Kaletra, Lexiva and Ziagen increase MIs

The DAD study presented controversial data on increased cardiovascular risks caused by Kaletra, Lexiva and Ziagen

Rosoglitazone for lipoatrophy

4 mg a day of rosiglitazone produced a gain of fat under the skin of 900 grams versus 300 grams in placebo in patients not taking zerit or azt after 48 weeks

Insulin resistance improved. No weight gain. It is not known if rosiglitazone will increase cardiovascular risks in poz people as it has in hiv negatives

No visceral fat measurements were taken

Gileads booster gs9350

Gilead is developing a booster than can do what Norvir does to boost drug levels. It seems that 150 mg of their booser may be equivalent to 100 mg

It seems that it may be more lipid friendly than norvir. No data on gut side effects were presented

They are using it in their quad formulation of one pill including their integrase inhibitor plus truvada

The community welcomes this drug

Abbott had better rush in making their new formulation of norvir that does not require refridgeration before gilead jumps in the booster market. We will see what happens!

Cancers in hiv

From 99 til 07 infection related cancers like anal have decreased slightly but are still a lot higher in incidence than in HIV hegatives. Liver, oral-throat and hodgkins lyphoma have increased 2-4 percent. 20305 poz patients were followed from 99 til 2007 at kaiser permanente in California. Mostly gay white men, however.

Opportunistic infections

By Dr Chaisson

TB has decreased a lot in Africa

Treating poz patients who have TB with HAART and TB treatment (rifampin)at the same time works best to improve survival.

Immune reconstitution disease in those with HIV and TB is a strong factor in complications.

Those with cryptococal meningitis and hiv have higher mortality with immune reconstitution.
Prednisone is being studied to treat immune reconstitution.

Hep B increases risk of liver toxicity of HAART

Complications and OIs

Richard Chaisson from John Hopkins presented survival and mortality data.

There is a direct relation between economic development and mortality. Haiti has the highest mortality rate in the americas and argentina, the us and canada have the lowest.

Head, esophagus, anal lung and bladder cancers have increased in poz patients

Factors involved are immune defficiency, inflammation, pro coagulation effect, drug toxicities, smoking, lifestyle, and family history

Increased in Il6 and D dimer seem to be related to increased heart disease in the SMART study.

Vaccine Strategy

Dr richard koup reviewed where we are in vaccines. Vaxgen, the merck vaccine and the canarypox vaccines were not succesful

Three trials were stopped in 2007. The STEP trial showed that those with pre existing exposure to adenovirus ad5 had a higher infection rates on the vaccine versus placebo. Those infected were also mostly uncircumcised. Those who were not exposed to ad5 prior to the study and who were uncircumcized actually showed lower infection rates.

Extra ad5 in those ad5 positive at baseline may have increased cd4 activation that made those people were prone to hiv infection.

HIV infection in the brain

Dr Gonzalez also explained that immune activation may also have a worse effect on the brain than the virus itself. Activated infected monocytes penetrate the blood brain barrier .

People with high LPS (lipopoly saccharides that come from a leaky gut) in their blood had higher dementia also.