HIV becoming more virulent?

A study in the May issue of Clinical Infectious Diseases found a decline in the initial CD4+ T cell counts reported at diagnosis among some HIV-positive people in the U.S. from 1985 to 2007 -- a finding that suggests HIV may be adapting and becoming more virulent -- Reuters reports. The report analyzed data for 2,174 HIV-positive people who were enrolled in the TriService AIDS Clinical Consortium HIV Natural History Study. None of the participants previously had taken antiretroviral therapy, and all had their CD4+ cell counts measured within six months of HIV diagnosis.

The average initial CD4+ cell counts during the periods from 1985 to 1990, 1991 to 1995, 1996 to 2001, and 2002 to 2007 were 632, 553, 493 and 514, respectively. According to the report, the percentage of subjects with initial CD4+ cell counts less than 350 were 12%, 21%, 26% and 25%, respectively, during the same periods. Similar CD4+ cell count reductions were seen in black and white participants, and the report also noted that similar trends were seen in the CD4+ cell count percentage and the total lymphocyte count. Lead author Nancy Crum-Cianflone of the Naval Medical Center-San Diego said the study's findings "agree with those of other investigators" who report that "patients starting HIV care more recently may be presenting with lower initial CD4+ cell counts and requiring antiretroviral therapy initiation earlier in the disease course."

In an accompanying editorial, Maria Dorrucci of Rome's Istituto Superiore di Sanita and Andrew Phillips of London's University College Medical School write that although some current studies suggest that HIV virulence is rising, there have been other studies that report either stable or declining HIV virulence. Dorrucci and Phillips write that the differences may relate to how virulence is determined and that "it is unclear whether simple immunological or virological proxies for virulence can be expected to adequately capture the whole complexity of HIV virulence and host susceptibility" (Reuters, 4/15).

An abstract of the report is available online. A citation of the accompanying editorial is also available online.

Africa Should Manufacture Generic HIV/AIDS Drugs

Africa should produce its own generic antiretroviral drugs in order to fight HIV/AIDS and ensure that the global financial crisis does not hinder treatment access, UNAIDS Executive Director Michel Sidibe said on Wednesday in Addis Ababa, Ethiopia, Reuters reports. "We should facilitate a discussion around how we can build a business case for producing generic drugs in Africa so that it can increase coverage but can, at the same time, be a profitable business," he said, adding, "It's important politically, it's important economically, it's important for the integration of Africa in the global market."

According to Sidibe, increased production of generic drugs in Africa needs to occur soon because most people living with HIV on the continent do not have drug access. He said that during his tenure as UNAIDS executive director, he will focus on ensuring universal drug access worldwide. Sidibe added that the current economic situation could hinder this goal. "Governments need to start anticipating minimum spending on social services so we don't have a breakdown in our respective systems," he said, adding, "My worry about the crisis is that if we are not careful, we could face a breakdown in our caring society"

New Jersey Legislature Examining Ways To Avoid HIV/AIDS Medication Copayments in State Budget

New Jersey lawmakers on Tuesday indicated that they are examining ways to avoid proposed co-payments for some people living with HIV/AIDS who receive medications though the state, NorthJersey.com reports. The copayments are part of Gov. Jon Corzine's (D) $29.8 billion spending proposal for the state's new fiscal year and would collect $1.36 million by creating co-payments for HIV/AIDS drugs based on a sliding scale determined by income (Reitmeyer, NorthJersey.com, 4/21). The copayments would affect 9,000 people living with HIV/AIDS who have obtained no-cost medicine from the state because they do not qualify for other assistance programs. Advocates said that the copayments will hurt patients who are already struggling because of the poor economy (Kaiser Daily HIV/AIDS Report, 3/26).

According to NorthJersey.com, Heather Howard, commissioner of the state Department of Health and Senior Services, met with the Assembly budget committee to review the agency's spending plan and policies. During the meeting, committee Chair Lou Greenwald (D) suggested that state funding for a transportation program that benefits HIV-positive people could be pulled instead of implementing the proposed copayments. Howard said that the department is willing to examine all possibilities. The copayments would not be assessed for the largest group of patients who benefit from the state program because of their low incomes. The proposal is part of a larger effort by Corzine to remove $3 billion in spending from the budget that the Legislature approved in 2008. The Legislature has until June 30 to pass a balanced budget (NorthJersey.com, 4/21).

HIV/AIDS in Washington, D.C., a Critical Issue

The recent report that 3% of Washington, D.C., residents are living with HIV/AIDS "evokes an array of reactions that speak to the complexity of this compelling public health issue," Guy Weston -- former director of Data and Research at the district's HIV/AIDS Administration -- writes in a Washington Informer opinion piece. He adds that the statistic is "'quite serious'" when one realizes that it "translates into life-altering impact on 15,120 district residents," their spouses, partners and family members. The district's HIV/AIDS rate is a "critical issue for a significant proportion of [the city's] population," Weston writes, adding that the report "tells us that the highest rates of HIV are among residents aged 40 to 49 and among African-American male residents."

It also is "critical to confront findings of the city's report that frequently escape public discourse," Weston writes, adding that heterosexual sex "is emerging as the leading mode of HIV transmission in recent years, according to the report's analysis." He notes that this "becomes a sticky subject in the world of HIV funding and politics, where discussions of the dynamics of HIV transmission frequently lead to stigma and blame. The fact that such findings affect resource allocation complicates the discussion further." Weston adds that there is no data to suggest that "one transmission mode ... is the primary transmission mode to the exclusion of all others." Therefore, "HIV prevention messages that exclude potential transmission modes will not effectively protect our communities from HIV," he writes. He adds that there is a "'modern, generalized and critical' epidemic that affects a number of populations, albeit in different proportions," concluding, "In addition to the health department's promotion of early testing and condom availability, we, as affected communities, must deal with the message of statistics frankly, so that persons at risk can feel vulnerable enough to know that the testing and condom messages apply to them" (Weston, Washington Informer, 4/16).

HIV Infection Rates in Minnesota Rising

Minnesota saw an increase in the number of newly reported HIV cases in 2008 to 326, the Minnesota Department of Health reported Wednesday, the Minneapolis Star Tribune reports. According to the Star Tribune, it was the third consecutive annual increase in newly recorded HIV cases. Peter Carr -- director of the sexually transmitted infections and HIV section of the department -- said that Minnesota has had an average of 320 new cases reported for the last three years, up from an average of 300 in 2001.

According to the Star Tribune, the increase in the number of cases among men ages 13 to 24 and men who have sex with men is causing concern among public health officials. Young men accounted for 42 new cases in 2008, up from 18 in 2002. Some health experts point to better HIV treatment, which has led some people to believe that the disease is manageable, and apathy toward the disease as a reason for the increase. According to the report, minorities are disproportionately affected by HIV/AIDS, with minority men, who represent 12% of the male population, accounting for 39% of new cases among all men. Minority women, who make up 11% of the female population, accounted for 70% of new cases among all women, according to the report. Carr said, "Socioeconomic status appears to be the most important factor in communities and neighborhoods where higher rates" of HIV were reported, adding that low economic status could result in a lack of insurance and limited access to health care, among other factors such as homelessness and stigma.

The report also showed that the number of HIV cases among immigrants has increased from 19 in 1990 to 62 in 2008, driven mostly by an increase in African-born immigrants and immigrants from Central and South America, the Star Tribune reports. An estimated 6,220 people are living with HIV in the state, health officials said, adding that there could be an additional 2,000 people who are unaware of their HIV-positive status (Marcotty, Minneapolis Star Tribune, 4/15).

Canadian Prison Tattoo Program Reduced Risk of HIV

A Canadian prison tattoo parlor program that was canceled by the government was cost-effective and successful in raising awareness and reducing the risk of bloodborne diseases such as HIV and hepatitis C, according to a new report from the Correctional Service of Canada, the Alberta Daily Herald-Tribune reports. The 70-page report -- dated January 2009 but just publicly released -- said that early results of the federal pilot program "indicate potential to reduce harm, reduce exposure to health risk, and enhance the health and safety of staff members, inmates and the general public." The program -- which cost about one million Canadian dollars, or about $820,000 -- was launched at six federal prisons across Canada in 2005 but was canceled by then Public Safety Minister Stockwell Day in 2006. According to the Herald-Tribune, the move was hailed by some taxpayers and other groups but condemned by prisoners' advocates, who argued the decision was made based on ideology rather than pragmatism.

Among its 11 key findings, the report said that under the program, there was a reduction in seized tattoo contraband and "illicit" tattooing in medium-security prisons, which suggests a decreased risk of contact with previously used needles. Additionally, the report said that cost of the program was "low" when compared with its potential benefits and that it provided work skills that could be used in the community after inmates are released. Although there are some issues related to the program's implementation -- such as providing sufficient skill level, training and availability for the sessions -- the report concluded that the program was "consistent with the goals and objective of the federal initiative to address HIV/AIDS in Canada." The prevalence of HIV is 10 times higher in Canadian prisons than in the general population, and the prevalence of hepatitis C is 20 times higher, the Canadian HIV/AIDS Legal Network said. Christopher McCluskey, a spokesperson for Public Safety Minister Peter Van Loan, said the federal government has no intention to reinstate the program. He said CSC "continues to provide education and information to inmates on the risks of disease transmission from needles for drugs or any other purpose" (Harris, Daily Herald-Tribune, 4/15).

Canada Should Pass Bill That Would Expedite Export of Low-Cost Drugs for HIV

"For many years, countries such as Canada have avoided the uncomfortable truth that millions are dying in the developing world due partly to legal barriers that render access to medicines unaffordable," Michael Geist, chair of Internet and E-commerce law at the University of Ottawa, writes in a Toronto Star opinion piece in response to a recently introduced bill that would reform Canada's Access to Medicines Regime by expediting the process of exporting generic drugs for diseases such as HIV to developing countries. According to Geist, Canada "became an early adopter" of a 2003 World Trade Organization agreement aimed at easing the export of drugs. However, "[s]everal years later, most agree the policy has been a near-total failure," he adds. According to Geist, the law "has only been used once, and the company involved in the process found it so burdensome that it has vowed not to repeat it."

The new bill, introduced by Sen. Yoine Goldstein, "includes important reforms to" Canada's Patent Act, Geist writes, adding that it "would not remove all barriers, but it would help to streamline the process of obtaining the necessary approvals." He adds, "Most importantly, it would establish a 'one-license solution' to enable generic pharmaceutical manufacturers to send shipments of the same medication to multiple countries without needing new approvals for each shipment." In addition, current law allows only governments to "buy medicines on behalf of citizens," Geist writes, concluding that the bill "would make it easier for the many nongovernmental organizations focused on access to medicines to buy and distribute generic medications" (Geist, Toronto Star, 4/13).