(July, 2011) AIDS Funds Frozen for China in Grant Dispute (NY Times: Sharon LaFraniere)

BEIJING — The Global Fund to Fight AIDS, Tuberculosis and Malaria has frozen payments on hundreds of millions of dollars worth of disease-fighting grants to China, one of the charity’s biggest recipients, in a dispute over China’s management of the grants and its hostility toward involving grass-roots organizations in public health issues.

Related: China Reports AIDS Mortality Is Cut by Two-Thirds (May 19, 2011) 

The dispute may add to a growing debate among global health experts whether China, which spent an estimated $46 billion staging the 2008 Olympic games and last year’s Shanghai Expo and financed a $586 billion economic stimulus package, should be a recipient of such aid at all.

The fund, which has expanded to 150 countries since it was founded in 2002 as a pool for public and private donations to fight the world’s worst diseases, quietly decided to hold back payments from a major AIDS grant to China in November. It froze payments from other grants to China several weeks ago because of fresh concerns over lack of monitoring of funds.

Its decisions appear rooted in a collision between the fund’s conviction that grass-roots organizations must be intrinsically involved in the fight to control diseases like AIDS, and the Chinese government’s growing suspicion of any civil-society groups that are not directly under its control. They follow complaints by some AIDS activists that Chinese officials have sought to suppress their public-health activities, have shunted grant money to groups under government control and have failed to account for how some funds were spent.

At stake are hundreds of millions of dollars for programs to reduce the incidence of tuberculosis, prevent and treat H.I.V. infections and wipe out malaria. China has received $539 million from the Global Fund since 2003, according to the fund’s Web site. An additional $295 million is in the pipeline, making China the fund’s fourth largest recipient behind Ethiopia, India and Tanzania, one global health expert said.

A decision by the Global Fund to pull out of China would be hugely embarrassing for the Chinese government because it would suggest that China was unable to meet the standards of an international organization that dispersed funds to far less sophisticated governments. The fund can terminate grants that have been mismanaged or short of that,  formally suspend them. Suspension is a harsher step than halting payments and sets up a series of major obstacles to the release of additional funds.

Those more punitive measures seemed to have been averted Friday after two days of tense meetings between officials from the fund and the government. Jon Liden , a spokesman for the Global Fund, said China agreed Friday to a number of stipulations on how money would be used and monitored. “We came to a point where we needed to make clear signals to China,” he said. “We seem to share an understanding of the way forward.” This week, sources familiar with the negotiations said China pledged to the Global Fund that it would repay any funds that were misspent. But some fear that the inclusion of civil society groups in the health effort may still be an issue.

The meetings took place against the backdrop of growing questions over whether China should be allowed to benefit from the fund’s largesse. As a middle-income country, China qualifies for grants, as do Thailand, India, the Philippines and a number of Latin American countries. Unlike poorer countries, those nations are expected to contribute a certain percentage of the cost of the programs financed.

But China’s huge success in winning awards — coupled with growing evidence of the government’s deep pockets — has inspired fiery criticism, including from Jack Chow, a former first assistant director general of the World Health Organization who helped create the Global Fund. Dr. Chow, now a professor at Carnegie Mellon University, has argued that China’s Health Ministry seeks aid only because the Chinese government chooses instead to lavish funds on “hard power” agencies or to invest it in other sectors.

“China’s persistent appetite threatens to undermine the entire premise behind the Global Fund,” he wrote in the July issue of Foreign Policy. At a time when the fund is struggling for contributions, he wrote, “Donors will grow even more reluctant if they realize that substantial funds are being awarded to a country that can more than pay for its own health programs.”

China’s contributions to the fund amount to a mere $16 million, compared with $5.5 billion from the United States, the leading donor, he wrote. Fund officials have been reviewing the question of eligibility criteria, and lower-than-expected donations are now forcing them to be more selective about recipients.

Some fund officials suggest that China is not expected to apply for major new grants. Nonetheless, fund officials insist the controversy over eligibility criteria had no bearing on the fund’s decision to hold up payments.

The problems between the fund and China turned serious late last year after audits revealed that China had failed give 35 percent of a $283 million AIDS grant to community-based organizations, as it had pledged. The grant focused on community-based H.I.V. treatment and prevention, especially focusing on drug users and prostitutes.

According to a report by a nongovernment group called Global Fund Watch, China actually allocated less than 11 percent to nongovernment groups. An external audit found that community groups appeared to be left out of strategy sessions.

Chinese officials countered that many civil society groups could not be trusted to properly spend the Global Fund’s money and that government agencies were more trustworthy, sources said. But in interviews this week, activists challenged that view.

One, Chang Kun, alleged that government officials or “official NGOs” created by the government routinely pocketed more than half the grant funds. He said that an AIDS rights group that he headed in western China’s Xinjiang region had received a grant of roughly $3,000 in 2005, only to be forced to return it because the government disbanded his group.

“They view our campaigning as troublemaking. They don’t like private NGOs and people taking up organizing roles,” he said. “I have been campaigning for AIDS patients for seven years now, and I rarely see people getting any benefits from the Global Fund.”

The Hebei Province director of an AIDS support group, Shen Zhiqi, said that he supported the fund’s decision to withhold funds, because “I really don’t want to see something as well-intentioned as the Global Fund be sucked into the black hole of corruption.” But he said he did not endorse totally withdrawing financing because it would hurt grass-roots groups.

The Chinese government has been wary of such groups for years. One prominent official gave a taste of the government’s thinking earlier this week. In Qiushi, a Communist Party journal, Zhou Benshun, the secretary general of the party’s political and legislative affairs commission, wrote that China must “guard against being misled to the point of falling into the trap of so-called ‘civil society’ devised by certain Western countries.”

Email to Sharon LaFraniere from Tim Barrus

Charities like the Gates Foundation do the exact same thing as China. Essentially, the Gates Foundation has given up on AIDS anyway. "AIDS has turned out to be far more difficult that anything we expected," Bill Gates says. They feel they can impact malaria but not AIDS. But here's the kicker: There are no US charities that will fund programs that include sex workers. There isn't so much as any trickle down. To ignore sex workers is the typical US response from the government on down to NGOs. I work with a program that most definitely includes sex workers. We have time and time and time again approached the Gates Foundation and the hostility we receive is breath-taking. We have given up dealing with mainstream charities because every time they see that we work with sex workers -- especially young male/child prostitutes -- they recoil. I have news for the big foundations. If AIDS is more difficult to deal with than any of them ever thought it would be, what this really means is that they are going to have to climb down from their lofty office towers (this will never happen) and immerse themselves in the more gritty issues like children who are forced by their economic situations into prostitution. It's distasteful to the moral values of foundations like Gates, and to authoritarian governments like China. And both do essentially the same thing which is to ignore this part of the problem. Until they get real, until they are willing to deal with people they would rather spit on, until they are willing to deal with people they do not like, they will have little relevance in the fight against HIV/AIDS. China is no different.

(Sept, 2011) HIV MVA-B Vaccine May Reduce Virus To 'Minor Chronic Infection'

First Posted: 9/29/11 08:29 AM ET Updated: 9/29/11 08:44 AM ET http://www.huffingtonpost.com

Spanish scientists at the National Biotech Centre in Madrid say a new vaccine could reduce HIV to a "minor chronic infection."

The researchers report that 90% of participants given the MVA-B vaccine showed an immune response to the virus and 85% kept the immunity a year later.

According to a press release from The Spanish National Research Council (CSIC):

The success of this vaccine, CSIC's patent, is based on the capability of human's immune system to learn how to react over time against virus particles and infected cells. “MVA‐B vaccine has proven to be as powerful as any other vaccine currently being studied, or even more,” says Mariano Esteban, head researcher.

MVA‐B is an attenuated virus, which has already been used in the past to eradicate smallpox, and also as a model in the research of many other vaccines. The “B” stands for the HIV subtype it is meant to work against, the most common in Europe.

Once injected, the vaccine teaches the volunteer's immune system to track down and fight off the virus. "It is like showing a picture of the HIV so that it is able to recognize it if it sees it again in the future," Esteban says.

The researcher added “If this genetic cocktail passes Phase II and Phase III future clinic trials, and makes it into production, in the future HIV could be compared to herpes virus nowadays."

In other HIV news, a group of European economists says adult male circumcision is not the most cost-effective solution for stopping the disease and resources should be directed towards other options like finding an HIV vaccine, infant male circumcision, removing the risk of infection from blood transfusions, and stopping mother-to-child transmission of the virus.

USA Today reports that Bjorn Lomborg, director of the Copenhagen Consensus Center, told a group meeting at Georgetown University, "We need to spend money on things we know work," and added, "Making blood transfusions safe costs almost nothing, but we're not doing it."

(Sept., 2011) Scientists find way to "disarm" AIDS virus By Kate Kelland (reuters)

First Posted: 9/19/11 05:08 PM ET Updated: 9/19/11 08:20 PM ET http://www.huffingtonpost.com

LONDON (Reuters) - Scientists have found a way to prevent HIV from damaging the immune system and say their discovery may offer a new approach to developing a vaccine against AIDS.

Researchers from the United States and Europe working in laboratories on the human immunodeficiency virus (HIV) found it is unable to damage the immune system if cholesterol is removed from the virus's membrane.

"It's like an army that has lost its weapons but still has flags, so another army can recognize it and attack it," said Adriano Boasso of Imperial College London, who led the study.

The team now plans to investigate how to use this way of inactivating the virus and possibly develop it into a vaccine.

Usually when a person becomes infected with HIV, the body's innate immune response puts up an immediate defense. But some researchers believe HIV causes the innate immune system to overreact. This weakens the immune system's next line of defense, known as the adaptive immune response.

For this study -- published on Monday in the journal Blood -- Boasso's team removed cholesterol from the membrane around the virus and found that this stopped HIV from triggering the innate immune response. This in turn led to a stronger adaptive response, orchestrated by a type of immune cells called T cells.

AIDS kills around 1.8 million people a year worldwide. An estimated 2.6 million people caught HIV in 2009, and 33.3 million people are living with the virus.

Major producers of current HIV drugs include Gilead Bristol Myers Squibb, Merck, Pfizer and GlaxoSmithKline.

Scientists from companies, non-profits and governments around the world have been trying for many years to make a vaccine against HIV but have so far had only limited success.

A 2009 study in Thailand involving 16,000 volunteers showed for the first time that a vaccine could prevent HIV infection in a small number of people, but since the efficacy was only around 30 percent researchers were forced back to the drawing board.

An American team working on an experimental HIV vaccine said in May that it helped monkeys with a form of the AIDS virus control the infection for more than a year, suggesting it may lead to a vaccine for people.

HIV is spread in many ways -- during sex, on needles shared by drug users, in breast milk and in blood -- so there is no single easy way to prevent infection. The virus also mutates quickly and can hide from the immune system, and attacks the very cells sent to battle it.

"HIV is very sneaky," Boasso said in a statement. "It evades the host's defenses by triggering overblown responses that damage the immune system. It's like revving your car in first gear for too long -- eventually the engine blows out.

He said this may be why developing a vaccine has proven so tricky. "Most vaccines prime the adaptive response to recognize the invader, but it's hard for this to work if the virus triggers other mechanisms that weaken the adaptive response."

HIV takes its membrane from the cell that it infects, the researchers explained in their study. This membrane contains cholesterol, which helps keep it fluid and enables it to interact with particular types of cell.

Normally, a subset of immune cells called plasmacytoid dendritic cells (pDCs) recognize HIV quickly and react by producing signaling molecules called interferons. These signals activate various processes which are initially helpful, but which damage the immune system if switched on for too long.

Working with scientists Johns Hopkins University, the University of Milan and Innsbruck University, Boasso's team found that if cholesterol is removed from HIV's envelope, it can no longer activate pDCs. As a result, T cells, which orchestrate the adaptive response, can fight the virus more effectively.

(May 18, 2011) A five-year study made by researchers at John Jay College of Criminal Justice in New York City seeking to understand why Roman Catholic priests in such great numbers abused boys (mostly). Why did the priests abuse the boys?  Because they could. Why was it mostly boys?  Because that’s who was there.  What the bishop’s have learnt is closer to saying that the treatment of these boys reflects the careless and opportunistic behaviour of priests.  It is very important that boys infected with HIV by their abusers are provided with appropriate healthcare, so they may live and recover from their trauma.

(May 15, 2011) In what is being hailed as a breakthrough in HIV prevention, a new study has shown that giving antiretroviral drugs to HIV-positive people can reduce transmission of the virus by 96%. The results announced by the National Institute of Allergy and Infectious Diseases shows that not only does early treatment of HIV infections benefit the patient's health, but also "there is clearly a benefit of a profound decrease in the probability of transmission to his/her partner," said Dr. Anthony S. Fauci, the institute's director.

Yet, the cost of Gilead’s Atripla and other high-priced AIDS drugs are putting an unbearable strain on cash-strapped programs that are the last resort for thousands of people with AIDS who cannot afford their medications. As of April 2011, over 7,700 Americans are on waiting lists to receive these medications. These patients now face a potentially fatal interruption in their treatment. The AIDS Healthcare Foundation is calling on CEO John Martin to do the right thing and immediately lower drug prices.

It is important to acknowledge here that an estimated one million homeless people in the USA, and a further ten million around the world, are infected with HIV. It is inappropriate to wish for these human beings, including far too many male-children harnessed to sexwork, quietly die in the shadows of our communities. We are deeply saddened  each week, listening to voices that seek to challenge the reality of these male-children's lives.

They exist.

Show Me Your Life - Sexwork

http://TIM@SHOWMEYOURLIFE.ORG

Circumcision may not curb gay HIV transmission (Tue Dec 7, 2010): (Reuters Health) - While circumcision has been shown to lower a man’s risk of contracting HIV through heterosexual sex, a new study indicates that the value of circumcision for gay and bisexual men remains questionable.

In a study of more than 1,800 men from the U.S. and Peru, researchers found that overall, the risk of contracting HIV over 18 months did not significantly differ between circumcised and uncircumcised men.

Over the study period, 5 percent of the 1,365 uncircumcised men became HIV-positive, as did 4 percent of the 457 circumcised men, according to findings published in the journal AIDS.

All of the men in the study reported having sex with other men and were considered to be at increased risk of HIV infection because they were already infected with the genital herpes virus (herpes simplex type 2), which can make people more susceptible to HIV.

Male circumcision is far more common in the U.S. than in most other countries, and 82 percent of the 462 American men in the study were circumcised, compared with just 6 percent of the 1,360 Peruvian men.

The researchers did find some hints that circumcision could be protective among men who primarily had insertive sex with other men. Among men who said they’d had insertive sex with their last three male partners at least 60 percent of the time, circumcision was linked to a 69 percent lower HIV risk.

That difference, however, was not statistically significant, which means the finding could be due to chance.

Taken together, the results “indicate no overall protective benefit from male circumcision” when it comes to male-to-male HIV transmission, write the researchers, led by Dr. Jorge Sanchez of the research organization Impacta Peru, in Lima.

They add that studies should continue to look at whether circumcision affects HIV risk from insertive sex and do so in larger, more diverse study groups.

In general, the researchers write, public-health messages for gay and bisexual men should “reinforce the importance of condom use for HIV prevention.”

The findings may help inform debate over whether circumcision could stand as a weapon against HIV transmission among men who have sex with men.

In 2005 and 2006, three clinical trials in Uganda, South Africa and Kenya showed that circumcision can reduce a man’s risk of HIV infection through heterosexual sex by up to 60 percent.

The World Health Organization now recommends medically supervised circumcision as one way to lower men’s risk of HIV in countries where heterosexual transmission is common.

But the public-health value of circumcision in other countries, including the U.S., is a contentious issue. Most HIV infections in the U.S. are related to homosexual sex or IV drug use and studies have yet to find strong evidence that circumcision lowers HIV transmission among men who have sex with men.

Circumcision is thought to lower the heterosexual transmission of HIV and other sexually transmitted diseases through several mechanisms. One is by reducing the amount of mucosal tissue exposed during sex, which limits the viruses’ access to the body cells they target. Another theory is that the thickened skin that forms around the circumcision scar helps block the viruses’ entry.

One reason circumcision might have little effect on homosexual HIV transmission is that it would have no impact on the risk from receptive anal sex. Experts have also pointed out that in wealthier countries, many HIV-positive people are on powerful anti-viral drugs that reduce the risk of transmission, and any added effect of circumcision might be small.

Currently, the American Academy of Pediatrics does not recommend routine circumcision for newborns, citing insufficient evidence of overall health benefits. The U.S. Centers for Disease Control and Prevention, meanwhile, is in the process of developing recommendations on adult and infant circumcision for lowering HIV risk.
 

Another ill-contrived circumcision study by Timothy Kincaid (December 8th, 2010):  Should there be any researchers reading, let me give you a bit of advice: gay sex and straight sex are not identical. While most heterosexual men do not have penises inserted into their anuses with regularity, this is not an uncommon part of the sexual practices of many gay men.

And further, the easiest way that a gay guy can become infected with HIV is through anally receptive unprotected sex. That isn’t new, surprising, or even contested.

Yep, HIV transmission among gay men in the US is primarily due to taking it bare up the butt. And any research which seeks to understand factors contributing to HIV transmission which does not consider that simple fact is a complete waste of money and time.

And today we get word of yet another Wasted Money Study on whether circumcision impacts HIV transmission between gay men.

Reuters:

In a study of more than 1,800 men from the U.S. and Peru, researchers found that overall, the risk of contracting HIV over 18 months did not significantly differ between circumcised and uncircumcised men.

Over the study period, 5 percent of the 1,365 uncircumcised men became HIV-positive, as did 4 percent of the 457 circumcised men, according to findings published in the journal AIDS.

Well, gee, that information would be useful to know… if the study wasn’t conducted in a mind-numbingly stupid way.

Because, you see, that study doesn’t take into consideration whether the men were engaging in receptive or penetrative anal sex. I just assumes that gay men pass HIV to other gay men in some unknown and mysterious manner. Maybe by osmosis.

Well guess what? It really doesn’t matter one iota whether a bottom’s penis is circumcised, pierced, tattooed, or wearing a funny hat if he has semen up his butt. And any study that focuses only on whether a penis is circumcised – but not what you’re doing with it – is going to provide useless information.

I will give this study partial credit for even wondering, as a side note, whether circumcision impacts the transmission of guys who are using their penises in penetrative anal sex. And while they couldn’t bother to craft a study that looked at that issue, they did at least ask. Kinda.

And guess what?

The researchers did find some hints that circumcision could be protective among men who primarily had insertive sex with other men. Among men who said they’d had insertive sex with their last three male partners at least 60 percent of the time, circumcision was linked to a 69 percent lower HIV risk.

That difference, however, was not statistically significant, which means the finding could be due to chance.

But the truly stupid aspects of this Wasted Money Study isn’t limited to having no concept whatsoever about how HIV is transmitted.

It also made these glaring errors:

Male circumcision is far more common in the U.S. than in most other countries, and 82 percent of the 462 American men in the study were circumcised, compared with just 6 percent of the 1,360 Peruvian men.

D’ya think that this may be a material difference in populations? That perhaps there are differences between the cultures, practices, or even extent of HIV exposure between the two countries?

All of the men in the study reported having sex with other men and were considered to be at increased risk of HIV infection because they were already infected with the genital herpes virus (herpes simplex type 2), which can make people more susceptible to HIV.

So we’re talking about men who potentially have open sores… which are known to be ways in which HIV enters the body… but all that can be ignored to discuss the results of circumcision.

None of which discouraged declarations based on the results of the “study.”

Taken together, the results “indicate no overall protective benefit from male circumcision” when it comes to male-to-male HIV transmission, write the researchers, led by Dr. Jorge Sanchez of the research organization Impacta Peru, in Lima.

No, Dr. Sanchez, taken together the results indicate an incredibly stupid study which tells us absolutely nothing whatsoever about circumcision and HIV transmission and was a complete waste of time and money. I really hope that my tax dollars did not fund your folly.

We don’t really need studies that inform us that anally receptive men don’t reduce their HIV risk by becoming circumcised. They also aren’t benefited by having flocked wall-paper or a charming haircut.

But I, for one, would be interested in a study that looked at whether HIV transmission could be reduced by means of circumcision among anally penetrative men. That question has not been answered (this Wasted Money Study, notwithstanding) and it would be beneficial to know whether circumcision is a risk mitigator among this subset of gay men, and to what extent.

And, I guess they did add that recommendation to their nonsensical reporting of their results.

They add that studies should continue to look at whether circumcision affects HIV risk from insertive sex and do so in larger, more diverse study groups.
 

More gay and bisexual teens expelled and jailed By Alison McCook (NEW YORK | Mon Dec 6, 2010): (Reuters Health) - Many teens act out, but those with a history of homosexual feelings or relationships are more likely to be punished for it, a new study finds.

“We’re seeing that lesbian, gay, and bisexual youth are more likely to be expelled from school, or stopped by the police or whatever sanction we’re looking at,” researcher Kathryn Himmelstein told Reuters Health.

Specifically, they found that when all teens committed the same amount of bad behavior, those with a history of homosexual feelings or relationships were between 30 and 50 percent more likely to be stopped by the police, 40 percent more likely to be convicted of a crime as adults and more likely to be expelled from school.

Teens who self-identified as lesbian, gay or bisexual were also more likely to be arrested and convicted of a crime as juveniles.

“Lesbian, gay and bisexual youth are being singled out for punishment and there needs to be intentional steps taken to address this disparity,” Himmelstein said in an interview. For instance, adults who mete out punishments should receive training in the needs and challenges of non-heterosexual youth, she suggested. “It may not even be intentional on the part of the people making these decisions.”

Meanwhile, parents of these teenagers can try to minimize the bias by sticking up for their children, Himmelstein noted. “To the best of their ability, parents can be advocates for their children with other adults,” including school administrators, police and judges.

The teenage years can be tough for people who have homosexual feelings or relationships. Previous research has found that one-quarter of these teenagers leave home because of their sexual orientation and even more suffer family violence or are harassed by their peers.

As a result, many experience depression, commit suicide or become homeless. They are also more likely to carry weapons and engage in petty crimes, presumably for survival on the streets.

To investigate how lesbian, gay and bisexual young people are treated when they get in trouble, Himmelstein and her co-author Dr. Hannah Brückner of Yale University reviewed data collected from more than 15,000 teens in grades 7 through 12 during the 1994-1995 school year. The interviews were conducted in teens’ homes, during which they could answer sensitive questions about sexuality and bad behavior anonymously, by entering their responses into a computer. Seven years later, participants were re-contacted and asked about their behaviors and punishments as adults.

Brückner and Himmelstein, now based at the New York City Department of Education, measured non-heterosexuality by including teens who said they had either experienced same-sex attraction, had a same-sex relationship or identified themselves as lesbian, gay or bisexual.

Most participants said they’d engaged in some type of bad behavior — three-quarters admitted to minor transgressions, such as running away, graffiti or shoplifting. Thirty percent said they’d committed more serious acts, such as selling drugs or stealing. More than 40 percent admitted to violent behavior, such as fighting or hurting someone.

The result of this bad behavior differed between the groups, however. Reporting in the journal Pediatrics, the authors found that nearly 10 percent of participants who said they’d been attracted to someone of the same sex had been expelled from school, versus 7 percent of those with only heterosexual feelings. Twenty-six percent of participants who’d had a same-sex relationship said they’d been stopped by the police, but only 21 percent of those with no history of same-sex relationships said the same.

When the researchers used statistical tools to equalize the rates of bad behavior among heterosexual and non-heterosexual teens, they found that those with homosexual feelings or relationships were significantly more likely to be punished for their behavior.

Why non-heterosexual young people are being singled out, however, is unclear, Himmelstein noted. “We just showed these disparities exist.”

“I wish I could say that their results are surprising but unfortunately they are not,” Dr. Karine Igartua, co-founder and co-medical director of the McGill University Sexual Identity Centre, told Reuters Health. Anti-homosexual bias can occur anywhere, she noted, such as in the police officer who lets go a teenaged boy and girl for making out in a park, but charges two teenaged boys with public indecency. But she agreed that often, authority figures aren’t being consciously biased.

“Authority figures ill-at-ease with homosexuality may feel that the non-exclusively heterosexual youth’s transgression may be more indicative of the youth being ‘out of control’ since they consider that his/her sexuality is also a transgression,” Igartua said in an e-mail. “In this case, they may feel that more sanctions are needed to attempt to steer the youth ‘back’ to more ‘normal’ behaviors.”
 

Neurological Problems Common Despite HIV Treatment

Antiretroviral (ARV) therapy does not appear to prevent the development of mild neuropsychological impairment, at least in people who waited to start ARVs until their CD4s dropped below 200. These data, published December 7 in Neurology, appear to contradict other recent studies showing a neurological benefit from ARVs.

At one time, up to 15 percent of people with HIV went on to develop severe HIV-associated dementia. While the rate of dementia has fallen below 2 percent in more recent years, studies also suggest that at least 50 percent of people living with HIV still experience some degree of mild neurological impairment. Generally, the impairment is so mild that specialized testing is necessary to uncover it. Though this impairment appears to progress only slowly, if at all, it is unknown whether it could ultimately result in higher rates and earlier onset of age-related dementia.

To further add to this growing knowledge of neuropsychological (NP) deficits in people with HIV, Robert Heaton, PhD, from the University of California in San Diego, and his colleagues with the CNS HIV Antiretroviral Therapy Effects Research (CHARTER) study, conducted an analysis of the cohort’s participants. More than 1,500 HIV-positive men and women are enrolled in CHARTER and being followed over time to determine the frequency and causes of HIV-associated neurocognitive disorders (HAND) and other neurological disorders that occur in people with HIV.

Most of the participants are taking ARVs. About 56 percent of those on ARVs have undetectable virus levels in the blood, and 84 percent have undetectable viral loads in the central nervous system (CNS). Complicating factors are common, with a significant percentage of the participants having a history of depression, substance abuse or both.

Previous reports on CHARTER indicate that about half of the participants have mild to moderate neuropsychological impairment. In the current study, Heaton and his colleagues analyzed how much a variety of factors—including ARV use, lowest ever CD4 count (nadir) and viral load—influenced the likelihood of a person having NP impairments.

Heaton’s team found that, overall, ARVs did not protect against NP impairment. In fact, people using ARVs were actually more likely to have NP deficits than those not on ARVs—a finding that mirrors those of an AIDS Clinical Trials Group study reported last year. The authors make clear, however, that people taking ARVs are also far more likely to have been living with HIV for longer and to have had more severe disease progression.

In a deeper analysis, the researchers found that two factors were significantly predictive of NP impairment in people who had no other complications (such as depression or substance abuse). These were a CD4 nadir under 200 cells and a detectable viral load.

Heaton and his team acknowledge that the nature of their study, which looked at a single snapshot in time, rather than multiple measures over time, means that their results cannot be broadly interpreted. This study design may also help explain why they did not find that ARV therapy had a protective effect, in contrast to studies that did follow study participants over time.

The authors state, however, that their data do lend weight to a growing consensus that NP impairment may be set in motion quite early in HIV disease, perhaps in the first months or years following infection, and that early treatment—especially before CD4s drop below 200—may be warranted to prevent its development.

“Randomized clinical trials targeting each of these mechanisms are needed to determine what will be the most clinically useful approach to the prevention and treatment of [HIV-associated neurological disorders],” the authors conclude.

(Dec. 14, 2010) Marinol (synthetic THC) Decreases Mortality and Viral Load? by Sean Strub

A study recently found that administration of chronic THC (the active ingredient in marijuana; administered in this study via the prescription product Marinol) decreased mortality, helped retain body mass and reduced viral load in plasma and cerebralspinal fluid (CSF).

Researchers at the Louisiana State University Health Services Center, used a “well established nonhuman primate model of HIV disease”, and reported surprise at their findings, writing that the results were “contrary to what we expected”.  Not quite so surprising to me, and perhaps not to others familiar with the anti-inflammatory effects of marijuana.

I have been fascinated with Marinol, the prescription drug that delivers a synthetic form of THC, since it was introduced in the early 1990s.  It was approved for HIV-related wasting (and chemo-induced nausea) in part as a response to demands for the legalization of medicinal marijuana.  For many people with HIV, myself included, it has been an important part of our ability to regain weight.

But Marinol is expensive and inaccessible to many people with HIV, even though it is preferable to smoking pot, which carries smoking-associated health risks.

Marinol is typically prescribed for daily dosing and the side effects can include a disorienting effect for a few days until one’s body gets accustomed to the drug.  That disorienting effect is remarkably similar to what others would characterize as “getting high”; but more like the slower and extended effect of a pot brownie rather than the more immediate impact of smoking weed. If one takes it daily, the high quickly goes away.  I’ve found it curious that the “abuse” of Marinol involves taking too little of it (which retains the psychotropic effect).

(December 2010) Antiretroviral drugs used in the treatment of HIV infection:  The Citizen/allAfrica.com explores the potential impact a free-trade agreement between the EU and India currently under negotiation could have on patients living with HIV/AIDS in developing countries.  Namely, that provisions within the EU-India trade agreement relating to intellectual property (IP) and data exclusivity will result in a restriction of generic drug production, compromising access to low-cost generic drugs, such as antiretrovirals (ARVs).  "Available records show that 92 percent of people living with HIV on treatment in low- and middle-income countries currently use generic antiretroviral (ARVs), mostly manufactured in India."