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TREATMENT B U L L E T I N ISSN 1472-4863 HIV-treatment bulletin VOLUME 3 NO.7 AUG/SEP2002 FORMERLYh- Doctor Fax tb H I V i - B a s e TREATMENT bulletin. 7 Volume 3 No.7 - AUGUST / SEPTEMBER 2002 SPECIAL ISSUE : CONFERENCE REPORTS from XIV INTL. AIDS CONFERENCE, Barcelona, and XI INTL. HIV DRUG RESISTANCE WORKSHOP, Seville, CONFERENCE REPORTS: • ART can successfully tackle advanced disease in resource poor settings, reports MSF THE XIV INTERNATIONAL AIDS CONFERENCE, Barcelona, 7-12 • Investment in treatment and care significantly reduces company July 2002 health and social expenditure in Abidjan TREATMENT ACCESS AND THE GLOBAL RESPONSE TO THE • Financing the global response to the epidemic will cost $9.2 EPIDEMIC 3 billion a year, according to one estimate • Bill Clinton and Nelson Mandela promise to lead peer education • The Global Fund: what, where, how much? among political leaders as world looks for $10 billion a year to • Leading businesses spurn Global Fund fight HIV/AIDS • 14 Caribbean governments sign cut-price drugs agreement with • South African activist unveils campaign to force compulsory six pharmaceutical companies licences • Thailand offers low-cost transfer to African countries of • MSF study shows treatment in resource-poor settings is effective technology for the local production of generic antiretrovirals • ‘Barcelona Declaration’ demands 2m poor people are treated in • Informal market plays a role in distributing antiretrovirals but the next two years exposes clients to several risks • Lives were lost as experts argued the merits of care versus • The epidemic in numbers prevention, says Stefano Vella CLINICAL SCIENCE 19 • Peter Piot sets out the global political agenda in the fight • Abacavir hypersensitivity reactions in patients who rechallenge against HIV/AIDS after interruptions for reasons other than hypersensitivity • Health should be a right, not a commodity, and medicine must • Prolonged CNS side-effects of efavirenz can be severe and lead be removed from the World Trade Organisation, argues key to treatment discontinuation speaker • Paediatric reports at ICA 2002 • Governments must act to cut drug prices, says Kenya’s health • Study of MTCT programme finds resistance in women on two minister doses of monotherapy • Civil society had to fight for universal access to AIDS drugs in • Emergence of resistance in children treated with ddI/d4T after Brazil treatment to reduce MTCT • Coalitions of local NGOs can effectively demand access to • Correlates of fatigue in HIV disease medicines, reports MSF • Optimum hydroxyurea dose determined • Involvement of PLWHA is key to improving access to treatments contents continued on page 2... Editor: Paul Blanchard Associate Editor: Graham McKerrow Medical Consultants: Dr Graeme Moyle, Chelsea & Westminster Hospital, London. Dr Stefan Mauss, Düsseldorf. Prof. Clive Loveday, Royal Free Hospital, London. Dr Gareth Tudor-Williams, Imperial College, London. Dr Karen Beckerman, UCSF, USA. HIV Treatment Bulletin Vol 3 No 7/8 August/September 2002 contents continued from page 1... • Management of treatment experienced patients • ViroLogic announces launch of “viral fitness” assay for HIV • Pharmacokinetics and therapeutic drug monitoring (TDM) infection • HIV-associated malignancies in the HAART era: flickers of OTHER NEWS 62 hope and understanding • Investigations fault HIV/AIDS cure claims • Lopinavir/r exhibits sustained virologic response in • US antitrust case could break GlaxoSmithKline’s hold on key antiretroviral-naïve patients: 3-year data drugs • Patients will have options regarding T-20 (Enfuvirtide) injection ON THE WEB 64 sites • Adherence research roundup from the International AIDS • The role of tenofovir in antiretroviral-naive patients Conference • Treatment interruption strategy reports from the XIV • Highlights of presentations on gender from Barcelona International AIDS Conference • Additional ICA2002 reports at thebody.com • New data from clinical trials of antiretrovirals • Medscape conference coverage, based on selected sessions • EFAVIP-2 Study at the: XIV International AIDS Conference IMMUNOLOGY AND BASIC SCIENCE 42 • Selected daily updates from the XIV International AIDS • Behind the headlines about vaccine research Conference at HIVandHepatitis.com • NATAP reports from AIDS 2002 Barcelona THE XI INTERNATIONAL HIV DRUG RESISTANCE WORKSHOP, 2- • Monkey puzzles 5 July, 2002. Seville 44 • Diversity considerations in HIV-1 Vaccine Selection • Short resistance reports from Seville • Confronting the limits of success • New anti-HIV compounds discussed at the Seville HIV Drug • Mycobacterium avium complex and atypical mycobacterial Resistance Workshop and the Barcelona World AIDS infections in the setting of HIV infection Conference • Management of anal and cervical dysplasia in men and women, • Review of phenotypic resistance testing data presented at the Presentation XI International HIV Drug Resistance Workshop • Anaemia, neutropenia, and thrombocytopenia: pathogenesis and evolving treatment options in HIV infected patients ANTIRETROVIRALS • Identifying and managing morphologic complications of HIV • Trial supports lopinavir/ritonavir as first-line therapy in HIV and HAART infection • Achieving adherence with antiretroviral medications for • Ritonavir has anti-neoplastic effects independent of HIV paediatric HIV disease inhibition • “Natural” resistance to HIV: Is the evidence good enough to • Antiretroviral use in pregnancy and the risk of an adverse design an effective vaccine? outcome • Efficacy and safety of once-daily antiretroviral therapy METABOLIC TOXICITIES AND SIDE EFFECTS • Therapeutic implications of acute hepatitis C infection • Triglyceride increase can predict lipodystrophy in HIV patients • New antiretrovirals in development: The View in 2002 under highly active antiretroviral therapy • Update on IL-2: where it’s been and where it’s going • Peripheral neuropathy: New data on risk factors, incidence and • Insights into HIV-specific CD4+ T cell immunity association with viral load • Updated knowledgebase chapters, Cytomegalovirus • High prevalence of osteonecrosis of the hip found in HIV- • The switching spiral: a triumph of hope over benefit infection • peripheral neuropathy PATHOPHYSIOLOGY • The push for once-daily HAART: a call for caution • Gene discovery offers fresh perspective on HIV/AIDS therapies • Enhancing adherence to antiretrovirals: Strategies and • Growth hormone effective in increasing thymic activity regimens • HIV long term nonprogressors have increased immune • High doses of riboflavin and thiamine may help in secondary responsiveness to other viral pathogens prevention of hyperlactatemia • Red blood cells new sensitive markers for HIV disease • Conference Report, HAART and prevention of HIV transmission progression? PAEDIATRICS 60 PUBLICATIONS AND SERVICES FROM i-BASE 71 • Increased risk of heart abnormalities in children born to mothers • Updated edition of our guide to avoiding and managing side with HIV-1 effects OPPORTUNISTIC INFECTIONS 60 • The latest issue of Positive Treatment News (PTN) • Paclitaxel effective for advanced AIDS-related Kaposi Sarcoma • Changing treatment: an updated guide to second-line and MISCELLANEOUS 61 salvage therapy • Study finds sexual dysfunction common in HIV-infected men • Treatment information request service receiving HAART but unrelated to protease inhibitors • Order i-Base publications via the internet, post or fax 2 HIV i-Base publication HIV Treatment Bulletin Vol 3 No 7/8 August/September 2002 CONFERENCE REPORTS THE XIV INTERNATIONAL AIDS CONFERENCE Barcelona, 7-12 July 2002 TREATMENT ACCESS AND THE GLOBAL RESPONSE TO THE EPIDEMIC Bill Clinton and Nelson Mandela promise to lead peer education among political leaders as world looks for $10 billion a year to fight HIV/AIDS Graham McKerrow, HIV i-Base On the Thursday evening of the conference former US president Bill Clinton was asked at a “town hall meeting” to act as a peer educator to make other world leaders respond to the AIDS crisis. The next day he told perhaps 10,000 delegates at the closing ceremony: “I pledge that in every speech I make and in every meeting I have I will raise this and I ask you both to hold me accountable to that pledge and to tell me what more I can do.” Speaking from the same platform as former South African president Nelson Mandela, Clinton added: “President Mandela and I have agreed to work together to launch the World Leaders AIDS Network … to raise the global commitment to end AIDS.” The first 12 International AIDS Conferences were focused on the scientific work to develop treatments, and the 13th conference, two years ago in Durban, directed attention towards the need for political leadership to confront the AIDS crisis in developing countries. The 14th conference, held in Barcelona, Spain, in July, highlighted the need for world leaders to make sure there were sufficient resources to respond to the epidemic. Most estimates put this at $10 billion a year. Some people said it was more like $25 billion. Political leaders stayed away from the Durban conference as poor countries ignored their own problems, and the host, President Thabo Mbeki, was booed for questioning the link between HIV and AIDS. This year countless presidents, prime ministers, former presidents and former prime ministers and ministers of health attended the conference. A list of just some of them appears at the foot of this article. During the conference, Dr Denzil Douglas, the prime minister of St Kitts and Nevis, announced that he had signed an
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