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Thu Jan 23, 7:57 PM ET
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Randy Dotinga, Gay.com / PlanetOut.com Network
SUMMARY: Researchers in Colorado and Louisiana are suggesting that the hazards of "partner notification" about HIV aren't all they're cracked up to be.
If you've been exposed to HIV by your boyfriend, don't expect the government to let you know about it. Only about a third of health departments in the United States make efforts to contact the sexual partners of people found to be infected with the AIDS virus. But researchers in Colorado and Louisiana are suggesting that the hazards of "partner notification" aren't all they're cracked up to be.
Two studies published this month, including one that mostly looked at gay men, report that couples weren't much more likely to break up if one partner learned that the other is HIV-positive. One study, in the conservative enclave of Colorado Springs, found that HIV-positive patients who received counseling as part of a partner notification program were actually more likely to use condoms.
The debate over HIV disclosure continues, however, and one observer said the findings may not represent what happens in the "real world" where health department employees may not be well-trained.
"Horrible abuses may still occur," said David Evans, program director at the STOP AIDS Project in San Francisco.
Health departments first got into the business of contacting the sexual partners of sick people in the 1930s. Officials figured it made sense to warn partners of syphilis patients so they could get tested, be treated and avoid infecting others, said John J. Potterat, former director of STD and HIV Control in Colorado Springs.
But the same approach met plenty of resistance in the early days of AIDS, when treatments were rarely effective. Some people, like Potterat, argued that the potentially exposed partners "had the right to know they might have something serious." Critics -- including the American Civil Liberties Union -- argued against government interference and invasion of privacy.
In the new studies, researchers wanted to see how partner notification affected couples and their relationships.
In New Orleans, they looked at two groups of people -- 76 patients with syphilis and 81 with HIV -- and tracked down about a third of their sex partners. And in Colorado Springs, researchers examined several groups, including 19 HIV-positive patients whose partners were notified of their risk of illness and 74 people in HIV-negative couples. Most of the subjects in New Orleans were straight, while most in Colorado Springs were gay or bisexual.
The findings of the two studies appear in the January 2003 issue of the journal Sexually Transmitted Diseases.
The researchers found that notifying partners of their HIV risk didn't do much to boost their risk of breakups when compared to the other couples.
Potterat, who wrote a commentary in the journal in support of partner notification, said the findings provide even more evidence that health departments must make efforts to contact the partners of people with HIV.
Unfortunately, he said, critics have made it sound like health departments force HIV patients into listing their sexual partners. "Patients never have to cooperate nor are ever intimidated into it. Repeat: never."
Evans, the Stop AIDS Project official, is a bit more cautious. He has heard stories of partner notification programs in the South and Midwest "where people literally had notices taped to their front doors from the local health department notifying them of their HIV test results."
But he supports programs that train their staff members to be sensitive and careful. "A few earlier studies found that a vast majority of people who test positive for HIV and other STDs willingly provide a list of partners for notification if they are asked. Many are grateful that someone else will do it (the notification) for them," he said.
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Mon Jan 27, 8:15 PM ET
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Lance Evans
A magazine article about San Francisco's AIDS epidemic has sparked outrage and calls for a printed clarification.
The Rolling Stone story describes an underground world of gay men in San Francisco who romanticize HIV -- the virus that causes AIDS -- and who are allegedly deliberately infecting themselves with the disease.
Reaction in the Castro District was strong.
"I think it's irresponsible," said Lance Schema. "I think for them to print something like that is just playing on people's fears."
The article calls the men "bug chasers" and the men who give them the virus "gift givers." It quotes San Francisco psychiatrist Bob Cabaj calling the practice "a real phenomenon" which is "like a fraternity" where one in four newly-infected gay men become so intentionally.
But Cabaj refutes the quotes, saying there was some misinformation and misquotes attributed to him. He's demanding that Rolling Stone print a clarification.
The article comes in the face of an aggressive HIV ad campaign in San Francisco which hopes to decrease the number of new HIV cases -- a number that has doubled from an average of 500 a year to over 1000 last year. The "HIV is No Picnic" ads show infected men exhausted from night sweats and suffering from facial wasting.
"These are the real-life side effects of having HIV," said Shana Krochmal of the Stop AIDS Project. "It's not as simple as taking a pill everyday. And part of our challenge has been to make sure that people understand it's still a very real disease."
The Stop AIDS Project also addresses syphilis -- a sexually-transmitted disease also on the rise in San Francisco. The group says that syphilis is an STD that most gay men feel is more relevant to their lives today.
As for Rolling Stone, a representative offered no comment and no clarifications.
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Tue Jan 28, 7:43 PM ET
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Randy Dotinga, Gay.com / PlanetOut.com Network
SUMMARY: New research suggests that waiting too long for HIV therapy could doom patients to a devastating side effect -- gaunt, hollow faces due to the loss of fat deposits.
Just a few years ago, doctors thought they needed to hit quickly with powerful AIDS drugs when people were diagnosed with HIV. Then some experts questioned the wisdom of moving so fast. Now, new research suggests that waiting too long could doom patients to a devastating side effect -- gaunt, hollow faces due to the loss of fat deposits.
The condition, known as lipoatrophy, has been considered a side effect of treatment with powerful AIDS drugs. But researchers found that it is more common in AIDS patients who waited to begin so-called combination therapy, said Dr. Kenneth A. Lichtenstein, chairman of the Department of Medicine at Rose Medical Center in Denver.
"The current dogma is that this is a drug-related (condition). Our study says that the disease is a bigger player," he said.
Lipoatrophy appears to be medically harmless in some cases, but it can drastically change a person's appearance. Patients lose fat in their faces, limbs and buttocks, and there is often no effective treatment.
"Sometimes changing the medications can help a little bit, but each person has their own individual reactions," said Dr. Michael Horberg, an AIDS specialist with the Kaiser Permanente Health Plan in Santa Clara, Calif. And in some cases, patients don't have a choice about switching drugs.
Many gay men have learned to recognize caved-in faces as a sign of HIV infection, adding stigma to the psychological trauma of developing an unusual appearance. Members of the community also know about a related disorder (lipodystrophy) in AIDS patients that causes disfiguring buildups of fat in the back of the neck -- a "buffalo hump" -- or in the abdomen.
According to Lichtenstein, the two conditions -- loss of fat and redistribution of it -- appear to be related, but doctors don't know exactly how. "Nobody's sure if it's the same syndrome," he said.
Lichtenstein and colleagues examined the medical records of 337 HIV-positive patients who were tracked for 21 months. Their findings appear in the Jan. 1 issue of the Journal of Acquired Immune Deficiency Syndromes.
Thirteen percent of the patients developed lipoatrophy, and they were more likely to do so if they were already thin or if their T-cell levels had been especially low before they started taking AIDS drugs. (The T-cell count is a measurement of the strength of the immune system.)
Patients whose lowest T-cell counts were under 200 were 30 percent more likely to develop the condition. In other words, those who let their immune systems deteriorate before taking drugs were at higher risk.
"What we have to learn from that is that we should not delay therapy to treat HIV," Lichtenstein said.
His viewpoint is sure to be controversial. But Horberg, the California AIDS specialist, said the findings point to the need to avoid unchangeable "absolute dogmas" when it comes to starting drug treatment in HIV patients.
"The early mantra of treatment was hit early, hit hard," he said. "Now I would say it's hit when appropriate, hit smart."
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Tue Jan 28, 9:00 PM ET
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San Diego-based Epicyte Pharmaceutical Inc. is working on a preventative treatment for HIV. But it isn't being concocted in a test tube. It's being cultivated in a stalk of corn.
As an early entrant in the emerging field of plant-derived pharmaceuticals, privately held Epicyte uses its proprietary plantibodies technology to develop human monoclonal antibodies. On Tuesday, the biopharmaceutical company said it is growing the first greenhouse plant lines to yield an antibody product that might potentially be used to prevent the transmission of HIV.
Kevin Whaley, Epicyte's director of antibody discovery, says the company's work is in the pre-clinical stage, which involves testing on primate models. It could be a year or two before the antibodies are tested on humans.
Epicyte will produce three different human antibodies -- called 2G12, 4E10 and 2FS -- in corn. Dow Chemical is a partner in the research, and the HIV plantibodies were developed with funds from the National Institutes of Health .
Epicyte officials say the antibodies work by binding HIV envelope proteins critical in the infectious pathway. It can be explained in simpler terms as enabling the antibodies to keep one step ahead of the pathogens, making the immune system more resistant to disease, Whaley said.
The corn used in Epicyte's research is really just a platform on which the antibodies can be produced. Maarten Chrispeels, director of the San Diego Center for Molecular Agriculture, says corn, soy, tobacco and certain aquatic plants can yield more proteins for less money than alternatives such as cultured animal cells.
Plant-derived pharmaceuticals are never intended to make it to the dinner plate, Chrispeels said.
Epicyte's Whaley, too, is quick to make the distinction between genetically modified foods and other plant-based sciences.
"This is not conventional agriculture, this is pharmaceutical manufacturing," Whaley said.
Epicyte's use of plants in drug discovery does present some unique regulatory constraints. Because crops are involved, Epicyte's work is monitored by the U.S. Department of Agriculture. And because drug candidates are involved, the U.S. Food and Drug Administration's Center for Drug Evaluation and Research must approve clinical trials and potential drug commercialization.
Epicyte's focus extends beyond HIV, to include the development of potential therapeutics for a variety of inflammatory and infectious diseases. Epicyte expects to be the first U.S. company to enter Phase I clinical trials of a human herpes antibody, called HX8, that was produced in plants.
Chrispeels says plant-derived pharmaceuticals are gaining attention and importance in the scientific community, especially as consumers have been slow to accept the concept of genetically modified foods.
He said that San Diego, in particular, has attracted plant biologists to public research institutions including the University of California, San Diego, the Salk Institute and The Scripps Research Institute, and companies including Diversa and Dow AgroSciences LLC, a subsidiary of Dow Chemical.
The Center for Molecular Agriculture, which operates as an organized research unit of UCSD, has seen enough interest in plant-derived pharmaceuticals to make it the topic of its October symposium, to be held at the Salk Institute. Epicyte is expected to be among the invited participants.
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Wed Jan 29,11:56 PM ET
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WEDNESDAY, Jan. 29 (HealthScoutNews) -- A clinical trial of a new AIDS vaccine begins this month at three locations in the United States.
The Phase I clinical trial will include 30 people at the University of Alabama at Birmingham, the University of Washington in Seattle, and the San Francisco Department of Public Health.
This vaccine strategy includes two different components -- two inoculations of a DNA vaccine that primes the immune system to recognize HIV, followed by a booster vaccine based on a recombinant poxvirus.
Neither of these components incorporates the actual HIV virus. Instead, the vaccine produces the three major proteins expressed by HIV. That primes the body's immune system to respond to the distinguishing features of HIV so it is ready to battle the virus if it enters the body, the researchers say.
The trial will last one year. It will focus on assessing the safety of the primer DNA vaccine among people who are HIV-negative. They'll be randomly assigned to receive either a high-dose vaccine, low-dose vaccine or a placebo.
A separate trial will examine the safety of the booster vaccine, and a third trial will test the safety of the combined regimen.
The vaccine was developed at the Yerkes Primate Research Center of Emory University, the Emory Vaccine Center, and the Laboratory of Viral Diseases at the U.S. National Institute of Allergy and Infectious Diseases.