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TN KY CARES/ HIV/AIDS NEWS
WELCOME TO TN KY CARES / HIV/AIDS NEWS. WE WILL BE POSTING NEWS AND ISSUES CONCERNING HIV/AIDS: THIS SITE IS OWNED AND COPYRIGHTED BY TN KY CARES 2000 / PRESENT
TN KY CARES / HIV/AIDS
DRUGS;ETC. -- No name, 13:26:17 01/26/02 Sat

WHAT IS INTERLEUKIN-2?
Interleukin-2 (IL-2) is a protein made by the body. T-helper cells, a kind of white blood cell, produce IL-2 when they are stimulated by an infection. IL-2 makes infection-fighting cells multiply and mature. Patients who use IL-2 have large increases in their T-cell (CD4+ cell) counts. IL-2 is called an immune modulator.

Interleukin-2 has been approved by the FDA for the treatment of some types of cancer, but has not yet been approved for the treatment of HIV disease.

Using gene splicing, the Chiron Corporation developed a way to manufacture IL-2. Their version is called Proleukin®.


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WHO SHOULD TAKE INTERLEUKIN-2?
IL-2 stimulates the immune system and increases the number of CD4+ cells. People who start with higher T-cell counts get larger CD4+ cell increases.

Scientists do not agree on the value of the new T-cells generated by IL-2. That is, a T-cell count of 700 after IL-2 therapy might not be as good as a count of 700 before IL-2 therapy. The difference has to do with how many different types of T-cells you have.

Before HIV disease attacks your immune system, you have a full range of T-cells. There are actually millions of different types of T-cells, but an easier way to think about them is like the letters of the alphabet. Each letter is programmed to respond to one particular type of infection. With a healthy immune system, you have many copies of each letter. As your T-cell count goes down, you have fewer copies of each letter, and you might run out of some letters.

Let's say that you need to spell the word "zebra" in order to fight pneumonia. If you have lost all your copies of the letter "z", you can't spell zebra and you might develop pneumonia.

People who take IL-2 seem to get more copies of the "letters" (types of T-cells) that they still have, but don't get back the ones they have lost. They could still have gaps in their immune defenses.

Scientists are still studying the benefits of the CD4+ cells produced by IL-2 therapy. We do not know if these higher T-cell counts mean that people will stay healthier.

Researchers also used IL-2 to try to clear infected "resting" T-cells from the blood. These experiments were not successful. New studies are examining the possible benefits of IL-2 during treatment interruptions (See Fact Sheet 417).


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HOW IS INTERLEUKIN-2 TAKEN?
IL-2 has been given as an intravenous infusion and as twice-daily subcutaneous (below the skin) injections. Early research showed that the largest increases in T-cells occurred when IL-2 was given every day for 5 days, once every 8 weeks. If the T-cell count climbs enough after the first few cycles, future cycles can occur less frequently.

The best dosage of IL-2 has not been determined. The dosage is stated as "millions of international units", or MIU.


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WHAT ARE THE SIDE EFFECTS?
Without antiviral treatment, IL-2 can increase HIV viral load up to six times its pre-treatment level. These increases disappear within one month. Combination antiviral medication controls these "spikes" in viral load. You should not use IL-2 unless you are taking antiviral drugs.

When IL-2 is given by intravenous infusion, the most common side effect is called capillary leak syndrome. This causes weight gain, swelling, low blood pressure, and other problems.

At lower doses, people taking IL-2 get flu-like symptoms, including fever and muscle aches. Because IL-2 stimulates the immune system, it can make some immune disorders get worse, including arthritis, psoriasis, and diabetes. It can also reduce the number neutrophils, a particular type of infection-fighting cell, and can cause low levels of thyroid.

When IL-2 is given by subcutaneous injection, the side effects are usually milder than with intravenous infusions. There is the added side effect of irritation where the injection is given. Side effects show up from 2 to 6 hours after injection of IL-2, and disappear quickly after the end of each cycle.

IL-2 can cause mood changes including irritability, insomnia, confusion, or depression. These can continue for several days after IL-2 is stopped.


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HOW DOES INTERLEUKIN-2 REACT WITH OTHER DRUGS?
The body naturally produces IL-2. No serious interactions with antiviral medications have been noted. Also, there is no evidence that the body develops resistance to IL-2 when it is given in cycles.


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THE BOTTOM LINE
IL-2 stimulates the immune system and can lead to large increases in the number of CD4+ (T-helper) cells. We still don't know if these increases in T-cells help people stay healthy longer.

IL-2 is usually administered in 5-day cycles of 2 subcutaneous injections a day. One cycle is given every 8 weeks. IL-2 causes irritation where the injections are given and flu-like symptoms. These side effects usually start within a few hours of IL-2 injections and disappear after the end of a cycle.

IL-2 has not yet been approved for use in HIV disease.



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Revised April 19, 2001



WHAT ARE VACCINATIONS?
Vaccinations, or immunizations, are injections that build up your body's defenses against certain infections. For example, many people get flu shots each fall. It can take a few weeks for your immune system to respond after a vaccination.

"Live" vaccines use a weakened form of the germ. They can give you a mild case of disease, but then your immune system kicks in to protect you against a severe case. Other "inactivated" vaccines don't use a living germ. With them, you don't get the disease, but your body can still build up its defenses.

Vaccines can have some side effects. With live vaccines, you might get a mild case of the disease. Even with inactivated vaccines, your immune system will respond. You could have pain, redness, and swelling where you got the shot. You might also feel some weakness, fatigue, or nausea for a day or so.


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WHAT'S DIFFERENT FOR PEOPLE WITH HIV?
If HIV has damaged the immune system, it might not respond as well to a vaccine, or for the same length of time. Also, vaccines might cause more side effects in people with HIV. They might even cause the disease they are designed to prevent.

There has not been much research on vaccines and people with HIV, especially since people started using combinations of anti-HIV drugs. However, there are a few key guidelines for people with HIV:

Vaccinations can increase the viral load (see fact sheet 413) for a little while. However, getting sick with the flu, hepatitis, or other preventable diseases would be much worse. Do not measure your viral load within 4 weeks of any vaccination.
Flu shots have been studied more than any other vaccination for people with HIV. They are considered to be safe and effective.
If your T-cell count (see fact sheet 412) is very low, vaccines might not work. If possible, strengthen your immune system by taking strong anti-HIV medications before vaccination.
HIV-positive people should not receive most live vaccines (see below.) However, the "MMR" vaccine against measles, mumps and rubella is considered safe if your T-cell count is over 200.


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WHICH VACCINATIONS ARE RECOMMENDED?

1. Pneumonia: Having HIV greatly increases your risk of developing pneumococcal pneumonia. The vaccine takes 2 or 3 weeks to become effective. The protection lasts for about 5 years in people with HIV.

2. Hepatitis (See fact sheet 505): Hepatitis can be caused by several different viruses. Vaccines exist for hepatitis A and B. Hepatitis A is usually not serious but it can be for someone with a weakened liver. This includes people who are infected with hepatitis B or C. Getting two hepatitis A vaccine shots can protect you for about 20 years.

Hepatitis B can cause serious disease. If you were exposed to hepatitis B, you should have antibodies. If you don't, you should get vaccinated. A series of three hepatitis B shots should protect you for about 10 years. People who have a higher risk of hepatitis A or B include men who have sex with men and people who use street drugs or who inject drugs.

3. Influenza (Flu): A flu vaccine is offered each year, based on the most active type of flu. Flu shots are recommended for all people with HIV. For best protection, you should get the shot by mid-November, before flu season. A case of the flu can sometimes develop into pneumonia. Some flu vaccines can cause an allergic reaction in people who are allergic to eggs.

4. Tetanus and Diphtheria: Tetanus is a serious disease caused by common bacteria. Tetanus infection can occur in any cut in the skin. It cannot be passed from person to person. Injecting drug users have a higher risk of a tetanus infection. Diphtheria is another bacterial disease. It can be passed from person to person and is common in homeless people. Diphtheria vaccine is always combined with tetanus vaccine.

Tetanus and diphtheria vaccines are usually given to children as a series of three shots. A single booster shot can be given every ten years. People with HIV should not receive the shots more than once every 10 years, or else they might have a painful local reaction. The shots can cause a lump that can last for a few weeks.

5. Measles, Mumps and Rubella: These are three diseases caused by viruses. They are very contagious and can be spread by coughing or sneezing. Children are normally vaccinated against these diseases with an "MMR" shot. The vaccine usually gives life-long protection against these diseases. If you were born after 1957 and did not get these vaccines as a child, you should get an MMR vaccination. However, since this is a live vaccine, it is not recommended for people with a CD4 cell count below 200.


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HIV-POSITIVE TRAVELLERS
Every traveler with HIV should be sure they are vaccinated against hepatitis A and B.

Countries have different vaccination requirements for entry. In general, inactivated vaccines should not be a problem for travelers with HIV. However, they should avoid live vaccines, including typhoid, yellow fever, and vaccinia. If polio vaccine is required, it should be the inactivated version, not the live oral version.

Instead of getting a live vaccine, people with HIV should get a doctor's letter explaining that they have a medical reason not to be vaccinated. This is accepted by most countries.


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Revised January 19, 2002


WHAT ARE ALTERNATIVE THERAPIES?
A health treatment that does not fit into standard western medical practice is called "alternative" or "complementary". This includes many different therapies:

Traditional healing practices such as ayurveda, Chinese acupuncture, and Native American healing
Physical therapies such as chiropractic, massage, and yoga
Homeopathy or herbs
Energy work such as polarity therapy or reiki
Relaxation techniques, including meditation and visualization.
Some doctors don't like alternative therapies. They want to see more research on these therapies. They think that patients would probably do better if they use western medicine.

Other physicians like to use alternative therapies along with western medicine. They think alternative therapies can reduce stress, relieve pain or stomach upsets caused by many antiviral drugs, or have other benefits for patients.


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HOW MANY PEOPLE USE ALTERNATIVE THERAPIES?
Alternative therapies are very popular. In the United States, over 70% of people with HIV have used some kind of an alternative therapy. Many people use them regularly. Some health insurance plans pay for therapies such as chiropractic or acupuncture.


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ARE THEY SAFE?
Alternative therapies can have dangerous side effects. The words "natural" or "non-drug" do not guarantee safety. The FDA (Food and Drug Administration) does not approve dietary supplements or monitor their safety or contents. Some herbs can lower blood levels of antiviral drugs. Consumers need to be careful when using alternative therapies.


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DO THEY REALLY WORK?
It is difficult to find good information on alternative therapies. Get as much information as you can before using them. Try to find out:

When and how was this therapy developed?
How does it work?
Are there any articles or studies of this therapy?
Are the therapists trained, certified, or licensed?
Are there any known side effects or other risks?
Sometimes this information is truly not available. However, if it seems like people don't want to answer your questions, be extra careful. You might be dealing with a health fraud. See Fact Sheet 205, How To Spot HIV/AIDS Fraud, for more information.


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WHY AREN'T THERE MORE STUDIES OF ALTERNATIVE THERAPIES?
Most research tests treatments for a particular disease or condition. Every patient gets exactly the same treatment. Many alternative therapies don't fit this model of health care, and there may be no sponsor to pay for the research.

Specific Disease or Condition: Some alternative therapies treat the whole person, not an illness. They might restore harmony, balance, or normal energy flow. Acupuncturists, for example, use the pulse to find out how your body's energy might be out of balance. Acupuncture for people with HIV is based on their individual energy pattern, not on their HIV. Therapies like this are not designed to treat HIV, although they might help some HIV-positive people. Some dietary supplements appear to work directly against HIV, but better studies are needed to confirm this.

Standardized Treatment: Few alternative therapies are standardized. Different brands of herbs can have different amounts of the active ingredient, although more standardized products are being made. Chiropractic, acupuncture, and other therapies are not standard: they are adjusted for each patient. Research is very difficult when treatments are not standardized.

Safe Treatments: The FDA wants to know that a therapy is safe before they test how well it works. Even if many people have used a treatment for many years with no reports of health problems, a scientific study is usually required to show that it is safe.

Paying for the Study: Scientific research is very expensive. The makers of alternative therapies often cannot afford to pay for scientific studies. The government prefers to pay for studies of western medical drugs because they appear to be more effective. Patents allow drug manufacturers to make large profits that help pay for research; most alternative therapies cannot be patented.

Despite these barriers, some alternative therapies have been carefully studied. Often, this research has been conducted outside the US. Unfortunately, the FDA has no procedure for evaluating the results of non-US research. The Fact Sheets for each alternative therapy mention research that has been done.


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WORKING WITH YOUR DOCTOR
Tell your doctor as much as possible about how you want to deal with your HIV infection. It's best if you tell your doctor about all the therapies you use. This is very important if you have any kind of bad reaction to a medicine that you are taking. There could be some alternative therapies that you should not use together with your HIV medications.

Check your doctor's attitude and knowledge on alternative therapies. Ideally, your doctor can keep an open mind and help you evaluate alternative therapies that interest you.


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THE BOTTOM LINE
Most people with HIV use some kind of alternative or complementary therapy. Some alternative therapies can be dangerous. Others are safe to use. Some have been carefully studied and can improve your health.

It is difficult to study alternative therapies. Find out as much as you can before you start using an alternative therapy. Let your doctor know about the therapies you are using.



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Revised March 29, 2001



WHAT IS ACUPUNCTURE?
Acupuncture is a healing technique used in traditional Chinese medicine. Very thin needles are used to stimulate specific points in the body. These points lie on energy pathways called "meridians." Acupuncture treatments are designed to improve the flow and balance of energy along these meridians.

Traditional Chinese medicine is at least 2,500 years old. It views the human body as a system of energy flows. When these flows are balanced, the body is healthy. Practitioners take their patients' pulses and examine their tongues to diagnose energy imbalances. In Chinese medicine, pulses can be taken at three positions on each wrist, and at three depths at each position.

Illness is not defined by symptoms or the name of a disease like "HIV infection." Instead, a practitioner of Chinese medicine will talk about energy imbalances. The language can sound very strange, like "yin deficiency" or "liver heat rising." The Chinese words yin and yang refer to opposing energies that should be in balance, and Qi (pronounced "chee") can be roughly translated as energy or life force.

In traditional Chinese medicine, there are many ways to improve the balance of the body's energy flows. The most common techniques used in the western world are exercise techniques such as Qigong or Tai Chi, acupuncture, and herbalism. Fact Sheet 704 has more information on Chinese herbalism.

Many practitioners of Chinese medicine specialize in either acupuncture or herbalism. Very few use both methods.


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WHY DO PEOPLE WITH HIV USE ACUPUNCTURE?
Because acupuncture deals with energy balance, there are not specific acupuncture points used to treat HIV. Instead, your acupuncturist will use your pulses and will probably look at your tongue to find out how your energy flows are out of balance.

Acupuncture does not cure HIV infection. Many people, however, believe that it has helped them improve their overall energy, or deal with the side effects of antiviral medications. Some people have used acupuncture to reduce the stomach upset or diarrhea caused by their medications. Other people find that it helps ease the pain caused by neuropathy (See Fact Sheet 553 for more information on neuropathy).


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HOW IS ACUPUNCTURE USED?
Based on your energy imbalances, your acupuncturist will select acupuncture points to stimulate. You will lie on a table, either on your stomach or on your back. Needles will be inserted at the selected points. You may feel a little pain, tingling or numbness as the needles are inserted. The needles are left in place for up to 30 or 45 minutes, depending on what the acupuncture is intended to accomplish. During that time, many people fall asleep.

You might receive additional treatments during acupuncture to increase the flow of energy:

The needles might be stimulated with a very mild electric current (electroacupuncture)
Moxa is soft material prepared from dried mugwort, an herb. Moxa may be put on the top end of acupuncture needles or (rarely) right on the skin. Moxa is burned to provide penetrating heat. This is called moxibustion.
Round glass cups can be used to create suction over specific points (cupping). The suction stimulates the flow of energy. If the cups are left on for a long time they can leave a red mark.
Some practitioners use small beads or tiny needles held in place with adhesive to keep pressure on an acupuncture point for a few days.



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WHAT ARE THE RISKS AND SIDE EFFECTS?
Some people feel slight pain, numbness or tingling when acupuncture needles are inserted. In rare cases, people will feel dizzy or nauseated during acupuncture. There may be a drop of blood when a needle is removed. Acupuncture has far fewer side effects than most western medicines.

You should not go for an acupuncture treatment if you have had any alcoholic beverage within an hour, or if you are using any recreational drugs.

Be sure your acupuncturist knows if you are pregnant. Some acupuncture points should not be stimulated during pregnancy.


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HOW DO WE KNOW IT WORKS?
Research on acupuncture shows that it is effective in treating some kinds of pain and nausea. This led the National Institutes of Health in 1997 to issue a statement supporting the value of acupuncture for certain conditions. The World Health Organization lists over 40 conditions that may be helped by acupuncture.

A recent study on acupuncture to relieve the pain of neuropathy did not show any benefits. However, the study design has been criticized for using the same acupuncture points for everyone in the study, and for using fake acupuncture points for comparison. Many people with neuropathy believe that acupuncture has helped them.



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Revised May 24, 2001



WHAT IS HERBALISM?
Healers in many different health traditions use herbs. This fact sheet discusses herbs as a part of traditional Chinese medicine.

Traditional Chinese medicine is at least 2,500 years old. It views the human body as a system of energy flows. When these flows are balanced, the body is healthy. Practitioners take their patients' pulses and examine their tongues to diagnose energy imbalances. In Chinese medicine, pulses can be taken at three positions on each wrist, and at three depths at each position.

Illness is not defined by symptoms or the name of a disease like "HIV infection." Instead, a practitioner of Chinese medicine will talk about energy imbalances. The language can sound very strange, like "yin deficiency" or "liver heat rising." The Chinese words yin and yang refer to opposing energies that should be in balance, and Qi (pronounced "chee") can be roughly translated as energy or life force.

In traditional Chinese medicine, there are many ways to improve the balance of the body's energy flows. The most common techniques used in the western world are exercise techniques such as Qigong or Tai Chi, acupuncture, and herbalism. Fact Sheet 703 has more information on Chinese acupuncture.

Many practitioners of Chinese medicine specialize in either acupuncture or herbalism. Very few use both methods.


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WHY DO PEOPLE WITH HIV USE CHINESE HERBALISM?
Chinese herbs do not cure HIV infection. Many people, however, believe that the herbs have helped them improve their overall energy, or deal with the side effects of antiviral medications. Some people have used herbs to reduce the upset stomach or diarrhea caused by their medications.

In general, an herbalist makes up a personalized mixture for each patient, based on that person's particular energy flows and imbalances. However, some practitioners of Chinese medicine have noticed a consistent "toxic heat" pattern of energy imbalances in people with advanced HIV disease. Due to Chinese medicine's emphasis on long life and immune enhancement, they feel that some herbal preparations will probably help anybody with HIV.


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HOW ARE CHINESE HERBS USED?
Based on your energy imbalances, your herbalist will prescribe a combination of herbs for you to use. The Chinese meaning of herbs can include various parts of plants as well as minerals and animal parts. The herbs can come in several forms:

"Loose" or "raw" herbs: you get a bag of various dried pieces of roots, bark, leaves, seeds, powders, and other items. These are usually boiled and you drink the "tea." This is considered the most potent form for herbs, but it can be difficult to prepare them.
Powdered herbs: Dried herbs are ground into a powder. The powder might be mixed into water to drink, or taken in a capsule.
Tinctures: Dried herbs are prepared in a mixture of water and alcohol. You drink a dose of the tincture.
Patent medicines: Some of the most common combinations of herbs are available in prepared form as pills, capsules, creams, or other forms. There is usually very little or no labeling on these medicines except in Chinese.
Chinese herbs are prescribed to correct energy imbalances. You might feel better, or symptoms might disappear, but the best way to know if it's time to stop or change the herbs you are taking is to consult with your herbalist.


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WHAT ARE THE SIDE EFFECTS?
Most herbs used in Chinese medicine are safe at a wide range of dosages. However, some may be toxic at very high doses, or might not be safe to use during pregnancy. The safest way to use Chinese herbs is according to the instructions of a trained herbalist. Be sure to tell your herbalist and your doctor if you think the herbs are causing diarrhea, headaches, or any other problems.


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HOW DO HERBS INTERACT WITH OTHER THERAPIES?
Almost no controlled research has been done on specific interactions between Chinese herbs and other therapies, including antiviral medications. There is no information on any dangerous interactions.

It is always a good idea to let every practitioner on your health care team know about all of the therapies you are using. In some cases, a western medicine and Chinese herbs might have a similar effect and combining them would be too much. For example, it might not be a good idea to use Chinese herbs that help calm you down and sleeping pills at the same time.


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HOW DO WE KNOW IT WORKS?
There are several scientific journals that present research on the health benefits of Chinese herbs. However, almost all of them are published in China.

Studies on treating HIV with Chinese herbs have had mixed results. However, these studies usually studied Chinese herbs as antiviral treatments. More recently, herbs are being combined with antiviral medications. Some herbalists believe that the best use of herbs will be to help deal with the side effects of strong antiviral drugs, and to generally strengthen the immune system.



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Reviewed May 24, 2001


[ Edit | View ]

DRUGS;ETC. -- No name, 13:28:45 01/26/02 Sat

WHAT IS NATIVE AMERICAN TRADITIONAL HEALING?
Most Native American tribes have traditions about health and illness. These traditions are not based on western science. Instead, they come from the tribe's beliefs about how individuals fit in the web of life. This web includes the tribe, all humanity, the earth, and the universe. Many healing traditions focus on harmony. Healing occurs when someone is restored to harmony and connected to universal powers.

Traditional healing is "holistic". It does not focus on symptoms or diseases. Instead, it deals with the total individual. Different people with HIV disease may get different treatments. Healing focuses on the person, not the illness.

Certain people in each tribe are recognized as healers. They receive special teachings. Healing traditions are passed from one generation to the next through visions, stories, and dreams.

Healing does not follow written guidelines. Healers work differently with each person they help. They use their herbs, ceremony and power in the best way for each individual.

Healing might involve sweat lodges, talking circles, ceremonial smoking of tobacco, shamans, herbalism, animal spirits, or "vision quests". Each tribe uses its own techniques. The techniques by themselves are not "traditional healing." They are only steps towards becoming whole, balanced and connected.


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WHO WOULD BENEFIT FROM TRADITIONAL HEALING?
Traditional healing can be very powerful for Native Americans dealing with HIV. It can restore a sense of connection to their tribe and culture. This promotes spiritual, psychological, emotional, and physical healing.
Some traditional healers only work with members of their own tribe. Others will work with outsiders. Some people who are not Native American believe that working with a traditional healer has helped them.

Most healers work in their local tribal communities. A few participate in public conferences. If you are not a tribal member, it is very difficult to know if someone is really a traditional healer.

Many people use the techniques of traditional healing. However, there is a big difference between traditional healing and using traditional techniques. Participating in a sweat lodge might help almost anyone. However, the experience could be very different depending on who runs the sweat lodge. Were they raised in a tradition that used sweat lodges? Or did they simply learn about the technique? Also, a sweat lodge will mean more to someone who grew up in a tribe that traditionally uses them. Some techniques might have no meaning unless you grew up using them.

Traditional ceremonies usually involve much more than outsiders are aware of. When you attend a ceremony, show respect by asking about guidelines for observing or participating.


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HOW DOES TRADITIONAL HEALING INTERACT WITH WESTERN MEDICINE?
Healers have different views about combining their methods with western medicine. Some do not see any value in medical science or treatments. Others believe that the systems deal with different aspects of an individual so there is no problem using both.

Most western physicians do not understand the value or importance of traditional healing to their Native American patients. A few, especially in areas with large Native American populations, are more open to traditional healing.

If you combine western medicine and traditional healing, let your physician know about any treatments you are using. There might be interactions. For example, a traditional healer might use an herbal preparation to help you sleep. In that case, your physician would probably not want you to take sleeping pills. Your healer might want you to use herbs to cleanse your system. These might interact with western medications that you are taking. Your physician might help you avoid negative interactions.


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THE BOTTOM LINE
Native American traditional healing is a holistic approach to health. Each tribe has its own healing traditions.

Traditional healers do not follow a standard procedure. Instead, they apply their skills to each person individually.

By themselves, techniques such as sweat lodges or vision quests are not "traditional healing." They have the most meaning as part of an overall healing tradition.

Traditional healers and western physicians are often skeptical of each other. However, it is best if your care providers all know about everything you are doing for your health. There may be interactions among different techniques that you want to avoid.



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Reviewed May 24, 2001



WHAT IS CAT'S CLAW?
Cat's claw is a vine that grows in Peru. The plant gets its name from pairs of large, curved thorns that grow along the vine. In Spanish, the vine's name is uña de gato. Its scientific name is Uncaria tomentosa. Traditionally, the inner bark and the root of the vine are used to make a tea. A similar vine, Uncaria guaianensis, lacks a potentially important compound. A Chinese variety, Uncaria rhynchophylla, has many similar compounds.

WARNING: A plant called "cat's claw" grows in northern Mexico and southern Texas. This plant, Acacia gregii, has no known health benefits and its bark may be poisonous.

Natives of the Peruvian jungle, especially the Ashaninka tribe, have used cat's claw for hundreds of years as a medicine. It did not come to the attention of researchers until the 1970s.

Cat's claw contains chemicals called oxindole alkaloids. A researcher named Klaus Keplinger patented some of these based on evidence that they affect immune function. However, a patent is not the same thing as approval by the Food and Drug Administration. Keplinger has used cat's claw to treat some people with herpes or HIV.

Other research showed that cat's claw also contains different kinds of alkaloids that affect the central nervous system. These alkaloids might work against the alkaloids that affect the immune system. More research is needed.


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WHAT ARE THE BENEFITS OF CAT'S CLAW?
Peruvian natives use cat's claw to treat inflammatory diseases like arthritis, to clean out the digestive tract and to treat cancer. It has also been used to treat dysentery, recovery from childbirth, and women's hormone imbalances.

In laboratory studies, cat's claw normalizes some immune system functions. It also appears to help reduce blood clotting. We do not know if these laboratory results will carry over to studies in people.

There have been some small human studies, including in people with AIDS. The results were inconclusive. In one study, cat's claw speeded the healing of people with herpes simplex virus (cold sores or genital herpes) and herpes zoster virus (shingles). A company that makes a purified version of cat's claw did this study. No independent researchers have gotten similar results.


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WHY DO PEOPLE WITH HIV USE CAT'S CLAW?
Many people with HIV are attracted to herbs that are supposed to strengthen the immune system. However, the benefits of cat's claw have not yet been documented in humans. Also, it is possible that cat's claw could stimulate the immune system in ways that lead to progression of HIV disease. Without controlled studies, we don't know if it does anything, good or bad.

Health food companies promote cat's claw as a possible treatment for a wide range of health conditions. Some promotional materials call it a "miracle herb" and claim it is stronger than many other herbal products. These claims are not supported by careful research.


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HOW IS CAT'S CLAW USED?
The traditional use of cat's claw was to make a tea from the inner bark of the vine. Health food companies offer cat's claw in capsules of powdered dried bark, as a liquid extract to use under the tongue, as tea bags and as bulk bark and root to make into a tea. It is difficult to know the best dosage to use. In addition, there is no way to standardize the concentration of the active ingredients of cat's claw. It contains at least six chemicals that are supposed to have health benefits.


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WHAT ARE THE SIDE EFFECTS?
There are no recorded side effects from the use of cat's claw. However, very few people have been treated with cat's claw in scientific research studies. Some cat's claw products say that they should not be used by pregnant women, or by people with immune disorders like multiple sclerosis.


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HOW DOES IT INTERACT WITH OTHER THERAPIES?
There are no known interactions between cat's claw and medications or other herbs. However, most interactions between herbs and medications have not been studied. Tell your doctor if you are using herbal supplements.


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HOW DO WE KNOW IT WORKS?
We do not know if cat's claw has any beneficial effects for people with HIV. There have been several laboratory studies that show promising results. However, very few people have taken cat's claw in careful scientific studies.


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THE BOTTOM LINE
Cat's claw is an herbal product made from the bark and root of a vine that grows in Peru. Local native people have used it for hundreds of years to treat a variety of health problems.

Although some laboratory studies have shown promising results for cat's claw, there are very few studies in humans. Until there is more research on cat's claw it is difficult to feel confident about its benefits or side effects.

Note: This Fact Sheet is based largely on the work of Direct AIDS Alternative Information Resources (DAAIR). For more details, contact DAAIR at 1-888-951-5433 or http://www.daair.org.



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Reviewed July 30, 2001



WHAT IS DHEA?
Dehydroepiandrosterone (DHEA) is a hormone produced by the adrenal glands. A hormone is a chemical produced in one part of the body that is carried to another part of the body where it has a specific effect. The adrenal glands are located on top of the kidneys.

DHEA is a steroid, which means that it has a particular chemical structure that looks like connected rings. DHEA has not demonstrated the same effects as anabolic (muscle-building) steroids, but the Food and Drug Administration has already examined the possibility of classifying DHEA as a Schedule III drug. If this happens, it will be extremely difficult to get DHEA.

DHEA is the most common steroid in humans. It can be transformed in the body into testosterone (the primary male sex hormone), estrogen (an important female sex hormone), or other steroids.

In normal adults, DHEA levels are highest at about age 20, and then decrease steadily. HIV patients with lipodystrophy have very low levels of DHEA.


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WHAT ARE THE BENEFITS OF DHEA?
People with various diseases have levels of DHEA that are unusually low. DHEA has been used in the last thirty years or so to treat obesity, diabetes, and lupus. It has also been found to improve sleep. Many people who have taken DHEA report improved energy levels and a better sense of well being.


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WHY DO PEOPLE WITH HIV USE DHEA?
Some people with HIV take DHEA in amounts designed to restore normal levels. This might help improve their energy levels. Several studies have found that DHEA increases levels of IL-2, a chemical messenger that increases the production of CD4+ (T-helper) cells. DHEA also improves the ability of CD8+ (T-killer) cells to destroy infected cells. DHEA may help normalize the immune system.


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HOW IS DHEA USED?
DHEA is available in "regular" form or as DHEA-S (DHEA sulfate). The body can convert DHEA into DHEA-S and back again.

A doctor in San Francisco who uses DHEA with his HIV-positive patients tries to maintain blood levels that are typical for young adults. This usually means taking 200 milligrams of DHEA either once or twice a day.

A blood or saliva test can measure the amount of DHEA in your blood. This can help determine how much DHEA to take and whether your level is where you want it to be. DHEA levels vary during the day, so you should do each test at the same time of day.

We do not know the best doses of DHEA for women, and it has not been studied in children or adolescents with HIV.


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WHAT ARE THE SIDE EFFECTS?
There are no documented side effects of DHEA at doses up to 2,500 mg per day, except for an increase in acne, especially in women.

Some studies suggest that people with HIV and Kaposi's Sarcoma (KS) have very high levels of DHEA. Taking more DHEA might be harmful for these people. Check your blood or urine levels before you take DHEA.


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HOW DOES DHEA INTERACT WITH OTHER THERAPIES?
There are no documented interactions of DHEA with other therapies. Because DHEA occurs naturally in the body, interactions are unlikely. It is possible that DHEA could affect the processing of drugs by the liver, but this has not been studied.


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HOW DO WE KNOW IT WORKS?
There is increasing scientific interest in DHEA, with well over 100 scientific articles written in each of the last four years. However, there have not been many studies that document health benefits in humans, and some initial good results have not been confirmed in follow-up studies. There is not good scientific support for taking DHEA supplements (that is, getting more than normal amounts in your body). However, some doctors recommend DHEA replacement, which means taking enough DHEA to bring your levels back into the normal range.


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THE BOTTOM LINE
DHEA is a steroid hormone produced by the body. DHEA levels go down with age, and go down even faster with some illnesses including HIV. DHEA may help with immune function or with patients' energy levels.

It may be helpful to take enough DHEA to bring levels up to the normal range. This is called "replacement" therapy. Before you take DHEA, check your blood or saliva levels.

At this point, there are no research studies that support taking DHEA supplements (amounts that would give you higher than normal levels).



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Note: This Fact Sheet is based on the work of Direct AIDS Alternative Information Resources (DAAIR). For more details, contact DAAIR at 1-888-951-5433 or http://www.daair.org.



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Revised March 30, 2001



WHAT IS DNCB?
Dinitrochlorobenzene (DNCB) is a chemical used in color photography processing. DNCB is a "contact sensitizer", which means that it causes an itchy red rash similar to poison oak or poison ivy. Some doctors have used DNCB to measure the strength of the immune system: the greater the skin reaction to DNCB, and the faster it shows up, the stronger the immune response.


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WHAT ARE THE BENEFITS OF DNCB?
Some researchers and community activists believe that when DNCB is applied to the skin once a week, it stimulates the immune system to control HIV replication and delay opportunistic infections. Some research shows that DNCB leads to increases in T-killer (T-8 or CD8+) cells. These cells are an important part of the immune system.

There is almost no good research on DNCB. Some studies suggest that DNCB decreases the number of T-helper (CD4+ or T4) cells.


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WHY DO PEOPLE WITH HIV USE DNCB?
Research on DNCB shows that it stimulates the immune system. It has been used to treat skin lesions caused by Kaposi's Sarcoma (KS).

Advocates of DNCB claim that it can clear up all symptoms of HIV disease, except for pneumocystis carinii pneumonia (PCP). A small group of activists formerly known as DNCB Now! Is the main supporter of this therapy. The group is also known as ACT UP San Francisco, but it is not connected with any other ACT UP groups around the world.

DNCB's supporters claim that antiviral drugs are bad for the immune system. Despite dropping death rates from AIDS and many research reports, they argue that antiviral drugs do not lead to longer life or a better quality of life for people with HIV disease. They have used civil disobedience to promote their point of view that AIDS medications are poison and should not be used.


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HOW IS DNCB USED?
DNCB is available as a liquid solution in four strengths: 10%, 2%, 0.2%, and 0.02%. The solution is applied on the skin once a week to a 2-inch square area. Then the area is bandaged and should be kept dry for 10 hours. After the first skin response (a red, itchy rash), the strength of the DNCB solution is lowered.

Instructions for using DNCB originally provided by DNCB Now! say that most other therapies could prevent it from working. This includes long-term acupuncture, most herbs if used for more than a few days, high doses of vitamins, and antiviral medications.

These controversial instructions have made it difficult for most people to try to use DNCB, especially since there is almost no research to support its use.


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WHAT ARE THE SIDE EFFECTS?
The first application of DNCB may produce a chemical "burn" in addition to the normal itchy rash. The rash occurs each time DNCB is applied and lasts for a few days. Some people have persistent scarring or rashes where they apply DNCB. It may also cause sensitivity to other chemicals.

No other side effects have been reported. However, DNCB has not been carefully studied in any large clinical trials. Long-term side effects are unknown, although one study suggested that DNCB might cause cancer.


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HOW DOES DNCB INTERACT WITH OTHER THERAPIES?
DNCB advocates believe that almost every other HIV therapy reduces the action of DNCB. They do not recommend the use of any antiviral medications, of high-dose vitamins, or more than short-term use of most herbs or of acupuncture.


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HOW DO WE KNOW IT WORKS?
There is very little research to support the benefits of DNCB. No research study on DNCB has started with more than 24 patients, and many patients dropped out of the studies. However, some studies have continued for over two years. DNCB seems to restore immune responses in the skin that are lost as AIDS develops. However, we don't know if the skin response is a good indicator of overall immune health. Because DNCB is very inexpensive and can not be patented, it is very difficult to find a sponsor to pay for clinical trials.


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THE BOTTOM LINE
DNCB is a "contact sensitizer" that stimulates one part of the immune system. There is almost no research to support its use. However, a small group of AIDS activists called ACT UP San Francisco strongly supports the use of DNCB.



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Revised March 30, 2001



WHAT IS ECHINACEA?
Echinacea is a flowering plant. It is sometimes called Purple Coneflower. It grows mainly in Europe and the North America. There are several closely related species: Echinacea purpurea, angustifolia, and pallida. They have slightly different medicinal properties. Echinacea purpurea seems more active in the test tube. Echinacea angustifolia appears more effective in people.

Echinacea was the main medicinal herb used by Native Americans in the Great Plains region. Since the late 1930s, German researchers have studied echinacea and its effects on the immune system. Echinacea is one of the most frequently sold herbs in the United States.

The German government has approved Echinacea pallida root and Echinacea purpurea leaf for use against colds, flu, and chronic respiratory or urinary infections.


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WHAT ARE THE BENEFITS OF ECHINACEA?
The major use of echinacea is to treat colds and flu. It is also used for urinary tract infections, skin wounds that aren't healing well, and skin conditions such as psoriasis and eczema.

Echinacea stimulates the immune system. It promotes T-cell activation and increases the activity of the immune system. It helps white blood cells attack germs. These effects may decrease if people take echinacea for more than a few weeks.

Echinacea is generally not recommended for use by people with diseases of the immune system such as HIV, multiple sclerosis, or tuberculosis. The German government recommends against using echinacea if you have these conditions. Some researchers believe that echinacea could actually worsen these immune system problems.


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WHY DO PEOPLE WITH HIV USE ECHINACEA?
Many people with HIV have used echinacea because it stimulates the immune system, or for short-term treatment of colds and the flu. The use of echinacea for people with HIV is controversial.


Some doctors believe that it is not a good idea to stimulate the immune system in people who have some type of immune disorder. Increasing the activation of T-cells could give HIV more "target cells" to infect. Other doctors believe that some parts of the immune system are already overactive, causing damage to healthy cells and tissues.

They are also concerned about an animal study showing that echinacea increased levels of tumor necrosis factor alpha (TNF-alpha), a substance produced by the immune system to kill unhealthy cells. High levels of TNF-alpha have been linked to the progression of HIV disease.

Unfortunately, as with most herbal products, there is no careful research in people with HIV. There is no published research to document any dangerous results from the use of echinacea by people with HIV. Some researchers believe that short-term use of echinacea (up to two weeks) to treat colds or flu does not present any serious risks to people with HIV.


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HOW IS ECHINACEA USED?
Echinacea is available in capsules containing a powder of the dried plant or root, and also as a tincture (an alcohol-based preparation). In some cases, people drink pressed juice from fresh plants. For treating skin conditions, special preparations containing pressed juice are used.

The suggested dosage of echinacea depends on which species and which parts of the plant were used. In general, it should not be used for more than 1-2 weeks.


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WHAT ARE THE SIDE EFFECTS?
There are no known side effects from internal or external use of echinacea. The warnings about negative effects of echinacea use in people with immune disorders are based on laboratory studies. There are no human studies that document these side effects.


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HOW DOES IT INTERACT WITH OTHER THERAPIES?
There are no known interactions between echinacea and medications or other herbs. However, most interactions between herbs and medications have not been studied. Tell your doctor if you are using herbal supplements.


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THE BOTTOM LINE
Echinacea (purple coneflower) is a flowering plant used for respiratory problems and to stimulate the immune system. It is a very popular herb in the United States. There are hundreds of published research studies on echinacea, mostly done in Europe. These studies document echinacea's effects on the immune system and its benefits for treating colds and flu.

Some researchers believe that echinacea's effects on the immune system might cause problems for people with HIV. However, there are no published studies showing any harmful effects from echinacea. There may be no risk from using echinacea for less than two weeks.



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Reviewed July 30, 2001


[ Edit | View ]

DRUGS;ETC. -- No name, 13:32:45 01/26/02 Sat

WHAT IS ESSIAC?
Essiac is a tea made from four herbs. A Canadian nurse named Rene Caisse developed it in 1922. She said the formula originally came from an Ojibwa Indian medicine man. She named it after the backward spelling of her own last name, Caisse. The 4 main herbs in Essiac are burdock root (Arctium lappa), Indian or Chinese rhubarb (Rheum palmatum), sheep sorrel (Rumex acetosella) and the inner bark of slippery elm (Ulmus fulva or Ulmus rubra).

Burdock root is used in folk medicine to improve digestion, to clean the blood, to increase urination or as a laxative. Laboratory studies have shown some anti-tumor effects. Rhubarb can be a strong laxative. Sheep sorrel is claimed to be effective against cancer. Slippery elm has a long, safe history in alleviating sore throats. It is used in many herbal cough drops or teas for sore throats.

Caisse used the herbal tea to treat patients with cancer. Some of them claimed to be cured; others said the herbal tea eased their pain. In 1938 in Canada a bill was introduced to authorize Caisse to treat cancer. Instead, the legislature passed a bill that required her to disclose the formula for Essiac. She refused to do so. In 1977 she sold the formula to a Canadian corporation, Resperin.

Essiac is widely available as an herbal health food, without any specific health claims. There are several different versions of the product. There are also many claims and counterclaims about authenticity. In 2000, the US Federal Trade Commission filed a complaint against a distributor of Essiac for misleading health claims on several web sites.


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WHAT ARE THE BENEFITS OF ESSIAC?
Proponents of Essiac claim that it strengthens the immune system, improves appetite, relieves pain and improves overall quality of life. They also claim that it shrinks tumors and prolongs the lives of people with cancer.


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WHY DO PEOPLE WITH HIV USE ESSIAC?
All of the claims that Essiac can help people with HIV seem to have come from Dr. Gary Glum, a chiropractor. In 1988 he wrote "Calling of an Angel," a biography of Rene Caisse. Glum claims to have treated several AIDS patients with Essiac with good results. No report of this study was published.


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HOW IS ESSIAC USED?
Many providers of Essiac claim that the only correct way to use the product is to drink a freshly brewed tea, one to three times a day on an empty stomach. Essiac is available in liquid form but is also sometimes sold as a mixture of herbs to be boiled and steeped by the user or in capsule form.

Caisse reportedly had several variations of the recipe to treat different forms of cancer. Some versions of Essiac have more than the original four ingredients. The added ingredients are supposed to enhance the product's effectiveness and improve its taste. Two common additions are watercress and Pau d'arco. Yellow dock or curly dock are sometimes used instead of sheep's sorrel.


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WHAT ARE THE SIDE EFFECTS?
There are no recorded side effects from the use of Essiac. In 1982, the Canadian Department of National Health and Welfare authorized the availability of Essiac on a "compassionate use" basis. Their decision was based in part on the lack of reports of problems in 78 patients who used Essiac between 1978 and 1982.


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HOW DOES IT INTERACT WITH OTHER THERAPIES?
There are no known interactions between Essiac and medications or other herbs. However, most interactions between herbs and medications have not been studied. Tell your doctor if you are using herbal supplements.


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HOW DO WE KNOW IT WORKS?
Essiac is supported by many personal testimonials from cancer patients, but there are no careful scientific studies. Resperin Corporation received approval in 1978 from the Canadian government to study Essiac in humans. This permission was withdrawn four years later when the studies were not proceeding as expected. The Canadian Government does not consider Essiac to be an effective cancer treatment.

There are no reports of research studies in people with HIV infection. On the other hand, laboratory studies of the herbs used in Essiac document some anti-tumor effects. Carefully designed research studies are needed.


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THE BOTTOM LINE
Essiac is a tea originally made from four herbs. A Canadian nurse developed it in 1922 and used it to treat many cancer patients. Essiac is claimed to strengthen the immune system, relieve pain, and shrink cancerous tumors. Despite many personal reports of health benefits from Essiac, there are no scientific studies to support its use.

Essiac appears to be safe to use. It is available in several forms, based on different recipes, from competing providers. Prices vary widely. Be sure to obtain a complete list of ingredients.



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Revised July 30, 2001



WHAT IS ST. JOHN'S WORT?
St. John's Wort is a flowering plant. ("Wort" is an old English word for an herb or plant.) It grows in many parts of the world. Its scientific name is Hypericum perforatum. All of the aboveground parts of the plant are used. They are collected while the plant is flowering.

St. John's Wort has traditionally been used to treat bruises, burns, and mild depression or anxiety. St. John's Wort contains many different substances that work together. A major compound is hypericin.


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WHAT ARE THE BENEFITS OF ST. JOHN'S WORT?
Currently, the major use of St. John's Wort is to treat mild depression or anxiety. In 1996, the British Medical Journal published a review of scientific studies on St. John's Wort and depression. This review supports the herb's use to treat mild or moderate depression. Exactly how St. John's Wort treats depression is unclear, although it may be similar to the action of some pharmaceutical products.

Hypericin is active against several viruses, including cytomegalovirus, human papillomavirus, hepatitis B, and herpes. This antiviral activity has been shown in the laboratory and animal studies, but not in human studies. The herb seems to work against viruses by oxidation. The herb's antiviral effect is stronger when exposed to light.

St. John's Wort was studied in 1991 in people with HIV disease. The doses were much higher than for treating depression. Patients were given intravenous doses of purified hypericin. The study was stopped when every white-skinned patient in the trial became very sensitive to light. They developed skin rashes and some could not go outside until after they stopped taking hypericin. The one black-skinned patient did not have this reaction.


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WHY DO PEOPLE WITH HIV USE ST. JOHN'S WORT?
Although St. John's Wort has some antiviral activity at high doses, there are no scientific studies to show that it can reduce people's HIV viral load. However, it is effective against mild to moderate depression and anxiety. Many people with HIV have used St. John's Wort for this purpose. Early in 2000, a study showed that St. John's Wort causes a large drop in blood levels in indinavir. See "How Does It Interact With Other Therapies."


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HOW IS ST. JOHN'S WORT USED?
St. John's Wort is used in several forms. The most common form is in capsules containing a powder of the dried plant. It is also used in oil-based preparations, especially for use on the skin. As mentioned earlier, a highly purified form of hypericin was used in research studies but caused serious sensitivity to light.

The British review of the use of St. John's Wort to treat depression found that many different doses were used. The best dosage is not known.


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WHAT ARE THE SIDE EFFECTS?
The only known side effect of St. John's Wort is skin rash and sensitivity to light. This side effect is only seen with a purified extract or at extremely high dosages. St. John's Wort has sometimes been used to increase women's menstrual flow. Pregnant women should not use it.


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HOW DOES IT INTERACT WITH OTHER THERAPIES?
There are very few studies of interactions between St. John's Wort and medications or other herbs. Some bad reactions have been reported in people who combine St. John's Wort with anti-depression medications. Do not use St. John's wort with other antidepressants.

A study published in February 2000 showed that St. John's Wort affects the liver and reduces the levels of indinavir (Crixivan®) in the blood. Even low doses of St. John's Wort made the blood levels of indinavir go down by more than 50%. This could make indinavir ineffective against HIV and allow resistance to develop rapidly. St. John's Wort probably also changes the blood levels of other drugs that are broken down by the liver, including non-nucleoside reverse transcriptase inhibitors and protease inhibitors. DO NOT USE ST. JOHN'S WORT IF YOU ARE TAKING ANTIVIRAL DRUGS. Be sure your doctor knows if you are using St. John's Wort.

However, most antidepressant drugs also change the blood levels of some HIV drugs. You and your doctor should discuss the costs, risks and benefits of different treatments for depression.


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THE BOTTOM LINE
St. John's Wort is a flowering plant used for several health problems. It is mainly used to treat mild or moderate depression. It is active against viruses in the laboratory and in some animal studies. However, high doses of a purified extract used in human studies of its antiviral effect caused serious sensitivity to light.

St. John's Wort interacts with the liver and speeds up the processing of some drugs, including protease inhibitors. Do not use St. John's Wort if you are taking antiviral drugs.

People with HIV may want to take St. John's Wort to deal with mild or moderate depression, if they are not taking anti-HIV drugs. Be sure your doctor knows if you are taking St. John's Wort while taking ANY medications.



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Reviewed July 30, 2001



WHAT IS MARIJUANA?
Marijuana is an herb that grows in many places around the world. It is also called hemp, reefer, or cannabis. Its scientific name is Cannabis sativa. Historically, it has had many uses in different cultures. These including reducing pain and increasing appetite. Marijuana contains chemicals called cannabinoids. The most active one is tetrahydrocannabinol or THC.

Marijuana was legal for medical use in the United States until the late 1930s. Then there were claims of "reefer madness." These led lawmakers to believe that marijuana caused crime, violence, insanity, and death. In 1970, US drug law classified marijuana as having a high potential for abuse and no medical use.

Marijuana was later found to have other health benefits. It can lower pressure within the eye. This can help treat the eye disease called glaucoma, which can cause blindness. However, this would require long-term use of marijuana, which would increase the risk of negative side effects. Marijuana can also prevent vomiting in patients taking chemotherapy treatment for cancer. It can reduce muscle spasms in people with nerve problems like multiple sclerosis. These uses led to the development of the drug dronabinol (Marinol®), a synthetic version of THC.

NOTE: Federal and state laws generally forbid the sale or possession of marijuana. A few states have passed "medical marijuana" laws that permit limited use for health reasons. However, in May 2001 the US Supreme Court ruled that medical use of marijuana is illegal under federal law.


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WHAT ARE THE BENEFITS?
Marijuana reduces pain and anxiety and stimulates the appetite. It also reduces vomiting for people taking strong medications. Higher doses reduce anxiety and make users feel good.


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WHY DO PEOPLE WITH HIV USE MARIJUANA?
People with HIV use marijuana to stimulate appetite and to reduce nausea.

Many people with HIV have low appetite. This can be due to fatigue or drug side effects. Low appetite can lead to AIDS wasting. Marijuana stimulates the appetite, preventing these problems.

Some people with HIV get nauseated when they take antiviral medications. This makes it difficult to take all scheduled doses. Marijuana can help control the nausea.


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HOW IS MARIJUANA USED?
Normally, dried marijuana leaves and flowers are smoked or baked into food. Doctors can legally prescribe Marinol®. Some people get the same effects from Marinol as from smoked marijuana. Others prefer to smoke marijuana. They can use the amount they need without bad effects from higher doses.


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WHAT ARE THE SIDE EFFECTS?
Smoking marijuana causes most of the same health problems as smoking tobacco. Smoked or eaten marijuana can disrupt balance, physical coordination and visual perception. This can make it dangerous to drive a car or operate machinery. Some people feel stoned (very disoriented or dizzy) when using marijuana. This effect can be stronger when marijuana is eaten than when it is smoked.

Some users develop a tolerance to marijuana. This means they need higher and higher doses to get the same effect. Users can also become dependent on marijuana. They may have mild withdrawal symptoms when they stop using it.


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HOW DOES IT INTERACT WITH OTHER THERAPIES?
There are no known interactions between marijuana and medications or other herbs. However, very few interactions between herbs and medications have been studied. Tell your doctor if you are using any herbs or supplements.

A research study found that smoking marijuana does not increase HIV viral load.


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HOW DO WE KNOW IT WORKS?
There are many scientific studies that document marijuana's ability to reduce nausea, to increase appetite, and to decrease pressure in the eye.


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THE BOTTOM LINE
Marijuana is an herb that is smoked or baked into food. It has been used for health purposes for thousands of years. It was legal in the United States until the 1930s. It stimulates the appetite, reduces nausea, and reduces pressure inside the eye.


US drug policy made marijuana illegal in 1970. However, doctors can prescribe Marinol. It is a synthetic version of THC, the most active substance in marijuana. Not everyone gets the same results from Marinol as from marijuana.

Some people with AIDS use marijuana to stimulate their appetites or to avoid nausea when taking their antiviral medications. A few states have passed medical marijuana laws that permit limited use for health purposes.

For more information, read the Institute of Medicine (IOM) 1999 report, Marijuana and Medicine: Assessing the Science Base; Joy, Janet E., editor. Call (800) 624-6242, or read it or order it on-line at http://www.nap.edu.



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Revised May 14, 2001



WHAT IS SILYMARIN?
Silymarin refers to the extract from the seeds of the plant Silybum marianum, also called "milk thistle". It has been used for over 2,000 years. During the Middle Ages the seed of the milk thistle was commonly used to treat liver diseases.

The active ingredients of milk thistle are chemicals called flavonoids. The flavonoids in milk thistle are silybin, silydianin, and silychristin. Together, they are called silymarin.


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WHAT ARE THE BENEFITS OF SILYMARIN?
Silymarin protects the liver by acting as an antioxidant and by promoting the growth of new liver cells. Silymarin also helps with the digestion of fats. It appears to help keep harmful substances out of liver cells.

Milk thistle can help prevent or reverse liver damage caused by alcohol, recreational drugs, pesticides, some poisons, or hepatitis.

Silymarin has been used (especially in Europe) to treat hepatitis, liver damage due to alcoholism, and poisoning by certain types of mushrooms.

There is no evidence that silymarin acts directly against HIV.


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WHY DO PEOPLE WITH HIV USE SILYMARIN?
Some medicines used to fight HIV can damage the liver. People who have had hepatitis are more likely to have liver problems when they take anti-HIV drugs. Milk thistle might help prevent liver damage.

Several anti-HIV drugs can cause stomach problems, and silymarin can help treat indigestion.


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HOW IS SILYMARIN USED?
Silymarin is an extract of the seeds of the milk thistle plant. A standardized extract should be 80% silymarin (the active ingredient).

The usual dosage of milk thistle extract is between 300 milligrams (mg) and 600 mg daily.


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WHAT ARE THE SIDE EFFECTS?
There are no documented side effects of milk thistle. Even very high doses do not seem to have any negative effects. However, some people get an upset stomach or have more gas when they start using silymarin. If this happens, cut back on your dosage and then increase it slowly.


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HOW DOES IT INTERACT WITH OTHER THERAPIES?
There are no documented interactions of milk thistle with other therapies.


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HOW DO WE KNOW IT WORKS?
Milk thistle has been used for over 2,000 years, so a lot has been written about its health effects. There have been over 300 scientific studies of silymarin that document:

Antioxidant effects
Treatment of cirrhosis of the liver caused by alcoholism
Treatment of chronic hepatitis
Treatment of poisoning due to eating wild mushrooms
Helping the liver repair itself
Most of the scientific studies of silymarin were published in Europe.


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THE BOTTOM LINE
Silymarin is an extract of the seeds of the milk thistle plant. It has been used for over 2,000 years to treat liver problems. No side effects or dangerous interactions have been noted.

For people with HIV, especially if they have had hepatitis, silymarin might help protect the liver from damage caused by antiviral medications. It might also reduce stomach upset caused by medications.


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Note: This Fact Sheet is based on the work of Direct AIDS Alternative Information Resources (DAAIR). For more details, contact DAAIR at 1-888-951-5433 or http://www.daair.org.



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Reviewed March 29, 2001


[ Edit | View ]

Currently Approved Drugs for HIV -- TKC, 08:18:24 01/28/02 Mon

Currently Approved Drugs for HIV: A Comparative Chart
Protease Inhibitors (PIs)
Drug Adult Dosing Possible Side Effects Notes
Fortovase® (saquinavir soft gel capsules), by Roche Laboratories Eight 200-mg capsules, twice a day, or Six 200-mg capsules, three times a day (a total of 16-18 pills a day) Nausea; diarrhea; stomach discomfort; insomnia; headache; increased liver enzyme levels
See long-term side effects below. Take within one hour of a full meal, preferably containing at least 28 grams of fat. Should refrigerate for long-term storage (greater than 3 months), otherwise, room temperature storage is okay.
Norvir® (ritonavir), by Abbott Laboratories Six 100-mg capsules, twice a day* (a total of 12 pills a day). Start with 3 capsules, twice a day, and increase to full dose over 14 days. Nausea; vomiting; diarrhea; loss of appetite; stomach discomfort; oral tingling and numbness; increased liver enzyme levels
See long-term side effects below. Take with food. High-fat snacks may reduce side effects. Capsules and oral solution may be stored at room temperature, but should be refrigerated in hot weather. Solution can be mixed with chocolate syrup, chocolate ice cream, or Ensure® to mask the taste. Used at lower doses to enhance other protease inhibitors.
Crixivan® (indinavir), by Merck & Co. Two 400-mg capsules, every 8 hours (a total of 6 pills a day) Kidney stones (seen in 6 - 8% of patients); nausea; vomiting; diarrhea; stomach discomfort; headache; insomnia; rash; back pain
See long-term side effects below. Take on an empty stomach (no food two hours before or one hour after dosing), or with a light, low-fat snack. Drink at least 48 ounces (six 8-oz. glasses) of water daily to prevent kidney stones.
Viracept® (nelfinavir), by Agouron Pharmaceuticals Three 250-mg tablets, three times a day, or five 250-mg tablets twice a day (a total of 9-10 pills a day) Diarrhea (common); nausea; stomach discomfort; gas; rash; increased liver enzyme levels
See long-term side effects below. Take with a meal or light snack.
Agenerase™ (amprenavir), by GlaxoSmithKline Eight 150-mg capsules, twice a day (a total of 16 pills a day) Rash (seen in 20% of patients); diarrhea; nausea; vomiting; oral tingling and numbness
See long-term side effects below. Take with or without food, however high-fat meals should be avoided.
Kaletra™ (lopinavir + ritonavir), by Abbott Laboratories Three capsules, twice a day (a total of 6 pills a day). Each capsule contains 133.3 mg lopinavir + 33.3 mg ritonavir. Diarrhea (common); nausea; feeling week/tired; headache
More rarely: Pancreatitis
See long-term side effects below.
Take with a meal or light snack. If combining with Sustiva™ (efavirenz), dose should be increased to 4 capsules, twice a day (a total of 8 pills a day). Should refrigerate for long-term storage (greater than 2 months), otherwise, room temperature storage is okay.
Long-term side effects of protease inhibitors: Use of protease inhibitors may be associated with changes in blood sugar levels (and rarely, development of diabetes), elevations in blood fat levels, and changes in the way the body stores fat (including development of fat deposits in the abdomen and on the back of the shoulders as well as loss of fat in the arms, legs and face) -- see our lesson on Lipodystrophy. In addition, there have been reports of uncontrolled bleeding in hemophiliacs.
Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTIs)
Drug Adult Dosing Possible Side Effects Notes
Retrovir® (AZT), by GlaxoSmithKline One 300-mg tablet, twice a day* (a total of 2 pills a day) Nausea; stomach discomfort; headache; insomnia
More rarely: Muscle wasting; anemia (low red blood cell count); neutropenia (low white blood cell count)
See long-term side effects below. Taking with food may minimize stomach discomfort.
Epivir® (3TC), by GlaxoSmithKline One 150-mg tablet, twice a day* (a total of 2 pills a day) Nausea
See long-term side effects below. Take with or without food.
Combivir® (AZT+3TC), by GlaxoSmithKline One tablet (contains 300mg AZT + 150mg 3TC), twice a day (a total of 2 pills a day) Nausea; loss of appetite; headache; fatigue; stomach discomfort
More rarely: Muscle wasting; anemia (low red blood cell count); neutropenia (low white blood cell count)
See long-term side effects below.
Take with or without food, however taking it with food may minimize stomach upset.
Trizivir™ (AZT+3TC + abacavir), by GlaxoSmithKline One tablet (contains 300mg AZT + 150mg 3TC + 300mg abacavir), twice a day (a total of 2 pills a day) Similar side effects to Retrovir (AZT), Epivir (3TC), and Ziagen (abacavir), listed above. Please note Ziagen's serious allergic reactions.
See long-term side effects below. Take with or without food. Do not take Trizivir if you weigh less than 90 pounds (40 kg).
Ziagen™ (abacavir), by GlaxoSmithKline One 300-mg tablet, twice a day* (a total of 2 pills a day) Nausea; vomiting; diarrhea; loss of appetite; insomnia

Serious allergic reactions have been reported in about 3 - 5% of patients, with one death. The signs and symptoms of this reaction include fever, malaise, severe nausea, diarrhea, abdominal pain, sore throat, cough, shortness of breath, and rash. If allergic reaction is diagnosed, therapy should be discontinued and NOT restarted. Symptoms of allergic reactions usually appear within six weeks of starting therapy and resolve within 24-48 hours of stopping the drug. A rash without other signs of allergic reaction has also been reported in about 7% of patients. These rashes can usually be managed without stopping therapy.
See long-term side effects below.
Take with or without food.
Videx® (ddI): buffered versions, by Bristol-Myers Squibb Two 100-mg tablets twice a day* (a total of 4 pills a day), or Two 200-mg tablets, once a day (a total of 2 pills a day). For patients weighing less than 133 lbs. (60 kg), click here. Numbness, tingling, or pain in the hands or feet (peripheral neuropathy, seen in 15% of patients); nausea; diarrhea; headache; vomiting; rash
More rarely: Pancreatitis
See long-term side effects below. Clinical data supports twice-daily dosing as more effective. Take on an empty stomach (2 hours after & 30 minutes before a meal). Okay to take at the same time as all NRTIs, Viramune, & Sustiva. Rescriptor & Crixivan must be taken at least 1 hour prior, and Viramune can be taken 1 hour after. Kaletra should be taken at least 1 hour after, or 2 hours before. Avoid alcohol.
Videx® EC (ddI): delayed-release capsules, by Bristol-Myers Squibb One 400-mg capsule once a day. For patients weighing less than 133 lbs. (60 kg), the dose is one 250-mg capsule once a day. Numbness, tingling, or pain in the hands or feet (peripheral neuropathy, seen in 15% of patients); nausea; diarrhea; headache; vomiting; rash
More rarely: Pancreatitis
See long-term side effects below. Clinical data supports twice-daily dosing of the buffered versions of Videx as more effective. Videx EC is indicated for adults whose management requires once-daily dosing or a non-buffered version of ddI. Take Videx EC on an empty stomach (2 hours after & 1 hour before a meal). Avoid alcohol.
Zerit® (d4T), by Bristol-Myers Squibb One 40-mg capsule, every 12 hours (a total of 2 pills a day). For patients weighing less than 133 lbs. (60 kg), click here. Nausea; numbness, tingling, or pain in the hands or feet (peripheral neuropathy)
See long-term side effects below. Take with or without food.
Hivid® (ddC), by Roche Laboratories One 0.75-mg tablet, every 8 hours (a total of 3 pills a day) Numbness, tingling, or pain in the hands or feet (peripheral neuropathy, seen in 17-31% of patients); nausea; mouth ulcers
See long-term side effects below. Works best if taken on an empty stomach.
Viread™ (tenofovir DF), by Gilead Sciences One 300-mg tablet once a day. Nuasea, vomiting, diarrhea, and flatulence (intestinal gas).
See long-term side effects below.
Works best if taken with food, preferably a meal that contains some fat.
Long-term side effects of NRTIs: NRTIs have been associated with damage to the mitochondria (the cell parts that provide energy to the cell). This damage may cause low red and white blood cell counts, muscle pain and wasting (particularly in the arms and legs), fatigue, peripheral neuropathy, and more rarely, serious liver (lactic acidosis) or pancreas problems.
Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)
Drug Adult Dosing Possible Side Effects Notes
Viramune® (nevirapine), by Roxane Laboratories One 200-mg tablet per day for 14 days, then one 200-mg tablet, twice a day*, or two 200-mg once a day (a total of 2 pills a day) Rash; stomach upset; headaches; increased liver enzyme levels

More rarely: hepatitis Take with or without food. Once daily dosing recommendation based on limited clinical data.
Rescriptor® (delavirdine), by Agouron Pharmaceuticals Two 200-mg tablets, three times a day (a total of 6 pills a day) Rash; headache; fatigue; stomach upset; elevated liver enzymes Take with or without food.
Sustiva™ (efavirenz), by Bristol-Myers Squibb Three 200-mg capsules once a day (a total of 3 pills a day) Rash; drowsiness; insomnia; confusion; inability to concentrate; dizziness; vivid dreams; nausea; stomach discomfort; fever; insomnia; elevated liver enzymes Take with or without food, however high-fat foods should be avoided. Dose should be taken at bedtime to minimize dizziness, drowsiness and impaired concentration.

*available in oral solution/mix for children or for patients who have trouble swallowing pills


[ Edit | View ]

HIV Infection and AIDS, An Overview-English and Espanol -- moonotter, 21:17:30 01/29/02 Tue

HIV Infection and AIDS, An Overview
National Institutes of Health, National Institute for Allergy and Infectious Disease - May 2000



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AIDS -- acquired immunodeficiency syndrome -- was first reported in the United States in 1981 and has since become a major worldwide epidemic. AIDS is caused by the human immunodeficiency virus (HIV). By killing or damaging cells of the body's immune system, HIV progressively destroys the body's ability to fight infections and certain cancers. People diagnosed with AIDS may get life-threatening diseases called opportunistic infections, which are caused by microbes such as viruses or bacteria that usually do not make healthy people sick.

More than 700,000 cases of AIDS have been reported in the United States since 1981, and as many as 900,000 Americans may be infected with HIV. The epidemic is growing most rapidly among minority populations and is a leading killer of African American males. According to the U.S. Centers for Disease Control and Prevention (CDC), AIDS affects six times more African Americans than whites and three times more Hispanics than whites.

Transmission
HIV is spread most commonly by having sex with an infected partner. The virus can enter the body through the lining of the vagina, vulva, penis, rectum, or mouth during sex.

HIV also is spread through contact with infected blood. Before blood was screened for evidence of HIV infection and before heat-treating techniques to destroy HIV in blood products were introduced, HIV was transmitted through transfusions of contaminated blood or blood components. Today, because of blood screening and heat treatment, the risk of getting HIV from such transfusions is extremely small.

HIV frequently is spread among injection drug users by the sharing of needles or syringes contaminated with very small quantities of blood from someone infected with the virus. It is rare, however, for a patient to give HIV to a health care worker or vice-versa by accidental sticks with contaminated needles or other medical instruments.

Women can transmit HIV to their babies during pregnancy or birth. Approximately one-quarter to one-third of all untreated pregnant women infected with HIV will pass the infection to their babies. HIV also can be spread to babies through the breast milk of mothers infected with the virus. If the mother takes the drug AZT during pregnancy, she can reduce significantly the chances that her baby will be infected with HIV. If doctors treat mothers with AZT and deliver their babies by cesarean section, the chances of the baby being infected can be reduced to a rate of 1 percent.

A study sponsored by NIAID in Uganda found a highly effective and safe drug regimen for preventing transmission of HIV from an infected mother to her newborn that is more affordable and practical than any other examined to date. Interim results from the study show that a single oral dose of the antiretroviral drug nevirapine (NVP) given to an HIV-infected woman in labor and another to her baby within three days of birth reduces the transmission rate by half compared with a similar short course of AZT.

Although researchers have detected HIV in the saliva of infected individuals, no evidence exists that the virus is spread by contact with saliva. Laboratory studies reveal that saliva has natural properties that limit the power of HIV to infect. Research studies of people infected with HIV have found no evidence that the virus is spread to others through saliva such as by kissing. No one knows, however, whether so-called "deep kissing," involving the exchange of large amounts of saliva, or oral intercourse increase the risk of infection. Scientists also have found no evidence that HIV is spread through sweat, tears, urine, or feces.

Studies of families of HIV-infected people have shown clearly that HIV is not spread through casual contact such as the sharing of food utensils, towels and bedding, swimming pools, telephones, or toilet seats. HIV is not spread by biting insects such as mosquitoes or bedbugs.

HIV can infect anyone who practices risky behaviors such as:

sharing drug needles or syringes, or having sexual contact with an infected person without using a condom or with someone whose HIV status is unknown.
Having a sexually transmitted disease such as syphilis, genital herpes, chlamydial infection, gonorrhea, or bacterial vaginosis appears to make people more susceptible to acquiring HIV infection during sex with infected partners.

Early Symptoms
Many people do not develop any symptoms when they first become infected with HIV. Some people, however, have a flu-like illness within a month or two after exposure to the virus. This illness may include fever, headache, tiredness, and enlarged lymph nodes (organs of the immune system easily felt in the neck and groin). These symptoms usually disappear within a week to a month and are often mistaken for those of another viral infection. During this period, people are very infectious, and HIV is present in large quantities in genital fluids.

More persistent or severe symptoms may not surface for a decade or more after HIV first enters the body in adults, or within two years in children born with HIV infection. This period of "asymptomatic" infection is highly individual. Some people may begin to have symptoms as soon as a few months, while others may be symptom-free for more than 10 years. During the asymptomatic period, however, the virus is actively multiplying, infecting, and killing cells of the immune system. HIV's effect is seen most obviously in a decline in the blood levels of CD4+ T cells (also called T4 cells) -- the immune system's key infection fighters. At the beginning of its life in the human body, the virus disables or destroys these cells without causing symptoms.

As the immune system deteriorates, a variety of complications start to take over. For many people, their first sign of infection is large lymph nodes or "swollen glands" that may be enlarged for more than three months. Other symptoms often experienced months to years before the onset of AIDS include: lack of energy, weight loss, frequent fevers and sweats, persistent or frequent yeast infections (oral or vaginal), persistent skin rashes or flaky skin, pelvic inflammatory disease in women that does not respond to treatment, or short-term memory loss. ome people develop frequent and severe herpes infections that cause mouth, genital, or anal sores, or a painful nerve disease called shingles. Children may grow slowly or be sick a lot.
AIDS
The term AIDS applies to the most advanced stages of HIV infection. The CDC in Atlanta, GA, develops official criteria for the definition of AIDS and is responsible for tracking the spread of AIDS in the United States.

CDC's definition of AIDS includes all HIV-infected people who have fewer than 200 CD4+ T cells per cubic millimeter of blood. (Healthy adults usually have CD4+ T-cell counts of 1,000 or more.) In addition, the definition includes 26 clinical conditions that affect people with advanced HIV disease. Most of these conditions are opportunistic infections, which rarely cause harm in healthy people. In people with AIDS, these infections are often severe and sometimes fatal because the immune system is so ravaged by HIV that the body cannot fight off certain bacteria, viruses, fungi, parasites, and other microbes.

Opportunistic infections common in people with AIDS cause symptoms such as:

coughing and shortness of breath,
seizures and lack of coordination,
difficult or painful swallowing,
mental symptoms such as confusion and forgetfulnesss,
severe and persistent diarrhea,
fever,
vision loss,
nausea, abdominal cramps, and vomiting,
weight loss and extreme fatigue,
severe headaches, and
coma.
Although children with AIDS may get the same opportunistic infections as adults with the disease, they also experience severe forms of the bacterial infections which all children may get, such as conjunctivitis (pink eye), ear infections, and tonsillitis.

People with AIDS are particularly prone to developing various cancers, especially those caused by viruses such as Kaposi's sarcoma and cervical cancer, or cancers of the immune system known as lymphomas. These cancers are usually more aggressive and difficult to treat in people with AIDS. Signs of Kaposi's sarcoma in light-skinned people are round brown, reddish, or purple spots that develop in the skin or in the mouth. In dark-skinned people, the spots are more pigmented.

During the course of HIV infection, most people experience a gradual decline in the number of CD4+ T cells, although some may have abrupt and dramatic drops in their CD4+ T-cell counts. A person with CD4+ T cells above 200 may experience some of the early symptoms of HIV disease. Others may have no symptoms even though their CD4+ T-cell count is below 200.

Many people are so debilitated by the symptoms of AIDS that they cannot hold steady employment or do household chores. Other people with AIDS may experience phases of intense life-threatening illness followed by phases in which they function normally.

A small number of people (fewer than 50) initially infected with HIV 10 or more years ago have not developed symptoms of AIDS. Scientists are trying to determine what factors may account for their lack of progression to AIDS, such as particular characteristics of their immune systems or whether they were infected with a less aggressive strain of the virus, or if their genes may protect them from the effects of HIV. Scientists hope that understanding the body's natural method of control may lead to ideas for protective HIV vaccines and use of vaccines to prevent the disease from progressing.

Diagnosis
Because early HIV infection often causes no symptoms, a doctor or other health care worker usually can diagnose it by testing a person's blood for the presence of antibodies (disease-fighting proteins) to HIV. HIV antibodies generally do not reach levels in the blood which the doctor can see until one to three months following infection, and it may take the antibodies as long as six months to be produced in quantities large enough to show up in standard blood tests.

People exposed to the virus should get an HIV test as soon as they are likely to develop antibodies to the virus. By getting tested early, they can get the right treatment at a time when their immune systems are most able to combat HIV and thus prevent the emergence of certain opportunistic infections (see Treatment below). Early testing also alerts HIV-infected people to avoid high-risk behaviors that could spread the virus to others.

Most doctors' offices or health clinics can do HIV testing and will usually offer counseling to the patient at the same time. Of course, individuals can be tested anonymously at many sites if they are concerned about confidentiality.

Doctors diagnose HIV infection by using two different types of antibody tests, ELISA and Western Blot. If a person is highly likely to be infected with HIV and yet both tests are negative, a doctor may look for HIV itself in the blood. The person also may be told to repeat antibody testing at a later date, when antibodies to HIV are more likely to have developed.

Babies born to mothers infected with HIV may or may not be infected with the virus, but all carry their mothers' antibodies to HIV for several months. If these babies lack symptoms, a definitive diagnosis of HIV infection using standard antibody tests cannot be made until after 15 months of age. By then, babies are unlikely to still carry their mothers' antibodies and will have produced their own, if they are infected. New technologies to detect HIV itself are being used to more accurately determine HIV infection in infants between ages 3 months and 15 months. A number of blood tests are being evaluated to determine if they can diagnose HIV infection in babies younger than 3 months.

Treatment
When AIDS first surfaced in the United States, no medicines were available to combat the underlying immune deficiency and few treatments existed for the opportunistic diseases that resulted. Over the past 10 years, however, researchers have developed drugs to fight both HIV infection and its associated infections and cancers.

The Food and Drug Administration has approved a number of drugs for treating HIV infection. The first group of drugs used to treat HIV infection, called nucleoside reverse transcriptase (RT) inhibitors, interrupts an early stage of the virus making copies of itself. Included in this class of drugs (called nucleoside analogs) are AZT (also known as zidovudine or ZDV), ddC (zalcitabine), ddI (dideoxyinosine), d4T (stavudine), and 3TC (lamivudine). These drugs may slow the spread of HIV in the body and delay the onset of opportunistic infections.

Non-nucleoside reverse transcriptase inhibitors (NNRTIs), such as delvaridine (Rescriptor) and nevirapine (Viramune), are also available for use in combination with other antiretroviral drugs.

More recently, a second class of drugs has been approved for treating HIV infection. These drugs, called protease inhibitors, interrupt virus replication at a later step in its life cycle. They include ritonavir (Norvir), saquinivir (Invirase), indinavir (Crixivan), amprenivir (Agenerase), and nelfinavir (Viracept). Because HIV can become resistant to both classes of drugs, combination treatment using both is necessary to effectively suppress the virus.

Currently available antiretroviral drugs do not cure people of HIV infection or AIDS, however, and they all have side effects that can be severe. Some of the nucleoside RT inhibitors may cause a depletion of red or white blood cells, especially when taken in the later stages of the disease. Some may also cause an inflammation of the pancreas and painful nerve damage. Other complications, including lactic acidosis and severe hepatomegaly (enlarged liver) with steatosis (fatty liver) that may result in liver failure and death, have also been reported with the use of antiretroviral nucleoside analogs alone or in combination, including AZT, ddI, ddC, 3TC, and abacavir.

The most common side effects associated with protease inhibitors include nausea, diarrhea, and other gastrointestinal symptoms. In addition, protease inhibitors can interact with other drugs resulting in serious side effects.

Researchers have credited highly active antiretroviral therapy, or HAART, as being a major factor in reducing the number of deaths from AIDS in this country by 47 percent in 1997. HAART is a combination of several drugs to treat patients. These drugs include reverse transcriptase inhibitors and protease inhibitors. Patients who are newly infected with HIV as well as AIDS patients can take the combination.

HAART is not a cure. The health of HIV and AIDS patients has benefited dramatically by combining protease inhibitors with other AIDS drugs, but there are drawbacks. Also, though HIV may not be found in the patients successfully treated with HAART, researchers know that it is still present, lurking in hiding places such as the lymph nodes, the brain, testes, and the retina of the eye.

A number of drugs are available to help treat opportunistic infections to which people with HIV are especially prone. These drugs include foscarnet and ganciclovir, used to treat cytomegalovirus eye infections, fluconazole to treat yeast and other fungal infections, and trimethoprim/sulfamethoxazole (TMP/SMX) or pentamidine to treat Pneumocystis carinii pneumonia (PCP).

In addition to antiretroviral therapy, adults with HIV whose CD4+ T-cell counts drop below 200 are given treatment to prevent the occurrence of PCP, which is one of the most common and deadly opportunistic infections associated with HIV. Children are given PCP preventive therapy when their CD4+ T-cell counts drop to levels considered below normal for their age group. Regardless of their CD4+ T-cell counts, HIV-infected children and adults who have survived an episode of PCP are given drugs for the rest of their lives to prevent a recurrence of the pneumonia.

HIV-infected individuals who develop Kaposi's sarcoma or other cancers are treated with radiation, chemotherapy or injections of alpha interferon, a genetically engineered naturally occurring protein.

Prevention
Because no vaccine for HIV is available, the only way to prevent infection by the virus is to avoid behaviors that put a person at risk of infection, such as sharing needles and having unprotected sex.

Many people infected with HIV have no symptoms. Therefore, there is no way of knowing with certainty whether a sexual partner is infected unless he or she has repeatedly tested negative for the virus -- and has not engaged in any risky behavior.

People should either abstain from having sex or or use latex condoms, which may offer partial protection, during oral, anal, or vaginal sex. Only condoms made of latex should be used, and water-based lubricants should be used with latex condoms.

Although some laboratory evidence shows that spermicides can kill HIV, researchers have not found that these products can prevent a person from getting HIV.

The risk of HIV transmission from a pregnant woman to her baby is significantly reduced if she takes AZT during pregnancy, labor and delivery, and her baby takes it for the first six weeks of life.

Research
NIAID-supported investigators are conducting an abundance of research on HIV infection, including the development and testing of HIV vaccines and new therapies for the disease and some of its associated conditions. Twenty-eight HIV vaccines are being tested in people, and many drugs for HIV infection or AIDS-associated opportunistic infections are either being developed or being tested. Researchers also are investigating exactly how HIV damages the immune system. This research is suggesting new and more effective targets for drugs and vaccines. NIAID-supported investigators also continue to trace how the disease progresses in different people.

Scientists are investigating and testing chemical barriers, such as topical microbicides, that people can use in the vagina or in the rectum during sex to prevent HIV transmission. They also are looking at other ways to prevent transmission such as controlling sexually transmitted diseases and modifying people's behavior as well as ways to prevent transmission from mother to child.

Resources
For information about Food and Drug Administration-approved HIV-related clinical trials being conducted throughout the United States, call the AIDS Clinical Trials Information Service:

1-800-TRIALS-A
(1-800-874-2572)
1-800-243-7012 (TDD/Deaf Access)



For federally approved treatment guidelines on HIV/AIDS, call the HIV/AIDS Treatment Information Service:



1-800-HIV-0440
(1-800-448-0440)
1-800-243-7012 (TDD/Deaf Access)



Both services operate from 9 a.m. to 7 p.m. Eastern Time, Monday through Friday. Spanish-speaking specialists are available.

To obtain information specifically about clinical trials conducted by the NIAID Intramural AIDS Research Program, call 1-800-243-7644.

To obtain materials for adolescents with HIV, or more information about adolescents and HIV, contact the National Prevention Information Network at 1-800-458-5231 or 1-800-243-7012 (TDD/Deaf Access).



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NIAID, a component of the National Institutes of Health, supports research on AIDS, tuberculosis and other infectious diseases as well as allergies and immunology.

Prepared by:
Office of Communications and Public Liaison
National Institute of Allergy and Infectious Diseases
National Institutes of Health
Bethesda, MD 20892

Public Health Service
U.S. Department of Health and Human Services

DT 20000501
DOCN: NIAID2000_FACT_SHEET_HIVINF


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Source: National Institute of Allergy and Infectious Disease (NIAID). NIAID, a component of the National Institutes of Health (NIH), supports research on AIDS, tuberculosis, malaria and other infectious diseases, as well as allergies and immunology. NIH is an agency of the U.S. Department of Health and Human Services.

ÆGiS is made possible through unrestricted grants from Roxane Laboratories, Inc., iMetrikus, Inc., the National Library of Medicine, and donations from users like you. Always watch for outdated information. This article first appeared in 2000. This material is designed to support, not replace, the relationship that exists between you and your doctor.

ÆGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1990, 2000. ÆGiS & the Sisters of Saint Elizabeth of Hungary. All materials appearing on ÆGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of ÆGIS and the Sisters of Saint. Elizabeth of Hungary, or the party credited as the provider of the content.


Espanol
¿QUE SIGNIFIQUE "SIDA"?
SIDA es siglas para Síndrome de InmunoDeficiencia Adquirido:

Un Síndrome es un grupo de problemas de salud que constituyen una enfermedad;
Una Deficiencia Inmunológica es una debilidad en el sistema del cuerpo que combate las enfermedades;
Adquirido significa que puede contraerlo.
El SIDA es causado por un virus llamado el VIH: Virus de Inmunodeficiencia humano. Si usted se infecta con el VIH, su cuerpo intentará atacar la infección, y creará "anticuerpos", moléculas especiales que combaten el VIH.

Cuando se hace una prueba de sangre para el VIH, la prueba busca dichos anticuerpos. Si los tiene en su sangre, significa que está infectada por el VIH. Las personas que tienen los anticuerpos contra el VIH se llaman "VIH-positivo."

Siendo VIH-positivo, o teniendo la enfermedad de VIH, no es igual que tener SIDA. Muchas personas son VIH-positivas pero no se enferman durante muchos años. Cuando la infección continúa, desgasta el sistema inmunológico. Los virus, parásitos, hongos y bacteria que normalmente no causan ningún problema pueden enfermarlo si su sistema inmunológico se daña. Éstas enfermedades se llaman "infecciones oportunistas."


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¿COMO SE CONTRAE EL SIDA?
La sangre, el fluido vaginal, el semen, y la leche materna de las personas VIH-infectadas tiene bastante virus para infectar a otras personas. Puede contraer el VIH de cualquier persona que este infectada, aun cuando ellos no parecen enfermos, o no han salido positivo (todavía). La mayoría de las personas contraen el virus de VIH:

Por tener sexo con alguien infectado;
Por compartir una aguja (tomando drogas) con alguien infectado;
Por nacer cuando la madre esta infectada, o por beber la leche maternal de una mujer infectada.
Conseguir una transfusión de sangre de un donador infectado era manera de contraer el SIDA, pero ahora el suministro de la sangre se protege muy cuidadosamente y el riesgo es sumamente bajo.

No hay ningún caso documentado de que el VIH se haya transmitido por las lágrimas o la saliva, pero es posible transmitir el VIH a través del sexo oral, sobre todo si tiene heridas abiertas en su boca o las encías sangrantes.

En los Estados Unidos, hay entre 800,000 y 900,000 personas VIH-positivas. Más de 300,000 personas viven con SIDA. Cada año, hay unas 40,000 nuevas infecciones. Durante los años 90, el SIDA estaba una causa principal de muerte. Sin embargo, tratamientos nuevos han bajado dramáticamente la tasa de muertos debidos al SIDA.


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¿QUE PASA SI SOY VIH-POSITIVO?
Usted no podría saber si se infecta por el VIH. Algunas personas tienen fiebre, dolor de cabeza, estómago, músculos o articulaciones, glándulas linfáticas hinchadas, o un salpullido superficial durante una o dos semanas. La mayoría piensa que es la gripe. Algunas personas no tienen ningún síntoma.

El virus se multiplicará en su cuerpo durante unas semanas o incluso unos meses antes de que su sistema inmunológico responda. Durante este tiempo, puede tener resultado negativo para el VIH, pero puede infectar a otras personas. Cuando su sistema inmunológico responde, empieza a crear anticuerpos. Cuando esto ocurre, usted será VIH-positivo.

Después de los primeros síntomas, algunas personas con el VIH quedan saludables durante diez años o más. Pero durante este tiempo, el VIH está dañando su sistema inmunológico.

Una manera de medir el daño a su sistema inmunológico es contar sus células CD4+. Estas células, también llamado células "T-auxiliadores", son una parte importante del sistema inmunológico. Las personas saludables tienen entre 500 y 1,500 células CD4+ por mililitro de sangre.

Sin tratamiento su conteo de células CD4+ bajará. Podría empezar a tener señales de enfermedad del VIH como fiebres, sudores nocturnos, diarrea, o nodos de la linfa hinchados. Si está VIH-infectado, estos problemas durarán más de unos días, y probablemente continuarán durante varias semanas.


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¿COMO SE SI TENGO EL SIDA?
La enfermedad del VIH se vuelve SIDA cuando su sistema inmunológico está tan dañado que tiene menos de 200 células CD4+ o es atacado por una infección oportunista. Hay una lista "oficial" de estas infecciones, publicada por El Centro de Control de Enfermedades (en ingles, Centers for Disease Control, o CDC). Las más comunes son:

Neumonía neumocitis carinii, una infección pulmonar (siglas en inglés: PCP);
Sarcoma de Kaposi, un cáncer superficial (siglas en inglés: KS);
CMV (Citomegalovirus), una infección que normalmente afecta los ojos; y
Candidiasis, una infección fungina que puede causar manchitas blancas en la boca o infecciones en la garganta o la vagina.
El síndrome del SIDA también incluye pérdida de peso seria, tumores del cerebro, y otros problemas de salud. Sin tratamiento, estos problemas pueden llevarlo a la muerte.

El SIDA es diferente en cada persona infectada. Algunas personas mueren pronto después de infectarse, mientras otros viven casi normalmente durante muchos años, aun después de que ellos tienen el SIDA "oficialmente".



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¿HAY UNA CURA PARA EL SIDA?
No hay ninguna cura para el SIDA. Hay medicamentos que pueden reducir su progresión y reducen la velocidad del daño a su sistema inmunológico. Pero no hay ninguna manera de sacar todo el VIH de su cuerpo.

Hay otros medicamentos que puede tomar para prevenir o tratar algunas de las infecciones oportunistas. En la mayoría de casos, estos medicamentos funcionan muy bien. Sin embargo, algunas infecciones todavía son muy difíciles para tratar.

001206
001e-what-is-aids


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Copyright © 2001 - La InfoRed SIDA de Nuevo México es un proyecto del Centro para la Educación y Entrenamiento sobre el SIDA de Nuevo México de Nuevo México de Nuevo México

Parcialmente consolidado por la Biblioteca Nacional de Medicina y el Departamento de Salud de Nuevo México


[ Edit | View ]

Immune Failure Delayed by Continuing Treatment With PI After Virologic Failure -- moonotter, 19:06:20 02/27/02 Wed


[Publication Logo]
Immune Failure Delayed by Continuing Treatment With PI After Virologic Failure

Reuters Health Information 2002. © 2002 Reuters Ltd
Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.
Introduction
NEW YORK (Reuters Health) Feb 19 - CD4+ cell counts stay elevated longer when patients who experience virologic failure while on at least one protease inhibitor (PI) continue to take medication rather than stopping therapy altogether, according to California investigators.

Dr. Steven G. Deeks and associates, of the University of California, San Francisco, followed 291 patients who maintained CD4+ cell counts higher than their pre-therapy counts, despite virologic failure.

As the researchers report in the January 25th issue of AIDS, the median time to immunologic failure--return of CD4+ cell counts to below those measured before PI treatment was initiated--was 3.1 years. However, only 36.8% of patients who remained on therapy experienced immunological failure by 3 years.

"This observation suggests that therapy selects for a virus with reduced ability to deplete CD4 T cells (i.e., reduced virulence or reduced pathogenicity)," the California research team posits.

The time to immunologic failure was also associated with the change in viral load from a pre-therapy baseline, such that those with a smaller degree of viral suppression exhibited a higher risk of decline in CD4+ cell counts. The absolute level of viremia after virologic failure was a less significant factor, the authors report.

"Compared to patients with a plasma HIV RNA level <2.98 log-10 copies/mL, only those with the very highest levels of viremia (> 4.5 log-10 copies/mL) were at increased risk of immunologic failure after adjustment for the change in HIV RNA levels from pre-therapy levels," the investigators write.

Based on these estimations, Dr. Deeks and his colleagues suggest that current recommendations to switch therapy as soon as virologic failure occurs may not be practical for many patients. "Our data provide support for a more conservative strategy, particularly for those patients with limited therapeutic options," they recommend.

AIDS 2002;16:201-207.


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Immune Failure Delayed by Continuing Treatment With PI After Virologic Failure -- moonotter, 19:19:34 02/27/02 Wed


[Publication Logo]
Immune Failure Delayed by Continuing Treatment With PI After Virologic Failure

Reuters Health Information 2002. © 2002 Reuters Ltd
Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.
Introduction
NEW YORK (Reuters Health) Feb 19 - CD4+ cell counts stay elevated longer when patients who experience virologic failure while on at least one protease inhibitor (PI) continue to take medication rather than stopping therapy altogether, according to California investigators.

Dr. Steven G. Deeks and associates, of the University of California, San Francisco, followed 291 patients who maintained CD4+ cell counts higher than their pre-therapy counts, despite virologic failure.

As the researchers report in the January 25th issue of AIDS, the median time to immunologic failure--return of CD4+ cell counts to below those measured before PI treatment was initiated--was 3.1 years. However, only 36.8% of patients who remained on therapy experienced immunological failure by 3 years.

"This observation suggests that therapy selects for a virus with reduced ability to deplete CD4 T cells (i.e., reduced virulence or reduced pathogenicity)," the California research team posits.

The time to immunologic failure was also associated with the change in viral load from a pre-therapy baseline, such that those with a smaller degree of viral suppression exhibited a higher risk of decline in CD4+ cell counts. The absolute level of viremia after virologic failure was a less significant factor, the authors report.

"Compared to patients with a plasma HIV RNA level <2.98 log-10 copies/mL, only those with the very highest levels of viremia (> 4.5 log-10 copies/mL) were at increased risk of immunologic failure after adjustment for the change in HIV RNA levels from pre-therapy levels," the investigators write.

Based on these estimations, Dr. Deeks and his colleagues suggest that current recommendations to switch therapy as soon as virologic failure occurs may not be practical for many patients. "Our data provide support for a more conservative strategy, particularly for those patients with limited therapeutic options," they recommend.

AIDS 2002;16:201-207.


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Incidente inmune retrasado continuando el tratamiento -- moonotter, 19:29:47 02/27/02 Wed

Incidente inmune retrasado continuando el tratamiento con el pi después del incidente de Virologic La nueva edición Reuters Ltd del © 2002 de la información 2002, de la salud de Reuters o la redistribución del contenido de Reuters, incluyendo por enmarcar o medios similares, expreso se prohíbe sin el consentimiento anteriormente escrito de Reuters. Reuters no será obligado para ningunos errores o retardos en el contenido, o para ninguna acciones tomada en confianza sobre eso. Reuters y la insignia de la esfera de Reuters son marcas registradas registradas y marcas registradas del grupo de Reuters de compañías alrededor del mundo. Introducción Nueva York (salud) de Reuters de febrero el 19 - las cuentas de la célula de CD4+ permanecen elevadas más de largo cuando los pacientes que experimentan incidente virologic mientras que en por lo menos un inhibidor del protease (pi) continúe tomando la medicación más bien que el parar la terapia en conjunto, según los investigadores de California. El Dr. Steven G. Deeks y asociados, de la universidad de California, San Francisco, seguido 291 pacientes que mantuvieron la célula de CD4+ cuentan más arriba que sus cuentas de la pre-terapia, a pesar de incidente virologic. Como los investigadores señalan en la aplicación de enero del 25 el SIDA, el tiempo mediano al incidente inmunológico -- vuelta de la célula de CD4+ cuenta debajo de ésos medidos antes de que el tratamiento del pi fuera iniciado -- era 3,1 años. Sin embargo, solamente 36,8% de los pacientes que permanecían en terapia experimentaron incidente inmunológico por 3 años. " esta observación sugiere que la terapia seleccione para un virus con capacidad reducida de agotar las células de CD4 T (es decir, virulencia reducida o pathogenicity reducido), " al equipo de investigación de California postula. El tiempo al incidente inmunológico también fue asociado al cambio en la carga viral de una línea de fondo de la pre-terapia, tal que ésos con un grado más pequeño de supresión viral exhibieron un riesgo más alto de la declinación en cuentas de la célula de CD4+. El nivel absoluto del viremia después de que el incidente virologic fuera un factor menos significativo, los autores señala. " comparó a los pacientes con un nivel del RNA del VIH del plasma < 2,98 log-10 copies/mL, sólo ésos con los niveles muy más altos del viremia (> 4,5 log-10 copies/mL) estaban en el riesgo creciente del incidente inmunológico después del ajuste para el cambio en niveles del RNA del VIH de niveles de la pre-terapia, " los investigadores escriben. De acuerdo con estas valoraciones, el Dr. Deeks y sus colegas sugieren que las recomendaciones actuales a la terapia del interruptor tan pronto como ocurra el incidente virologic pueden no ser prácticas para muchos pacientes. " nuestros datos proporcionan a la ayuda para una estrategia más conservadora, determinado para esos pacientes con opciones terapéuticas limitadas, " recomiendan. SIDA 2002;16:201-207.


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Outbreaks of Oral Warts Coinciding With HAART? -- moonotter, 18:20:01 07/24/02 Wed

Outbreaks of Oral Warts Coinciding With HAART?


Medscape HIV/AIDS 8(2), 2002. © 2002 Medscape
Posted 07/10/2002


Question
A very difficult-to-manage patient with advanced AIDS, HIV cholangiopathy, and hepatitis C was finally started on a triple-drug regimen which his liver could tolerate. Since then he has had multiple, severe outbreaks of oral/lingual/buccal warts which disappear when he is off medications but reappear when his therapy is restarted. We are unable to control them with local measures. Any suggestions on management?


Response
from Graeme Moyle, MD, MBBS , 07/11/2002

A striking increase in oral warts has been reported in surveys comparing the HAART vs pre-HAART eras. For example, in one report oral warts were 3-fold more common in patients on antiretroviral therapy and 6-fold more common among those on HAART (P = .01).[1] In another study, oral warts were associated with reductions in viral load,[2] which suggests that this phenomenon may in part be related to immune reconstitution, as described in this case.
The warts may spontaneously resolve with further immune recovery but this may take many months or longer. The mainstays of wart treatment are local destructive therapy and immunomodulation.

The principle of locally destructive therapy is to avoid leaving more damage behind than is being caused by the wart. The oral mucosa recovers readily from freezing with directed liquid nitrogen sprays. This may be suitable for debulking and treating lesions on the gums and tongue in accessible areas. YAG lasers (as used for warts in the anal canal) and direct surgical excision may also be used by an experienced surgeon. Intralesional treatment may also be helpful. Bleomycin has been used for oral warts in an HIV-infected person,[3] and in another report a small series of patients with oral warts were treated with intralesional interferon-alfa.[4]

Immunomodulators are generally more gentle therapy, but there is less reliable evidence of their efficacy. Multiple randomized trials have generally failed to prove benefits. In an Iraqi study, zinc sulfate at a range of doses was reported to be superior to placebo for recalcitrant skin warts in immunocompetent patients with low plasma zinc levels,[5] although high-dose zinc should be used with caution in HIV-infected patients and plasma levels are unreliable. Methisoprinol (isoprinosine or inosine pranobex), a synthetic agent with immunomodulatory properties and some antiviral activity against HPV, was reported to reduce recurrence of proliferative verrucous leukoplakia, an oral lesion linked to HPV, in a nonrandomized comparative series.[6] Oral isotretinoin (1 mg/kg daily) for 3 months was associated with around 50% complete or partial response rates in a series of persons with recalcitrant skin warts[7] but has not been tested in randomized studies. Finally, there are anecdotes about the use of cimetidine for warts but randomized trials did not reliably indicate benefit,[8] causing one dermatologist to dub it a modern day "snake oil."[9] Its use with levamisole is superior to cimetidine alone for recalcitrant warts in children.[10]

In the long term, successful management of oral warts will rely on effective HIV therapy. Short-term therapy may be a matter of trial and error.



References
Greenspan D, Canchola AJ, MacPhail LA, Cheikh B, Greenspan JS. Effect of highly active antiretroviral therapy on frequency of oral warts. Lancet. 2001;357:1411-1412.
King MD, Reznik DA, O'Daniels CM, Larsen NM, Osterholt D, Blumberg HM. Human papillomavirus-associated oral warts among human immunodeficiency virus-seropositive patients in the era of highly active antiretroviral therapy: an emerging infection. Clin Infect Dis. 2002;34:641-648.
Girao L, Franca I, Macedo H, et al. Treatment of oral condylomata acuminata in a HIV-1 patient with bleomycin. J Eur Acad Dermatol Venereol. 2000;14:321-322.
Lozada-Nur F, Glick M, Schubert M, Silverberg I. Use of intralesional interferon-alpha for the treatment of recalcitrant oral warts in patients with AIDS: a report of 4 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001;92:617-622.
Al-Gurairi FT, Al-Waiz M, Sharquie KE. Oral zinc sulphate in the treatment of recalcitrant viral warts: randomized placebo-controlled clinical trial. Br J Dermatol. 2002;146:423-431.
Femiano F, Gombos F, Scully C. Oral proliferative verrucous leukoplakia (PVL); open trial of surgery compared with combined therapy using surgery and methisoprinol in papillomavirus-related PVL. Int J Oral Maxillofac Surg. 2001;30:318-322.
Tsambaos D, Georgiou S, Monastirli A, Sakkis T, Sagriotis A, Goerz G. Treatment of condylomata acuminata with oral isotretinoin. J Urol. 1997;158:1810-1812.
Rogers CJ, Gibney MD, Siegfried EC, Harrison BR, Glaser DA. Cimetidine therapy for recalcitrant warts in adults: is it any better than placebo? J Am Acad Dermatol. 1999;41:123-127.
Bigby M. Snake oil for the 21st century. Arch Dermatol. 1998;134:1512-1514.
Parsad D, Pandhi R, Juneja A, Negi KS. Cimetidine and levamisole versus cimetidine alone for recalcitrant warts in children. Pediatr Dermatol. 2001;18:349-352.




Graeme Moyle, Associate Director of HIV Research, Department of HIV, Chelsea & Westminster Hospital, London
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HIV Protease Inhibitor And NNRTI Regimens Comparably Effective -- moonotter, 18:22:53 07/24/02 Wed

HIV Protease Inhibitor And NNRTI Regimens Comparably Effective


Reuters Health Information 2002. © 2002 Reuters Ltd.
Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.


By Deborah Mitchell
BARCELONA, Spain (Reuters Health) Jul 11 - Treatment outcomes of patients with HIV infection who receive initial highly active antiretroviral therapy with a nonnucleoside reverse transcriptase inhibitor (NNRTI) or a protease inhibitor (PI) are similar, according to the findings of two trials presented this week at the XIV International AIDS Conference.

In the first trial, Dr. J. Mallolas of Hospital Clinic-IDIBAPS, here in Barcelona, and colleagues designed a 2-year trial to compare the outcome of patients with moderate HIV infection who received one of two highly active antiretroviral therapies as first-line treatment.

The antiretroviral-na ve patients were randomly assigned to ddI, d4T and nelfinavir, or ZDV, 3TC and nevirapine. If treatment failure occurred, the patients were switched to the other treatment arm. A total of 136 patients were available for evaluation at 18 months.

At followup, the proportion of patients who reached the study endpoint of treatment failure was similar in both treatment groups. Likewise, the CD4+ cell counts in both groups were similar.

"These data suggest that the strategy of nelfinavir- or nevirapine-based therapy show similar efficacy in HIV-infected patients," Dr. Mallolas concluded.

In the second trial, Dr. Jose R. Arribas, of Hospital La Paz in Madrid, and colleagues conducted a similar trial with patients with very low CD4+ counts (<40 cells/ L) and very high viral loads (>250,000 copies/mL) at baseline.

Ninety-two patients were assigned HAART containing efavirenz and 122 received a protease inhibitor (indinavir or nelfinavir). None of the patients had a history of antiretroviral therapy.

After adjustment , there were no differences in immunologic or virologic outcome between the efavirenz and the protease-inhibitor groups. After approximately 18 months, time to treatment failure was "significantly longer" in the efavirenz group, Dr. Arribas reported.

Several other studies that compared PI- versus NNRTI-containing regimens were presented at the conference this week.

"When these regimens are taken as prescribed--religiously--the potency is relatively equivalent," Dr. Michael Saag of the University of Alabama at Birmingham told Reuters Heath. "You cannot find a huge difference between any triple drug regimen. In my opinion, a lot of this boils down to tolerability."

In his clinic, the "overwhelming" majority of patients who stop their first regimen within 90 days do so because of tolerability problems. "So the regimen fails, but it doesn't fail because of potency, it fails because of tolerability," he said.

"There are of course some situations in which there is high-level viremia where the potency differences start to segregate. But for the average patient, what matters most is how well the drug is tolerated," Dr. Saag continued.

"We're now more attuned to these concepts as we start therapy," Dr. Saag said. "When I sit down and discuss regimens, I'll present options. The patient who buys into the regimen is the one who's going to take it."



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Low CD4+ Count at Start of Treatment Predicts Poor Outcome in HIV Patients -- moonotter, 18:30:19 07/24/02 Wed

Low CD4+ Count at Start of Treatment Predicts Poor Outcome in HIV Patients


Reuters Health Information 2002. © 2002 Reuters Ltd.
Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.


By Deborah Mitchell
BARCELONA, Spain (Reuters Health) Jul 09 - In treatment-na ve HIV-infected patients, baseline CD4+ T lymphocyte count, rather than viral load, appears to be the key prognostic factor following initiation of highly active antiretroviral therapy (HAART), according to several reports presented here at the XIV International AIDS Conference.

Exactly when to initiate HAART still remains a significant question for clinicians treating HIV-infected patients. Tuesday morning, several multinational teams presented data to help answer this question.

"CD4+ at baseline was the most strongly predictive factor" of patient prognosis, Dr. Genevieve Chene of the University of Bordeaux, France, told conference attendees. Dr. Chene and members of the ART Cohort Collaboration evaluated the results of 13 cohort studies conducted in Europe and North America.

At baseline, all 12,574 HIV-infected subjects were treatment-na ve before starting HAART with three drugs: two nucleotide reverse transcriptase inhibitors plus a protease inhibitor (PI) or a nonnucleoside reverse transcriptase inhibitor (NNRTI).

The median baseline CD4+ count was 250 cells/ L and median viral load was 4.9 log10 copies/mL. The median age was 38 years, and 21% of the patients were women. The combined study endpoints were time to AIDS or death.

At 3-year followup, there were 870 AIDS-related events and 344 deaths.

Patients with baseline CD4+ levels greater than 350 cells/ L had the best prognosis. However, there was only a "small absolute difference between patients who started HAART with >350 counts and those with 200 to 349 counts," Dr. Chene said.

Baseline viral load was only predictive if it was >5 log10 at baseline. After 6 months of HAART, viral load was predictive at all levels. Other patient factors that predicted outcome at 3 years included age >50 years, a history of injection drug use and stage C disease at baseline.

Overall, patient prognosis after HAART initiation varied widely, depending on CD4+ cell counts at baseline and at 6 months, Dr. Chene said. She also stressed the importance of taking into account each individual patient's response to therapy.

"These type of data are now needed in the developing world," she added.

The study findings are scheduled for publication in The Lancet.

In a second presentation, Dr. John T. Brooks reported the findings from the Adult and Adolescent Spectrum of HIV Disease Working Group on behalf of his team at the US Centers for Disease Control and Prevention in Atlanta. They evaluated the effect of baseline CD4+ cell count on the outcome of patients with no known history of antiretroviral therapy who began HAART after 1996.

Of 1464 subjects, data were evaluated for 583 who initially responded to HAART. Of these patients, Dr. Brooks found that 56 developed virologic failure, defined as a >0.5 log10 increase from viral load nadir after HAART initiation, followed by a second elevated viral load measurement or a change in antiretroviral therapy.

Patients with baseline CD4+ cell counts between 0-199 cells/ L had more than 10 times the risk of treatment failure compared with those with CD4+ cell counts >350 cells/ L. Patients with CD4+ counts between 200 and 349 cells/ L were twice as likely to fail HAART compared with those with higher levels.

Based on these findings, a more durable HAART response appears to be achieved by patients with CD4+ counts >350 cells/ L at baseline, Dr. Brooks said.

In another report, Dr. Robert S. Hogg and colleagues at the British Columbia Centre for Excellence in HIV/AIDS in Vancouver, evaluated the mortality risk associated with intermittent HAART use and the use of a regimen that included an NNRTI instead of a protease inhibitor.

The population-based study included 1416 treatment-na ve, HIV-infected adults who began therapy between 1996 and 2000. Thirty-one percent started an NNRTI-containing regimen.

Multivariate results indicated that baseline CD4+ counts below 200 cells/ L, intermittent use of HAART and older age were the only factors independently associated with predicted mortality, he told conference participants. Regimens with "NNRTI and PIs were associated with similar outcomes."



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Low CD4+ Count at Start of Treatment Predicts Poor Outcome in HIV Patients -- moonotter, 18:31:36 07/24/02 Wed

Low CD4+ Count at Start of Treatment Predicts Poor Outcome in HIV Patients


Reuters Health Information 2002. © 2002 Reuters Ltd.
Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.


By Deborah Mitchell
BARCELONA, Spain (Reuters Health) Jul 09 - In treatment-na ve HIV-infected patients, baseline CD4+ T lymphocyte count, rather than viral load, appears to be the key prognostic factor following initiation of highly active antiretroviral therapy (HAART), according to several reports presented here at the XIV International AIDS Conference.

Exactly when to initiate HAART still remains a significant question for clinicians treating HIV-infected patients. Tuesday morning, several multinational teams presented data to help answer this question.

"CD4+ at baseline was the most strongly predictive factor" of patient prognosis, Dr. Genevieve Chene of the University of Bordeaux, France, told conference attendees. Dr. Chene and members of the ART Cohort Collaboration evaluated the results of 13 cohort studies conducted in Europe and North America.

At baseline, all 12,574 HIV-infected subjects were treatment-na ve before starting HAART with three drugs: two nucleotide reverse transcriptase inhibitors plus a protease inhibitor (PI) or a nonnucleoside reverse transcriptase inhibitor (NNRTI).

The median baseline CD4+ count was 250 cells/ L and median viral load was 4.9 log10 copies/mL. The median age was 38 years, and 21% of the patients were women. The combined study endpoints were time to AIDS or death.

At 3-year followup, there were 870 AIDS-related events and 344 deaths.

Patients with baseline CD4+ levels greater than 350 cells/ L had the best prognosis. However, there was only a "small absolute difference between patients who started HAART with >350 counts and those with 200 to 349 counts," Dr. Chene said.

Baseline viral load was only predictive if it was >5 log10 at baseline. After 6 months of HAART, viral load was predictive at all levels. Other patient factors that predicted outcome at 3 years included age >50 years, a history of injection drug use and stage C disease at baseline.

Overall, patient prognosis after HAART initiation varied widely, depending on CD4+ cell counts at baseline and at 6 months, Dr. Chene said. She also stressed the importance of taking into account each individual patient's response to therapy.

"These type of data are now needed in the developing world," she added.

The study findings are scheduled for publication in The Lancet.

In a second presentation, Dr. John T. Brooks reported the findings from the Adult and Adolescent Spectrum of HIV Disease Working Group on behalf of his team at the US Centers for Disease Control and Prevention in Atlanta. They evaluated the effect of baseline CD4+ cell count on the outcome of patients with no known history of antiretroviral therapy who began HAART after 1996.

Of 1464 subjects, data were evaluated for 583 who initially responded to HAART. Of these patients, Dr. Brooks found that 56 developed virologic failure, defined as a >0.5 log10 increase from viral load nadir after HAART initiation, followed by a second elevated viral load measurement or a change in antiretroviral therapy.

Patients with baseline CD4+ cell counts between 0-199 cells/ L had more than 10 times the risk of treatment failure compared with those with CD4+ cell counts >350 cells/ L. Patients with CD4+ counts between 200 and 349 cells/ L were twice as likely to fail HAART compared with those with higher levels.

Based on these findings, a more durable HAART response appears to be achieved by patients with CD4+ counts >350 cells/ L at baseline, Dr. Brooks said.

In another report, Dr. Robert S. Hogg and colleagues at the British Columbia Centre for Excellence in HIV/AIDS in Vancouver, evaluated the mortality risk associated with intermittent HAART use and the use of a regimen that included an NNRTI instead of a protease inhibitor.

The population-based study included 1416 treatment-na ve, HIV-infected adults who began therapy between 1996 and 2000. Thirty-one percent started an NNRTI-containing regimen.

Multivariate results indicated that baseline CD4+ counts below 200 cells/ L, intermittent use of HAART and older age were the only factors independently associated with predicted mortality, he told conference participants. Regimens with "NNRTI and PIs were associated with similar outcomes."



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HIV-Specific Response Can Be Preserved With Short-Course ART During Primary Infection -- moonotter, 18:33:31 07/24/02 Wed

HIV-Specific Response Can Be Preserved With Short-Course ART During Primary Infection


Reuters Health Information 2002. © 2002 Reuters Ltd.
Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.


By Deborah Mitchell
BARCELONA, Spain (Reuters Health) Jul 09 - A short course of antiretroviral therapy in patients with primary HIV infection can prevent destruction of HIV-specific CD4 T-cell responses, UK researchers reported here on Tuesday at the XIV International AIDS Conference.

Dr. Sarah J. Fidler of the Imperial College Faculty of Medicine in London and colleagues hypothesized that a short course of ART (SCART) administered during early infection may be sufficient to preserve HIV-specific CD4+ T-helper responses that would otherwise be lost without intervention.

This approach may also benefit patients by avoiding toxicity from long-term therapy and development of drug resistance. It can also substantially reduce treatment costs, making it a potentially useful approach in resource-poor settings where long treatment is not possible, Dr. Fidler told conference attendees.

So far, Dr. Fidler's team has recruited approximately 60 patients with acute symptomatic HIV infection who were offered SCART. The median time from the development of symptoms to treatment was 30 days. Followup data were presented on 52 patients who opted for treatment and seven who declined.

The patients were evaluated monthly for CD4+ counts and plasma HIV load.

The length of SCART varied by patient, but after a median of 12 weeks, all of the treated patients had plasma HIV RNA loads below 50 copies/mL. Only a handful of patients had evidence of phenotypic drug resistance at baseline and none developed resistance mutations after SCART.

After approximately 48 weeks of followup, the majority of SCART patients had no evidence of HIV progression. In contrast, four of the seven patients who did not receive treatment had rapid disease progression; one was able to control viremia.

Overall, the majority of patients who received SCART during primary HIV infection showed a preservation of HIV-specific, CD4 T-helper responses, she told conference participants. The intervention was safe and generally well tolerated.

She noted, however, that primary HIV infection is "highly heterogeneous," and patients experience a wide range of virologic and immunologic responses. Therefore, large-scale randomized trials of SCART during primary HIV infection are warranted.



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New AIDS Drugs Less Likely to Cause Lipid Abnormalities -- moonotter, 18:36:14 07/24/02 Wed

New AIDS Drugs Less Likely to Cause Lipid Abnormalities


Laurie Barclay, MD
Medscape Medical News 2002. © 2002 Medscape


July 11, 2002 — New weapons in the AIDS armamentarium are less likely to cause lipid abnormalities than other antiretroviral medications, according to a presentation at the XIV International AIDS conference in Barcelona, Spain, and a report in the July 10 issue of The Journal of the American Medical Association.
"Atazanavir is unique in that it is taken once daily, has a favorable resistance profile and, best of all, has no adverse effect on cholesterol and triglycerides," lead author Robert L. Murphy, MD, from Chicago's Northwestern University, says in a news release. "All other current protease inhibitors adversely affect lipid levels and therefore increase the risk of cardiovascular disease."

In earlier phase III studies, atazanavir was potent, safe and effective. In this study of 346 patients, switching from nelfinavir to atazanavir led to significant improvement in lipid profiles at 12 weeks, with reductions in total cholesterol, low-density lipoprotein (LDL) cholesterol and triglycerides, and increased high-density lipoprotein (HDL) cholesterol. The magnitude of the improvement was sufficient to reduce cardiovascular risk or to eliminate the need for dietary or pharmacologic intervention.

In a separate study described in JAMA, HIV patients with lipoatrophy taking a nucleoside reverse transcriptase inhibitor were randomized to either continue their initial treatment or switch to abacavir. At 24 weeks, those who had switched experienced significant but modest improvements in limb fat measured by dual-energy X-ray absorptiometry. Computed tomography also showed a trend toward improvement in subcutaneous thigh, arm and abdominal fat areas.

"Clinical lipoatrophy, as assessed subjectively, did not resolve, however, and at the rate of increase observed may take years to resolve with use of this strategy," write Andrew Carr, MD, and colleagues from the Mitochondrial Toxicity (MITOX) Study Group.

This randomized, open-label study involving 17 centers in Australia and England enrolled 111 adults (109 men) with moderate or severe lipoatrophy who were receiving stavudine or zidovudine, who had stable HIV RNA levels less than 400 copies/mL, and who had not previously received abacavir. Switching to abacavir was safe, with no unexpected adverse events and good control of HIV replication and CD4 cell count. After six months, limb fat mass had only increased by about 11% from baseline. Metabolic measures were unchanged.

"Longer follow-up of this population is needed to determine if lipoatrophy can improve clinically or even resolve," the authors write. "Other strategies under investigation include intermittent antiretroviral therapy and concurrent therapy with thiazolidinediones."

XIV International AIDS Conference: Abstract WeOrB1306. July 10, 2002.
JAMA. 2002;288(2):207-215

Reviewed by Gary D. Vogin, MD






Laurie Barclay, MD, is a staff writer with WebMD.

Medscape Medical News is edited by Deborah Flapan, an associate editor at Medscape. Please send press releases and comments to news@webmd.net.
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Substituting Abacavir For Older NRTIs May Improve HIV-Related Lipoatrophy -- moonotter, 18:40:28 07/24/02 Wed

Substituting Abacavir For Older NRTIs May Improve HIV-Related Lipoatrophy


Reuters Health Information 2002. © 2002 Reuters Ltd.
Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.


By Megan Rauscher
NEW YORK (Reuters Health) Jul 09 - In a study of adults with HIV lipoatrophy, switching from stavudine or zidovudine to abacavir led to a "significant, albeit modest" improvement in objective measures of limb fat, without affecting control of HIV replication.

"This is the first study to convincingly show that lipoatrophy can be improved," lead investigator Dr. Andrew Carr of St. Vincent's Hospital in Sydney, Australia, told Reuters Health. "This is important as lipoatrophy is distressing to patients, potentially stigmatizing and has been significantly linked with poorer adherence to antiretroviral therapy," he added.

Nucleoside reverse transcriptase inhibitor (NRTI)-induced mitochondrial toxicity is thought to underlie HIV lipoatrophy, Dr. Carr and colleagues explain in The Journal of the American Medical Association for July 10th, noting that abacavir may be less toxic to mitochondria.

The investigators had 111 subjects with moderate to severe lipoatrophy being treated with stavudine or zidovudine either continue with those drugs or switch to abacavir 300 mg twice daily, while continuing to take their other antiretroviral drugs.

"All patient subgroups seemed to derive benefit from the switch, even those with more severe lipoatrophy," Dr. Carr told Reuters Health. Dual-energy x-ray absorptiometry showed that patients gained "about 10% of the limb fat they had probably lost," he said.

However, subjective improvements in lipoatrophy did not correlate with objective measures, a finding that may reflect the short followup period. "We are continuing to follow these patients, hopefully for another 2 years, to see if the improvement continues and becomes clinically observable," Dr. Carr said.

The metabolic abnormalities associated with lipoatrophy were not significantly altered by the switch to abacavir, although the study was not statistically powered to look at this, Dr. Carr told Reuters Health.

The switch did not adversely effect plasma HIV RNA levels, a secondary study endpoint, but five subjects (10%) developed hypersensitivity to abacavir.

The fact that lipoatrophy affects upwards of 50% of patients on antiretroviral therapy suggests that "we really need to start exploring prevention," Dr. Carr concluded.

JAMA 2002;288:207-215.



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HIV Drug Resistance Surveillance Network Launched -- moonotter, 18:46:09 07/24/02 Wed

HIV Drug Resistance Surveillance Network Launched


Reuters Health Information 2002. © 2002 Reuters Ltd.
Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.


By Deborah Mitchell
BARCELONA, Spain (Reuters Health) Jul 10 - In response to the growing problem of antiretroviral resistance, a Global HIV Drug Resistance Surveillance Network has been created, in part, to "facilitate antiretroviral 'gear-up' in the South," Dr. Scott Hammer of Columbia University in New York told participants at the XIV International AIDS Conference here on Wednesday.

Although there is much concern about the spread of HIV drug resistance, "it is not a reason to delay the introduction of antiretroviral therapy" in developing countries, he said. "We need to take the lessons we have learned about drug resistance in the developed world to the developing world." The data that we have on HIV drug resistance is "scattered," he continued. The network will provide a central source of this information.

The new global network on HIV drug resistance is a collaborative effort supported by the International AIDS Society, the World Health Organization, and other partners. The new program will be entirely Internet-based.

The WHO's current goal is to have 3 million HIV-infected patients on antiretroviral therapy by 2005. For the most part, there is currently very little HIV drug resistance in the South, Dr. Hammer said. One of the goals of the new surveillance network is to keep it that way after antiretrovirals are introduced in developing countries.

Another important reason to monitor drug resistance is the possibility that "there may be different susceptibilities of different HIV subtypes," Dr. Hammer continued.

"We're essentially talking about 'molecular epidemiology'," he elaborated. This new surveillance program will provide "data on the circulation, intermingling and recombinant forms of various HIV subtypes."



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Transmission of NNRTI-Resistant HIV Strains Is Increasing -- moonotter, 18:49:41 07/24/02 Wed

Transmission of NNRTI-Resistant HIV Strains Is Increasing


Reuters Health Information 2002. © 2002 Reuters Ltd.
Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.


NEW YORK (Reuters Health) Jul 08 - In areas where antiretroviral drug use is common, more than 25% of newly HIV-infected individuals harbor a virus that is resistant to at least one antiretroviral class, according to a report published in the July 10th issue of the Journal of the American Medical Association (JAMA).
However, in the last 5 years, only transmission of nonnucleoside reverse transcriptase inhibitor (NNRTI)-resistant HIV has increased significantly.

To evaluate time trends in primary HIV-1 drug resistance, Dr. Robert M. Grant, from the Gladstone Institute of Virology and Immunology in San Francisco, and colleagues analyzed viral strains from 225 patients who presented with recent HIV infection between June 1996 and June 2001 at San Francisco General Hospital.

The overall prevalence of resistant strains in 2000/2001 was 27.4%, not significantly different from the 25% prevalence found in 1996/1997, the authors note. However, the prevalence of strains that were resistant to at least two antiretroviral classes increased significantly from 2.5% to 13.2% between the two time periods (p = 0.004 for trend).

Of the entire study group, only one patient, seen in 2000/2001, was infected with a strain that was resistant to three antiretroviral classes, the researchers note.

None of the patients seen in 1996/1997 were infected with NNRTI-resistant strains. In contrast, in 2000/2001, 13.2% of patients harbored strains resistant to NNRTIs (p = 0.01 for trend). No significant increase in the prevalence of strains resistant to other antiretroviral classes was noted.

"Primary resistance indicates triple failure of the healthcare system, including failure of drug treatment to control viral replication in the source partner, failure of behavioral prevention in the source partner receiving treatment, and failure of behavioral prevention in the recently infected person," the authors note.

Findings from another study, also reported in JAMA, highlight the clinical significance of NNRTI-resistant strains. Dr. Scott M. Hammer, from Columbia University in New York, and colleagues assessed the outcomes of 481 patients who were treated with dual or single protease inhibitor (PI) therapy after experiencing virologic failure with a PI-containing regimen.

In addition to receiving amprenavir, abacavir, efavirenz, and adefovir, the patients were randomized to receive saquinavir, indinavir, nelfinavir, or placebo twice daily. Therefore, the study included three dual PI groups and one single PI group.

Patients in the dual PI groups were significantly more likely to achieve viral loads less than 200 copies/mL than those in the single PI group (p = 0.002).

Of note in light of the previous study's findings, patients who were na ve to NNRTIs and those whose strains were highly susceptible to efavirenz, in particular, were significantly more likely to achieve adequate viral suppression than their counterparts.

In a related editorial, Dr. Joel D. Trachtenberg and Dr. Merle A. Sande, from the University of Utah in Salt Lake City, comment that both articles "illustrate the importance of the NNRTI class and its pivotal role in the future management of HIV infection."

The current findings are particularly relevant for developing countries, the editorialist note. "Without the ready availability of PIs, preservation of NNRTI susceptibility is clearly a critical factor to ensure a sustained, widespread treatment success in sub-Saharan Africa and other resource-limited areas," they add.

JAMA 2002:288:169-188,239-241.



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Hollis-Eden Says HIV Drug Shows Viral Load Reduction in Phase II Trial -- moonotter, 18:56:43 07/24/02 Wed

Hollis-Eden Says HIV Drug Shows Viral Load Reduction in Phase II Trial


Reuters Health Information 2002. © 2002 Reuters Ltd.
Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.


NEW YORK (Reuters Health) Jul 08 - Hollis-Eden Pharmaceuticals Inc. on Monday said that one dosing group in a phase II trial of its investigational HIV drug, HE2000, exhibited a statistically significant downward slope in viral load, according to a preliminary analysis of the clinical data.
Hollis-Eden presented the data Monday at the International AIDS conference in Barcelona, Spain.

The company is developing HE2000, an immune-regulating hormone, with the goal of using the drug to delay the progression of HIV to AIDS. A drug such as HE2000 would support the new National Institutes of Health (NIH) recommendation to delay initiation of antiretroviral treatment until HIV has significantly progressed towards AIDS, to help reduce the long-term side effects and emergence of viral resistance to HAART, according to Hollis-Eden.

The 24 treatment-na ve subjects in the South Africa-based trial received three cycles of daily subcutaneous injections of either a 50-mg or 100-mg dose of HE2000, or placebo, for five consecutive days every six weeks, and were followed for an additional 12 weeks after the last dosing cycle.

In the 50-mg dose group, investigators observed a statistically significant downward slope in viral load versus placebo during the study period, and the maximum viral load reduction from baseline (0.66 log) at the end of the 30-week study, according to Hollis-Eden.

Patients in the 100-mg arm likewise experienced a downward slope in viral load, but the decline achieved was not statistically significant. A maximum viral load reduction (0.45 log) was observed in the group treated with a 100-mg dose of HE2000.

Hollis-Eden said HE2000-treated patients exhibited statistically significant increases in several cell types associated with innate and adaptive cell-mediated immunity during the study. These cell types include killer cells, dendritic cells and Th1 cells. Investigators noted that these types of cells in the six-patient placebo group generally declined during the course of the study.

"It is very encouraging to...[observe] that the trend line for viral load continued to decline over the course of the eight-month study," said Hollis-Eden Medical Director Dr. Dwight Stickney, in a statement. "This viral load reduction is significant because it demonstrates immunologic control of HIV replication versus a direct antiviral mechanism, particularly given that HE2000 was administered as a single agent on an intermittent basis rather than as part of a drug cocktail given daily."

Investigators observed no serious drug-related adverse events, according to the company. The most commonly reported side effect was mild to moderate reaction at the site of the injection.

Hollis-Eden said it has treated more than 150 patients with HE2000 in phase I/II and phase II clinical trials.



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Structured Treatment Interruption Seen to Benefit Patients With Highly Resistant HIV -- moonotter, 19:01:10 07/24/02 Wed

Structured Treatment Interruption Seen to Benefit Patients With Highly Resistant HIV


Reuters Health Information 2002. © 2002 Reuters Ltd.
Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.


BARCELONA, Spain (Reuters Health) Jul 10 - Patients with advanced HIV infection that has become resistant to all available antiretroviral drug classes might benefit from structured treatment interruption, a leading French researcher said on Wednesday.
Dr. Christine Katlama, of the Hôpital Pitie-Salpetriere in Paris, told Reuters Health at the 14th International AIDS Conference that taking these patients off antiretroviral therapy for a period of 8 weeks resulted in a reduction in viral load when treatment was resumed.

In an open-label study, the French team studied 68 patients who had exhausted all currently available anti-HIV therapies. Eligible patients had a viral load of at least 50,000 copies/mL and CD4 counts below 200/ L.

Half the study group was immediately given "GIGAHAART" (maximal highly active anti-retroviral therapy), including three or four nucleoside reverse transcriptase inhibitors, 500 mg BID hydroxyurea, one non-nucleoside reverse transcriptase inhibitor and three protease inhibitors. The other 34 patients were given an 8-week break before starting the same salvage therapy.

Fifty-three percent of patients in the deferred treatment group experienced a loss of at least one of 29 resistant genotypes examined, Dr. Katlama reported.

Interrupting the treatment seemed to have no adverse effects in these already seriously ill patients, she added.

Viral load in patients randomized to continuous treatment remained constant for 24 weeks after the study began. In contrast, viral load among the structured treatment interruption group dropped by 1 log10 after 24 weeks of resumed drug therapy.

"I was very surprised to see this. I think anyone would have been surprised," Dr. Katlama said. "This study is proof of principle that this approach can benefit those patients who no longer have any treatment options."



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Structured Treatment Interruption Seen to Benefit Patients With Highly Resistant HIV -- moonotter, 19:04:36 07/24/02 Wed

Structured Treatment Interruption Seen to Benefit Patients With Highly Resistant HIV


Reuters Health Information 2002. © 2002 Reuters Ltd.
Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.


BARCELONA, Spain (Reuters Health) Jul 10 - Patients with advanced HIV infection that has become resistant to all available antiretroviral drug classes might benefit from structured treatment interruption, a leading French researcher said on Wednesday.
Dr. Christine Katlama, of the Hôpital Pitie-Salpetriere in Paris, told Reuters Health at the 14th International AIDS Conference that taking these patients off antiretroviral therapy for a period of 8 weeks resulted in a reduction in viral load when treatment was resumed.

In an open-label study, the French team studied 68 patients who had exhausted all currently available anti-HIV therapies. Eligible patients had a viral load of at least 50,000 copies/mL and CD4 counts below 200/ L.

Half the study group was immediately given "GIGAHAART" (maximal highly active anti-retroviral therapy), including three or four nucleoside reverse transcriptase inhibitors, 500 mg BID hydroxyurea, one non-nucleoside reverse transcriptase inhibitor and three protease inhibitors. The other 34 patients were given an 8-week break before starting the same salvage therapy.

Fifty-three percent of patients in the deferred treatment group experienced a loss of at least one of 29 resistant genotypes examined, Dr. Katlama reported.

Interrupting the treatment seemed to have no adverse effects in these already seriously ill patients, she added.

Viral load in patients randomized to continuous treatment remained constant for 24 weeks after the study began. In contrast, viral load among the structured treatment interruption group dropped by 1 log10 after 24 weeks of resumed drug therapy.

"I was very surprised to see this. I think anyone would have been surprised," Dr. Katlama said. "This study is proof of principle that this approach can benefit those patients who no longer have any treatment options."



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Therapeutic DNA Vaccine to Be Tested in Patients With Chronic HIV Infection -- moonotter, 19:09:10 07/24/02 Wed

Therapeutic DNA Vaccine to Be Tested in Patients With Chronic HIV Infection


Reuters Health Information 2002. © 2002 Reuters Ltd.
Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.


By Claudio Lavanga
BARCELONA, Spain (Reuters Health) Jul 10 - Researchers in Italy and the US will soon begin human trials with a 'therapeutic' AIDS vaccine designed to help people infected with HIV control the infection in combination with drugs.

The vaccine already been shown to benefit monkeys chronically infected with SHIV in laboratory studies, Dr. Franco Lori told Reuters Health at the International AIDS Conference. Dr. Juliana Lisiewicz, cofounder with Dr. Lori of the Research Institute for Genetic and Human Therapy based in Washington, DC, and Pavia, Italy, is presenting details of the monkey study on Thursday at the Barcelona meeting.

Dr. Lori told Reuters Health that the researchers, when developing the vaccine, studied the case of a man in Berlin whose immune system spontaneously controlled HIV. From these studies, they concluded that they needed to stimulate cytotoxic T cells.

"We do this by using a novel DNA vaccine that contains most of the HIV proteins," he said. "In this way we guarantee a wide spectrum of action, and do not target a specific protein."

He explained that the DNA vaccine is administered topically. "We gently rub the skin so that we expose a network of Langerhans cells. When the vaccine gets in contact with the Langerhans cells, they signal the danger to the closest lymph node, propelling it to recognize the HIV virus, and activate HIV-specific killer cells that can eliminate infected cells."

In the monkey trials, seven chronically infected rhesus macaques were given antiretroviral therapy 3 weeks on and 3 weeks off, while seven others were given the drugs on the same schedule plus the vaccine.

The monkeys that did not receive the vaccine exhibited a rebound in virus levels each time there was a break in drug therapy. The seven that received the vaccine progressively controlled the rebound in viral levels from a median 33,860 copies/mL to <200 copies/mL.

A separate group of monkeys with AIDS showed a viral load drop from a mean of 4,292,260 copies/mL to <200 copies when given the drug-vaccine combination.

"The vaccine is designed to work with the drugs. Drugs can control the virus when people take them as directed, but the bad news is that when patients stop--either because they can't afford them or because they simply forget them--the virus rebounds immediately. In this case, the vaccine would come into action, keeping the virus in check," said Dr. Lori.

"Our preliminary animal data provided promising results where, for the first time, a vaccine therapy suppressed the virus in chronic infection. We are optimistic that we will demonstrate similar results in humans," he told Reuters Health.

The group hopes to begin human trials at the end of this year both in Italy and in the United States. First results are expected at the end of 2003.



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Remune, Other Vaccines Prime Immune System Without IL-2 -- moonotter, 19:12:43 07/24/02 Wed

Remune, Other Vaccines Prime Immune System Without IL-2


Reuters Health Information 2002. © 2002 Reuters Ltd.
Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.


NEW YORK (Reuters Health) Jul 10 - A 38-patient study sponsored by the Adult AIDS Clinical Trials Group of the National Institutes of Health shows the patients developed stronger immune responses to HIV after receiving only Remune, an investigational therapeutic vaccine, than they did when they received Remune plus interleukin 2 (IL-2).
Dr. Hernan Valdez of the Case Western Reserve Center for AIDS Research presented the results of the study at the XIV International AIDS Conference in Barcelona, Spain. The Immune Response Corp. (IRC) developed Remune.

All patients in the study had been on regimen of highly active anti-retroviral therapy (HAART) or HAART plus IL-2 for at least 60 days, according to Immune Response. The 38 subjects were immunized with tetanus toxoid; inactivated, gp-120 depleted HIV-1 (Remune); and hepatitis A and B vaccines.

Even though investigators observed increased in CD4+ cell counts, the researchers concluded IL-2 did not enhance immunization responses. Patients receiving Remune alone developed relative stronger immune responses to HIV by a 70% to 24% margin, according to Immune Response.

The patients also experienced a stronger hepatitis A response after receiving the hepatitis A vaccine without IL-2. The group that received only the hepatitis A vaccine developed stronger hepatitis A antibodies (88%) compared to the group that received the vaccine plus IL-2 (36%).

"Non-specific stimulation via IL-2 may hinder the immune response to both Remune and non-HIV vaccines," said Ronald Moss, vice president of medical and scientific affairs for Immune Response, in a statement.

While Remune was once touted as a preventive vaccine, Immune Response is now positioning Remune as a treatment option in several scenarios, according to a company spokeswoman. The therapeutic vaccine may be appropriate as monotherapy to delay the start of HAART treatment, or it may be used in conjunction with HAART.

In May, however, Immune Response reported results of a new product that combines Remune and an adjuvant consisting of sequences of immunostimulatory DNA. The combination vaccine, which Immune Response is developing as a preventive vaccine, proved to be capable of boosting levels of HIV-specific T cells in non-human primates.



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HCV Coinfection Does Not Affect Outcome in HIV Infection -- moonotter, 19:15:17 07/24/02 Wed

HCV Coinfection Does Not Affect Outcome in HIV Infection


Laurie Barclay, MD
Medscape Medical News 2002. © 2002 Medscape


July 8, 2002 — Coinfection with hepatitis C virus (HCV) does not adversely affect the outcomes from treatment with highly active antiretroviral therapy (HAART) for HIV, according to a presentation on July 6 at the XIV International AIDS Conference in Barcelona, Spain. Physicians should therefore treat coinfected patients as aggressively as those without HCV infection, the investigators suggest.
"In the U.S. and Europe, it is estimated that one in three of HIV-infected persons are also infected with hepatitis C and many of them are injection drug users," Glen R. Hanson, Acting Director of the U.S. National Institute on Drug Abuse, says in a news release. "Research needs to continue to determine best approaches to treating those who are coinfected with HIV and hepatitis C."

Between January 1995 and January 2001, 1,955 HIV-infected patients without an AIDS diagnosis enrolled in this study, including 873 patients (44.6%) with HCV seropositivity. The latter group was older, more likely to be African-American and to have a history of intravenous drug abuse than those who were HCV seronegative.

During the study, 1,199 patients were prescribed HAART, including 54% of the HCV-seropositive patients and 67% of the HCV-seronegative patients.

Physicians may be less likely to prescribe HAART to patients infected with both HCV and HIV for fear of liver complications, explains lead author Mark S. Sulkowski, MD, from Johns Hopkins University in Baltimore, Maryland. In this study, fewer patients with HCV seropositivity had received HAART, resulting in relatively high incidences of AIDS and death in this group.

In a subgroup of 429 HCV-seropositive patients with baseline CD4 cell counts between 50 and 200 cells/mm3, risk of death was increased (relative hazard ratio, 1.51, 95% confidence interval, 1.01-2.27). However, after correction for differences in exposure to effective HAART among HCV-seropositive and HCV-seronegative patients, HCV seropositivity was not independently associated with CD4 cell decline, death, progression to AIDS, or immune reconstitution after HAART.

Although the authors acknowledge various study limitations and the need for additional research, they conclude that "these findings emphasize the importance of effective antiretroviral therapy among HCV infected and uninfected persons at immediate risk for the development of AIDS."

XIV International AIDS Conference. July 6, 2002.

Reviewed by Gary D. Vogin, MD





Laurie Barclay, is a staff writer with WebMD.

Medscape Medical News is edited by Deborah Flapan, an associate editor at Medscape. Please send press releases and comments to news@webmd.net.
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Protesters Blast US Over AIDS Funding -- moonotter, 19:20:36 07/24/02 Wed

Protesters Blast US Over AIDS Funding


Reuters Health Information 2002. © 2002 Reuters Ltd.
Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.


BARCELONA, Spain (Reuters) Jul 09 - Protesters stormed the stage and shouted down the US health secretary Tuesday as he addressed the world's biggest conference on AIDS, which has highlighted a gulf in access to treatment between rich and poor.
Some 30 AIDS activists rushed forward as U.S. Health and Human Services Secretary Tommy Thompson got up to speak, while dozens more drowned out his words with chants and whistles.

The protesters' action was to press accusations that Washington was failing people with AIDS by not committing more money to a new international global fund against the disease. Thompson, surrounded by a gaggle of bodyguards, continued to deliver his speech unheard.

The week-long meeting, attended by 15,000 delegates, has thrown into sharp relief the difference in prospects for those in Western countries and those in the developing world who are infected with HIV. Those in the poorer group account for 95% of infections.

The UN's Global Fund to fight AIDS, Tuberculosis and Malaria, created in 2001, aims to bridge the gap between treatment and prevention--but has so far won commitments from governments of only $2.8 billion, against the $10 billion it needs each year.

In a prepared text of his speech, Thompson said the United States was leading the world in its support for the fund by committing $500 million, but activists said $300 million was "stolen" from other health programs.

The fund's newly appointed executive director, Richard Feachem, told delegates that existing pledges were a start but billions more dollars were needed.

"These commitments will double the current number of people receiving HAART in the developing world and in Africa HAART recipients will increase six-fold," he said. "This is nothing like enough."

Currently, a mere 0.1% of the 28.5 million people infected with HIV in sub-Saharan Africa get modern drugs, a figure French President Jacques Chirac described as unacceptable in a message to the meeting.

Drug firms unveiled more progress in developing innovative AIDS therapies but anger over the cost of treatments prompted noisy protests and the invasion of company stands at the conference exhibition.

Experts also dampened speculation that the holy grail of an effective vaccine against AIDS could be less than five years away, warning that developing protection against the virus would require more time.

"HIV vaccine development is not a sprint. HIV vaccines need to be developed within the context of a larger prevention effort," Lawrence Corey, principal investigator of the HIV Vaccines Trials Network in the US, told the conference.



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Simplified Treatment of HIV Promoted For Developing Countries -- moonotter, 19:23:03 07/24/02 Wed

Simplified Treatment of HIV Promoted For Developing Countries


Reuters Health Information 2002. © 2002 Reuters Ltd.
Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.


By Stephen Pincock
BARCELONA, Spain (Reuters Health) Jul 09 - New guidelines that simplify options for HIV therapy will help millions more people in the developing world gain access to treatment, the World Health Organization and the International AIDS Society said on Tuesday.

Only about 2% of the 6 million people in the developing world who need AIDS drugs now are getting them, despite significant drops in the prices of the medicines.

Improving access has been a key issue at the International AIDS Conference in Barcelona this week, where activists have called for greater efforts from governments, and researchers have tried to find ways to make other aspects of treatment cheaper and simpler.

WHO and IAS say reducing the complexity of highly-active antiretroviral therapy could have a major impact. On Tuesday in Barcelona they officially released new guidelines that give options to poor regions lacking medical staff or sophisticated laboratories.

"For the first time we now have the chance to apply a simplified, easy-to-follow public health approach to AIDS treatment rather than complex individual treatment regimes," said Dr. Gro Harlem Brundtland, WHO director-general.

"This, combined with the falling costs of medicines, means it should be possible to extend the life-span of those living with HIV in resource-limited settings."

The new guidelines aim to provide countries with simple advice on options for treating the disease, as well as monitoring treatment response and other treatment aspects--while taking into account the reality that many places lack even the most basic medical facilities.

"There are almost 'bush' options in there," IAS President Dr. Joep Lange told Reuters Health. "I consider these guidelines to be a major milestone."



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Inexpensive HIV Monitoring Tests May Help Developing Countries -- moonotter, 19:27:43 07/24/02 Wed

Inexpensive HIV Monitoring Tests May Help Developing Countries


Reuters Health Information 2002. © 2002 Reuters Ltd.
Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.


BARCELONA, Spain (Reuters Health) Jul 08 - Two drastically cheaper tests to measure CD4+ cell counts and HIV plasma load in individuals with HIV infection are as effective as standard tests, and could play an important role in helping poor countries control the AIDS epidemic, researchers said on Monday at the International AIDS Conference.
Despite significant price reductions in antiretroviral drugs to treat HIV infection in Africa and elsewhere, scientists from the US Centers for Disease Control and Prevention (CDC) said crucial tests that help determine when to start therapy and monitor treatment response are too expensive for many poor countries.

"Drug access alone is not the answer to the treatment challenges in developing countries," CDC researcher Dr. Mandy Wilja told reporters at the conference. "Some countries are in the paradoxical situation where HIV drugs are cheaper than the CD4+ and viral load tests needed to use them effectively."

Dr. Wilja reported that a technique known as panleucogating (PLG) could effectively determine CD4+ cell counts for a quarter of the cost of existing tests.

Dr. Wilja and colleagues from the CDC's laboratories in Uganda compared PLG, which costs less than US$5, with the standard test, FACSCount, which costs US$20. They also compared the blood samples after they were stabilized using Transfix to extend the time between blood drawing and testing.

PLG results correlated closely with the results of the standard FACSCount test when used with fresh blood samples. For blood collected 3 days earlier and stabilized, the correlation between PLG results (R2=0.96) and FACSCount (R2=0.97) was also excellent.

In another study, Dr. Robert Downing, head of the CDC's Uganda labs, reported that a US$30 test to measure the plasma HIV load could be as effective as the standard RNA viral load test, which costs US$150.

The new test measures blood levels of virus-associated reverse transcriptase (RT).

In preliminary tests on a series of samples from three patients, Dr. Downing said the new RT test was as good as the standard assay for measuring trends in viral load over time for patients taking antiretroviral drugs.

However, for two of 13 specimens containing viral loads greater than 10,000 copies/mL, the new test did not detect virus.

"While more research is needed to better understand the variation seen in patients with high viral loads...we believe that the test will provide an affordable alternative for monitoring trends in viral load and guiding treatment decisions," Dr. Downing said.



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Brazil to Share Generic AIDS Drugs And Technology -- moonotter, 19:30:21 07/24/02 Wed

Brazil to Share Generic AIDS Drugs And Technology


Reuters Health Information 2002. © 2002 Reuters Ltd.
Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.


BARCELONA, Spain (Reuters) Jul 09 - Brazil offered on Monday to share its generic AIDS drugs and technology with 10 of the world's poorest countries in an effort to close the gap in treatment between rich and poor.
Brazil has pioneered the use of generic antiretroviral drugs--to the ire of the pharmaceutical industry--in a highly successful programme for fighting HIV.

Paulo Teixeira, director of the national AIDS programme, said the country now had a duty to share its know-how with other countries in Africa, Asia, Latin America and the Caribbean ravaged by the virus.

"Brazil feels responsible for sharing its experiences with other developing countries, especially when it is related to access to antiretroviral drugs," he told reporters at the International AIDS Conference.

The Brazilian government will provide $1 million of initial funding for the program which will pay for the transfer of technology, training and the donation of drugs manufactured by Brazilian government laboratories.

Teixeira said he was also in discussions with other international organisations, including the Ford Foundation, which has shown interest in participating in one particular project in Africa.

Developing countries are being invited to submit proposals for 10 pilot projects, each of which will treat 100 patients initially, under the scheme launched at the AIDS meeting in Barcelona.

"The quantity is not significant if you consider the number of [HIV-infected] people in developing countries. But we know that to start with treatment we have to prepare professionals and institutions, which means small projects," he said.

Teixeira said he believed there was room for more cooperation between developing countries in fighting AIDS, following last November's decision at a World Trade Organisation ministerial meeting in Doha to allow states to produce cheap generic drugs to combat a "national emergency".



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Clinton Calls For Resources to Combat Global AIDS Epidemic -- moonotter, 19:35:39 07/24/02 Wed

Clinton Calls For Resources to Combat Global AIDS Epidemic


Reuters Health Information 2002. © 2002 Reuters Ltd.
Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.


By Ben Hirschler
BARCELONA, Spain, July 12 (Reuters) Jul 11 - The International AIDS Conference closes on Friday with rousing calls from Bill Clinton and other world leaders to mobilise resources for millions of sufferers in the developing world.

Two decades into an epidemic that kills one person every 10 seconds, the gulf between rich and poor is starker than ever. The sophisticated drugs that have turned HIV infection into a chronic condition in the West reach only one in a thousand in Africa, the epicentre of the crisis.

Former U.S. president Clinton, who is the co-chairman of the International AIDS Trust, described AIDS as the biggest single problem for the world, barring nuclear war, and called on Western governments to pay up for a new global AIDS fund.

"First of all, the rich countries should figure out what they owe and pay in a timely fashion," he said. "For the first time in history the world has to take responsibility for a global health crisis."

The U.S. and other Western governments have borne the brunt of protests at the biennial meeting, with activists noisily demanding they commit $10 billion a year to the U.N.'s Global Fund to fight AIDS, Tuberculosis and Malaria. Created in 2001, it has so far secured just $2.8 billion.

Without that money, the World Health Organisation's target of getting antiretroviral drugs to three million people by 2005 will remain a pipedream.

A debate has raged throughout the conference over the balance between prevention and treatment in the developing world, home to 95% of the world's 40 million infections.

Dollar for dollar, prevention is more cost-effective. But to ignore the provision of medicines would be like driving past bus crash victims for an urgent meeting on seatbelt legislation, said Richard Feacham, new head of the global fund.

Despite steep price cuts for poor countries and competition from generic drugs, combination therapy remains out of reach for the vast majority of those in the developing world.

A vaccine is still far from assured. Seth Berkley, president of the International AIDS Vaccine Initiative, said the meeting had been "a reality check" on how the world was doing in the fight against AIDS.



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Most Young HIV-Positive Gay/Bisexual Men in US Unaware of Serostatus -- moonotter, 19:41:09 07/24/02 Wed

Most Young HIV-Positive Gay/Bisexual Men in US Unaware of Serostatus


Reuters Health Information 2002. © 2002 Reuters Ltd.
Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.


By Deborah Mitchell
BARCELONA, Spain (Reuters Health) Jul 08 - The majority of young gay and bisexual men infected with HIV who live in large US urban areas are unaware of their serostatus, according to the results of a community-based study present here Monday at the XIV International AIDS Conference.

Furthermore, 59% of the HIV-positive men surveyed reported that they considered themselves to be at low risk for infection, lead researcher Dr. Duncan MacKellar, of the Centers for Disease Control and Prevention, told conference participants.

Dr. MacKellar and his colleagues conducted an anonymous survey of 5719 gay or bisexual men, between the ages of 15 and 29 years old, who resided in Los Angeles, Seattle, Dallas, Baltimore, Newark or Miami. The data were collected in neighborhoods, dance clubs and other settings popular among gay men.

Of the 573 men who tested positive for HIV infection, 440 (77%) were unaware of their infection and may have inadvertently transmitted the virus to their partners. The rate was especially high among HIV-infected African American men, 91% of whom reported they did not know their serostatus. Seventy and 60% of Hispanic and white men, respectively, did not know they were infected.

"Over half had either not been tested in the past year or had never been tested for HIV," Dr. MacKellar said. In the previous 6 months, half of the 440 reported having unprotected anal intercourse with one or more men, and nearly half of these men reported that they did not use condoms because they believed that they or their partners were at low risk of infection.

"We definitely need to do more research into barriers to HIV testing," Dr. MacKellar told Reuters Health. Although this study did not explore those factors, others have suggested that the stigma of being tested for HIV remains a barrier to testing, he said. In the current study, the subjects listed two primary reasons for not getting tested--they perceived themselves to be at low risk of infection or they were "scared to learn the results."

"We've got to do a better job of making sure that young men who have sex with men really understand the risks they are engaging in and the risks for acquiring HIV infection," Dr. MacKellar concluded. "We also need to do a better job of getting the word out of the benefits of early diagnosis and care."

In a second report, Dr. Ron Stall, also of the CDC, told conference participants that four psychosocial health problems--multiple drug use, partner violence, history of childhood sexual abuse, and depression--appear to interact to increase high-risk sexual behavior among gay and bisexual men in the US.

"The Urban Men's Health Study is a population-based sample of men who have sex with men," Dr. Stall told conference participants. Rather than sampling men in bars and other venues as is done in many other studies, the researchers "sampled neighborhoods in four American cities than are known to have a relatively high proportion of men who have sex with men. The four cities were San Francisco, Los Angeles, Chicago and New York."

In the course of surveying the 2281 men on a broad range of health problems that included sexual and mental health issues, "we were struck by the extent to which each of the health problems turned out to predict the other," Dr. Stall explained. There appeared to be "an interlocking web" of health problems among the gay men in these cities constituting "simultaneous epidemics that are feeding each other."

The correlation between HIV risk behaviors and multiple drug use, partner violence, history of childhood sexual abuse and depression were particularly "striking." Of those who reported all four problems, 33.3% also reported high-risk sexual behaviors. In contrast, among those who reported none of these problems, only 7.1% reported high-risk sexual behaviors. Similarly, HIV infection was reported by 25% with all four problems, compared with only 13% of those with none of these four other problems.

Overall, the HIV epidemic in this population is "intertwined with and fueled by other psychosexual health problems," Dr. Stall concluded. "One of the reasons why these men may not be able to respond to [HIV] intervention campaigns is that they are dealing with these other problems." He therefore suggests that HIV prevention efforts may be enhanced by focusing on these other issues, "particularly substance abuse and depression."



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Specimen Pooling Feasible for HIV Screening -- moonotter, 19:44:07 07/24/02 Wed

Specimen Pooling Feasible for HIV Screening


Laurie Barclay, MD
Medscape Medical News 2002. © 2002 Medscape


July 9, 2002 — Routine screening for acute infection with HIV in a low-risk population is feasible using blood specimen pooling and nucleic acid testing, according to a report in the July 10 issue of The Journal of the American Medical Association. The findings were also presented on July 6 at the XIV International AIDS Conference in Barcelona, Spain.
"The acute stage of the infection is almost never diagnosed in clinical practice and is always missed by routine antibody tests," lead author Christopher D. Pilcher, MD, from the University of North Carolina School of Medicine in Chapel Hill, says in a news release. "Without this type of testing, we miss the time when we know that people have by far the most virus in their blood and are at their most infectious. If we can catch infected people during the first weeks when routine antibody tests are still negative, we can help them avoid spreading HIV to their husbands, wives, unborn children, or other intimate partners."

This study tested 8,505 subjects seen at 110 publicly funded testing sites in North Carolina for routine HIV testing and counseling in August and December of 2001. Serum specimens negative by HIV enzyme immunoassay were screened in pools using an ultrasensitive HIV RNA reverse transcriptase-polymerase chain reaction (PCR) assay. Screening all specimens required 147 HIV RNA tests. Confirmatory testing reclassified results for individual HIV RNA-positive specimens as true- or false-positives.

"The reason this wasn't done before was that there are extraordinary difficulties in doing this kind of collaborative research effort in clinical public health settings," Pilcher says. "That we were able to do it is a credit not only to the UNC faculty and staff involved, but also to the people at the state's department of health and laboratory of public health who have shown an ability to think outside the box with regard to HIV."

Of the 8,194 subjects who had not previously tested positive for HIV and who also had sufficient serum for additional evaluation, 39 had long-term HIV infection (prevalence, 47.6 per 10,000 individuals at risk; 95% confidence interval [CI], 33.8-65.0 per 10,000).

Of the 8,155 individuals at risk with negative antibody tests, five were positive for HIV RNA, including four women with true-positive acute infection (prevalence, 4.9 per 10,000; 95% CI, 1.3-12.5 per 10,000). Two of these women developed symptoms consistent with an acute retroviral syndrome in the week after testing. Overall specificity of this screening strategy was 0.999.

"The nucleic acid testing, or PCR, detects patients who may represent a public health threat and who would ordinarily get a falsely reassuring 'negative' test result. We hope that this type of testing can help us cut the risk for the unsuspecting partners of acutely infected patients," Pilcher says.

Increased costs of this testing would be about $2 per test, or $4,109 for each new case diagnosed, which may be a small price to pay to prevent further HIV transmission or begin treatment earlier when it is most effective. "These people can potentially benefit themselves if we know to start them quickly and aggressively on antiretroviral treatment," Pilcher says. "Several very exciting but preliminary studies have shown recently that early treatment in this way may improve their long-term prognosis."

JAMA. 2002;288(2):216-221

Reviewed by Gary D. Vogin, MD






Laurie Barclay, MD, is a staff writer with WebMD.

Medscape Medical News is edited by Deborah Flapan, an associate editor at Medscape. Please send press releases and comments to news@webmd.net.
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AIDS Abolishes Life-Expectancy Gains Achieved in Africa Over Past Century -- moonotter, 19:47:17 07/24/02 Wed

AIDS Abolishes Life-Expectancy Gains Achieved in Africa Over Past Century


Reuters Health Information 2002. © 2002 Reuters Ltd.
Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.


BARCELONA, Spain (Reuters Health) Jul 08 - The average life expectancy of people in eleven African countries will drop below 40 by 2010 as HIV continues to shorten the lives of millions, US government researchers said on Sunday.
"By 2010, we project that life expectancies in these countries will be back to levels that have not been seen since the nineteenth century," US Census Bureau's Karen Stanecki told reporters at the International AIDS Conference. "Unfortunately, many African countries are only beginning to see the impact of high levels of HIV prevalence."

Her "middle-case scenario" report, which assumes that the epidemic will begin to level off in Africa over the next 8 years, predicts that the average life expectancy in Botswana and Mozambique will drop to 27 years. Swaziland will see an average of 33 years and Zimbabwe, Zambia and Namibia 34 years. Angola, Lesotho, Malawi and Rwanda and Mali will see life expectancy drop to the mid to late 30s.

The figures, prepared on behalf of the US Agency for International Development, are just the latest in a series that show Africa buckling under the growing AIDS pandemic. Sub-Saharan Africa has some 28 million of the world's 40 million infected people, with infection rates rising over 30% in some countries.

Without AIDS, average life in southern African countries such as Botswana, Namibia and Swaziland would have been around 70 years by 2010, the report shows.

Instead, deaths will outstrip births in five countries by 2010, meaning negative population growth. Without AIDS, Botswana, Mozambique, Lesotho, Swaziland and South Africa would have expected a population growth rate of at least 2%, Stanecki said.

The Census Bureau report confirms that the epidemic will continue to undermine the economic stability of Africa, with the biggest increases in early deaths coming among people in their 30s, 40s and 50s, when they would be at their most productive.

It also shows that the millions of AIDS orphans currently overwhelming many countries will be a growing problem.

"You have a lot of adults missing, and then you have a lot of children who don't have adult supervision or don't have adult leadership. That means increases in orphans, increases in street children," Stanecki said.



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South African AIDS Crisis Goes Unabated -- moonotter, 19:49:54 07/24/02 Wed

South African AIDS Crisis Goes Unabated


Reuters Health Information 2002. © 2002 Reuters Ltd.
Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.


By Deborah Mitchell
BARCELONA, Spain (Reuters Health) Jul 11 - In the absence of a significant breakthrough in prevention or therapeutic technologies, the South African Department of Health predicts that the cumulative AIDS mortality may reach 4.5 million by 2010.

Zackie Achmat, founder of the Treatment Action Campaign in South Africa, spoke to members of the XIV International AIDS Conference at a plenary session on Wednesday. His message was heard via videotape because he was too ill to attend the conference. Achmat, who is HIV-positive, has refused to take antiretroviral drugs until these drugs become available to his fellow countrymen.

In addition to the predicted high death toll, the Department of Health reports that in 2000, AIDS-related illness accounted for 628,000 hospital admission, amounting to 24% of all public hospital admissions. The associated costs add up to at least 3.6 billion Rand annually, or 12.5% of the nation's budget.

Achmat pointed to evidence for the feasibility of providing antiretroviral therapy to South Africans. Since the last International AIDS conference 2 years ago in Durban, M dicins Sans Fronti res began to offer antiretroviral therapy to HIV-infected patients in Khayelitsha, outside of Cape Town.

Most of these patients presented with CD4+ counts <48 cells/ L and HIV RNA loads >170,000 copies/mL, Achmat said. Yet after 6 months of treatment, 90% of the patients achieved undetectable viral loads and improved immune responses.

These findings, Achmat pointed out, follow the success achieved in Haiti by Dr. Paul Farmer of Partners in Health. Dr. Farmer, who is also affiliated with Brigham and Women's Hospital in Boston and a professor at Harvard Medical School, and his colleagues have implemented in Haiti a program of directly observed therapy with highly active antiretroviral therapy (DOT-HAART). The strategy is similar to the approach that has been used with tuberculosis with great success.

"Treatment does work; treatment is cheaper than letting people fall ill and die; and treatment is attainable," AIDS activist Judge Edwin Cameron of South Africa told conference participants. Cameron, who also has AIDS, echoed the call to action that energized the Durban conference.

"Treatment for the world's people with HIV living in resource-poor settings is an obtainable goal," Cameron continued. What is now needed, he said, is the $10 billion per year for the Global Fund.

"We also need to appeal to the drug companies to issue voluntary licenses with small royalties" to poor countries, he added.

"It is expected in 2002 that 300,000 people in South Africa will die of AIDS," he said. "Thousands, and eventually millions, of South Africans like myself will die because they do not have access to these treatments."



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Number of HIV Cases in Former USSR Now Outstrip Those in US -- moonotter, 19:52:47 07/24/02 Wed

Number of HIV Cases in Former USSR Now Outstrip Those in US




BARCELONA, Spain (Reuters Health) Jul 11 - The HIV epidemic in the former Soviet Union is growing faster than anywhere in the world and threatens to spread from injecting drug users into the wider population unless action is taken, researchers said on Thursday.
"From a small number of cases in 1995, HIV infections have grown so quickly that an estimated one million people in the former Soviet Union are infected with HIV--more than in the US," Dr. Anna Shakarishvili from the US Centers for Disease Control and Prevention told reporters at the International AIDS Conference.

At present, 90% of HIV-infected people in former Soviet states are injecting drug users, but Dr. Shakarishvili and colleagues from the Russian Association for Sexually Transmitted Infection Prevention now report worrying signs of an epidemic among sex workers and the homeless that threatens to spread further through heterosexual sex.

The researchers studied 400 non-drug using men and women at centers for the homeless in Moscow and found that 1% were HIV-positive, compared to just 0.18% in the general population. Thirty percent were infected with sexually transmitted diseases like chlamydia and gonorrhea, which increase the risk of becoming infected with HIV.

Over 64% of men and 40% of women in the study said they did not use a condom the last 10 times they had sex, Dr. Shakarishvili added.

In another study, the researchers looked at HIV rates and risk-taking among 190 women who exchanged sex for money or other commodities, only 21% of whom considered themselves as sex workers. Of these women, 2.8% were HIV-positive and around 70% had one or more sexually transmitted disease.

The women had an average of 168 partners in the past year, 1% took opiate drugs, and 5% used cannabis. Ninety percent said they used condoms, 63.2% practiced oral sex and 15.8% had anal sex.

"This research shows marginalized women are at significant risk through heterosexual sex," Dr. Shakarishvili said. "Without intervention, the epidemic could spread more widely to the general heterosexual population through commercial sex work."




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Reuters Health Information 2002. © 2002 Reuters Ltd.
Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.


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