Exciting New Data on The Use of JAK Inhibitors to Control HIV

This abstract was recently presented at the  International Workshop on HIV and Hepatitis in Sitges

Abstract 37 by RF Schinazi and colleagues was on the topic of a novel series of inhibitors of HIV replication called Jak inhibitors. These compounds are able to interfere with the Jak-STAT pathway in activated lymphocytes and macrophages in the aftermath of HIV infection. Activation and reactivation of cells was performed using monoclonal antibodies against CD3 and/or CD28 and activation was monitored by flow cytometry. The Jak-STAT pathway is routinely stimulated in HIV-infected cells and can therefore be perceived as a logical target for drug development. Now, in this proof of concept study, it has been shown that two lead compounds termed Tofacitinib and Jakafi demonstrated excellent inhibition of HIV replication at concentrations ranging between 0.02-0.3 µM in cultured human lymphocytes and macrophages as well as against replication of a SHIV in lymphocytes and macrophages obtained from rhesus macaques. Moreover, these compounds were not toxic and the selectivity index for each of these compounds was high. This is the first demonstration that targeted blockage of the Jak-STAT pathway might be an effective way of interfering with HIV replication in both macrophages and lymphocytes. Moreover, the data suggest that these compounds might interfere with the ability of HIV to achieve latency in a variety of target cell types and that they were active against all of a variety of forms of drug-resistant HIV-1 that were tested. In addition, activity was demonstrated in regard to latently infected cells that were re-activated so as to become overt producers of HIV. The field will now await further studies on some of the molecules in this series, at least some of which are already approved by the Food and Drug Administration in regard to other disease indications, such as rheumatoid arthritis and myeleofibrosis.

Source: http://www.natap.org/2012/ResisWksp/ResisWksp_13.htm

Nutrition vs Safety: Omega 3 Oils and Mercury in Seafood

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The Economist: The business of HIV - Battling the virus- A huge, strange drug market

If the process for developing HIV drugs has been unusual, selling them has been even more so. America is the rich world’s biggest market, with 841,000 patients diagnosed—ten times as many as in Britain. More than 60% of HIV drugs in America are bought with public money. Insurers give HIV special treatment: patients are rarely pressed to buy the cheapest pills, as they might be if they had another disease.

http://www.economist.com/node/21556275

Heart Disease and HIV- What to Do?

Some HIV+ people have emailed me worried about this report:

Heart Attacks Found Early and Frequently in HIV Positive People

Calculate your 5 year estimated cardiovascular risk: D-A-D Cardiovascular Risk Equation for HIV+ People

My suggestions to minimize heart disease (not in any other of importance):

1- Do not smoke

2- Keep your cholesterol and triglycerides within normal ranges (with exercise, diet, HIV medication change, fish oils, even medications)

3- Exercise 4 times a week for an hour

4- Take a baby aspirin every day (81 mg)

5- Take 200 mg of Coenzyme Q-10 and 2000 mg of carnitine per day

6- Get a stress test every two years 

7- Have one to two glasses a day of red wine, no more.

8- Controversial topic: avoid abacavir (Ziagen, Epzicom), D4T, AZT, Crixivan.

9- Control your HIV to under 50 copies all the time

10- Manage stress: meditate, take a hobby, do pleasurable things every day, let go of what you cannot control, etc

11- Avoid street drugs, except moderate pot for pain or appetite.

12- Get your blood pressure under control 

13- Keep your weight down

14- Keep your gums healthy

15- Eat cold water fish (salmon, sardines, etc) at least once a week

16- Have a hand full of nuts once a day

17- Keep your testosterone and thyroid hormones within healthy ranges.

18- Know the symptoms of a heart attack and call 911 immediately if you ever have them. Do not deny them or "sleep them off".  Do not have a friend take you to the hospital. Call 911 and paramedics will pre-treat you right when they are driving you to the hospital. Read about symptoms: Symptoms of a heart attack

The Stigma Project Social Media Campaigns

I want to congratulate the Stigma Project (http://www.thestigmaproject.org ) for their great campaigns to fight stigma.

I particularly love this last ad called "Clean UB2"

On the internet, HIV negative (or those who do not know their status) often refer to themselves as "clean" or DDF (drug and disease free), two terms that really stigmatize HIV positive people. We are not dirty.  And to use DDF as a term that combines HIV and drug use also pisses me off.

If you are HIV negative and want to have sex only with HIV negatives, that is your prerogative and we should respect that.  But stop using those terms.  Just say  "HIV negative and looking for same".

We need to correct people when they use terms that stigmatize.  Words are loaded weapons that have been used to discriminate and bully many people who are seen as " different".

So, good for the people who operate The Stigma Project.  We need to support your innovative work!


Nelson

Nucleoside and Norvir Free HIV Medication Regimen May Provide an Option for Patients with Kidney Problems

http://www.hivandhepatitis.com/hiv-aids/hiv-aids-topics/hiv-treatment/3629-nrti-sparing-art-with-atazanavir-raltegravir-conflicting-data-for-naive-and-experienced-patients 

 NRTI-sparing antiretroviral regimen of unboosted atazanavir (Reyataz) plus raltegravir (Isentress) suppresses HIV in treatment-naive patients as well as standard 3-drug combinations, but its twice-daily dosing, side effects, and low barrier to resistance limit its appeal. For treatment-experienced people already doing well on atazanavir triple therapy, however, the dual regimen may be an attractive simplification option.

According to the latest U.S. antiretroviral treatment guidelines, preferred first-line regimens consist of a NNRTI, a ritonavir-boosted protease inhibitor, or the integrase inhibitor raltegravir, all combined with 2 nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs). NRTIs and ritonavir can cause multiple drug toxicities, however, prompting researchers to explore alternative regimens.

My comments:

I bet this nucleoside-free regimen could do even better when it comes to side effects if the Reyataz (atanazavir) dose was cut to 150 mg twice a day instead of the 300 mg twice a day. However, this lower dose of atanazavir has not been tested in combination with raltegravir, so patients should not take the risk to experiment with it.

I think twice a day dosing is not a big deal, no matter how bad pharmaceutical companies and clinicians make twice a day dosing to be. Many patients will be happy to take a twice a day combination if they do not have to be exposed to nucleosides.

I really believe this is a great option for patients who do not want to take nucleosides  due to kidney and bone issues, or who have hypersensitivity to abacavir.

Both raltegravir and atanazavir boost each other, but it seems that raltegravir boosts atanazavir so much that 20 percent of patients experience high bilirubin, a common side effect of atanazavir.

Note: Nucleoside-free combos are not recommended with patients coinfected with Hepatitis B and HIV (Tenofovir, a nucleoside analog, is also a treatment for Hepatitis B)

Fw: Hot Topics at TheBody.com's "Ask the Experts" Forums

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June 19, 2012 Visit the Forums "Hot Topics" Library Change/Update Subscription
Living With HIV/AIDS Mixed-Status Couples Insurance, Workplace & Legal Concerns Body Shape Changes & HIV/AIDS HIV/AIDS Treatment Other Health Issues & HIV/AIDS Understanding HIV/AIDS Labs HIV & Hepatitis Transmission  How Is the "Berlin Patient" Doing? Dear Nelson Vergel: I've read some of your posts about "Berlin Patient" Timothy Brown, the guy who was cured of HIV. I was shocked to find out he's been struggling here in the United States since moving back here from Germany. How is he doing now? What's he been up to? How is his health? Is there anything the community can do to help him out? Nelson Vergel responds in the "Nutrition and Exercise" forum  How Can I Support My Partner, and Hold Onto My Own Faith and Hope? I met my fiancé last year, right before he went into a coma, and that's how I found out he's HIV positive. It's been a challenging year but we've made it through. However, we recently found out he needs to start taking HIV meds as soon as possible. I don't know how we're going to afford the meds, and my fiancé's afraid he might lose his job if he can't handle the side effects. I just ask God to make me stronger in this new challenge. How can I support him on this new path with meds? How can I stop crying all the time and thinking, "Why me?" Rev. Todd A. Brown responds in the "Spiritual Support and HIV" forum  I Think I Was Fired for Being HIV Positive: What Can I Do? I was hired by a local firm last July 12. On September 1 the owner's wife, who is the bookkeeper, gave me a health insurance form to complete, which led me to believe that I'd be with the company long term. On September 3 I was terminated from the company. The reason given by the company owner was that I was not a good match. During my tenure with the company I never received any disciplinary action of any sort. I think owners of the firm saw what I put on my health insurance forms and decided to terminate my employment. Can you help? Christa Douaihy, Esq., responds in the "Legal Issues and HIV" forum  Should I Help Others Get Low-Cost Meds From Overseas? I have friends who go back and forth to India all the time. They provide me with Viraday, a generic form of Atripla (efavirenz/tenofovir/TFC) made in India, which is working perfectly for me. If others want information on this, I would assist. Is that legal? Can I get in trouble for helping others access a source of lower-cost meds? Jacques Chambers, C.L.U., responds in the "Workplace and Insurance Issues" forum It's easy for someone to tell you, "Just take all your meds, and you'll be fine." But the challenge of taking HIV meds every single day, and the obstacles that life throws in your way, can make adherence a lot tougher in real life than it might seem on paper. Check out some invaluable advice on adhering to meds from HIV experts and people living with HIV. You can read first-person stories, watch videos and get more information and advice on adherence in TheBody.com's Resource Center on Keeping Up With Your HIV Meds!  Could Liposuction Work in Combating Belly Fat Gain? I've been HIV positive for five years. I take Norvir (ritonavir), Reyataz (atazanavir) and Truvada (tenofovir/FTC) and my CD4 count has always been over 600. However, I've recently developed a round belly. I've exercised and watched my food intake to control it, but it's still there. I was thinking of getting liposuction but I wonder, if I get this done, if the problem will come back. Do you know if liposuction would work, or is this a losing battle? Keith Henry, M.D., responds in the "Managing Side Effects of HIV Treatment" forum  Tried Meth Once: Will It Ruin My Chance to Do Well on HIV Meds? I take Isentress (raltegravir) and Truvada (tenofovir/FTC). I've used meth once since being on HIV meds and will never use again! I've been on meds for a year and a half, my viral load has been undetectable since three weeks after starting meds, and my last CD4 count was 964. What can I expect from my next lab results in three months? Could meth have seriously affected my body's ability to control the virus? Nelson Vergel responds in the "Aging With HIV" forum  Which Meds Are Best for Primary Infection? I was very recently infected with HIV, so I'm still experiencing primary sickness. What treatments would you recommend to someone in this early stage of HIV infection? Benjamin Young, M.D., Ph.D., responds in the "Choosing Your Meds" forum More Questions About HIV/AIDS Treatment: What if I Throw Up Right After Taking My Pills? Are My HIV Meds Causing My Nose to Be Dry?  Are Shock Treatments My Best Option for Treating Severe Depression? I was wondering if you or anyone you know has tried electroconvulsive therapy (ECT) for their depression. I have clinical depression and OCD (obsessive compulsive disorder). I've tried every antidepressant and had to be pulled off due to side effects or for it just not working. I spend every minute just trying to hang on so I don't commit suicide. My family and friends do not understand; it does not help for people to tell you to just take your meds because they don't want to listen to you. What can I do? David Fawcett, Ph.D., L.C.S.W., responds in the "Mental Health and HIV" forum  Is Different Dosing Normal for People With HIV and Kidney Problems? I have a friend that has kidney problems; for that reason his doctor changed his Epzicom (abacavir/3TC, Kivexa) dose to Epivir (lamivudine, 3TC) and Ziagen (abacavir) in an oral solution once a day. Is it appropriate to change from the standard doses of HIV meds for people with kidney dysfunction? Benjamin Young, M.D., Ph.D., responds in the "Choosing Your Meds" forum Seroconverted and Scared: Will My CD4 Count Jump Back Up? (A recent post from the "I Just Tested Positive" board) I just tested positive on the 10th of June. I am yet to be advised of my viral load, but my CD4 count is 334 and 29%. … I am petrified. I am getting tested again next Saturday. I was very sick with seroconversion and I am trying to comfort myself with the fact that my CD4 count will jump back up again now that I am over my illness. Can anyone offer me words of encouragement? -- Richardph1234 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!  Is There a Reason I'm Doing So Well? I was given an HIV-positive diagnosis in 2004. They told me I'd be dead in five years. Now I still have an undetectable viral load and my CD4 count is around 750, and I've never taken HIV meds. Is that normal? What do you think is going on? Joseph P. McGowan, M.D., F.A.C.P., responds in the "Choosing Your Meds" forum  Can I Transmit Inactive Hepatitis B? Since there's no virus to be found in my blood, can i infect other people? How many years will it take for me to become HbsAg negative, if that can happen? Barbara McGovern, M.D., responds in the "Hepatitis and HIV Coinfection" forum  Can My Daughter Safely Play With an HIV-Positive Kid? My daughter is in grade school and I recently found out that a friend of hers is HIV positive. The girls do many things together including sleepovers, summer camp, swimming and sports. I've discussed with my daughter that if she is bleeding or her friend is bleeding, they shouldn't be in contact with each other's blood. Still, though, I don't want anything to endanger her. Am I worrying needlessly? Is there anything else I need to be concerned with? Should I discuss anything else with my daughter to ensure she is safe? Richard Cordova 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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