strategy of “shaking” the sleeping virus out if its hiding places with a cancer drug, romidepsin and panobinostat. By giving these medications and a therapeutic vaccine to boost the immune system, the researchers hope to eradicate HIV. This hopeful strategy is in the very early stages, so don’t expect a cure soon.
New Rules: Since PrEP is $6-1500/month most insurances have agreed on these rules to pay for a prescription. There are check off lists and consents now for this formal process.
There was a study that showed those who need PrEP the most were interested in taking it and they did well. This group had a 44% reduction of HIV transmission compared to the group without the PrEP. That is helpful, but not close to 100% that condoms will provide. Getting people to use condoms is difficult, but once they are used to them and it is introduced as an erotic experience, the sexual satisfaction is good. For PrEP, there may be some forgiveness if 4 or more pills are taken per week–but then isn’t this risky to keep track of which days you take it and which not? The participants took PrEP on and off over the 18 months, depending on whom they were active with, i.e. probably meaning whether condoms were acceptable to that couple.
HORMONAL BIRTH CONTROL AND HIV TRANSMISSION
FYI for your hetero friends: oral and implanted contraception did not increase the risks of HIV transmission from the male to the female partner using these birth control methods. But there was a mild increase of transmission with use of the DepoProvera® injections every 3 months. This was performed in Africa on many patients over many years. So condoms still are the main prevention method.
HEPATITIS C CURES
The news keeps getting better except for the cost of the therapy. We are done talking about interferon except in rare, resistant cases. If there is no virus detected at 12 weeks of therapy, then those patients are cured, per Dr Mark Sulkowski. We are talking about with or without HIV. The treatments under study are now for less than 3 months. These studies are available, call the hepatitis research sites. For those who do not have the later stages and their insurances do not pay for treatment, costs will be lower next year due to more competition so your insurance may pay for it then. Getting into a study may be quicker.
Finally Ebola has broken out of the rural areas of West Africa. It is just a plane ride away. There are travel advisories and inspections of those getting on planes now. Ebola’s fatality rate was 90%, now it is about 53%. If a germ kills you instantly, you don’t have a chance to pass it on. So, like Herpes, the virus with the ability of keeping a person in circulation, will be the one that is passed on, to get around our protections. So this theory predicts that the case fatality rate will decrease further. Consider not getting close to someone who is ill, coming from Africa. Stay away from anything of theirs that is or once was wet, as the virus may be on that part. Isolation, quarantine measures work very well. Rest assured that the health care workers taking care of these patients in the US are using the correct precautions so it will not be transmitted from a well-isolated case. Keep reading the news.
Keep those questions coming. Be Safe!
Daniel Pearce, D.O., FACOI, AAHIVS
Clinical Associate Professor of Medicine, Loma Linda University School of Medicine
Adjunct Professor of Internal Medicine and HIV, Touro University California College of Osteopathic Medicine and Midwestern University Arizona College of Osteopathic Medicine
Researcher, Veterans Administration Hospital, Loma Linda
HIV Specialist, Riverside County Public Health Department
Hepatitis C Specialist and Researcher, Southern California Liver Centers, Riverside