So there’s a new strain of HIV from Cuba that is resistant to all known medications. Do you feel that this is a huge risk now that we have opened relations with Cuba especially for naysayers of condoms? And people who intentionally seek to become infected?
—Wolf Carver
First let me inform my readers what this whole thing is all about.
It was reported in mid-February by several on-line and newspaper sources that there is a “new” HIV strain that was found in Cuba. The Miami Herald reported that the HIV strain, if left untreated, will progress to AIDS in three years. Scientists at Belgium’s Catholic University of Leuven are concerned that people who are infected with the aggressive HIV strain will not at first seek treatment, and, by the time they try to seek treatment for their HIV infection, it will be too late.
First, let me say that the strain is not new (the strain has previously been found in countries in Africa), though it is rare.
…this study was only done with ninety-five people, which leaves a lot of scientists and researchers skeptical of the methodology.
While researching just about anything in public health, we, as experts, always make sure that we have enough data from which to establish or deduce noteworthy and substantial findings for the patient populations, like the thousands of people in Cuba living with HIV, that we represent. For example, this study was only done with ninety-five people, which leaves a lot of scientists and researchers skeptical of the methodology that was used. Seventy-three patients in the study were recently infected with HIV. Twenty-one of the seventy-three patients were not classified as having AIDS, but the remaining fifty-two patients were. Those patients were then compared with twenty-two patients whose HIV had progressed after living with the virus for three years. Additionally, the study also did not take into account how the subjects in the study contracted HIV.
According to the Miami Herald, Hector Bolivar, a physician and infectious disease specialist with the University of Miami Miller School of Medicine, said, “The only thing now is that in Cuba, it is associated with rapid progression [of the disease]. It’s something that hasn’t been seen before that clearly.”
Bolivar also noted: “It’s very difficult for us in the United States or Europe or many places where there are treatments [for HIV] to replicate these findings in the long-term because it’s unethical to wait until someone progresses until they can no longer benefit from treatment.”
With that being said, let me first say this. Every now and then we hear of a new HIV superbug that is resistant to HIV treatment. We cannot add to public hysteria without knowing the facts through research and science. Knowing the facts is key. Then and only then will one know how to prevent infection of others and safeguard themselves from infection of not only HIV but of any illness. There will always be a risk of being infected with a sexually transmitted infection (STI) while having sex, unless we all decide to be abstinent (which we all know there is no way in hell, at least for my ass….literally).
Honestly, Wolf, whether this was happening in Cuba or Japan or any other country, there is always a risk. All in all, I really do not think it matters.
Looking at your question about the opening relations with Cuba, I cannot help but think of the HIV travel ban. Frankly, the question disturbs me not because you asked it but because other with political power might use this as an excuse to try to bring it back. If I were HIV-negative or positive I WOULD NEVER SUPPORT SUCH A BIASED LAW.
As for your second question, people who intentionally seek to become infected, which are also known as bug chasers will find a way to become infected with HIV. It honestly isn’t up to us to tell anyone what to do with their own bodies; all we can do is give them advice on what their options are. I personally think there are deeper issues with bug chasers than people would like to admit.
Justin B. Terry-Smith, MPH, has been fighting the good fight since 1999. He’s garnered recognition and awards for his work, but he’s more concerned about looking for new ways to transform society for the better than resting on his laurels. He started up in gay rights and HIV activism in 2005, published an HIV-themed children’s book, I Have A Secret (Creative House Press) in 2011, and created his own award-winning video blog called, “Justin’s HIV Journal”: justinshivjournal.blogspot.com. Presently, he is working toward his doctorate in public health. Visit his main Web site at www.justinbsmith.com. He welcomes your questions at jsmithco98@hotmail.com.
Know the Score
Uniting a Love of Soccer and HIV Education, Africa Goal Explains Why “Zero” Is the Score It Is Shooting For by Chael Needle
Photos courtesy Africa Goal
They call it “the beautiful game” because of its simplicity. According to FIFA World Cup commentator and writer Jamie Trecker, soccer (or, football, as it is known everywhere but the U.S.) has clear rules of play. It’s easy to follow, too. Individual players shine, but always as part of a collaborative effort. You can always play it anywhere, with most anything.
Africa Goal knows another simple reason why soccer can be considered “the beautiful game.” It brings people together as fans, and, during the World Cup matches, communal excitement is at an all-time high. The organizers of Africa Goal realized that the World Cup playoffs was the perfect time to reach communities hard-hit by AIDS with HIV prevention and treatment awareness, as well as on-site testing and counseling. Activities also seek to empower individuals in marginalized groups and extend the impact of local service organizations.
Traveling across various communities in African nations wracked by the highest HIV prevalancy rates in the world, the members of the all-volunteer Africa Goal team sets up live-feed, jumbo-sized projection screenings for communities to enjoy the matches and joins in any other soccer-related fun. In coordination with local partners who are expert in HIV services, the team engages community members about HIV with culturally tailored and age-appropriate materials. In particular, the team and partnering organization strive to bend the ears of youth, men, sex workers, truck drivers, marginalized groups, and those engaged in transactional sex, who have traditionally been more difficult to reach through conventional health-promotion means.
Africa Goal is comprised of a ten-member soccer-loving team of dedicated experts in the fields of HIV services, health, community partnering, technology, and travel, among others. It is extremely grateful for its sponsors and help from organizations like SAfAIDS, which develops HIV information for distribution during the project.
Africa Goal has completed two HIV prevention awareness road trips so far, in 2006 and 2010, the last World Cup Years. Now, in 2014, they are setting out again, traveling a route through Kenya, Uganda, Tanzania, Malawi, Zambia, Zimbabwe, Mozambique, and Swaziland. New this year are stop-offs in rural fishing villages in Western Kenya and Uganda, which comprise some of the areas hardest-hit by AIDS in East Africa. The route has been called the “AIDS highway,” a multinational corridor where a booming transport-and-trade economy and increased HIV risk intermix. According to a 2012 UNAIDS report, East and Southern Africa comprise only five percent of the world’s population, yet these regions account for half of the world’s population living with HIV, forty-eight percent of the world’s new HIV infections among those ages fifteen to forty-nine, and forty-eight percent of all AIDS-related deaths.
“2010 was a great success and was really well received by community members and partners alike,” notes Kenyan Mary Leakey, Africa Goal project coordinator, about why 2014’s trip will not change much in terms of the concept or implementation. “We are working with many of the same partners this time so, having implemented the events a couple of times with them, we have a pretty good mutual sense of what we all want to achieve through the events—we achieved that last time and hope to do so again this time.”
Some of the information has changed to reflect new WHO treatment guidelines that have been adopted, and this will, in turn, change the focus of some of the events, says Leakey, who works as a grants officer for Mildmay Uganda, an HIV materials author for SAfAIDS, as well as a development consultant for a number of other NGOs. “For example, as part of a big push to eliminate pediatric transmission of HIV, all pregnant women living with HIV are now eligible for ART for life so there will be a bigger focus on prevention of mother-to-child transmission (PMTCT) and couple’s testing in many of our event locations, along with the other key prevention and treatment information.”
Emboldened by the successes of 2010, when some of the partners introduced on-site HIV counseling and testing in response to increased access to HIV treatment, Africa Goal is encouraging all of its partners to offer testing and counseling during this campaign. Access to personal technology in the form of smart phones has increased, too, so the organizers created the Africa Goal 2014 mobile app, which provides another World Cup-centered way to disseminate information.
“We were thrilled to reach almost 25,000 people during 2010 in one month—but, of course, this year we would like to reach even more! As we revisit places, many people remember the previous events so that definitely helps with bringing together more people each time,” shares Leakey. “People always ask us to come back the next World Cup and we always say we will try—but four years is a long time to pass so it’s great to see people genuinely excited that we have actually come back!”
Chael Needle: In 2010, the World Cup took place in South Africa, the first time on African soil. Do you expect soccer fever to be diminished now that it is taking place in Brazil?
Mary Leakey: 2010 was definitely an incredibly exciting year for Africa—not least because it was embraced as a show of faith in Africa, a continent which is too often better known for bad news stories. There was certainly a very palpable feeling of hope, excitement and opportunity across Africa and, of course, the hype around soccer was at an all-time high! Having said that, much of the “extra” excitement was about what hosting the World Cup signified. Even though the World Cup will not be hosted in Africa this year, we are not at all concerned that soccer fever will have diminished. The love, excitement and passion around watching and playing “the beautiful game”—and following the World Cup—remains as strong as ever.
A common love of soccer and a celebratory mood makes for a good opportunity to talk about a proactive approach to health, but how exactly do you juggle the two? Do the partnering organizations help prepare the residents before you arrive?
Yes, we work very closely with our partner organizations to plan the events in advance—we are covering long distances, often on roads in poor condition, so it is not uncommon for us to arrive at the event locations with just enough time to set up and start the events. Our partners are fantastic—the project would not be possible without their collaboration and help with coordination. They see the potential of the events as a great way to reach out to the communities where they are working in a new and exciting way—their support and endorsement of the project is truly gratifying.
Our partners promote the events ahead of our arrival—both the World Cup match screenings and the activities. They also often arrange football tournaments to coincide with the events which also helps with promotion. People who have heard that the World Cup is coming—live and on a big screen—to their community see the cars arrive, get excited and start forming a crowd. Others, seeing the crowd forming, figure something interesting must be happening and join in…we regularly have audiences of several thousand people at the events! The fact that our audience members are united both by a common love of football and by all having been touched, in some way, by the HIV epidemic (HIV prevalence is as high as thirty percent or more—which is almost one in three people living with HIV—in many of the communities in which we work) is a powerful introduction to the events and reason for marrying the two goals of the events: to celebrate a love of football together and to recognize the role that each and every one of us has to play in the HIV response.
Living with HIV/AIDS and even talking about HIV/AIDS are often highly stigmatized. In 2010, to what extent did you face resistance or reluctance along the route?
HIV-related stigma and discrimination is certainly a major obstacle to addressing HIV and a key challenge contributing to community members’ fear of attending health centers and clinics for HIV information and services. Creating a non-stigmatizing, non-discriminatory and non-confrontational platform for engagement is one of Africa Goal’s key priorities—and one of the major reasons that our partners embrace the project so enthusiastically. By approaching HIV as an issue which has, and continues, to affect everyone—and something which we all have a role in addressing—the events create a sense of inclusiveness which helps to overcome potential resistance.
We are routinely impressed by peoples’ willingness to participate actively in the events—including choosing to go for on-site HIV counseling and testing. During 2010, one young man in his early twenties came to talk to us after having received the results of his HIV test. He said that it was the first time that he had been for an HIV test: “I have known that I should go for a test for a long time—everyone should know their status—but I have always put it off. Today, my friends and I were talking and we decided that we had more to be scared of if we didn’t know. So we agreed that we would all go—my girlfriend and I both went for testing today.”
Children read age-appropriate comic-book-style HIV information, developed in partnership with SAfAIDS
We also often saw people at the matches engrossed, reading the Africa Goal information materials, developed in partnership with SAfAIDS, which we distributed. The materials were packaged in a drawstring sports bag and included HIV information booklets (which also detailed the World Cup match schedule); posters and stickers. We had different age-appropriate packages for adults and children: the adult bags also contained male and female condoms and we had comic book style HIV information booklets for children.
It was really rewarding—and encouraging—to see groups of people, particularly groups of young men, reading and discussing the materials and the information together.
What other highlights from your last campaign stand out in your mind?
There were so many events and instances which were definite highlights, but I’ll start with the event we held in Swaziland. When we arrived, we found around 5,000 people had gathered! It was our biggest event of the 2010 project. We partnered with SAfAIDS for the event and they had engaged the Minster of Health who was really excited about the project and turned it into a National event. They brought together several local HIV organizations to conduct information sessions and activities, including on-site HIV counseling and testing and organized a football tournament between local youth leagues. Swaziland has the highest HIV prevalence in the World so it was great to see so many people coming together to use the opportunity that the World Cup presented to tackle key HIV issues—and it was amazing to see that so many people had gathered for the event (despite it being really cold that day!).
Another highlight was the event we held in Salima, in Malawi. We worked with the Salima HIV/AIDS Support Organization (SASO), which is a small HIV organization based in this very rural village in Malawi. We followed SASO’s directions to a football field on the outskirts of the village and looked back to find hundreds of people following the car, either on foot or on bikes. There was not a light in sight from the event location—it was one of the most rural events that we held in 2010 and there was a huge amount of excitement from the crowd!
There were a lot of individual highlights too—when someone at the event comes to you to thank you not only for bringing the World Cup to their community but for providing an accessible opportunity to find out more about HIV, get tested for the first time or talk to their partner about HIV—it makes all the long drives, car problems, exhaustion and sleeping in very much “less than salubrious” establishments more than worthwhile! The Trading Footballs program swaps hand-crafted soccer balls—beautifully constructed from materials at hand—with industry-standard ones.
This will run in June. Is there still time to support Africa Goal or something like your Trading Footballs program, which swaps homemade soccer balls in communities for industry-standard ones and then exhibits the handcrafted ones to raise funds to purchase more balls and HIV/AIDS projects?
Absolutely! We have an on-line fundraising site: http://africagoal2014.causevox.com/ where anyone who would like to support the project can make safe and secure donations. Once the project starts, any funds raised will be used to purchase factory-standard footballs for our Trading Footballs program and to print HIV information materials—the materials are hugely popular and our partners are always asking whether we can print more for them.
For whom is Africa Goal rooting, on the field and off?
Africa Goal is always rooting for Africa—both on and off the field! We would be thrilled to see an African team take the tournament title and, even more so, would love to see the global goal of zero new infections, zero AIDS-related deaths and zero HIV-related stigma brought to reality across the continent which has been hardest hit by the epidemic.
Cannabinoids may be effective in treating HIV, not just relieving symptoms
The legalization of medical marijuana has been a hot topic for years, often provoking fierce opinions on both sides. A recent survey by the Pew Research Center (“Majority Now Supports Legalizing Marijuana”) shows that for the first time the majority of U.S. citizens now support the legalization of pot. Regardless of whether the fight for the right to party ever comes to fruition in more than a few states, one benefit of this battle has become evident. The discussion on medical marijuana and the increasing support of legalizing weed has cracked open the door for universities and biotech companies to research the therapeutic benefits of cannabinoids and the results pouring in are nothing short of astonishing by any standard.
The benefits of marijuana have long been reported for people suffering from HIV/AIDS and cancer treatment, although there is not a lot of direct research on the medicinal value of the cannabis plant for symptoms related to HIV. The fact that marijuana as a whole can’t be patented does not fare well for it being researched by Big Pharma as there is therefore limited profit to be made from therapeutics from the plant itself. The legal status of marijuana and its stigma also hampered research as medical marijuana is not legal in all fifty states.
However, a wealth of anecdotal data on the benefits of cannabinoids for HIV and cancer patients does exist. Numerous studies describe findings of self-reported benefits, including a decrease in nausea, stimulation of appetite, decrease in nerve pain, particularly in people suffering from HIV-related peripheral neuropathy and relief from depression, anxiety, and sleeping problems.
Mounting data shows that cannabis, or more precisely, cannabinoids (a group of compounds present in the cannabis plant) may hold the potential to play much more of a role in the treatment of HIV then just the relief of symptoms. Growing evidence has shown that cannabinoids may be invaluable in the treatment of inflammatory diseases such as HIV, as well as inflammatory bowel disease and Alzheimer’s, just to name a few. These effects appear to be mainly mediated by cannabinoid 2 (CB2) receptors.
CB2 receptors are located in the immune system and hematopoietic cells (cells which give rise to other cells such as T-cells and macrophages—the main targets of HIV). CB2 receptors are activated by cannabinoids. Unlike CB1, which is located throughout the body and particularly on nerve cells in the brain, CB2 does not mediate the psychoactive effects for which cannabis is known.
Various agents that activate CB2 receptors and how this process works are currently being researched in HIV. As our knowledge of cannabinoids and CB2 agonism grows, so does the likelihood that this research will equate to the successful development of cannabinoid-based antiviral agents to combat HIV.
Research conducted at Temple University School of Medicine and published in the May issue of Journal of Leukocyte Biology has focused on macrophages and inflammation. Whereas the available HIV treatments as well as the majority of HIV research focus on T-cells, macrophages appear to play a pivotal part in HIV. Macrophages, long-lived cells targeted by HIV, may be the primary source of HIV reservoirs and thus the main hindrance to eradicating HIV from the body, evidence suggests. Inflammation, which persists in people with HIV despite effective viral-suppressing ARTs, is the leading cause of many “non-AIDS related” complications such as neurocognitive dysfunction, cardiovascular disease (CVD), bone diseases, and cancers. This study showed that the administration of cannabinoid agonists, used as an anti-inflammatory agent, decreased the level of HIV in macrophage cells, providing more evidence that cannabinoids hold the ability to limit HIV replication.
Senior investigator, Yuri Persidsky, MD, PhD, chair of the Department of Pathology and Laboratory Medicine at Temple University School of Medicine, and his team examined the connection between CB2 and the neurocognitive damage which results from inflammation associated with long-term HIV infection. It is hypothesised that macrophages may be responsible for introducing HIV into the brain, which eventually initiates HIV-associated cognitive disorder. Persidsky’s research suggests that reducing HIV in macrophages may reduce inflammation in the central nervous system and thus the neurocognitive damage caused by HIV.
A 2012 NIH-funded study conducted by Mount Sinai School of Medicine demonstrated the ability of cannabinoids to suppress HIV infection by blocking the signaling process between HIV and CXCR4, one of the main receptors on T-cells which HIV attaches in order to penetrate and infect the cell.
Several cannabinoid-based therapeutics are being studied and developed as CB2 agonists. Cannabis Science, an emerging biotechnology company, is working to develop a phytocannabinoid-based HIV Tat inhibitor (CS-TATI-I) to inhibit HIV-associated Kaposi’s sarcoma (KS). Harvard Medical School studies found that cannabinoids inhibit KS tumor growth.
When asked of the potential for cannabinoids to be used as treatments for diseases such as HIV, Dr. Bob Melamede, president and director of Cannabis Science, stated: “If people are able to objectively look at the medical research on cannabis, there would likely be no debate regarding the widespread need for cannabis-based medicines.”
Jeannie Wraight is the editor-in-chief and co-founder of HIV and HCV Haven (www.hivhaven.com) and a blogger and writer for TheBody.com. She is a member of the Board of Directors of Health People and an advisor to TRW (Teach me to Read and Write). She lives with her husband in the Bronx, New York.
HIV/HCV drug interaction updates from CROI
by Larry Buhl
Several panels from CROI 2012 showed drug-drug interactions between new direct-acting antiviral agents for hepatitis C (HCV) and antiretroviral HIV drugs.
Approximately one-third of HIV-positive people are coinfected with HCV, but new direct-acting antivirals for HCV are not yet approved for coinfected patients. The concern is that some drug interactions can cause side effects or reduce the effectiveness of one or all of the drugs.
Research involved small samples of healthy volunteers with neither HIV nor HCV. Right now no pharmaceutical company is planning clinical trials of PIs on coinfected patients.
Boceprevir (Victrelis) was tested with the ritonavir-boosted HIV protease inhibitors (PIs) atazanavir (Reyataz), darunavir (Prezista) and lopinavir/ritonavir (Kaletra). Thirty-nine volunteers first received 800 mg three-times-daily boceprevir for six days. They then took 300/100 mg once-daily atazanavir/ritonavir, 600/100 mg twice-daily darunavir/ritonavir, or 400/100 mg twice-daily lopinavir/ritonavir for about two weeks, adding boceprevir during the last five days.
Co-administration of boceprevir with all three boosted HIV PIs was generally well-tolerated, with no serious side effects. It did lead to some significant decreases in blood levels of HIV PIs. Boceprevir decreased ritonavir exposure in all three combinations. Co-administration with atazanavir/ritonavir did not significantly alter total boceprevir levels. Lopinavir/ritonavir, however, decreased boceprevir total concentration by forty-five percent and darunavir/ritonavir did so by thirty-two percent.
These drug-drug interactions were already known, and Merck does not recommend co-administration of boceprevir with ritonavir-boosted HIV PIs.
Another CROI presentation showed that boceprevir combined with older HCV meds, pegylated interferon and ribavirin, appeared safe and effective for HIV/HCV coinfected individuals taking boosted HIV PIs.
Researchers investigated interactions between TMC435 and the antiretrovirals rilpivirine (Edurant), tenofovir (Viread), efavirenz (Sustiva),
and raltegravir.
Forty-eight volunteers were randomly assigned to receive 150 mg TMC435 once-daily, followed by an antiretroviral alone (25 mg rilpivirine once-daily, 300 mg tenofovir once-daily, 600 mg efavirenz once-daily, or 400 mg raltegravir twice-daily), followed by TMC435 combined with an antiretroviral.
All drug combinations were well-tolerated, with no serious adverse events or discontinuations for this reason. Plasma concentrations of rilpivirine, tenofovir, efavirenz, and raltegravir did not change significantly when co-administered with TMC435. TMC435 levels did not change appreciably when combined with rilpivirine, tenofovir, or raltegravir. Co-administration with efavirenz, however, reduced total TMC435 concentration by about seventy percent.
Researchers concluded that no dose adjustments are required when combining TMC435 with rilpivirine, raltegravir, or tenofovir, but co-administration of TMC435 and efavirenz is not recommended.
In two studies, a total of twenty-nine participants first received 60 mg daclatasvir once-daily for four days, then added either 300/100 mg atazanavir/ritonavir once-daily or 600 mg efavirenz once-daily for up to eighteen days. In the third study, twenty participants took the same dose of daclatasvir or 300 mg tenofovir once-daily or both for seven days.
All drug combinations were well-tolerated. Atazanavir/ritonavir and efavirenz plasma concentrations did not change significantly when co-administered with daclatasvir. Daclatasvir total exposure (AUC) was 110 percent higher and peak concentration (Cmax) was thirty-five percent higher when given with atazanavir/ritonavir. Total and peak daclatasvir levels were reduced by thirty-two percent and sixty-seven percent, respectively, when co-administered with efavirenz. Levels of both daclatasvir and tenofovir remained within expected ranges when administered together.
Researchers said lowering the daclatasvir dose when given with atazanavir/ritonavir, or raising it when used with efavirenz, may provide optimal daclatasvir exposure.
HIV/HCV drug-drug interactions, when they occur, could be managed by adjusting the dosages. Although some interactions decreased the effectiveness of some drugs, researchers say the growing diversity of antiretrovirals for treating HCV means that HIV/HCV coinfected people should be able to find a safe and effective antiretroviral regimen, as long as doctors are aware of the drug-drug interactions and frequently monitor both HIV and HCV viral load.
Larry Buhl is a freelance journalist and screenwriter living in Los Angeles.
First let me inform my readers what this whole thing is all about.
