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.

Medicare seeks comments from community and clinicians about facial lipoatrophy reimbursement needs

For everyone who has complained about the lack of insurance
reimbursement for facial lipoatrophy treatment, or about the lack of
good permanent fillers approved for facial lipoatrophy, now is your
chance to do something. Please follow the link below
to submit a comment in response to Mediare's request for comments on
Reconstructive Treatment for Facial Lipodystrophy Syndrome. Even if
you have private insurance, private insurers are likely to follow the
lead of Medicare, the country's largest health program. Manufacturers
of facial fillers are more likely to seek FDA approval if there is a
potential for insurance reimbursement for their products. This is
probably the best opportunity we've ever had to do something about
insurance reimbursement for facial wasting procedures. With a new,
more enlightened administration in the White House, I think there's a
good chance that Medicare will change its policies in response to
reasonable arguments that treatment for facial wasting is
reconstructive (like reconstruction of a breast after breast cancer or
like surgery to eliminate disfiguring burn scars).

Powerful personal anecdotes about how facial wasting has affected you
are likely to be persuasive, particularly if you can talk about how it
has caused social isolation or impaired your ability to work. Pictures
will speak louder than words; if you have pictures of your face
before and after treatment for facial wasting, posting them with your
comments could help the cause enormousely. There is an email link on
the form for attachments.

If you choose to write personal anecdotes or submit pictures, the
government will redact (delete) anything you write about your personal
experience with facial lipoatrophy from the comments posted on the
website, and will not post personal photos (before you can comment,
you are required to read a statement from the government stating that
statements about personal health conditions will not be posted on the
website). But presumably, these comments (and photos) will still reach
the intended decision makers in the government in their unredacted
form. I personally chose to begin with a paragraph that stated my
opinion about the proposed change to policy and then discussed my
experience from working with people with HIV. Presumably, these
comments will be posted on the website. Then I went on to describe my
personal experience with facial lipoatrophy, providing a couple of
anecdotes that I thought demonstrated the effect it has had on me. I
presume these comments will not be posted, although I don't really
mind if they are.
Please click on the orange "comment" button to explain to Medicare why you think facial lipoatrophy is a medication-induced side effect that needs to be treated and covered. If you can add your own personal experience as a patient or as a clinician, even better!

We do not have much time. The deadline is Feb 16

http://www.cms.hhs.gov/mcd/ncpc_view_document.asp?id=20


For more information about facial reconstruction products in HIV, please visit facialwasting.org

A New Book on the Medical Use of Anabolic Steroids

A New Book on the Medical Use of Anabolic Steroids

Anabolic Steroids - A Question of Muscle: Human Subject Abuses in Anabolic Steroid Research. By Dr Michael Scally

Available at Amazon.com

http://www.amazon.com/Anabolic-Steroids-Question-Subject-Research/dp/096622311X/ref=sr_1_1?ie=UTF8&s=books&qid=1232669135&sr=1-1


My review:

Along with Michael Mooney, I am the co-author of the book "Built to Survive: a comprehensive guide to the medical use of anabolic therapies, nutrition and exercise for HIV+ men and women." I am very happy to see that Dr Scally spent months of work researching the effects of anabolics on the Hypothalamic Pituitary Testicular Axis (HPTA)and how these compounds can cause long term hypogonadism (low testosterone) if not used properly.
Most doctors in clinical practice are not trained on how to avoid hypogonadism after anabolic steroid use for medical and non medical purposes. We have used them with great results them for HIV wasting for many years using good physician monitoring. Hopefully, this book will make it possible for clinicians to learn the main issues surrounding the proper use of these life-saving compounds.

I am so glad that Dr Scally wrote a simple explanation on a protocol that may help reset our body's own hormonal axis to prevent the debilitating effects of "post-steroid crashing." There are no published data on the subject, so this book is groundbreaking.

Dr Scally reviews data on the use of anabolic steroids for the following medical uses:

- To treat wasting syndrome related to the Human Immunodeficiency Virus (HIV),
- To treat strength and weight loss associated with Chronic Obstructive Pulmonary Disease (COPD) and Chronic Kidney Disease/Hemodialysis
- To counteract osteoporosis and the negative effects of glucocorticoids on bone density and lean body mass,
- To reverse and prevent the age-related loss of lean body mass (Sarcopenia.)

For physicians and lay people who love to read easy-to-understand clinical information, this book is for you. Every man using testosterone or anabolic steroids should do their research to avoid the most common and untreated side effect caused with the use of these compounds. When used correctly with solid research data and monitoring, anabolics can be great to improve quality of life and lean tissue in people suffering from many debilitating conditions. However, most of the benefits disappear after their use is stopped and quality of life tends to worsen unless an effective HPTA reset protocol is used. This book explains such approach.

Nelson Vergel