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					HIV/AIDS                                                   NEWS
OCTOBER 26, 2006

HIV/AIDS News is published by the British Columbia Persons With AIDS Society. This publication is a compilation
of various articles collected from various news sources. Opinions and information expressed are those of the
individual authors and not necessarily those of the Society.

 LIST OF NEW ARTICLES                                                                        WHAT’S NEW
                                                              Upcoming Treatment Workshop Series:
     BC & Canadian News                                                            Positive Eating
                                                                   A 6-week series of free workshops for persons
                                                                 living with HIV and other interested participants.
 1. Canada Urged To Give Day's Pay For AIDS
                                                                                        Refreshments provided.
 2. AIDS Vaccine Heads To Clinical Trials
                                                                   Week 1/Nov 7: Nutrition and Advocacy Issues:
                                                                        MNSB, diet allowance, food crisis benefits
                                                                Week 2/Nov 14: Healthy Eating & Meal Planning
                                                                Week 3/Nov 21: Vitamin & Mineral Supplements
      International News                                                Week 4/Nov28: Lipodystrophy & Nutrition
                                                                                         Week 5/Dec 5: Exercise
 3. HIV/AIDS Advocate Jeff Getty Dies at Age 49                                    Week 6/Dec 12: Grocery Tour
 4. Gay AIDS Head Gets Christians Talking
 5. HIV Complicates Africa's "Super TB" Threat                      Presenter: Diana Johansen, Oak Tree Clinic
    Says WHO                                                         Where: BCPWA Society, 1107 Seymour St.
 6. Fight Against HIV/AIDS in Africa Should                                           When: Tuesday evenings
    Focus More on Blood Safety, Dybul Says                                November 7 – December 12; 6:30 PM
 7. Indian Orphanage Expels Two HIV-Positive                                          Refreshments provided
    Boys                                                                      Contact: RSVP: 604.893.2243 or
 8. HIV in China Spreading Beyond High-Risk                                    
    Groups, Health Official Says
                                                                                         New Director in
                                                                            Positive Prevention Program
    Studies and Treatment News                                         BCPWA's Positive Prevention Department
                                                                      welcomes a new Director, Elgin Lim, to the
                                                                 program. The Department is enthusiastic about
 9. HIV Exploits Competition Among T-cells
                                                                bringing new energy to prevention work, with the
 10. “Impossible” HIV Infection Linked To
                                                                                 aim of revitalizing the program.
                                                                           Get involved. Contact: 604.893.2225
 11. HIV Protease Inhibitors May Reduce the
                                                                                                      [ More info ]
     Cancer-causing Ability of Human
 12. Can Counseling and Testing in Bathhouses                                       New Hours at BCPWA!
     Help Reduce HIV Transmission?                              Please note our extended hours of operation.
 13. French Doctors Report Treatment Failure For                                      Mon/Wedn/Fri: 9am – 5pm
     Syphilis                                                 Tues/Thurs: 9am – 9pm. Workshops, info sessions
 14. Merck Buys Protease Inhibitor From Ambrilia,                    and trainings will be scheduled on Tuesday
     May Be Potent Booster Of Other PIs                        evenings. Drop-ins for Treatment Information and
 15. AIDS Virus May Hide in the Gut, Study Finds                Advocacy will take place on Thursday evenings.
HIV/AIDS                                                       NEWS

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     BC & Canadian News
Article 1
Canada Urged To Give Day's Pay For AIDS
October 17, 2006

The Maple Leaf‟s General Manager John Ferguson is going to do it.

So is Ontario‟s Health Minister George Smitherman.

If Toronto area doctor Jane Philpott has her way the rest of Canada is going to do it as well.

Philpott is asking Canadians to give a day‟s pay to help fight the AIDS pandemic on December 1st - World AIDS

The idea began modestly in 2004 when Philpott challenged her colleagues at the Markham-Stouffville Hospital to
give up a day‟s pay and donate it to the AIDS battle. That year they raised $33,000.

Then in 2005 eight hospitals across the province got on board, donating close to $100,000 to the cause. Now,
Philpott is hoping this year s campaign, which was kicked off at a news conference in downtown Toronto earlier
today, will go truly national.

And she‟s calling on everyone - from all walks of life -- to dig deep into their pockets and donate a day‟s pay.

"This is a call to action," she said at a news conference. "Canada, let‟s see what a difference we can make in a day.

"This is one part of the human family responding to the broader human family," said Philpott, who worked in Niger
for nine years. She knows only too well the face of tragedy, having herself lost a daughter to meningitis when her
family lived in Africa.

"This is a day to show global solidarity, human decency and compassion. This is a day for Canadians to make a
personal sacrifice and to make a difference."

Aside from Ferguson and Smitherman, she has also managed to convince the lawyers at Osler, Hoskin and
Harcourt; Borden Ladner Gervais and Filion Wakely Thorup Angeletti as well as David Smith, the vice-president of
EllisDon Consulting Ltd, the staff at the MaRS Collaboration Centre and even just this morning CBC Radio s Andy
Barrie to give up a day s income for the cause.

Why donate? "I‟m in a position to help those who are less fortunate," said the Maple Leaf‟s GM Ferguson, who
refused to reveal what a day‟s salary is for him. "Dr. Philpott‟s message small ideas can achieve great results is why
I m here."
HIV/AIDS                                                        NEWS
All the funds raised will be used to support the work of Dignitas International and the Stephen Lewis Foundation,
both Canadian organizations working at a community level to fight AIDS.

The Give a Day campaign, said Stephen Lewis, the UN Special Envoy on HIV/AIDS in Africa and the chair of the
Stephen Lewis Foundation, is an "inspired idea" that gives each of us a chance to respond - to perhaps help silence
this pandemic.

There is a political vacuum when it comes to financing the fight against AIDS, said Lewis.

"The world is now spending $10 billion a month to fight the war in Iraq and Afghanistan," said Lewis. "In all of 2005
we raised $8.3 billion from every source worldwide to fight AIDS."

For more information on the Give a Day to World AIDS campaign go to

By Debra Black, The Toronto Star

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Article 2
AIDS Vaccine Heads To Clinical Trials
October 18, 2006

London, Ontario - The door to success in the search for an effective AIDS vaccine was pried open yesterday with
the announcement that a major South Korean firm is committing $50 million to clinical tests of a vaccine developed
by a research team headed by University of Western Ontario professor

The commitment of $50 million immediately by Curocom Co. Ltd. will be "absolutely critical" to gaining the U.S.
Food and Drug Administration clearance to conduct the clinical trials needed before the new vaccine is cleared for
use, said virology professor Dr. Yong Kang.

"We expect FDA approval within a year," he said, adding that Curocom is also committed to another $35 million for
the final phase of three rounds of testing that will follow an initial series of toxicology tests on animals to show that
the vaccine has no harmful effects.

"We expect that the initial tests will clear the way for this vaccine to be used therapeutically within three years to
treat patients suffering from low-level HIV infection," Kang said.

It will not be a cure for those suffering from full-blown AIDS, he said.

Kang said he expected the full set of clinical trials, to be completed in six or seven years, will clear the vaccine for
widespread use as a HIV/AIDS preventative.

"We hope it will give total immunity," he said from London.

Kang was hopeful but cautious about the vaccine's chances of success.

"We have to be careful. Because we have done the animal, the immune response studies. But that doesn't mean
we can repeat exactly the same kind of results in humans," he said.
HIV/AIDS                                                      NEWS
There are currently more than 30 HIV vaccines in various stages of clinical trials, according to the International
AIDS Vaccine Initiative. It has been estimated that at least as many more have been abandoned after work that
looked promising in animal studies failed to pan out in human trials.

Peter Hayes, executive director of the AIDS Committee of London, called the announcement "very good news." But,
he warned, "I've been living with (HIV) for 15 years, and this is not a cure yet."

About 43 million people worldwide are HIV-positive or have AIDS.

By Pat Currie with files from The Canadian Press, The Toronto Star

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      International News

Article 3
HIV/AIDS Advocate Jeff Getty Dies at Age 49
October 16, 2006

Prominent HIV/AIDS advocate Jeff Getty, 49, died on Oct. 9 in Joshua Tree, Calif., of heart failure following
chemotherapy treatment for cancer, the AP/Albany Times Union reports. Getty, who was diagnosed with HIV in the
1980s, in December 1995 underwent an experimental bone marrow transplant using cells taken from a baboon, a
species that has shown natural immunity to HIV. The transplant was unsuccessful in making Getty resistant to the
virus, but his health improved, according to the AP/Times Union (AP/Albany Times Union, 10/15). Getty advocated
for early approval of experimental HIV/AIDS treatments and increased access to antiretroviral drugs for HIV-positive
people, and he was a "pioneer" who helped enable the development of highly active antiretroviral therapy, the San
Francisco Chronicle reports. Getty also created experimental guidelines for liver transplants for people living with
AIDS, many of whom experience liver failure because of hepatitis or the toxicities of their antiretroviral treatment.
Getty's partner of 26 years, Ken Klueh, said Getty was proudest of these efforts (Russell, San Francisco Chronicle,
10/15). Steven Deeks, a University of California-San Francisco professor who was the lead investigator of the
baboon bone marrow transplant, said Getty was "emblematic of a whole group of men who survived AIDS in the
early 1980s and 1990s and made it into the HAART era but had developed so much resistance to the drugs that
they never got their virus fully under control" (AP/Albany Times Union, 10/15).

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Article 4
Gay AIDS Head Gets Christians Talking
October 19, 2006

With the swearing-in of Mark Dybul, an out gay man, as the head of the US federal AIDS programme, some
Christian organisations are wondering how far acceptance of homosexuality has gone in the Bush Administration.

Mr Dybul was sworn in this week as the United States     Global AIDS Coordinator, a position that carries the rank of
ambassador by Secretary of State Condoleeza Rice.
HIV/AIDS                                                       NEWS
In this role he will lead the implementation of President Bush s Emergency Plan for AIDS Relief.

According to conservative news source, Christians are asking how appointing a gay man to be in
charge of the US AIDS policy could achieve anything other than further promotion of acceptance of homosexuality.

"We have to face the fact that putting a homosexual in charge of AIDS policy is a bit like putting the fox in charge of
the henhouse," said Peter Sprigg, vice president for policy at the Family Research Council, in an email to
supporters. "Does the party want to represent values voters or Mark Foley and friends?"

The LA Times reports that the long-simmering tension in the GOP between gays and the religious right has erupted
into open conflict at a sensitive time, just weeks before a midterm election that may cost Republicans control of
"The big-tent strategy could ultimately spell doom for the Republican Party," said Tom McClusky, chief lobbyist for
the Family Research Council, a Christian advocacy group. "All a big-tent strategy seems to be doing is attracting a
bunch of clowns."

Now the GOP is facing a hard choice risk losing the social conservatives who are legendary for turning out the
vote, or risk alienating the moderate voters who are crucial to this election's outcome.

"There's a huge schism on the right," said Mike Rogers, a gay-rights activist who runs a blog to combat what he
calls hypocrisy among conservative gay politicians.

"The fiscal conservatives are furious at the religious conservatives, because they need the moderates for economic
policy. But they need the social conservatives to turn out the vote."

This week, according to the Times, a list that is said to name gay Republican staffers has been circulated to several
Christian and family values groups, presumably to encourage an outing and purge.

Tom McClusky, chief lobbyist for the Family Research Council, acknowledged seeing the list but said his group did
not produce it and had no intention of using it.


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Article 5
HIV Complicates Africa's "Super TB" Threat Says WHO
October 17, 2006

Pretoria - Highly drug-resistant tuberculosis could become a major killer in AIDS-hit parts of Africa where
governments have been slow to roll out TB control programmes, the World Health Organization said on Tuesday.

Urgent efforts are underway to redirect donor funds to fight virulent strains of TB, known as extremely drug resistant
or XDR-TB, after an outbreak in South Africa that has killed at least 74 people since January 2005.

Most of those cases were among HIV-positive people whose immune systems were already weakened by the AIDS

"The XDR-TB crisis will not in most parts of the world be solved unless HIV is properly considered. We have for now
HIV/AIDS                                                       NEWS
been paying lip service," Teguest Guerma, of the HIV department of WHO, told health officials at a TB workshop in

"Underlying HIV will add significant challenges to the clinical response." Tuberculosis is the leading killer of AIDS
patients and both diseases are on the rise in southern Africa.

Tuberculosis could have a disastrous impact in sub-Saharan Africa -- the hardest hit region in the global AIDS
epidemic -- which has a poor health infrastructure.

The best way to fight the dual problems of HIV/AIDS and TB is to overlap strategies to combat them, said experts.

A big hurdle is that no new medical antibiotics for TB have been developed in four decades and it will be at least
2020 before new treatments are widely available.

It could also be difficult to attract new funds as the $4.7 billion required by the Global Plan to Stop TB each year
consistently comes up short, said officials.

However, representatives from the Global Fund to Fight AIDS, Tuberculosis and Malaria have agreed to shift
existing funds to combat XDR-TB and the U.S.-backed PEPFAR is considering a similar request, said Paul Nunn of
the WHO.

Government representatives from Swaziland, Lesotho, Namibia, Malawi, Zimbabwe, Mauritius, and Mozambique,
and WHO officials and scientists were invited to attend the two-day workshop by South African Health Minister
Manto Tshabalala-Msimang.

The minister was unable to attend because she is in hospital being treated for what is being described as a lung

By Sarah McGregor, Reuters

Further to this:

South Africa: Emergency Plan To Counter Deadly TB Stain

October 18,2006

Pretoria - Cases of extremely drug-resistant tuberculosis (XDR-TB) are being diagnosed throughout South Africa
and could be going undetected in other parts of the region.

This emerged at a two-day workshop convened in Pretoria this week at the urgent request of the South African
Health Department, attended by experts from the World Health Organization (WHO), and health ministers and
scientists from the Southern African Development Community (SADC).

The aim of the meeting was to develop an emergency action plan for controlling the spread of the deadly strain.
XDR-TB poses a particularly serious threat to this part of the continent, where HIV prevalence is the highest in the

In a telephone interview with PlusNews, Paul Nunn of the WHO's Stop TB Department confirmed that HIV-positive
people were much more susceptible to XDR-TB infection, and that the disease progressed more rapidly in such
patients. "This means you need to be much quicker in your diagnosis and treatment, and you can't afford to make
any mistakes in treatment."
HIV/AIDS                                                      NEWS
So far over 100 cases of XDR-TB have been detected in the country, most of them in KwaZulu-Natal Province on
the east coast, while none have been reported elsewhere in southern Africa. Prof Ronnie Green-Thompson from the
Department of Health pointed out that South Africa was one of only a handful of countries on the continent with the
equipment and technical knowledge to diagnose the deadly strain.

"We don't know the prevalence of XDR-TB in the rest of Africa because other countries don't have the capacity to
do the tests, so it's not that South Africa is polluted, it's that South Africa has the diagnostic equipment."

Part of the WHO's response to the crisis will involve equipping other countries in the region to diagnose cases of the
resistant strain. "It's not just a question of flying in some equipment but of improving the capacity of laboratories,
training staff and changing policies, so it will take time," Nunn said.

As an emergency measure, the WHO will conduct rapid surveys, using laboratories in other countries if necessary,
to determine the size and extent of the epidemic and the role of HIV; patients not responding to a first course of TB
treatment, particularly those who were HIV-infected, would be tested for the XDR strain.

Workshop participants also discussed the need to strengthen existing TB programmes. About 250,000 new TB
cases are diagnosed in South Africa each year, but only about 53 percent are cured. Drug-resistant TB arises when
patients with ordinary TB fail to complete the six-month course of medication.

Most countries, including South Africa, have adopted the Directly Observed Treatment, Short-course (DOTS)
strategy for TB drug adherence, in which patients are closely monitored to make sure they complete the course of
drugs, but Nunn said implementation was often lacking.

"Part of this, of course, is because of the burden of HIV, which has multiplied the number of TB cases by five or six
times, and public health services haven't been able to keep up with that rate of increase," he said.

Green-Thompson dismissed the possibility of introducing quarantine measures to prevent XDR-TB from spreading
in South Africa, while Nunn took the view that complete isolation should only be used as a last resort for patients
who refused treatment, but added that the WHO does provide a legal framework for this.

Despite the high death rate from XDR-TB in South Africa - to date 74 of the 78 patients confirmed with XDR-TB in
KwaZulu-Natal have died - Nunn told PlusNews that the infection was "most likely" treatable with a combination of
four drugs: two are already available in South Africa and the other two were recently imported, but they would need
to be prescribed under highly controlled conditions to avoid further drug resistance developing.

Implementing the workshop recommendations will depend to a large extent on the resources available. "The WHO
can provide the expertise and the knowledge, but international development agencies or governments will need to
come up with the commodities and the funding," Nunn said.

He added that the Global Fund to Fight AIDS, Tuberculosis and Malaria had agreed to requests by grant recipients
to redirect existing funds towards combating XDR-TB, and that the US-backed President's Emergency Plan for
AIDS Relief was considering similar requests.


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Article 6
Fight Against HIV/AIDS in Africa Should Focus More on Blood Safety, Dybul Says
October 19, 2006
HIV/AIDS                                                      NEWS
A renewed focus on unsafe blood transfusions and used syringes is needed to combat the spread of HIV in sub-
Saharan Africa, Ambassador Mark Dybul -- who serves as the U.S. global AIDS coordinator and administers the
President's Emergency Plan for AIDS Relief -- said on Wednesday during a visit to Zambia, Reuters reports.
Evidence shows that sexual transmission of HIV in sub-Saharan Africa is stabilizing because of education
programs, Dybul said, adding that preventing transmission through blood transfusions remains a challenge in the
region because of inadequate medical facilities and high HIV prevalence. Dybul during his four-day visit aims to
evaluate HIV/AIDS programs in Zambia, where one-fifth of the country's 10 million people are HIV-positive,
according to official estimates (Shacinda, Reuters, 10/18). The U.S. has pledged $149 million in PEPFAR funding in
2006 to HIV/AIDS programs in Zambia to increase access to antiretroviral drugs, train health workers and broaden
counseling and testing in rural areas. PEPFAR has committed $570 million to Zambia for its HIV/AIDS programs,
according to the AP/CBS News (Mwanwangombe, AP/CBS News, 10/18). According to Reuters, much of the
funding from the U.S. goes to the Maina Soko military hospital in the capital, Lusaka, which serves only military
personnel and their families. Dybul during his visit also urged African countries to build on programs that stress
abstinence and condom use and that focus on non-sexual transmission of HIV, including preventing mother-to-child
HIV transmission (Reuters, 10/18).

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Article 7
Indian Orphanage Expels Two HIV-Positive Boys
October 20, 2006

Ahmedabad, India - Two HIV-positive boys have been forced to leave an orphanage in India's Gujarat state after
staff said they posed an unacceptable risk to the safety of other children, an official said on Friday.

"I am sad and sorry for them. Children play, eat and fight we cannot take chances, others can get infected," V.
Vachonidhi, secretary of an orphanage run by Arya Samaj, a Hindu reform movement, told Reuters.

The two boys, aged six and nine, are now with relatives after leaving the home in the town Kutch, 450 km (280
miles) west of the state capital, Ahmedabad, where they had lived for four years with about 150 other children.

Staff could not tell Reuters what had happened to their parents or how they had become infected with the HIV virus.

The Indian "network for people living with HIV" said it would launch a legal challenge.

In India families often disown HIV-positive family members, and the children of HIV/AIDS patients have been thrown
out of schools. Landlords have refused to rent houses those infected.

India has the world's highest national HIV/AIDS caseload with 5.7 million infected people. Although the country
reported its first case over 20 years ago, many sufferers still face acute stigma due to a lack of awareness and
misconceptions about the disease.

"We will make sure that the boys receive the best of medical treatment and a healthy upbringing," said Umashankar
Pandey, who works to improve awareness of HIV/AIDS in the state.

HIV/AIDS                                                       NEWS
                                                                                                    Back to articles list

Article 8
HIV in China Spreading Beyond High-Risk Groups, Health Official Says
October 18, 2006

HIV in China has spread beyond high-risk groups -- such as injection drug users, commercial sex workers and men
who have sex with men -- a senior health official said recently, Reuters reports (Lyn, Reuters, 10/17). The Chinese
government estimates that there are 650,000 HIV-positive people in the country, 75,000 of whom have developed
AIDS. According to the government, in 2005 there were 70,000 new HIV cases and 25,000 AIDS-related deaths.
The country's current HIV/AIDS prevalence is approximately 0.05%, according to government statistics (Kaiser
Daily HIV/AIDS Report, 10/5). "We're now like Africa," Hao Yang, deputy director of disease control for the Ministry
of Health, said, adding, "Last year, we found that 48% of those who were newly infected contracted the disease
from sex, so it's not a disease that afflicts only high-risk groups." To combat the spread of HIV, the Chinese
government has made it mandatory for all entertainment venues to provide condoms, and methadone clinics have
been established throughout the country, Reuters reports. In addition, Chinese officials have been in talks with
Abbott Laboratories and Gilead to negotiate a plan to provide second-line antiretroviral drugs for HIV-positive
people who have built up resistance to first-line antiretrovirals, according to Hao. "We have to prepare for this," Hao
said, adding, "In a short time, we will sign some accords with these companies to bring in these drugs" (Reuters,

                                                                                                    Back to articles list

      Studies and Treatment News

Article 9
HIV Exploits Competition Among T-cells
October 16, 2006

A new HIV study shows how competition among the human immune system's T cells allows the virus to escape
destruction and eventually develop into full-blown AIDS. The study, which employs a computer model of
simultaneous virus and immune system evolution, also suggests a new strategy for vaccinating against the virus - a
strategy that the computer simulations suggest may prevent the final onset of AIDS.

The research, which is slated for publication in Physical Review Letters, is available online at

"Competition among T cells exerts a small influence for most diseases, but it's fatal for HIV," said study co-author
Michael Deem, Rice University's John W. Cox Professor in Biochemical and Genetic Engineering and professor of
physics and astronomy.

The new computer model, created by Deem and Guanyu Wang, now an assistant professor of physics at George
Washington University, is the first to accurately reproduce all three stages of HIV infection. The first is marked by an
initial spike in virus production that's immediately followed by dramatic drop as the immune system recognizes the
threat, mounts a defense and destroys most of the invading viruses. The second phase is a long period of clinical
HIV/AIDS                                                       NEWS
latency that can last up to 10 years. In this phase, a small amount of virus mutates fast enough to escape initial
detection and continues to mutate over time. The third phase, AIDS, occurs when the virus has changed so much
that the body's T cells are no longer effective at keeping it in check.

Deem and Wang's computer model accurately describes all three phases of HIV infection by incorporating a key
component: competition among T cells. The model includes two forms of competition. The first form leads to a
phenomenon known as deceptive imprinting, or original antigenic sin. Original antigenic sin is the tendency for
memory immune cells produced in response to a first viral infection to suppress the creation of new immune cells in
response to a second infection by a related strain. The second type of competition, immunodominance, occurs
when several viral strains simultaneously infect one person. In this case, T cells compete to recognize the different
strains. The winners - the T cells that the body produces in mass quantities to fight the disease - are the ones with
the best overall record against the most recognizable strains. Among the losers, however, there may be T cells that
better control the other less recognizable, but still deadly, strains.

"Once the immune system chooses a winning set of T cells, it has a natural tendency to go with those cells when it's
confronted by new strains of the same disease in the future," Deem said. "For HIV, which mutates rapidly, this is an
Achilles' heel. We found a direct correlation between the level of competition among T cells and the rate at which
the virus escaped."

Deem said one strategy to combat this effect would be to vaccinate against the strains of HIV that will inevitably
evolve in the body in a manner that was designed to reduce immunodominance. One such strategy - polytopic
vaccination - involves giving vaccines against different strains of the same disease simultaneously in different parts
of the body. The approach capitalizes on the fact that different lymph nodes - the sites where T cells compete to be
chosen as the winners against a particular disease - act as collection points for different parts of the body.
Moreover, because it takes 4-5 days for T cells produced in a lymph node to begin to leave it, the possibility exists
to set up simultaneous, independent competition against each of the multiple strains that will evolve by injecting
each strain simultaneously so that they drain to different lymph nodes. In this case, no single T cell is chosen as a
winner. Instead, a separate winner for each strain is picked in each affected lymph node before immunodominance
can come into play.

"In our simulations, this strategy appears effective at all but eliminating competition among T cells," Deem said. "As
a result, HIV remained in a state of permanent latency and was never able to escape the immune system's grasp to
develop into AIDS."

Rice University,

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Article 10
”Impossible” HIV Infection Linked To Dementia
October 19, 2006

Researchers have found that HIV can get into cells it theoretically shouldn‟t be able to infect. These include cells in
the intestine and brain, and may help to explain how HIV still manages to cause brain damage and gut problems,
even in people on treatment.

Meanwhile, another study of HIV dementia has found that nearly as many people who have HIV dementia get better
as get worse, and it‟s not an inevitably progressing condition.

A number of studies recently have found that there‟s a lot we still dont know about HIV infection. It used to be
thought that in can only infect certain types of cell: those that have both a protein called CD4 on their surface, and
HIV/AIDS                                                       NEWS
also one of two proteins called CCR5 and CXCR4. These, generally, are cells of the immune system.

However a group of scientists from the University of California, Los Angeles have managed to infect with HIV a
number of different cells that lack CD4.

Dr Junyin Zheng and colleagues incubated HIV for a short while with a range of different cells that are found on the
membranes lining the vagina, cervix and gut and also two different types of brain cell, the nerve cells themselves
(neurons) and cells called glial cells which form the “insulation” of nerves.

Zheng found that HIV was able to infect one in 30 to one in 100 of the glial cells and the vaginal and cervical cells,
and one in 150 to one in 300 of the nerve cells and cells taken from the large intestine.

Furthermore these cells weren‟t just passively taking up HIV but were actively subverted into becoming virus-
producing factories, in other words being “productively” infected.

Fluid taken from the medium in which the cells were growing was able to infect CD4 cells with HIV.

So, Zheng thought, maybe the gp120 knobs on HIV are able to stick to another kind of cell-surface molecule? To
find out if this was the case he tried the same experiment with HIV that had been genetically modified to be
  smooth and lack gp120.

To his astonishment the „knobless‟ HIV - which should have been uninfectious - was just as able to get into the
cells. Zheng and colleagues say "the mechanism is not identified" by which HIV gets into these cells, meaning
they‟re completely baffled and some unsuspected new method of infection must be involved.

Once we find out how HIV does this, we may be able to stop some of the direct effects of HIV infection.

As well as deranging the immune system and making us vulnerable to other disease, HIV causes direct damage to
the brain, guts, kidneys and bone marrow, causing dementia, diarrhea, kidney damage and blood abnormalities
such as a low platelet count, even in people on treatment.

Platelets are the cell fragments that form blood clots and too few of them mean you bleed and bruise too easily.

Another team of scientists led by Dr Justin McArthur of Johns Hopkins University in Baltimore recently investigated
HIV dementia and found that a low platelet count in people with CD4 counts under 200 was the strongest indicator
that they would get dementia, or that it would get worse, indicating a link between platelet destruction and nerve

The good news however was that McArthur found that nearly as many people get spontaneously better from HIV-
related brain impairment as get worse.

Out of a group of 101 patients with low CD4 counts he found that only 22% had no evidence of brain impairment.
Half of them had mild impairment such as a slight difficulty in concentrating, one in five had mild dementia, and one
in eight had moderate or severe dementia.

When the same group of patients was tested six years later, McArthur found that 27% of the patients with mild
impairment had progressed to a degree of HIV dementia and 8% who d had normal brain results developed mild
impairment. So 35% got worse.

However 27% of patients went the other way going from having dementia to only having mild impairment or to
complete normality.

MrArthur found that a low platelet count was the strongest predictor of HIV dementia, indicating that HIV s ability to
HIV/AIDS                                                      NEWS
get cells to make something called Platelet Activating Factor (PAF) was an important part of what was going on.

If we could people with HIV dementia anti-PAF drugs - which already exist - we might be able to help them get

By Gus Cairns,,

                                                                                                  Back to articles list

Article 11
HIV Protease Inhibitors May Reduce the Cancer-causing Ability of Human
October 20, 2006

The HIV protease inhibitor lopinavir (co-formulated with ritonavir in the Kaletra pill) and indinavir (Crixivan) also
interfere with the cancer-causing activity of a strain of human papillomavirus (HPV) that can cause anal/genital
dysplasia (abnormal cell changes) and cervical and anal cancer, according to a recent study. Both cervical and anal
dysplasia are common in people with HIV.

Researchers from the University of Manchester presented their findings at the 23rd Papillomavirus Conference and
Clinical Workshop in Prague and in the September 2006 issue of Antiviral Therapy.

While HIV protease inhibitors (PIs) mainly target the HIV proteases 1 and 2, they also selectively inhibit
proteasomes, structures within cells that break down proteins. High-risk (cancer-causing) HPV types such as 16
depend on expression of viral E6 proteins, which activate the 26S proteasome to degrade p53 (a tumor suppressor
protein) and other cellular proteins that interfere with viral replication.

The researchers assessed whether the PIs lopinavir, indinavir, ritonavir (Norvir), amprenavir (Agenerase),
atazanavir (Reyataz), nelfinavir (Viracept), and saquinavir (Invirase) inhibited E6-mediated proteasomal degradation
of mutant p53 in laboratory cultures containing various cell types.


* Treatment with 15-micromolar lopinavir, 1 mm indinavir, or 125-micromolar ritonavir for 24 hours produced a
stable increase in the level of nuclear p53 in C33A cells, with minimal cell death.

* After SiHa cells infected with HPV type 16 were exposed to 15 micromolar lopinavir, there was a transient
increase in wild-type p53 expression, which was associated with a 7% reduction in the chymotryptic (protein-
destroying) activity of the 20S proteasome and apoptosis (programmed cell death) after 24 hours.

* Comparison of growth rates of PI-treated SiHa, CaSki, C33A, C33A-E6, and non-transformed NIH/3T3 cells
showed that SiHa cells were the most sensitive, whereas NIH/3T3 cells were least affected.


In conclusion, the authors wrote, "these data show that specific HIV PIs, such as lopinavir and possibly indinavir,
can induce selective toxicity of HPV-transformed cervical carcinoma cells expressing wild-type p53."

"The drug [lopinavir] works as a selective proteosome inhibitor," explained co-author Ian Hampson. "It allows
cellular proteins that are detrimental to the [HPV type 16] virus to persist."
HIV/AIDS                                                      NEWS
The researchers suggested that PIs in a topical formulation, such as a gel or a cream, might offer an "alternative to
surgery for the treatment of HPV-related pre-malignant lesions of the cervix." Lopinavir appears to be the most
viable candidate for this purpose, since it demonstrated activity at relatively low concentrations.

If effective, this strategy could be especially beneficial in developing countries, where cervical dysplasia is
widespread and routine Pap screening is uncommon. The same method should also work for pre-cancerous anal

"If this proves successful we could see the treatment available fairly rapidly," Hampson predicted.

L Hampson, H C Kitchener, I N Hampson. Specific HIV protease inhibitors inhibit the ability of HPV16 E6 to degrade
p53 and selectively kill E6-dependent cervical carcinoma cells in vitro. Antiviral Therapy 11(6): 813-825. 2006.

By Liz Highleyman,

                                                                                                  Back to articles list

Article 12
Can Counseling and Testing in Bathhouses Help Reduce HIV Transmission?
October 20, 2006

Since the mid-1980s, there have been periodic debates within gay communities concerning the wisdom of closing
bathhouses and similar public sex facilities as a means of reducing the transmission of HIV. While some have
argued that bathhouses foster conditions conducive to sexual transmission, others counter that public sex
environments offer a unique opportunity for HIV prevention efforts.

In the October 1, 2006 Journal of Acquired Immune Deficiency Syndromes, researchers with the Center for AIDS
Prevention Studies at the University of California at San Francisco reported on a recent study to assess the
feasibility and effectiveness of conducting voluntary counseling and testing for HIV in a bathhouse setting.

A total of 492 men participated in bathhouse-based voluntary counseling and testing at a single venue over a 13-
month period. A convenience sample of 133 men was more extensively assessed immediately before and 3 months
after testing and counseling.


* 38% of men in the sample reported unprotected anal intercourse with 1 of their 2 most recent sexual partners in
the 3 months before testing.

* 48% of those men had not otherwise been tested for HIV in the previous 12 months.

* In the months after voluntary counseling and testing, men reported that they were:

- Less likely to engage in unprotected anal intercourse;
- Less often engaged in sex while drunk or high;
- Were more likely to communicate about HIV with their sexual partners.


In conclusion, the authors wrote, "Bathhouse-based voluntary counseling and testing seems to be a feasible
HIV/AIDS                                                      NEWS
approach for reaching significant numbers of men at risk for HIV and shows preliminary evidence of effectiveness in
changing some specific HIV-related risk and precautionary behaviors."


D M Huebner, D Binson, W J Woods, and others. Bathhouse-Based Voluntary Counseling and Testing Is Feasible
and Shows Preliminary Evidence of Effectiveness. JAIDS 43(2): 239-246. October 1, 2006.

By Liz Highleyman,

                                                                                                  Back to articles list

Article 13
French Doctors Report Treatment Failure For Syphilis
October 20, 2006

HIV is largely transmitted through unprotected anal, vaginal and, in some cases, oral sex. Syphilis is also passed on
in generally the same manner. An increase in syphilis is occurring in many parts of North America and Western
Europe, including among sexually active men who have sex with men (MSM), some of who are co-infected with
HIV. This infection increases the risk of acquiring and transmitting HIV and possibly other sexually transmitted
infections (STIs), such as LGV (lymphogranuloma venereum).

If left untreated, syphilis can damage the brain and other parts of the nervous system, as well as the heart and other
organs. Before antibiotics became available, people died from complications due to syphilis. But since 1944,
penicillin and its analogues have been used to treat syphilis. Indeed, one of the standard treatments for the early
(primary and secondary) stages of syphilis is at least one intramuscular injection of an analogue called benzathine
penicillin. This therapy is usually effective. However, doctors in Lyon, France, recently reported a troubling
development: the apparent emergence of syphilis resistant to benzathine penicillin in some HIV positive MSM.
Moreover, treatment failure led to the rapid spread of syphilis in the brain, causing neurological complications.

The French doctors described this problem and subsequent developments in three men. Here is a summary of their

Case 1
A 45-year-old man sought medical care from his doctor because of fever and rash. He had been taking highly active
antiretroviral therapy (HAART) for some time. His viral load was below the 50-copy mark and his CD4+ count was
356. Standard blood tests suggested infection with treponemes, the microbes that cause syphilis. Other tests
revealed that the level of liver enzymes in the man‟s blood was higher than normal. He was treated with 2.4 million
units (MU) of benzathine penicillin, injected into muscle once weekly for three weeks. This therapy is usually very
effective at helping people recover from syphilis.

However, two months later the man sought help from hospital doctors because of the following symptoms:

* decreased vision
* dizziness
* headache
* mild weakness

Blood tests again suggested syphilis. A neurological examination revealed damage to some nerves, particularly
those involving his sense of hearing. A magnetic resonance imaging (MRI) scan of his brain revealed lesions on the
HIV/AIDS                                                       NEWS
membrane surrounding this organ. Analysis of fluid taken from a spinal tap, or lumbar puncture, found higher-than-
normal levels of white blood cells, indicating a possible infection. No microbes were detected in this fluid.

The doctors made a diagnosis of neurosyphilis and the man received the antibiotic ceftriaxone, 2 grams daily,
intravenously for two weeks. His recovery began after five days of this therapy. Tests six months later confirmed his

Case 2
The second man was 34 years old and sought help from his doctor because of a skin rash without any obvious
neurologic symptoms. Standard blood tests suggested infection with treponemes and the man received 2.4 MU of
benzathine penicillin intramuscularly, once weekly for two weeks. Seven months later he sought hospital care
because of the following symptoms:

* dizziness
* difficulty walking
* loss of hearing
* sharp, intermittent pain on the right side of his face

His viral load was below the 50-copy mark and his CD4+ count was 730. Blood tests suggested syphilis and a CAT
scan of his brain did not reveal any abnormalities. Fluid taken from a lumbar puncture suggested the presence of an
infection but researchers could not find any germs in his fluid sample. Neurosyphilis was diagnosed and he received
a 10-day course of ceftriaxone, 2 grams daily, intramuscularly. His improvement was rapid and recovery was
confirmed six months later.

Case 3
The third man was 58 years old and he had stopped taking HAART a year earlier. He sought medical care because
of sores in his mouth. Blood tests helped diagnose syphilis, and the man received intramuscular injections of
benzathine penicillin, 2.4 MU once weekly for three weeks. The sores healed quickly.

However, within a month of his recovery, the man went to the hospital because of the following:

* dizziness
* loss of hearing in his left ear
* sores in his mouth

Neurologic examination revealed that his left inner ear was damaged, a situation which often results in dizziness
and other complications. An MRI scan of his brain revealed no abnormalities. As in the other two cases, blood tests
indicated infection with treponemes. Analysis of fluid taken from a lumbar puncture suggested neurosyphilis. The
man‟s treatment this time consisted of two weeks of intramuscular injections of ceftriaxone, 2 grams daily. His
symptoms improved and six months later doctors confirmed his recovery.

Lumbar puncture found to be important
Based on these cases, the Lyon doctors decided to perform lumbar punctures on future cases in which HIV positive
people had secondary syphilis. Their preferred treatment for secondary syphilis now consists of two weeks of
treatment with the following antibiotics:

* high doses of the penicillin analogue intravenous penicillin G
* intramuscular or intravenous ceftriaxone

A year after the three men first appeared in their clinic, the Lyon doctors have treated at least six other HIV positive
men who had symptom-free neurosyphilis. All of the patients have successfully responded to therapy and there
have not been any cases of relapse.
HIV/AIDS                                                      NEWS
Points to consider
1. Even in early-stage syphilis, treponemes can invade the brain. HIV/AIDS, because of its impact on the immune
system, may help to weaken defenses against treponemes, making syphilis harder to treat in this population.
Benzathine penicillin does not reach high concentrations in the spinal fluid, and so it is not sufficient therapy for
killing treponemes in the brain and spinal cord (the central nervous system, or CNS). In the case of the three men in
this report, treponemes may have invaded their CNS very early in the course of syphilis, which might explain the
failure of benzathine penicillin therapy.

2. The Lyon team of doctors concludes that the three men likely experienced treatment failure rather than new
infections of treponemes. Earlier this year, researchers reported the increasing problem of treatment failure with
another antibiotic against syphilis, azithromycin (Zithromax). Together, these findings suggest that new antibiotics
with activity against treponemes will have to be developed if syphilis is to be brought under control.

3. Although routine lumbar punctures are not always practical nor necessary in forming a diagnosis of neurosyphilis,
in the case of the three men this procedure was very useful.

4. The best treatment for neurosyphilis is not clear. Intravenous aqueous penicillin G potassium at a dose ranging
between 12 and 24 MU daily for two weeks is usually effective at treating this condition. Alternatively, aqueous
penicillin G procaine and probenecid taken for 10 to 14 days can be used. The French doctors note that ceftriaxone
does penetrate the brain and impair the growth of treponemes. But more studies are needed before ceftriaxone can
be recommended for the routine treatment of neurosyphilis.

5. The cases of rapid progression of syphilis in these HIV positive men suggest the urgent need for educational
opportunities to reinforce information about how to prevent STIs, including syphilis, particularly among people with
HIV/AIDS. The French report and others also suggest that the immunologic improvements seen with HAART are
not sufficient to provide protection from syphilis. With outbreaks of syphilis occurring in North America and the
European Union, other cases of treatment failure in early syphilis may occur in the future.

For more information about recognizing and treating syphilis in people with HIV/AIDS, see "The Story of Syphilis" ( ) in The Positive Side magazine, spring/summer 2004 issue.

1. Walter T, Lebouche B, Miailhes P, et al. Symptomatic relapse of neurologic syphilis after benzathine penicillin G
therapy for primary or secondary syphilis in HIV-infected patients. Clinical Infectious Diseases 2006 Sep

2. Mitchell SJ, Engelman J, Kent CK, et al. Azithromycin-resistant syphilis infection: San Francisco, California, 2000-
2004. Clinical Infectious Diseases 2006 Feb 1;42:337-45.

3. Lynn WA and Lightman S. Syphilis and HIV: a dangerous combination. Lancet Infectious Diseases 2004

4. LaFond RE and Lukehart SA. Biological basis for syphilis. Clinical Microbiology Reviews 2006 Jan;19(1):29-49.

By Sean R. Hosein, CATIE

                                                                                                  Back to articles list

Article 14
Merck Buys Protease Inhibitor From Ambrilia, May Be Potent Booster Of Other PIs
HIV/AIDS                                                      NEWS
October 20, 2006

Merck & Co announced last week that it has licensed an experimental protease inhibitor that does not require
ritonavir boosting and which may be active against highly drug-resistant HIV. The compound, PPL-100, was
developed by Ambrilia Biopharma (formerly Procyon) and previously by Pharmacor, both Montreal-based
companies. PPL-100 appears to be just as potent a booster of other HIV protease inhibitors as ritonavir (Norvir).

So far the only human study of PPL-100 has been a phase 1a single dose pharmacokinetic study in healthy
volunteers, which showed that the drug may have a half-life of up to 36 hours at doses of 2400mg a day, making it a
strong candidate for once-daily dosing. Drug exposure with and without ritonavir boosting is currently being
evaluated in a phase IIB dose-ranging study; this study is testing PPL-100 doses of 600 and 1200mg once daily in
order to determine whether the drug can be given with a lower pill burden, without ritonavir, once daily.

In vitro studies suggest that selection of resistance mutations over 52 weeks is limited with this compound,
indicating a high genetic barrier to drug resistance. No cross-resistance to amprenavir, lopinavir, atazanavir,
saquinavir, indinavir, and nelfinavir was observed for any viral mutants, but resistance mutations associated with
PPL-100 led to hypersensitivity to saquinavir.

Ambrilia has also reported that PPL-100 is a cytochrome p450 3A4 inhibitor, like ritonavir, and a pharmacokinetic
enhancer for marketed PIs such as atazanavir, amprenavir, lopinavir, saquinavir, indinavir, and nelfinavir. At last
month‟s Interscience Conference on Antimicrobial Agents and Chemotherapy in San Francisco the company
reported data showing little difference in cytochrome p450 inhibition between PPL-100 and ritonavir when the
effects of each compound on clearance of other marketed protease inhibitors were measured in vitro using human
liver microsomes incubated with active drug for 60 minutes (Wu 2006).

If PPL-100 is safe and effective enough to be licensed, it will be a very significant entrant to the market, since
protease inhibitor boosting is dominated by ritonavir. Abbott Laboratories attracted severe criticism in December
2003 when it raised the price of ritonavir by 400%, raising the cost of boosted protease inhibitors above the price of
its own ritonavir-boosted product Kaletra.

Manufacturers of protease inhibitors will be interested to discover whether PPL-100 has the capacity to boost their
own products at a lower cost than ritonavir, and without the lipid elevations and gastrointestinal problems associated
with that drug. Pharmacokinetic studies to test the boosting effects in large populations of HIV-positive people will
not take place until the drug is closer to licensing, but Merck will face strong pressure to carry out a wide range of
studies before licensing, and also to discuss the potential for coformulation of this product as a booster for other
protease inhibitors, a path which has not been open with ritonavir due to difficulties in co-formulating it with most
other protease inhibitors.

A back-up analogue called PL-337 is also in development and Merck has an option to develop this product too.
Ambrilia also has an integrase inhibitor development programme that is engaged in pre-clinical screening of
compounds. Merck is already developing one integrase inhibitor, MK-0518, and has an interest in developing a
pipeline of similar products.


Wu JJ et al. PL-100, a next generation protease inhibitor against drug resistant HIV: in vitro and in vivo metabolism.
44th Interscience Conference on Antimicrobial Agents and Chemotherapy, San Francisco, abstract H-253, 2006.

Wu, J.J. et al. The HIV-1 protease inhibitor PL-100 has a high genetic barrier and selects a novel pattern of
mutations. XV International HIV Drug Resistance Workshop: Basic Principles and Clinical Implications, Sitges,
Spain, June 2006
HIV/AIDS                                                                    NEWS
Wu, J. et al. Pharmacological and cross-resistance profiling of PL-100 and its pro-drug, PPL-100. 6th International
Workshop on Clinical Pharmacology of HIV Therapy, Quebec City, Canada, April 2005.

Copies of these presentations can be downloaded from the Ambrilia website at

By Keith Alcorn,

                                                                                                                        Back to articles list

Article 15
AIDS Virus May Hide in the Gut, Study Finds
October 20, 2006

HIV replicates in the lining of the gut and wreaks havoc on the immune system there, Satya Dandekar, chairperson
of the Department of Medical Microbiology and Immunology at the University of California-Davis Health System, and
colleagues recently reported. According to Dandekar, the study is the first to explain why highly active antiretroviral
therapy (HAART) cocktails often fail to work completely.

"The real battle between the virus and exposed individuals is happening in the gut immediately after viral infection,"
Dandekar said. "We need to focus our efforts on improving treatment of gut mucosa, where massive destruction of
immune cells is occurring. Gut-associated lymphoid tissue accounts for 70 percent of the body's immune system.
Restoring its function is crucial to ridding the body of the virus."

Dandekar's team has been studying how HIV patients, even those not undergoing treatment, have survived at least
10 years with healthy immune systems, including T-cells targeted by HIV. "We looked at their gut lymphoid tissue
and did not see loss of T-cells there," said Dandekar. "This correlated with better clinical outcomes."

In the current study, the researchers followed 10 patients undergoing HAART treatment, taking blood and gut
samples at baseline and after three years of therapy. What they found was evidence of inflammation, which impairs
tissue function, promotes cell death, and destabilizes the normal balance of gut bacteria.

"We found a substantial delay in the time it takes to restore the gut mucosal immune system in those with chronic
infections," Dandekar reported. "In these patients the gut is acting as a viral reservoir that keeps us from ridding
patients of the virus."

The researchers said the findings suggest anti-inflammatory drugs could enhance the efficacy of HAART.

The study, "Viral Suppression and Immune Restoration in the Gastrointestinal Mucosa of Human Immunodeficiency
Virus Type 1-Infected Patients Initiating Therapy During Primary or Chronic Infection," was published in the Journal
of Virology (2006;80(16):8236-8247).

                                                                                                                        Back to articles list

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