November 23, 2011

Are you ready for World AIDS Day, December 1?

November 23, 2011
By Miguel Gomez, Director

“Leading with Science. United for Action.” is the U.S. Government theme for World AIDS Day 2011. This year, we are thankful for scientific advances in the response to HIV/AIDS, leading Secretary Clinton to call for an “AIDS-free generation.” Creating an AIDS-free generation has never been a policy priority for the U.S. Government until now, because this goal would have been unimaginable just a few years ago. Secretary Clinton’s call echoes the historic charge of the National HIV/AIDS Strategy.

On December 1st, people all around the world will commemorate World AIDS Day. We will think about how far we have come in the last 30 years and we at want everyone to get involved.

What can you do?
  1. Watch and share Secretary Hillary Clinton’s historic speech on HIV/AIDS which calls for an “AIDS Free Generation.”
  2. Plan a community event and/or take a photo for Facing AIDS. Share your message of why we all need to step up and face AIDS together.
  3. Print posters and tools from our World AIDS Day resources and use them at your events. Many are customizable and in English and Spanish.
  4. Locate HIV testing and other HIV services: Use and share the HIV/AIDS Prevention & Service Providers Locator and add the widget to your website or blog.
  5. Learn about and share the National HIV/AIDS Strategy. Read about agencies who are putting the strategy in action and talk about it with your colleagues — what would it take to make the goals of the Strategy real in your community?
  6. Follow our blogs and tweets  from guest blogs from the CDC and other Federal partners.
  7. Use the hashtag #WAD11  when sharing your thoughts on Twitter or Facebook.
We are all united together to take at least one small action to commemorate World AIDS Day. What are you doing in your community?


Researchers determine how antibody recognizes key sugars on HIV surface

November 23, 2011

HIV is coated in sugars that usually hide the virus from the immune system. Newly published research reveals how one broadly neutralizing HIV antibody actually uses part of the sugary cloak to help bind to the virus. The antibody binding site, called the V1/V2 region, represents a suitable HIV vaccine target, according to the scientists who conducted the study. In addition, their research reveals the detailed structure of the V1/V2 region, the last part of the virus surface to be visualized at the atomic level.

The study was led by Peter D. Kwong, Ph.D., chief of the Section of the Vaccine Research Center at the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health.

Some people who have been infected with HIV for several years begin to make antibodies that can neutralize a wide range of . These broadly neutralizing antibodies bind to one of four sites on the virus. One site involves a sugar at a spot called amino acid residue 160. ( are the building blocks of proteins.) The sugar is located on the protein-based spikes that jut out of the surface of HIV.

The new study demonstrates how a broadly neutralizing called PG9 disarms the virus by grabbing hold of the sugar at residue 160, along with part of a second sugar and a short string of amino acid residues in the V1/V2 region of an HIV spike.

Similarly, a separate, recently published report* from the IAVI Neutralizing Antibody Center at The Scripps Research Institute showed how a different broadly neutralizing HIV antibody also binds to the virus via two sugars and a string of . Taken together, these two studies indicate that in some cases, the combination of viral sugars and amino acids can form the binding site for broadly neutralizing HIV antibodies.

The new study may also help scientists who are examining data from the clinical trial of the first HIV vaccine to demonstrate effectiveness in people (

Recent analyses of blood samples from that trial showed that study participants who were vaccinated and then developed antibodies to the V1/V2 region were less likely to become infected. Although the role of those antibodies in protection against HIV is unknown, this finding underscores how understanding antibody-V1/V2 binding could aid the design of a more effective .

More information: JS McLellan et al., Structure of HIV-1 gp120 V1V2 domain with broadly neutralizing antibody PG9. Nature DOI: 10.1038/nature10696 (2011).

*R Pejchal et al., A potent and broad neutralizing antibody recognizes and penetrates the HIV glycan shield. Science DOI: 10.1126/science.1213256 (2011).
Provided by National Institutes of Health


Video: Mount Sinai Medical Center Launches Initiative to Erase the Stigma of Hepatitis C


Along with shattering the stigma surrounding the Hepatitis C virus, Dr. Dieterich wants patients to understand that testing positive for the virus is not a death sentence if caught early.

Also See: The Mount Sinai Medical Center Launches Initiative to Erase the Stigma of Hepatitis C and Encourage Everyone to Get Tested

Acetaminophen: Repeated Use of Slightly Too Much Can Be Fatal

Laurie Barclay, MD

November 22, 2011 — Repeated doses of slightly too much acetaminophen (known as paracetamol in the United Kingdom and elsewhere in Europe) can be fatal, according to the results of a large, single-center cohort study published online November 22 in the British Journal of Clinical Pharmacology.

"On admission, these staggered overdose patients were more likely to have liver and brain problems, require kidney dialysis or help with breathing and were at a greater risk of dying than people who had taken single overdoses," senior author Kenneth J. Simpson, MBChB (Hons), MD, FRCP (Edin), from the University of Edinburgh and Scottish Liver Transplant Unit in the United Kingdom, said in a news release.

"They haven't taken the sort of single-moment, one-off massive overdoses taken by people who try to commit suicide, but over time the damage builds up, and the effect can be fatal," he adds.

In the United Kingdom, acetaminophen hepatotoxicity is the leading cause of acute liver failure (ALF). However, the effect of a staggered overdose pattern or delayed hospital presentation on mortality or need for emergency liver transplantation was previously unknown.

Of 663 patients admitted with acetaminophen-induced severe liver injury between 1992 and 2008, 161 (24.3%) had taken a staggered overdose. Compared with patients who took an overdose at a single time, patients with staggered overdose were significantly older and more likely to abuse alcohol.

When asked why they repeatedly ingested more than the recommended dose of acetaminophen, patients with staggered overdose most often cited pain relief as their rationale (58.2%).
Compared with patients who took an overdose at a single time, those who took staggered overdoses had lower total ingested doses and lower serum alanine aminotransferase (ALT) levels on admission. Nonetheless, they were more likely to be encephalopathic and to require renal replacement therapy or mechanical ventilation.

Although mortality was higher in staggered overdoses than in single-time overdoses (37.3% vs 27.8%; P = .025), the staggered overdose pattern was not an independent predictor of mortality. For staggered overdoses, sensitivity of the King's College poor prognostic criteria was reduced (77.6%; 95% confidence interval [CI], 70.8% - 81.5%).

Delayed presentation to medical services more than 24 hours after single-time overdose occurred in 44.9% of those in whom accurate timings could be determined, and was independently associated with death or liver transplantation (odds ratio [OR], 2.25; 95% CI, 1.23 - 4.12; P = .009).

In their logistic regression analysis, the investigators controlled for signs and symptoms, such as hepatic encephalopathy and prothrombin time, as well as various demographic factors.

"Staggered overdoses or patients presenting late after an overdose need to be closely monitored and considered for the paracetamol antidote, N-acetylcysteine [NAC], irrespective of the concentration of paracetamol in their blood," Dr. Simpson said.

Because both these groups are at increased risk of developing multiorgan failure, they should be considered for early transfer to specialist liver centers.

Limitations of this study include reliance on patient recall regarding the time of last ingestion, total paracetamol dose, and suicidal intent; limited data regarding the use of concomitant P450 enzyme inducers or recent fasting; and selection bias for the more severe cases of acetaminophen toxicity in Scotland.

"[T]his large cohort study demonstrates the deleterious effects of delayed presentation and staggered overdose pattern upon outcome following paracetamol-induced acute liver injury," the study authors conclude. "Both delayed presentation > 24 hours and staggered overdoses are strongly associated with multiorgan injury and the need for [liver transplantation]. Patients presenting with these overdose patterns should be treated as high risk for progression to ALF, and should receive NAC in their presenting hospital whilst awaiting serial ALT and PT levels."

This study received no external funding. The authors have disclosed no relevant financial relationships.

Br J Clin Pharmacol. Published online November 22, 2011.


New HCV Drugs at AASLD

62th Annual Meeting of the American
Association for the Study of Liver Diseases
San Francisco 2011 Nov 6-9

from Jules of NATAP: There were so many positive presentations on new HCV drugs in development that one can only conclude SVR/'cure rates' will eventually be 100% for all treatable patients, whether patients are white, black or gentotypes 1 or 2/3. The once-daily HCV nucleotide PSI-7977 captured the imagination at AASLD with studies in only 40 patients with genotype 2/3 showing 100% cure rates receiving interferon-free regimen of PSI-7977+ribavirin for only 12 weeks, in this study their are 4 different regimens studied, see the link below to read the entire details. In the genotype 1 study 95 patients received PSI-7977+peg/rbv for 12 weeks followed by 12 additional weeks of Peg/Rbv alone, with 91-98% SVR rates, there were no viral failures, 4 patients withdrew due to Peg/Rbv side effects. This drug is entering Phase 3 studies in the Spring 2012, the last phase before FDA approval, which could take until 2014. The manufacturer Pharmasset has a 2nd nucleotide PSI-938 in earlier development and has already conducted studies combining these 2, and will conduct further studies combining them. Two other major classes of drugs are in accelerated development. The potent once-daily BMS NS5A inhibitor BMS-790052 is moving quickly through development being studied currently in an interferon-free 2-drug combination in genotype 1 patients with PSI-7977, the study is ongoing and results are not ready yet. Several studies of BMS-790052 presented at AASLD are reported below. Currently in Phase 3 are 2 new HCV protease inhibitors Tibotec's once-daily TMC-435 and Boerhinger Ingelheim's once-daily BI-201355, both are potent, and study results for both drugs were presented at AASLD and are linked to below. Tibotec is also studying their protease TMC-435 in combination with PSI-7977. BI also reported study results at AASLD of their interferon-free regimen which includes their protease BI-201335 + their NNRTI BI-207127 and ribavirin, linked to below. Tibotec announced study results for the first time for a new NNRTI TMC-647055, results presented below. Roche reported study results for their potent HCV protease danoprevir, linked to below, and will present at EASL new results of low-dose ritonavir boosted danoprevir in the near future. Study results of a combination of the BMS NS5A + their HCV protease BMS-790032 was reported at AASLD, linked to below. The first-in-class cyclophillin inhibitor from Novartis potent alisporivir/DEB025 is currently in phase 3 development, study results in genotype 1 were reported last Spring at EASL and study results in genotype 2 were reported at AASLD, linked to below. Vertex reported study results of their potent QUAD therapy regimen which includes telaprevir+ their NNRTI VX-222 + Peg/Rbv, results reported below. Merck reported early study results from an 8-day monotherapy study of their potent 2nd generation HCV protease inhibitor MK-5172, which showed 5 to 5.5 log reductions, so far perhaps the most potent protease, and they presented a poster showing in vitro this protease is active against, it suppresses protease resistant viruses, suggesting patients who fail with resistance would benefit from this protease and it would also be a potent first-line protease for treatment-naive patients, these studies linked to below. Merck also reported their first study pre-clinical data for a new NS5A inhibitor MK-4882 they discovered & are developing, which appears potent showing 4-log viral load reductions in the chimp after, linked to below. GSK reported for the first time on their new potent NS5A inhibitor GSK-2336805 showing early results from a single and repeat dose study in patients, see link below to view results. Gilead is researching 2, 3 and 4 drug HCV regimens with and without interferon and without ribavirin, Gilead has drugs of their own in every class including protease, NNRTI, NS5A and nucleotide, and have studies exploring these regimens ongoing, with further results to be presented in the near future, they did present some preliminary study data at AASLD, linked to below, but the study results expected to be reported in the near future from these ongoing studies will be much more informative and are highly anticipated. Abbott as well is in the middle of conducting ongoing studies so they did not have any study results to report at AASLD, but they have a potent HCV protease, 2 NNRTIs, and other classes of drugs in development, so it is expected they will in the near future also be presenting highly anticipated results from these ongoing studies. Presidio, a small biotech, is developing a potent NS5A inhibitor PPI-461and reported results from their dose-ranging study at AASLD, linked to below. Achillion & Inhibitex, 2 small biotechs, reported very promising study data on their drugs, Achillion is developing a potent HCV protease and a promising 2nd generation NS5A inhibitor, expected to be active against, to suppress NS5A resistant virus, they reported interesting data at AASLD, linked to below. As well Inhibitex reported their first new data on a higher dose of their nucleotide INX-189 at AASLD, it looks potent, data linked to below. BMS reported study results for their new peg-lambda interferon showing it to be potent with much less side effects, linked to below. Roche is developing a nuke mericitabine, it is rather advanced stage of development, and they reported encouraging resistance data, linked to below. In sum, is there any doubt that we can eventually expect a 100% 'cure rate' in all patients who will be treatable.

AASLD: PROTON: PSI-7977 & Peg/RBV in Treatment-naïve Patients with HCV GT1: Sustained Virologic Response - (11/08/11)

AASLD: PSI-7977: ELECTRON Interferon is not required for Sustained Virologic Response in Treatment-Naïve Patients with HCV GT2 or GT3 - (11/07/11)

AASLD: High sustained virologic response (SVR24) rates with response-guided danoprevir (DNV; RG7227) plus PegIFN alfa-2a (40KD) and ribavirin (P/R) in treatment-naive HCV genotype 1 (G1) patients: results from the ATLAS study - (11/07/11)

AASLD: Treatment with the 2nd generation HCV protease inhibitor BI 201335 results in high and consistent SVR rates - results from SILEN-C1 in treatment-naïve patients across different baseline factors - (11/08/11)

AASLD: High SVR following IFN-free treatment of chronic HCV GT1 infection for 4 weeks with HCV protease inhibitor BI 201335, polymerase inhibitor BI 207127 and ribavirin, followed by BI 201335 and PegIFN/ribavirin - the SOUND-C1 study - (11/08/11)

AASLD: Virologic response to an interferon-free regimen of BI 201335 and BI 207127, with and without ribavirin, in treatment-naïve patients with chronic genotype-1 HCV infection: Week 12 interim results of the SOUND-C2 study - (11/08/11)

AASLD: SILEN-C3: treatment for 12 or 24 weeks with BI 201335 combined with peginterferon alfa-2a and ribavirin in treatment-naïve patients with chronic genotype-1 HCV infection - (11/07/11)

AASLD: Positive Interim Results from Interferon-Free Phase 2b SOUND-C2 Study with Boehringer Ingelheim's Two Investigational HCV Direct Acting Antivirals Presented at AASLD - press release - (11/08/11)

AASLD: Once-daily alisporivir interferon (IFN)-free regimens achieve high rates of early HCV clearance in previously untreated patients with HCV genotype (G) 2 or 3 - (11/09/11)

AASLD: Novartis DEB025 data showed viral clearance as early as six weeks and potential for interferon-free therapy in hepatitis C patients - (11/07/11)

AASLD: TMC435 in Combination with Peginterferon and Ribavirin in Treatment-naïve HCV Genotype 1 Patients: Final Analysis of the PILLAR Phase IIb Study (TMC435-C205) - (11/08/11)

AASLD: Human safety, pharmacokinetics and antiviral activity of TMC647055, a novel HCV non-nucleoside polymerase inhibitor - (11/07/11)

AASLD: QUAD VX-222/Telaprevir in Combination With Peginterferon-alfa-2a and Ribavirin in Treatment-naïve Genotype 1 HCV Patients Treated for 12 Weeks: ZENITH Study, SVR12 Interim Analysis - (11/09/11)

AASLD: Daclatasvir (DCV; BMS-790052), an NS5A Replication Complex Inhibitor, in Combination With Peginterferon Alfa-2b and Ribavirin in Japanese Treatment-Naïve and Nonresponder Patients With Chronic HCV Genotype 1 Infection - (11/10/11)

AASLD: Combination Therapy of Treatment-Naïve and Nonresponder Patients With HCV Genotype 1 Infection With Daclatasvir (DCV; BMS-790052), an NS5A Replication Complex Inhibitor, in Combination With Peginterferon Alfa-2a and Ribavirin - (11/10/1

AASLD: Dual Oral Combination Therapy with the NS5A Inhibitor Daclatasvir(DCV; BMS-790052) and the NS3 Protease Inhibitor Asunaprevir(ASV; BMS-650032) Achieved 90% Sustained Virologic Response (SVR12) in Japanese HCV Genotype 1b-Infected Null Responders - (11/08/11)

AASLD: Evaluation of Drug Interaction Potential of the HCV Protease Inhibitor Asunaprevir (ASV; BMS-650032) at 200 mg Twice Daily (BID) in Metabolic Cocktail and P-glycoprotein (P-gp) Probe Studies in Healthy Volunteers - (11/16/11)

AASLD: Single-Dose Pharmacokinetics of Daclatasvir (DCV; BMS-790052) in Subjects With Hepatic Impairment Compared With Healthy Subjects - (11/16/11)

AASLD: Daclatasvir (DCV; BMS-790052) Has No Clinically Significant Effect on the Pharmacokinetics of a Combined Oral Contraceptive Containing Ethinyl Estradiol and Norgestimate in Healthy Female Subjects - (11/16/11)

AASLD: GSK2336805 HCV NS5A Inhibitor Demonstrates Potent Antiviral Activity in Chronic Hepatitis C (CHC) Genotype 1 Infection: Results from a First Time in Human (FTIH) Single and Repeat Dose Study - (11/09/11)

AASLD: Dose-Ranging Trial of PPI-461, a Potent New Pan-Genotypic HCV NS5A Inhibitor, in Patients with HCV Genotype-1 Infection - (11/07/11)

AASLD: Antiviral Activity/Resistance Monitoring of HCV Patients Treated for Three Days with the NS5A Inhibitor PPI-461 Reveals Rapid Emergence of Resistant HCV Variants - (11/07/11)

Inhibitex Nucelotide INX-189 Higher Dosing Increases Viral Load Reduction - Inhibitex reports third quarter financial results and recent corporate developments - (11/07/11)

AASLD: Antiviral Activity and Safety of INX-08189, a Nucleotide Polymerase Inhibitor, Following 7-Days of Oral Therapy in Naïve Genotype-1 HCV Patients - (11/07/11)

AASLD: Safety and Efficacy of Peginterferon Lambda-1a (Lambda) Compared With Peginterferon Alfa-2a (Alfa-2a) in HCV-Infected Patients (G1/2/3) With Compensated Cirrhosis: EMERGE Phase 2B Efficacy and Safety Results Through Week 12 - (11/10/11)


AASLD: Safety and Antiviral Activity of MK-5172, a Next Generation HCV NS3/4a Protease Inhibitor with a Broad HCV Genotypic Activity Spectrum and Potent Activity Against Known Resistance Mutants, in Genotype 1 and 3 HCV-Infected Patients - (11/07/11)

AASLD: MK-5172, a Second Generation HCV NS3/4A Protease Inhibitor is Active Against Common Resistance Associated Variants (RAVs) and Exhibits Cross-Genotype Activity - (11/07/11)

AASLD: Pharmacokinetics and Pharmacokinetic/Pharmacodynamic Relationship for MK-5172, a Novel Hepatitis C Virus (HCV) NS3/4A Protease Inhibitor, in Genotype 1 and Genotype 3 HCV-Infected Patients - (11/16/11)

AASLD: Discovery of MK-4882, a Novel Inhibitor of HCV NS5a with an Attractive Pre-clinical Profile - (11/07/11)

AASLD: The Effects of Combining Two Gilead Direct Acting Antivirals GS-9256+GS-9190, Ribavirin, and Pegylated Interferon on the Detection of Drug Resistance Mutations Early in Treatment of HCV - (11/15/11)

AASLD: Evaluation of Pre-Existing Levels of Y448H HCV NS5B Polymerase Mutant Using Viral Kinetics Monitored by Allele-Specific PCR in HCV Patients and Replicon Cells Treated with the HCV Non-Nucleoside Inhibitor Tegobuvir - (11/15/11)

AASLD: Characterization of HCV Resistance from a Multiple Dose Clinical Trial of GS-5885, a Novel HCV NS5A Inhibitor - (11/15/11)

AASLD: In Vitro Selection of Resistance to GS-9451, a Novel and Potent Inhibitor of HCV NS3 Protease - (11/15/11)



AASLD: Novel Hepatitis C Virus NS5A Inhibitors with Improved Potency Against Genotype-1a Replicons and Replicons Carrying Mutations Associated With Viral Resistance to 1st Generation NS5A Inhibitors - (11/10/11)

AASLD: Once-Daily Narlaprevir (NVR; SCH 900518) and Ritonavir (RTV) in Combination With Peginterferon Alfa-2b/Ribavirin (PR) for 12 Weeks Plus 12 Weeks PR in Treatment-Naive Patients With HCV Genotype 1 (G1): SVR Results From NEXT-1, a Phase 2 Study - (11/16/11)

AASLD: Safety and Efficacy of Vaniprevir (MK-7009) in Combination with Peg-interferon a-2a (Peg-IFN)/Ribavirin (RBV) in Genotype 1 Treatment-Experienced HCV-Infected Japanese Patients - (11/16/11)

AASLD: A Phase 2b Study of MK-7009 (vaniprevir) in Patients with Genotype 1 HCV Infection Who HaveFailed Previous Pegylated Interferon and Ribavirin Treatment - (11/15/11)


AASLD: Baseline and early on-treatment characteristics in HBeAg-positive patients with chronic hepatitis B infection achieving an early on-treatment response to pegylated interferon alfa-2a (40KD): interim results from the RGT study - (11/20/11)

AASLD: Patients with HBeAg-positive chronic hepatitis B with a maintained virologic response to entecavirachieved HBsAg clearance when switched to peginterferon alfa-2a (40KD) therapy (the OSST study) - (11/16/11)

AASLD: A novel combination regimen of peginterferon alfa-2a (40KD) and entecavir results in sustained post-treatment HBsAg clearance in HBeAg-positive chronic hepatitis B - (11/16/11)

AASLD: Peginterferon alfa-2a monotherapy as a strategy for achieving sustained response in patientsswitched from long-term nucleos(t)ide analog therapy: the results of 1 year follow up - (11/16/11)

AASLD: A response-guided approach to pegylated interferon alpha-2a (40KD) therapyto improve response rates in HBeAg-negative, genotype D patients - (11/16/11)

AASLD: Response rates are similar for patients with and without advanced fibrosis/cirrhosis, and highest with peginterferon alfa-2a (40KD) 180 μg for 48 weeks in the NEPTUNE study - (11/16/11)

AASLD: Five years of Treatment with Tenofovir DF for Chronic Hepatitis B Infection is Associated with Sustained Viral Suppression and Significant Regression of Histological Fibrosis and Cirrhosis - (11/14/11)

AASLD: No Detectable Resistance to Tenofovir Disoproxil Fumarate (TDF) Following up to 240 Weeks of Treatment in Patients with HBeAg+ and HBeAg-Chronic Hepatitis B Virus Infection - (11/14/11)

AASLD: Five years of Treatment with Tenofovir DF for Chronic Hepatitis B Infection in Asian Patients is Associated with Sustained Viral Suppression and Significant Regression of Histological Fibrosis and Cirrhosis - (11/14/11)

AASLD: Gilead Announces Positive Five-Year Data Showing Effect of Viread(R) on Liver Fibrosis and Cirrhosis Caused by Chronic Hepatitis B: '88% of patients on tenofovir in studies experienced reversal of fibrosis/cirrhosis' - press release - (11/14/11)

AASLD: Entecavir (ETV) monotherapy for 96 weeks is comparable to combination therapy with ETV plus tenofovir (TDF) in nucleos(t)ide-naïve patients with chronic hepatitis B (CHB): the BE-LOW study - (11/10/11)

AASLD: Phase IIIb Comparison of BARACLUDE® (entecavir) Monotherapy Versus BARACLUDE Plus Tenofovir Combination Shows No Statistical Difference Between Study Arms - press release - (11/10/11)