November 29, 2010

The Faces of Hepatitis C

The Faces of Hepatitis C

You are a doctor or a nurse--You are a fifth grade grade teacher

Your skin is white or brown or black--you are Mecxican or Asian,
Caucasian,or African American

You are very old, have grandchildren,near the end of your golden

You are middle-aged--children grown and gone-ready to "enjoy"
your life --

You are a young mother with a small child-a young father trying to
provide for his family--

You are a teenager--waiting for proms,boy or girlfriends, your first
kiss dreaming of college and a car of your own--

You are a newborn lying in your mother's arms

YOU are the Faces of Hepatitis C

I may not recognize you as you pass me on the street or in the store
where I shop or the church where I worship, but you are there

The Faces of Hepatitis C

My heart cries out for you,for what fate has given you--it was not
your fault--it was just meant to be

My heart swells with pride for you--your courage,your faith--you
have been asked to keep going when others would have given

You wait anxiously for another loving person to give you the
"The Gift of Life"

The gift of their own liver at the end of THEIR life.
I am filled with love for each of you--my brother--my sister
and those I have met and those I will never know--

You see--I am one of those faces

The faces of Hepatitis

Given by God...written by Selles Dole

Selles lost her battle with HCV November 29, 2008

May You Always Sleep In The Arms Of Angels

FDA Approves Merit Medical's HiQuality Clinical Trial Protocol for the Treatment of Primary Liver Cancer

Nov 29, 2010 (GlobeNewswire via COMTEX) --

First large-scale multi-site U.S. study comparing doxorubicin-eluting QuadraSphere(TM) Microspheres to conventional chemoembolization

Interventional radiologists from U.S., Europe, South America participating in liver cancer study

SOUTH JORDAN, Utah, Nov. 29, 2010 (GLOBE NEWSWIRE) -- The Food and Drug Administration (FDA) has approved Merit Medical Systems, Inc.'s /quotes/comstock/15*!mmsi/quotes/nls/mmsi (MMSI 14.89, -0.06, -0.40%) phase 3 clinical trial protocol to treat primary liver cancer with QuadraSphere(TM) Microspheres (hqTACE) for delivery of doxorubicin. The clinical trial will involve U.S. and international interventional radiologists who treat patients with localized, unresectable hepatocellular carcinoma (HCC), the most common form of liver cancer. The FDA action will result in the first phase 3 study in the U.S. comparing drug-eluting microspheres to conventional chemoembolization (cTACE) in the treatment of hepatocellular carcinoma. Currently in the U.S. there is no FDA-approved embolic for the treatment of liver cancer.

QuadraSphere is indicated for embolization of hypervascular tumors and peripheral arteriovenous malformations. The identical product marketed in Europe as HepaSphere Microspheres(TM) has been CE-marked in the European Union since 2007 for embolization of HCC and hepatic metastases, with or without delivery of doxorubicin.

"I am extremely pleased with the efforts of our BioSphere Regulatory and Medical Affairs Department headed by Dr. Melodie R. Domurad, PhD," said Fred P. Lampropoulos, Merit's Chairman and Chief Executive Officer. "We are very excited about the initiation of this important study."

Merit Medical is a leading manufacturer and marketer of proprietary disposable devices used primarily in cardiology, radiology and endoscopy. It has recently added the BioSphere microsphere products to its line of tumor treatment options.

The phase 3 study is a prospective, randomized, blinded and controlled investigation of HepaSphere/QuadraSphere Microspheres for delivery of doxorubicin for the treatment of hepatocellular cancer. Known as the HiQuality Study (HepaSphere/QuadraSphere in Liver Cancer Treatment), the primary endpoint of the clinical trial is survival. Secondary endpoints include tumor response by mRECIST criteria, safety, resource utilization such as length of hospitalization, and adverse events. The study will enroll 500 patients and be conducted in approximately 20 clinical sites in the U.S., Europe, and South America.

Dr. Riccardo Lencioni, who developed the guidelines for image acquisition and interpretation for the trial stated, "This study meets the highest standards for clinical research in hepatocellular carcinoma, as recommended in Design and Endpoints of Clinical Trials in Hepatocellular Carcinoma, guidelines for clinical research in HCC by an expert panel convened by the American Association for the Study of Liver Disease, and published in the Journal of the National Cancer Institute. The design of the investigation is rigorous, and has been extensively reviewed by the FDA."

Dr. Lencioni, M.D., Associate Professor of Radiology at the University of Pisa in Italy and Director of the Division of Diagnostic Imaging and Intervention at the Department of Hepatology and Liver Transplantation at the Pisa University Hospital, will be overseeing the central imaging review and evaluation of tumor response. Professor Lencioni is Chairman of the Membership Committee and a member of the Executive Committee of the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) and Chairman of the Programme Committee of the European Conference on Interventional Oncology (ECIO). He is also a member of the Steering Committee of the World Conference on Interventional Oncology (WCIO). Professor Lencioni has been one of the founders of the International Liver Cancer Association (ILCA), and is a member of the Governing Board. Professor Lencioni has received more than 40 international awards; authored 134 articles or editorials; and is the editor of seven books. Professor Lencioni has served on the editorial board of Cardiovascular and Interventional Radiology, Investigative Radiology, European Radiology, Journal of Hepatology, Journal of Interventional Oncology, and La Radiologia Medica.

Michael Soulen, M.D. from the University of Pennsylvania Medical Center and Professor of Radiology specializing in Interventional Radiology, will direct the study as principal investigator. Active in the Society of Interventional Radiology (SIR), Dr. Soulen has served on the Executive Council, chaired the 1999 Annual Scientific Meeting, and acted as Director of Research Education for the SIR Foundation. He also serves on committees of the Radiological Society of North America (RSNA) and the American College of Radiology (ACR). Dr. Soulen chairs the steering committee of the World Conference of Interventional Oncology (WCIO). He is also an editorial board member and/or reviewer for numerous publications, including the Journal of Vascular and Interventional Radiology. He has published nearly100 peer-reviewed articles and more than 50 editorials, chapters and invited manuscripts.

About Liver Cancer

Liver cancer is the third leading cause of cancer deaths worldwide. The sharp rise in hepatitis C infections, alcohol consumption and obesity are reported as key contributing factors to the increase in liver cirrhosis and liver cancer. Liver transplantation or tumor resection is considered potentially a curative treatment; however, only about 25 percent of liver cancers are diagnosed when they can be treated surgically.

Surgical removal is not possible for more than two-thirds of primary liver cancer patients and 90 percent of patients with secondary liver cancer. According to the U.S. National Cancer Institute (NCI), no standard treatment currently exists for liver cancer when tumors cannot be surgically removed and liver transplantation is not a viable option. However, both the NCI and the Society of Interventional Radiologists (SIR) report that transarterial chemoembolization (TACE) has shown promising results.

hqTACE - Merit Advances Chemoembolization

Drug-eluting embolization treats hepatocellular carcinoma through the dual action of delivering chemotherapy into the tumors while also cutting off the blood supply that supports them. QuadraSphere adds two benefits to embolization therapy. First, by ionically binding the doxorubicin throughout the microspheres and eluting it into the cancer in a sustained manner, more drug can be delivered into the tumor, with less escaping into peripheral circulation. Complementary to the targeted delivery, QuadraSphere Microspheres have a unique formulation that makes them highly compressible and conformable, so they mold to the vessel lumen, creating both excellent contact with the vessel walls for delivery of chemotherapy and very efficient occlusion of the vessels feeding the tumor. Initial clinical results have demonstrated improved safety and reduced adverse events compared to treatment by conventional chemoembolization.

About Conventional Transarterial Chemoembolization (cTACE)

Conventional transarterial chemoembolization (cTACE) is a two-stage process involving the injection of chemotherapeutic drugs, typically emulsified with iodized oil, directly into the blood vessels that feed a tumor. The drug is followed by the delivery of an embolic agent used as a plug to block the tumor's blood supply and temporarily retain the cytotoxic drugs in place. However, the occlusion is limited in area and some of the chemotherapy still escapes into circulation, which leads to adverse effects.

About Merit

Founded in 1987, Merit Medical Systems, Inc. is engaged in the development, manufacture and distribution of proprietary disposable medical devices used in interventional and diagnostic procedures, particularly in cardiology, radiology and endoscopy. Merit serves client hospitals worldwide with a domestic and international sales force totaling approximately 130 individuals. Merit employs approximately 2,170 people worldwide with facilities in Salt Lake City and South Jordan, Utah; Angleton, Texas; Richmond, Virginia; Maastricht and Venlo, The Netherlands; Paris, France; Galway, Ireland; Beijing, China; Copenhagen, Denmark; and Rockland, Massachusetts.

The Merit Medical Systems, Inc. logo is available at

Statements contained in this release which are not purely historical are forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995 and are subject to risks and uncertainties such as those described in Merit's Annual Report on Form 10-K for the year ended December 31, 2009. Such risks and uncertainties include risks relating to Merit's recent acquisition of BioSphere (including, without limitation, the risk that the operations of the two companies will not be integrated successfully; and the risk that Merit may be unable to successfully develop, commercialize and market new products and technology which Merit acquired through the acquisition); uncertainties associated with potential healthcare policy changes which may have a material adverse effect on Merit; possible infringement of Merit's technology or the assertion that Merit's technology infringes the rights of other parties; downturn of the national economy and the corresponding effect on Merit's revenues, collections and supplier relations; potential termination of supplier relationships, or failure of suppliers to perform; product recalls and product liability claims; delays in obtaining regulatory approvals, or the failure to maintain such approvals; Merit's inability to successfully manage growth through acquisitions, including the inability to commercialize technology acquired through recent, proposed or future acquisitions, including without limitation the Endotek acquisition; concentration of Merit's revenues among a few products and procedures; development of new products and technology that could render Merit's products obsolete; market acceptance of new products; introduction of products in a timely fashion; price and product competition; availability of labor and materials; cost increases; fluctuations in and obsolescence of inventory; volatility of the market price of Merit's common stock; foreign currency fluctuations; changes in key personnel; work stoppage or transportation risks; modification or limitation of governmental or private insurance reimbursement policies; changes in health care markets related to health care reform initiatives; impact of force majeure events on Merit's business, including severe weather conditions; failure to comply with applicable environmental laws; and other factors referred to in Merit's Annual Report on Form 10-K for the year ended December 31, 2009 and other materials filed with the Securities and Exchange Commission. All subsequent forward-looking statements attributable to Merit or persons acting on its behalf are expressly qualified in their entirety by these cautionary statements. Actual results will differ, and may differ materially, from anticipated results. Financial estimates are subject to change and are not intended to be relied upon as predictions of future operating results, and Merit assumes no obligation to update or disclose revisions to those estimates.

This news release was distributed by GlobeNewswire,

SOURCE: Merit Medical Systems, Inc.

CONTACT: Merit Medical Systems, Inc.
Anne-Marie Wright, Vice President, Corporate Communications
(801) 208-4167
Fax: (801) 253-1688


Study Highlights Liver Health Risk in UK

Large numbers of people are putting liver health at risk as they shun visits to GP on alcohol related matters' says new study but new test can help. The LiverCheck test developed by YorkTest can be used at home and is an easy way to understand the health of your liver.

LEEDS, England, Nov. 25, 2010 /PRNewswire/ -- Growing groups of the so-called "worried well" are putting their lives at risk by shunning visits to their GP over alcoholic health related matters, according to new evidence.

The study, which appears in Hepatology, based its findings on 1039 UK subjects (561 female/478 male) who took a LiverCheck home liver function test and showed that 73% would not consider going to their GP concerning their liver health, revealing the extent to which people are putting themselves at risk from liver disease.

Luckily LiverCheck, the UK's only home-to-lab blood testing kit, is able to help. The test, which is available from YorkTest Laboratories, can test for levels of the two enzymes, alanine aminotransferase (ALT) and aspartate aminotransferase (AST), which if found in high levels in the blood stream have been shown to increase higher risk of mortality.

Rajiv Jalan, Professor of Hepatology at University College London and co-author of the article says:

"This data confirms the medical importance of ALT and AST as a marker for premature mortality as a consequence of liver disease. Due to the nature of the illness, the symptoms only appear when irreversible damage has been done so a screening procedure to detect the early signs of liver damage is essential. A GP is always your first port of call but for some a self test does have a vital role to play in saving lives."

Further findings from the study also paint a worrying picture of the UK's current drinking habits with 44% admitting they drink alcohol on a daily basis. 26% also admitted they regularly consumed more than twice the government guidelines on safe drinking and with Christmas and New Year fast approaching it is thought that this figure could double.

It is hoped with the easy to use LiverCheck that people are able to understand their liver health helping to address a potentially life threatening problem which previously had been unavailable to thousands of people adversely affected by alcohol consumption.

The LiverCheck Liver Function Test is currently available from YorkTest for 99 pounds. YorkTest are based in York, West Yorkshire and specialise in home laboratory tests including food intolerance testing, allergy testing, homocysteine tests, and more. For more information visit

Dr. Gillian Hart
0800 074 6185



Therapeutic Acetaminophen Not Linked to Liver Injury in Children

Laurie Barclay, MD

November 29, 2010 — Hepatoxicity after therapeutic dosing of acetaminophen in children is rarely reported in defined-population studies, according to the results of a systematic review reported online November 22 in Pediatrics.

"Use of the drug has recently come under increased scrutiny by the Food and Drug Administration because of the increased recognition of the contribution of acetaminophen to acute liver injury globally," Dr. Laura James, section chief of clinical pharmacology and toxicology at Arkansas Children's Hospital and professor of pediatrics at University of Arkansas for Medical Sciences, told Medscape Medical News when asked for independent comment. "While most experts view acetaminophen to be safe when used as directed, there have been rare reports of toxicity occurring with recommended dosing of the drug. Individual susceptibilities in drug response and toxicity may occur with the use of any drug, including acetaminophen."

Eric J. Lavonas, MD, from Rocky Mountain Poison and Drug Center at Denver Health in Colorado, and colleagues systematically reviewed the medical literature to assess the rate at which liver injury has been reported for children prescribed therapeutic doses of acetaminophen, defined as up to 75 mg/kg per day orally or intravenously or up to 100 mg/kg per day rectally.

Studies in which acetaminophen was given to a defined pediatric population for at least 24 hours were identified from a search of MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials. Trained reviewers also searched these sources for all case reports of liver injury after therapeutic acetaminophen dosing and extracted data from each report. Major and minor hepatic adverse events (AEs) were defined prospectively, and the Naranjo algorithm allowed evaluation of causality.

Among 62 identified studies enrolling a total of 32,414 children, there were no reports (0%; 95% confidence interval [CI], 0.000 - 0.009) of a child showing signs or symptoms of liver disease, having received an antidote or liver transplantation, or having died. A total of 10 children were reported to have major or minor hepatic AEs (0.031%; 95% CI, 0.015 - 0.057), and the highest transaminase value reported was 600 IU/L, with Naranjo scores (2 - 3) suggesting "possible" causation. However, none of the children had other evidence of liver dysfunction.

Among 22 identified case reports, there were 9 cases in which the Naranjo score suggested "probable" causation. The investigators concluded that hepatoxicity after therapeutic dosing of acetaminophen in children is rarely reported in defined-population studies. Although case reports suggest that this phenomenon may occur, few reports contain sufficient data to support a probable causal relationship.

"The limitations of the report are that the study reviewed previously published studies that were not expressly designed to systematically collect laboratory measurements that would detect liver injury," Dr. James said. "The clinical signs and symptoms of liver injury can be subtle until significant liver injury is present. Acetaminophen is a drug with a narrow safety index and thus careful dosing of the drug is a necessity for safe use."

Other limitations noted by the study authors include imperfect indexing strategies of medical databases, publication bias, possible errors introduced by manual search, possible failure to detect liver inflammation in some children, lack of routine blood testing on children without signs or symptoms of liver injury in most studies, and possible differences in clinical trial participants from the general population of children who take acetaminophen. A major limitation that the reviewers pointed out is that incomplete safety reporting is common in published clinical trials.

The reviewers also warn that their findings should not be used to estimate the proportion of children taking acetaminophen who experience elevations in asymptomatic transaminase levels, because if routine screening had been performed in all studies, it would likely have revealed additional cases of hepatic enzyme elevation. They also note that threshold criteria used to define severe liver injury are arbitrary. Because few children in these studies received exactly 75 mg/kg per day of acetaminophen, and many did not receive the drug for longer than 3 to 5 days, this study has limited power to detect infrequent hepatic AEs associated with longer therapy and/or maximal therapeutic dosing.

"Pediatricians should continue to educate families and patients about the safe use of acetaminophen, including informing families about the widespread use of acetaminophen in many over-the-counter products and prescription pain medications," Dr. James concluded. "Ongoing studies will help determine the factors that may contribute to individual susceptibilities to acetaminophen-induced liver injury."

This review was internally funded. The Rocky Mountain Poison and Drug Center, Denver Health receives research funding from McNeil Consumer Healthcare, but the development and analysis of the database described in the review article was not supported by McNeil Consumer Healthcare. The study authors have disclosed no relevant financial relationships. Dr. James is the recipient of 2 National Institutes of Health grants for the study of acetaminophen toxicity. She also has a patent pending for the measurement of acetaminophen protein adducts in human blood samples.

Pediatrics. Published online November 22, 2010. Abstract


Immunitor Awarded the Key U.S. Patent Related to Oral Vaccine Technology Platform


Nov. 29, 2010, 7:38 a.m. EST

VANCOUVER, British Columbia, Nov 29, 2010 (GlobeNewswire via COMTEX) -- Immune Network Ltd. /quotes/comstock/11i!immff (IMMFF 0.03, +0.02, +194.12%) , advises that its potential acquisition, Immunitor USA Inc., has been issued a key patent by the U.S. Patent and Trademark Office (USPTO).

The patent (US 7,838,006 "Viral vaccine composition, process and methods of use") contains claims covering the composition of matter for Immunitor's lead product, V5. The patent also covers the process of making and use of the matter for treating and preventing the broad range of infectious diseases. Immunitor was previously awarded a U.S. patent covering another lead compound specifically designed for treatment of AIDS (US 7,384,637).

According to Vichai Jirathitikal, the principal inventor on these two patents, "The USPTO has validated the novelty and utility of Immunitor's technology and its use in the treatment and prophylaxis of a range of most diverse diseases and conditions." The co-inventor, Aldar Bourinbaiar, Immunitor's CEO, added: "With the issuance of these two patents, our lead programs are further protected, significantly enhancing their commercial value."

Over the course of the company's development, Immunitor has achieved a broad and deep intellectual-property position in the orally delivered immunotherapeutics area. The company's patent portfolio now includes more than eight pending patents (including two international), with at least two dozen scientific publications in the peer-reviewed medical literature describing various aspects of the technology in infectious and autoimmune diseases, cancer, and metabolic diseases such as atherosclerosis and obesity. The combined annual market for these and related indications is close to $100 billion.

Immunitor is the industry leader in tableted oral vaccines and immunotherapies. During the past three years Immunitor completed two phase II clinical trials using V5 for treatment of chronic hepatitis B and hepatitis C. This year Immunitor seized upon an unexpected clinical outcome, which revealed the intriguing potential of V5 in curing tuberculosis in almost 95% of patients within one month. The results of the first trial in patients with tuberculosis who were co-infected with hepatitis C virus and HIV were published in October issue of Journal of Vaccines and Vaccination ( Patient enrollment for two additional phase 2b placebo-controlled trials involving 120 patients with difficult-to-treat forms of tuberculosis has been just completed in Ukraine and results are anticipated in early 2011.

To date, all clinical trials of V5 have provided strong evidence of an excellent safety profile and provided insights into the unparalleled efficacy that will guide Immunitor in the design of follow-on hepatitis and tuberculosis studies, which are now being arranged in South Africa, Pakistan, India and China.

Immune Network is continuing its work toward meeting the pre-conditions for completion of a merger or similar transaction with Immunitor. Several aspects of the updated corporation and its anticipated transactions will be announced early in December 2010.

A temporary website for Immune Network is at The Immune Network Ltd. logo is available at  .

Safe Harbor Statement

The information in this release, other than historical information, may be considered forward-looking statements within the provisions of the Private Securities Litigation Reform Act of 1995. Projection and other forward-looking statements and management expectations regarding future events and/or financial performance of the Company -- although given in good faith -- are inherently uncertain and actual events and/or results may differ materially.

This news release was distributed by GlobeNewswire,

SOURCE: Immune Network Ltd

CONTACT: Immune Network Ltd


The Lesser-Known Complications of HIV/AIDS

Erin N. Marcus, MD
Posted: November 29, 2010 07:51 AM

At the age of 56, Jules Levin felt pretty invincible, despite being HIV positive. He went to the gym regularly and controlled his disease well by taking his antiretroviral medicines every day.

Then he slipped one day while on vacation and broke his wrist. He underwent an operation to insert pins in his bones and needed to wear a cast for a month, keep his arm elevated, and then do physical therapy for two months to get to the point where he could lift a five pound weight. "It was one of the most difficult things I've ever been through in my life," he said. "I ran, biked, lifted weights and now all of a sudden I couldn't turn the page of a newspaper. It just really got to me."

After a few simple tests, the reason for Levin's fracture became clear: His bones were weak from osteoporosis, a disease that's most commonly seen in older women, but that's also associated with HIV.

"The giddiness of the age of HAART is over," said Levin, referring to highly active antiretroviral therapy, the life-saving drug regimen prescribed to people with HIV. "We should have an aging clinic in every hospital that's serving HIV patients."

Osteoporosis is one of many conditions associated with old age that is now being seen with increasing frequency in people with HIV. Research suggests that long-term exposure to the virus, and to the inflammation it triggers, make people vulnerable to premature aging and to a host of conditions seen with aging, heart and kidney disease, dementia, and osteoporosis.

Additionally, the overall population of people with HIV is getting older, thanks to improved medical therapy. At present, 1 in 4 people with HIV is age 50 or older. The U.S. Senate Special Committee on Aging has predicted that half of all adults with HIV will be older than 50 by the year 2015. Over the past few years, the National Institute of Health has increased its funding for research on HIV and aging, and the White House hosted a conference on October 27 on HIV and aging.

"The evidence is pretty clear," said Levin, who directs The National AIDS Treatment Advocacy Project (NATAP), a New York-based HIV education and advocacy group. "We're going to see early frailty, early senescence and people are going to start dying at earlier ages."

Compared to other conditions associated with HIV and aging, osteoporosis is relatively straightforward to forestall and treat. To maintain bone strength, it's important for all people with HIV to make sure they are consuming an adequate amount of calcium and Vitamin D. A recent article in the journal Clinical Infectious Diseases recommends 1,000 to 1,500 mg of calcium and 800 to 1,000 IUs of Vitamin D daily, as well as at least 30 minutes of weight-bearing exercise, such as jogging or walking, at least three days a week. Calcium is plentiful in dairy products and sardines, and is available in supplements such as calcium carbonate and calcium citrate. The National Institutes of Health has an online information sheet listing ways to get calcium. It's also important to avoid smoking and heavy alcohol use, since these can cause osteoporosis.

HIV is thought to be associated with osteoporosis for a variety of reasons. The infection, itself, causes inflammation, which in turn impacts the cells that maintain bones. Many conditions common in people with HIV, such as Vitamin D deficiency, being underweight and low testosterone, are associated with osteoporosis. Antiretroviral therapy and other medications frequently prescribed to people with HIV, such as Prednisone, also cause bone loss.

Even though many antiretrovirals can cause bone loss, osteoporosis is not a reason to stop taking them. "Antiretroviral therapy is life-saving, and we know that stopping antiretroviral therapy is not a good strategy for preventing complications," said Dr. Todd Brown, an endocrinology specialist at Johns Hopkins University who co-wrote the article in Clinical Infectious Diseases.

Brown and his coauthors recommend that all HIV-positive men older than age 50 and women who are past menopause undergo testing for osteoporosis, since it's a condition that usually doesn't cause symptoms until the person breaks a bone. His own research has found that osteoporosis is "alarmingly" prevalent among African Americans in inner city Baltimore. "Because of the perception that osteoporosis is a white disease, people of color get short shrift for screening," he said. "This concept that African Americans are protected shouldn't be a reason to neglect them."

Once someone is diagnosed with osteoporosis, it's important to take action to prevent falling, such as removing clutter and slippery rugs from the floor. Physical therapy can help improve strength and balance, which also reduce the risk of a fall. The person also should get his or her vision checked and review his or her medication list with a doctor to try to minimize any drug side effects or interactions that might cause drowsiness or unsteadiness.

A class of medicines called bisphosphonates can improve bone strength, but do have some rare risks. "While they do decrease the risk of fracture, they're not totally benign drugs," Brown said. "On the flip side, you shouldn't not use them in the patient who is at high risk of a fracture."

Levin urges all people with HIV to be assertive about discussing osteoporosis and other age-related conditions with their doctor. "My guess is that 90 percent of patients know nothing about any of this and a lot of clinicians and case managers don't know about it either," he said. "Every patient should ask their clinician, 'are you aware, are you monitoring me for heart disease, diabetes, bone disease, cognitive impairment, kidney disease?' This is an important issue for everybody."

A similar version of this article originally appeared on the website of New America Media.