Posts Tagged ‘hiv treatment’
I was reading over reports from the briefing held just over a week ago by a host of prominent HIV/AIDS organizations including amfAR, the Foundation for AIDS Research; AVAC; HIV Medicine Association; IDSA/HIVMA Center for Global Health Policy; the San Francisco AIDS Foundation; and the Treatment Action Group.
The keynote speaker was Anthony Fauci, MD, director, National Institute of Allergy and Infectious Diseases, National Institutes of Health.
I like to look at the positive first, so let me share a bit about what they found was working for us right now. “More than 30 effective antiretroviral drugs are approved for use in HIV/AIDS, and these have “totally transformed the lives of HIV-infected individuals,” Dr. Fauci said. “We went from a 26-week lifespan to a 40-year-plus life span” for those infected with the virus in the past 15 years.
Of concern is that for every person who started on antiretroviral therapy in 2008, 2 to 3 people were infected with HIV. “We are not winning the game,” he said.
According to Dr. Fauci, we can reach our goal of controlling and ending the HIV/AIDS pandemic by focusing on three areas: scaling up delivery of proven therapies, curing existing infections, and preventing new infections. He feels that our greatest hope is a “functional cure,” in which HIV patients are treated early and aggressively and then go into permanent remission where the virus no longer replicates.
Dr. Fauci went on to say an additional strategy for preventing new infections was “critical” and “eminently feasible.” This strategy includes use of microbicides, male circumcision, blood supply screening, and the use of clean syringes and condoms.
But there have been devastating failures in reaching our goal of creating a vaccine that will prevent infection. “Last year for the first time we had the first signal of a success in a vaccine trial,” Dr. Fauci said. Much more research must still done.
It seems that we remain in the position where individual behavior is our primary weapon for prevention. We can provide the tools that assist with prevention, but they must be used.
As Dr. Fauci says, there may be an impression “that we really have our arms around this and that things are stable and they are not.”
Our science has brought us to the point of creating what can be described now as a chronic disease, but not to the point of curing it or truly preventing it. Stunning successes mixed with devastating failures – very much like a life spent living the battle of HIV.
San Francisco public health doctors are urging patients to begin taking HIV medications soon after their diagnosis rather than waiting until their immune systems become compromised. Reports of this major policy change first surfaced last week in a New York Times article.
These new city guidelines – to be announced next week by the Department of Public Health – may be the most forceful in the world in their strong endorsement of early treatment against HIV. Doctors will offer patients combination therapy and advise them to pursue early treatment, but the patients will ultimately decide whether to begin therapy right after their diagnosis.
Antiretroviral therapy is traditionally used to stall or prevent the progression of HIV to AIDS, and it can also prevent other side effects of a degenerating immune system, like opportunistic infections and cancers. The downside is that ART can also cause liver and kidney damage among other complications.
The issue of when to begin treatment is an often discussed decision that we are asked to make with very little information on when to begin a lifetime regimen of costly and sometimes toxic medications. The answer to when remains in dispute, but San Francisco doctors are opting for treatment before permanent damage is done
Even our nation’s experts are solidly divided on the issue of when to begin treatment. In December of last year, only half of the HIV experts on the 38 member Department of Health and Human Services panel favored starting drugs in patients with healthy levels of more than 500 T-cells.
The issue for doctors and patients is whether the damage caused by HIV is more life threatening than the damage caused by some of the antiretroviral drugs. Doctors just don’t know the answer to that question right now. You can expect a great deal of discussion on that in the coming weeks and months.
We will be exploring treatment options in the next few days on our blog. Please check back for new insights on when to start treatment.
Michael Mooney and Nelson Vergel wrote a great article in the September/October 2009 edition of Postively Aware http://positivelyaware.com/2009/09_05/index.shtml about using exercise to manage the side effects of HIV.
In their research, they found that exercise can improve muscle mass and bone density while decreasing triglycerides and LDL (bad cholesterol). Building back your weight with lean muscles and improving your overall strength make exercise an attractive complement to your HIV therapy.
Starting an exercise program is tough for all of us and they recommend beginning with getting your blood pressure, heart rate, weight, body dimensions, fasting cholesterol, triglycerides, and blood sugar checked. Your doctor should be able to tell you if you are capable of exercising without affecting your health.
The number to remember is 10,000 – as in steps per day. If you are new to exercise, start walking every day and do the best that you can. Walking can help increase energy levels and get your ready for a more intensive exercise program as you are feeling better. Using a cheap pedometer to measure your daily steps is helpful and the number of 10,000 per day supports good cardiovascular health and fat loss.
The article provides a comprehensive guide to getting your workout program off the ground. It is an informative read at http://positivelyaware.com/2009/09_05/exercise.shtml.
Exercise always works best on the buddy system and it a good time to share with friends and family who support you. Beyond the physical benefits, it can improve your overall outlook and help with your quality of life.
Bottomline is that is a choice you make to take back some control. Choose yoga or choose basketball. Exercise can improve strength, fight fatigue and depression, improve endurance, increase cardiovascular fitness, help to reduce stress and promote muscle strength. It may also help the immune system work better.
Last week, scientists at Johns Hopkins University made a startling announcement.
The common and inexpensive antibiotic known as minocycline has been used to treat acne. Researchers found it effectively targets infected immune cells where HIV lies dormant and prevents them from reactivating and replicating.
Minocycline can be used in combination with a standard drug therapy we know as HAART (Highly Active Antiretroviral Therapy), according to this new research published online and appearing in April 15, 2020 edition of The Journal of Infectious Diseases.
“The powerful advantage to using minocycline is that the virus appears less able to develop drug resistance because minocycline targets cellular pathways not viral proteins,” says Janice Clements, Ph.D., Mary Wallace Stanton Professor of Faculty Affairs, vice dean for faculty, and professor of molecular and comparative pathobiology at the Johns Hopkins University School of Medicine in their press release.
She went on to say that the big challenge for doctors is to keep the HIV in a dormant state and minocyline is another arm of the defense against HIV.
To read more about this new breakthrough, please go to http://www.hopkinsmedicine.org/Press_releases/2010/03_18a_10.html.