This Summer/Autumn 2001 issue of BETA presents some changes intended to facilitate our goal of delivering important HIV treatment information to our readers in a timely fashion.
Bone disorders have emerged as a worrisome complication in persons with HIV infection. Over the past few years there have been increasing reports of osteoporosis (wasting of bone tissue due to bone mineral depletion) and osteopenia (moderate bone mineral depletion) in HIV positive adults and children.
June 2001 marked the twentieth anniversary of the first medical reports of the disease that would later become known as AIDS. On June 5, 1981, the Centers for Disease Control and Prevention (CDC) published a report in its Morbidity and Mortality Weekly Report describing a cluster of cases of Pneumocystis carinii pneumonia (PCP) occurring in five gay men in Los Angeles.
After years of frustration, there is renewed optimism in the vaccine field. Promising research findings combined with new infusions of interest (and money) from private charities and large pharmaceutical companies have recently raised hopes for development of a vaccine against HIV.
The feature articles in this issue of BETA offer a prismatic look at treatment issues that may particularly concern people who have been living with HIV and taking antiretroviral treatments for some time.
Most Americans have no direct contact with the U.S. Food and Drug Administration (FDA), but their lives literally depend on the effectiveness of this agency. Charged with assuring the safety of specific foods and all medicines, the FDA has oversight over a staggering 25% of the U.S. economy.
The past couple of years have seen a marked increase in the use of combinations of highly active antiretroviral therapy (HAART) that contain two protease inhibitors (PIs), usually ritonavir (Norvir) plus another PI. Ritonavir’s function is not primarily to further contain HIV but rather to increase the blood levels of the second PI, decrease pill burden, simplify dosing schedules, and thereby improve drug adherence.
Fatigue can be one of the most debilitating symptoms experienced by people with HIV disease. Fortunately, there are several measures that people experiencing fatigue can take to improve their energy levels and overall quality of life.
In the entire world, sub-Saharan Africa is the region most affected by HIV/AIDS. At the end of 2000, 25.3 million adults and children were living with HIV/AIDS in the region, accounting for 70% of the global total. There were 2.4 million AIDS deaths in sub-Saharan Africa during 2000, representing 80% of global AIDS deaths that year. In 2000, 3.8 million people in the region became infected with HIV, representing about 72% of all new global HIV infections. At the end of 2000, the region’s adult (15–49) HIV/AIDS prevalence rate was 8.8%. Of the region’s HIV positive adults, 55% were women. Over 80% of women worldwide living with HIV/AIDS live in sub-Saharan Africa.
Ross G. Hewitt, MD; Nader Parsa, PhD; and Lawrence Gugino, MD
Recent studies have examined the experience of women and the potential for gender differences with respect to HIV progression and the acceptance, tolerance, adherence, and response regarding highly active antiretroviral therapy (HAART). Differences in CD4 cell count and viral load have not been reported in all studies. For any given CD4 cell count, women may be at a higher risk of HIV progression.
The 8th Annual Retrovirus Conference (also called the Conference on Retroviruses and Opportunistic Infections, or CROI) took place February 4–8, 2001, in Chicago. CROI is regarded as the most important annual conference in the U.S. concerning HIV/AIDS in the areas of clinical and basic sciences. There were 3,446 attendees from 58 countries worldwide (40% from outside the U.S.), including approximately 140 members of the general and community press.
According to the most recent thinking on the history of time, the Winter 2001 issue of BETA is the first issue of the true new millennium. BETA, like the HIV epidemic, spans two millennia-startling but not quite shocking observations. Whatever the case may be, the very name "BETA" is an anachronism, hearkening back to the clinic of the early days of the epidemic.
In 1997 epidemiologists at the World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) estimated conservatively that somewhere in the world a human being is infected with the human immunodeficiency virus (HIV) every ten seconds. WHO and UNAIDS also noted that sexual transmission of HIV accounts for approximately 90% of new HIV cases worldwide. The cumulative total of persons living with HIV and acquired immune deficiency syndrome (AIDS) throughout the world by the end of 2000 was estimated at 36.1 million.
It is generally known that men who have sex with men (MSM) are at increased risk for contracting hepatitis A virus (HAV) and hepatitis B virus (HBV), both of which can be prevented by vaccination. Less widely known is the fact that MSM have high rates of anal cancer, or carcinoma, compared with the general population, and that HIV positive MSM have a substantially greater risk for anal cancer than do HIV negative MSM.
Although some people equate anal cancer with cancer of the colon, the two diseases are distinct and considered to be unrelated. The anus comprises the very end of the large intestine.
NRTIs including ddI, d4T, lodenosine, and adefovir work against HIV by disrupting the function of the virus's reverse transcriptase enzyme, which converts the HIV gene set into a DNA form that inserts itself into human cell genomes. Nucleoside analog drugs are essentially defective versions of natural nucleosides (precursor compounds).
In early February the National Institutes of Health (NIH) updated its guidelines for treating HIV disease. The new guidelines shift emphasis away from the "hit hard, hit early" approach used since 1996, which advocated the use of highly active antiretroviral therapy (HAART) in persons with acute (early) HIV infection, those with symptomatic HIV infection, and asymptomatic persons with fewer than 500 CD4 cells/mm3 and a viral load greater than 10,000 copies/mL.
In a season that will likely see few drug candidates appearing on the market, Abbott Laboratories' lopinavir (more commonly known as ABT-378) may be the next drug to receive approval from the U.S. Food and Drug Administration (FDA).
This section includes selected highlights from two conferences that took place in Toronto last September: the 2nd International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV, held September 13-15, 2000, and the 40th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC), held September 17-20, 2000.
The rate of HIV infection in the United States has increased among women and individuals of color, while decreasing among White men. Women and individuals of color now represent 67% of people newly diagnosed with AIDS, 62% of individuals living with AIDS, and 69% of newly reported diagnoses of HIV infection.
This information is designed to support, not replace, the relationship that exists between you and your doctor.