Housing Works Establishes Haitian AIDS Relief Fund
ADAP Waiting Lists Increase 1,000% since January 2009
Merck & Co Pulls HIV Drug Application After Trial Failure
MPC-4326 Maturation Inhibitor Trial Now Enrolling
Mutant HIV May Compromise Treatment Programs in Poor Countries
Anal Cancer Screening Recommended for HIV-Positive Men and Women
Housing Works Establishes Haitian AIDS Relief Fund
In a press release issued on January 14, Housing Works announced that it will collaborate with PHAP+, a Haitian coalition of PWA-led organizations, to provide desperately needed medical services and supplies to Haitians living with HIVAIDS.
Housing Works is working with the Haitian AIDS group Fondation Esther B. Stanislas (FEBS), which is located in St.-Marc. FEBS founder Esther Boucicault is Haiti’s best-known AIDS activist and the president of PHAP+. After the earthquake, Housing Works received a desperate e-mail message from FEBS contact Edner Boucicaut (no relation) that read, “Please do whatever you can to provide some help down here. Clothes, food, medications. We are in need. Please! Please! We’re dying!” Housing Works staffers began to mobilize immediately. According to the release, on Friday, January 15, Housing Works staff, including Dr. Vaty Poitevien, the Haitian medical director of one of Housing Works’ clinics, and Charles King, President and CEO of Housing Works, will travel to St.-Marc to deliver the first shipment of thousands of dollars worth of HIV medications and other urgently needed medicines and supplies, such as tents, first aid kits and blankets.
To contribute cash donations to Housing Works’ relief efforts, go to www.housingworks.org. or text “HAITI” to “90999,” and a $10 donation will be charged to your phone bill.
The Red Cross is accepting donations at www.redcross.org.
Find out how to donate unused prescription drugs at www.aidforaids.org.
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ADAP Waiting Lists Increase 1,000% since January 2009
AIDS Drug Assistance Programs (ADAPs) are in a state of emergency. According to the National Alliance for State and Territorial AIDS Directors (NASTAD), wait lists have increased ten fold since the beginning of 2009, with 540 people in nine states now on waiting lists. There have already been deaths in several of the states.
In 2000, Congress appropriated 72% of the federal ADAP earmark; a portion which decreased to 54% in 2009. This severe drop in the federal commitment to ADAP, in addition to $167 million in state budget cuts to AIDS programs, has been a major catalyst for the most recent spike in HIV patients being placed on waiting lists.
In 2004, the standing record for number of people on waiting list was set at 1,629. At the current rate of growth, it is suspected that the record will be broken well before the end of 2010.
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Merck & Co Pulls HIV Drug Application After Trial Failure
Merck & Co announced on January 21 that it will not submit a New Drug Application in the USA for vicriviroc in treatment-experienced HIV-positive patients “at this time” after two Phase 3 studies did not meet their primary endpoints. The New Jersey-based drugs giant noted that these trials enrolled “a high percentage of patients who had three or more active drugs in their optimized background therapy regimen.”
However, Merck said that it will continue to evaluate vicriviroc, a CCR5 inhibitor, in treatment-naive HIV-positive patients. Ongoing Phase 2 studies in that set of patients have completed enrollment and will continue unchanged.
This is disappointing news because vicriviroc, which Merck acquired through its recent $41 billion purchase of Schering-Plough, was touted as potentially the best drug in the CCR5 class, of which there is currently only Pfizer’s Selzentry/Celsentri (maraviroc)and patients need to take a diagnostic test to see if they are suitable for treatment with it.
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MPC-4326 Maturation Inhibitor Trial Now Enrolling
Myriad Pharmaceuticals has announced that enrollment in its Phase 2 study of MPC-4326 is now open. MPC-4326, formerly known as bevirimat, is in an entirely new class of drugs called maturation inhibitors, which target the virus after is has “matured” and during the “budding” process of the HIV life cycle (see “HIV and your Immune System” in the September/October 2009 issue). There is currently no maturation inhibitor yet on the market, and the unique mechanism of action for MPC-4326 may make this drug useful for those failing their current regimen due to drug resistance.
For more detailed information, including a list of study sites, and to see whether you would eligible for the study, go to http://clinicaltrials.gov/ct2/show/NCT01026727?term=mpc-4326&rank=1.
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Mutant HIV May Compromise Treatment Programs in Poor Countries
In a study published online by the journal Science, it was reported that strains of mutant HIV emerging in the U.S. and Europe threaten to undermine progress made in expanding access to treatment in poor countries.
According to the study, researchers from the University of California, Los Angeles (UCLA) said, “About 60% of drug-resistant HIV strains circulating in San
Francisco can spur self-sustaining epidemics as patients who haven’t been treated spread them.” Similar trends are also emerging in New York, Chicago, and London, but newer treatments will likely curb the spread of drug-resistant HIV in wealthy cities, where patients have better access to those treatments.
Mutant strains are already starting to spread in poorer nations such as South Africa , where there is little access to back-up medicines when resistance develops, Sally Blower, lead researcher, said. “If the resistant strains we have identified in our analyses evolve in these countries, they could significantly compromise HIV treatment programs,” Blower and colleagues wrote. Mutant forms “pose a great and immediate threat to global public health,” they said.
The study casts doubt on research done by the World Health Organization published last year that predicted elimination of the spread of the virus by implementing the “test and treat” strategy of testing everyone and treating those infected immediately. According to Blower, “Universal test and treat is just a recipe for disaster. Our modeling is saying the drug resistant strains that you will generate from this kind of strategy are ones that will be very strong, transmissible, and therefore you will get an awful lot of problems.”
The continued use of drugs to which HIV has become resistant favors the survival and spread of mutant strains because the medicines eliminate the regular form, allowing carriers to transmit resistant strains, Blower explained.
“In Africa NNRTIs are the backbone of the treatment regimen,” James Kahn, associate director of San Francisco General Hospital’s HIV/AIDS clinic, which took part in the study. “Unlike San Francisco, where we have a lot of options to switch people to, they don’t have that many options in Africa.”
The full report can be accessed for a fee at www.sciencemag.org/sciencexpress/recent.dtl.
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Anal Cancer Screening Recommended for HIV-Positive Men and Women
According to an article in Science Daily, HIV-positive men who have sex with men (MSM) are up to 90 times more likely than the general population to develop anal cancer. However, both men and women who are living with HIV are at risk, especially if they have a history of anal-receptive sex, cervical dysplasia, genital warts, or have been diagnosed with human papiloma virus (HPV).
The American Academy of HIV Medicine joins the Centers for Disease Control and Prevention (CDC) and the American Cancer Society in recommending anal cancer screenings for HIV-positive patients.
Anal PAP smears have long been the conventional “first step” for detection of anal dysplasia (abnormal or pre-cancerous cells), but if any abnormality is found, High-Resolution Anoscopy (HRA) is a microscopic examination that results in identifying specific location of lesions. If high-grade, non-invasive lesions are found, Infrared Photocoagulation/Infrared Cautery (IRC) treatment is available and can make more invasive or toxic treatments like surgery, chemotherapy, and radiation unnecessary.
Dr. Gary Bucher of the Radius Health Anal Dysplasia Clinic in Chicago, says this office-based treatment is “well tolerated by patients, requires no special preparation, takes minimal time (approximately 45 minutes), results in no anal sphincter problems, and there are no operating room costs.”
Bucher added, “Considering all the risk factors, it’s wise to make sure anal cancers are caught in the early stages, when they are most easily treatable. After all, does someone living with HIV really need to suffer through chemo, radiation, or surgery? These tests are quick and painless and early IRC treatment is too, so there’s really no excuse not to check it out!”
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