July 25, 2010

30 years with HIV: 3 men reflect

By Saundra Young, CNN
July 23, 2010 4:23 a.m. EDT
 
Survivors Phill Wilson, Jim Chud and Cleve Jones share how living with HIV has changed

(CNN) -- June 5, 1981. The U.S. Centers for Disease Control and Prevention issued its first warning about a rare pneumonia called pneumocystis circulating among a small group of young gay men.

Unrealized at the time, it was the official beginning of the HIV/AIDS epidemic.

Dr. Michael Gottlieb, then a 33-year-old immunologist at the University of California Los Angeles, treated one of the first patients, a 31-year-old gay male with pneumocystis.

"In those days patients were essentially given a terminal diagnosis," Gottlieb says. "We had no medication whatsoever. At the very beginning we did not even know it was viral infection."

In 1982, the CDC coined the term AIDS, for Acquired Immune Deficiency Syndrome, but the cause was still unknown. In 1983, the virus was finally isolated and given a name: Human Immunodeficiency Virus or HIV.

At that time there were no treatments. Patients died quickly. Today, with the development of antiretroviral drugs and a much greater understanding of the disease, people who contract HIV in the United States are living decades.

The drugs carry side effects, some extremely debilitating, but because of those drugs, a small number of long-term survivors are experiencing what they couldn't have imagined when they got their diagnosis in the epidemic's early days -- middle age.

Gel cuts HIV transmission in study

"The first antiretrovirals were introduced in 1987; that gave us a glimmer of hope," Gottlieb says, describing drugs that disrupted the virus' ability to multiply in the body.

Dr. Michael Gottlieb, then a 33-year old immunologist at the University of California Los Angeles, treated one of the first patients."In 1996, the advent of the protease inhibitor and the so-called cocktail changed the prognosis for HIV, and that therapy has required considerable refinement, because even that therapy had complications from the drugs themselves that caused a lot of damage -- lasting damage -- and many of those long-term survivors suffered and continue to suffer the complications of the earlier medication."

Jim Chud is one of those long-term survivors. The 53-year-old AIDS activist says he was a 20-year old bisexual athlete at Yale University when he contracted the virus. Chud thinks it was 1977 when he got sick. He was leading a double life: He had a steady girlfriend, but took weekend visits to the bathhouses in New York.

By 1985, Chud was living in Washington. Having watched many of his friends get sick and die, Chud was at the head of the line when the new HIV test arrived. By 1989 he had full-blown AIDS -- the most advanced stages of HIV. "I thought I was going to die," he says. "I didn't think I would see 30."

He started volunteering for drug trials. One, a National Institutes of Health study looking at the combination of drugs AZT and DDC, left him paralyzed for four months. He has had more than 30 surgeries on his spine and neck.

World economic woes imperil AIDS advances

In 1999, Chud contracted a fungal infection in his sinuses that spread to his brain. There were more toxic drugs and six more surgeries. Over the years he's been on 12 different HIV drugs. Today he's disabled and along with HIV medications takes prescriptions to battle pain, infections and depression.

His concern? That HIV has vanished from the spotlight. "People are still dying, and to think that doesn't happen anymore and isn't newsworthy is a problem. Kids aren't getting the message today that we got many years ago that this is a fatal disease and it's not to be taken lightly."

Cleve Jones has never taken the disease lightly. The 55-year-old human rights activist and founder of the NAMES Project AIDS Memorial Quilt thinks he contracted the virus in the winter of 1978-79. Jones was living in San Francisco, California, and was working for pioneer gay rights leader and San Francisco Supervisor Harvey Milk. AIDS was already exacting a heavy toll on the community. After the HIV test became available in spring 1985, Jones received his official diagnosis.

"I was living with the virus in my body for a full 10 years before treatment became available," he says.

He participated in the first clinical trial looking at multiple drugs, now called combination therapy. But back then the drugs didn't work for very long. "The science was pretty primitive then," he says. "I was always looking a year ahead, two to three years ahead into the research pipeline, knowing that whatever combination was working for me at any particular moment -- the odds were good it wouldn't be working a few months later."

Bush led on AIDS funding; will Obama?

Today, the prognosis is much better. While other countries continue to struggle to manage the disease, in the United States a diagnosis is no longer an automatic death sentence. But Jones says there aren't many long-term survivors left. "It's bittersweet for us. There is nobody left in my life today that knew me when I was young."

When he looks back over the last 30-plus years, Jones can acknowledge how far the fight has come. "I still hope for an outright cure. I still hope for a vaccine. But it took a very long time and there were many dark periods where I felt the world had waited too long to respond."

Phill Wilson has devoted his life to stopping the AIDS pandemic in the black community. His diagnosis in 1985 spurred him to help found a number of AIDS service organizations. The 53-year-old was living in Los Angeles, California, with his partner and believes he was infected in 1980 at age 24. Like Chud and Jones, Wilson says he was also one of the first tested and diagnosed and among the first in Los Angeles put on AZT, the first antiviral drug approved for treating HIV.

Straight poor at higher risk of AIDS

"It was not a question of if you were going to die, it was a question of when you were going to die," he says. "We knew that AZT was not good enough and so the goal was to stay alive until there was another option."

Wilson says he no longer remembers what it's like not to live with HIV.

"When I was diagnosed, a long-term survivor was someone who lived 12 months, and most people were dead in six months. And so there was no expectation that someone would live as long as I have lived."

The disease and the drugs took a heavy toll on Wilson. There were three near-death experiences. Once, doctors gave him less than 48 hours to live. "It's hard to describe what it was like living in the middle of the storm during the worst of the plague years. But one of the things that I think happens is when you witness firsthand that kind of death and devastation, I don't think that you are so afraid."

In 1999, Wilson founded the Black AIDS Institute, the only national HIV/AIDS think tank that focuses solely on black people. In February, he was appointed to the Presidential Advisory Council on HIV/AIDS. He is driven and has no plans to slow down.

This week Wilson has been in Vienna, Austria, at the 18th International AIDS Conference, keeping his finger on the pulse of the disease. But in the shadow of these new advances, he can't help looking to the past.

"It's bittersweet, because while it is incredibly inspiring to know that there are going to be people who won't get infected and there are going to be people who get infected and won't get sick and there are people who'll get sick and won't die and that is inspirational, and I can celebrate the life I have to live, but I can never forget all the advances in the world came too late for my first partner and the literally hundreds of people that I know who have died from this disease."

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IAC: 18th AIDS Meeting One to Remember



By Michael Smith, North American Correspondent, MedPage Today

Published: July 23, 2010

VIENNA -- As the International AIDS Conference winds down, this InFocus video looks back at the high points of the week's events. In some ways, this meeting -- with nearly 20,000 people in attendance -- stands out from others in recent memory.

But in some areas, as some sessions made clear, there has been little progress.

North American Correspondent Michael Smith and Contributing Writer Ed Susman -- both veteran AIDS reporters -- discuss the highs and the lows.

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Family House Diaries: Getting Life Back After a Liver Transplant

Sheri and Dennis Foster

Almost seven weeks after receiving a new liver, Dennis Foster, 56, returns to work part-time as a ranger with the U.S. Forest Service, forever grateful for a second chance thanks to the kindness of strangers.

Media contact: Tom Hughes, (919) 966-6047, tahughes@unch.unc.edu

Thursday, July 22, 2010

Written by Elizabeth Swaringen for the UNC Medical Center News Office

CHAPEL HILL, N.C. – Sheri Foster was born at UNC Hospitals in 1957, but it was the liver transplant that Dennis, her husband of 30 years, received there in May 2010 that solidified Chapel Hill as a special place in her heart.

“I was born when my Dad was doing his psychiatric residency, and we say Dennis was reborn with the liver transplant,” said Sheri, 52, of Morehead City. “That both of these life-giving events happened here makes Chapel Hill a very special place in our lives.”

Dennis, 56, and a long-time ranger with the U.S. Forest Service on the Croatan National Forest, had known for seven years that chronic liver disease (cirrhosis) would necessitate a liver transplant sooner or later. He was added to the transplant list on March 22.

Classic complications of liver failure – fluid retention in the lungs and stomach – hospitalized Dennis locally, and he was transferred to UNC Hospitals as he became sicker. The sickest patients advance to the top of the transplant list, and on May 11, Dennis received a new liver, donated by the parents of a young man in his 20s who died in a motorcycle accident.

“A young man gave his life that I could continue mine,” Dennis said, teary-eyed, clearly still in awe and gratitude. “We cannot imagine that young man’s family’s grief or the difficult decision to donate his organs. As the father of three sons, I’m not sure I could have done that. I pray that each time I do something right the rest of my time on this Earth, that young man and his family share in the blessings I receive from God.”

The morning after the transplant, Dennis was wide awake, but tubes prevented him from speaking. So he tapped Morse Code – a holdover from his U.S. Army days at Fort Bragg – that attracted the attention of nurses who supplied pen and paper. Later in the day he was walking across the room. Four days later he was released from UNC Hospitals, but not before a pizza party with his family and healthcare team.

“One of my goals coming out of surgery was to again enjoy pizza with my boys,” said Dennis, who had been on a restricted diet as his diseased liver worsened. “If my boys, ages 26, 16 and 14, had something on their heart, we always talked about it over pizza, and I had missed that. We bought $99 worth of pizza for the ward, Sheri and our boys were there, and I ate a piece and a half. Pizza never tasted so good.”

Upon his hospital release, Dennis joined Sheri at SECU Family House, a 40-bedroom hospital hospitality house minutes from UNC Hospitals. Family House provides comfortable, convenient and affordable housing for seriously ill adult patients and their family member caregivers.

“Family House is such a place of healing, where hope abounds,” Sheri said. “Everybody pulls together here, and there is support and inspiration. We like to say ‘in spirit, action’. We have hope because of our faith, which also calls us to encourage others to embrace hope. We do a lot of counseling with people, and it’s amazing how much attention you get when you stop, listen and just pay attention to others.”

Beyond his love for his God, his family and the outdoors, Dennis is a talented songwriter and musician and found inspiration to pick up the guitar again while at Family House. Two earlier CDs of original music written and sung by Dennis have found new fans there.

“Music has been a part of his life since Dennis was 9 years old,” Sheri said. “He seemed to always have a tune in his head and tapped his foot to a beat. But then, as his disease progressed, there seemed to be a silence, akin to giving up or quitting. I prayed that wasn’t the case, and believe a friend who said ‘maybe he’s just turned the volume down’ to pay attention to getting well.”

On June 26, a little more than six weeks after his transplant, Dennis went to the beach with his sisters who were visiting from California. “I got in the ocean – the first time in two years – and I had a blast,” Dennis said. By July 1, he had donned his green pants, the uniform of the U.S. Forest Service, and returned to work part-time.

“He’s well on his way to getting his life back,” said David A. Gerber, MD, professor of surgery at the UNC School of Medicine who headed Dennis’ transplant team. “Dennis’ surgery was very smooth. He had a very robust and quick recovery immediately after surgery, which allowed him to be released from the hospital in near record time. He’s had the recovery you wish everybody could have.”

And Dr. Gerber believes that the Fosters are the perfect example of why the Family House exists.

“For Sheri to be able to stay at Family House while Dennis was hospitalized and for him to join her there while we monitored his care is exactly why that place was built,” Dr. Gerber said. “Their stress levels were greatly reduced, and we were able to provide the level of care Dennis deserved without keeping him in the hospital any longer than necessary. They’re both demonstrative personalities who share a love of life regardless of what comes their way. That’s as good as it gets.”

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Ribavirin treatment for chronic Hepatitis E

This month's issue of the Annals of Internal Medicine investigates ribavirin treatment for chronic Hepatitis E.

There is currently no accepted treatment of chronic hepatitis E virus infection.

Dr Vincent Mallet and colleagues from France evaluated case reports of 2 patients in whom ribavirin therapy seemed to alter the natural history of chronic Hepatitis E virus infection.

The research evaluated a kidney and pancreas transplant recipient and a patient with idiopathic CD4+ T lymphocytopenia, both with biopsy-proven chronic Hepatitis E virus infection.

Patients received oral ribavirin, 12 mg/kg of body weight daily for 12 weeks.

The team assessed liver function tests, detection of Hepatitis E virus RNA (viremia and stool shedding) by reverse transcriptase polymerase chain reaction, and anti-Hepatitis E virus IgM and IgG antibodies.

The research team noted that both patients had normalized liver function test results after 2 weeks of treatment and cleared Hepatitis E virus after 4 weeks of treatment.

The research team found that Hepatitis E virus RNA remained undetectable in the serum and stools throughout follow-up.

Side effects were considered mild.

Dr Mallet's team concludes, "Ribavirin is a potentially effective treatment of HEV infection and should be evaluated in patients with chronic Hepatitis E virus infection."

Ann Int Med 2010: 153(2): 85-89
21 July 2010
 
Source
Transplant International
Early View (Articles online in advance of print)
Published Online: 22 Jul 2010
Journal compilation © 2010 ESOT

Davide Bitetto 1 , Carlo Fabris 1 , Ezio Fornasiere 1 , Corrado Pipan 2 , Elisa Fumolo 1 , Annarosa Cussigh 1 , Sara Bignulin 1 , Sara Cmet 1 , Elisabetta Fontanini 1 , Edmondo Falleti 1 , Romina Martinella 2 , Mario Pirisi 3,4 and Pierluigi Toniutto 1

1 Medical Liver Transplantation Unit, Internal Medicine, University of Udine, Udine, Italy
2 Hygiene and Epidemiology, University of Udine, Udine, Italy
3 Department of Clinical and Experimental Medicine, University of Eastern Piedmont "A. Avogadro", Novara, Italy
4 Interdisciplinary Research Center of Autoimmune Diseases, University of Eastern Piedmont "A. Avogadro", Novara, Italy

Correspondence to Pierluigi Toniutto MD, DPMSC, Internal Medicine, Medical Liver Transplantation Unit, University of Udine, 33100 Udine, Italy. Tel.: +390432559801; fax: +39043242097; e-mail: pierluigi.toniutto@uniud.it

KEYWORDS
interferon • liver transplantation • recurrent hepatitis C • vitamin D

ABSTRACT

In immune-competent patients, higher vitamin D levels predicted sustained viral response (SVR) following interferon (INF) and ribavirin therapy for chronic hepatitis C. This study aimed to verify the influence of vitamin D serum levels and/or vitamin D supplementation in predicting SVR rates for recurrent hepatitis C (RHC). Forty-two consecutive patients were treated for RHC with combination therapy with INF-α and ribavirin for 48 weeks. Vitamin D serum levels were measured in all patients before antiviral therapy. In 15 patients oral vitamin D3 supplementation was administered to avoid further bone loss. SVR was observed in 13 patients; it was achieved in 1/10 severely vitamin D deficient (≤10 ng/ml) patients, in 6/20 deficient (>10 and ≤20 ng/ml) and in 6/12 with near normal (>20 ng/ml) 25-OH vitamin D serum levels (P < 0.05). Cholecalciferol supplementation, in the presence of a normal or near normal baseline vitamin D concentration, (improvement of chi-square P < 0.05, odds ratio 2.22) and possessing a genotype other than 1 (improvement of chi-square P < 0.05, odds ratio 3.383) were the only variables independently associated to SVR. In conclusion, vitamin D deficiency predicts an unfavourable response to antiviral treatment of RHC. Vitamin D supplementation improves the probability of achieving a SVR following antiviral treatment.

Received: 6 May 2010 Revision requested: 31 May 2010 Accepted: 28 June 2010

DIGITAL OBJECT IDENTIFIER (DOI)
10.1111/j.1432-2277.2010.01141.x About DOI
 
Source
Journal Archives of Gynecology and Obstetrics
Publisher Springer Berlin / Heidelberg
ISSN 0932-0067 (Print) 1432-0711 (Online)
Category General Gynecology
DOI 10.1007/s00404-010-1588-9
Subject Collection Medicine
SpringerLink Date Friday, July 23, 2010

Mohammad Ebrahim Ghamar Chehreh 1, Seyed Vahid Tabatabaei 1, Shahab Khazanehdari 1 and Seyed Moayed Alavian 1

(1) Research Center for Gastroenterology and Liver Disease, Ground floor of Baqiyatallah Hospital, Baqiyatallah University of Medical Sciences, Mollasadra Ave., Vanak Sq., P.O. Box 14155-3651, Tehran, Iran

Received: 11 October 2009 Accepted: 5 July 2010 Published online: 21 July 2010

Abstract

Background
Hepatitis C virus (HCV) vertical transmission is considered the main route of HCV infection in children. Some authors have stated that cesarean section (C/S) can reduce perinatal HCV transmission. However, the study findings are heterogeneous and high-quality studies are lacking.

Aims
To evaluate the effect of mode of delivery on the risk of perinatal mother-to-infant transmission of HCV.

Methods
Only the peer-reviewed published studies that compared perinatal transmission rate of HCV in elective or emergency cesarean section with vaginal delivery in HCV-RNA+/HIV− mothers were included. We applied the random effect model of DerSimonian and Laird method with heterogeneity and sensitivity analyses.

Results
We identified 8 studies that involved 641 unique mother–infant pairs which fulfilled our inclusion criteria. Aggregation of study results did not show a significant decrease in HCV vertical transmission among study (mothers who underwent C/S) versus control (mothers who gave birth vaginally) patients [pooled odds ratio, 1.1 (95% CI 0.45–2.67)]. The P value was 0.35 for our test of heterogeneity.

Conclusions
Our meta-analysis suggests that C/S does not decrease perinatal HCV transmission from HCV-RNA+/HIV− mothers to infants.

Keywords Meta-analysis - HCV - Cesarean section - Vaginal delivery - Vertical transmission

Source
Journal European Journal of Clinical Pharmacology
Publisher Springer Berlin / Heidelberg
ISSN 0031-6970 (Print) 1432-1041 (Online)
Category Pharmacoepidemiology and Prescription
DOI 10.1007/s00228-010-0868-4
Subject Collection Biomedical and Life Sciences
SpringerLink Date Friday, July 23, 2010

Gaetano  Bertino 1,4 , Annalisa Ardiri 1, Patrizia Maria Boemi 1, Giuseppe Stefano Calvagno 1, Irene Maria Ruggeri 2, Annalisa Speranza 1, Maria Milena Santonocito 1, Dario Ierna 1, Cosimo Marcello Bruno 1, Maria Valenti 1, Roberta Boemi 1, Simona Naimo 1 and Sergio Neri 3

(1) Hepatology Unit, Department of Internal Medicine and Systemic Diseases, University of Catania, S. Marta Hospital, Via Gesualdo Clementi, 36, 95124 Catania, Italy
(2) Emergency Department ARNAS Civic Hospital, Palermo, Italy
(3) Department of Internal Medicine and Systemic Diseases, Policlinic of Catania, University of Catania, Catania, Italy
(4) Largo E. Amari n.1 - C.A.P. 95030 S. Agata Li Battiati (Catania), Sicily, Italy

Received: 21 May 2010 Accepted: 6 July 2010 Published online: 22 July 2010

Abstract

Background
The conventional antiviral treatment of chronic hepatitis related to hepatitis C virus (HCV) often leads to anemia. In this case, it is necessary to reduce ribavirin dose or stop treatment, thus reducing the rate of sustained virological response.

Aim
We investigated whether epoetin alpha administration improves treatment adherence and leads to higher percentage of response at the end of therapy and sustained virological response.

Methods
Two hundred and fourteen individuals with genotype 1b HCV-related chronic hepatitis underwent treatment with pegylated (peg)-interferon alpha-2A 180 μg once weekly and ribavirin 1,000–1,200 mg/day; 174 were responders. Forty individuals completed treatment with no hemoglobin reduction; 134 developed anemia during therapy. Anemic responders were distributed randomly into two groups: group 1 continued therapy with epoetin alpha addiction; group 2 continued antiviral therapy with ribavirin reduction only.

Results
Patients in group 1 achieved better control of hemoglobin levels (13.8 ± 1.2 g/dl at the end of therapy) than tthose in group 2 (11.5 ± 0.8 g/dl). Sustained virological response was 59.7% in group 1 compared with 34.4% in group 2 (p < 0.01).

Conclusions
In patients with 1b HCV-related chronic hepatitis who develop anemia during antiviral treatment, administration of epoetin alpha increases hemoglobin levels and the end-of-treatment rate and sustains virological response by improving treatment adherence.

Keywords Epoetin alpha - Peg-interferon alpha-2A - Ribavirin - Genotype 1b HCV-related chronic hepatitis

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Can-Fite reports CF102 success against hepatitis

The firm's clinical trial is studying liver cancer patients, some of whom also carry the hepatitis C virus.

25 July 10 10:39, Globes' correspondent

Can-Fite BioPharma Ltd. (TASE:CFBI) reports that three liver cancer patients in the Phase I/II clinical trial of CF102 who also suffer from hepatitis C showed a significant decline in the level of the virus. The trial is designed to test CF102 against liver cancer, but since many of these patients also suffer from hepatitis C, the drug's effect on the hepatitis virus was also tested.

Can-Fite said that the trial's results were "very impressive", since the patients had severe hepatitis C and were only treated with CF102. The company that, in view of these results and the tolerability shown by patients to the drug, the clinical trial has been expanded for patients with hepatitis C, in order to test the continuing effect of the drug.

Can-Fite said that the hepatitis C treatment market currently amounts to $3 billion, and is expected to soar to $8.3 billion by 2012, based on an estimate of 180 million carriers of the virus worldwide. The current prevailing treatment is injections of interferon and Ribavirin tablets, whose effectiveness in short-lived and includes side effects.

Can-Fite recently obtained a US patent for use of CF102 for the treatment of viral diseases, including hepatitis, AIDS, and influenza. The company has already has intellectual property rights and patent protection in Europe, China, Japan, and other countries.

Can-Fite's share price rose 6.3% in early trading to NIS 0.56, giving a market cap of NIS 115 million.

Published by Globes [online], Israel business news - http://www.globes-online.com/ - on July 25, 2010
© Copyright of Globes Publisher Itonut (1983) Ltd. 2010

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