According to this article, the combination drug Truvada significantly reduces a gay man’s (or a member of other high risk populations) chance of contracting HIV.

A study published this week in the New England Journal of Medicine has found that a daily dose of anti-retroviral drugs in HIV-negative men was very effective in preventing infection of HIV while practicing unprotected sex.

Click here for the New York Times article.

On April 27, China announced that it had lifted a 20-year-old travel ban on foreign visitors with HIV, but the country’s visa application still asks people to disclose their health status.

Section 3.4 of the new Chinese travel visa application asks applicants if they have HIV. Section 3.6 says that if an applicant has noted that they are HIV-positive, they “do not lose eligibility for visa application.”

Asked for clarification, a service representative in the embassy’s Ottawa visa office said applicants only need to check off if they’re HIV positive and to declare if they are currently receiving treatment. The representative said applicants do not need a doctor’s note or proof of the medication they are taking. HIV-positive applicants will be dealt with in the same way as those without HIV, said the service representative.

The country’s decision to lift the ban is based on science, says a statement released by the Chinese State Council. The statement says China realizes the ban doesn’t prevent or control the spread of disease, and that the ban served to create a nuisance when hosting international activities. The announcement came days before the opening of the Shanghai Expo, which has already drawn thousands of foreign visitors and international media attention.

In the past, China temporarily lifted the ban for large-scale international events like the 2008 Beijing Olympic Games, the 1990 Beijing Asian Games and the Fourth World Conference on Women in 1995. This time, the lift is permanent. Until recently, China was one of 60 countries with an HIV travel ban, along with Armenia, Brunei, Iraq, Qatar, Libya, Moldova, Oman, the Russian Federation, Saudi Arabia and Sudan. China follows the United States and South Korea, both of which permanently lifted their bans in January 2010.

On Jan 4, 2010, activist Martin Rooney of Surrey, BC became the first HIV-positive person to legally cross the US border. He says the repeal is a sign of social progress and liberation in China.

“We had thought China was [going to lift the HIV travel ban] before the US,” says Rooney. “That was the information we had last summer. I believe the reason why it happened was because of Shanghai Expo.”

But even though the ban has been repealed, it may take time for the decision to trickle down to local consulates. This is because people working at the embassies and airports need to be educated. Even the very day the US ban was lifted, border security did not know about the changes, says Rooney. He had to show border security an email he received from the White House and it still took them 20 minutes to allow him to pass, he says.

“The country can announce they’re lifting the health ban, but running through the bureaucracy takes time. You have to educate the workers,” says Rooney. “Good luck getting a call back if you’re not from the country. It’s better if you physically go down to the consulate and ask all the questions you need answered.”

Mother-to-child transmission of HIV could be eliminated in five years if the current rate of health investments are at least maintained, officials said Monday.

The Global Fund to fight HIV, malaria and tuberculosis released its annual report ahead of a funding meeting in The Hague on March 24.

“A world where no children are born with HIV is truly possible by 2015,” said Michel Kazatchkine, head of the Global Fund.

“It is also possible now to imagine a world with no more malaria deaths, since already an increasing number of countries have been reporting a reduction in malaria deaths of more than 50 per cent over the past couple of years,” he said.

“No other area of development has seen such a direct and rapid correlation between donor investments and live-saving impact as these investments in fighting AIDS, TB and malaria.”

According to the report, programs supported by the fund saved at least 3,600 lives per day in 2009 and an estimated total of 4.9 million since the fund was created in 2002.

UNAIDS executive director Michel Sidibe and South African Health Minister Aaron Motsoaledi joined Kazatchkine in appealing to governments and private donors to continue investing in the fund.

“Without a fully funded Global Fund, our shared dream of universal access to HIV prevention, treatment care and support could become our worst nightmare — putting the lives of millions of people currently on treatment in jeopardy and millions of pregnant women in a position not able to protect their babies from becoming infected,” Sidibe said in a statement on the UNAIDS website.

By the end of 2009, these funded programs provided antiretroviral treatment to 2.5 million people, including 790,000 pregnant women with HIV, which reduces the chances that babies will be born with the virus.

Treatment was also given to six million people who had active TB, and 104 million insecticide-treated nets were provided to prevent malaria.

The group estimated that between $13 billion to $20 billion US will be needed from 2011 to 2013 to meet its goals of eliminating mother-to-child HIV transmission, eliminating malaria as a public health problem within a decade in most countries where it is endemic, and halving the prevalence of TB by 2015.

Read more: http://www.cbc.ca/health/story/2010/03/08/hiv-global-fund-un.html#ixzz0iG4Houjk

The combination of two anti-HIV drugs may lead to dangerous heart rhythm abnormalities, the FDA said.

The agency said it has preliminary data suggesting that adverse heart effects can be caused by saquinavir (Invirase) combined with ritonavir (Norvir) and is reviewing the information.

Both drugs are protease inhibitors, but ritonavir is mainly used as a booster of other drugs in the class, rather than as therapy on its own.

Saquinavir, on the other hand, is never used without the booster, since unboosted saquinavir is not as effective as other drugs in suppressing HIV replication.

The FDA said the combination may cause prolongation of the QT and PR intervals on an electrocardiogram, leading to torsades de pointes or heart block, respectively.

In either case, the agency noted, patients may experience lightheadedness, fainting, or abnormal heart beats. In some cases, torsades de pointes may progress to ventricular fibrillation, which can be life-threatening.

The preliminary data show that in healthy patients ages 18 to 55, 1,000 milligrams of saquinavir (boosted with 100 milligrams of ritonavir) led to a dose-dependent prolongation of the QT and PR intervals. The magnitude of the effect and the clinical implications are still being investigated, the agency said.

The combination should not be used in patients already taking medications known to cause QT interval prolongation, such as Class IA or Class III antiarrhythmic drugs, the FDA said.

Not should it be used in patients with a history of QT interval prolongation, preexisting conduction system disease, ischemic heart disease, cardiomyopathy, or underlying structural heart disease, the agency said.

The FDA said patients using the combination should talk to their doctors about the issue. Side effects should be reported to FDA’s MedWatch program.

Saquinavir was approved in 1995, but other protease inhibitors are more convenient to take, because they come in fewer pills. There is also wider clinical experience with many other drugs. On the other hand, the drug is less expensive than many other protease inhibitors and until now has had a good reputation in terms of adverse events.

One expert said the finding could raise questions about other drugs in the class.

Saquinavir is marketed by Genentech of San Francisco, a subsidiary of the Roche Group, while ritonavir is sold by Abbott Laboratories of Abbott Park, Ill.

By Michael Smith, North American Correspondent, MedPage Today
Reviewed by
February 23, 2010

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Gardasil, a vaccine against human papilloma virus (HPV), has been approved as a treatment to prevent genital warts in males aged nine to 26 in Canada, the vaccine’s manufacturer said Tuesday.Health Canada approved Gardasil to prevent infection caused by human papilloma virus Types six, 11, 16, and 18 and genital warts caused by HPV types six and 11.

HPV is the most common sexually transmitted infection in Canada, said Merck, the vaccine’s manufacturer.

In 2006, Health Canada approved Gardasil to prevent cervical cancer and genital warts in females aged nine to 26. All provinces and territories now offer school-based programs using Gardasil, which works best if given to females before they become sexually active.

Two weeks ago, GlaxoSmithKline announced that Health Canada has approved its HPV vaccine, Cervarix, in girls and women. Cervarix protects against three other cancer-causing strains, HPV 31, 33 and 45.

In most people who develop genital warts, the infection clears up on its own. For some women, the infection persists and can lead to cervical cancer.

A study published last year in the Journal of the American Medical Association concluded that Gardasil in females has a safety record on par with other vaccines.

In January, researchers in Montreal published a study in the journal Sexually Transmitted Diseases showing 56 per cent of young people in a new sexual relationship were infected with at least one type of HPV.

The federal government announced in its March 2007 budget that $300 million over three years will be available to the provinces and territories in support of a national HPV vaccination program for girls and women.

It is up to provinces and territories to recommend vaccines for use within their jurisdiction. Doctors may also prescribe any approved vaccine.

An estimated 40,000 new cases of ano-genital warts are diagnosed each year in Canadian men and women.

Read more: http://www.cbc.ca/health/story/2010/02/23/hpv-gardasil-males.html#ixzz0gYjJ4K1s

From the Associated Press – January 6, 2010

(Foster City, Calif.) Gilead Sciences Inc. said Wednesday its experimental four-drug HIV regimen is working as well as its current drug cocktail in a mid-stage clinical trial.

Gilead said the regimen of two experimental drugs called elvitegravir and GS 9350, as well as the combination drug Truvada, is meeting its main goal in the study. The combination was about as effective at reducing virus levels as Gilead’s drug Atripla, which contains three medications.

The trial is scheduled to last 48 weeks, and Gilead said the “Quad” regimen met its goal at 24 weeks of treatment. The drugs are being tested on 71 people with HIV who have not taken another anti-retroviral treatment.

Elvitegravir is an integrase inhibitor, meaning it blocks the enzyme integrase, which the is one of the types of enzymes the AIDS virus uses to reproduce and infect cells. GS 9350 is designed to boost blood levels of medicines like elvitegravir.

Truvada made up of emtricitabine and tenofovir, and Atripla consists of those two drugs plus a third, efavirenz. Those drugs have already been approved by the Food and Drug Administration.

Gilead said full results from the study will be submitted for presentation at a scientific meeting in the next few months.

The 2010 Atlantic Regional Conference from CATIE (Canadian AIDS Treatment Information Exchange) is coming to Charlottetown between August 2-4, 2010.  The conference will follow the International AIDS Conference in Vienna Austria, happening in July.

AIDS PEI is excited to co-host the 2nd annual conference, co-hosted in Truro, NS by the Northern AIDS Connection Society in 2009. “AIDS PEI and our staff and volunteers are excited to be involved in the co-hosting of this amazing regional conference which brings together our atlantic network of AIDS service organizations, specialists, researchers and people living with HIV/AIDS to expand capacity building in the region.”

Details on the conference to follow.

Michael Carter, Wednesday, August 05, 2009

Dutch investigators have found further evidence of the continuing epidemic of hepatitis C amongst HIV-positive gay men. In an article in the July 31st edition of AIDS researchers in Amsterdam report an 18% prevalence of hepatitis C co-infections amongst HIV-infected men attending a sexual health clinic and a high incidence of new infections with the virus.

Use of the recreational drug GHB and anal-brachial sex (fisting) were risk factors for infection with hepatitis C. However, there was no evidence of a hepatitis C epidemic amongst HIV-negative gay men. Preliminary findings of the study were presented to the International AIDS Conference in 2008.

Since 2000, outbreaks of sexually transmitted hepatitis C have been reported amongst HIV-positive gay men across Europe as well as in New York. One city with a notable epidemic is Amsterdam.

Investigators wished to obtain a better understanding of the prevalence of the infection and the risk factors for its acquisition.

They therefore performed a cross-sectional study involving 689 gay men who attended a sexual health clinic in the city between 2007 and 2008. Individuals were tested for both HIV and hepatitis C and interviewed about their sexual and drug using behaviours. Phylogenetic analysis was also performed comparing the strains of hepatitis C detected in the men in the study to those circulating in HIV-positive gay men in Amsterdam between 2000 and 2007.

Only two of the 532 HIV-negative men attending the clinic were infected with hepatitis C, a prevalence of below 0.5%. One of these men reported a history of injecting drug use. However, 28 of the 157 HIV-positive men were co-infected with hepatitis C, a prevalence of 18%.

In 2007, prevalence of the infection amongst HIV-positive men was 15%, but this increased to 21% by the end of the study in 2008. Of the 28 HIV-positive gay men diagnosed with the co-infection during the study, seven (25%) had recently acquired the infection.

The investigators’ first statistical analysis showed that infection with HIV, a greater number of life-time sexual partners, a history of sexually transmitted infections, unprotected anal intercourse, fisting, use of the drug GHB and a history of injecting drug use were all significantly associated with an increased risk of hepatitis C infection.

However, subsequent analysis restricted to HIV-positive men found that only three of these factors were significant: injecting drug use (adjusted odds ratio [AOR]: 13.4; 95% CI, 1.56-115.7), fisting (AOR: 10.6; 95% CI, 2.78-40.7), and the use of GHB (AOR: 4.6; 95% CI, 1.62-13.0).

Phylogenetic analysis revealed transmission clusters, with most of the new infections detected by the investigators located in a single cluster.

“We found a high and increasing hepatitis C virus prevalence in HIV-infected men who have sex with men attending the Amsterdam STI clinic”, comment the investigators, who add “the relatively large proportion of acute infections strongly indicate a rapid and recent spread of hepatitis C virus among high-risk HIV-positive men who have sex with men.”

Regarding the risk factors for hepatitis C infection, the investigators suggest “the practice of rough sexual techniques such as fisting, group sex and the sharing of sex toys might facilitate blood-to-blood contact by damaging the mucosal barrier.”

A third of the men were unaware of their hepatitis C infection. Therefore all HIV-positive men are now offered hepatitis C testing at the clinic.

The investigators conclude, “targeted preventions like raising awareness and internationally widespread routine testing are needed to minimize further spread among HIV-infected men who have sex with men, and spill-over into HIV negative men who have sex with men.”

Reference
Urbanus AT et al. Hepatitis C virus infections among HIV-infected men who have sex with men: an expanding epidemic. AIDS 23: F1-F7, 2009.