Staying Negative Breakthrough Advice Daily Pill Prevents HIV

My naturally optimistic nature, encourages me to believe that the before pill (e.g.Truvada) to prevent HIV will in a few short years become common place, adding another piece to solving the puzzle of new HIV infections in Australia. For people with the resources and inclination perhaps a “Perth Buyers Club” for Truvada is ready to be formed, enjoy your empowerment and sexual freedom :-).

Published in the April 2014 Online Edition of Out in Perth

Positive Advocate: Staying Negative Breakthrough Advice Daily Pill Prevents HIV

Cipriano Martinez

Making a bold move, this month the USA Centre for Disease Control and Prevention (CDC) has recommended that people who are “at substantial risk for HIV” consult their doctor about starting a daily pill (Truvada) to prevent HIV. Although condom use along with other prevention methods are also recommended the New York Times (NYT) reported that CDC officials are increasingly frustrated with consistently high annual new HIV infection rates of 50,000 and the ongoing decline of condom use. In 2011 a survey by the CDC reported that just under 60% of gay men had unprotected sex in the last year, this trend is repeated internationally, in Australia condom use has also declined.

When the before pill (Truvada) is taken daily, the reduction in HIV transmission amongst gay men reached a high of 99% (check out the scientific evidence, look up iPrEx trial). There is a direct correlation between the effectiveness of Truvada and how much of the drug you have in your blood (or to be more technically accurate the mucosal lining of your rectum, where most sexual transmission of HIV is likely to occur). So taking the pill the night before will probably not give the drug enough time to build up in your body for the full preventive effect. Daily dosing and the potential for side effects are the disadvantages of this HIV prevention strategy.

Focusing intentionally on gay men’s sexuality, for whom is the daily pill Truvada useful for? Predominately for gay men who don’t like to use condoms or use them inconsistently with their multiple partners. Keeping it simple some examples could include: if you’re having casual sex (fuck buddies included) and not using condoms every time, if you’re going to party hard or on holiday and are likely to meet lots guys and not always use a condom, if you’re starting a new relationship and are thinking of dropping condoms early (before mutual testing and sexual agreements), if you have regular Poz fuck buddies (who may not be on their own HIV treatments), or if you’re in a loving relationships with a man with HIV and would like intimacy without condoms. A daily pill to prevent HIV is not useful for gay men who are content with consistently using condoms.

In Australia, how could you get access to the before Pill Truvada (known as Pre Exposure Prophylaxis or PrEP) to prevent HIV? Well the answer is somewhat complicated.

Ideally you could walk into your local community pharmacy or gay men’s sexual health clinic, have a conversation with an appropriate person (e.g. pharmacist, doctor, trained community health worker) receive a three month supply and start.

In Australia you could get free access by participating in a Victorian Study called VICPrEP which aims to prove that PrEP can be implemented safely and effectively. You could find a Gay friendly HIV specialist doctor who is happy to prescribe, unfortunately Truvada is not listed under the PBS for PrEP. However you could pay the full retail price around $1350 a month, or email the script to a generic supplier (e.g. Cipla in India) or online pharmacy for approximately $250 a month. Another option is to travel and find a PrEP friendly country (e.g USA, India, Thailand) make a doctor’s appointment and receive a personal supply.

This conversation reminds me of the movie “Dallas Buyers Club” and how individuals felt compelled to work around a regulatory health system that failed to meet and respond to reasonable community demands. Having access to a before Pill (Truvada) is perhaps not a life and death scenario? However try telling that to a newly diagnosed individual, who could have benefited from this HIV prevention method.

Conceivably, as HIV medication patents expire and the cost declines, we will achieve more traction on the before pill for HIV prevention in our community. Every year we delay the implementation of science proven HIV prevention strategies about 1000 people acquire HIV in Australia. How badly do we want to end HIV in Australia? Daily pill to prevent HIV, bring it on!

Cipriano Martinez

 

PARTNER STUDY- Positive Advocate: We’re All Winning: Positive Sex Rules?

The Partner Study is an exciting confirmation of the “Swiss Statement” and the HPTN052 Study, broadly people with HIV successfully on HIV medication are “non-infectious”. Following is an opinion piece first published in the April online edition of OutinPerth

Positive Advocate: We’re All Winning: Positive Sex Rules?

Cipriano Martinez

A multi centre  European study has for years been following 767 poz-neg couples who were not using condoms and recently published breakthrough interim results. Take note, the persons studied with HIV were successfully on HIV meds, also known medically as having an “undetectable viral load” which means they took their HIV pills to maintain a level of HIV in the blood that was below the level of detection.

So how many HIV transmissions transpired? Drum roll and spotlight please, the answer ZERO! ZILCH! NADA! Whoo hoo, for poz-neg couples it seems Christmas has arrived early indeed.

The PARTNER Study was presented by Alison Rodger on the 4th March this year at the 21st Conference on Retroviruses and Opportunistic Infections (CROI) in Boston, at which two year interim data was revealed (www.croiwebcasts.org).

Of interest, 282 of the couples studied were gay men. 16% of the gay couples had another STI which did not alter the “zero” result of HIV transmission. Which brings into question STI public health messages that warn poz guys that, even though they’re on successful HIV medication, another STI could lead to an immediate and imminent viral load break out, making them more infectious?

Given the results from the PARTNER study, it seems at the very least the risks involved have been severely over stated and over played in the context of poz guys with successfully suppressed HIV (i.e. undetectable viral load). It also doesn’t take too much imagination for many to deduce that perhaps “HIV viral blips”, their occurrence, frequency and consequence have also been over stated.

Viral load sceptics aside, what does this mean in real life? It appears that  poz-neg couples can increasingly adopt the new default position, that while successfully on HIV medication a person with HIV is “non-infectious” (as adopted by the” Swiss Statement” of 2008). A potential challenge now, is for health science research to identify the exceptions to this new rule. We are in exciting times. There is now enormous incentive to immediately test and treat, thereby reducing the unknown positive in our communities. It’s a winning benefit to all if we want to end the HIV epidemic.

The National Association of People with HIV Australia (NAPWHA) announced this month a Public awareness campaign titled “The Wait Is Over “. It seeks to underline both the health advantages of starting treatment early and the additional HIV prevention benefits that can now be accessed. The Pharmaceutical Benefit Scheme (PBS) changes taking effect this month now allows people with HIV to effectively start treatment once HIV diagnoses occurs.

Professor David Cooper, Director of the Kirby Institute in Sydney has welcomed the NAPWHA campaign, saying , “HIV treatment has a powerful benefit of helping prevent transmission of HIV to others”. He added, “Interim results recently released from the PARTNERS study have confirmed that HIV positive people who are taking HIV treatment successfully have a greatly reduced risk of passing HIV onto their partners. The powerful impact of HIV treatment  in preventing onward HIV transmission should be a significant factor in choosing to commence treatment for many people who wish to do all they can to protect their partners. This PBS change will allow that to happen more easily”.

When reviewing some online commentary to the PARTNER study, it seems that most welcome the results, and many have responded with cautious optimism. For some liberated poz-neg couples, it could be easy too view opposing responses as (be warned some strong language follows) nothing more than, homophobic, hope obliterating, sex negative trolls on a moral panic crusade. However, once you get past the emotionally charged advocating warrior within, there are some valid concerns. For negative men who hook up with casual guys who claim to be HIV free (but are really untested) condoms remain an effective prevention strategy against HIV and will remain a gay cultural norm for some time to come.

It seems the rules of sexual engagement have changed however by working together everybody can win from treatment as prevention.

Cipriano Martinez

http://www.positiveadvocate.com

How to Date a Poz Guy

I enjoyed writing this story like narrative of a neg guy falling in love with a poz guy
This article below was first published Feb 2014 in OutinPerth

Positive Advocate: How to Date a Poz Guy
By Cipriano Martinez

So you’ve met the man of your dreams again, only this time it turns out he’s living with HIV. At first your cool about it: “Hey, he can’t help what he has, right?” and “It’s not like I’ve never barebacked, it could happen to anyone.”. Still annoying irrational 80’s thoughts keep creeping in. “I don’t want to die”. You rattle and shake the thought, after all you know that people with HIV now live for an almost normal life span. You also know you’re not alone, nearly 60% of poz guys who are in a relationship have a neg partner.

Still it’s time to brush up on your sexual education. Poz guys are not always born natural educators. You consider your options, WA AIDS Council educators “community friendly and free”, HIV specialist nurses and doctors “may cost, time limits”, Internet “mmm, better go to reputable sites”. You take all the options, but find your mate Josh who’s been in a pos-neg relationship for 3 years the best source.

With your knowledge refreshed and your confidence up, you continue to have intimacy and sex with your partner- “you’re so fucking hot” -minus all the angst you initially started with. After 6 months your emotional connection is now so strong you contemplate how cruel life would be without the constant love you create and accept from one another. Your desire for full, natural sex builds within, you share your thoughts with your partner only to find him adamant. “You don’t need to prove your love by barebacking”. He expresses his personal fears over transmission. “One of us with HIV is one too many, I want you safe for a life time.” He gets upset and you realise that he still has some of his own personal healing to do. The conversation brings you even closer as he communicates in more detail than ever his personal story and journey.

It finally happens, your partner’s worst fears, 9 months into the relationship, the condom broke. You have big discussions on what it could mean, what would change if you too were to have HIV. You decided to love each other no matter what. Secretly you’re glad it came to pass, as you wanted to experience all of him. Also you know that because he has an undetectable viral load, it’s almost impossible for him to pass on HIV and the risk is nearly zero. Still, you front up to the hospital emergency department, after asking about your circumstances and checking you’re within the 72 hours of the potential exposure, they give you PEP. A month’s worth of HIV medication to prevent HIV from potentially establishing itself.

You decide to be proactive and make an appointment with a knowledgeable and community friendly doctor. You discuss with him the potential of having a home starter kit: “the hospital drama feels completely unnecessary”. The pills in your case were easy to take, your result is still neg. You chat with your doctor whether you could have daily Truvada, a HIV pill that you read can reduce by 90% plus that chance of getting HIV if exposed. It kinda makes sense to you to do whatever you can to be with the man you love. Some family and friends have been supportive, some not so. Your partner trusted that you would only tell people you needed to talk things through. He’s still sensitive about who knows, and after some of the reactions from close friends you now understand why.

It’s now been almost a year, It’s funny how little you think about HIV now. Most of the time you’re playing, going out to dinner with friends and having fun with your partner. Talk has started about moving in together, his place is nicer, but you’re definitely the better cook. You’re happier than ever, the decision to love rather than stay scared has been worth it.

Cipriano Martinez

Time for Australia to catch up – Health workers with HIV cleared for dental and surgical work

It’s time for Australia to review its protocols once again and come inline with worlds best practice. C’mon Australasian Society of HIV Medicine continue to drive the change to scientific best practice.

UK health care workers with HIV to be cleared for dental and surgical work

Health care workers on treatment, with undetectable viral load, will carry out `exposure-prone` procedures

Keith Alcorn
Published: 15 August 2013

Health care workers in the United Kingdom living with HIV will be permitted to carry out exposure-prone surgical and dental procedures from April 2014, the Department of Health announced today, if they are on antiretroviral treatment, receive regular medical monitoring and have an undetectable viral load.

The decision follows a public consultation in 2012 and a review of the evidence by the Expert Advisory Group on AIDS.

An exposure-prone procedure is any medical or dental procedure which carries a risk of injury to the health care worker that might result in bleeding into the patient’s open tissues. These might occur in surgery, dentistry and during obstetric and gynaecological procedures.

HIV testing is compulsory for all health care workers who carry out exposure-prone procedures, and previous regulations banned any HIV-positive health care worker from carrying out these procedures. This is despite extremely limited evidence of transmission from health care workers to patients.

The recent consultation and review of the policy concluded that the risk of transmission from health care workers during exposure-prone procedures was extremely low.

Based both on the lack of evidence of transmission and the accumulating evidence regarding the lack of onward transmission in people with fully suppressed viral load, the Department of Health has recommended a new procedure that will allow health care workers with HIV to practice while protecting patient safety.

  • All health care workers with HIV who wish to practice exposure-prone procedures should be notified by occupational health physicians to the UK Advisory Panel for Healthcare Workers Infected with Blood-Borne Viruses (UKAP) for the first two years after revision of the guidance.
  • Health care workers should be on antiretroviral therapy, have viral load below 50 copies/ml (undetectable) and undergo three-monthly viral load testing.
  • If viral load is below 50 copies/ml health care workers may continue to practice exposure-prone procedures.
  • If viral load is between 50 copies/ml and 200 copies/ml re-testing should be carried out and the case should be reviewed on an individual basis if viral load is found to be between 50 copies/ml and 200 copies/ml.
  • Review of safety to practice will be carried out by the patient’s treating physician and occupational health physician.
  • If viral load is above 200 copies/ml the health care workers should cease to practice exposure-prone procedures until viral load falls below 200 copies/ml again.

Formal guidance for the NHS on implementation is being prepared by Public Health England.

“Today’s announcement brings England into line with nations including Sweden, France, Canada and New Zealand, and is good news for patients and HIV-positive dentists alike. We look forward to seeing its implementation,” said Professor Damien Walmesley, scientific advisor to the British Dental Association.

http://www.aidsmap.com/UK-health-care-workers-with-HIV-to-be-cleared-for-dental-and-surgical-work/page/2731599/

Time To Scale Up Stem-cell Therapy

 

It appears that we now have a cure for HIV (yipeee!!!!), which at this stage requires further research so that its not so toxic that it kills people on the way (either through the chemo or graft versus host disease), and scaled up so that it becomes affordable and sustainable to perform for many. Very excited at how close we now are :-).
Four people have now been cured of HIV, the “Berlin Patient”, “Mississippi Baby” and the “Boston Two” described below. I am very hopeful we are at the beginning of the end for HIV. Below an article posted by the ABC

 

Bone marrow stem-cell therapy appears to have eradicated HIV in two patients

 

Updated Thu Jul 4, 2013 1:17pm AEST

 

American doctors have revealed that two patients appear to have become HIV-free after having bone marrow stem cell transplants to treat cancer.

Both patients, who were treated in Boston and had been on long-term drug therapy to control HIV, received stem-cell transplants after developing lymphoma, a type of blood cancer.

Timothy Henrich from the Harvard Medical School says doctors have been unable to find any evidence of the HIV infection in the men since the transplants.

Dr Henrich, who made the announcement at an international AIDS Society conference in Kuala Lumpur, said it is too early to say for sure that the virus has disappeared from their bodies altogether.

 

However, he reported that one patient has now been off antiretroviral drug treatment for 15 weeks and the other for seven weeks.

 

Dr Henrich first reported last July that the two men had undetectable levels of HIV in their blood after their stem-cell treatment, but at that time they were still taking medicines to suppress HIV.

“Dr Henrich is charting new territory in HIV eradication research,” said Kevin Robert Frost, the chief executive officer of the Foundation for AIDS Research, which funded the study

The revelation has raised hopes for a cure of the virus, which infects about 34 million people worldwide, but experts in the field are urging caution until more work is done.

Using stem-cell therapy is not seen as a viable option for widespread use, since it is extremely expensive, but the latest cases could open new avenues for fighting the disease.

The latest cases resemble that of Timothy Ray Brown, known as “the Berlin patient”, who became the first person to be cured of HIV after receiving a bone marrow transplant for leukaemia in 2007. There are, however, important differences between the cases.

While Mr Brown’s doctor used stem cells from a donor with a rare genetic mutation, known as CCR5 delta 32, which renders people virtually resistant to HIV, the two Boston patients received cells without this mutation.

Scientific advances since HIV was first discovered more than 30 years ago mean the virus is no longer a death sentence and the latest antiretroviral AIDS drugs can control the virus for decades.

But many people do not get therapy early enough, prompting the World Health Organisation to call for faster roll-out of medicines after patients test positive.

In the meantime, Australian scientists said they are optimistic they have discovered a way for millions more people to get access to crucial antiretroviral drugs.

They have found a lower daily dose of one drug is just as effective, yet far cheaper, than the current dosage.

Danish Breakthrough for HIV cure expected ‘within months’

The story was published by The Sydney Morning Hearld , it was also published by many others. I believe that the Danes are on the right track. Finding a way to release/flush out the hidden reservoirs (insert HDAC inhibitors) of HIV from our DNA and then having other drugs or our own boosted immune system (or a combination of both) eliminate them/inhibit future replication, sounds like a strong plausible basis for a cure. Wearing my optimists hat, I wish the Danish researchers and their collaborators speed and efficiency in their endeavor.

After posting this page I received some valid criticism from Gus Cains re hype. The original article has been resubmitted   Scientists’ hope for HIV cure

Below the original article.

Danish breakthrough for HIV cure expected ‘within months’

Jake Wallis-Simons
Published: April 29, 2013 – 3:00AM

Advertisement

A breakthrough in the search for a cure for HIV will come ”within months”, researchers believe.

Danish scientists are expecting results showing that it will be possible to find a cure that is both affordable and can be provided to a large number of people.

They are running clinical trials to test a ”novel strategy” in which the HIV virus, which causes AIDS, is stripped from human DNA and destroyed by the immune system.

It has already been found to work in laboratory tests and the scientists are now running human trials.

The technique involves releasing the HIV virus from ”reservoirs” it forms in DNA cells, bringing it to the surface of the cells. Once it comes to the surface, the body’s immune system can kill the virus through being boosted by a ”vaccine”.

In vitro studies – those that use human cells in a laboratory – of the new technique proved so successful that in January the Danish Research Council awarded the team 12 million kroner ($2 million) to pursue clinical trials with human subjects.

Ole Sogaard, a senior researcher at the Aarhus University Hospital in Denmark who is leading the study, said: ”I am almost certain we will be successful in releasing the reservoirs of HIV.

”The challenge will be getting the immune system to recognise the virus and destroy it. This depends on the strength and sensitivity of individual immune systems.”

Fifteen patients are taking part in the trials, and if they are found to have been cured of HIV, the process will be tested on a wider scale.

The technique uses drugs called HDAC inhibitors, more commonly employed in treating cancer.

It is also being researched in Britain, but studies have not yet moved on to the clinical trial stage.

Telegraph, London

This story was found at: http://www.smh.com.au/national/health/danish-breakthrough-for-hiv-cure-expected-within-months-20130428-2imnp.htm

For some more hope read the article below

University of Minnesota doctors try to cure boy of HIV, cancer in risky operation