AIDS Action Committee’s Blog

There was some good news last week about promising antiviral drugs that could significantly expand treatment options for people living with HIV. The findings were presented at the 14th annual Conference on Retroviruses and Opportunistic Infections (CROI) in Los Angeles.

Two of the experimental drugs discussed at CROI are from entirely new classes of HIV drugs. New classes of drugs are especially important for HIV-infected persons who are running out of treatment options. Their options may be limited because they are infected with HIV that is highly resistant to many of the currently available drugs. Or they may also have experienced side effects that made some meds intolerable. For these persons, using new classes of drugs may offer the best chance of bringing HIV infection under control. 

One of these new drugs – raltegravir or MK-0518 – is in a drug class called integrase inhibitors. When HIV makes copies of itself, it uses a chemical called integrase to insert (integrate) its genetic material (DNA) into the cell’s control center, called the nucleus. Once HIV’s genetic materials been integrated into the cell’s own DNA, the cell can become a mini-factory for making new HIV. Integrase inhibitors disrupt this process by interfering with – inhibiting – the activity of integrase.

Another new drug called maraviroc is in a class known as CCR5 blockers. The drugs in this class are designed to stop HIV from binding to a protein called CCR5 on the surface of cells. By disrupting this binding process, the CCR5 blockers can protect cells from being infected with the virus.

Since the studies done to date have shown strong evidence that raltegravir and maraviroc are safe and effective, drug makers have been allowed to offer expanded access programs (EAPs) for both drugs. EAPs make promising experimental drugs available to a limited extent before they are approved by the Food and Drug Administration. 

The March issue of AIDS Action’s Forward Living newsletter has a feature article about EAPs, including more information about raltegravir and maraviroc.

Word has quickly spread that (another) Phase III microbicide candidate has been taken off the shelf. Cellulose sulfate, an attachment inhibitor, may have been causing increased risk for HIV transmission in trials being done at several sites. As a result, these trials have been halted.
This news follows the closure of another phase III trial in August 2006. As Keith Alcorn wrote yesterday, that trial was showing “a lower than expected rate of HIV infections”. Though this is a less controversial reason for trial closure, both were cellulose sulfate and showed promise as contraceptive gels.
This is quite disheartening news for those of us working diligently to make microbicides a reality for the millions of women and men at risk for HIV through unprotected sex. Microbicides, a topical gel that could be used inside the vagina or anus during intercourse to reduce the likelihood of HIV transmission and possibly other STDs, would provide a non-barrier risk prevention option to the rather slim arsenal of HIV prevention options that currently exists.

Advocacy will now focus on the three products (all are not cellulose sulfate based) still in Phase III development, one of which is nearing completion and expected to have results by the end of this year. In the meantime, the microbicide advocacy community will continue to call for the necessary funding and support to meet the highest standards in HIV clinical trials and to put forth a greater inventory of promising candidate products.

Despite very little if any concrete epidemiological data to support the assertion that bug-chasing (people intentionally seeking to become HIV infected) really exists, this urban legend continues to surface. In today’s Boston Metro an article about the shameful statistics of homelessness among gay youth a throw-away comment about the phenomena was highlighted and pulled out in a special box in the article labeled “Contracting HIV.”

When pressed, the source for the article agreed that there is only anecdotal evidence that homeless queer youth claim to be seeking HIV in order to receive services, and that in fact, these claims are likely to be cries for help rather than actual plans of action. Adolescence is by its very nature a time for drama, and what’s not more dramatic than alleging suicidal intentions? I don’t doubt for a minute the desperate nature of being a homeless queer kid – I just don’t want us all to overreact and further marginalize and demonize homeless queer kids by taking everything they say too seriously. And, the truth about homeless queer kids is that an estimated one-quarter to one-third of them report engaging in survival sex during their time on the streets. That’s a horrifying enough reality without over blowing anecdotal cries for help.

And as for the hullabaloo that there is a community of gay men out there seeking HIV, again, I think the evidence is incredibly limited. I’ll even agree with Andrew Sullivan for a moment in his brilliant piece on Salon.com refuting claims made in Rolling Stone Magazine in 2003.

There’s more than enough work to be done to support queer youth and support people at risk for HIV without making up scary stories.

The Food and Drug Administration (FDA) recently approved the injectable filler Radiesse for the treatment of HIV-related facial wasting. Facial wasting is a major concern for many people living with HIV. It is basically a loss of fat under the skin of the face. Facial wasting can cause changes in appearance such as sunken cheeks, hollow eyes, indentations, or a generally gaunt look. Facial wasting and other forms of abnormal fat loss (lipoatrophy) have been associated with HIV treatment involving the drugs d4T and AZT.

Radiesse is the second substance that FDA has approved specifically for HIV-related facial wasting.  (The first, Sculptra, was approved in 2004.) FDA describes Radiesse as “a sterile, semi-solid implant consisting of synthetic calcium hydroxylapatite suspended in a gel carrier.”  Radiesse is injected beneath the skin to fill in areas where fat has been lost. People receive an initial treatment, followed by “touch-up” injections as needed. Most people require two or three treatments. Radiesse is designed both to fill in areas of fat loss and to stimulate the body to produce new collagen. As a result, the benefits of the treatment are expected to last an average of one year or more. The most common side effects of Radiesse injections are temporary swelling, bruising, reddening, or discomfort at the injection sites.

Check out www.facialwasting.org  or e-mail me at health@aac.org  if you’d like to learn more about facial wasting and lipoatrophy.