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ICAAC 2008: Abacavir/lamivudine plus Boosted Atazanavir Provides Potent Antiviral Activity at All Viral Load Levels

Recently presented data have offered conflicting evidence concerning the relative effectiveness of nucleoside reverse transcriptase inhibitor (NRTI) backbone combinations using abacavir or tenofovir. New data presented this week at the 48th International Conference on Antimicrobial Agents and Chemotherapy (ICAAC 2008) in Washington, DC, provide further support for both sides of the debate. (The HEAT and GlaxoSmithKline trial review results were presented again as posters at ICAAC.)

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ICAAC 2008: Boosted Atazanavir (Reyataz) and Lopinavir/ritonavir (Kaletra) Are both Highly Effective through 96 Weeks

Long-term clinical trial data show that modern HAART regimens offer continued antiviral efficacy over time, although toxicities remain a concern.

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AIDS 2008: Pregabalin vs Placebo for the Treatment of Painful HIV-associated Peripheral Neuropathy

Painful peripheral neuropathy remains a significant problem for many HIV/AIDS patients and there are few palliative or otherwise helpful therapies for this serious adverse event that may be associated with antiretroviral drug treatment, HIV infection itself, or both.

Pregabalin, an anti-epileptic drug, has previously demonstrated efficacy in several neuropathic pain syndromes. The FDA has approved Pfizer's pregabalin (Lyrica) for the treatment of fibromyalgia.

At the XVII International AIDS Conference last week in Mexico City, David Simpson of the Mount Sinai Medical Center in New York City presented results from the first trial to evaluate the efficacy, safety, and tolerability of pregabalin as a treatment for pain associated with HIV sensory neuropathy.

This randomized, double-blind, placebo-controlled, multicenter trial included 302 participants, 151 allocated to receive pregabalin and 151 to receive placebo. At baseline, the mean pain score was about 6.93 for the pregabalin arm and 6.72 for the placebo arm.

There were 4 phases: 1-2 week screening, 2-week double-blind dose-adjustment (150-600 mg/day taken twice-daily), 12-week double-blind maintenance, and 1-week tapering off. Overall average daily dosage of pregabalin was 385.7 mg/day.

The primary efficacy measure was mean pain score using an 11-point numeric rating scale completed daily by patients; weekly man pain score was a supplemental analysis.

Results

• At weeks 1 and 2, patients taking pregabalin had significantly greater improvements in mean pain score relative to placebo:

• Week 2: -1.92 vs 1.43; P = 0.0393.

• In an analysis of PGIC scores, more patients taking pregabalin said their condition had improved, and fewer said it had worsened (P = 0.0077):

• 13.3% and 25.4%, respectively, experienced "no change."

• The most common adverse events (AEs) in the pregabalin arm were somnolence (23.2% pregabalin vs 8.6% placebo) and dizziness (19.2% vs 10.6%, respectively).

• Seven patients (4.6%) in the pregabalin group and 2 patients (1.3%) in the placebo group discontinued because of treatment-related AEs.

Based on these findings, the study authors concluded, "Pregabalin and placebo were associated with substantial improvements in pain and PGIC, with no significant difference in endpoint mean pain score. Adverse events were consistent with the tolerability profile of pregabalin in other neuropathic pain clinical trials."

Mount Sinai Medical Center, New York, NY; Pfizer Global Pharmaceuticals, New York, NY.

8/15/08

Reference

DM Simpson, TK Murphy, E Durso-De Cruz, and others. A randomized, double-blind, placebo-controlled, multicenter trial of pregabalin vs placebo in the treatment of neuropathic pain associated with HIV neuropathy. XVII International AIDS Conference (AIDS 2008). August 3-8, 2008. Mexico City. Abstract THAB0301.

ICAAC 2008: Continuous HAART Associated with Elevated Risk of Bone Loss in SMART Treatment Interruption Trial

Evidence has accumulated over the past several years showing that antiretroviral treatment interruption guided by CD4 cell count is a risky strategy that can lead to a higher risk of both AIDS-defining opportunistic illnesses and serious conditions such as cardiovascular disease that are not traditionally considered HIV-related, but may be due to inflammation and other abnormalities associated with ongoing viral replication.

Researchers initially explored structured treatment interruption in an effort to spare patients some of the side effects, inconvenience, and costs of life-long therapy. But most studies to date have demonstrated few such benefits, especially given the development of more tolerable and easier to use drugs.

The latest analysis from the large SMART trial, however, indicates that continuous HAART may increase the risk of bone loss (osteopenia, or the more serious osteoporosis). Data were presented this week in a late-breaking poster at the 48th International Conference on Antimicrobial Agents and Chemotherapy (ICAAC) this week in Washington, DC.

Research looking at bone mineral density (BMD) in people with HIV has produced conflicting results. Several studies have shown that HIV positive people have lower BMD compared with the general population, but it is not clear whether this is related to HIV infection itself, antiretroviral therapy, an accelerated aging process, or other unknown factors.

Briefly, the SMART study included 5472 HIV positive participants with a CD4 cell count above 350 cells/mm3 at baseline who were randomly assigned to either stay on continuous antiretroviral therapy (the "viral suppression" arm), or to interrupt treatment when their CD4 count was above 350 cells/mm3, resuming when it fell below 250 cells/mm3 (the "drug conservation" arm). The study was halted prematurely in January 2006 after interim results showed that people who periodically stopped therapy had both a higher rate of AIDS-related opportunistic infections or death and serious heart, liver, and kidney disease.

The substudy presented at ICAAC included 275 SMART participants, of whom 214 had sufficient available bone data (98 in the continuous therapy arm, 116 in the treatment interruption arm). Most (81%) were men, the median age was 44 years, and about 45% smoked (a known risk factor for bone loss).

Hip and spine BMD were measured annually using dual-energy x-ray absorptiometry (DEXA), and trabecular BMD of the spine was assessed using quantitative computed tomography (CT). The investigators used longitudinal models to compare BMD changes in the 2 arms, and assessed the incidence of reported fractures in the study as a whole. Further, they evaluated associations between BMD decline and cumulative antiretroviral drug use in the continuous therapy arm.

At baseline, 12% of the patients had osteoporosis, median t-scores (a standard measure of bone density) were -0.5 for the femur, -0.9 for the spine by CT, and -0.7 for the spine by DEXA. Participants were followed for a mean of 2.4 years.

Results

• In the continuous therapy group, patients received ART for 93% of total follow-up time, compared with 37% in the treatment interruption group.

• In the continuous therapy group, femur BMD declined by 0.9% per year, spine BMD by CT declined by 2.9% per year, and spine BMD by DEXA decreased by 0.4% annually.

• BMD decreases were significantly smaller in the treatment interruption group, especially during the first year when most were not yet on therapy.

• Over the entire follow-up period, the estimated differences in BMD changes in the treatment interruption group compared with the continuous therapy group were:

• Femur: 1.4% (P = 0.002);

• Spine by CT: 2.9% (P = 0.01);

• Spine by DEXA: 1.2% (P = 0.05).

• No consistent significant associations were observed between BMD decline and use of specific antiretroviral drugs.

• In the study as a whole, during a mean 2.8 years of follow-up, 10 of 2753 patients in the continuous therapy arm and 2 of 2720 in the treatment interruption group reported fractures as grade 4 adverse events.

• The rate of fractures was nearly 5 times higher in the continuous therapy arm compared with the treatment interruption arm (0.13 vs 0.03 per 100 person-years; hazard ratio 4.9; P = 0.04).

Based on the results of this analysis, the researchers concluded that, "Continuous antiretroviral therapy is associated with decline in BMD and possibly more fractures relative to intermittent, CD4-guided antiretroviral therapy."

Given the now-obvious detrimental effects of treatment interruption, however, they emphasized that "Intermittent antiretroviral therapy is not recommended due to increased risk of AIDS and death observed in the SMART study."

Univ. of Minnesota, Minneapolis, MN; St. Vincent's Hosp. and Univ. of NSW, Sydney, Australia.

10/31/08

Reference

B Grund and A Carr (for INSIGHT/SMART Study Group). Continuous Antiretroviral Therapy (ART) Decreases Bone Mineral Density: Results from the SMART Study. 48th International Conference on Antimicrobial Agents and Chemotherapy (ICAAC 2008). Washington, DC. October 25-28, 2008. Abstract H-2312a.

AIDS 2008: Protective Effect of Circumcision against HIV Infection Is Sustained for Nearly 2 Years

Over the past two years, it has become increasingly clear that adult circumcision helps protect men from acquiring HIV. As previously reported recent studies have shown that circumcision reduced the rate of HIV infection by as much as 60% in high-prevalence countries in Africa. At the XVII International AIDS Conference last week in Mexico City, researchers who conducted one of the pivotal African studies in Kisumu, Kenya, reported follow-up data showing that the benefits appear to be long-lasting.

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ICAAC 2008: Long-term Safety of Investigational CCR5 Antagonist Vicriviroc in Treatment-experienced Patients

Schering-Plough's investigational CCR5 antagonist vicriviroc has demonstrated potent activity against HIV in laboratory studies and clinical trials of treatment-experienced patients. More than 200 patients received vicriviroc in Phase II trials. In a poster presented at the 48th International Conference on Antimicrobial Agents and Chemotherapy (ICAAC 2008), taking place this week in Washington, DC, researchers described long-term safety data from this population.

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Agencies Release New Report on State of HIV Prevention Across the U.S.

The Kaiser Family Foundation and the National Alliance of State and Territorial AIDS Directors (NASTAD) has released a new report assessing the status of HIV prevention efforts in the U.S., at a time of increasing budget constraints.

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ICAAC 2008: Efficacy and Safety of Boosted Darunavir (Prezista) Are Comparable to Lopinavir/ritonavir (Kaletra) at 96 Weeks: ARTEMIS Trial

Tibotec's second-generation protease inhibitor darunavir (Prezista) was approved in June 2006 for treatment-experienced HIV patients, to be administered at 600 mg boosted with 100 mg ritonavir twice-daily. As previously reported, in the Phase III ARTEMIS trial darunavir/ritonavir demonstrated safety and efficacy comparable to that of lopinavir/ritonavir (Kaletra) at 48 weeks. In a late-breaker session at the 48th International Conference on Antimicrobial Agents and Chemotherapy (ICAAC 2008), taking place this week in Washington, DC, researchers presented longer-term 96-week data from the study. Follow-up is scheduled to continue through 192 weeks.Boosted darunavir has also been studied in treatment-naive individuals, and earlier this month received approval for use in this patient population.

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AIDS 2008: Are Abacavir/lamivudine (Epzicom) and Tenofovir/emtricitabine (Truvada) Equally Effective?

With more than 20 antiretroviral drugs to choose from, one of the most frequently asked questions is what is the best regimen to start with in terms of efficacy and safety? Currently 2 nucleoside/nucleotide reverse transcriptase inhibitor (NRTI) backbones are recommended by U.S. HIV treatment guidelines as part of a first-line regimen: abacavir/lamivudine (Epzicom) and tenofovir/emtricitabine (Truvada; also combined with efavirenz in the Atripla pill). While lamivudine and emtricitabine are similar in their structure, activity, and side effects, the differences between abacavir and tenofovir are of more interest.

ACTG A5202

As previously reported, AIDS Clinical Trials Group (ACTG) study A5202 was modified earlier this year after interim data showed that among patients who started with a high viral load (100,000 copies/mL or more), abacavir/lamivudine did not suppress HIV as well as tenofovir/emtricitabine when both were used in combination with either efavirenz (Sustiva) or ritonavir-boostedatazanavir (Reyataz).

At the XVII International AIDS Conference last week in Mexico City, investigators reported data from an analysis of the high viral load patients, who were unblinded after the interim results became known.

This Phase IIIb study initially enrolled 1858 treatment-naive participants, 797 of whom had HIV RNA > 100,000 copies/mL at screening. Most (85%) were men, about half were white, and one-quarter each black and Hispanic. The mean CD4 count was 181 cells/mm3. The median follow-up period was 60 weeks.

Virological failure was defined as confirmed viral load > 1,000 copies/mL at or after 16 weeks and before 24 weeks, or else HIV RNA > 200 copies/mL at or after 24 weeks. The 16-week time frame was unusual in ACTG 5202, as most trials to not report virological response before 24 weeks.

Results

• In an intent-to-treat analysis, time to virological failure was significantly shorter in the abacavir/lamivudine arm than in the tenofovir/emtricitabine arm (HR 2.33; p = 0.0003).

• There were no differences between the arms with regard to CD4 cell changes.

• Patients receiving abacavir/lamivudine had a shorter time to emergence of grade 3/4 adverse events (AEs) compared with those taking tenofovir/emtricitabine (HR 1.87; p < 0.0001).

• Suspected drug hypersensitivity reactions were reported in 7% of participants taking each NRTI backbone.

• There were 2 cases of kidney failure in each arm.

Based on these findings, the researchers concluded, "In subjects entering A5202 with screening HIV RNA > 100,000 copies/mL, there was a significantly shorter time to virological failure and grade 3/4 adverse events" among those randomized to abacavir/lamivudine compared with tenofovir/emtricitabine.

Presenter Paul Sax noted that many of the adverse events were small lipid changes that were "unlikely to be clinically significant." Participants in this trial did not receive HLA-B*5701 genetic screening for susceptibility to abacavir hypersensitivity reactions, since the test had not been validated when the study started. The frequency of suspected hypersensitivity in both arms was high, suggesting that site investigators were highly vigilant since they did not know who was taking abacavir.

Comparisons of the NRTI backbones in the still-blinded lower HIV RNA stratum (< 100,000 copies/mL at baseline), and each regimen's third drug (efavirenz or boosted atazanavir) in both viral load strata, are ongoing.

Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Harvard School of Public Health, Boston, MA; University of Washington School of Medicine, Seattle, WA; University of Miami School of Medicine, Miami, FL; National Institute of Allergy and Infectious Diseases, Bethesda, MD; ACTG Operations Center, Social & Scientific Systems Inc., Silver Spring, MD; Frontier Science & Technology Research Foundation Inc., Amherst, MA; Bristol-Myers Squibb, New York, NY; Gilead Sciences, Inc., Foster City, CA; GlaxoSmithKline, Research Triangle Park, NC; Abbott Laboratories, Abbott Park, IL; Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, CA.

GSK Analysis

After the interim ACTG 5202 results were released, abacavir manufacturer GlaxoSmithKline (GSK) performed an analysis of other clinical trials of abacavir/lamivudine-containing regimens that employed the same efficacy endpoint as ACTG5202 -- including the unusually short 16-week time point -- in order to assess the impact of baseline viral load on virological response.

The investigators looked at 48-week efficacy outcomes from 6 clinical trials including a total of 2940 antiretroviral-naive patients, analyzing the data by baseline viral load strata (again, <100,000 or > 100,000 copies/mL). Along with their NRTIs, participants took efavirenz or various boosted protease inhibitors.

The efficacy endpoint was time to virological failure, defined as in ACTG 5202. The safety endpoint was time to onset of the first grade 3/4 sign, symptom, or laboratory abnormality that was at least 1 grade higher than baseline.

Results

• Virological response also did not differ significantly among patients with a high viral load.

• At 96 weeks, abacavir/lamivudine and tenofovir/emtricitabine remained comparable with respect to virological response.

• Median CD4 gains at week 96 were similar, about 450 cells/mm3 in both arms.

• Lipid changes were similar in both arms.

• Looking at biomarkers associated with inflammation, levels of high sensitivity C reactive protein (hsCRP) and interleukin-6 (IL-6) fell slightly after starting therapy, and changes were similar in both groups.

The HEAT investigators concluded that "[Abacavir/lamivudine] is comparable to [tenofovir/emtricitabine] in virologic efficacy and safety when combined with lopinavir/ritonavir through 96 weeks. Both treatment regimens were well tolerated with few discontinuations due to adverse events in either arm."

It remains unclear why ACTG 5202 and HEAT produced disparate results, and further study is needed to definitively say which of these 2 backbones is superior if terms of efficacy and safety, or whether for all practical purposes they are the equal.

Rush University Medical Center, Chicago, IL; Johns Hopkins University School of Medicine, Baltimore, MD; GlaxoSmithKline, Research Triangle Park, NC; Southwest Infectious Disease Associates, Dallas, TX; North Texas Infectious Disease Consultants, Dallas, TX; ID Consultants, Charlotte, NC; Georgetown University, Washington, DC.

8/12/08

References

P Sax, C Tierney, A Collier, and others. ACTG 5202: shorter time to virologic failure with ABC/3TC than TENOFOVIR/FTC in treatment-naive subjects with HIV RNA >100,000. XVII International AIDS Conference (AIDS 2008). Mexico City. August 3-8, 2008. Abstract THAB0303. (Abstract)

K Pappa, J Hernandez, B Ha, and others. ABC/3TC shows robust virologic responses in ART-naive patients for baseline (BL) viral loads of >100,000c/mL and <100,000c/mL by endpoint used in ACTG5202. XVII International AIDS Conference (AIDS 2008). Mexico City. August 3-8, 2008. Abstract THAB0304. (Abstract)

KY Smith, D Fine, P Patel, and others. Similarity in efficacy and safety of abacavir/lamivudine (ABC/3TC) compared to tenofovir/emtricitabine (TENOFOVIR/FTC) in combination with QD lopinavir/ritonavir (LPV/r) over 96 weeks in the HEAT study. XVII International AIDS Conference (AIDS 2008). Mexico City. August 3-8, 2008. Abstract LBPE1138.

October 15 is National Latino AIDS Awareness Day -- CDC Study Looks at HIV/AIDS in U.S. Hispanic/Latino Population

Wednesday, October 15, is National Latino AIDS Awareness Day. This observance presents an opportunity to increase awareness of the disproportionate burden of HIV/AIDS within the Hispanic/Latino community.

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AIDS 2008: Boosted Atazanavir and Lopinavir/ritonavir Have Similar Efficacy, Side Effects Differ across Racial/ethnic Groups

Race-based differences in efficacy and safety have been reported among HIV positive individuals on HAART. However, data on this issue are limited. It is widely known that rates of obesity, diabetes, and the metabolic syndrome are increasing. In addition, studies suggest that certain racial/ethnic groups may be more susceptible to the risks associated with these conditions.

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Routine Opt-out Screening in Emergency Rooms Identifies Few Additional People with HIV

Routine opt-out HIV screening in an urban emergency department -- testing not targeted specifically to people thought to be at risk -- identified only a "modest" number of additional cases compared with standard diagnostic testing, according to a U.S. study reported in the July 21, 2010 Journal of the American Medical Association (JAMA) HIV/AIDS theme issue, released to coincide with the XVIII International AIDS Conference (AIDS 2010) last month in Vienna. Most of the additional people found to be infected had late-stage disease, suggesting that a better method is needed to identify HIV positive individuals sooner so they can benefit from timely care.

A Comparison of the Single-dose Bioavailability of a Ritonavir Tablet Formulation Compared with the Current Soft Gel Capsule

Ritonavir (Norvir) has been approved by regulatory agencies worldwide and is indicated for use in combination with other antiretroviral agents for the treatment of HIV infection. Due to its cytochrome P450 inhibition properties, ritonavir dosed 100 mg once-daily (QD) to 200 mg twice-daily (BID) is frequently used as a pharmacokinetic enhancer of other antiretrovirals, including protease inhibitors.

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PrEP using Tenofovir plus Emtricitabine May Offer Benefits even if HIV Infection Occurs

Animal studies of pre-exposure prophylaxis (PrEP) using tenofovir (Viread), with or without emtricitabine (Emtriva), have produced promising results, and large clinical trials in humans are currently underway. Prevention strategies using antiretroviral drugs are unlikely to be 100% effective, due to variations in efficacy, adherence, and other factors. But there is growing evidence that PrEP may have benefits even for individuals who become infected.

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AIDS 2008: Investigational Next-generation NNRTI Rilpivirine (TMC278) Demonstrates Potent Antiviral Activity at 96 Weeks in Treatment-naive Patients

Tibotec's investigational next-generation non-nucleoside reverse transcriptase inhibitor (NNRTI) rilpivirine (TMC278) has previously demonstrated good efficacy and tolerability in an international Phase 2b trial of treatment-naive patients through 48 weeks. Investigators presented 96-week follow-up data at the XVII International Conference on AIDS taking place this week in Mexico City.alt

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How Safe is HIV Serosorting for Men who have Sex with Men?

HIV “serosorting” -- in which HIV positive people have unprotected sex only with other positive people, and negative people only with other negatives -- has been proposed as a strategy for reducing the risk of HIV transmission. The method is far from foolproof, however, requiring that individuals accurately know and honestly convey their current status.

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Growth Hormone Improves Lipodystrophy, but has Detrimental Effect on Blood Glucose

For reasons that are not fully understood, antiretroviral therapy and HIV infection itself are associated with lipodystrophy, a syndrome characterized by visceral adiposity (fat accumulation) and metabolic complications associated with an elevated risk for cardiovascular disease.

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Antiretroviral Therapy during Pregnancy Significantly Reduces Mother-to-child HIV Transmission, but is Linked to Low Birth Weight

Since the mid-1990s, it has been known that prophylactic use of certain antiretroviral drugs during pregnancy -- namely zidovudine (AZT; Retrovir) and nevirapine (Viramune) -- dramatically reduces the risk of mother-to-child HIV transmission. However, outcomes in women who use triple combination antiretroviral therapy during pregnancy are less well characterized.

In a report published in the September 12, 2008 issue of AIDS, researchers with the French/African Ditrame Plus and MTCT-Plus Projects studied pregnancy outcomes in 326 HIV-1-infected pregnant women receiving antiretroviral therapy in Abidjan, Cote d'Ivoire.

Between March 2001 and July 2003, HAART was not yet available, and women who would have been eligible for combination therapy based on their own disease status instead received a short-course of zidovudine (with or without lamivudine) plus a single dose of nevirapine during labor to prevent mother-to-child transmission (PMTCT group; n = 175). Between August 2003 and August 2007, women eligible for HAART received combination therapy (HAART group; n = 151). All infants received zidovudine and nevirapine after birth, and women were advised to either feed formula or exclusively breast-feed (shown to be safer than mixed feeding of breast milk plus other foods). Median CD4 cell counts were similar in the 2 groups (177 vs 182 cells/mm3, respectively).

The researchers recorded the frequencies of low birth weight (<2500 g), very low birth weight (below 2000 g), stillbirth, and infant mortality within the first year. Risk factors associated with low birth weight were investigated using a logistic regression model.

Results

• At 12 months, 3 infants (2.3%) became infected with HIV in the HAART group compared with 25 infants (16.1%) in the PMTCT group (P < 0.001).

• The rate of very low birth weight was similar in the 2 groups.

• The rate of low birth weight was nearly twice as high in HAART group compared with the PMTCT group (22.3% vs 12.4%; P = 0.02).

• In a multivariable analysis, after adjusting for maternal CD4 count, WHO disease stage, age, and body mass index (BMI), the following factors were significantly associated with low birth weight:

• HAART initiated before pregnancy (adjusted odds ratio [AOR] 2.88);

• HAART started during pregnancy (AOR 2.12);

• Low maternal BMI at the time of delivery (AOR 2.43).

• The rate of stillbirth was similar in both groups, at about 3%.

• The overall infant mortality rate during the first year was about 7%.

• Low birth weight and HAART use were not associated with a greater risk of infant death, though being HIV infected led to greater mortality.

Based on these findings, the study authors concluded that "HAART in pregnant African women with advanced HIV disease substantially reduced mother-to-child transmission, but was associated with low birth weight."

HIV transmission is less likely to occur when viral load is fully suppressed, and mothers are more likely to achieve undetectable viral load with combination HAART than with only zidovudine/nevirapine.

Given the highly significant reduction in the rate of HIV infection in babies born to women on HAART, and given that low birth weight infants were not more likely to die, this study indicates that the benefits of HAART for pregnant women outweigh the risks.

9/23/08

Reference

DK Ekouevi, PA Coffie, R Becquet, and others. Antiretroviral therapy in pregnant women with advanced HIV disease and pregnancy outcomes in Abidjan, Côte d'Ivoire. AIDS 22(14): 1815-1820. September 12, 2008 (Abstract).

AIDS 2008: Attitudes and Perceptions about HIV/AIDS among HIV Patients

Results from an international survey of HIV-positive patients – the largest of its kind conducted to date – were released today at the 17th International AIDS Conference (AIDS 2008). Conducted by the International Association of Physicians in AIDS Care (IAPAC), the survey looked at the attitudes and perceptions of nearly 3000 people living with HIV from 18 countries and shows an urgent global need for improved HIV and AIDS understanding and increased dialog about quality of life.

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AIDS 2008: Didanosine (Videx EC) + Emtricitabine (Emtriva) + Atazanavir (Reyataz) Inferior for Initial HIV Treatment: PEARLS Trial

For a variety of reasons, physicians may recommend an alternative initial antiretroviral regimen rather than one of the first-line regimens recommended by current treatment guidelines. A once-daily regimen of didanosine (ddI; Videx-EC), emtricitabine (Emtriva), and unboosted atazanavir (Reyataz) has potential advantages over other alternative regimens, but the efficacy of this combination is unknown.

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Antiretroviral Therapy is Effective for Injection Drug Users

Injection drug users (IDUs) with HIV can benefit as much from antiretroviral therapy as non-users, according to a study presented Sunday, August 3, in advance of the XVII International AIDS Conference in Mexico City, and published in the August 6 Journal of the American Medical Association.

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