Anabolic steroids help people with HIV put on weight and muscle mass

People with HIV who are treated with anabolic steroids to prevent AIDS wasting may realize modest gains in weight and muscle mass, a new review shows.
The review covered 13 studies of adults age 24 to 42 with HIV, 294 of whom received anabolic steroids for at least six weeks and 238 of whom received placebo. The average weight increase in those taking anabolic steroids was nearly three pounds.

“The magnitude of weight gain observed may be considered clinically relevant,” said lead author Karen Johns. “One hopes there would be greater weight gain with the long-term use of anabolic steroids; however, this has not been proven to date in clinical trials.”

AIDS wasting, which leads to significant weight loss in people with HIV, causes severe loss of weight and muscle and can lead to muscle weakness, organ failure and shortened lifespan. Researchers have long sought to reverse this common, destructive effect of HIV with mixed success.

The wasting stems from loss of the body’s ability to grow muscle and from low levels of testosterone.

Anabolic steroids are synthetic substances similar to the male sex hormone testosterone that promote growth of skeletal muscle and the development of male sexual characteristics.

Although most recently in the news for their misuse by professional athletes, anabolic steroids have legitimate medical application for men with low testosterone and people with certain types of anemia. Two anabolic steroids available in the United States, nandrolone decanoate and oxandrolone, have been used to help increase weight and muscle mass in small studies of people with wasting.

Conversely, anabolic steroid use has been associated with increased rates of HIV in those who share needles or use nonsterile needles when they inject steroids.

In the review studies, anabolic steroids were administered to patients either orally or by injection. The main side effects were mild and included abnormal liver function tests; acne; mild increase in body hair; breast tenderness; increased libido, aggressiveness and irritability; and mood swings — all common side effect of anabolic steroid use.

“The risks and side effects of taking anabolic steroids long-term are certainly of concern,” Johns said. “We were unable to assess these risks in our review due to the short duration of treatment in the studies.”

Wayne Dodge, M.D., the HIV/AIDS program director at the Group Health Cooperative in Seattle, suggests that clinicians should obtain blood testosterone levels, “if an HIV-infected individual has had significant weight loss, significant fatigue or muscle wasting, and particularly if associated with a significant decrease in libido and erections. If [testosterone] is in the low or low-normal range then a trial of [steroids] could be tried. The individual and the clinician should decide what result would constitute a successful trial: weight gain of 15 pounds, a 30 percent improvement in sense of well-being [or] a successful erection once a week.”

The reviews authors conclude that further studies are needed to determine if increase in weight leads to improved physical functioning and quality of life, and ultimately increased survival, as well as the potential for serious side effects, especially with prolonged use.

AIDS & HIV: Treatment & Prevention

While 1.1 million Americans currently live with HIV/AIDS, the incurable virus is no longer a quick death sentence and has become a chronic, manageable condition.

Symptoms & Complications

When a person is first exposed to HIV, they may show no symptoms for several months or longer. Typically, however, they experience a flu-like illness that includes fever, chills, headache, fatigue, muscle aches and enlarged lymph nodes in the neck and groin areas. This early illness is often followed by a “latency” phase where the virus is less active and no symptoms are present, according to the U.S. Department of Health and Human Services. This latent period can last up to a decade or more.

As HIV progresses into full-blown AIDS, it severely damages the immune system, causing a wide variety of symptoms such as:

• Rapid weight loss or “wasting”
• Extreme fatigue
• Recurring fevers and night sweats
• Prolonged gland swelling
• Prolonged diarrhea
• Sores in the mouth, genitals or anus
• Pneumonia
• Skin blotches
• Depression, memory loss and other neurological effects

According to the U.S. Centers for Disease Control (CDC), untreated HIV is also linked to serious conditions such as cancer, liver disease, cardiovascular disease and kidney disease. 

Diagnosis & Tests

Since HIV/AIDS can set off so many other illnesses, it may be difficult initially to pinpoint the source. Typically, however, these illnesses appear in clusters over a short period of time, cluing patients and doctors into the presence of the virus. According to NIAID, two types of blood tests can confirm HIV/AIDS infection:

• ELISA, or enzyme-linked immunosorbent assay, which detects disease-fighting proteins called antibodies that are specific to HIV; and

• Western blot, which detects antibodies that bind to specific HIV proteins

After someone is first infected it may take weeks or months for the immune system to produce enough detectable antibodies in an HIV blood test. Ironically, an infected person’s viral load may be very high during this time, making the infection exceptionally contagious. Because of this, the CDC recommends routine HIV testing for all adolescents, adults and pregnant women, and advises that everyone between the ages of 13 and 64 should be tested at least once.

Conventional HIV/AIDS tests are sent to a laboratory for analysis and may take a week or more for results. A rapid HIV test is also available that offers results in about 20 minutes, but positive results from either type of test are confirmed with a second test.

Prevention

More than 56,000 Americans become infected with HIV each year, according to the U.S. Department of Health and Human Services. While some AIDS patients have been infected through blood transfusions during medical procedures, preventing infection usually depends on avoiding risky habits or behaviors that lead to exposure to the virus, which can be transmitted through blood, bodily fluids such as semen and infected needles.

Prevention measures include:

• Knowing yours and your partners’ HIV status
• Using latex condoms correctly during every sexual encounter, whether gay or straight
• Limiting the number of sexual partners
• Abstaining from injectable drug use
• Seeking medical treatment immediately after suspected HIV exposure, since medications can sometimes prevent infection if started early

It’s just as important to know the ways HIV cannot be spread, such as by:

• Saliva, tears or sweat
• Water or air
• Casual contact such as closed-mouth kissing or shaking hands
• Insects, including mosquitoes

Early HIV Treatment a Win-Win

A cost-effective way to help patients stay healthy and prevent virus transmission. Providing early antiretroviral drug treatment for recently infected HIV patients and their uninfected sexual partners is a cost-effective way to help patients stay healthy and prevent transmission of HIV, a new study finds.

The study, looked at HIV patients in India and South Africa. Some of the patients received early antiretroviral therapy while the start of treatment was delayed for other patients. HIV is the virus that causes AIDS.

During the first five years of the study, 93 % of those who received early antiretroviral therapy survived, compared with 83 % of those whose treatment was delayed. Life expectancy was nearly 16 years for those in the early treatment group, compared with nearly 14 years for those in the delayed treatment group.

During the first five years, the potential costs of infections - particularly tuberculosis - prevented by early treatment of HIV patients in South Africa outweighed the costs of antiretroviral therapy drugs, suggesting that the early treatment strategy would reduce overall costs.

This was not the case in India, where the costs of treating HIV-related infections are less. Even so, early antiretroviral therapy in India was projected to be cost-effective according to established standards, the researchers said.

They also found that across patients' lifetimes, early antiretroviral therapy was very cost-effective in both countries. While most of the benefits of early treatment were seen in the HIV-infected patients -- fewer illnesses and deaths -- there were also added health care and economic cost savings from reducing HIV transmission, according to the study.

"By demonstrating that early HIV therapy not only has long-term clinical benefits to individuals but also provides excellent economic value in both low- and middle-income countries, this study provides a critical answer to an urgent policy question," study corresponding author Dr. Rochelle Walensky, of the Massachusetts General Hospital Division of Infectious Disease. "HIV-infected patients live healthier lives, their partners are protected from HIV, and the investment is superb," she added.

Walensky, a professor of Medicine at Harvard Medical School, said the findings point to a need to "redouble international efforts" to provide early antiretroviral therapy to any HIV-infected person who can benefit from it. Her colleague, Dr. Kenneth Freedberg, director of the Medical Practice Evaluation Center at Massachusetts General, agreed.

"Some people have questioned whether providing early [antiretroviral therapy] to all who need it would be feasible in resource-limited countries," he said in the news release. "We've shown that in countries like South Africa, where it actually saves money in the short-term, the answer is 'yes.' We believe that continued international public and private partnerships can make this true in other countries as well."

Freedberg said such an investment could bring about dramatic decreases in infections and illness that could save millions of lives over the next decade.

Multivitamins May Help Fight HIV Progression

But supplements tested only on those who hadn't started medications

New research from Africa suggests that basic multivitamin and selenium supplements might greatly lower the risk that untreated people with the AIDS virus will get sicker over a two-year period.

It's not clear how patients who take the vitamins and mineral might fare over longer periods. And the impact of the study in the United States will be limited because many Americans diagnosed with HIV, the virus that causes AIDS, immediately begin treatment with powerful medications known as anti-retroviral drugs. Those in the African study hadn't yet begun taking drugs to keep the virus at bay.

Still, "it is incredibly useful to find new strategies to delay the progression of HIV disease," said Dr. Jared Baeten, an associate professor of global health at the University of Washington in Seattle who's familiar with the findings. "Not every HIV-infected person is immediately willing, or able, to initiate anti-retroviral therapy. Inexpensive, proven treatments ahead of starting anti-retroviral therapy can fill an important role."

At issue: Do HIV-infected people benefit from nutritional supplements? Previous research has suggested that even well-fed people infected with HIV may not properly process nutrients in food, said study author Marianna Baum, a professor of dietetics and nutrition at Florida International University's Stempel School of Public Health.

The researchers wondered whether the immune system would get a boost if patients who hadn't yet begun anti-retroviral treatment took nutritional supplements. No study had looked at this before, Baum noted.

For the study the researchers divided nearly 900 HIV-infected patients in the African country of Botswana into several groups. Some took a placebo, a sugar pill with no active ingredients. Others took a multivitamin including B, C and E vitamins. Another group took the multivitamin along with supplements of the mineral selenium, and still others took only selenium.

None of the treatments had a noticeable effect except the combination of multivitamin and selenium. After adjusting their statistics so they wouldn't be thrown off by various factors, the researchers reported that those who took the combination were about half as likely to show signs over two years that their infection had progressed toward AIDS as those who took the placebo.

Overall, the risk that the disease would progress over the two years of the study was fairly low: 32 of the 217 who took the placebo suffered progression of the disease, she said, compared to 17 of the 220 who took the vitamin/mineral combination.

Baum didn't have information about the costs of the supplements, but she said they are low. In the United States, supplements that contain many vitamins and minerals can cost just pennies a day.

The supplements appeared to have no side effects, said Baum, who recommends that people newly diagnosed with HIV begin taking multivitamins. They seem to boost the immune system, she said. The selenium supplements, in particular, may provide enough of the mineral that the virus isn't able to hog it, she said.

Baeten cautioned that not just any multivitamin will do. "The results of this study appear to illustrate that it is not just any supplement," he said.

"Only the combination of vitamins plus selenium was effective," Baeten said. "For U.S. patients, this latter point is relevant, as there's a huge variety of supplements available. I would suggest talking with a doctor before taking any supplements."

He added that the study doesn't detract from the crucial importance of anti-retroviral drug treatment.

Researchers next want to see if the supplements help patients already taking anti-retroviral medications, study author Baum said.

Researchers Block Replication of AIDS Virus

A multidisciplinary team of scientists from Spanish universities and research centres, among which is the University of Valencia, has managed to design small synthetic molecules capable of joining to the genetic material of the AIDS virus and blocking its replication.

This achievement has been obtained for the first time in the world by a group of researcher led by José Gallego from Universidad Católica de Valencia "San Vicente Mártir." The University of Valencia, the Príncipe Felipe Research Centre, and the Instituto de Salud Carlos III have participated.

The newly designed synthetic molecules inhibit the output of genetic material of the virus from the infected cell nucleus to the cytoplasm, thus the virus replication is blocked and avoids the infection of other cells. The genetic material of the AIDS virus, or HIV-1, is formed by ribonucleic acid (RNA), and encodes several proteins that allow it to penetrate the human cells and reproduce within them. The new virus inhibitors, called terphenyls, developed by this group of scientists, were designed by computer to reproduce the interactions of one of the proteins encoded by the virus, the viral protein Rev.

In this way, the terphenyls join Rev's receptor in the viral RNA, preventing the interaction between the protein and its RNA receptor. This interaction is necessary for the virus genetic material to leave the infected cell nucleus and, thus, it is essential for the survival of HIV-1. The fact that the terphenyls block the virus genetic material output of the cell prevents the infection of other cells.

This discovery is the result of a close collaboration between three research groups throughout several years. Thus, the scientists of the Universitat Católica de Valencia were in charge of the computational design and verified experimentally that the terphenyls were capable of joining the Rev receptor in the viral RNA and inhibit the interaction between this RNA and the protein.
For its part, the molecules were synthesised in professor Santos Fustero's organic Chemistry laboratory in the Príncipe Felipe Research Centre and the University of Valencia. Also, through experiments with cells infected by the virus, the group of José Alcamí in the Instituto de Salud Carlos III demonstrated that the inhibitors block the replication of the HIV-1 and inhibit the function of the Rev protein, confirming this way the validity of the models generated by computer.

Traditionally, pharmaceutical companies have focused on the development of medicines that act on target proteins, as the approach to the receptors made out of RNA is considerably complex.

Although several natural antibiotics act at the bacterial ribosomal RNA level, up to now designing by computer a new synthetic chemical entity capable of joining RNA target and have a relevant pharmacological effect was not possible. The terphenyl structures identified in this research could open new ways to approach other therapeutic targets formed by nucleic acids.
On the other hand, the infection by HIV affected 34 million people worldwide in 2010, according to the World Health Organisation (WHO). The emergence of resistance to the current antiretroviral therapies and the lack of an effective vaccine highlight the necessity of identifying the new medicines that act on other virus targets. Rev protein constitutes one of this alternative targets, but so far they it has not been possible to develop antiviral agents based in their inhibition.

The results of this research have been the objectives of a patent application, and the three laboratories involved in the research keep their collaboration with the objective of improving the pharmacological properties of new Rev inhibitors.

Untreated HIV Carriers Transmit Resistant Viruses

Human-Immunodeficiency Viruses that resist AIDS medicines are primarily transmitted by people who are not actually undergoing treatment. In order to prevent a spread of the resistant viruses increased efforts in prevention and early diagnosis of new infections are needed, as concluded by the Swiss HIV Cohort Study that is supported by the Swiss National Science Foundation (SNSF).

Around one in every ten newly infected HIV carriers in Switzerland has viruses that are resistant to at least one of the three classes of drugs used to treat AIDS. Contrary to previously held assumptions, resistant viruses are primarily transmitted by people who are not yet receiving treatment, according to the reports in "Clinical Infectious Diseases" from the researchers headed by Roger Kouyos and Huldrych Günthard at Zurich University Hospital.

Reconstruction of transmission chains - In their molecular epidemiological analysis of 1674 male carriers of HIV who had sex with other men, the researchers demonstrated resistant viruses in 140 patients. The research group reconstructed the transmission chains of these viruses on the basis of the patients' estimated infection dates and the degree of genetic relatedness of their blood-borne viruses. Most of the transmission chains commence in HIV carriers who were not yet undergoing treatment at the time at which the resistant viruses were transmitted.

"We were astonished to note that the resistant viruses are primarily brought into circulation by untreated people," said Günthard. "Previously we had assumed that the resistant viruses came from patients for whom treatment had failed as resistances were produced while treatment was ongoing."

Early diagnosis is vital - The principal role of untreated HIV carriers in the transmission of resistant viruses means that combating these resistant strains is not solely reliant on optimised treatment, but also on preventing transmission by people who are not undergoing treatment. Prevention and early detection of newly infected persons are particularly vital in this respect. "In contrast to other tests, such as that for hepatitis, the HIV test requires that permission is obtained from the patient," explained Günthard. Since many doctors are reluctant to discuss their patients' sexuality with them openly, many infections are not discovered until much later than they could and should have been. While progress in medicine has robbed AIDS of its deadly effect, Günthard went on to stress, "there is still a great deal to be done."

The Swiss HIV Cohort Study - The aim of the study, which started in 1988, is to better understand HIV infection and AIDS, and improve the treatment of patients. All of Switzerland's specialist HIV clinics (Basel, Berne, Geneva, Lausanne, Lugano, St. Gallen and Zurich) collect data on treatment and the progress of the disease. Currently over 8,800 people are taking part in the Swiss HIV Cohort Study, of whom almost one third are women.

Aloe vera helps reverse cancer and AIDS

One of the best kept secrets in the nutritional field is aloe vera. Commonly recognized for soothing ulcers, hemorrhoids, sunburns, wounds and other skin ailments, many don't know the power pure raw aloe vera juice has for improving and even reversing serious diseases that baffle mainstream medicine.

That's because those claims are suppressed.

If a supplement or nutritional product promotes any kind of cure, the FDA and other agencies send their bootjack militia to raid them. A frightening example occurred in Tampa, Florida a couple of decades ago as research physician Ivan Danhoff MD was attempting to crash the medical mafia's cancer party. That's when his nutritional clinic was using aloe extracts and curing terminal cancer patients from hospice. Health agency thugs raided, pulling IVs out of patients whose condition had improved dramatically. Many died months later. The clinical trial was going by FDA guidelines to get the aloe extract approved

Improving on nature is probably unnecessary with aloe vera

The desire to modify or isolate ingredients from aloe vera to create an accepted medical model that is efficacious without side effects is commendable. But it appears Big Pharma and the cancer industry's good fellas want to protect their turf. Allowing an actual cure would even put the cancer cure fund raisers out of business. Most store shelf aloe vera juices don't do much beyond soothing the minor ailments mentioned earlier. Those juices are processed, heated, and diluted. That's not the case with all aloe vera products. The right aloe vera juice products are miracle healers

The most dramatic clinical proof of pure raw aloe vera juice comes from research done with AIDS patients. Almost all who were put on a regimen of daily aloe vera juice got better with white T cell counts skyrocketing. It's obvious that aloe vera is a potent immune booster, which implies it can be applied to other diseases.

One of the AIDS patients in this trial was diagnosed with advanced liver cancer and told he had less than two months to live. His liver was so tumor riddled it was four times its normal size. He continued with the juice, improved gradually, and within a year all his tumors were gone.

A doctor involved with this trial, pathologist H. Reginald McDaniel MD, was at first skeptical. But now he has seriously ill patients using aloe successfully. What turned him around was his own illness, a viral pneumonia for which conventional medicine had no answer. He was given a couple of cases of aloe juice, and his cure turned him into an aloe advocate.

Two short videos covering the aloe AIDS/cancer story are linked at the end of this paragraph. The last part of video 2 is censored, evidently to exclude information for ordering that particular juice. Promoting non-pharmaceutical AIDS and cancer cures is a no-no with the FDA. That data was probably pulled to protect them from FDA harassment

Aloe's healing power known for ages

The juice's power has been known by indigenous groups for ages. Franciscan Friar Romano Zago discovered how to make the juice from Brazilian Indians, used it with local villagers, and published his findings in the 1980s. He used their recipe based on the indigenous aloe arborescense plant . Father Zago's juice and others are from whole leaves. It's possible to get aloe juices without leaf skins (filleted) or reduced aloin content to minimize potential diarrhea side effects.

Immune Protein Found to Block HIV Spread in Some

One percent of people infected with HIV have a second line of defense deep in their immune system, which serves as a back-up for the body's defenses that get wiped out by the virus. These people, known as "controllers," are able to maintain long-term control of HIV without a daily regimen of antiviral medication because of a defensive immune protein, known as A3, which blocks the virus from spreading throughout their body.

Scientists from Northwestern University suggested their findings could help shorten the drug treatment required for others who have HIV, the virus that causes AIDS. "Preserving and even increasing this defense in cells may make more HIV-infected persons into controllers and prevent HIV from rebounding to high and damaging levels when anti-HIV medications are stopped," the study's senior author, Dr. Richard D'Aquila, director of Northwestern's HIV Translational Research Center, said.

In conducting the study, the researchers analyzed the cells of controllers in a lab. They found that these rare individuals have a greater supply of the A3 protein in specific white blood cells called resting memory T cells. Any new HIV made from those cells is rendered harmless by A3 and is unable to infect other cells. Unlike other cells in the immune system that are unable to recognize HIV once it mutates, A3 is part of the so-called intrinsic immune system that isn't fooled by the virus. "The intrinsic immune system recognizes the basic guts of the virus -- the nucleic acids -- that HIV can't change and then damages those nucleic acids," D'Aquila explained.

The researchers suggested that earlier treatment could help others eventually maintain control of their HIV without medication by protecting their reserves of A3.

"Perhaps starting anti-HIV drugs very soon after HIV is caught, rather than the current practice of waiting until later to start, would work like the controllers' first line of defense," D'Aquila said. "If we preserve A3, it could minimize HIV's spread through the body as this protein seems to do in controllers."

The researchers noted there are several cases of early HIV treatment resulting in long-term control of the virus. For example, in January 2013, a baby born to an HIV-positive woman became infected with the virus but was given anti-HIV drug treatment within 36 hours of birth. That baby is now off antiviral medication and apparently cured of HIV, D'Aquila said.

If HIV remains unchecked for several months, however, the researchers suggested reserves of A3 are simply wiped out. They are currently working to develop a drug that would boost the A3 protein. "Early-as-possible detection -- much easier with our new technology -- and early drug treatment will be the future of HIV therapy," D'Aquila concluded. He added that the new U.S. health law, the Affordable Care Act, now requires insurance companies to pay for routine HIV testing.

Child 'Cured' of HIV Remains Free of Virus

A 3-year-old Mississippi girl apparently cured of HIV infection by aggressive treatment right after her birth remains free of the virus, her doctors report.

Early treatment with a combination of potent antiretroviral drugs appears to have kept the virus from successfully establishing a reservoir in the child's system, said immunologist Dr. Katherine Luzuriaga, of the University of Massachusetts Medical School, who is part of the research team tracking the case.

Doctors are hesitant to declare the child fully cured, but they said that no actively replicating HIV has been found in her system by even the most sensitive tests available. The girl stopped taking HIV medication when she was 18 months old.

A couple of tests have found very low-level indications of HIV in the girl's blood, but doctors cannot tell if they are false positives or simply remnants of the eradicated virus.

"If they are remnants, the question is whether they are capable of reigniting," Luzuriaga said. "For that reason, we are calling this a remission because we want to follow the baby over a longer period of time to see if the child continues to control the virus without rebound."

The girl's pediatrician, Dr. Hannah Gay, of the University of Mississippi Medical Center, launched HIV treatment just 30 hours following her birth. Doctors normally put HIV-positive mothers on two antiretroviral medications prior to birth as a way of preventing transmission of the virus to their unborn children, Luzuriaga said. After delivery, doctors test the newborns for HIV and continue treatment if the virus appears.

But in this girl's case, no one knew the mother was HIV-positive before delivery and the girl was born infected. This led Gay to put the newborn on antiretroviral treatment immediately, and that timing appears to have made a difference. Gay also chose to employ a combination of three antiretroviral drugs, all at doses commonly used to treat HIV-infected infants, and kept the girl on the medications until she was 18 months old. This prevented the virus from mounting any drug resistance before it could be wiped clean from her body, Luzuriaga said.

Tests showed progressively diminishing HIV levels in the infant's blood, until it reached undetectable levels 29 days after birth. The child remained on antiretrovirals until 18 months of age, at which point doctors said they lost track of her and she stopped treatment. Doctors next saw her about 10 months after her treatment ceased. The child underwent repeated standard HIV tests, which detected no virus in her blood.

The two factors -- timing and medication -- appear to have prevented HIV from gaining a foothold in the girl's immune system. The virus was unable to create a reservoir in her body in which dormant HIV can hide and later reignite when drug therapy is suspended.

"What studies in other babies have shown us is if you treat very early, you're not only able to treat the viral replication but also able to limit the number of cells in which HIV integrates itself into the host genes," Luzuriaga said. "Basically, HIV makes copies of DNA and that DNA integrates itself into host genes. That's the barrier to cure. As long as you have those white blood cells floating around the body that have HIV stitched into the host DNA, the patient is not cured."

A key point is that the child exhibits none of the immune characteristics seen in "elite controllers," the tiny percentage of HIV-infected people whose immune systems are so active that they can keep the virus in check without treatment, the researchers said. The absence of these characteristics indicates that early therapy -- rather than natural immune mechanisms -- led to the child's remission.

Based on this girl's case, a federally funded study set to begin in early 2014 will test the early treatment method to determine whether the approach could be used in all HIV-infected newborns.

This method could cure newborns infected with HIV but is unlikely to help adults, given that they rarely learn of their infection until months or years after transmission, said Dr. Rowena Johnston, vice president of research at the Foundation for AIDS Research (amfAR).

"If there is something key to treating HIV within the first couple of days of transmission, it's going to be incredibly difficult to treat adults in this manner," Johnston said. "But this case really opens up the possibility that there may be different HIV cures for different populations, depending on what the circumstances are."

Dr. Michael Horberg, director of HIV/AIDS treatment and research for Kaiser Permanente, agreed that the infant's case is very encouraging, but said it's not an indication of a potential cure for all people with HIV.

"This is a very unique situation, but it does show that very early treatment is very successful," Horberg said. "We can envision potential future pathways with correct medication and vigilance where there might be a percentage of patients who could be successfully treated."

Only one other instance of an HIV cure has been documented, in the so-called "Berlin patient." An American man living in Germany received a bone marrow transplant for leukemia, with cells from a donor who had a rare genetic mutation that increases immunity against HIV. This patient has remained HIV-free after discontinuing drug therapy.

Breast milk found to kill HIV

Is it possible that breast milk contains the magic potion which kills the virus that causes AIDS? According to new research, that's a distinct possibility.

A recent study, which was conducted by researchers from the University of North Carolina School of Medicine, found that mice did not contract HIV after ingesting virus-tainted breast milk.

Moreover, the researchers found, the breast milk actually killed the virus.

The mice used in the study had previously been injected with human cells to reconstitute their bodies, the CBS affiliate in Charlotte reported. Other reports said the mice were injected with human bone marrow, liver and thymus tissues so they would have fully functional human immune systems and be nearly as susceptible to the HIV virus.

It's the first study to examine the effect of breast milk on HIV in a mammalian model. Prior research has only been done in test tubes.

"The results of these experiments highlight the potent HIV inhibitory activity of normal human breast milk and demonstrate that the in vitro HIV inhibitory activity of human breast milk is also capable of efficiently preventing oral transmission of cell-free HIV," the study said.

Breast milk serves a 'protective role'

Researchers who conducted the study hope it demonstrates that it's safe for an HIV-positive woman who is taking anti-retrovirals to breastfeed her children, even though for years they have been told not to do so if infected.

"Our results highlight the protective role of human breast milk against HIV transmission and suggest that components in both the skim milk and lipid fractions may contribute to its HIV inhibitory activity," the study said.

Dr. Viktor Garcia, the study's senior author, said in a press release that this study will help "close this important door to the spread of AIDS."

"No child should ever be infected with HIV because it is breastfed. Breastfeeding provides critical nutrition and protection from other infections, especially where clean water for infant formula is scarce," he said in a press release to the university. "Understanding how HIV is transmitted to infants and children despite the protective effects of milk will help us close this important door to the spread of AIDS."

Study results provide the path ahead

Angela Wahl, a post-doctoral researcher at UNC School of Medicine and lead author of the paper, said, "These results are highly significant because they show that breast milk can completely block oral transmission of both forms of HIV that are found in the breast milk of HIV-infected mothers: virus particles and virus-infected cells.

Wahl added: "This refutes the 'Trojan horse' hypothesis which says that HIV in cells is more stubborn against the body's own innate defenses than HIV in virus particles."

Despite the encouraging study, it's not a certainty that mothers with HIV who breastfeed their children won't pass the virus along. But Wahl said the research is, essentially, a good starting point for further study because it lays the foundation for the next step - figuring out what component of breast milk actually provides the protection. To do that, researchers will now have to study breast milk from mothers who did pass along the virus and the milk of mothers who did not, to find the difference.

"What we have shown is that breast milk is indeed a protective agent, so it should not be denied even to children of HIV-infected women," "What we know is that infants who acquire HIV during breastfeeding weren't infected at the time of birth, and when you look at the virus that eventually infects the infant and the virus in mother's breast milk, it's the same. But it doesn't mean it couldn't be the result of contact with blood."

HIV Vaccines Elicit Immune Response in Infants

A new analysis of two HIV vaccine trials that involved pediatric patients shows that the investigational vaccines stimulated a critical immune response in infants born to HIV-infected mothers

The finding at the AIDS Vaccine 2013 meeting in Barcelona, Spain, examined samples from two previously completed pediatric HIV vaccine trials - called PACTG 230 and PACTG 326 - to determine whether they elicited a key immune response that has only recently been associated with reduced HIV infection.

Searching for evidence of an anti-V1V2 IgG antibody response - the newly identified mechanism for protection against HIV - the researchers found that both of the old pediatric vaccine candidates triggered this key immune defense. While babies born to HIV-infected mothers had maternally acquired anti-V1V2 IgG antibodies at birth, infants who were vaccinated had better and longer-lasting antibody responses than their counterparts who received a placebo vaccine.

"Effective infant HIV vaccination may be affected by the presence of maternal HIV-specific antibodies and the immaturity of the infant immune system," said the study's lead author, Genevieve Fouda, M.D., PhD, of Duke. "Our findings suggest that vaccination of infants born to HIV-infected mothers can elicit a robust anti-HIV envelope IgG immune response."

Fouda said the results of the study highlight the importance of including pediatric populations in HIV vaccine studies. "Mother-to-child transmission continues to be an important public health issue in resource limited areas," Fouda said. "Every year, approximately 300,000 infants are infected with HIV. Antiretroviral drugs have reduced the rate of mother to child transmission rate in the United States below 2 percent, but overall in low and middle income countries less than 60 percent of known HIV infected women receive drugs to prevent transmission to their infants. Immune-based interventions such as a vaccine are needed to eliminate pediatric HIV."

Anabolic steroids help people with HIV put on weight and muscle mass

People with HIV who are treated with anabolic steroids to prevent AIDS wasting may realize modest gains in weight and muscle mass.

The review covered 13 studies of adults age 24 to 42 with HIV, 294 of whom received anabolic steroids for at least six weeks and 238 of whom received placebo. The average weight increase in those taking anabolic steroids was nearly three pounds.

“The magnitude of weight gain observed may be considered clinically relevant,” said lead author Karen Johns, a medical assessment officer from the agency Health Canada. “One hopes there would be greater weight gain with the long-term use of anabolic steroids; however, this has not been proven to date in clinical trials.”

AIDS wasting, which leads to significant weight loss in people with HIV, causes severe loss of weight and muscle and can lead to muscle weakness, organ failure and shortened lifespan. Researchers have long sought to reverse this common, destructive effect of HIV with mixed success.

The wasting stems from loss of the body’s ability to grow muscle and from low levels of testosterone.

Anabolic steroids are synthetic substances similar to the male sex hormone testosterone that promote growth of skeletal muscle and the development of male sexual characteristics.

Although most recently in the news for their misuse by professional athletes, anabolic steroids have legitimate medical application for men with low testosterone and people with certain types of anemia. Two anabolic steroids available in the United States, nandrolone decanoate and stanozolol, have been used to help increase weight and muscle mass in small studies of people with wasting.

Conversely, anabolic steroid use has been associated with increased rates of HIV in those who share needles or use nonsterile needles when they inject steroids.

In the review studies, anabolic steroids were administered to patients either orally or by injection. The main side effects were mild and included abnormal liver function tests; acne; mild increase in body hair; breast tenderness; increased libido, aggressiveness and irritability; and mood swings — all common side effect of anabolic steroid use.

“The risks and side effects of taking anabolic steroids long-term are certainly of concern,” Johns said. “We were unable to assess these risks in our review due to the short duration of treatment in the studies.”

Wayne Dodge, M.D., the HIV/AIDS program director at the Group Health Cooperative in Seattle, suggests that clinicians should obtain blood testosterone levels, “if an HIV-infected individual has had significant weight loss, significant fatigue or muscle wasting, and particularly if associated with a significant decrease in libido and erections. If [testosterone] is in the low or low-normal range then a trial of [steroids] could be tried. The individual and the clinician should decide what result would constitute a successful trial: weight gain of 15 pounds, a 30 percent improvement in sense of well-being [or] a successful erection once a week.”

The reviews authors conclude that further studies are needed to determine if increase in weight leads to improved physical functioning and quality of life, and ultimately increased survival, as well as the potential for serious side effects, especially with prolonged use.

Barriers to HIV Vaccine Response Explored

Researchers at The Scripps Research Institute (TSRI) discovered that an antibody that binds and neutralizes HIV likely also targets the body's own "self" proteins. This finding could complicate the development of HIV vaccines designed to elicit this protective antibody, called 4E10, and others like it, as doing so might be dangerous or inefficient.

"We developed two new mouse models that allow us to visualize the fate of the rare B cells that can see HIV and we thought could be stimulated by vaccines to produce neutralizing antibodies -- the type of antibodies we seek to produce in response to a vaccine," said David Nemazee, PhD, professor in the Department of Immunology and Microbial Science at TSRI and senior author of the study. "We were able to study vaccine responses of b12, an antibody that sees the CD4 binding site of HIV, but, surprisingly to us, not 4E10, an antibody that sees the stem of the HIV envelope protein."

Nemazee and his team went on to discover that cells with the potential to produce 4E10 antibodies trigger several natural safeguards that shut down the production of any antibody that might recognize and destroy the body's own tissues. They concluded that 4E10 cross-reacts with host tissues in this way, prompting its removal before it can do any harm - or good.

HIV Vaccine Development

4E10 antibodies were originally isolated from a human HIV patient. The antibodies specifically recognize and bind an HIV surface protein called gp41. The virus uses gp41 like a long spike to poke holes in its host's immune cells. But when 4E10 antibodies clog up gp41, the virus is neutralized and host cells are protected.
4E10 especially interests HIV researchers because the antibody recognizes and binds to gp41 on the surface of many different strains of the virus, not just the one strain with which the patient was most recently infected. If a vaccine could be made to specifically and safely stimulate 4E10-like production, recipients would likely be protected against multiple HIV strains.

In humans, HIV slowly destroys the immune system, leading to Acquired Immune Deficiency Syndrome (AIDS). According to the Centers for Disease Control and Prevention, more than 1.1 million people in the U.S. are living with HIV infection. While treatments developed in the past decade can keep the virus in check for many years, there is no vaccine and there is no cure.

Proceeding with Caution

In several ongoing studies, the TSRI team and others are working out how to make a vaccine that stimulates the production of 4E10, b12 and other broadly neutralizing anti-HIV antibodies. However, this latest study indicates that this approach might be complicated by unwanted self-reactivity. Antibodies that cross-react with host tissue -- like 4E10 has now been shown to do -- are associated with autoimmune diseases such as multiple sclerosis and lupus.
The TSRI study also raises the question of how 4E10 was generated in the first place. According to Nemazee, 4E10 may be a fluke, cropping up in an HIV patient who was also prone to autoimmune diseases. Alternatively, the autoreactive antibody could have arisen in the patient as a consequence of the disease -- perhaps the body's normal mechanism for weeding out such antibodies failed, allowing the serendipitous production of an anti-HIV antibody.

Despite this new concern, there is still hope for 4E10's role in HIV vaccine development. A companion paper published in the same issue of The Journal of Immunology (http://www.jimmunol.org/content/191/6/3179.long) found that another potent, broadly neutralizing anti-HIV antibody, b12, was not self-reactive and could respond to a candidate vaccine preparation provided by Richard Wyatt, TSRI Professor of Immunology and Director of Viral Immunology at the International AIDS Vaccine Initiative Neutralizing Antibody Center.

"It's still possible that we could safely elicit the 4E10-like antibody in order to protect against HIV," Nemazee said. "We just have to think about how to generate the best antibodies without causing other problems. We have a lot of questions. And now we have a good model to help us answer them."

Man cured of AIDS after receiving stem cell transplant

In what many in the mainstream media and medical community have now dubbed their first known case of cured AIDS, Timothy Ray Brown's miraculous healing from the deadly syndrome is sending shock waves throughout the world. After receiving a bone marrow stem cell transplant back in 2007, Brown inherited a genetic immunity from those stem cells that cured him of not only AIDS, but also leukemia.

Dubbed "The Berlin Patient," Brown first tested positive for HIV back in 1995. And for years, he unsuccessfuly battled the disease using conventional methods. But when doctors decided to give him a stem cell transplant, everything changed.

"I quit taking my HIV medication the day that I got the transplant and haven't had to take any since," said Brown to reporters from CBS 5 in San Francisco. "I'm cured of HIV. I had HIV, but I don't anymore."

According to reports, roughly one percent of Caucasians have a natural immunity to HIV and AIDS, and the stem cells Brown received came from someone within this rare one percent. As a result, the white blood cells created in his body via the injected stem cells ended up giving him that same immunity.

Brown's doctors, as well as various other experts and scientific journals, have all confirmed that Brown has been cured of both his AIDS and his leukemia. And Dr. Judy Auerbach from the San Francisco AIDS Foundation told CBS reporters that "things have shifted" in terms of using the word "cure" in reference to AIDS, which is breathing new hope into those hopeful for a cure themselves.

However, despite the numerous references in the media to Brown being the first person ever to have been cured of AIDS, there have actually been many others who have successfully defeated the syndrome through immune support -- but these cases, of course, have been ignored by the mainstream medical and scientific community. In fact, a healthy immune system is the true key to both resisting HIV infection, and successfully reversing it. 

HIV: Predicting Treatment Response More Accurately

The HI virus is feared, not least, because of its great adaptability. If the virus mutates at precisely the point targeted by a drug, it is able to neutralise the attack and the treatment fails. To minimise these viral defence mechanisms, doctors treat patients with modern combination therapies involving the simultaneous administration of several drugs. This approach forces the virus to run through a series of mutations before it becomes immune to the drugs.

"It is not easy to decide which of the over 30 combination therapies is best suited to a patient," says Huldrych Günthard from Zurich University Hospital, president of the Swiss HIV Cohort Study. The decision is based on the prospects of success and therefore on the genetic make-up of a particular virus. The established prediction models already consider the genetics of the virus but they neglect that the virus continuously evolves through sequential mutations.

Choosing the right therapy for each patient

In cooperation with the Swiss HIV Cohort Study, Niko Beerenwinkel and his team from ETH Zurich have now developed a more accurate prediction model based on a probabilistic method. This model calculates the possible evolutionary paths of the virus and yields a new predictive measure for the development of resistances: the so-called individualised genetic barrier. When applied retrospectively to 2185 patients of the HIV Cohort, the new approach made it possible to predict treatment success more accurately compared to the existing models. "We are now introducing the individualised genetic barrier in a pilot project and hope that it will help us in the future to identify the best therapy for each patient," says Günthard.

Preventive Antibiotics for Tuberculosis Reduce Deaths Among People With HIV Disease

The research team's findings, stem from what is believed to be the largest expansion of a clinic-based, community health program designed to curb the spread of TB, and the first evidence that such a community-wide effort can be highly effective at preventing people who are co-infected from developing active TB disease.

According to senior study investigator and Johns Hopkins infectious disease specialists Richard Chaisson, M.D., his team's latest study results firmly support broad use of preventive isoniazid therapy for millions of people infected with HIV in Latin American, Asian, and Eastern European countries heavily burdened by TB.

Chaisson says TB disease remains the leading cause of death worldwide among those with HIV/AIDS and is epidemic in developing countries with the highest HIV-infection rates. Isoniazid treatment, which costs less than $1 for a full course of therapy, is already recommended by the World Health Organization to prevent TB in people with HIV disease. The policy, however, has not been widely adopted and its broad impact on the HIV-infected community never shown until the Johns Hopkins and Brazilian team's latest study.
All of the 12,816 study participants were eligible for screening for TB infection or active TB disease. Some 1,186 tested positive for TB infection, but did not have symptoms of TB sickness and could start taking 300 milligrams of isoniazid daily for six months. All received routine follow-up care for as little as a few weeks to as long as four years after initially seeking treatment at any of 29 HIV clinics across Brazil, a country hit hard by both infectious diseases. Some 838 deaths occurred during the study, which took four years to complete, and 475 developed TB. Symptoms of active TB disease, indicating the disease has progressed from latent infection, include persistent cough, chest pain, chills, fever, muscle weakness and fatigue.
"Our study results show that routine testing for TB and preventive isoniazid therapy works well at the community level in people with HIV disease in curbing the spread of TB and lowering the number who die," says Chaisson, a professor at the Johns Hopkins University School of Medicine and founding director of its Center for Tuberculosis Research.

"People with HIV disease living in all countries with rampant TB should be asking their physicians if they are good candidates for preventive isoniazid therapy," says Chaisson, who leads the overall global research effort, in support of this study and others, called the Consortium to Respond Effectively to the AIDS/TB Epidemic. CREATE, as it is known, is funded by the Bill and Melinda Gates Foundation.
When researchers restricted their analysis to 12,196 study participants who kept at least one annual check-up appointment, the overall death rate and number of new TB cases was even lower, at 55 percent. The number of active TB cases decreased by 58 percent. Among study participants who received isoniazid, commonly marketed under the brand names Niazid, Laniazid and Nydrazid, 85 percent took a full course of drugs for six months, as prescribed.

Another important finding, researchers say, was that initial TB screening of those seeking HIV care led to diagnosis of over a third (34 percent, or 250) of the total 725 new clinic patients found to have active TB. All were offered treatment for their disease but were excluded from the study analysis.

Lead study investigator and Johns Hopkins epidemiologist Jonathan Golub, Ph.D., M.P.H., says the study was, on its own, an effective screening tool, and affirms how unknown TB cases can be found when public health officials focus on community health programs in local clinics that service people more likely to become infected. In Brazil, an estimated 10 percent of people diagnosed with TB sickness are co-infected with HIV.
Golub says further research is needed to determine how long lasting are isoniazid's protective effects are and whether the single course of treatment used in the latest study is sufficient, or if repeat or lifelong antibiotic therapy is needed to suppress TB.

"Our efforts highlight the importance of continuous training in diagnosing TB, and our immediate priority is to train community doctors and nurses in HIV clinics to make TB testing part of routine HIV care," says Golub, an associate professor at Johns Hopkins. Golub points out that in Brazil, TB screening policies have been in place since 1995, but simply not followed. Golub says that once clinics involved in the study began more rigorous screening, the number of initial TB skin tests performed jumped threefold, and the number of patients taking isoniazid went up fourfold.

For the study, clinic staff were rigorously trained in correct procedures for screening all patients with HIV for possible TB infection and signs of active TB disease. Patients who tested positive for active TB disease were offered treatment, but were not included in study monitoring. Those who met study criteria were offered preventive isoniazid therapy. To detect TB, a simple skin test is initially performed, which if positive for signs of an immune response, can lead to further, confirmatory lab and X-ray testing.

Intensive training at all 29 clinics was randomly staggered every two months, allowing staff at all clinics to eventually benefit from the enhanced study effort. The staggered timeline also gave researchers a long period to assess isoniazid's effects pre- and post-training. Study participants were 61 percent male, and on average 37 years old. Sixty percent were receiving antiretroviral therapy for HIV.

Chaisson says the team next plans to evaluate faster diagnostic tests for TB, other than the initial skin test, which takes only minutes to administer, but requires a 48-hour waiting period to show any reaction. He says the ideal test would be a blood test that could be performed at the same time as routine anti-HIV tests for blood levels of CD4 immune cells.

Brain functioning in HIV-infected adults improved by Exercise

Regular exercise is not only good for health, but can give people living with HIV a significant mental boost. This is according to a study by Dr. David J. Moore and colleagues at the University of California, San Diego (UCSD)

The study found that HIV-infected adults who exercise suffered significantly less neurocognitive impairment compared to patients who do not exercise.

Moore and his team, including UCSD medical student Catherine Dufour, found that HIV-infected adults who exercise were approximately half as likely to show signs of neurocognitive impairment as compared to those who do not. They also had better working memory and could process information faster than patients who follow a sedentary lifestyle.

Despite recent advances in antiretroviral treatment, impaired brain functioning is a reality faced by nearly half of all people living with HIV. This ranges from asymptomatic neurocognitive impairment, to more pronounced deficits that interfere with daily functioning, such as problems with financial management, driving and taking medication regularly.

The major benefit of exercise to the brain seems to be the reduction of neurocognitive risk factors, such as high blood pressure and abnormally high levels of lipids in the blood. Metabolic syndrome associated with the use of antiretroviral treatment is also linked to an increase in cerebrovascular risk factors, such as diabetes, hypertension and obesity.

In the study, 335 community-dwelling HIV-infected people were asked how much exercise they undertook during the previous 72 hours, and persons were classified into those who engaged in significant exercise (e.g., activities that make the heart beat rapidly) and those who did not. Seven cognitive areas commonly affected by HIV were tested, including verbal fluency, working memory, speed of information processing, learning, recall, executive function and motor function.

The study extends prior findings about the link between exercise and cognition among HIV-infected people by showing that this association is also true in a diverse and large group of people living with the disease. Compounding factors were taken into account, such as demographics, HIV disease characteristics, substance use, past and current depression, mental health status and physical functioning.

"Exercise as a modifiable lifestyle behavior may reduce or potentially prevent neurocognitive impairment in HIV-infected persons," says Moore. "Physical exercise, together with other modifiable lifestyle factors such as education, social engagement, cognitive stimulation and diet could be fruitful interventions to support people living with HIV."

HIV as You Get Older

Many people think of HIV as a young person's disease, but it's not. "By 2015, half of all people with HIV will be 50 or older," says Brad Hare, MD, director of the HIV/AIDS clinic at San Francisco General Hospital. This greying of the HIV population shows how well today’s HIV treatments can work.

HIV makes aging itself more complicated. But plenty of people have had HIV for years, even decades, and are doing well.  "These days, we fully expect that someone with HIV will live a long, healthy life," says Christine A. Wanke, MD, professor of medicine and director of the nutrition and infection unit at Tufts University School of Medicine. "But that means they have to plan ahead and adopt the healthy habits to stay that way, just like anyone without HIV."

HIV and Aging: 5 Common Challenges

As you get older with HIV, you may face issues including:

1. Other conditions. Just like anybody, getting older means you're more likely to have health problems, and HIV seems to bump up the risk even more. "HIV accelerates the aging process and magnifies its effects," says John G. Bartlett, MD, professor at the Johns Hopkins School of Medicine and director of its AIDS service. So HIV may make you more likely to get heart disease, diabetes, cancer, osteoporosis, kidney problems, and other conditions.

2. Drug interactions. Since you’re already taking medicines for HIV, additional drugs for other conditions can increase the chance of interactions.

3. Loss of support. Some people become more isolated as they age. That happens more often to people with HIV, who may also be dealing with embarrassment about the condition or strained family relationships. If you're alone and disconnected, you're more likely to get depressed.

4. Changing roles. Like many people without HIV, you may be caring for your aging parents. That can add emotional and financial pressures.

5. Difficulty adjusting. "I talk to people with HIV who say, 'I didn't expect to live to middle age,'" says Hare. "'But now I'm middle-aged and I'm probably going to live another 30 years.'" Many people who got HIV long ago didn't plan for a long life, and adjusting can be a challenge. For instance, you might not have saved for a longer life.

7 Steps to Take

1. See an HIV expert. The more your health is complicated by age and other conditions, the more crucial it is to have an expert overseeing your HIV care.

2. Get good routine medical care. Specialty HIV care is not enough. Because your risks of other medical problems are higher, keep on top of your general health, says Hare. Get your annual physicals, keep tabs on your blood pressure, cholesterol, and other tests your doctor recommends.

3. Avoid drug interactions. Make certain every doctor you see knows about every medication and supplement you take, including prescription drugs, over-the-counter products, vitamins, and natural products. Doctors may adjust your medicines, dosages, or schedules to prevent interactions.

4. Improve your lifestyle. To enjoy life as you age, stay fit. Exercise regularly, and if you smoke, stop.

5. Eat a healthy diet. Go for lots of fruits and vegetables, lean proteins, whole grains, and healthy fats. "Eating a heart-healthy diet makes sense for everyone," says Bartlett. "But because people with HIV have higher risks of heart disease, it makes even more sense for them."

6. Seek support. Having a support system of family and friends is key. Make an effort to stay connected. If close friends or family have died or moved away, work on making new friends. You might also connect through a support group.

7. Get help. Call your local health department to learn about local resources for people with HIV, says Hare. Your local Council on Aging is a good place to start; it can point you toward programs and services that could help. A financial planner may also help you work on savings and expenses.

Plant-Based Compound May Inhibit HIV

A compound found in soybeans may become an effective HIV treatment without the drug resistance issues faced by current therapies

It's in the early stages, but genistein, derived from soybeans and other plants, shows promise in inhibiting the HIV infection, says Yuntao Wu, a professor with the George Mason-based National Center for Biodefense and Infectious Diseases and the Department of Molecular and Microbiology.

Still, that doesn't mean people should begin eating large amounts of soy products. "Although genistein is rich in several plants such as soybeans, it is still uncertain whether the amount of genistein we consume from eating soy is sufficient to inhibit HIV," Wu says.

Genistein is a "tyrosine kinase inhibitor" that works by blocking the communication from a cell's surface sensors to its interior. Found on a cell's surface, these sensors tell the cell about its environment and also communicate with other cells. HIV uses some of these surface sensors to trick the cell to send signals inside. These signals change cell structure so that the virus can get inside and spread infection.

But genistein blocks the signal and stops HIV from finding a way inside the cell. It takes a different approach than the standard antiretroviral drug used to inhibit HIV. "Instead of directly acting on the virus, genistein interferes with the cellular processes that are necessary for the virus to infect cells," Wu says. "Thus, it makes the virus more difficult to become resistant to the drug. Our study is currently it its early stage. If clinically proven effective, genistein may be used as a complement treatment for HIV infection."

Wu sees possibilities in this plant-based approach, which may address drug toxicity issues as well. Because genistein is plant-derived, it may be able to sidestep drug toxicity, a common byproduct of the daily and lifelong pharmaceutical regimen faced by patients with HIV to keep the disease at bay, Wu says. Typically, patients take a combination of multiple drugs to inhibit the virus. The frequency can lead to drug toxicity. Plus, HIV mutates and becomes drug-resistant.

Wu and his team are working at finding out how much genistein is needed to inhibit HIV. It's possible that plants may not have high enough levels, so drugs would need to be developed, Wu says.

HIV/AIDS Vaccines: Defining What Works

Designing an effective HIV/AIDS vaccine is something of a paradox: a good vaccine would be safe and look enough like HIV to kick-start the immune system into neutralizing the virus -- but the problem is that this is exactly what the human immune system has trouble doing even when it's exposed to the real thing.

Now a team of researchers led by scientists at The Scripps Research Institute in La Jolla, CA has developed a strategy for inducing a key part of an effective immune response to HIV. By tracing the evolution of HIV-recognizing molecules called antibodies taken from the blood of rare individuals whose immune systems are naturally able to target and neutralize the virus, they may have found a way to replicate this for everybody.
At a talk next week at the American Crystallographic Association meeting in Hawaii, the team will present multiple crystal structures, which like detailed architectural blueprints show how the virus interacts with components of the immune system. Examining these structures has allowed them to reverse engineer molecules that specifically activate the precursors of effective, neutralizing antibodies against the virus -- molecules that may be components of a future vaccine against HIV.
"What we tried to do was to learn how those [effective] antibodies developed over the course of natural infection and attempt to guide the immune response in the direction of what we know works in certain HIV-infected individuals," said structural biologist Jean-Philippe Julien, who is presenting the work in Hawaii.
He conducted the research under the direction of Professors Ian Wilson and William Schief of The Scripps Research Institute. The work was funded by the International AIDS Vaccine Initiative Neutralizing Antibody Center, the Scripps Center for HIV/AIDS Vaccine Immunology and Immunogen Discovery and the National Institute of Allergy and Infectious Diseases (one of the National Institutes of Health). Additional support was provided through a Canadian Institutes of Health Research fellowship.
Julien cautioned that the work might not, by itself, be the final answer that shows how to make an effective HIV/AIDS vaccine -- but it is a step in the right direction. Most likely, Julien said, any future HIV/AIDS vaccine would combine multiple biological components in order to give the broadest possible protection against the virus.
He added that their candidate molecule was able to achieve the desired immune reactions in the test tube, and they are currently testing it in animals to see if it is able to kick start the desired immune response. If those experiments go well, he said, further studies will examine whether it can protect animals against infection, and human trials for safety and vaccine efficacy would be next -- though it may be years before those results are known.
While designing a vaccine against any pathogen is a long, hard process, HIV has been particularly difficult, and despite decades of efforts and hundreds of millions of dollars spent in the process, we still do not yet have an effective vaccine that can prevent infection.

Marital Status Reduces Risk of Death

At the height of the AIDS epidemic in the 1980s men who were married were significantly less likely to die of HIV/AIDS than their divorced or otherwise single counterparts

 For women, marital status had little impact on who was more likely to die of the disease. But race proved to be a significant risk factor, with African-American women nine times more likely to die of HIV/AIDS and Latinas seven times more likely to die of the disease than white women. Those mortality rates were considerably higher than those for men of color compared to white men.
The study by UCR sociology professor Augustine Kposowa -- "Marital status and HIV/AIDS mortality: evidence from the U.S. National Longitudinal Mortality Study" -- is the first to examine the effects of marital status on deaths of individuals with HIV/AIDS.

Using data from a recent release of the U.S. National Longitudinal Mortality Study and the National Death Index, Kposowa tracked nearly 763,000 individuals age 15 and older between 1983 and 1994. A total of 410 of those individuals died of HIV/AIDS in that period of time.

"These data capture when HIV/AIDS was approaching pandemic level," Kposowa explained. "People were very afraid. The perception was that only men who had sex with men were getting infected, so no one was looking at risk factors for people who were married, widowed or separated."

Kposowa's analysis of 11 years of mortality data found that marital status was a significant risk factor for men, but not women. Divorced and separated men were more than six times more likely to die of AIDS than married men, and those who had never married were 13.5 times more likely to die of the disease than those who were married. African-American men were 2.7 times as likely to die of HIV/AIDS as white men, and Hispanic men were more than twice as likely to die of the disease as white men.

"It turns out that the big story for women is race, particularly for African-Americans and Latinos," Kposowa said. "The question is, why would Latino and African-American women have been more at risk of HIV?"
The most logical explanation, Kposowa believes, relates to how little was known in the 1980s about how the HIV virus was transmitted, and a health care system that historically disadvantages the poor.

"Those without care are more likely to be minority women," he said. "It's really a function of the health care system, who has access, and how soon people seek care. So in the 1980s, poor people and minorities, who often lack information about health care, were at greater risk of death from HIV/AIDS. By the time they presented themselves for health care, the disease would have progressed."

Kposowa said his assertion is supported by other studies showing that women of color typically receive less aggressive treatment for diseases such as cancer, and that African-Americans and Hispanics are less likely to be prescribed narcotic pain medications for back pain than whites even when one takes into account pain severity. He noted that in the US, post diagnosis cancer survival rates are much lower for people of color than whites.

"The elephant in the room is the health care system and the value we put on different people because of their color and background," the sociologist added. "We don't say that consciously, but it is why the Obama administration has put so much emphasis on reducing health disparities in this country."

Pregnancy and HIV Testing

HIV, or human immunodeficiency virus, is the virus that causes AIDS (acquired immune deficiency syndrome). HIV weakens a person's immune system reducing their ability to fight infections and cancers. A person can get HIV by coming into contact with an infected person's body fluids (blood, semen, vaginal fluids, breast milk), and HIV can be spread through:

• Vaginal, oral, or anal sex
• Sharing unclean needles to take drugs
• Pregnancy (from an infected mother to baby)
• Blood transfusions (since 1985, blood donations have been routinely tested for HIV, so infection from blood transfusions is rare)

You cannot get HIV from:

• Touching or hugging someone who has HIV or AIDS
• Public bathrooms or swimming pools
• Sharing cups, utensils, telephones, or other personal items
• Bug bites

Doctors recommend all pregnant women get tested for HIV. Medications are available to prevent the spread of the virus to your unborn baby. In addition, steps can be taken during delivery to prevent spreading the infection. Some studies show a woman can further reduce the risk of spreading the virus to her baby by having a cesarean section before her water breaks. Moreover, your health care provider can take steps to help you stay healthy longer.

HIV testing is voluntary. Anyone is free to decline testing. Your decision to not get tested, or the test result itself, will not prevent you from getting health care during pregnancy.

What Do the HIV Test Results Mean?

A confirmed, positive test result means you have been infected with HIV. Being infected with HIV does not necessarily mean that you have AIDS. It can take many years for people with HIV to develop AIDS.

A negative test result means that no signs of HIV infection were found in your blood. A negative test does not always mean that you do not have HIV. Signs of HIV may not show up in the blood for several months after infection. For this reason, you should be tested again if you could have been exposed to HIV or are at risk for HIV infection.

Though HIV tests performed at most doctors offices become part of the patient's medical record, there are places you can go that provide confidential HIV testing. These places will perform HIV tests without even taking your name (anonymous testing). An anonymous HIV test does not become part of your medical record.

Should you discover that you have HIV, inform you medical providers so that you can receive proper care.

When AIDS Viruses Are Transmitted Despite Treatment

While antiretroviral drugs offer an efficient means of preventing the replication of HIV in the blood, shedding of HIV may occur in semen, so that other persons can become infected during unprotected sexual intercourse. This occurs in particular if the male genital tract also has other viral infections.

That is the conclusion reached by a scientist who is supported by the Swiss National Science Foundation (SNSF).
In principle, modern combination therapies are very effective at keeping AIDS causative agents in check. The treatment usually leads to a situation in which there is no longer any evidence of Human-Immunodeficiency Viruses (HIV) in the body. In this way, the drugs can also reduce the disease transmission rate to just one tenth. So why do new infections occur despite treatment?

Sperm containing a cocktail of viruses

The answer, according to findings recently published by the Swiss researcher Sara Gianella Weibel and her American colleagues, is that other viruses also play a role. Working at the University of California in San Diego, the SNSF-funded scientist studied the semen of 114 HIV-infected men undergoing treatment who have sex with men. She found that the seminal fluid of 11 of the men contained a considerable quantity of HI viruses, even though the viral load of the blood of all of the men was very low. In eight of these 11 cases, Gianella Weibel also found evidence of various forms of herpes.

Locally activated immune system

Some of these herpes viruses, such as cytomegalovirus, often remain unnoticed. However, if the viruses infect the male genital tract, they locally activate the immune system. As a result, there is a build-up of immune cells, including those in which HIV replicate, in the genital area. "Our data suggests that we must also direct our focus towards other viruses, if we really want to interrupt the transmission of AIDS," explains Gianella Weibel.

Myths and Facts about HIV/AIDS

Having HIV Means You Have AIDS?

Myth. Human immunodeficiency virus (HIV) is a virus that destroys the body's CD4 immune cells, which help fight disease. With the right medications, you can have HIV for years or decades without HIV progressing to AIDS. AIDS (acquired immunodeficiency syndrome) is diagnosed when you have HIV as well as certain opportunistic infections or your CD4 cell count drops below 200.

It's Difficult to Get HIV From Casual Contact?

Fact. You can't catch or spread HIV from hugging someone, using the same towel, or sharing the same glass. It's very rare to get HIV from a blood transfusion -- the U.S. blood supply is carefully tested. However, you can spread the disease from having unprotected sex, sharing needles, or getting a tattoo from unsterilized equipment.

You Have Just a Few Years to Live?

Myth. Everyone with HIV experiences it differently. Some people may develop AIDS within a few months as the virus quickly weakens their immune system. Many others can live for decades with HIV and have a normal life expectancy. You can help prevent HIV from progressing to AIDS by seeing your doctor regularly and following your doctor's recommendations.

You'll Know You Have HIV Because of Your Symptoms?

Myth. Some people don't show any signs of HIV for years after being infected. Many can have some symptoms within 10 days to a few weeks after infection. These first symptoms are similar to the flu or mononucleosis and may include fever, fatigue, rash, and sore throat. They usually disappear after a few weeks and you may not have symptoms again for several years. The only way to tell you have HIV is to get tested.

HIV Can Be Cured?

Myth. There is no cure for HIV, but treatment can keep virus levels low and help maintain your immune system. Some drugs interfere with proteins HIV needs to copy itself; others block the virus from entering or inserting its genetic material into your immune cells. Your doctor will consider your general health, the health of your immune system, and the amount of virus in your body to decide when to start treatment.

Anyone Can Get HIV?

Fact. About 56,000 people in the U.S. get HIV each year, and 18,000 people with AIDS die each year. Anyone can get HIV -- men, women, and children, people who are gay or straight. Men who have sex with men make up more than half (53%) of new HIV infections each year. Women account for 27% of new infections, and children 13%. African-Americans make up almost half of all new HIV infections each year.

Sex Is Safe When Both Partners Have HIV?

Myth. Just because you and your partner both have HIV, doesn't mean you should forget about protection when you have sex. Using a condom or other latex barrier can help protect you from other sexually transmitted diseases as well as other strains of HIV, which may be resistant to anti-HIV medication. Even if you are being treated and feel well you can still infect others.

You Can Have a Baby if You Are HIV-Positive?

Fact. Infected mothers can indeed pass HIV to their babies during pregnancy or delivery. However, you can lower the risk by working with your doctor and getting the appropriate care and medication. Pregnant women with HIV can take medications to treat their infection and to protect their babies against the virus.

You Can’t Avoid Other HIV-Related Infections?

Myth. Due to weakened immune systems, people with HIV can be vulnerable to infections like pneumocystis pneumonia, tuberculosis, candidiasis, cytomegalovirus, and toxoplasmosis. The best way to reduce your risk is to take your HIV medications. Some infections can be prevented with drugs. You can lessen your exposure to some germs by avoiding undercooked meat, litter boxes, and water that may be contaminated.

Without Insurance You Can't Get Lifesaving Drugs?

Myth. There are government programs, nonprofit groups, and some pharmaceutical companies that may help cover of the cost of HIV/AIDS drugs. But be aware: These drug "cocktails" can cost $15,000 a year. Talk to your local HIV/AIDS service organization to learn about financial help.