March 23, 2012

The Affordable Care Act: Our Second Most Important Tool for Combating HIV and Ending AIDS

Posted: 03/23/2012 7:49 pm

As the nation turns its eyes toward the Supreme Court and its review of the Patient Protection and Affordable Care Act (the "ACA") this coming week, people living with HIV and their advocates will be among those watching carefully and most anxiously awaiting the outcome. For many of the approximately 1.2 million people with HIV in this country, the Court's decisions will directly affect access to quality care and life-saving treatment. Though not by any means the only group with a great deal at stake here, those affected by HIV present an exceptionally strong example of the positive impact the ACA will have, and a particularly compelling argument for the statute's constitutionality.

People living with HIV have been systematically excluded from the health-care insurance and health-care markets. Only 17 percent of people living with HIV have private health insurance, compared with 67 percent of the general population. While some of the remaining 83 percent have insurance through public programs (e.g., Medicare, Medicaid, the VA, etc.), nearly 30 percent are forced to rely exclusively upon the often spotty benefits provided through the overburdened and underfunded Ryan White programs, or to go without care altogether.

The consequences of this patchwork quilt of health care for people living with HIV are devastating: they discover their status later, go longer without lifesaving care and treatment, suffer greater complications and poorer health outcomes, and continue to die at frustratingly high and unnecessary rates. These negative consequences are more pronounced and concentrated in already marginalized populations, such as low-income communities; the gay, bisexual, and transgender communities; and communities of color -- most acutely, the black community.

We have at our disposal the means to avoid many of these consequences. Antiretroviral medications (ARVs) provide us with the opportunity to seriously impede progression of the disease, especially when it is discovered in a timely fashion, to prevent most of the complications and poor health outcomes associated with an AIDS diagnosis, and to dramatically reduce the number of AIDS-related deaths each year. For those with access to consistent, quality care and treatment, HIV can now be a chronic, manageable condition -- akin to diabetes or high blood pressure.

What's more, quality care and effective treatment for those currently living with HIV will significantly curtail the further spread of HIV. ARVs work by reducing the level of virus in a person's blood to extremely low levels -- and the less virus in the blood, the lower the chances of transmitting the disease. Recent studies show that the already-lower-than-generally-realized risk of contracting HIV sexually is reduced by up to 96 percent when a person's viral load is suppressed to undetectable levels. Not only is near-universal access to quality health care good for people living with HIV, but it is also one of the best prevention tools we have.

The positive effects of the ACA and the near-universal access to health care it will provide to people living with HIV by 2015 are not just theoretical. Massachusetts, where health-care reform similar to the ACA was enacted years ago, experienced a 37-percent reduction in new HIV infections from 2005 to 2008, while the rest of the country experienced an 8-percent increase. And Massachusetts's age-adjusted HIV/AIDS death rate is almost half the national average (2 percent vs. 3.7 percent). These statistics, and the improved circumstances they describe, foretell what the nation can expect when the ACA is fully implemented.

When viewed through the prism of the HIV/AIDS epidemic, the argument for the constitutionality of the ACA's minimum coverage requirement (or "individual mandate") is relatively simple. Congress has the power to address the exclusion of a particular group -- specifically people living with HIV, but more broadly anyone with a pre-existing condition -- from a market that operates in interstate commerce. But the ban on preexisting condition exclusions will not work without the accompanying individual mandate, which requires every American to become a part of the health-care insurance pool regardless of their current health status. For that reason, the individual mandate is a necessary and proper means by which Congress can effectuate its clearly constitutional power to regulate an interstate market under the Commerce Clause.

Full implementation of the ACA is absolutely critical in our battle against HIV/AIDS. Public health authorities are already talking about the "end of AIDS," meaning the ability to prevent a person's progression from HIV-positive to an AIDS diagnosis and the most detrimental effects of the disease. Let's hope the Supreme Court recognizes the constitutionality of the action Congress took when it passed the ACA, which will similarly prevent our nation's broken health-care system from going from bad to worse -- not just for people living with HIV but for all of us.

For a more detailed explanation of the legal arguments discussed above, read the friend-of-the-court brief submitted by Lambda Legal on behalf of 16 HIV advocacy groups, which was subsequently endorsed by 130 more groups.


9 Simple Ways to Boost Your Liver


Michelle Schoffro Cook June 23, 2011 3:01 pm

The liver is the body’s main fat-digesting and detoxification organ. Every molecule of fat that you eat must pass through your liver, but if your liver is overburdened by its more than 500 other essential activities, it can become sluggish. Here are ways to boost your liver function:

1. Since the liver requires high amounts of vitamins and minerals to perform its many functions, your diet should be high in fruits and vegetables and nutrient-rich foods.

2. Because food additives and preservatives need to be filtered by your liver, your diet should be free of processed foods, artificial food additives, colors, and preservatives to take the load off your liver. Additionally, choose to eat a diet low in refined sugar and synthetic sweeteners.

3. You should definitely be avoiding margarine, shortening, commercial oils (choose unrefined oils from the refrigerator section of your local health food store). Avoid eating animal fat and fried foods as well.

4. Drink between eight to ten glasses of pure, filtered water every day. This is the only way your liver can flush toxins out of your body.

5. Better yet, start every day with a large glass of water with the fresh juice of one-half to one lemon added. Lemon helps bolster you liver’s detoxification abilities.

6. Eat plenty of liver-rebuilding foods, including: carrots, beets, leafy greens, and other green vegetables.

7. Eat lots of garlic, onions and broccoli since these foods contain sulfur that is required to increase the liver’s detoxification ability.

8. Detoxification in the liver requires considerable amounts of nutrients to function properly so be sure to take a high quality multivitamin and mineral supplement. Even a single nutrient deficiency can seriously disrupt natural detoxification processes.

9. While lying flat on your back, you can gently massage the liver/gallbladder area, which is located along the lower rib area on the right side of your body. This helps improve circulation to the area.

Always consult your physician prior to making dietary changes or taking nutritional supplements.


Hepatitis C Treatment for Drug Users

March 23, 2012

The stigma surrounding addiction may discourage Hepatitis C treatment for drug users - but the evidence encourages these individuals to do triple therapy.

By Nicole Cutler, L.Ac.

Across a variety of cultures, the ability to receive quality medical treatment is not uniform. Unfortunate for some with chronic Hepatitis C, access to the latest drugs can be unjustly withheld. Having health insurance coverage, being considered a good candidate for treatment and assumption of a low relapse risk can be determining factors in who gets the most advanced medications for fighting the Hepatitis C virus. Despite being a population particularly inundated by this viral infection of the liver, intravenous drug users are often excluded from the latest approved Hepatitis C drug regimen.

Clinically acknowledged as a disabling disease, drug addiction is found in every socioeconomic class, within every ethnic group and gender. Addicts typically have extremely strong physiological and psychological cravings to use drugs despite their negative effects. The cravings can be as strong as a human's desire for food and water. Society imposes stigma on addicts because many still believe that addiction is a character flaw or weakness that is incurable. Despite addiction being a treatable disease, the stigma against addicts remains deeply rooted.

Click here to continue reading full article …

AASLD Grant Supports Hepatitis Projects in Mongolia

AASLD News: March 22, 2012

AASLD recently provided a grant in support of the Flagstaff International Relief Effort’s (FIRE) hepatitis related projects in Mongolia.

FIRE is dedicated to providing resources and support to individuals and communities in need, from poverty, political instability, or natural disasters. Their programs are currently focused in Mongolia, an area of the world that a recent article in the Lancet concluded "…has the world's highest rate of liver cancer (deaths) - six times the global average - and the number is increasing..." According to the World Health Organization, "…one of every ten deaths in the country is due to HCC (hepatocellular carcinoma or liver cancer) or its frequent precursor, cirrhosis. In the absence of a solid understanding of this epidemiology, the country's hepatitis C prevalence continues to rise…" Seldom do we hear about these silent tragedies. One of FIRE's missions is to get the message out to the world and to make a change.
With funding from AASLD and other organizations, FIRE has since August been able to:

  • Test 400 health care workers for hepatitis B
  • Send 300 samples to NIH for testing and epidemiological study of hepatitis B, C and D
  • Facilitate the vaccination of 400 selected health care workers for hepatitis B
  • Facilitate the distribution of 20,000 sharps containers

FIRE’s goals for the spring and summer of 2012 are to:

  • Complete a training video for health care workers on health safety practices and hepatitis prevention
  • Facilitate the distribution of 40,000 sharps containers
  • Train 200 health care workers on hepatitis prevention
  • Send 500 blood samples to NIH to conduct testing and epidemiological study of hepatitis B, C, and D
  • Continue the development of a new project with the National Cancer Institute (NCI), a division of NIH, addressing liver cancer

To learn more about FIRE’s hepatitis related projects in Mongolia visit


Studies see link between HIV and abuse among women


Steptoe now sees her medication regimen as prolonging her life

Liz Hafalia / The Chronicle

Erin Allday

Friday, March 23, 2012

Diagnosed with HIV in the late 1980s, Cassandra Steptoe didn't tell anyone for years, and she didn't get any treatment.

She was depressed and hopeless after a lifetime of physical and sexual abuse. She assumed the infection would kill her. But, somehow, she survived - not just the HIV infection, but far more.

During the past decade, she's received help overcoming the trauma from the years of abuse, and in turn, she's finally faced her HIV diagnosis. And she is far healthier for it, she says.

"I'm a stronger person, a better person, than I was before," said Steptoe, who started treatment in 2003 at the Women's HIV Program at UCSF. "Now when I look at my pills, it's like another day of life."

Steptoe's story - especially her history of trauma and abuse - is hardly unique among women with HIV and AIDS, say doctors and public health experts. In fact, trauma and post-traumatic stress syndrome are closely tied both to the risk of becoming infected with HIV and lower rates of successful treatment, according to two recent UCSF studies.

Address the trauma

And health care providers could better serve many of their female HIV patients if they tackled trauma at the same time as the infection, said Dr. Edward Machtinger, director of the Women's HIV Program and lead author of the studies.

"Screening and responding to trauma needs to be a core element of health care for HIV-positive women, alongside medication and CD4 counts and viral load," Machtinger said.

Machtinger's studies were published this month in the journal AIDS and Behavior. The first study, an analysis of 29 previous reports, found that HIV-positive women were two to six times more likely to have suffered trauma or post-traumatic stress than women without HIV.

According to the study, roughly 30 percent of women with HIV have PTSD - six times the rate of PTSD in the general population of women. More than 60 percent of HIV-positive women have experienced sexual abuse in their lives, compared with 12 percent of women overall, and 55 percent of women with HIV have been a victim of domestic violence, compared with 25 percent of women overall.

The second study looked at patients in UCSF's Women's HIV Program. Based on surveys given to 113 patients, women who had suffered a recent trauma were four times more likely than women who hadn't suffered a trauma to have detectable levels of virus in their blood - meaning that their drug treatment wasn't working.

Those women were also nearly four times more likely than their peers to have unprotected sex with someone who wasn't infected with HIV - or whose status was unknown.

"It appears to us that trauma fuels the HIV epidemic among women," Machtinger said.

A common thread

Health care providers who work with HIV-positive women said physical and sexual abuse is without question common. And when women have experienced a very recent trauma or are in an abusive relationship, the effect on their HIV treatment can be disastrous.

These women may suffer depression or self-esteem issues that make it difficult for them to seek treatment, health care providers said. Or women in an abusive relationship may have partners who won't let them see doctors or pick up their medications.

In many cases, women haven't told their partners that they are HIV-positive, which makes it more difficult to get treatment, said Mary Lawrence Hicks, a nurse practitioner at San Francisco General Hospital who works in the women's HIV clinic there.

"These (HIV) meds must be taken at least on a once-a-day basis, and that's hard for anyone to maintain," Hick said. "But with the chaotic lifestyles that some folks end up in when there's a lot of trauma, it's very, very difficult."

Like many health care providers who treat HIV patients, Hicks said that working with HIV-positive women requires as much focus on mental health care as traditional medical treatment. Many women-centered HIV clinics have social workers and psychiatrists on staff.

"We can't just say here's the prescription and I'll see you in six months," said Dr. Deborah Cohan, director of the Bay Area Perinatal AIDS Center at San Francisco General Hospital. "That's not a realistic way of taking care of these women, because their lives are much more complicated than that."

Road to recovery

For Steptoe, confronting her past trauma was one of the first steps she needed to take toward treating her HIV. She's lucky, she said, that she lived so long without medical care, even as she watched other women die of AIDS.

After moving to San Francisco in 2001, Steptoe went to UCSF for treatment and met Machtinger. He got her started on antiretroviral drugs and pushed her toward counseling programs. Her self-esteem has skyrocketed, she said.

She's now living with her granddaughter and taking care of them both. Her HIV is under control, and she said she's never felt healthier.

"I want to tell other women, we don't have to be beaten up on or have low self-esteem and no value or respect about our bodies," Steptoe said. "I'm on the right path now."

Erin Allday is a San Francisco Chronicle staff writer.


Investigating the Serotonin-Liver Relationship

March 23rd, 2012

Serotonin, the hormone known to make people happy, may also be deeply involved in liver fibrosis.

By Nicole Cutler, L.Ac.

The human body is a complexity, involving countless amazing feats at every moment. Nowhere is this seemingly miraculous series of events more pronounced than in the liver. An organ subjected to repeated abuse, the liver maintains a remarkable ability to regenerate itself upon incurring cellular damage. A new study published in a peer-reviewed journal has found that a hormone known predominantly for its link to emotional well-being also appears to play a role in liver cell regeneration.

Especially in the presence of the Hepatitis B or C virus, alcoholism, a fatty liver or an autoimmune disease, sometimes the balance required to repair liver cells gets disrupted. This disruption impairs the liver’s regenerative abilities so that it can no longer keep up with relentless liver cell injury – and scars form. The propensity to scar more than repair the cellular damage describes the course of chronic liver disease – and British researchers believe that a well-known hormone could be the key to regaining balance.

Click here to continue reading full article …

March 23, 2012, 8:00 a.m. EDT Nordion to Launch Improved Physician Tools for TheraSphere® Liver Cancer Treatment at SIR Annual Scientific Meeting 2012



March 23, 2012, 8:00 a.m. EDT

OTTAWA, March 23, 2012 /PRNewswire via COMTEX/ -- Company will also present expert speakers and introduce new iPad app

Nordion Inc. ,a leading provider of products and services for the prevention, diagnosis and treatment of disease, will be attending the Society for Interventional Radiologists (SIR) Annual Scientific Meeting 2012, taking place March 24-29 in San Francisco. The company will introduce several new or updated physician education tools and resources for TheraSphere®, Nordion's Y-90 microsphere treatment for liver cancer.

"With more than 5,000 physicians, scientists and healthcare professionals in attendance, SIR represents one of the most important annual medical meetings Nordion attends," says Peter Covitz, Nordion Senior Vice President, Innovation. "SIR provides an opportunity to connect directly with our key users, share the latest information about TheraSphere, listen to feedback, and respond to questions firsthand."

Nordion representatives will be at Booth #1234 to talk about TheraSphere. The company will host two "Eat and Be Educated" learning sessions at the booth:

Sunday, March 25, 12:15pm How TheraSphere Y-90 Glass Microspheres Fits in Our Treatment Algorithm Matthew Johnson, MD Professor of Radiology and Surgery Indiana University School of Medicine Indianapolis, IN

Tuesday March 27, 12:15pm TheraSphere Multi-Vessel Delivery Siddharth Padia, MD Assistant Professor, Interventional Radiologist University of Washington - Harbourview Medical Center Seattle, WA

Each session will be followed by a Nordion presentation on how to start a TheraSphere program.

Other Nordion TheraSphere activities at SIR include:

Launch of the:

New custom dose feature in Europe and Canada*

Updated Treatment Window Illustrator tool to assist physicians with dose selection

New animated video demonstrating how TheraSphere works

Preview of the upcoming TheraSphere iPad app

Participation in SIR's Residents in Training program

* Nordion has filed a request with the Food and Drug Administration for approval of the custom dose feature in the United States.

About TheraSphere TheraSphere is a liver cancer therapy that consists of millions of small glass beads (20 to 30 micrometers in diameter) containing radioactive yttrium-90 (Y-90). The product is injected by physicians into the artery of the patient's liver through a catheter, which allows the treatment to be delivered directly to the tumour via blood flow.

In the US, TheraSphere is used to treat patients with unresectable hepatocellular carcinoma (HCC), the most common form of primary liver cancer, and can be used as a bridge to surgery or transplantation in these patients. It is also indicated for the treatment of HCC patients with portal vein thrombosis (PVT). TheraSphere is approved by the U.S. Food and Drug Administration (FDA) under a Humanitarian Device Exemption (HDE). HDE approvals are based on demonstrated safety and probable clinical benefit. However, effectiveness of the indication for use has not been established.

TheraSphere® is used in the European Union and in Canada for the treatment of hepatic neoplasia in patients who have appropriately positioned arterial catheters.

Common side effects include mild to moderate fatigue, pain and nausea for about a week. Physicians describe these symptoms as similar to those of the flu. Some patients experience some loss of appetite and temporary changes in several blood tests. For details on rare or more severe side effects, please refer to the TheraSphere package insert/instructions for use at .

About Nordion Inc. Nordion Inc. is a global health science company that provides market-leading products used for the prevention, diagnosis and treatment of disease. We are a leading provider of medical isotopes, targeted therapies and sterilization technologies that benefit the lives of millions of people in more than 60 countries around the world. Our products are used daily by pharmaceutical and biotechnology companies, medical-device manufacturers, hospitals, clinics and research laboratories. Nordion has more than 500 highly skilled employees in three locations. Find out more at  and follow us at  .

SOURCE Nordion Inc.


Largest Comparative Study of Radioembolisation Shows SIR-Spheres Microspheres Significantly Improves Survival for Cancer Patients with Inoperable Liver Tumours



March 23, 2012, 10:00 a.m. EDT

ORLANDO, March 23, 2012 /PRNewswire via COMTEX/ -- New Australian Data Provides Further Evidence of Survival Benefit for Radioembolisation

Findings from the largest comparative multi-centre study performed to date using radioembolisation report a significantly prolonged survival benefit following SIR-Spheres microspheres in patients with treatment-refractory liver tumours from colorectal and other cancers. The results of the study were presented today at the 65th Annual Cancer Symposium of the Society of Surgical Oncology, by Associate Professor Lourens Bester, Director of Radiology at St Vincent's Hospital, Sydney.[1]

Radioembolisation, which is also called Selective Internal Radiation Therapy or SIRT, is a novel approach to treating liver tumours using microspheres labelled with radioactive yttrium-90 (90Y). The microspheres are implanted by interventional radiologists to selectively target the tumours with radiation while sparing the remaining healthy liver tissue.

Prof. Bester and his colleagues evaluated 463 patients with chemotherapy refractory liver-dominant tumours and found that "radioembolisation is associated with a significantly improved and clinically meaningful survival benefit. Whilst confounding factors may play a role, offering this treatment may confer the best prognosis for these patients," he said.

Among the 251 patients with colorectal liver metastases, median survival in the 220 patients treated with SIR-Spheres microspheres was 11.6 months, compared to only 6.6 months for the 31 patients who received standard or best supportive care (p=0.021). In 212 patients with liver tumours from other cancers, including cholangiocarcinoma (41), neuroendocrine (40), hepatocellular carcinoma (27), pancreatic (13) breast (11), gastric (9) and other cancers (71), median survival was 9.5 months in the 180 patients treated with SIR-Spheres microspheres versus 2.6 months in 32 patients who received standard or best supportive care (p=0.013).

"The significant improvement in overall survival in this study confirm the benefits demonstrated in two previous but smaller comparative studies that were performed in patients with treatment-refractory colorectal liver metastases, notably the multi-centre phase III randomised controlled trial conducted by Hendlisz and colleagues in Belgium, and the matched-pair analysis by Seidensticker and colleagues from Magdeburg, Germany, that reported median survivals of 10.0 and 8.3 months, respectively," Prof. Bester added.[2,3]

Two large international randomised controlled trials are currently underway to evaluate the effectiveness of adding radioembolisation using SIR-Spheres microspheres to first-line chemotherapy in order to assess whether this treatment should be used as an early intervention in the treatment of patients with colorectal cancer liver metastases. In addition, three large randomised controlled trials are evaluating radioembolisation using SIR-Spheres microspheres in hepatocellular carcinoma.

About the study

The aim of the study conducted at St Vincent's Hospital was to compare the outcomes of patients with liver tumours treated using radioembolisation with patients receiving standard or best supportive care alone in the setting of treatment-refractory disease.

All patients had chemotherapy refractory liver-dominant tumours with radiologically confirmed progression, and were no longer qualified for other treatment modalities such as resection, ablation or chemoembolisation.

The study excluded any patient with extensive extrahepatic metastases, symptoms that confined them to bed for more than 50% of the waking hours (ECOG performance status >2), excessive liver tumour burden (>75% of liver replaced by tumour) and/or compromised residual liver function.

Of the 463 patients who underwent initial evaluation for radioembolisation, 63 patients were considered unsuitable, due either to (a) hepatic arterial anatomy that could not be corrected and which could otherwise have led to complications, (b) extensive hepatopulmonary shunting between the liver and lungs, which raised the potential for excess radiation exposure to the lungs (>30 Gy), or (c) reasons relating to patient consent, such as a preference for another treatment option.

"The patients who were unsuitable for radioembolisation were referred back to their treating physician for conservative treatment or continued supportive care," explained Prof Bester. "This group was unlikely to represent patients with more advanced disease and was consequently used as a standard-care comparison cohort."

About Colorectal Cancer

In 2008, 153,000 people in the United States of America and 333,000 in the European Union were diagnosed with colorectal cancer.[4] Around half of these patients will develop metastases that have spread from the original site of the disease, predominately to the liver. Up to 90% of these patients ultimately die from liver failure due to the spread of the disease.


Saxena A, Chua TC, Meteling B et al. Radioembolization with yttrium-90 microspheres is associated with a significantly improved survival compared to conservative therapy after treatment of unresectable hepatic tumors: A large single center experience of 537 patients. 65th Annual Cancer Symposium of the Society of Surgical Oncology, Asia-Pacific Journal of Clinical Oncology 2012; 7 (Supplement s4): Abstract 212.

Hendlisz A, Van den Eynde M, Peeters M et al. Phase III trial comparing protracted intravenous fluorouracil infusion alone or with yttrium-90 resin microspheres radioembolization for liver-limited metastatic colorectal cancer refractory to standard chemotherapy. Journal of Clinical Oncology 2010; 28: 3687-3694.

Seidensticker R, Denecke T, Kraus P et al. Matched-pair comparison of radioembolization plus best supportive care versus best supportive care alone for chemotherapy refractory liver-dominant colorectal metastases. Cardiovascular and Interventional Radiology 2011; ePub doi: 10.1007/s00270-011-0234-7.

International Agency for Research on Cancer. GLOBOCAN 2008: Colorectal Cancer Incidence and Mortality Worldwide in 2008. accessed 12/8/2011.

SOURCE St Vincent's Hospital Sydney Limited


Video: Discovery Provides Blueprint for New Drugs That Can Inhibit Hepatitis C Virus

Chemists at the University of California, San Diego have produced the first high resolution structure of a molecule that when attached to the genetic material of the hepatitis C virus prevents it from reproducing.

Also See: Discovery provides blueprint for new drugs that can inhibit hepatitis C virus on this blog.