Ellen DeGeneres named special envoy for global AIDS awareness

Ellen DeGeneres

While speaking today on HIV/AIDS issues at the National Institutes of Health, Secretary of State Hillary Rodham Clinton announced that out, proud lesbian comedian, actress and talk show host Ellen DeGeneres has been named a special envoy for global AIDS awareness.

In a statement in response to the announcement, DeGeneres said she is honored to have been chosen by Secretary Clinton for the position.

“The fight against AIDS is something that has always been close to my heart.  And I’m happy that I can use my platform to educate people and spread hope,” DeGeneres said. “Now, if you’ll excuse me, I have to go look up what ‘envoy’ means.”

In a letter to DeGeneres, Clinton said the talk show host’s “energy, compassion and star power” will make her an effective voice for AIDS awareness.

“Your words will encourage Americans in joining you to make their voices heard in our campaign to achieve an AIDS-free generation. The enormous platform of your television show and your social media channels will enable you to reach millions of people with the strong and hopeful message that we can win this fight,” Clinton wrote.

In addition to her studio and television audience for her talk show each day, DeGeneres reaches 8 million followers on Twitter and 5.8 million people through Facebook. She has been outspoken advocate on anti-bullying issues and an advocate on animal rescue and rehabilitation and breast cancer issues. DeGeneres previously worked with the advocacy organization ONE to raise awareness on HIV/AIDS issues.

Clinton’s speech today is expected to be the first in a series of speeches and messages from the Obama administration leading up to World AIDS Day on Dec. 1.

—  admin

Premature aging an issue for AIDS survivors

30 years after 1st diagnoses, scientists work to pin down cause of complications, while doctors develop treatment guidelines

LISA LEFF | Associated Press

SAN FRANCISCO — Having survived the first and worst years of the AIDS epidemic, when he was losing three friends to the disease in a day and undergoing every primitive, toxic treatment that then existed, Peter Greene is grateful to be alive.

But a quarter-century after his own diagnosis, the former Mr. Gay Colorado, now 56, wrestles with vision impairment, bone density loss and other debilitating health problems he once assumed he wouldn’t grow old enough to see.

“I survived all the big things, but now there is a new host of things. Liver problems. Kidney disease. It’s like you are a 50-year-old in an 80-year-old body,” Greene, a San Francisco travel agent, said. “I’m just afraid that this is not, regardless of what my non-HIV positive friends say, the typical aging process.”

Even when AIDS still was almost always fatal, researchers predicted that people infected with HIV would be more prone to the cancers, neurological disorders and heart conditions that typically afflict the elderly. Thirty years after the first diagnoses, doctors are seeing these and other unanticipated signs of premature or “accelerated” aging in some long-term survivors.

Government-funded scientists are working to tease apart whether the memory loss, arthritis, renal failure and high blood pressure showing up in patients in their 40s and 50s are consequences of HIV, the drugs used to treat it or a cruel combination of both. With people over 50 expected to make up a majority of U.S. residents infected with the virus by 2015, there’s some urgency to unraveling the “complex treatment challenges” HIV poses to older Americans, according to the National Institutes of Health.

“In those with long-term HIV infection, the persistent activation of immune cells by the virus likely increases the susceptibility of these individuals to inflammation-induced diseases and diminishes their capacity to fight certain diseases,” the federal health agency’s chiefs of infectious diseases, aging and AIDS research wrote, summing up the current state of knowledge on last September’s National HIV/AIDS and Aging Awareness Day. “Coupled with the aging process, the extended exposure of these adults to both HIV and antiretroviral drugs appears to increase their risk of illness and death from cardiovascular, bone, kidney, liver and lung disease, as well as many cancers not associated directly with HIV infection.”

In San Francisco, where already more than half of the 9,734 AIDS cases are in people 50 and over, University of California, San Francisco AIDS specialists are collaborating with geriatricians, pharmacists and nutritionists to develop treatment guidelines designed to help veterans of the disease cope with getting frail a decade or two ahead of schedule and to remain independent for as long as possible.

“Wouldn’t it be helpful to be able to say, are you at high risk, low risk or moderate risk for progressing to dependency in the next five, the next 10 years, being less mobile, less able to be functional in the workplace. Are you going to be safe in your home, are you going to remember to take all those medications? How are they going to interact?” explained Dr. Malcolm John, who directs UCSF’s HIV clinic. “All those questions need to be brought into the HIV field at a younger age.”

Research so far suggests that HIV is not directly causing conditions that mimic old age, but hastens patients toward ailments to which they may have been genetically or environmentally predisposed. Plus, their immune systems are being weakened over time even when they are being successfully treated for AIDS, John said.

“That’s probably true for a lot of these things. We aren’t saying HIV’s starting the problem, but it’s added fuel on top,” he said.

Stokes, a patient of John’s who goes by only his last name, is a prime example. At 53, HIV-positive since 1985 and in substance abuse recovery for the last 11 years, he says he is happier than he ever has been. Yet the number of ailments for which he is being treated would be more commonly found in someone 30 years his senior: a condition called Ramsay Hunt syndrome that causes facial paralysis, a rare cartilage disorder for which he has undergone four ear surgeries, bone death in the hip and shoulder, deterioration of his heart muscle, osteoporosis and memory loss.

A specialist recently diagnosed a Kaposi’s sarcoma spot on Stokes’ ankle. Although the cancer is not life-threatening, the sight of young men disfigured by KS lesions was a harbinger of the early AIDS crisis, and its presence on his own body is unsettling.

At his therapy group for men with HIV, aging “comes up frequently,” he said. “I say, ‘Just think what we have come through to have a life today.”’ At the same time, he acknowledges sometimes feeling self-conscious about his physical appearance and worries if “people are not attracted to me and unwilling to go the length of what it means to be with me, no matter how brilliant my mind or my zest for life.”

Loneliness, financial worries and concerns about who will care for them and where can weigh on long-term AIDS survivors in the same way as all adults living in a society that values youth, Charles Emlet, a social work professor at the University of Washington, Tacoma, said.

As they get older and sicker, many feel “doubly stigmatized,” he said. Some people who have lived with the virus for a long time have been getting by on private disability benefits that will run out when they turn 65, forcing them to move to less expensive locations or to consider turning to estranged family members. Like soldiers from a distant war, many lost partners and their closest friends to AIDS.

Such emotional side effects, combined with the physical toll of managing chronic health problems, put older AIDS patients at risk for depression. At the same time, Emlet has uncovered evidence that a majority of long-term survivors also share another trait that typically comes with advanced age: that is, the ability to draw strength from their difficult experiences.

“The older adults I’ve interviewed, many of them talk about how much it means to them to give back, to do something positive with the years they never expected to have,” he said.

Peter Greene can relate to that. At times, like the days he is so exhausted he can’t get out of bed or the pain from his multiple maladies is too intense, he asks himself “the Carrie Bradshaw question — are we really lucky to still be alive?” Carrie Bradshaw was the character played by Sarah Jessica Parker in the Sex and the City TV shows and films.

As frightening and uncertain as this phase of AIDS is, he thinks he knows the answer.

“I’ve tried to make the time I have count, and really, now that I have the body of an 80-year-old, I probably have the wisdom of an 80-year-old as well, which counts for a lot,” Greene said. “Everything becomes clear at the end of your life and in some ways, thinking you’ve been dying all these years, you get moments of clarity that I don’t think everyone gets.”

—  John Wright

UN urges more funds for early HIV treatment

Report comes on heels of study showing medicines dramatically reduce spread of virus

EDITH M. LEDERER | Associated Press

UNITED NATIONS — The United Nations AIDS agency on Friday urged increased funding for early treatment of people with HIV following a new international study showing it could dramatically reduce the number of new infections through sexual transmission.

UNAIDS Executive Director Michel Sidibe said pushing for early treatment “is at the top of the agenda” following the striking results of an international study overseen by the U.S. National Institutes of Health.

The nine-nation study offered convincing evidence of what scientists have long believed — that HIV medicines don’t just benefit the patient, but may act as a preventive by making those people less infectious. Earlier treatment in the study meant patients were 96 percent less likely to spread the virus to their uninfected partners, according to preliminary results announced last month.

Sidibe told a news conference launching a new report by UNAIDS that early treatment and prevention efforts must also be accompanied by better skills for health workers and sex education for young people.

“Access to treatment will transform the AIDS response in the next decade,” Sidibe said. “Anti-retroviral therapy is a bigger game-changer than ever before — it not only stops people from dying, but also prevents transmission of HIV to women, men and children.”

Sidibe stressed that billions of dollars will be needed to meet the agency’s vision for the future — “zero new HIV infections, zero discrimination and zero AIDS-related deaths.”

The report said “universal access” to drug treatment for those with HIV is achievable.

UNAIDS released the 139-page document ahead of today’s 30th anniversary of the first official report of what would become the HIV epidemic by the U.S. Centers for Disease Control and Prevention. The General Assembly is holding a high-level meeting on AIDS at U.N. headquarters from June 8-10, where 20 world leaders and over 100 ministers are expected.

U.N. Deputy Secretary-General Asha-Rose Migiro said at Friday’s launch that the world is “at a turning point in the AIDS response” and the meeting is an opportunity to “expand HIV services … (and) chart a new path.”

“The goal towards achieving universal access to HIV prevention, treatment, care and support must become a reality by 2015,” she said.

The last decade has seen a nearly 25 percent decline in new HIV infections, a reduction in AIDS-related deaths, and “unprecedented advances” in access to treatment, prevention services and care, the report said.

In India, which has the largest number of people living with HIV in Asia, the rate of new infections fell by more than 50 percent, while in South Africa, which has the largest number of HIV cases in Africa, the rate fell by more than 35 percent, the report said.

But UNAIDS said these achievements are unevenly distributed, exceedingly fragile, and fall short of global targets.

“People in rich countries don’t die from AIDS any more,” former U.S. President Bill Clinton wrote in the report, “but those in poor countries still do — and that’s just not acceptable.”

The report said more than 34 million people were living with HIV at the end of 2010 — including 2.6 million who became newly infected with the virus that causes AIDS in 2009.

It said the proportion of countries conducting systematic surveillance of HIV among high-risk populations increased between 2008 and 2010: from 44 percent to 50 percent for sex workers, and from 30 percent to 36 percent for gay men. An estimated 20 percent of the 15.9 million people who inject drugs worldwide are living with HIV, the report said.

An estimated 6.6 million people in low- and middle-income countries were receiving antiretroviral drug treatment at the end of last year, but about 9 million eligible people in those countries were not, the report said.

According to the report, investment in the response to HIV in low-and middle-income countries rose from US$1.6 billion in 2001 to US$15.9 billion in 2009.

U.N. Secretary-General Ban Ki-moon wrote in the preface that “the number of people becoming infected and dying is decreasing, but the international resources needed to sustain this progress have declined for the first time in 10 years, despite tremendous unmet needs.”

Sidibe said financial challenges are putting “unprecedented downward pressure on funding sources, internally and internationally.” But he said the right approach can spur all countries “to do things better, with maximum value for money.”

The Lancet, a British medical journal, published a proposal developed byFriday a study group set up by UNAIDS which outlines what the group called “a more targeted and strategic approach to investment.”

Implemeting the new investment framework “would avert 12.2 million new HIV infections and 7.4 million deaths from AIDS between 2011 and 2020 compared with continuation of present approaches,” it said,

“The yearly cost of achievement of universal access to HIV prevention, treatment, care, and support by 2015 is estimated at no less than $22 billion,” the Lancet report said, but in the long term the cost of responding to AIDS would be reduced.

—  John Wright

AIDS breakthrough: Gel helps prevent infection

MARILYNN MARCHIONE  |  AP Medical Writer

MILWAUKEE — For the first time, a vaginal gel has proved capable of blocking the AIDS virus: It cut in half a woman’s chances of getting HIV from an infected partner in a study in South Africa. Scientists called it a breakthrough in the long quest for a tool to help women whose partners won’t use condoms.

The results need to be confirmed in another study, and that level of protection is probably not enough to win approval of the microbicide gel in countries like the United States, researchers say. But they are optimistic it can be improved.

“We are giving hope to women,” who account for most new HIV infections, said Michel Sidibe in a statement. He is executive director of the World Health Organization’s UNAIDS program. A gel could “help us break the trajectory of the AIDS epidemic,” he said.

And Dr. Anthony Fauci of the U.S. National Institutes of Health said, “It’s the first time we’ve ever seen any microbicide give a positive result” that scientists agree is true evidence of protection.

The gel, spiked with the AIDS drug tenofovir, cut the risk of HIV infection by 50 percent after one year of use and 39 percent after 2 1/2 years, compared to a gel that contained no medicine.

To be licensed in the U.S., a gel or cream to prevent HIV infection may need to be at least 80 percent effective, Fauci said. That might be achieved by adding more tenofovir or getting women to use it more consistently. In the study, women used the gel only 60 percent of the time; those who used it more often had higher rates of protection.

The gel also cut in half the chances of getting HSV-2, the virus that causes genital herpes. That’s important because other sexually spread diseases raise the risk of catching HIV.

Even partial protection is a huge victory that could be a boon not just in poor countries but for couples anywhere when one partner has HIV and the other does not, said Dr. Salim Abdool Karim, the South African researcher who led the study. In the U.S., nearly a third of new infections each year are among heterosexuals, he noted.

Countries may come to different decisions about whether a gel that offers this amount of protection should be licensed. In South Africa, where one in three girls is infected with HIV by age 20, this gel could prevent 1.3 million infections and 826,000 deaths over the next two decades, he calculated.

He will present results of the study Tuesday at the International AIDS Conference in Vienna. The research was published online Monday by the journal Science.

“We now have a product that potentially can alter the epidemic trends … and save millions of lives,” said Dr. Quarraisha Abdool Karim, the lead researcher’s wife and associate director of the South African program that led the testing.

It’s the second big advance in less than a year on the prevention front. Last fall, scientists reported that an experimental vaccine cut the risk of HIV infection by about 30 percent. Research is under way to try to improve it.

If further study shows the gel to be safe and effective, WHO will work to speed access to it, said its director-general, Dr. Margaret Chan.

The gel is in limited supply; it’s not a commercial product, and was made for this and another ongoing study from drug donated by California-based Gilead Sciences Inc., which sells tenofovir in pill form as Viread. If further study proves the gel effective, a full-scale production system would need to be geared up to make it.

The study tested the gel in 889 heterosexual women in and near Durban, South Africa. Researchers had no information on the women’s partners, but the women were heterosexual and, in general, not in a high-risk group, such as prostitutes.

Half of the women were given the microbicide and the others, a dummy gel. Women were told to use it 12 hours before sex and as soon as possible within 12 hours afterward.

At the study’s end, there were 38 HIV infections among the microbicide group versus 60 in the others.

The gel seemed safe — only mild diarrhea was slightly more common among those using it. Surveys showed that the vast majority of women found it easy to use and said their partners didn’t mind it. And 99 percent of the women said they would use the gel if they knew for sure that it prevented HIV.

This shows that new studies testing the gel’s effectiveness without a placebo group should immediately be launched, said Salim Abdool Karim. The only other study testing the gel now compares it to placebo and will take a couple more years to complete.

The study was sponsored by the Centre for the AIDS Programme of Research in South Africa, or CAPRISA; Family Health International; CONRAD, an AIDS research effort based at Eastern Virginia Medical School; and the U.S. Agency for International Development, or USAID.

Gilead has licensed the rights to produce the gel, royalty-free, to CONRAD and the International Partnership on Microbicides for the 95 poorest countries in the world, said Dr. Howard Jaffe, president of the Gilead Foundation, the company’s philanthropic arm.

The biggest cost of the gel is the plastic applicator — about 32 cents, which hopefully would be lower when mass-produced, researchers said.

Mitchell Warren, head of the AIDS Vaccine Advocacy Coalition, a nonprofit group that works on HIV prevention tools, said the study shows a preventive gel is possible.

“We can now say with great certainty that the concept has been proved. And that in itself is a day for celebration,” he said.

—  John Wright