HPV vaccine wears off quickly in HIV-positive women

Women with HIV probably need a booster shot of HPV vaccine within 2 years to maintain efficacy, according to a Canadian study of quadrivalent HPV vaccine (Gardasil) in 136 HIV-positive women.

Antibody response to the vaccine is strong enough at 2 years to protect about 90% of HIV-negative women against HPV [human papillomavirus]. "But in our population, with approximately a year and a half of follow-up, that number decreased to about 63%. There’s a much more rapid decline in antibody levels" among HIV-positive women, "which suggests this population might in fact benefit from a booster," said lead investigator Erin Moses, R.N., a researcher at the Women’s Health Research Institute in Vancouver, B.C.

http://www.familypracticenews.com/news/infectious-diseases/single-article/hpv-vaccine-wears-off-quickly-in-hiv-positive-women/6c13159316dce4a302a07794cef74fa7.html

HIV and HPV - Short Lecture on What You Should Know to Prevent Anal Cancer

There are no guidelines currently set about anal cancer diagnosis. But many doctors are referring their patients to colon-rectal surgeons every two years or so to get high resolution anoscopies. Others just use anal pap smears as a first step to determine if an anoscopy is justified. These simple tests can detect precancerous tissue before they may become a problem. They are removed with infrared coagulation. Biopsies are usually taken prior to the removal of the suspect tissue to determine it is low grade or high grade dysplasia.
Wkipedia has a good explanation for dysplasia:
"Dysplasia is the earliest form of pre-cancerous lesion recognizable in a pap smear or in a biopsy by a pathologist. Dysplasia can be low grade or high grade (see "Carcinoma in situ," below). The risk of low grade dysplasia transforming into high grade dysplasia, and eventually cancer, is low. Treatment is usually straightforward.
High grade dysplasia represents a more advanced progression towards malignant transformation.
Carcinoma in situ, meaning "cancer in place," represents the transformation of a neoplastic lesion to one in which cells undergo essentially no maturation, and thus may be considered cancer-like. In this state, epithelial cells have lost their tissue identity and have reverted back to a primitive cell form that grows rapidly and without regulation. However, this form of cancer remains localized, and has not invaded past the basement membrane into tissues below the surface.
Invasive carcinoma is the final step in this sequence. It is a cancer which has invaded beyond the basement membrane and has potential to metastasize (spread to other parts of the body). Invasive carcinoma can usually be treated, but not always successfully. However, if it is left untreated, it is almost always fatal."
The American Cancer Society says that a great deal of research is now under way to learn how HPV might cause anal cancer. There is good evidence that HPV causes many anal squamous cell carcinomas. But the role of this virus in causing anal adenocarcinomas is less certain. More than 100 subtypes of HPV have been found. The subtype known as HPV-16 is often found in squamous cell carcinoma and is also found in some anal warts. Another type, HPV-18, is found less often. Most anal warts are caused by HPV-6 and HPV-11. Warts containing HPV-6 or HPV-11 are much less likely to become cancerous than those containing HPV-16.
The HPV tests on the market are only used to help screen for cervical cancer. There is no general test for men or women to check one's overall "HPV status," nor is there an HPV test to find HPV on the genitals or in the mouth or throat. But HPV usually goes away on its own, without causing health problems. So an HPV infection that is found today will most likely not be there a year or two from now.
I tell HIV+ long term survivors not to neglect their anal area ( tops or bottoms, women or men). Although anal cancer is a disease that progresses slowly, it is better to be proactive about it than waiting until it needs chemotherapy.

I posted a list of doctors in a previous answer on this subject. I live in Houston and used to travel to New York once a year for an anoscopy, but gladly there is now a physician trained in my city. If you live in a place where there is no colon rectal doctors who perform this procedure, have your doctor contact local physicians to see if any of them is interested in being trained at the University of California- San Francisco. They provide a two day training session. Their web site is http://www.ucsfhealth.org/adult/special/d/12748.html
Doctors that are trained on this issue will be better equipped to help people as they age with HIV, so it is a good thing to do right now while we wait for more data that will support future guidelines on this important cancer that is showing up as one of the highest incidence in HIV.

AIDS Nelson Vergel, AIDS expert, talks HIV and healthy aging by Kate Sosin, Windy City Times

http://bit.ly/lRCGbu

	AIDS Nelson Vergel, AIDS expert, talks HIV and healthy agingby Kate Sosin, Windy City Times2011-06-08
Nelson Vergel and Jeff Berry from TPAN. Photo by Kate Sosin
Nelson Vergel is not what you think of when you say "AIDS over 50."With hefty round muscles pushing out against a tight blue t-shirt and a lively demeanor, Vergel looks more like Mighty Mouse than a person resistant to nearly every HIV drug on the market. But Vergel is in the business of de-bunking myths about aging with HIV, and while his own HIV is a struggle, he's also the living example of his work. Vergel presented some of the latest findings on HIV and aging at Center on Halsted May 31, during his free talk, "Promising Advances in HIV Cure and Healthy Aging Research." The event was sponsored by Test Positive Aware Network. The Houston-based author and activist focused heavily on the scientific reasons why a cure to HIV/AIDS is both a distant dream and an impending reality. But while Vergel is following progress on possible cures, his own work focuses on informing other HIV-positive people on the changes HIV causes in the body and strategies for living well with the virus. "We're getting older. What is the quality of life going to be?" Vergel asked an audience of about 30 people. According to Vergel, medication is just one of four useful in battling HIV. He also includes stress reduction, exercise, and nutrition. In three years, he said, there will be four once-a-day HIV pills on the market (there is currently just one—Atripla). Still, HIV drug production is slowing because it's less profitable than other drugs. "We're moving into a new world," Vergel said. He expects that some HIV patients will be asked to go off their medications in time so that new possible cures can be tested. That possible cure might include one found four years ago in an American living in Germany. The famous "Berlin Patient" may have been cured of his HIV when he received a bone marrow transplant from a donor whose genetic mutations made him resistant to HIV. Research on that method is ongoing, Vergel said, but it's also still very risky and not enough information is available to make it a viable option yet. In the meantime, Vergel recommends nutrition and exercise. Because people living with HIV are at heightened risk of osteoporosis, HPV, and other illnesses, Vergel said it is especially important to remain vigilant about getting screened for other illnesses, especially HPV. "We're not talking about bottoms or tops or women or men," Vergel said. "[HPV] is affecting everyone." Medicine aside, exercise is the best medicine, said Vergel. "We [HIV-positive people] have an acceleration of the aging process by about 15 years," Vergel said. "Frailty in aging is most related to body strength." Vergel suggests leg squats for preventing frailty. He also said a healthy combination of cardio and muscle resistance can slow the aging process. New research has also shown merits of some vitamins in relieving some HIV symptoms. D vitamins can help maintain bone strength, while B vitamins can help relieve depression. Vergel warned, however, that patients talk to their doctors about vitamins as some can interact with HIV medications. Vergel doesn't stop at health, however. His talk also included strategies for fighting changes in body fat and fat under the skin (also known as lipohypertrophy and lipoatrophy) because Vergel said, "it's not about getting older. It's about getting your healthy look back as you age." Vergel thinks that a lot of doctors are reluctant to offer facial treatments to HIV patients who lose fat under facial skin because they see it as unnecessary, but he said that changes to body weight prevent some people from going on medication at all. However, a number of treatments exist for preventing weight changes while on HIV medication. Finally, Vergel discussed testosterone treatments, which he has covered in his latest book Testosterone: A Man's Guide. Testosterone is often taken by HIV-positive patients to combat fatigue, lack of motivation, poor appetite, and muscle loss. Vergel warns that these should be taken with caution because they can fuel cancer. Before making any decisions, he said, talk to your doctor. But do your own homework, too, he said because not every doctor will cover all the bases on HIV management. "The thing is, we don't have standards," he said. "We don't have guidelines." Information on Vergel's work as well as his complete slideshow presentation is available on his website:www.powerusa.org .

Nelson's lecture in Chicago addresses aging with HIV

COH talk addresses aging and HIV/AIDS

by MATT SIMONETTE on Jun 5, 2011 • 10:05 am0 Comments and 0 Reactions

CHICAGO – A long-time AIDS activist and author spoke May 31 at Center on Halsted, 3656 N. Halsted, about recent breakthroughs in research and potential issues persons with HIV/AIDS might face as they get older.

Matt Simonette

Long-time AIDS activist and author Nelson Vergel

Nelson Vergel, who lives in Houston, said that he has lived with HIV for 27 years at the beginning of his talk, “Promising Advances in HIV Cures and Healthy Aging Research,” which was sponsored by Test Positive Aware Network.

Even as the GLBT community observes a rather grim milestone, the 30th anniversary of the CDC publishing its first reports of AIDS on June 5, 1981, Vergel said much still needs to be understood about the infection, especially its implications for the aging process.

“We’re all getting older and there are things that are showing up in all of us,” Vergel said.

Vergel, a former chemical engineer, opened by discussing the state of current research on vaccines and cures for the infection. He lamented that many pharmaceutical companies, not having made tremendous profits in recent years with HIV/AIDS drugs in America, have ratcheted back investment in that area.

“When it comes to potent new drugs, we’re getting drier and drier,” Vergel said. “Unfortunately, it is market driven.” He did add, however, that some companies have been preparing new one-pill-a-day treatments that might eventually replace more complex treatments.

“I tell people, if you take one vitamin a day, you’ll get used to this,” Vergel said.

He also discussed Timothy Ray Brown, also known as “the Berlin Patient,” who seems to have had the AIDS virus completely wiped clear from his body thanks to a stem cell bone marrow transplant.

“It’s not until now that people are using the ‘c-word,’” Vergel said.

But while Brown’s story should inspire hope—Vergel’s own mother was ready to begin a fundraiser for him so he could have the same treatment—a great deal of research and testing must take place before Brown’s situation can be duplicated.

New studies in the wake of Brown’s case “are asking for a lot from people,” according to Vergel. Subjects are expected to get off HIV meds and undergo extremely invasive testing procedures, among other requirements.

Another consideration is that chemotherapy played so heavily into Brown’s treatment. “What are we going to do with the healthy (men and women) who don’t have leukemia?” Vergel asked.

By 2015, over 50 percent of persons with HIV/AIDS will be over the age of 50. As such, both medical professionals and the government will have to rethink standard treatments for people who are aging and have the infection.
“We’re going to live longer, but what’s our quality of life going to be?” Vergel asked.

Many infected individuals, for example, must contend with facial wasting. But Medicare usually refuses to pay for treatments unless a physician marks in the patient’s file that the person is suffering from a depression brought about by the wasting.

“Most people just want to get their face back, but you have to have ‘depression’ on your chart in order to have anything done about it,” Vergel said, adding that community activists need to start advocating on behalf of physicians as well as patients.

“Many doctors are refusing (to see Medicare patients) because Medicare doesn’t want to pay enough,” he said.

Vergel suggested that persons with HIV/AIDS be extra vigilant in guarding against afflictions beguiling older Americans. Bone density scans, exercise and vitamin D, for example can help stave off osteoporosis.

HPV infections were another condition to be concerned with. Vergel said the condition was common—“We’re not talking top or bottom, men or women,” he said—and concerned individuals should not be afraid to ask their physician about having an anuscopy done to check for anal warts if they think they might need it.

Doctors are rarely proactive about that particular procedure, Vergel said, adding that it was not the same thing as a colonoscopy, which usually is probing for gastro-intestinal issues.

Infected individuals are often “more frail by about 15 years,” Virgil suggested, so he said good overall advice is to be sure to take plenty of exercise.

“Exercise is the best therapy for most health problems,” Vergel said.