TAG: "AIDS/HIV"

Different approaches needed to control cardiovascular risks for those with HIV


Study authors recommend greater emphasis on cardiology in HIV treatment, research.

Heejung Bang, UC Davis

Even if treated, hypertension and high cholesterol are common for people with human immunodeficiency virus (HIV), according to a new study from researchers at Mount Sinai St. Luke’s and Mount Sinai Roosevelt hospitals in New York and UC Davis.

The finding — published online in the Journal of Acquired Immune Deficiency Syndromes — persuaded the study authors to recommend greater emphasis on cardiology in HIV treatment and research.

“It is clearly important to add cardiology specialists to the care teams for patients with HIV,” said Heejung Bang, professor of public health sciences at UC Davis and senior author of the study. “We also need more research focused on identifying treatments that work in controlling heart disease and stroke risks for this patient population.”

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UCLA receives $2M to provide dental care to patients with HIV/AIDS


Patients will receive diagnostic services and corrective care.

Accessing affordable medical and dental care is a major challenge for people living with HIV and AIDS, many of whom are disabled and can not afford dental exams and treatment. For this underserved, vulnerable population, maintaining oral health is important not only for functional and aesthetic reasons, but also as part of overall HIV disease management.

To address that need, the Los Angeles County Department of Public Health recently awarded the UCLA School of Dentistry a two-year grant of $2.36 million, which will enable UCLA to provide dental care for more than 1,000 people with HIV or AIDS each year.

The funding is being channeled through the federal government’s Ryan White HIV/AIDS Program, which works with cities, states and community-based organizations to provide HIV-related services to individuals who do not have sufficient health care coverage or financial resources. An estimated 50,550 people who have been diagnosed with HIV and AIDS are living in Los Angeles County — and, counting undiagnosed cases, experts believe the number might actually exceed 60,000.

“With this funding, we are going to be able to provide quality dental care and oral health specialty services to thousands of HIV and AIDS patients,” said Fariba Younai, a UCLA professor of clinical dentistry. “The patients who we will be treating are financially disadvantaged and have extremely limited access to care.”

Patients will receive diagnostic services such as exams and radiographs; preparatory work such as cleanings and removal of tooth decay; and corrective care including extractions, fillings, crowns and other prostheses, and periodontal surgery. In addition, care providers will emphasize prevention and early detection of oral diseases by teaching patients about the importance of proper oral care at home and periodic visits to the dental office for examinations.

“The dental needs of HIV-positive and AIDS patients can be extensive and complex,” said Dr. Paulo Camargo, the school’s associate dean of clinical dental sciences. “This contract allows the delivery of comprehensive dental treatment to a large patient population that would otherwise not have access to this type of care.”

The majority of the patients who will be treated will be referred by neighboring clinics that specialize in caring for people with HIV and AIDS. A patient care liaison will assist with communication between the referring clinics and the UCLA Dental Clinics to help position dental care as an integral component of the patients’ overall health.

“Thanks to this contract from the county of Los Angeles, we will be able to provide needed and valuable services and to work with other health care providers to improve quality of life for people with HIV/AIDS,” said Dr. No-Hee Park, the school’s dean. “This partnership helps us fulfill our mission of improving the oral and systemic health of people throughout our community.”

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New patient care model reduces readmission rates


Early results are promising.

Medical specialists within integrated care teams are helping to lower hospital re-admission rates for patients who are HIV positive. (Photo by Elena Zhukova)

>>Related: Pilot program reduces hospital readmissions for people with HIV and AIDS

By Kate Rix

A demonstration project aimed at improving patient care for people with HIV and AIDS has reduced the number of hospital readmissions at one Bay Area hospital by 44 percent.

The new approach — jointly funded by the California HIV/AIDS Research Program (CHRP) at the University of California, the Alameda County Health Care Services Agency, the Gordon and Betty Moore Foundation and Alameda Health System  — puts primary care physicians at the helm of an integrated care team that includes social workers, psychologists and medical specialists.

These collaborative teams form virtual “patient-centered medical homes” that work together to ensure that patients come to appointments, take their medications and get the care they need.

“The HIV epidemic has had a history of clients being advocates for their own care,” said John Mortimer, CHRP health policy and health services research program officer. “Our goal is to make medical care even more client-centered to help improve patient outcomes.”

Promising results

Early results are promising. Highland Hospital in Oakland looked at how many patients were readmitted to the hospital in 2010 before the demonstration project started and compared it to rehospitalizations during the pilot program.

As a result of patient-centered medical home care strategies, which included support for care transitions from hospital to outpatient care, the number of readmissions fell significantly. Of 89 patients admitted in 2010 for HIV-related treatment, 35 were readmitted within a month. From October 2012 to September 2013, 63 patients were admitted, and only 14 of them were readmitted within 30 days.

“This shows that our system is working,” says Dr. Kathleen Clanon, medical director of the Health Program of Alameda County. “The supports are successfully in place outside the hospital.”

In addition to Oakland’s Highland Hospital, four other community clinics are participating: the Tri-City Health Center in Fremont, Lifelong Medical Care in Berkeley, and La Clínica and Asian Health Services, both in Oakland.

“UC is happy to have supported this innovative and effective pilot research program,” said Dr. George Lemp, director of CHRP.

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Grad students to present research on STDs, parasites in Latin America


UCLA Blum Center conference to feature latest research on health, poverty in Latin America.

UCLA graduate student Claire Bristow conducted research at a Peruvian university.

In Peru, HIV and syphilis are more widespread among transgender women and men who have sex with men, and so ensuring that these groups get tested and treated is crucial.

A research project supported by UCLA’s Blum Center for Poverty and Health in Latin America is contributing to efforts in Peru to make this happen.

Claire Bristow, a UCLA Ph.D. student in public health who conducted research in Peru, and Rebecca Foelber, a master’s student in public health who worked in Brazil on another project, will present their research on behalf of the center at its Second Annual Spring Conference May 6-7 at UCLA’s De Neve Auditorium. Bristow and Foelber were selected for the Blum Center’s inaugural Summer Scholars Program.

Conference participants, who include UCLA students, faculty and staff as well as policy and health professionals from 10 Latin American countries, will discuss the latest research on health and poverty in Latin America. The conference will also highlight solutions and projects such as Bristow’s.

“The Summer Scholars Program was developed for students to examine how poverty, government practices and policies, and other factors impact poor health in Latin America,” said Dr. Michael Rodriguez, Blum Center director. “More importantly, the scholars’ research can lead to better health practices and solutions in a region that is so desperately in need of them.”

Bristow spent last summer in Lima, Peru, where she developed a study that asked people in these high-risk groups what type of HIV and syphilis testing they would prefer.

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Harm-reduction program optimizes HIV/AIDS prevention


Stonewall Project helps decrease stimulant use, reduce sexual risk behavior, study shows.

Adam Carrico, UC San Francisco

New research from UC San Francisco and the San Francisco AIDS Foundation has found that clients participating in a harm-reduction substance use treatment program, the Stonewall Project, decrease their use of stimulants, such as methamphetamine, and reduce their sexual risk behavior.

Harm reduction is a public health philosophy and strategy designed to reduce the harmful consequences of various, sometimes illegal, human behaviors such as the use of alcohol and other drugs regardless of whether a person is willing or able to cease that behavior.

“We found that even when participants were using methamphetamine, they reported engaging in HIV risk-reduction strategies such as having fewer anal sex partners after enrolling in Stonewall,” said the study’s lead investigator, Adam W. Carrico, Ph.D., UCSF assistant professor of nursing.

The research findings appear online today (April 18) in the Journal of Urban Health. The Stonewall Project, a San Francisco AIDS Foundation program, serves substance-using gay and bisexual men as well as other men who have sex with men.  Stonewall implements evidence-based, cognitive-behavioral substance use treatment from a harm-reduction perspective. At Stonewall, clients have the option of abstinence, but also may use harm-reduction strategies such as transitioning to less potent modes of administration (e.g., injecting to snorting) or reducing sexual risk taking while they are under the influence.

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Community-based HIV prevention can boost testing


Prevention efforts also can help reduce new infections, study shows.

Thomas Coates, UCLA

Communities in Africa and Thailand that worked together on HIV-prevention efforts saw not only a rise in HIV screening but a drop in new infections, according to a new study in the peer-reviewed journal The Lancet Global Health.

The U.S. National Institute of Mental Health’s Project Accept — a trial conducted by the HIV Prevention Trials Network to test a combination of social, behavioral and structural HIV-prevention interventions — demonstrated that a series of community efforts boosted the number of people tested for HIV and resulted in a 14 percent reduction in new HIV infections, compared with control communities.

Much of the research was conducted in sub-Saharan Africa, which has particularly high rates of HIV. The researchers were interested not just in how the clinical trial participants’ behavior changed, but also in how these efforts affected the community as a whole, said Thomas Coates, Project Accept’s overall principal investigator and director of UCLA’s Center for World Health.

“The study clearly demonstrates that high rates of testing can be achieved by going into communities and that this strategy can result in increased HIV detection, which makes referral to care possible,” said Coates, who also is an associate director of the UCLA AIDS Institute. “This has major public health benefit implications — not only suggesting how to link infected individuals to care, but also encouraging testing in entire communities and therefore also reducing further HIV transmission.”

These findings were previously presented at the 2013 Conference on Retroviruses and Opportunistic Infections in Atlanta.

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Twitter ‘big data’ can be used to monitor HIV and drug-related behavior


Studying link between HIV, drug use could help prevention, detection efforts.

Sean Young, UCLA

Real-time social media like Twitter could be used to track HIV incidence and drug-related behaviors with the aim of detecting and potentially preventing outbreaks, a new UCLA-led study shows.

The study, published in the peer-reviewed journal Preventive Medicine, suggests it may be possible to predict sexual risk and drug use behaviors by monitoring tweets, mapping where those messages come from and linking them with data on the geographical distribution of HIV cases. The use of various drugs had been associated in previous studies with HIV sexual risk behaviors and transmission of infectious disease.

“Ultimately, these methods suggest that we can use ‘big data’ from social media for remote monitoring and surveillance of HIV risk behaviors and potential outbreaks,” said Sean Young, assistant professor of family medicine at the David Geffen School of Medicine at UCLA and co-director of the Center for Digital Behavior at UCLA.

Founded by Young, the new interdisciplinary center brings together academic researchers and private sector companies to study how social media and mobile technologies can be used to predict and change behavior. (See the center’s Twitter account.)

Other studies have examined how Twitter can be used to predict outbreaks of infections like influenza, said Young, who is also a member of the UCLA Center for Behavioral and Addiction Medicine; UCLA’s Center for HIV Identification, Prevention and Treatment Services; and the UCLA AIDS Institute. “But this is the first to suggest that Twitter can be used to predict people’s health-related behaviors and as a method for monitoring HIV risk behaviors and drug use,” he said.

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Venice Family Clinic, Common Ground merge


The merger will provide enhanced HIV/AIDS care.

The UCLA-affiliated Venice Family Clinic and the nonprofit Common Ground, two pre-eminent health care and service providers for those in need on Los Angeles’ Westside, have merged, bringing their respective HIV services under a single umbrella — the Common Ground program of Venice Family Clinic.

As the Westside’s only provider of comprehensive HIV services for low-income and homeless patients, the Common Ground facility in Santa Monica will continue to offer critical support to those living with HIV and AIDS.

With recent changes to federal funding reimbursements for service providers mandated under the Affordable Care Act, Common Ground realized it would not be able to keep its doors open. Venice Family Clinic, one of Common Ground’s longtime community partners, acted quickly to ensure that the organization’s important contributions to this vulnerable community would continue.

For the last 20 years, Common Ground and Venice Family Clinic, which receives support from UCLA Health System and other medical centers, have collaborated to provide the only continuum of HIV care on the Westside to thousands of people living with HIV.

“As longtime partners of Common Ground, we know how many people rely on the critical, high-quality services they provide,” said Elizabeth Benson Forer, CEO of Venice Family Clinic. “This merger will ensure there will be no gap in service by bringing together two renowned teams committed to working in partnership to address the health care and service needs of those living with HIV.”

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Researchers open door to new HIV therapy


UC Berkeley researchers focus on a fourth protein, Nef.

The AIDS virus enters immune cells by binding to CD4 receptors embedded in the membrane (parallel lines) of the cell. But once a virus enters the cell, it makes a protein, Nef, that binds to the protein complex underlying CD4, tagging it for the waste bin. Potential anti-HIV drugs would disable one of the proteins (colored blobs) to which Nef binds, interfering with HIV’s strategy for spreading through the body. (Image by James Hurley, UC Berkeley)

The AIDS virus enters immune cells by binding to CD4 receptors embedded in the membrane (parallel lines) of the cell. But once a virus enters the cell, it makes a protein, Nef, that binds to the protein complex underlying CD4, tagging it for the waste bin. Potential anti-HIV drugs would disable one of the proteins (colored blobs) to which Nef binds, interfering with HIV’s strategy for spreading through the body.

People infected with the Human Immunodeficiency Virus (HIV) can stave off the symptoms of AIDS thanks to drug cocktails that mainly target three enzymes produced by the virus, but resistant strains pop up periodically that threaten to thwart these drug combos.

Researchers at the University of California, Berkeley, and the National Institutes of Health have instead focused on a fourth protein, Nef, that hijacks host proteins and is essential to HIV’s lethality. The researchers have captured a high-resolution snapshot of Nef bound with a main host protein, and discovered a portion of the host protein that will make a promising target for the next-generation of anti-HIV drugs. By blocking the part of a key host protein to which Nef binds, it may be possible to slow or stop HIV.

“We have imaged the molecular details for the first time,” said structural biologist James H. Hurley, UC Berkeley professor of molecular and cell biology. “Having these details in hand puts us in striking distance of designing drugs to block the binding site and, in doing so, block HIV infectivity.”

Hurley, cell biologist Juan Bonifacino of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) of the National Institutes of Health and their colleagues report their findings in a paper published today (Jan. 28) by the open-access, online journal eLife.

The report comes a month after President Barack Obama pledged to redirect $100 million in the NIH budget to accelerate development of a cure for AIDS, though therapies to halt the symptoms of AIDS will remain necessary for the immediate future, Bonifacino said.

“For many patients, current drug therapies have transformed HIV infection into a chronic condition that doesn’t lead to AIDS, but anything we can develop to further interfere with replication and propagation of the virus would help keep it in check until we find a way to completely eliminate the virus from the body,” he said.

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No link found between HIV-prevention pill, higher sexual risk behavior


Biological markers confirm behavioral data, underscore Truvada’s effectiveness.

Robert Grant

Robert Grant

In 2012, the HIV antiretroviral drug Truvada became the first and only medication approved by the FDA for HIV prevention. Led by Gladstone Institutes’ investigator Robert Grant, M.D., M.P.H., this research was hailed as an important step towards reducing the worldwide HIV/AIDS epidemic. Now, a new study provides further proof that regular Truvada use can reduce one’s risk for contracting HIV – without increasing sexual risk behavior.

This research, published today (Dec. 18) in the online journal PLOS ONE, builds on the 2010 Global iPrEx clinical study, which reported that Truvada, an FDA-approved drug used for years to treat HIV-positive patients, could also prevent new infections in people likely to come in contact with the virus. Lending further support to Truvada’s efficacy, a 2012 follow-up study found that taking Truvada regularly reduced risk of HIV infection by more than 90 percent.

Questions about the drug’s real-world effectiveness remained, however, particularly concerning the issue of whether taking the drug could lead to a behavioral effect called risk compensation. Risk compensation is the notion that individuals adjust their behavior in response to a change in their perceived level of risk—such as increasing exposure to the sun in response to sunscreen use. While iPrEx participants did self-report decreases in sexual risk behavior over the course of the study, Grant and his team decided to examine those findings more closely, by studying biological markers of risk behavior.

“After the initial iPrEx study, there was concern that self-reported behavior may not tell the whole story,” said Grant, who is also a professor at the UC San Francisco, with which Gladstone is affiliated. “Here, we not only gathered behavioral data, but we also tested each participant for both HIV and syphilis — allowing us to map over time how reported changes in overall behavior correlated with actual changes in infection rates.”

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Scientists ID potential drug to block AIDS


Gladstone plans to launch Phase 2 trial with existing anti-inflammatory.

Warner Greene

Warner Greene

Research led by scientists at the UC San Francisco-affiliated Gladstone Institutes has identified the precise chain of molecular events in the human body that drives the death of most of the immune system’s CD4 T cells as an HIV infection leads to AIDS. Further, they have identified an existing anti-inflammatory drug that in laboratory tests blocks the death of these cells — and now are planning a Phase 2 clinical trial to determine if this drug or a similar drug can prevent HIV-infected people from developing AIDS and related conditions.

Two separate journal articles, published simultaneously today (Dec. 18) in Nature and Science, detail the research from the laboratory of Warner C. Greene, M.D., Ph.D., who directs virology and immunology research at Gladstone, an independent biomedical-research nonprofit. His lab’s Science paper reveals how, during an HIV infection, a protein known as IFI16 senses fragments of HIV DNA in abortively infected immune cells. This triggers the activation of the human enzyme caspase-1 and leads to pyroptosis, a fiery and highly inflammatory form of cell death. As revealed in the Nature paper, this repetitive cycle of abortive infection, cell death, inflammation and recruitment of additional CD4 T cells to the infection “hot zone” ultimately destroys the immune system and causes AIDS. The Nature paper further describes laboratory tests in which an existing anti-inflammatory inhibits caspase-1, thereby preventing pyroptosis and breaking the cycle of cell death and inflammation.

“Gladstone has made two important discoveries, first by showing how the body’s own immune response to HIV causes CD4 T cell death via a pathway triggering inflammation, and secondly by identifying the host DNA sensor that detects the viral DNA and triggers this death response,” said Robert F. Siliciano, M.D., Ph.D., a professor of medicine at Johns Hopkins University and a Howard Hughes Medical Institute investigator. “This one-two punch of discoveries underscores the critical value of basic science — by uncovering the major cause of CD4 T cell depletion in AIDS, Dr. Greene’s lab has been able to identify a potential new therapy for blocking the disease’s progression and improving on current antiretroviral medications.”

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Sustainable science to promote health in Africa


UCSF establishes regional headquarters in East Africa to anchor research, train local scientists.

When someone is diagnosed with HIV in western Kenya, chances are he will get help from FACES, a network of clinics that takes a family-focused approach to prevention, care and treatment of the virus.

Likewise, a villager in Uganda who wants to know her HIV status is likely to get tested at a traveling clinic from SEARCH, a community-based trial with the goal of stopping the spread of HIV through a strategy known as “test and treat.”

Both projects were launched in collaboration with African scientists by researchers from UC San Francisco, which has been working in East Africa for more than two decades. UCSF scientists and clinicians have provided AIDS, tuberculosis and malaria-related treatment to tens of thousands of people, researched the causes and trajectories of the diseases and trained scientists and physicians throughout the region.\

Now, UCSF’s many and varied efforts – which are spread throughout the African continent, but are most concentrated in Uganda, Kenya and Tanzania – finally have a regional headquarters in Nairobi, Kenya, sponsored by the UCSF/Gladstone Center for AIDS Research (CFAR). CFAR also is supporting the expansion of a core immunology lab at the Infectious Diseases Institute (IDI) at Makerere University College of Health Sciences in Kampala, Uganda.

“This will increase the opportunity for UCSF researchers to get involved in collaborative programs in East Africa,” said Phil Rosenthal, M.D., a professor in the Division of Infectious Diseases at San Francisco General Hospital and Trauma Center (SFGH) and a malaria expert who has been training scientists in Uganda for more than a dozen years.

Like others at UCSF, Rosenthal has approached his scientific work with a dual aim: treat disease while sustainably building up the local health care system. These researchers have been at the forefront of a push toward more sustainable work that was embraced as national policy under the leadership of Ambassador Eric Goosby, M.D., who recently returned to UCSF after serving as Obama’s global AIDS coordinator and head of PEPFAR, the President’s Emergency Plan for AIDS Relief.

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