HIV Infected People Are Living For Years

Posted on April 16, 2018

HIV-infected people are living for years, but age-related diseases set in early

A woman receives an HIV/AIDS blood test on World AIDS Day last December. (Efrem Lukatsky/AP)
 April 14

David Hardy has been treating HIV-infected patients since the early 1980s, when the epidemic began. In those days, people newly diagnosed with AIDS lived for only about six months. Hardy, an infectious-disease specialist and internist, was ecstatic when powerful new drug combinations came into widespread use in 1996, enabling HIV-infected people to measure their lives in decades rather than months. But in recent years, his euphoria has turned bittersweet.

“Most people assume that the medicines have worked and that everything has gone back to normal, and that’s not really true,” says Hardy, who directs research for Whitman-Walker Health in Washington and who still sees patients weekly. “While we have suppressed HIV very well, we’ve now discovered that the medicines only treat part of the problem.”

Many HIV-infected people, now in their 50s and 60s, who have lived for years with HIV under control, are developing aging-related conditions — heart, liver and kidney disease, certain cancers and frailty, for example — at a rate significantly higher than uninfected people of the same age. “These are things that people develop all the time as they get old, but they are occurring at an earlier age in HIV-positive people,” Hardy says.

“The first goal was to save someone from dying of HIV infection,” agrees Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID) and a leading researcher involved in developing the AIDS drug combinations. “After we started successful therapy that suppressed the virus and extended lives, we began to notice that people were getting diseases associated with aging sooner than their chronological age would indicate they should be getting them.”

An aging HIV population

In 2014, an estimated 45 percent of Americans living with HIV were older than 50, amounting to 428,724 people, according to the Centers for Disease Control and Prevention, while 27 percent were older than 55 and 6 percent were 65 and older. These include people diagnosed a decade or more before life-prolonging drugs became available, as well as older Americans diagnosed with late-stage AIDS who did not begin HIV drug therapy until then.

Experts believe this timing — the point at which someone starts therapy after infection — is key to understanding what is happening now. It involves how the body’s immune system behaves following infection with HIV.

“If you are in your 50s today and you were infected when you were 20, you had about 10 years of living without therapy before the drugs came along and helped you survive,” says Carl Dieffenbach, director of NIAID’s AIDS division. In this group, and in older people diagnosed with late-stage AIDS, the period without treatment “led to a tremendous amount of damage to their immune system.”

HIV not only damages the immune system, it also turns on that system indefinitely, meaning the immune response triggered by HIV never really shuts down, even once drugs have begun to quell the virus. “With most infectious invaders, the immune system responds and then is supposed to rest, like a fire engine waiting to come out when there is a fire to be fought,” Dieffenbach says. “With HIV, those firetrucks keep driving around looking for fires, even when there are none.”

Fauci agrees. “It isn’t only the [initial] immune response against HIV,” he says. “It’s a global turning-on of the immune system — and the longer you wait to take drugs, the more robust the immune activation.”

Many AIDS researchers believe that this “immune activation” is the primary mechanism underlying the accelerated rate of age-related diseases. HIV-infected patients must take multiple medications daily, some with side effects, but experts believe the AIDS drugs aren’t a major contributor to these conditions. “It’s much less the drugs; it’s the immune activation,” Fauci says.

Medications don’t cure

HIV medications control HIV, but they don’t cure it. The virus persists in numerous reservoirs in the body, including the lymph nodes, which prompt immune activation as well as chronic inflammation. “Inflammation and immune activation accelerate heart disease and stroke, and chronic HIV infection results in both,” says Robert T. Schooley, a longtime AIDS researcher and professor of medicine in the infectious-diseases division at the University of California at San Diego. “One can calculate a given patient’s risk for stroke or heart attack based on how elevated laboratory markers of inflammation are.”

Several studies have shown the heightened risk of cardiovascular disease among those with HIV. They have a 50 percent higher risk of heart attack compared with noninfected controls, and a more than fourfold higher rate of sudden cardiac death compared with the general population. They also are in greater danger from complications associated with heart failure.

Certain cancers are increasing among them as well. Early in the epidemic, some cancers — Kaposi’s sarcoma, non-Hodgkin’s lymphoma and invasive cervical cancer, for example — often developed in HIV-infected individuals, signaling the onset of full-scale AIDS. These “AIDS-defining” cancers initially decreased with the introduction of anti-HIV drugs and have remained relatively steady during the past two decades. However, the burden of non-AIDS-defining cancers — anal cancer, lung cancer, Hodgkin’s lymphoma, liver cancer and head and neck cancers, among others — has grown during that period. Many of these are caused by viruses other than HIV.

(These include hepatitis B and C viruses and liver cancer; human papillomavirus and head, neck and anal cancers; and Epstein Barr virus and Hodgkin’s lymphoma.)

Experts believe these arise in HIV-infected people predominantly because their impaired immune systems can’t effectively fight the viruses responsible. Lung cancer is an exception because it is not caused by a virus. But many HIV-infected people smoke, and also suffer lung infections and other assaults.

These cancers account for a growing number of cancer-related deaths among the HIV population. “As people are dying less often of AIDS and opportunistic infections, cancer is becoming one of the most common causes of death in people with HIV,” says Robert Yarchoan, chief of the National Cancer Institute’s HIV and AIDS malignancy branch. “Also, the incidence of most cancers increases as people age, and HIV-infected people are becoming more susceptible, just like the rest of us.”

One ongoing study has shown that patients who start AIDS antiretroviral drug therapy early generally fare better than those who wait, including significantly reducing their chances of developing full-scale AIDS. But even a brief period between infection and the onset of therapy can harm the immune system and cause problems, experts say.

Leaky gut

“Very shortly after someone is infected, the lymphatic system in the gastrointestinal tract undergoes a major transformation” known as microbial translocation, often called “leaky gut,” a condition where microbes from the GI tract escape and enter the bloodstream, according to Amy Justice, a professor of medicine at Yale University who studies HIV among veterans. “It happens quickly after infection, and we’re not very good at preventing it. Even when we treat them [with anti-HIV drugs] early, they still have more microbial translocation than people who don’t have HIV — and it feeds the chronic inflammation.”

Moreover, drinking alcohol exacerbates leaky gut, “so drinking when you have HIV is not a good thing,” she says.

In fact, drinking, smoking, recreational drug use and obesity — a common side effect of antiretroviral therapy — also probably contribute to the medical problems of HIV patients, experts say. “The challenge is to try to get them to change ingrained health behaviors at midlife,” Justice says. “This is hard for anyone, with or without HIV, but probably more important if you’ve got HIV.”

While the risk of developing age-related conditions “is substantially increased” for people with HIV, the situation isn’t necessarily all grim, Justice says. “Not everyone is miserable and sick,” Justice says. “Many are doing incredibly well. A lot is in their control, if they can change their health behaviors.”

The NIAID’s Dieffenbach agrees. “Everybody has his or her own set of risk factors, and what HIV infection tends to do is magnify your lifestyle choices, or your genetics,” he says. “What we are grappling with now is defining this. Aging occurs, and with it the risk of getting one or more of these diseases. What is it about HIV that hastens the process? Can we do anything about it? Those are the things we are trying very hard to address.”

health-science@washpost.com

Eliminating Mother-To-Child Transmission of HIV In the U.S. Is Possible, Study

Posted on December 29, 2016

By: Alex Kopel

From HIVEqual.org

March 27th, 2017

The U.S. has made huge gains in the last few decades in reducing mother-to-child transmission (MTCT) of HIV, according to a new study published in Jama Pediatrics. Scientists found that only 69 babies were born with the virus in the U.S. in 2013 compared to 216 in 2012.

A late HIV diagnosis for expectant mothers, a lack of antiretroviral medication, and other missed opportunities for preventive measures are all factors that can lead to MTCT of HIV. Thus, due to an increasing rate of HIV testing among women, there has been a dramatic drop in the rates of transmission.

While only 38 percent of mothers knew of their HIV status before pregnancy in the years from 2002-2005, this figure increased to 50 percent of women knowing their status in the years from 2010-2013.

Prospective mothers knowing their status is the most critical step in reducing transmission, which is why many doctors feel that an HIV test should be mandatory and highly encouraged in the first trimester of pregnancy. Once expectant mothers know their status, they can then start antiretroviral therapy (ART). Pregnant woman adhering to treatment only have a 1-2 percent chance of passing HIV on to their babies.

Even expectant mothers who aren’t diagnosed with HIV until their third trimester, can still reduce the risk of MTCT by beginning late treatment. And even during labor it is still possible to avoid MTCT by giving an HIV-positive mother medication and IV drug treatment to protect the baby from exposure during delivery.

“We have made great strides in decreasing HIV in mother-to-child transmission in the USA,” said Dr. David Rosenthal, the director of the Center for Young Adult, Adolescent and Pediatric HIV in New York. “In New York State alone in the 1990s we had more than 500 new cases of mother-to-child transmission a year, but now in 2015-2016 we had an 18-month period with zero new mother-to-child transmissions.”

About 150,000 babies are diagnosed with HIV each year from around the world, down from a peak of more than 600,000 per year in the 1990s.

“The idea of eliminating mother-to-child transmission of HIV is officially on the table,” said Dr. Deborah Cohan, the director of the Perinatal HIV Clinic at the University of California, San Francisco.

Yet while the U.S. as a whole made great strides in reducing mother-to-child transmissions, there were specific demographics that did not fare as well as the general population. Even though African-Americans compose only 17 percent of the general population, about 66 percent of babies born with HIV belonged to African-American women, between the years 2002 to 2013, according to the study.

More than 80 percent of MTCT during this time period were from Latina and African-American mothers, which underscores the high rate of HIV prevalence among these populations. Now that we have the scientific tools, the only reason that MTCT continues to exist has to do with access. There must be more testing and treatment facilities for these key populations, according to the authors of the study.

Additionally, five Southern states in particular, Florida, Texas, Georgia, Louisiana and Maryland, took the brunt of the MTCT cases, accounting for 38 percent of the new cases of HIV in the U.S. from 2012 to 2013.

The stigma of HIV can still lead to otherwise avoidable MTCT. Doctors often fail to suggest an HIV test for pregnant mothers because they do not want to offend a mother, or they assume that the mother is not at risk. Similarly, many prospective mothers believe that HIV is “something that happens to other kinds of people.” These types of stereotypes lead them to believe that they don’t need to be tested. It’s easy to forget that anyone from any background can get HIV.

Completely reducing mother-to-child transmissions is crucial for ending the HIV epidemic and now, thanks to advancements in medicine, they are entirely avoidable. Antiretroviral treatment (ART) taken by the mother during pregnancy and ART for the infant six weeks after birth are enough to ensure that all children are born HIV-free.

“Together, these methods are incredibly effective in decreasing mother-to-child transmission,” Rosenthal said. “In order to make this happen, we have to help ensure mothers receive good medical care early in their pregnancy, and we need to ensure that mothers of all races and ethnicities receive the same outstanding medical care we offer.”

Almost Half Regain Ability to Work Within 1 Year of Starting Treatment

Posted on May 11, 2016

By Mark Mascolini
From TheBodyPRO.com

April 18, 2016

One year after starting antiretroviral therapy (ART), 46% of HIV-positive people initially judged unable to work regained the ability to work full- or part-time, according to a 5800-person analysis of the Swiss HIV Cohort Study (SHCS). The proportion of people who regained the ability to work almost doubled from 1998-2001 to 2009-2012.

The newest antiretroviral combinations have increased the life expectancy of some HIV-infected groups to near-normal spans. But the impact of more robust health on ability to rejoin the work force remains poorly understood. To address that question, SHCS investigators conducted this prospective analysis of cohort members less than 60 years old who started ART from January 1998 through December 2012.

The researchers defined inability to work as “a medical judgment of the patient’s ability to work as 0%,” independent of the patient’s opinion or current employment status. Partial ability to work meant a medical judgment that the patient had 1% to 99% ability to work part-time. Full work ability meant a medical judgment that the patient had 100% ability to work full time. The primary endpoint was the proportion of people unable to work at baseline who recovered the ability to work after one year of ART.

Of the 5800 study participants, 4382 (75.6%) had full ability to work at the baseline pre-ART visit, 471 (8.1%) had the ability to work part-time and 947 (16.3%) had no ability to work. Median age was slightly but significantly lower in people with 100% ability to work than in those with ability to work part-time and those unable to work (37 versus 38 versus 39 years, P < .001). The group fully able to work included a higher proportion of men than the groups partly able or fully unable to work (73.1% versus 62.2% versus 65.3%, P < .001). And the group fully able to work included a lower proportion of whites than the other two groups (73.3% versus 80.5% versus 81.6%, P < .001).

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Among the 947 people fully unable to work at baseline, 508 (53.6%) remained fully unable after one year of ART, 310 (32.8%) regained full ability to work after one year of ART, and 129 (13.6%) regained partial ability to work. Among the 4382 people fully able to work at baseline, only 217 (5%) lost ability to work during the first year of ART.

Multivariate analysis identified five factors independently associated with higher odds of recovering full ability to work after one year of ART: nonwhite ethnicity, more education, CD4+ count at least 500 cells/mm3 (versus

The overall proportion of people fully able to work rose after one year of ART from 64.4% in 1998-2001 to 85.9% in 2009-2012 (P < .001). Among the 947 people initially completely unable to work, the proportion fully able to work after one year of therapy rose from 24.0% in 1998-2001 to 41.2% in 2009-2012 (P = .001). Participants who regained the ability to work full- or part-time after one year of ART sustained that ability after five years of treatment. But the proportion of HIV-positive people fully capable of working for whom a job was their primary source of income did not increase over time, a result suggesting that “barriers for work reintegration of persons with HIV/AIDS still exist” in Switzerland.

The authors propose that ability to work in the study population depended mainly on reaching an undetectable viral load, on beneficial psychosocial factors and on absence of specific comorbidities. They suggest that reintegration of ART responders into the work force may improve with offers of modified work schedules to sick workers, training of supervisors and communication between employers and health care providers.

Mark Mascolini writes about HIV infection.

Copyright © 2016 Remedy Health Media, LLC. All rights reserved.

Breakthrough: Even When Undetectable, HIV Replicates New Cells

Posted on February 2, 2016

By Tyler Curry new-research-sheds-light-on-how-to-penetrate-hivs-hiding-spots-x750

www.hivplusmag.com

February 01 2016 9:37 AM EST

Scientists have long struggled with how to penetrate the body’s reservoirs to eliminate HIV.

For the past decade, researchers have known that, although antiretroviral medication can suppress HIV in the blood, the virus remains in the body at the tissue level hiding in the body’s reservoirs. Now, a team of international researchers led by Northwestern University has discovered that HIV continues to replicate new cells at low levels in the lymphoid tissue, even when it is undetectable in a patient’s blood.

Although seemingly minute, this discovery could be the breakthrough that many scientists have been searching for to take the next step in HIV treatment and prevention.

“We now have a path to a cure,” said corresponding author Dr. Steven Wolinsky, chief of infectious diseases at Northwestern University’s Feinberg School of Medicine and a Northwestern Medicine physician. “The challenge is to deliver drugs at clinically effective concentrations to where the virus continues to replicate within the patient.”

Currently, HIV treatment can virtually eradicate the virus in a person’s bloodstream, but it remains in viral reservoirs within lymphoid tissue. Scientists previously believed that these infected cells were long-lived rather than newly formed. With these findings, Scientists now know that the virus is constantly replenished by low-level replication instead of older cells that have stayed in a resting state since a person seroconverted.

The study, published in the journal Nature, used a mathematical model to track the amount of virus and the number of infected cells as they grew and evolved in drug sanctuaries, then moved through the body. The model explains how HIV can grow in drug sanctuaries in lymphoid tissue where antiretroviral drug concentrations are lower than in the blood, and why viruses with mutations that create high-level drug resistance do not necessarily emerge.

“The study is exciting because it really changes how we think about what is happening in treated patients,” said co-author Angela McLean, professor of mathematical biology at Oxford University, who supervised the mathematical modeling. “It helps explain why some strategies that tried to clear the reservoir have failed.”

Now, scientists can focus on developing new delivery systems to penetrate and eliminate these drug sanctuaries for replenishing cells, effectively taking one step closer to a cure.

Gene Therapy To Treat HIV In Clinical Trial

Posted on January 5, 2016

One of the more interesting developments I learned about at the recent Till-McCulloch conference is a novel gene therapy with great promise for HIV patients.

Calimmune, based in Tucson, Arizona, is currently in a Phase I clinical trial to test safety of the procedure, and while the company is holding comment until more data become available, their approach to blocking the HIV virus looks fascinating.

HIV virus enters the cell via the CCR5 receptor (image courtesy of Wikipedia)

HIV affects over 30 million people worldwide (over 1.2 million in the U.S.), and while there is no cure yet, there are various drug treatments to contain the virus, which attacks the immune system.

Antiretroviral treatments consist of so-called cocktails of chemicals that mainly attack the virus’s ability to replicate in the bloodstream. They have to be taken daily and can have short term and long term side effects.

But what if there were a means of rendering the virus harmless by altering the accessibility of the patient’s own white blood cells? That’s the goal of Calimmune’s treatment, called Cal-1.

HIV attacks the immune system by destroying CD4+ T-lymphocytes, subsets of white blood cells that are crucial to the health of the immune system. A key landing point for the virus is the CCR5 receptor on the outer surface of these white blood cells.

Cal-1 is designed to block the virus by preventing it from binding to CCR5. It achieves this by replacing the CCR5 receptor with a natural variant of the protein found only in the very small percentage of people that are born resistant to HIV.

How it works in broad strokes: The patient’s own blood is drawn and the Cal-1 is introduced into the hematopoietic progenitor/stem cells and the mature CD4+ T lymphocyte populations of white blood cells. The T cells with altered CCR5 will naturally proliferate and outnumber the T cells infected with HIV once they are returned to the patient’s circulation.

It should be noted, Cal-1 is not a cure for HIV, but if it is successful it would allow HIV patients a healthier way to fight the infection than is currently offered with antiretroviral therapies.

As I mentioned, the primary focus of the current initial study is safety. And while the trial officially doesn’t end until September, a company spokesperson told me the company hopes to discuss their data before then.

Definitely a company to keep an eye on in 2016.

At Last, HIV-Positive Americans Can Get Life Insurance

Posted on December 8, 2015

life_insurance

Prudential Insurance has become the first major American insurer to allow HIV-positive people to buy traditional life insurance policies.

The landmark move, which Prudential chief underwriting officer Mike McFarland announced on  World AIDS Day, reflects an important change in the perception of HIV and AIDS in America, as medical advances now allow those with the virus to live for nearly as long as the general population.

“With advances in the successful treatment of people with HIV, we are now able to offer this population the opportunity to apply for life insurance — a milestone we see as a significant step in the right direction,”  McFarland said in a statement Tuesday.

It’s unclear how much the policy will cost, but Think Progress notes HIV-positive applicants were traditionally only allowed to purchase minimal coverage from providers. The life insurance industry has covered those with other chronic illnesses, including cancer, in the past — albeit for higher fees.

Under Prudential’s new policy, anyone who is HIV-positive but otherwise healthy could obtain a plan. The coverage will come in the form of a convertible 10- or 15-year plan, so the policies would last for a set period but could transition into permanent full life-coverage at a certain time.

The Centers for Disease Control and Prevention estimates more than 1.2 million Americans are currently living with HIV.

More information available here.

Critical Fact: Not All Condoms Protect Against HIV

Posted on September 1, 2015

Did you know?

condoms
There are several types of condoms on the market. Nearly all types offer protection against HIV and other STDs. But some don’t and should be avoided to help stop the spread of HIV and other STDs.

Condoms that Offer Protection from HIV & STDs

Latex Condoms for Men

Latex condoms are made of a particular kind of rubber. Laboratory studies show that intact latex condoms provide a highly effective barrier to sperm and micro-organisms, including HIV and the much smaller hepatitis B virus. Their effectiveness has been proven over many years. Use only water-based lubricants with latex condoms.

Synthetic Condoms

For people who are allergic to latex, several new types of materials are being used to make condoms. One new type is polyurethane, a soft plastic. Another new type is Tactylon TM, a synthetic latex. Lab tests have shown that both these materials provide an effective barrier against sperm, bacteria, and viruses such as HIV.

Polyurethane Condoms for Women

The female condom (Reality TM) fits inside the vagina and covers some of the area outside of the vagina. It also is made of polyurethane. When a male condom cannot be used, couples should consider using a female condom.

There are two important points to consider with polyurethane condoms:
•Unlike latex condoms, synthetic condoms such as male and female polyurethane condoms can be used with either water-based or oil-based lubricants.
•Although not as thoroughly tested as latex condoms, synthetic condoms likely provide similar protection.

Condoms That Offer NO Protection from HIV & STDs

Lambskin condoms

These condoms are made from animal membranes that contain tiny holes. While they can prevent pregnancy, they should not be used for STD or HIV prevention because viruses may be able to pass through these holes.

Novelty Condoms

Novelty (play) condoms are for sexual amusement only. The FDA does not allow them to be labeled as condoms, and they should never be used for STD/HIV or pregnancy prevention.

For more information about proper condom use, visit the About Health website.

Tulsa CARES Nourishing Neighbors by Hosting a Super Food Drive

Posted on August 4, 2015

Tulsa CARES is joining forces with St. Jerome’s Catholic Church and Reasor’s at 41st & Yale and 21st & Yale for a Healthy Food Drive August 10 through August 31.

Reasors-logo-21StJerome_Logo_Horiz-Right_rgb

Reasor’s is stepping up in the fight for healthy living to help Tulsa CARES and St. Jerome’s reach those in need.
We’re asking for protein-rich foods:

CANNED TUNA,
CANNED CHICKEN,
PEANUT BUTTER and
OATMEAL

Dense with nutrients, the long shelf lives of these foods are ideal for distribution from our pantries.

Together, St. Jeromes’s The Garden Grocery Pantry and Tulsa CARES provide monthly nutritional assistance to over 150 economically challenged families affected by HIV/AIDS. Healthy eating is a must for those impacted by the disease by enhancing the effectiveness of treatments.

Stop by the Reasor’s stores at 21st and Yale and 41st and Yale starting August 10. Donate and post a selfie in front of the banner or donation box using the hashtag #superfooddrive

Give the gift of health by donating healthy food today!

View flyer here

Tulsa CARES Making Progress on Nutrition Advocacy

Posted on July 16, 2015

OK ACBP - white background
The concept of “food is medicine‟ has a long history, as illustrated by the Haitian proverb, popularized by Paul Farmer, “Giving drugs without food is like washing your hands and drying them with dirt.” While adequate food and nutrition are basic to maintaining health for all persons, good nutrition is crucial for the management of HIV infection. Proper nutrition is needed to increase absorption of medication, reduce side effects, and maintain healthy body weight. Qualitative and quantitative research suggests that, for many people living with HIV/AIDS (PLWHA), access to medically tailored food and nutrition services constitutes an urgent and unmet need.

The vision of the Oklahoma Nutrition Advocacy Team is to establish collaboration between AIDS Service Organizations, medical providers, and other businesses on a level not yet realized in Oklahoma. To date, the advocacy team has made progress in establishing awareness of food insecurity among Oklahomans living with HIV and has created nutrition referral processes for medical providers to start addressing these issues. Additionally, the team has built trust between organizations laying the groundwork for addressing other issues in the state for our fellow Oklahomans. We believe that together, the members of the Oklahoma Nutrition Advocacy Team can make a difference in the lives of PLWHA by creating a more stable, secure, and nutritionally appropriate food supply and, as a result, may also prevent new cases of HIV infection.

Read the full Nutrition Advocacy Building Project Mid-Year Report here.

Announcing Tulsa CARES Collaboration with Walgreens Pharmacy

Posted on July 1, 2015

walgreens

Tulsa CARES is proud to announce a new collaboration with Walgreens pharmacy for medication prescriptions for our HIV/AIDS clients.

Walgreens HIV-specialized pharmacies are committed to HIV/AIDS patient care, sensitivity, and personalized adherence support. They support medication synchronization to reduce pharmacy visits, side effect counseling and management, and pill reminder alerts via Walgreens mobile app.

For more information, visit HIV.Walgreens.com

Thanks to our friends at Walgreens for helping make this happen!