Thursday, July 18, 2013

My HIV Journey "Live" : HIV Care Continuum Initiative

The HIV Care Continuum Initiative: The Next Step of the National HIV/AIDS Strategy

The HIV Care Continuum Initiative: The Next Step of the National HIV/AIDS Strategy

Posted: 07/15/2013 12:25 pm -                                                       
Three years ago, President Obama announced an historic comprehensive plan to help turn the tide on HIV/AIDS in the United States: the National HIV/AIDS Strategy. The Strategy has given a new sense of direction, and purpose in our fight against HIV and AIDS.
Since the Strategy's release, scientific developments have advanced our understanding of how to best fight HIV. We now understand that to prevent long-term complications of HIV, treatment is recommended for all adults and adolescents living with HIV in the United States.
This is a significant shift; previous recommendations were to hold treatment until people showed signs of immune decline. Recent research also shows that an important benefit of earlier treatment is that it dramatically reduces the risk of HIV transmission to partners. Furthermore, HIV testing technology is faster, and more accurate than ever before, and HIV drug treatment is less toxic, and easier to administer.
All of this has powerful implications for how we focus our efforts.
And there is a clear need to do so: data released since the Strategy shows that along the HIV continuum of care -- which is the progression from diagnosis to receiving optimal treatment -- nearly 200,000 persons living with HIV in the United States are undiagnosed, and only one in four has the virus under control.
Today we are thrilled to announce two new developments specifically focused on addressing many of the factors that lead people to fall out of the continuum of care.
First, President Obama signed an Executive Order creating the HIV Care Continuum Initiative.

The Initiative directs Federal agencies to prioritize addressing the continuum of HIV care by accelerating efforts and directing existing federal resources to increase HIV testing, services, and treatment, and improve patient access to all three.

To ensure we succeed in this effort, the President's Executive Order establishes an HIV Care Continuum Working Group. The group will coordinate federal efforts to improve outcomes nationally across the HIV care continuum, and will be co-chaired by the White House Office of National HIV/AIDS Policy and HHS's Office of the Assistant Secretary for Health. The working group will provide annual recommendations to the President on actions to take to improve outcomes along the HIV care continuum.
Second, today HHS announced a new multi-year demonstration project that brings together OASH, CDC, and the Health Resources and Services Administration (HRSA) in a collaboration to expand the capacity of community health centers, local health departments, and their grantees to better integrate HIV prevention and treatment across the continuum of care. HHS will invest $8-10 million a year to support health centers and local health departments in integrating public health practice, and clinical care. The project will target areas with high numbers of racial and ethnic minorities, who are disproportionately affected by the epidemic, and communities with a substantial unmet need for comprehensive HIV services.
These two actions complement many of the ways we are already addressing the importance of continuum of care now.
The National Strategy shares its third anniversary with the Affordable Care Act, landmark legislation that is vital to our fight against HIV/AIDS.
Already, the law has expanded access to HIV testing, and ends the practice of putting lifetime caps on care when patients need it the most. Beginning in 2014, it will bring to an end to insurance practices like denying coverage for pre-existing conditions, including HIV infection.
Beginning this October, when the online Health Insurance Marketplaces open for enrollment, millions more Americans will have the opportunity to enroll in affordable coverage that includes HIV testing and other preventive care, with coverage set to begin January 1, 2014.
And the health care law also allows states to expand their Medicaid programs. Many people living with HIV will no longer have to wait for an AIDS diagnosis to become eligible for Medicaid.
The law aligns with the National HIV/AIDS Strategy's overall goals to reduce new infections, improve access to care, and reduce HIV-associated health disparities.
This includes fighting HIV stigma and discrimination. It includes advocating for the health of communities at greatest risk for HIV, including young, black, gay men and transgender people. It includes supporting research, in order to find more prevention and treatment breakthroughs.
And it means making smarter, more coordinated investments to fight the epidemic. That's why the president's Executive Order is so important.
Just a few months ago, President Obama spoke of realizing the promise of an AIDS-free generation in his State of the Union. Thanks to remarkable advances in HIV treatment and prevention, we have the opportunity to reach that landmark sooner than most of us would have imagined even just a few years ago. The HIV Care Continuum Initiative will help us get there even faster.

Long-acting GSK1265744 and TMC278-LA appear safe and practical in early study

Long-acting GSK1265744 and TMC278-LA appear safe and practical in early study
Liz Highleyman
Published: 05 July 2013
William Spreen of GlaxoSmithKline. Photo by Liz Highleyman,
A combination of antiretroviral drugs in long-acting nanosuspension formulations achieved adequate blood levels and appeared safe in HIV-negative study volunteers, offering the potential for a maintenance or PrEP option that could be taken once a month, researchers reported on Wednesday at the 7th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention in Kuala Lumpur.
While modern antiretroviral therapy is highly safe and effective, agents that could be administered less frequently could improve convenience for people with HIV. A long-acting option could prove especially attractive for maintenance therapy once viral load is suppressed, or for pre-exposure prophylaxis (PrEP) in HIV-negative people.
William Spreen from GlaxoSmithKline and colleagues evaluated the safety and pharmacokinetics of a nanosuspension formulation GSK1265744 an investigational HIV integrase inhibitor similar to dolutegravir, plus TMC278-LA, a long-acting formulation of Janssen's approved non-nucleoside reverse transcriptase inhibitor rilpivirine (Edurant). GSK1265744 has shown good antiviral activity in a ten-day monotherapy study and is now in phase 2b development. A nanosuspension refers to tiny drug crystals suspended in a liquid, enabling it to remain active for longer in the body. Decreasing particle size increases the total drug surface area, allowing for a manageable injection volume.
This phase 1 trial enrolled 47 healthy, HIV-negative volunteers, 40 of whom received at least one injection. Just over half were women, most were white and the mean age was 40 years. 
Participants were randomly allocated to four treatment cohorts. Due to limited safety data, all participants received a 14-day lead-in of 30mg/day oral GSK1265744 to assess its safety and tolerability. Following a seven-day 'wash-out' period, they then got a single 800mg 'loading dose' via intramuscular (IM) injection. After this they received:
  • Cohort 1 – three doses of 200mg GSK1265744 via subcutaneous (SC) injection at weeks 4, 8 and 12 (no TMC278-LA).
  • Cohort 2 – three monthly doses of 200mg GSK1265744 via IM injection at weeks 4, 8 and 12, plus 1200mg TMC278-LA via IM injection at week 8 and 900mg at week 12.
  • Cohort 3 – three monthly doses of 400mg GSK1265744 via IM injection at weeks 4, 8 and 12, plus 1200mg TMC278-LA via IM injection at week 8 and 600mg at week 12.
  • Cohort 4 – a second 800mg GSK1265744 dose via IM injection at week 12 (no TMC278-LA).
Seven participants withdrew prematurely from the study for any reason during the oral lead-in phase and three did so during the injection phase.
In all dose cohorts, plasma drug concentrations reached levels expected to be therapeutic within three days. Levels of both GSK1265744 and rilpivirine between doses remained well above the IC90, or 90% inhibitory concentration. GSK1265744 reached concentrations that reduced viral load in a previous monotherapy study of people with HIV.
Both drugs had a long PK 'tail', meaning concentrations remained high for a prolonged period and declined slowly. In practice, this would allow for some 'forgiveness' in case of missed or delayed doses, Spreen explained. 
All regimens were generally safe and well tolerated. One participant discontinued the study during the oral lead-in phase due to dizziness, and one stopped during the injection phase due to transient skin rash. Overall, headache was the most common non-injection-related side-effect. There were no reported severe (grade 4) side-effects or laboratory abnormalities and no notable electrocardiogram changes. 
Most participants reported injection-site reactions such as pain, tenderness, redness or nodules, but these were mostly mild and no one withdrew for this reason. Moderate injection-site pain was more common with IM compared with SC injections, but nodules were more common and somewhat larger with SC administration.
"Co-administration of injectable long-acting nanosuspensions [of GSK1265744 and TMC278] was safe and generally well tolerated in healthy adults," the researchers concluded. 
"Monthly or quarterly dosing regimens achieved clinically relevant plasma concentrations" of GSK1265744 and TMC278, they continued, adding that these data support evaluation in longer-term clinical studies.
Spreen noted that a dosing-ranging study is pending, and researchers plan to look at various strategies involving oral lead-in or induction therapy with both drugs for up to six months before proceeding to long-acting injections.

Negative Gay Men Consider Viral Load Before Unprotected Sex

Negative Gay Men Consider Viral Load Before Unprotected Sex
July 17, 2013- POZ.COM

HIV-negative gay men are much less likely to engage in unprotected anal intercourse with an HIV-positive partner if they perceive him to have a detectable viral load, the National AIDS Treatment Advocacy Project reports. Australian researchers looked at risk behavior in an ongoing study of 76 serodiscordant couples (meaning that one was HIV positive and the other HIV negative) and presented their findings at the 7th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2013) in Kuala Lumpur.

Fifty-six (74 percent) of the HIV-positive partners had an undetectable viral load at the beginning of the study, and the remainder had a detectable viral load. Meanwhile, sixty-one (80 percent) of the HIV-negative partners believed their partner had an undetectable viral load, while the remainder believed their partner had a detectable viral load or didn’t know their viral load. This left a difference of five HIV-negative men who were either mistaken or uninformed about their partner’s viral load.

Fifty-five (72 percent) of the HIV-negative partners reported unprotected anal intercourse (UAI) with their partner. Among them, 48 (63 percent of the study group) reported insertive UAI—or being the top—while 32 (45 percent) reported receptive UAI (bottoming) without ejaculation and 19 (25 percent) reported receptive UAI with ejaculation. In other words, the HIV-negative partners were more likely to be the top during condomless anal sex.

Of the 61 HIV-negative men who thought their partner had an undetectable viral load, 49 (80 percent) had UAI in the previous three months. Of the 15 HIV-negative men who thought their partner had a detectable viral load or did not know his viral load, six (40 percent) had UAI in the previous three months.

Believing that a partner had a detectable viral load lowered the likelihood of UAI by 84 percent.

US: Bill to lift ban on HIV positive organ donation passes House committee

US: Bill to lift ban on HIV positive organ donation passes House committee

by for
18 July 2013, 12:21am
A bill which could eventually allow the donation of HIV positive organs to HIV positive recipients has passed the House after having passed the US Senate back in June.
The HIV Organ Policy Equity Act (HOPE), which is sponsored by both Democrats and Republicans would allow organs from HIV positive people to be donated to HIV positive recipients, and more so would allow researchers to study the safety of such practice.

The Human Rights Campaign also commended the passage of the bill. Back in March, the HRC praised the passage of the bill in the Senate Committe, and in June it passed in the full Senate.

“The HOPE Act represents sound public health policy,” said HRC legislative director Allison Herwitt. “The action by the House Energy & Commerce Committee is a major step forward in removing an outdated barrier which impedes access to lifesaving transplants for persons living with HIV and AIDS.”
The bill was sponsored by Representative Lois Capps.

HIV-positive patients in the US have been lobbying for the right to receive HIV-infected transplant organs for some time. They argue that there are hundreds of HIV-infected organs available every year and that making the change would save lives and give more people the chance of a transplant.
There are more than 100,000 actively waiting for life-saving organs, and around 50,000 more are added annually, and lifting the ban could decrease waiting time for all.

Allowing organs from HIV positive donors to HIV positive recipients with liver or kidney failure could save up to 1,000 people each year.
The ban on HIV positive organ donation was put in place in 1988, and aruments for it being lifted come partly from the fact that the treatment of HIV and AIDS has advanced significantly since.
The Centers for Disease Control issued draft Public Health Service Guidelines in September 2011, recommending research in this area, but said that in the US, federal law blocks it from taking place.
Over 40 medical and patient advocacy groups endorse the act, including the United Network for Organ Sharing, which manages the US’s organ transplant system.

Wednesday, July 17, 2013

Am I responsible for my friend’s HIV infection, addiction and death?

Am I responsible for my friend’s HIV infection, addiction and death?

By: Aaron M. Laxton- Writer, Blogger and Activist

Do we have an obligation to intervene when our friends are engaging in behaviors that are dangerous and potentially deadly? Some of my closest friends and peers are shooting, snorting, and sleeping their way to potential HIV infection and eventually death.  Am I responsible through inaction for their ultimate demise? We have all seen the commercials that teach us to stop a person who has been drinking from getting behind the wheel of a vehicle, however why do we not do the same thing for other dangerous actions?  If we expect to turn the tide of new infections as well as the death of our generation by way of addiction to drugs such as crystal meth and heroin, then it is time that we start to have REAL conversations with each other.

Recently Glee fans from around the world were saddened to hear of the sudden death of the Cory Monteith, who played the lead character of Finn. Monteith made his own personal struggle with addiction public last year when he entered drug rehab for the first time.  It now appears as if Monteith’s battle with addiction to methamphetamines was still ongoing. Monteith’s death follows on the heels of Spencer Cox, world renowned AIDS Activist, who also lost his battle with addiction and only further serves to highlight the need for action.

Crystal Meth

As I travel across the United States sharing my experiences as a person living with HIV since June 6, 2011 one thing stands out to me, people are still using crystal meth.  As a recovering addict, I can tell you that during the height of my addiction I would have loved for anyone to have told me how much I was hurting myself.  What started out simply as something I would do while partying with friends soon became a major addiction that wrecked every aspect of my life, ending with my being becoming infected with HIV. I could easily have been another Monteith or Cox. My life while using meth consisted of trolling hookup sites looking for my next trick, while looking for my next fix. There were never enough tricks and there was definitely never enough meth.  Psychologically, I had devolved to state of amphetamine-psychosis, a consequence of chronic amphetamine use. Symptoms mimic those of schizophrenia and include hallucinations, hearing voices, paranoia, mental confusion, loss of time, emotional flatness, not eating, inability to sleep just to name a few.  

 Logging on to any hook-up application or websites I’m  continually amazed to see the headlines for “Party N Play”, “PNP” all code for fellow-tweakers  (a term used to describe a person who uses meth).  Bathhouses are filled with guys who are doped up on chemicals purchased from warehouse store; the actions they engage in while under the influence creates a breeding ground, no pun intended, for new HIV infection. You might ask, “How does this guy know about what goes on in my bathhouse?” My response is that I am most likely a card-carrying member of your bathhouse. I have no shame is disclosing the fact that I frequent bathhouses around the world. Regardless of what your social standing we are all equalized when we are wandering the halls of the bathhouse in a towel simply looking for our next trick. It is time for us to have the tough conversations with our friends who are dealing with addiction. 

The reality is that the bathhouses are filled with your friends who slip in after a night of partying.  You may never know about it because they believe that you would judge them. It is time to admit that you likely have at least one friend or acquaintance who is an addict, but they believe they have it under control. All addicts think that they have it under control but the truth is that addiction is in control.

Raw, Bareback Sex

We need to face it that there are two messages being told. The most prevalent and politically-correct message is that condoms need to be used each and every time that you have sex. The reality is thatthat not everyone wants to use condoms and consequently we are not wearing them, more personally… I will not wear them. The reason that no one freely admits that we are not using condoms is because we do not want to be preached at and shamed. While condoms offer protection against exposure to HIV they are just one of many tools that we have currently. If we are truly committed to reducing shame and having a conversation about reducing new HIV infections we must end the stigma surrounding unprotected sex. I will always choose to have no sex at all than to have sex with a condom.

It is time for us to have these tough conversations with each other regarding risk-reduction practices and prevention outside of simply putting a condom on. It is time to wake up and recognize that beating people over the head with the “condom” message isn’t cutting it. A better conversation to have with friends who refuse to use condoms might be whether they have heard of PrEP (Pre-exposure Prophylaxis) or what other risk-reduction practices they use.

People are going to make their own choices regardless of how you feel about it. If we are committed to changing the tide of new HIV-infections & addiction then it is time for us to start having real conversations free of judgment and stigma.  Are you responsible for your friend’s HIV infection? That is only something that you can answer. Ultimately each person is responsible for their own actions. As friends and family don’t we have a higher responsible to intervene when a person is engaging in behavior that presents a high probability of negative results such as HIV-infection and in some cases death? Without these tough conversations, how many more of our friends fall victim to addiction and risky behavior?