In this issue:
WTP announces leadership changes
Opponents softening stance on PPP
Salt in semen, breast milk aids HIV transmission
Merck finds new step in infection cycle
T-20 found to work well in patients
Use of HAART may impact HIV infection rate
Magic Johnson to publish treatment magazine
We The People Membership Meeting: Feb. 24th
Charles Starnes, president of the Board of Directors of We The People, has announced the resignation of executive director Rob Capone and board member Rick Britt, as the 12-year-old PWA coalition seeks to re-organize after several months of internal disputes.
Starnes said that tensions between Capone and some board members over the past year on personnel issues and his management style had made it impossible for the group to continue without major leadership changes. He said that the WTP board has asked the city's AIDS Activities Coordinating Office, which provides the bulk of the coalition's funding, to provide administrative help to the group while it seeks a new executive director.
Capone's resignation was effective February 4th. Britt, who was a major critic of Capone's on the board, also resigned, and the board confirmed his resignation at its regular meeting on February 9th.
Starnes said that both resignations were important to "clear the air" so that the WTP membership could move ahead with serving people living with HIV disease.
"I'm sorry that things ended up this way," Starnes told the Philadelphia Gay News in announcing Capone's resignation. "But it's a board decision that it's better for Rob to leave," Starnes said. "He's not leaving on bad terms. He's agreed to help us with the transition [to a new executive director]."
Capone had served as WTP director since June 1998. He was the third director in as many years. Joseph Cronauer, who now is a co-director of AACO, assumed the post in 1996, and was succeeded by Curtis Osborne, who led the agency in 1997. David Fair served as WTP director from 1991 to 1996.
In his PGN interview, Starnes praised Capone's accomplishments at We The People. He said the agency expanded greatly during Capone's leadership.
"Rob did great work here," Starnes said. "He's raised an enormous amount of money for this agency." Capone presided over the opening of We The People's 25-unit West Philadelphia apartment complex for low-income people with AIDS and the opening of its first neighborhood storefront site, also in West Philadelphia.
Pennsylvania governor Tom Ridge has proposed a 23% increase - about $2.1 million - in the state budget for the Special Pharmaceuticals Benefits Program (SPBP), which provides free medications to people with AIDS and other Pennsylvanians who cannot get the drugs through insurance. But funding for AIDS direct care and prevention services will not be increased under the Ridge plan.
Bruce Flannery, executive director of the Pennsylvania Coalition of AIDS Service Organizations, called the SPBP increase "significant" and "a reasonable increase based on middle of the road assumptions for program constituent growth and new FDA approvals." With regard to SPBP, Flannery said that "here also seems a willingness within DPW to reexamine projections as the budget process moves along and to advocate for additional increases before the final budget bill is brought to the House and Senate. " The Department of Public Welfare administers the free medication program. скачать выпусками метро книги по прямой ссылке
The Ridge proposal "level" funds existing HIV prevention and care programs at slightly over $6.5 million. The state also distributes slightly more than that amount in federal Ryan White CARE Act Title II funding.
Flannery attributed the lack of an increase in AIDS funding generally as a sign of the lack of confidence the Ridge Administration has in the state's AIDS network. "Based on our discussions with various parties, it appears that there is growing awareness within the administration that parts of our system (particularly the inability of the state to build a statewide plan from the seven regional plans) are broken," Flannery wrote in a memorandum to PCASO members. "The administration's position seems to be that until such a time as we can demonstrate statewide need with cohesive data supporting that need, it seems highly unlikely that the Governor's office will part with any further HIV funding for care and prevention." capitally odessa apartments rent treat site
Flannery noted that the Ridge budget proposal will likely undergo some changes as it is debated in the state House and Senate over the coming months.
With all the alarming reports recently about the study showing that oral sex carries a higher risk of transmitting HIV than originally thought, one important detail was missing.
The reports were that, in the "most definitive study to date," researchers found that eight out of 102 Gay and bisexual men most "likely" acquired HIV through oral sex (seven as the recipient partner, one as the insertive partner). A previous study by the U.S. Centers for Disease Control and Prevention calculated the risk of oral transmission, for the receptive partner when the top does not use a condom, as 0.04 percent per contact -- a risk that was the lowest for all sexual practices but "not without risk."
In all those news reports, nobody discussed to what extent, if any, the eight men who contracted HIV through oral sex were suffering from ulcers or gum disease. The presence of bleeding gums, scratches, and ulcers is known to facilitate HIV's ability to enter the bloodstream. The detail was not on the poster at the Retrovirus Conference, not in the press release issued by the CDC, and was not known readily by the University of California-San Francisco researcher who was taking questions about the study at the conference.
But that researcher, Rick Hecht, did, at the Blade's request, look up the information back at his office, and this week he responded: "About half did have gum disease or an oral ulcer."
Thus, it would seem that "about half" of the eight out of 102 men did have an additional risk factor for contracting HIV through oral sex, suggesting that about 4 percent of men contracted HIV that way -- a percentage more in line with previous studies.
It is worth noting again, however, that even before the study stirred up new attention for the risk of transmitting HIV through oral sex, most AIDS prevention messages have urged men to use a condom -- and women to use dental dams -- when engaging in oral sex.
"There is nothing in this study that should make us change our message about HIV transmission," said Gay Men's Health Crisis official Ronald Johnson in a Feb. 2 press release. "We have consistently been telling the public for many years that oral sex can possibly result in HIV transmission but that the risk is much smaller than the risk of unprotected anal intercourse." The GMHC press release noted that the Gay clinic received an increased number of calls following news reports last week from the Retrovirus Conference in San Francisco.
In related news, another poster at the Retrovirus conference indicated last week that some men with HIV "shed" virus through their semen even when they are asymptomatic. The study, from the University of Pittsburgh, examined the blood and semen of 18 men with HIV infection every week for 10 weeks. Five of the men never showed HIV in their semen, five always had HIV detectable in their semen, and the remaining eight men had HIV detectable 70 percent of the time. (Lisa Keen, Washington Blade
Opponents softening stance on PPP
Kensington city councilman Rick Mariano said February 10th that he is not trying to shut down the region's only syringe exchange program, but that he continues to be outraged that Prevention Point Philadelphia obtained approval from the Health Dept. to distribute a brochure aimed at helping sex workers stay safe while they ply their trade.
"I'm not an expert in this," Mariano told the Philadelphia Daily News, which has been fanning the flames of the controversy for the past several weeks, "but I want to get some answers. I object to city funds being used for something that isn't supposed to be used for." The newspaper said that Mariano was also concerned that officials of the Health Dept.'s Coordinating Office of Drug and Alcohol Abuse Programs (CODAAP) were slow in responding to his request for information about the approval of the brochure by assistant health commissioner Mark Bencivengo, who directs the city's drug and alcohol treatment programs.
"I suspect they didn't have all the answers, but that's why we want to bring this out in the open," Mariano said.
Mariano has made something of a name for himself in Kensington politics by his aggressive tactics aimed at reducing prostitution in his district, which is one of the city's poorest. Several years ago, he gained notoriety for confronting individuals he said were soliciting for sex on Kensington Avenue with a loaded gun.
Daily News columnist Elmer Smith, who generated the most recent PPP controversy, also appeared to be softening his sometimes strident position on the issue in a column published on February 11th, and the Daily News editors published an editorial calling for continued funding for PPP on February 16th.
Smith said that he, too, is not seeking to hurt Prevention Point, but that he continued to believe that the pamphlet aimed at sex workers went too far.
"It crossed the line," Smith wrote, " by offering tips on pricing and on how to negotiate with a john, and other information that had nothing to do with health or safety. The city, which provides $300,000 a year for Prevention Point's operation, finds itself in the position of paying to curtail prostitution through police efforts while helping to sustain the sex trade through Prevention Point."
Smith also called on Mariano and others who were energized by his previous columns to engage in a "period of reflection" before taking any action that would harm PPP's syringe exchange program.
"That would be a mistake," Smith wrote. "...It would be a mistake to abandon a needle-exchange program that may be doing as much to curtail the spread of HIV as any publicly funded initiative in town."
Smith quoted Mariano aide Walter DeTreux as confirming that Mariano does not want to shut down PPP.
"We're not looking to do that," DeTreux said. "We met with Prevention Point last week and told them that we are not trying to shut down the needle exchange. We're only interested in making sure these pamphlets aren't distributed with city money."
Daily News editors also clarified the newspapers position, with an editorial reviewing the data supporting syringe exchange and calling on politicians to assure PPP's continued funding. The editorial appeared after PPP representatives met with the paper's editorial board, and on the day that the Health Dept. budget was being considered in City Council.
"Needle exchange in Philadelphia does work and should continue," the paper's editorial said. "And while Prevention Point has shown questionable judgment, at this point they are the only organization willing to do the work. The city should continue its funding."
Meanwhile, the new director of Prevention Point, Rob O'Brien, has again asserted that the organization has not distributed the pamphlet and agrees with critics that it and similar leaflets photocopied by the organization before he became its director - including one brochure advising crack cocaine addicts on how to continue their habit safely that engendered controversy last summer - are not useful to the group's HIV prevention efforts.
O'Brien told a group of PPP supporters at a meeting last week that the pamphlets were photocopied from materials developed in New York City, and that the organization has since changed its leadership and more clearly defined its mission in ways that would prevent a similar series of controversies in the future.
O'Brien said that PPP has been effective in linking a number of active needle addicts to drug treatment and medical care, and that he continues to believe that syringe exchange not only works as an HIV prevention message, but is an important took in reaching a population that usually cannot be reached by more traditional public health approaches.
O'Brien said that he is gratified at the expressions of support the group has received from Mayor Street, some members of City Council, and the new chairperson of the Black Clergy of Philadelphia and Vicinity. He said that group is hopeful that public hearings on the issue, which may be scheduled by the Council's Health and Welfare Committee, will provide an additional opportunity to clarify both the group's role in HIV prevention and the effectiveness of syringe exchange in reducing the levels of HIV infection among the city's most at-risk residents.
The higher salt content of seminal fluid and breast milk may overcome the ability of saliva to fight HIV infection, according to researchers at the University of Texas Medical Branch in Galveston. The finding helps to explain how semen and breast milk transmit the virus via the mouth.
Salivary transmission of HIV is relatively rare, Dr. Samuel Baron and colleagues explain. Saliva is thought to protect against HIV-transmitting white blood cells because of its unique low salt concentration, which helps to kill these cells, the authors note in the February issue of The Journal of Infectious Diseases. However, HIV is successfully transmitted via seminal fluid, breast milk and colostrum, white cell-rich fluid secreted in the first days of breast-feeding.
To further investigate how HIV-infected seminal fluid and milk overcome the protective effects of saliva, Baron's team conducted a series of laboratory studies using mixes of samples of saliva and milk, colostrum, and seminal fluid.
The researchers found that as the percentage of saliva was reduced, and the percentage of seminal fluid, milk or colostrum was increased, the ability of saliva to inactivate HIV-infected white blood cells decreased.
"When saliva was reduced to only one third of the mixture, with the remaining two-thirds being the saltier substances, then saliva was no longer protective against HIV," Baron commented in a University press release.
"Under normal circumstances, there is just about one-fifth of a teaspoon of saliva in the mouth," he continued. "Deposited semen typically would equal more than four times that volume and mother's milk much, much more. So it's easy to see that saliva can't kill the infected cells because there's just too much of the saltier substances."
Baron also believes these findings have implications for the actual cause of HIV infection. "There is very good evidence that infected white blood cells are the main transmitting agent of HIV in the vagina and the rectum," he continued.
While many "physicians still believe that HIV is transmitted by free virus" from HIV-infected individuals, "most cell-free virus is not infectious, probably because HIV carriers make sufficient antibodies, which bind to the virus and hamper its ability to infect other cells," Baron explained.
Conversely, "HIV-positive milk and semen are highly infectious, probably because these fluids contain white blood cells that are infected by HIV and the antibodies can't get inside these cells to attack the virus," he added.
Baron's group is currently trying to develop anti-HIV gel that can mimic the protective effects of saliva in the vagina and rectum, environments that are both more salty than the mouth.
Merck finds new step in infection cycle
Scientists have become increasingly frustrated in the hunt for novel ways to attack the AIDS virus, but now they are getting some encouraging news: Drug giant Merck & Co. has mapped the way toward a long-elusive target. It will take years of additional research to turn the finding into a usable medication, experts cautioned.
But the research gives scientists another - and long-awaited - place to aim in fighting the virus, important because today's AIDS drugs are slowly losing their edge, with few options in sight.
It's called integrase, an enzyme carried by the AIDS virus that causes a crucial step in HIV infection: It melds HIV's genetic material with the patient's own DNA inside the patient's cells, essentially hijacking cells. Only then can HIV begin reproducing at its infamously furious rate.
Scientists have long known about integrase's crucial function and tried to create "integrase inhibiting" drugs to block its effect, much like the popular AIDS-fighting "protease inhibitors" block the action of a different HIV enzyme called protease.
But attempts to create integrase inhibitors have failed so far.
Merck's advance, reported in today's issue of the journal Science, was to uncover the exact spot in the enzyme's action that must be blocked for an integrase inhibitor to work.
Merck researchers screened 250,000 samples in the company's library of chemicals and found two compounds known as "diketo acids" that hit that spot. In laboratory tests, the compounds successfully inhibited integrase and fought HIV.
In an unusual move, Merck executives refused to allow the lead scientist - Daria Hazuda - to discuss her discovery with reporters.
But a Merck spokesman said the compounds described in Science have certain problems that prevent them from being pursued as drugs, so the company is hunting better candidates.
Other AIDS researchers welcomed the news.
"It's opened up a third target, a target everyone knew was out there but . . . that no one's been able to hit," said Jeffrey Laurence of Cornell University, senior scientist for the American Foundation for AIDS Research.
"They have now developed methodology, which is a critical step in developing drugs against this target," added Douglas Richman of the University of California, San Diego.
Doctors now have two ways to attack HIV: Drugs such as AZT and ddI block an enzyme called reverse transcriptase that is vital to early HIV infection, while protease inhibitors work at one of the latest stages of HIV replication.
Combinations of those drugs have helped patients live longer, but the drugs are not a cure, don't help everyone, and lose their effectiveness over time. Integrase inhibitors would target HIV infection between the steps those other drugs hit.(Biotech Week)
T-20 found to work well in patients
An experimental HIV drug that stops the virus from infecting cells is working in severely ill patients and seems to be boosting their immune systems, the company that makes the drug said on Friday.
The drug, T-20, is the first of a new class called fusion inhibitors. Made by Durham, North Carolina-based Trimeris Inc. in partnership with F. Hoffmann-La Roche, the drug has been tested on several dozen patients for eight months.
Dr. Sam Hopkins, senior vice president of medical affairs at Trimeris, said the 32-week data from the Phase II trial showed the drug was lowering the amount of virus circulating in patients' bodies and was also helping immune system cells known as CD4 T-cells recover.
"If one looks at HIV treatment literature, a very clear characteristic one sees is the T-cells reconstituting. Typically there is an acute phase with a rather rapid rise for eight to 12 weeks, then, if there is a persistent antiviral effect, there is a continued increase in T-cell numbers albeit at a lower slope," Hopkins said in a telephone interview.
"That's the trend that we seeing now at 32 weeks ... It is really encouraging."
Trimeris will be presenting information about the trial at a meeting of HIV experts in San Francisco that begins on Sunday. There is strong interest in finding new classes of HIV drugs that work well because patients are starting to show resistance to the current cocktails of medicines.
Hopkins said about one-third of the 71 patients originally enrolled in the trial had dropped out. Two died and the rest were mostly too ill to continue, he said. "You are dealing with an extremely advanced patient population," he said.
But to his surprise the patients staying in the trial were, by and large, taking the drug. Some experts had worried that T-20 might not be a popular drug because it has to be injected twice a day. Other HIV drugs come in pill form.
"I have to admit that it is completely counterintuitive that anyone would comply with an injected therapy," Hopkins said.
"What we actually see is the complete opposite." He said his team was taking random samples of blood and the patients were mostly taking T-20 as directed.
Both T-20 and a second Trimeris experiment fusion inhibitor called T-1249 have been given fast-track designation by the U.S. Food and Drug Administration (FDA). This cuts review time in half, from about 12 to six months.
A once-a-day non-nucleoside reverse transcriptase inhibitor (NNRTI) that looked promising in phase I studies has been dropped by Glaxo-Wellcome because its interactions with other anti-HIV drugs are so problematic.
GW420867X was dropped because experts felt that its profile as a powerful cytochrome p450 3A4 inducer would make it very difficult to partner with other anti-HIV drugs. Most anti-HIV drugs are metabolized through this route, and drugs that induce cytochrome p450 3A4 metabolism will speed up the clearance of other drugs processed that way.
In order to counteract this process, doses of other drugs would have to be increased, possibly resulting in unacceptable increases in pill burdens and drug-related adverse events.
In a statement, a spokesman for Glaxo-Wellcome said that the company was very reluctant to make the decision, and will be actively pursuing the development of other NNRTIs.
Expanding the use of antiretroviral drugs in San Francisco will not only reduce AIDS-related mortality in the next 10 years, it may also substantially reduce the incidence of HIV infection, according to researchers at the University of California, San Francisco (UCSF).
Dr. Sally Blower and colleagues developed a mathematical model of HIV transmission for the gay community in San Francisco, which now has 30% prevalence of HIV infection. Only about half of these individuals are currently receiving the combination of antiretroviral drugs that are most effective for fighting HIV.
"Our model found that over 10 years, expanding antiretroviral therapy in San Francisco will reduce HIV incidence rates and AIDS death rates below what they would be without expanded treatment," said Blower in a statement issued by UCSF.
They also found that in the worst-case scenario, if risk behaviors were doubled and if 60% of patients became drug resistant, "infection rates and deaths would still be lower after 10 years than if treatment were not expanded."
Some experts have feared that antiretroviral therapy "could lead to an increase in the infection rate," the study authors write in the January 28th issue of Science. Even though treatment can drop blood levels of HIV to undetectable levels, "treated individuals are likely to retain some degree of infectivity," the investigators note. The development of drug resistance and the recently reported increase in HIV risk behavior in this population may compound the problem.
Therefore, the researchers' statistical model took into account the potential effects of antiretroviral therapy, increases in HIV-risk behavior and the emergence of drug resistance over the next 10 years. The effectiveness of antiretroviral therapy "was predicted in terms of the cumulative number of HIV infections prevented and the cumulative number of AIDS deaths averted," Blower and colleagues note.
However, Blower stresses that "even small changes in risk behavior will reduce the benefits in the short run." She therefore believes "it is imperative that bath houses not be re-opened and that people practice protected sex, particularly those who are on treatment."
Former NBA basketball star Magic Johnson, among the most well-known American celebrities living with HIV disease, has announced that he will join with the AIDS Healthcare Foundation (AHF) of California to produce Thrive Magazine, an HIV treatment publication targeted to African Americans and other communities of color.
In a press release, AHF said that the new magazine seeks to address the severity of the impact of AIDS among people of color by providing minority communities a unique, multicultural perspective on resources and information concerning HIV education and treatment.
"Our intent is to reach communities most challenged by the AIDS crisis, who, for a number of reasons, are not accessing medical care for the treatment of HIV," said editor Peter Hale. "By providing a magazine that is informative, accessible and entertaining, we hope to empower readers with vital information to assist them in effectively managing their health."
The magazine, first expected out in early summer, will cover a variety of subjects which appeal to the interests and lifestyle of a broad-based readership and various groups within minority communities most impacted by AIDS. Featured segments stress the importance of developing a healthy lifestyle. Articles include updates on new drug treatments, alternative therapy and behavior modification. To strengthen its appeal, the magazine will feature stories on high profile figures well regarded among potential readers.
The press release says that the magazine "seeks to sensitize health care professionals to the needs of minorities living with HIV/AIDS and complement existing efforts to heighten awareness among communities most challenged by the epidemic."
Collectively, ethnic minorities represent well over half the number of AIDS cases in the United States. However, since the initial stages of the epidemic, HIV has disproportionately impacted African Americans, more than any other ethnic group. According to the Centers for Disease Control (CDC), African Americans constitute 49% of all AIDS cases, yet represent only 13% of the total U.S. population. New data released by the CDC revealed that despite a 20% decline in the number of AIDS-related deaths in the U.S. the mortality rate among African Americans is more that 10 times that of their Caucasian
counterparts.
Interpretation of the data suggests African Americans are diagnosed in later stages of the disease and therefore are not accessing early, potentially life saving treatment. In Philadelphia, statistics indicate that the local epidemic is even more dramatically concentrated in ethnic minority populations, with African Americans and Latinos comprising almost 80% of all diagnosed cases reported in Philadelphia over the past several years.
Thrive Magazine will have an editorial board of over 50 leading national AIDS researchers and front line clinicians to guide editorial development and ensure the magazine connects with its target audience. Over one-third of the board members are people of color.
We The People will hold a meeting of the membership on Thursday, February 24th, following the weekly dinner at St. Mary's Episcopal Church, 1831 Bainbridge Street. The dinner begins at 5:30 p.m.