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

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	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 .

GSK- ViiV start their phase 3 study for their second generation integrase inhibitor (dolutegravir) in raltegravir experienced patients

http://clinicaltrials.gov/ct2/show/NCT01328041?term=dolutegravir&rank=1

For more on dolutegravir:

Report from CROI 2011

Dr Joe Eron presented new dosing and efficacy phase 2b data on the new GSK integrase inhibitor dolutegravir (DTG, S/GSK1349572) using 50 mg twice a day in patients whose HIV virus has developed resistance to raltegravir (Isentress). Prior data presented in Vienna from a cohort (cohort 1) of patients who took 50 mg once a day showed that patients with one or more Q148+ associated integrase mutations had reduced activity to the drug, so GSK decided to recruit a second cohort (cohort 2)  of patients who took 50 mg twice a day in hopes that the increased blood levels would overcome some of this lower efficacy. Despite a long half life supporting once-daily dosing, the lack of dose proportional increase in exposure above 50 mg precluded using 100 mg once daily.

Adult patients with HIV-1 RNA ≥1000 copies/mL showing genotypic resistance to raltegravir and to ≥2 other ARV classes received 50 mg twice daily of DTG while continuing their failing regimen (without RAL) to day 11, after which the background regimen was optimized with another active agent. Unlike the previously presented 50 mg qd cohort I, eligibility required at least 1 fully active ARV for day 11 optimization.

All patients in this 50 mg bid cohort II with extensive raltegravir resistance (mutations Q148+ others) virus responded compared to 3 of 9 in the 50 mg qd cohort I. The mean reductions in plasma HIV-1 RNA (log10 copies/mL) at day 11 were –1.76  for  50 mg bid cohort II ( a lower but still attractive response of –1.57 for Q148+ virus) and –1.45 for  50 mg qd cohort I ( a reduced response of –0.72 for Q148+ virus). DTG was generally well tolerated:  mild to moderate diarrhea was the most common adverse event (n = 6), while 1 subject experienced 2 severe adverse events (demyelinating polyneuropathy, at day 23; diabetes mellitus, at day 79) considered unrelated to study drug.

 Although the day 11 responses were numerically better in cohort II, the baseline fold change range in virus susceptibility to DTG for cohort II was more limited due to extensive raltegravir related mutations.  46% of patients taking the 50 mg bid dose had one or more Q148 associated mutations that were associated with reduced response to the prior 50 mg qd dose cohort.  Longer-term (24 weeks) assessments in this phase 2b study are ongoing.

The data from cohort 2 provide promise for patients with extensive raltegravir resistance. However, many of these patients are in deep salvage with no remaining active ARVs to construct a viable regimen, so even if DTG works for them they will need another active agent.  Luckily, several companies are currently collaborating in an upcoming expanded access program that will allow these patients at higher risk of disease progression and death to obtain more than one active investigational drugs without waiting three years for all of them to be approved.  I will write about this project in future articles.

DTG will also be tested in naïve patients in head-to-head with raltegravir  in phase 3 studies (using a background of Epzicom  (abacavir (Ziagen) + 3TC (Epivir) ) or Truvada. 

Fw: Hot Topics at The Body's "Ask the Experts" Forums

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June 7, 2011 Visit the Forums "Hot Topics" Library Change/Update Subscription
Living With HIV/AIDS Mixed-Status Couples Body Shape Changes & HIV/AIDS HIV/AIDS Treatment Other Health Issues & HIV/AIDS Understanding HIV/AIDS Labs HIV Transmission LIVING WITH HIV/AIDS  How Can I Keep My CD4 Count From Falling? My CD4 count is 690. I'm not taking HIV meds yet but I do doctor visits every three months to monitor my HIV health. Is there anything else I can do to help hold onto my CD4 cells? Nelson Vergel responds in the "Nutrition and Exercise" forum  Newly Diagnosed: What Are My Open-Enrollment Insurance Options at Work? I tested HIV positive six months ago. I've been working for the same company for five years. I'm currently covered under my company's group health and life insurance policy. I have a small $25,000 insurance policy. I also set up a $600 flexible spending account that has really helped with my doctor visit co-pays. Our open enrollment period will begin within the next few weeks. Will I be able to increase my life insurance? Would I qualify for short- or long-term disability coverage? Could my new HIV status jeopardize my flexible spending account? Lynn Franzoi responds in the "Workplace and Insurance Issues" forum MIXED-STATUS COUPLES  How Do I Tell My Partner I'm HIV Positive? We're a gay couple. We've been intimate, and I see our relationship really going somewhere. I just don't know how to tell him I'm HIV positive, and in what atmosphere. Should I sit him down and come out and say it? Should I take him out for a nice dinner, then tell him after he's finished his steak? David Fawcett, Ph.D., L.C.S.W., responds in the "Mental Health and HIV" forum BODY SHAPE CHANGES & HIV/AIDS  Fat Loss Around the Eyes: How Do You Treat It? I'm 25 years old and I've been taking HIV meds for two years. I've read some past responses of yours from 2008 noting your preference for Radiesse (calcium hydroxylapatite, Radiance) in correcting deep under-eye lipoatrophy. Three years later, Juvaderm and Restylane are popular for use in this area, with less "lumpy-bumpiness" reported than with Sculptra (poly-L-lactic acid, New-Fill) or Radiesse. Has your practice shifted to using either of these? What are your current recommendations? Gerald Pierone, M.D., responds in the "Facial Wasting" forum This past Sunday, June 5, marks the 30th anniversary of the first-ever report on the illness that would come to be known as AIDS. To commemorate the day, we asked community members of all ages what they were up to 30 years ago -- and at what point they first became conscious of HIV/AIDS. Read others' responses, and feel free to add your own in the comments section at the bottom of the page. You can view more articles, reflections, events and blog entries about the anniversary on TheBody.com's 30 years of AIDS index page. HIV/AIDS TREATMENT  What Do You Know About Edurant, the Latest HIV Med? How does the HIV med Edurant (rilpivirine, TMC278), recently approved in the U.S., compare to other options for first-line HIV treatment? What do we know so far about the advantages and drawbacks to taking this drug? Joseph P. McGowan, M.D., F.A.C.P., responds in the "Choosing Your Meds" forum  Are Stomach Burning and Bloating Side Effects of Isentress? I was on Atripla (efavirenz/tenofovir/FTC) for four years and had problems sleeping because of the Sustiva (efavirenz, Stocrin) component of it. My doctor and I had a long conversation and I switched to Isentress (raltegravir) and Truvada (tenofovir/FTC). I started the new treatment last week and am sleeping much better, but have a burning sensation in my stomach and feel a little bloated. Is this a temporary side effect or do you think it'll last? Keith Henry, M.D., responds in the "Managing Side Effects of HIV Treatment" forum More Questions About HIV/AIDS Treatment: Should a Provider "Make" an HIV-Positive Person Take HIV Meds? Shouldn't I Be Taking Norvir With Prezista? Threw Up After Taking Meds: Do I Need to Take Them Again? OTHER HEALTH ISSUES & HIV/AIDS  Could Meth Use Have Done Long-Term Damage? About seven years ago I engaged in intravenous meth use. This went on for about a year and a half. During that time I became HIV positive. I haven't used since then and am well off the drugs. My CD4 count was 150 at its lowest, which was right before I went on HIV meds. I've never been able to get higher than about 425 though I've remained adherent to my meds and my viral load has stayed undetectable. Could my meth use have had lasting repercussions? David Fawcett, Ph.D., L.C.S.W., responds in the "Substance Use and HIV" forum  How Often Should HIVers Have Their Bone Density Checked? I'm 45 years old and I've been HIV positive for 20 years. Considering that bone loss is connected to longtime HIV infection, how often should DEXA (bone density) scans be performed on people living with HIV? I had one a year ago; is it too soon for another? Keith Henry, M.D., responds in the "Managing Side Effects of HIV Treatment" forum My Partner and I Tested Positive Together, But He's Doing Better Than I Am! (A recent post from the "I Just Tested Positive" board) It has been really hard the past week trying to get my mind around the fact that we have HIV. Luckily my partner's numbers are good; mine are not good at all, though I am told once I get on meds they will get much better. Scared and feel like an emotional wreck. My partner is taking this much better than I. He is just moving through the process and it does not seem to be fazing him. Might be that he has other problems that he has to deal with daily and has since he was 5, so he accepts his body needs help to go on, while I am used to being well and just charging on. Can anyone else relate? -- DAH13 Click here to join this discussion, or to start your own! To do this, you'll need to register with TheBody.com's bulletin boards if you're a new user. Registration is quick and anonymous (all you need is an e-mail address) -- click here to get started! UNDERSTANDING HIV/AIDS LABS  What's the Difference Between Creatine and Creatinine? My creatinine level is a little high. Before I was diagnosed with HIV I used to take a creatine supplement on a regular basis. Could that be the reason for my elevated levels of creatinine? What's the connection between the two? Nelson Vergel responds in the "Nutrition and Exercise" forum HIV TRANSMISSION  If I'm HIV Positive and I Get Someone Pregnant, Is She Definitely Infected? If an HIV-positive man has unprotected sex with an HIV-negative woman and impregnates her, does that automatically mean she's become HIV positive? Is there any chance of her staying HIV negative after such an encounter? Robert J. Frascino, M.D., responds in the "Safe Sex and HIV Prevention" forum Worried Your Spam Filter Might Trash Our Mailings? The Body's e-mail updates are especially prone to being caught up in spam filters, since our newsletters tend to refer frequently to sex, drugs, the human anatomy and so forth. To make sure you never miss one of our mailings because anti-spam software labeled it as junk mail, add update@news.thebody.com to your address book, talk to the person who manages your e-mail security or check your anti-spam program's instructions for more information. About This E-mail This e-mail update has been sent to nelsonvergel@yahoo.com. Want to change your subscription? Click here or send us a message at updates@thebody.com. Missed an update? Our archive of past updates will keep you in the loop. Have any other questions or comments, and don't want to send an e-mail? 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Donate to grass roots activism for the cure of HIV

Email not displaying correctly? View it in your browser. The AIDS Policy Project. Dedicated to a cure for AIDS. June 7, 2011 Dear Nelson, Here’s something amazing. A cure for AIDS may be within reach—soon—for millions of people.  "I want to pull out all the stops to go for it," said Dr. Anthony Fauci, head of the NIH’s National Institute of Allergy and Infectious Diseases, last Friday. Fauci didn’t always feel that way. Until the AIDS Policy Project got into the picture, the National Institutes of Health wasn’t sure a cure for AIDS was even needed. Together, we can keep the pressure on decisionmakers, change minds, cut red tape, and promote new ideas. But we need your help. Here’s Dr. Fauci in 2008, talking about the first cure of a person with AIDS: “It’s very nice, and it’s not even surprising,” said Fauci, Director of the National Institutes of Allergy and Infectious Diseases, in the New York Times. “But it’s just off the table of practicality.” Top NIH officials told us repeatedly that the AIDS drugs we have are good enough; a cure wasn’t necessary.  We swung into action. The AIDS Policy Project uncovered data showing that the National Institutes of Health was spending only 3% of its AIDS research budget actually trying to develop a cure for AIDS. Before us, no one had ever bothered to track cure research spending. We challenged Dr. Fauci in personal email and public forums. Our friend Larry Kramer sent him a message about the cure: “Stop operating like a bureaucrat and start acting like a genius.” We mobilized hundreds of people with AIDS to send letters to NIH Director Dr. Francis Collins demanding more money for a cure. In private meetings, elite research workshops and major press conferences, we called on Carl Dieffenbach, head of the Division of AIDS, to bump up the funding. We called the White House. No other group was--or is--asking the NIH to spend more money on a cure. We are truly speaking truth to power in the service of people with AIDS. Our work made the cover of POZ Magazine. We talked about the NIH in our town meetings—the first town meetings held on AIDS cure research in 15 years. The NIH began to capitulate—they announced $13 million more for cure research. They agreed to track their spending on a cure for the first time in the AIDS epidemic. We didn’t stop. We worked for seven months with Pulitzer-Prize winning reporter Tina Rosenberg on a cure article for New York Magazine. The piece appeared last week; it isNew York’s most read and emailed article. In it, Fauci talks about cure research: “I don’t see a hot product.” Yet pressure was building. Finally, on Friday, Fauci committed to “pull out all the stops” for a cure. We need to hold him to his word.  A crack team of AIDS activists—HIV doctors, community organizers, and policy advocates with decades of experience—has put the cure for AIDS back on the map. Join us to support this crucial work by helping us raise $30,000 by June 30. We will kick off a grassroots campaign this Fall calling for $240 million for AIDS cure research at the NIH—four times the current level. We don’t take money from drug companies or the NIH, which allows us to remain an independent voice. And we're not just fundraising from the work. We're doing the work.   Together, we can do this. Warmly, Kate Krauss and Stephen LeBlanc, for everyone at the AIDS Policy Project The AIDS Policy Project 5120 Walton Ave. Philadelphia, PA 19143 tel: +1 215.939.7852 www.AIDSPolicyProject.org "What this group in Philadelphia has so miraculously done is reignite this issue and run with it." –Larry Kramer, playwright and AIDS activist icon; author of The Normal Heart      We send email to people who support the fight against HIV/AIDS. | Forward to a friend | Our mailing address is: AIDS Policy Project 5120 Walton Ave. Philadelphia, PA 19143

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.

Interview with the first doctor who reported the first cases of AIDS 30 years ago

I'm honored to have Dr. Michael Gottlieb in this interview. He's agreed to speak to us about the 30-year anniversary of the first report that he made to the CDC [U.S. Centers for Disease Control and Prevention] on the first cases of AIDS.

Dr. Gottlieb, obviously, has been treating HIV since the beginning. He has his own medical practice in Los Angeles. He's one of my heroes. I'm honored to have him here, speaking to us about the first report that he made, and about his thoughts on the present and future of HIV research and access.


CLICK HERE TO READ INTERVIEW