HIV Plus Magazine #85

Styx Rocker on Life With HIV + AIDS Research Alliance

+ A Beauty Queen Comes Out

H E A L T H + S P I R I T + C U L T U R E + L I F E

worldy aids da 2011

It Takes a Village

Six people who are changing the world together

10 Great Discoveries in 2011 A year of progress IN HIV

dionne warwick

is listening

november/december 2011 www.hivplusmag.com

The Grammy Award–winning singer and activist reflects on her commitment to fighting AIDS

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TABLE OF CONTENTS NOVEMBER / DECEMBER 2011

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STATUS SYMBOLS 6 Badge of Dishonor An Atlanta man fights for his right to become a police officer.

8 Ms. (HIV) Plus America Pageant winner Michelle Anderson has HIV and a message for women.

8 Gaming For a Cure Online gamers solve a perplexing HIVrelated question.

9 social services swindle?

A scandal over allegedly misused HIV/ AIDS funds turns ugly.

AROUND THE GLOBE 14 PERFORMANCE PIECE John Legend performs at amfAR’s annual Cinema Against AIDS benefit.

HAART BEATS

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41 The Trouble With ADAP

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What to do when your state can’t help you obtain the medication that you need.

42 Protein Power A new study on the powerful properties in saliva that may prevent HIV transmission.

43 Antiretrovirals & Cholesterol New research on how HIV treatment affects cholesterol levels

43 Chewed Out

34 COLUMNS 44 MIND + MOOD Feeling exasperated is easy when you have HIV, but getting over it doesn’t have to be an ordeal.

46 lady in red Teaching her kids not to be afraid goes hand in hand for this mom with HIV

ALSO 48 ASK & TELL: Chuck Panozzo

lending her voice

Dionne Warwick reflects on her commitment to the fight against AIDS.

25 IT TAKES A VILLAGE TO STOP HIV

In honor of World AIDS Day, we look at six individuals working to end HIV in their own singular way.

28 Ten Greatest HIV Discoveries in 2011

A look at some of the year’s bigger medical breakthroughs.

30 The Hunt For a Cure

Top leaders at the AIDS Research Alliance tell us how close they are to ending HIV. COVER Dionne Warwick photographed by Bryan Adams

clock wise from top: ge t t y images, courtesy mayo clinic, ge t t y images (3)

A common—but little-discussed—habit could be putting babies at risk.

NOW ON

HIVPlusMag.com Editor in chief

Diane Anderson-Minshall

managing Editor Winston

Gieseke Scott McPherson Senior Editor Neal Broverman digital Editor Michelle Garcia contributing editor Michael Matson creative director

Publisher

Joe Valentino

senior director, client services

advertising coordinators

Stephanie Block advertising intern

manager, editorial and marketing operations

Charles Culbert copy editor

Trudy Ring

HERE MEDIA

Stephen P. Jarchow ceo Paul Colichman cfo Tony Shyngle cPo Robert Ames executive vice president Stephen Macias senior vice president & group publisher Joe Landry advocate group editorial director Matthew Breen senior vice presidents Christin Dennis, Alex Paul, Bernard Rook, Josh Rosenzweig vice presidents John Knoebel, Joe Valentino chairman

Stewart Nacht Steven O’Brien

senior advertising coordinator

Shamila Siddiqui,

Derek Davis II

vice president, digital and integr ated marketing

Stephanie Rubin Jennifer Borck

senior integr ated marketing MANAGEr director, public relations and

Mark Umbach Robert Hébert

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Jeff Lettiere Argus Galindo

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Dave Johnson Lisa Brown senior online producer Christopher Harrity web DEVELOPEr Peter Di Maso web production coordinator Joe Okonkwo

creative director, digital media

director, digital media, development

advertising & subscriptions offices P.O. Box 1253, Old Chelsea Station, New York, New York 10113-1251 Phone (212) 242-8100 • Advertising Fax (212) 242-8338 Subscriptions (212) 242-8100, Ext. 19 • Subscriptions Fax (212) 242-1344 editorial offices 10990 Wilshire Blvd., Penthouse Suite, Los Angeles, California 90024 Phone (310) 806-4288 • Fax (310) 806-4268 • Email mail@HIVPlusMag.com

The People's Politico

Check out our extended interview with New York representative Jerrold Nadler, one of Congress's top advocates for the rights of HIVers.

False Prophet

Electric foods? Lemon juice?

Take a look at our list of ridiculous (ineffective) cures we've heard over the years.

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Do you have an interesting story about yourself or someone you know that you want to share? You might be a candidate for a profile in one of our departments or another section. We want to hear from you, and we want to know what you’ve been up to. So email us at mail@HIVPlusMag.com or write us at HIV Plus, 10990 Wilshire Blvd., Penthouse Suite, Los Angeles, CA 90024. We’ll even take faxes at (310) 806-4268.

HIV Plus (ISSN 1522-3086) is published bimonthly by Here Publishing Inc., 10990 Wilshire Blvd., Penthouse Suite, Los Angeles, CA 90024. HIV Plus is a registered trademark of Here Media Inc. Entire contents © 2011 by Here Publishing Inc. All rights reserved. Printed in the USA.

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n o vember / december 2 0 1 1 H I V P L U S

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A volunteer health worker takes a blood sample from a patient in Ghana for an HIV detection test.

6 | HIV PLUS nov ember /december 201 1

Badge of Dishonor

Mitchell Funk

An Atlanta man fights for his right to become a police officer

it takes a certain type of courageous person to protect and serve fellow citizens by donning a badge. But in Atlanta, strength of character doesn’t matter if you have HIV. An Atlanta man is moving forward with a federal lawsuit against the city after a U.S. district court ruled that he could possibly be a threat to others because of his HIV status. The man, going by the name Richard Roe to protect his identity, applied to be an officer for the Atlanta Police Department in 2006.

He found out that he was HIV-positive during a pre-employment medical exam, according to Lambda Legal, the organization providing him with legal assistance.

The doctor who administered the exam told Roe that the positive result disqualified him from joining the police department. The plaintiff then sued the department in 2008, citing antidiscrimination protections from two federal laws, the Americans With Disabilities Act and the Rehabilitation Act. Initially the city’s lawyers argued that Roe’s HIV was not considered to be a disqualifying condition for a police officer candidate. Later, however, the city’s stance changed, and its attorneys argued that a police officer with HIV could present a “direct threat to the health and safety of others.” But, according to Roe’s attorneys, the city made its case without providing supporting evidence. Even so, the court ruled in the city’s favor, saying

Roe had not produced enough evidence to prove that his condition is not a threat to others.

Roe, 39, and his legal team filed an appeal before the U.S. Court of Appeals for the 11th Circuit in July—they are currently awaiting a hearing.

Greg Nevins, supervising senior staff attorney at Lambda Legal’s southern regional office in Atlanta, and Scott Schoettes, Lambda Legal’s HIV Project director, are handling the case. Nevins wrote in a reply brief in September, that the city of Atlanta’s “procedural game-playing of asserting HIV is not a disqualifying condition and then arguing it is, should not be countenanced by any court.”

Roe’s attorneys are now arguing in their appeal that they provided enough evidence that he would not be a physical threat to others while serving on the force and that the city of Atlanta did not make a convincing argument that Roe would not be a good police officer.

“The City of Atlanta is talking out of both sides of its mouth. They claim that having HIV doesn’t prevent someone from becoming a police officer; then they walk into court and say that it does,” Nevins said in a statement in September, right after filing the brief. “It was unfair for the district court to allow the Atlanta Police Department to get away with this, especially when the available science supports our client.” —Michelle Garcia

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Gaming For a Cure An innovative website dares online gamers to solve a perplexing HIVrelated question—and the call is answered

Ms. (HIV) Plus America Pageant winner Michelle Anderson is HIV-positive and has a message for women

the ms. plus america pageant celebrates plus-size women as beautiful contributors to society, and its newest winner is an HIV-positive woman who is taking that message of female unity even further.

“I am hoping that by sharing that we can tear down the walls of being stigmatized,” says Michelle Anderson, who was crowned Ms. Plus America 2011 and plans to use her title to cross boundaries between women who are HIV-positive and those who aren’t. The crown sits on her mantle, but it has given Anderson access to tell her story in “rooms that I couldn’t go in just being HIV-positive.”

Anderson, who works to help women and girls learn about HIV prevention, is a lead peer educator and programs assistant at the Afiya Center for HIV Prevention and Sexual Reproductive Justice in Dallas. The new Ms. Plus America, who has been positive since 1999, remembers first feeling the stigma that comes with the disease—an experience she hopes to help others avoid

by telling her story to as many people as will listen.

“When I was first diagnosed, I was in a treatment facility, and this might be gross to you, but women go through their thing monthly and someone apparently had dropped some blood on the toilet seat,” she remembers. “Guess who you think they made go clean it up? Me.” Anderson remembers saying, “That’s not mine.” But it didn’t matter. “To be cautious, they asked me to do it. What was that about? That really made me feel low and worthless.”

The memory of moments like that motivated her to carry on whenever she felt like giving up the pageant work—the group dance numbers to learn and the interviews to prepare for. A friend spoke up and reminded her, “You can’t quit, because every time you walk across this stage, you are walking across the stage for every HIVpositive woman who can’t say that they’re positive.” —Lucas Grindley

8 | HI V PLUS nov ember /december 201 1

After boggling scientists for 10 years, a complicated question involving a monkey virus similar to HIV was solved in just 10 days by video-game players after it was posted on a website featuring online puzzles connected with medical and science questions.

The gamers managed to decipher the structure of a protein on MasonPfizer virus, a simian HIV-like virus, which may assist in the development of protease inhibitors to fight HIV and other retroviruses. A major breakthrough came from the work of a British science technician going by the name “Mimi.” Her finding and those of others came via Foldit, a website developed by the University of Washington offering puzzles whose solutions can potentially be applied to real-life medical issues.

The advance has given the medical world hope that other scientific questions can be answered by releasing them on the Internet.

“The bottom line is that this story may be of greater interest for structural biologists,” Benhur Lee, a professor of microbiology, immunology, and molecular genetics department at the University of California, Los Angeles, medical school, tells HIV Plus. “It demonstrates that human intuition can be harnessed to help solve structures of proteins that are hard to do by standard automated computational techniques.”

But does the advance count as tangible progress in the effort to end AIDS? The possibility of a more effective protease inhibitor is perhaps not as relevant as the mere fact that gamers were able to crack the protein’s code, Lee says, “since there are already almost a dozen FDA-approved protease inhibitors for HIV that work well with other antiretrovirals.”

—Neal Broverman

Social Services Swindle?

opposite page (from top): Studio Prime Time Photography/Videography., photos.com; this page: stadium club photo courtesy stadiumclubdc.com; books(3) courtesy publisher

In Washington, D.C., a scandal over allegedly misused HIV/AIDS funds turns ugly

some people have boundless audacity. If the fraud allegations in a recent lawsuit are true, Cornell Jones is one of them.

A former drug kingpin, now reformed (or so the narrative goes), Jones is the executive director of Miracle Hands, a social services organization in Washington, D.C., that he founded after serving nine years of a 27-year federal prison sentence. Once a hustler of near-mythic proportions, he is now accused of falsifying expense reports totaling $329,653 for the renovation of a former warehouse, one that was supposed to be turned into a job training facility assisting individuals living with HIV. Instead, the building, located just north of the National Arboretum in a derelict area of northeast D.C., is now the Stadium Club, an upscale strip club and restaurant (pictured), one with $45 rack of lamb entrees and VIP tables accommodating bachelor parties and “divorce celebrations” starting at $800 for an evening.

Jones allegedly leased the building to a local entertainment club propri-

etor—once it was spiffed up at taxpayer expense, that is. When two City Council members, David Catania and Jim Graham, expressed outrage at the possibility that Miracle Hands had misappropriated funds, Jones stated on his radio show that they were simply “a couple of gay guys who sometimes get to acting like little faggots.”

Catania has been on Jones’s case since The Washington Post ran a 2009 investigative series on questionable use of AIDS funds in the nation’s capital, which has the highest HIV infection rate in the nation. Sadly, he asserts that Miracle Hands is no anomaly in a city with a long and troubled history of poor oversight on grant money. As for Jones’s rant, Catania replies, “The irony of having a person be a provider of services to the community afflicted by HIV going on homophobic rants speaks for itself. I won’t stoop to his level.”

In its lawsuit, filed in August in D.C. Superior Court, the district is seeking about $1 million from Jones, who could not be reached for comment. A court hearing on the matter is scheduled for early December. —Andrew Harmon

Reading Shelf The latest novels, memoirs, and other books on HIV and AIDS Ashamed to Die: Silence, Denial, and the AIDS Epidemic in the South Andrew J. Skerritt writes that the United States has failed to adequately address the threat of HIV in communities of color, and that taboos about race, sex, and love—along with Southern conservatism and a legacy of racism—continue to create an unacceptable death toll. (Lawrence Hill Books, $24.95)

Delicate Courage: An Exquisite Journey of Love, Death, and Eternal Communication Following the 1978 murders of San Francisco city officials Harvey Milk and George Moscone, author Jim Geary joined the Shanti Project, which he later helped develop into an internationally acclaimed model of AIDS services. In this book, he documents those early days in San Francisco, ground zero of the AIDS epidemic in the 1980s. (iUniverse, $32.95)

Ten Days With Minor Tackling a triptych of issues—immigration, AIDS, and love—Nsedu Onyile’s first novel relies on the author’s experience as a Nigerian immigrant with AIDS to tell the tale of Minor, a dying man struggling to adjust to Western society, and Usukuma, a free spirit whose West African traditions help Minor cope. (AuthorHouse, $8.69)

Songs for the New Depression Drawing on his experience of losing a partner to AIDS, Kergan Edwards-Stout has crafted a work of fiction that follows middle-aged Gabe, a man who must finally tackle his demons with a little help from his mother’s new wife.

(Circumspect Press, $15.99)

The River: A Journey to the Source of HIV and AIDS Of all the books on HIV and AIDS today, few look at the origin of the virus, but Edward Hooper, a former United Nations official and BBC correspondent, searches for the source in this amazingly comprehensive history of the disease that is for serious readers only. (Little, Brown, $9.99 Kindle edition)

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PREZISTA IMPORTANT SAFETY INFORMATION AND INDICATION Talk to your healthcare ABOUT PREZISTA professional about the ® PREZISTA (darunavir) is a signs and symptoms of liver prescription medicine. It is one problems. These may include treatment option in the class of yellowing of your skin or whites HIV (human immunodeficiency of your eyes, dark (tea-colored) virus) medicines known as urine, pale-colored stools protease inhibitors. (bowel movements), nausea, PREZISTA is always taken with vomiting, loss of appetite, and at the same time as ritonavir or pain, aching or sensitivity on (Norvir®), in combination with other your right side below your ribs HIV medicines for the treatment of • In a small number of patients, HIV infection in adults. PREZISTA PREZISTA has been reported should also be taken with food. to cause a severe or life• The use of other medicines active threatening rash. Contact against HIV in combination with your healthcare professional PREZISTA/ritonavir (Norvir®) may immediately if you develop increase your ability to fight HIV. a rash.

Your healthcare professional will Can PREZISTA be taken with work with you to find the right other medications? combination of HIV medicines • Taking PREZISTA with • It is important that you remain certain medicines could under the care of your healthcare cause serious and/or lifeprofessional during treatment with threatening side effects PREZISTA or may result in loss of its effectiveness. Do not take PREZISTA does not cure HIV PREZISTA if you are taking infection or AIDS, and does not the following medicines: prevent passing HIV to others. alfuzosin (Uroxatral®), dihydroergotamine (D.H.E.45®, Please read Important Safety Migranal®), ergonovine, Information below, and talk to ergotamine (Wigraine®, your healthcare professional Ergostat®, Cafergot®, Ergomar®), to learn if PREZISTA is right methylergonovine, cisapride for you.

(Propulsid®), pimozide (Orap®), oral midazolam, triazolam IMPORTANT SAFETY (Halcion®), rifampin (Rifadin®, INFORMATION Rifater®, Rifamate®), sildenafil (Revatio®) when used to treat What is the most important pulmonary arterial hypertension, information I should know indinavir (Crixivan®), lopinavir/ about PREZISTA? ritonavir (Kaletra®), saquinavir • PREZISTA, together with (Invirase®), lovastatin (Mevacor®, Norvir®, has been observed Altoprev®, Advicor®), pravastatin in a small number of (Pravachol®), simvastatin (Zocor®, patients to cause liver Simcor®, Vytorin®), salmeterol problems which may be life(Serevent®), or products threatening. Your healthcare containing St. John’s wort professional should do • Before taking PREZISTA, tell your blood tests prior to starting healthcare professional if you combination treatment are taking sildenafil (Viagra®), including PREZISTA. If you vardenafil (Levitra®), tadalafil have chronic hepatitis B or (Cialis®, Adcirca®), atorvastatin C infection, your healthcare (Lipitor®), atorvastatin/amlodipine professional should check (Caduet®), rosuvastatin (Crestor®), your blood tests more or colchicine (Colcrys®). This often because you have is not a complete list of an increased chance of medicines. Be sure to tell developing liver problems

your healthcare professional about all the medicines you are taking or plan to take, including prescription and nonprescription medicines, vitamins, and herbal supplements

• As with other protease inhibitors, taking PREZISTA may strengthen the body’s immune response, enabling it to begin to fight infections that have been hidden.

Patients may experience signs and symptoms of inflammation that can include swelling, tenderness, or redness • Tell your healthcare professional if you are taking estrogen-based • The most common side effects contraceptives (birth control). related to taking PREZISTA include PREZISTA might reduce the diarrhea, nausea, rash, headache, effectiveness of estrogen-based stomach pain, and vomiting. Other contraceptives. You must take important severe side effects additional precautions for birth include inflammation of the liver control, such as condoms or pancreas and increased blood fat levels.

What should I tell my • This is not a complete list of healthcare professional all possible side effects. If you experience these or other side before I take PREZISTA? effects, talk to your healthcare • Before taking PREZISTA, tell your professional. Do not stop taking healthcare professional if you have PREZISTA or any other medicines any medical conditions, including without first talking to your allergy to sulfa medicines, healthcare professional diabetes, liver problems (including You are encouraged to report hepatitis B or C), or hemophilia negative side effects of • Tell your healthcare professional prescription drugs to the FDA. if you are pregnant or planning Visit www.fda.gov/medwatch, to become pregnant, or are or call 1-800-FDA-1088 breastfeeding Please refer to the ritonavir (Norvir®) - The effects of PREZISTA on Product Information (PI and PPI) pregnant women or their unborn for additional information on babies are not known. You and precautionary measures. your healthcare professional Dosing Information: will need to decide if taking PREZISTA is right for you For adults taking HIV meds for the first time and for many - Do not breastfeed if you are adults who have taken HIV meds taking PREZISTA. You should in the past: PREZISTA 800 mg not breastfeed if you have (two 400-mg tablets) must be taken HIV because of the chance of at the same time with 100 mg passing HIV to your baby Norvir® once daily every day.

PREZISTA must be taken with food.

What are the possible side For some adults who have taken effects of PREZISTA? HIV meds in the past: • High blood sugar, diabetes or PREZISTA 600 mg/Norvir® 100 mg worsening of diabetes, and must be taken twice daily at the increased bleeding in people with same time every day with food. hemophilia have been reported in Your healthcare professional can patients taking protease inhibitor determine which dose is right for you. medicines, including PREZISTA Please see Important Patient • Changes in body fat have been Information on the next page seen in some patients taking HIV for more information, or visit medicines, including PREZISTA. www.PREZISTA.com.

The cause and long-term health effects of these conditions are not If you or someone you know needs help paying for medicine, call known at this time 1-888-4PPA-NOW (1-888-4772669) or go to www.pparx.org.

www.PREZISTA.com Distributed by: Tibotec Therapeutics/Division of Centocor Ortho Biotech Products, L.P., Titusville, NJ 08560

©2011 Tibotec Therapeutics

05/11

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ONCEDAILY PREZISTA

EXPANDED ONCE-DAILY DOSING FOR PREZISTA For adults who have not taken HIV medications before and ALSO for many adults who have taken HIV medications in the past Once-Daily PREZISTA 800 mg (two 400-mg tablets) must be taken with Norvir速 100 mg and food at the same time every day, as part of combination HIV therapy.

Talk to your healthcare professional about your HIV treatment options and ask if Once-Daily PREZISTA is right for you.

Please read Important Safety Information and dosing information on adjacent page.

www.PREZISTA.com Registered trademarks are the property of their respective owners.

IMPORTANT PATIENT INFORMATION PREZISTA (pre-ZIS-ta) Darunavir ALERT: Find out about medicines that should Not be taken with PREZISTA. Please also read the section “Who should not take PREZISTA?”.

Read this Patient Information before you start taking PREZISTA and each time you get a refill. There may be new information.This information does not take the place of talking to your doctor or healthcare provider about your medical condition or your treatment.

What is the most important information I should know about PREZISTA? PREZISTA, together with NORVIR® (ritonavir), has been observed in a small number of patients to cause liver problems which may be life-threatening.

Your healthcare provider should do blood tests prior to initiating combination treatment including PREZISTA. If you have chronic hepatitis B or C infection, your healthcare provider should check your blood tests more often because you have an increased chance of developing liver problems. Talk to your healthcare provider about the signs and symptoms of liver problems. These may include yellowing of your skin or whites of your eyes, dark (tea colored) urine, pale colored stools (bowel movements), nausea, vomiting, loss of appetite, or pain, aching or sensitivity on your right side below your ribs.

In a small number of patients, PREZISTA has been reported to cause a severe or life-threatening rash. Contact your healthcare provider immediately if you develop a rash.

Please also read the section “What are the possible side effects of PREZISTA?” What is PREZISTA? PREZISTA is a prescription anti-HIV medicine used with other anti-HIV medicines used to treat adults. PREZISTA is a type of anti-HIV medicine called a protease (PRO-tee-ase) inhibitor. PREZISTA is used with ritonavir and other anti-HIV medicines to treat people with human immunodeficiency virus (HIV-1) infection. HIV is the virus that causes AIDS (Acquired Immune Deficiency Syndrome).

How does PREZISTA work?

PREZISTA blocks HIV protease, an enzyme which is needed for HIV to multiply. When used with other anti-HIV medicines, PREZISTA can help to reduce the amount of HIV in your blood (called “viral load”) and increase your CD4 (T) cell count. HIV infection destroys CD4 (T) cells, which are important to the immune system. The immune system helps fight infection. Reducing the amount of HIV and increasing the CD4 (T) cell count may improve your immune system and, thus, reduce the risk of death or infections that can happen when your immune system is weak (opportunistic infections).

PREZISTA is always taken with and at the same time as ritonavir (NORVIR®), in combination with other anti-HIV medicines. PREZISTA should also be taken with food.

Does PREZISTA cure HIV or AIDS? PREZISTA does not cure HIV infection or AIDS. At present, there is no cure for HIV infection. People taking PREZISTA may still develop infections or other conditions associated with HIV infection. Some of these conditions are pneumonia, herpes virus infection, and Mycobacterium avium complex (MAC) infections. Because of this, it is very important for you to remain under the care of a healthcare provider. Although PREZISTA is not a cure for HIV or AIDS, PREZISTA can help reduce your risks of getting illnesses associated with HIV infection (AIDS and opportunistic infection) and eventually dying from these conditions.

Does PREZISTA reduce the risk of passing HIV to others?

PREZISTA does not reduce the risk of passing HIV to others through sexual contact, sharing needles, or being exposed to your blood. For your health and the health of others, it is important to always practice safer sex by using a latex or polyurethane condom or other barrier method to lower the chance of sexual contact with any body fluids such as semen, vaginal secretions, or blood. Never re-use or share needles.

Ask your healthcare provider if you have any questions on how to prevent passing HIV to other people.

What should I tell my doctor before I take PREZISTA? PREZISTA may not be right for you. Before taking PREZISTA, tell your doctor or healthcare provider if you: • are allergic to sulfa medicines.

• h ave diabetes. Anti-HIV medicines, such as PREZISTA, might increase sugar levels in the blood.

• have liver problems, including hepatitis B and/or C. • have hemophilia. Anti-HIV medicines, such as PREZISTA, might increase the risk of bleeding.

• are pregnant or planning to become pregnant. The effects of PREZISTA on pregnant women or their unborn babies are not known. You and your healthcare provider will need to decide if taking PREZISTA is right for you. If you take PREZISTA while you are pregnant, talk to your healthcare provider about how you can be included in the Antiretroviral Pregnancy Registry.

• are breastfeeding. Do not breastfeed if you are taking PREZISTA. You should not breastfeed if you have HIV because of the chance of passing HIV to your baby. Talk with your healthcare provider about the best way to feed your baby. The Centers for Disease Control and Prevention (CDC) recommends that HIV-infected mothers not breastfeed to avoid the risk of passing HIV infection to your baby.

Who should not take PREZISTA?** Together with your healthcare provider, you need to decide whether taking PREZISTA is right for you.

Do not take PREZISTA if you: • are allergic to darunavir or any of the other ingredients in PREZISTA • are allergic to ritonavir (NORVIR®) • take any of the following types of medicines because you could experience serious side effects: – alfuzosin (Uroxatral®) – dihydroergotamine (D.H.E. 45®, Migranal®), ergonovine, ergotamine (Cafergot®, Ergomar®), methylergonovine – cisapride – pimozide (Orap®) – oral midazolam, triazolam (Halcion®) – St. John’s wort (Hypericum perforatum) – lovastatin (Mevacor®, Altoprev®, Advicor®), simvastatin (Zocor®, Simcor®, Vytorin®) – rifampin (Rifadin®, Rifater®, Rifamate®, Rimactane®) – sildenafil (Revatio®) when used to treat pulmonary arterial hypertension Can PREZISTA be taken with other medications?** Tell your healthcare provider about all the medicines you take including prescription and nonprescription medicines, vitamins, and herbal supplements. PREZISTA and many other medicines can interact. Sometimes serious side effects will happen if PREZISTA is taken with certain other medicines (see “Who should not take PREZISTA?”).

Tell your healthcare provider if you are taking estrogen-based contraceptives (birth control). PREZISTA might reduce the effectiveness of estrogen-based contraceptives. You must take additional precautions for birth control such as a condom.

Tell your healthcare provider if you take other anti-HIV medicines.

PREZISTA can be combined with some other anti-HIV medicines while other combinations are not recommended.

Tell your healthcare provider if you are taking any of the following medicines: – bepridil, lidocaine, quinidine, amiodarone (Cordarone®), digoxin (Lanoxin®), flecainide (Tambocor®), propafenone (Rythmol®) – warfarin (Coumadin®) – carbamazepine (Tegretol®, Carbatrol®), phenobarbital, phenytoin (Dilantin®, Phenytek®) – trazodone (Desyrel®), desipramine (Norpramin®) – colchicine (Colcrys®) – clarithromycin (Biaxin®) – ketoconazole (Nizoral®), itraconazole (Sporanox®), voriconazole (Vfend®) – rifabutin (Mycobutin®), – metoprolol (Lopressor®, Toprol-XL®), timolol (Betimol®, Combigan®, Istalol®, Cosopt®, Timoptic®) – midazolam administered by injection – felodipine (Plendil®), nifedipine (Adalat®), nicardipine (Cardene®)

IMPORTANT PATIENT INFORMATION – dexamethasone, fluticasone (Advair Diskus®, Cutivate®, Flonase®, Flovent Diskus®) – bosentan (Tracleer®) – atorvastatin (Lipitor®), pravastatin (Pravachol®), rosuvastatin (Crestor®) – cyclosporine (Sandimmune®, Neoral®), tacrolimus (Prograf®), sirolimus (Rapamune®) – salmeterol (Serevent®) – Methadone, buprenorphine, buprenorphine/naloxone – risperidone (Risperdal®, Risperdal® Consta®, Risperdal® M-TAB®), thioridazine – sildenafil (Viagra®), vardenafil (Levitra®), tadalafil (Cialis®) – tadalafil (Adcirca®) – paroxetine (Paxil®), sertraline (Zoloft®) Tell your healthcare provider if you are taking any medicines that you obtained without a prescription.

This is not a complete list of medicines that you should tell your healthcare provider that you are taking. Know and keep track of all the medicines you take and have a list of them with you. Show this list to all of your healthcare providers and pharmacists any time you get a new medicine. Both your healthcare provider and your pharmacist can tell you if you can take these other medicines with PREZISTA. Do not start any new medicines while you are taking PREZISTA without first talking with your healthcare provider or pharmacist. You can ask your healthcare provider or pharmacist for a list of medicines that can interact with PREZISTA. How should I take PREZISTA? Take PREZISTA tablets every day exactly as prescribed by your healthcare provider. You must take ritonavir (NORVIR®) at the same time as PREZISTA. • Do not change your dose of PREZISTA or stop treatment without talking to your healthcare provider first.

• Take PREZISTA and ritonavir (NORVIR®) with food.

• Swallow PREZISTA tablets whole with a drink.

What should I do if I miss a dose?

People who take PREZISTA one time a day: • If you miss a dose of PREZISTA or ritonavir (NORVIR®) by more than 12 hours, wait and then take the next dose of PREZISTA and ritonavir (NORVIR®) at your regularly scheduled time. If you miss a dose of PREZISTA or ritonavir (NORVIR®) by less than 12 hours, take your missed dose of PREZISTA and ritonavir (NORVIR®) right away. Then take your next dose of PREZISTA and ritonavir (NORVIR®) at your regularly scheduled time.

People who take PREZISTA two times a day • If you miss a dose of PREZISTA or ritonavir (NORVIR®) by more than 6 hours, wait and then take the next dose of PREZISTA and ritonavir (NORVIR®) at your regularly scheduled time.

• If you miss a dose of PREZISTA or ritonavir (NORVIR®) by less than 6 hours, take your missed dose of PREZISTA and ritonavir (NORVIR®) right away.

Then take your next dose of PREZISTA and ritonavir (NORVIR®) at your regularly scheduled time.

If a dose of PREZISTA or ritonavir (NORVIR®) is skipped, do not double the next dose. Do not take more or less than your prescribed dose of PREZISTA or ritonavir (NORVIR®) at any one time.

What are the possible side effects of PREZISTA? PREZISTA can cause side effects. The following is not a complete list of side effects reported with PREZISTA when taken either alone or with other antiHIV medicines. Do not rely on this leaflet alone for information about side effects. Your healthcare provider can discuss with you a more complete list of side effects.

PREZISTA, together with NORVIR® (ritonavir), has been observed in a small number of patients to cause liver problems which may be life-threatening.

Your healthcare provider should do blood tests prior to initiating combination treatment including PREZISTA. If you have chronic hepatitis B or C infection, your healthcare provider should check your blood tests more often because you have an increased chance of developing liver problems.

Talk to your healthcare provider about the signs and symptoms of liver problems. These may include yellowing of your skin or whites of your eyes, dark (tea colored) urine, pale colored stools (bowel movements), nausea,

vomiting, loss of appetite, or pain, aching or sensitivity on your right side below your ribs.

Rash has been reported in 10.3% of patients receiving PREZISTA. In a small number of patients, PREZISTA has been reported to cause a severe or life-threatening rash. Contact your healthcare provider immediately if you develop a rash.

Other relevant severe side effects were inflammation of the liver or pancreas, increased blood fat levels, diabetes, and changes in body fat.

The most common side effects include diarrhea, nausea, rash, headache, abdominal pain and vomiting.

Other side effects of PREZISTA include the following: • high blood sugar (hyperglycemia) and diabetes. This can happen in patients taking PREZISTA or other protease inhibitor medicines. Some patients have diabetes before starting treatment with PREZISTA which gets worse. Some patients get diabetes during treatment with PREZISTA. Some patients will need changes in their diabetes medicine. Some patients may need new diabetes medicine.

• increased bleeding in patients with hemophilia.

• changes in body fat. These changes can happen in patients taking anti-HIV medicines, including PREZISTA. The changes may include an increased amount of fat in the upper back and neck, breast, and around the back, chest, and stomach area. Loss of fat from the legs, arms, and face may also happen. The exact cause and long-term health effects of these conditions are not known.

• immune reconstitution syndrome. In some patients with advanced HIV infection (AIDS) and a history of opportunistic infection, signs and symptoms of inflammation from previous infections may occur soon after anti-HIV treatment, including PREZISTA, is started.

Tell your healthcare provider promptly about these or any other unusual symptoms. If the condition persists or worsens, seek medical attention.

This medication is prescribed for your particular condition. Do not use it for any other condition or give it to anybody else. Keep PREZISTA and all of your medicines out of the reach of children. If you suspect that more than the prescribed dose of this medicine has been taken, contact your local poison control center or emergency room immediately.

This is a brief summary of information about PREZISTA for adult patients with HIV. If you have any questions or concerns about either PREZISTA or HIV, talk to your healthcare provider.

For additional information, you may also call Tibotec Therapeutics at 1-877-REACH-TT or 1-877-732-2488. ** The brands listed are the registered trademarks of their respective owners and are not trademarks of Tibotec Pharmaceuticals

Manufactured for Tibotec, Inc. by: JOLLC, Gurabo, Puerto Rico Distributed by: Tibotec Therapeutics, Division of Centocor Ortho Biotech Products, L.P., Raritan NJ 08869 NORVIR® is a registered trademark of its respective owner.

PREZISTA® is a registered trademark of Tibotec Pharmaceuticals © Tibotec, Inc. 2006

Revised: December 2010

10101712P

AROUND THE GLOBE

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clock wise from left: Joe Scarnici/Ge t t y Images for amfAR, ge t t y images (2)

 Washington D.C.: (top) Rep. Trent Franks speaks at a news conference, along with

co-chairs Rep. Jim McDermott (far left) and Rep. Barbara Lee for the launch of the Congressional HIV/AIDS Caucus on Capitol Hill on September 15. The bipartisan caucus has attracted approximately 50 members.

Ahmedabad, India: (above) Children who reportedly contracted HIV after being given contaminated blood protest along with their parents on September 18. At least 23 children who received blood transfusions have tested positive for HIV.  Toronto, Canada: Musician John Legend performs at amfAR’s annual Cinema Against

AIDS benefit on September 11.

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AROUND THE GLOBE

▲ Yangon, Myanmar: (top) U.S. coordinator for policy on Myanmar, Derek Mitchell, receives flowers from an HIV-

positive child during a visit to an AIDS care center on September 11.

Johannesburg: (above) Two models perform during the launch of 46664 Apparel on August 24. The clothing line will  Beverly Hills: Dr. David Hardy, Director of the Division of Infectious Diseases and the AIDS/Immunodeficiency Unit at Cedars-Sinai Medical Center, and actress Holland Taylor pose with singer Frenchie Davis (right) while attending the “A Faire of the Heart” dinner at the Beverly Hilton. All three were honored by The Serra Project and Aid for AIDS for their continued efforts in the fight against HIV/AIDS.

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AFP/Ge t t y Images (2)

give 7% to 9% of profits for its clothing sales to the Nelson Mandela Foundation for activities related to HIV prevention.

Tony DiMaio for the serra projec t

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AROUND THE GLOBE

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New York City: Celebrity designer

and HGTV host David Bromstad unveils his HIV testing awareness mural September 20 at NYC’s LGBT Community Center for the Know Yourself: Get HIV Tested initiative.

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Ge t t y Images

AROUND THE GLOBE

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▲ Los Angeles: (top) Actresses Garcelle Beauvais and Vanessa Williams attend the 2011 End Of Summer Celebration

from top: wireimage, AFP/Ge t t y Images

benefiting the Black AIDS Institute on September 3.

Mbabane, Swaziland: (above) Tens of thousands of young Swazi women converge outside one of King Mswati’s royal residence for the traditional Umhlanga ceremony on August 24. The event is a coming-of-age moment for young women in Swaziland, and many AIDS organizations use it to educate them on HIV.  Berlin, Germany: During the Reminders Day AIDS Gala 2011 on August 27. Photographer Nan Goldin holds up her

award. She was honored for giving a face to AIDS through her work.

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www.egrifta.com

Actual patient living with HIV since 2000

You HAVE YouR HIV unDER ConTRoL. noW, on To

HIV-RELATED EXCESS BELLY FAT. In two separate clinical trials of HIV-infected people with lipodystrophy, each lasting 6 months, EGRIFTA® reduced HIV-related excess belly fat by an average of 18% in the first trial, and 14% in the second trial.

This reduction in excess belly fat resulted in an approximate 1-inch reduction in waist size. Individual results may vary.

On average, patients on EGRIFTA® did not lose weight.

Like HIV, HIV-related excess belly fat is a chronic condition. In clinical studies: • People who used EGRIFTA® continuously for 1 year maintained their results over this time period • People who stopped taking EGRIFTA® after 6 months had their HIV-related excess belly fat come back EGRIFTA® is believed to work with your own body to produce natural growth hormone to reduce your excess belly fat.

Indication: EGRIFTA® is a daily injectable prescription medicine to reduce the excess in abdominal fat in HIV-infected patients with lipodystrophy.

Limitations of use: • The impact and safety of EGRIFTA® on cardiovascular health has not been studied • EGRIFTA® is not indicated for weight-loss management • It’s not known whether taking EGRIFTA® helps improve compliance with antiretroviral medications • EGRIFTA® is not recommended to be used in children Important Risk Information: Do not use EGRIFTA® if you: • Have pituitary gland tumor, pituitary gland surgery or other problems related to your pituitary gland • Have or had a history of active cancer (either newly diagnosed or recurrent) • Are allergic to tesamorelin or any of the ingredients in EGRIFTA®, including mannitol or sterile water • Are pregnant or become pregnant Before using EGRIFTA®, tell your healthcare provider if you: • Have or have had cancer • Have diabetes • Are breastfeeding or plan to breastfeed • Have kidney or liver problems • Have any other medical condition • Take prescription or non-prescription medicines, vitamins, or herbal supplements EGRIFTA® may cause serious side effects, including: • Serious allergic reaction. Stop using EGRIFTA® and get emergency help right away if you have any of the following symptoms: rash over your body, hives, swelling of your face or throat, shortness of breath or trouble breathing, fast heartbeat, feeling of faintness or fainting • Swelling (fluid retention). EGRIFTA® can cause swelling in some parts of your body. Call your healthcare provider if you have an increase in joint pain, or pain or numbness in your hands or wrist (carpal tunnel syndrome) • Increase in glucose (blood sugar) intolerance and diabetes 110628-115709 7/11

• Injection-site reactions, such as redness, itching, pain, irritation, bleeding, rash, and swelling. Change (rotate) your injection site to help lower your risk for injection-site reactions The most common side effects of EGRIFTA® include: • joint pain • numbness and pricking • pain in legs and arms • nausea • swelling in your legs • vomiting • muscle soreness • rash • tingling • itching EGRIFTA® will NOT cure HIV or lower your chance of passing HIV to others.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

Please see Consumer Brief Summary of EGRIFTA® on following page.

Ask your healthcare provider if EGRIFTA®, the first and only FDA-approved medicine for HIV-related excess belly fat, may be right for you.

For more information, visit www.egrifta.com or call the AXIS Center at 1-877-714-AXIS (2947).

T:7 in S:6.625 in

Consumer Brief Summary for EGRIFTA® (tesamorelin for injection) EGRIFTA® (eh-GRIF-tuh) (tesamorelin for injection) for subcutaneous use Read the Patient Information that comes with EGRIFTA® before you start to take it and each time you get a refill. There may be new information. This leaflet does not take the place of talking to your healthcare provider about your medical condition or your treatment.

What is EGRIFTA®?

• EGRIFTA® is an injectable prescription medicine to reduce the excess in abdominal

fat in HIV-infected patients with lipodystrophy. EGRIFTA® contains a growth hormonereleasing factor (GRF).

• The impact and safety of EGRIFTA® on cardiovascular health has not been studied.

• EGRIFTA® is not indicated for weight loss management.

• It is not known whether taking EGRIFTA® helps improve compliance with antiretroviral medications.

• It is not known if EGRIFTA® is safe and effective in children. EGRIFTA® is not recommended to be used in children.

Who should not use EGRIFTA®?

Do not use EGRIFTA® if you: • have pituitary gland tumor, pituitary gland surgery or other problems related to your pituitary gland • have or had a history of active cancer (either newly diagnosed or recurrent) • are allergic to tesamorelin or any of the ingredients in EGRIFTA®. See the end of this leaflet for a complete list of ingredients in EGRIFTA® • are pregnant or become pregnant. If you become pregnant, stop using EGRIFTA® and talk with your healthcare provider. See “What should I tell my healthcare provider before using EGRIFTA®?”

What are the possible side effects of EGRIFTA®?

EGRIFTA® may cause serious side effects including: • Serious allergic reaction. Some people taking EGRIFTA® may have an allergic reaction.

Stop using EGRIFTA® and get emergency help right away if you have any of the following symptoms: – a rash over your body

will measure your blood sugar periodically.

• Injection-site reactions. Change (rotate) your injection site to help lower your risk for

injection-site reactions. Call your healthcare provider for medical advice if you have the following symptoms around the area of the injection site: – bleeding – redness – rash – itching – swelling – pain – irritation The most common side effects of EGRIFTA® include: – joint pain – nausea – vomiting – pain in legs and arms – rash – swelling in your legs – itching – muscle soreness – tingling, numbness and pricking Tell your healthcare provider if you have any side effect that bothers you or that does not go away.

These are not all the possible side effects of EGRIFTA®. For more information, ask your healthcare provider or pharmacist.

Call your healthcare provider for medical advice about side effects. To report side effects, contact EMD Serono toll-free at 1-800-283-8088 ext. 5563. You may report side effects to FDA at 1-800-FDA-1088.

Keep EGRIFTA® and all medicines out of the reach of children.

General information about the safe and effective use of EGRIFTA®: Medicines are sometimes prescribed for purposes other than those listed in a Patient Information leaflet. Do not use EGRIFTA® for a condition for which it was not prescribed.

Do not give EGRIFTA® to other people, even if they have the same symptoms you have.

It may harm them.

Do not share your EGRIFTA® syringe with another person, even if the needle is changed.

Do not share your EGRIFTA® needles with another person.

This Patient Information leaflet summarizes the most important information about EGRIFTA®. If you would like more information, talk with your healthcare provider. You can ask your healthcare provider or pharmacist for information about EGRIFTA® that is written for healthcare professionals.

For more information about EGRIFTA®, go to www.EGRIFTA.com or contact the AXIS Center toll-free at 1-877-714-2947.

What are the ingredients in EGRIFTA®?

Active ingredient: tesamorelin Inactive ingredients: mannitol and Sterile Water for Injection

©2011 EMD Serono, Inc. 110627-101931 7/11 All rights reserved. EGRIFTA is a registered trademark of Theratechnologies Inc.

S:9.75 in

How should I use EGRIFTA®?

• Read the detailed “Instructions for Use” that comes with EGRIFTA® before you start using EGRIFTA®. Your healthcare provider will show you how to inject EGRIFTA®.

• Use EGRIFTA® exactly as prescribed by your healthcare provider.

• Inject EGRIFTA® under the skin (subcutaneously) of your stomach area (abdomen).

• Change (rotate) the injection site on your stomach area (abdomen) with each dose.

Do not inject EGRIFTA® into scar tissue, bruises or your navel.

• Do not share needles or syringes with other people. Sharing of needles can result in the transmission of infectious diseases, such as HIV.

• Increase in glucose (blood sugar) intolerance and diabetes. Your healthcare provider

T:10.125 in

What should I tell my healthcare provider before using EGRIFTA®?

Before using EGRIFTA®, tell your healthcare provider if you: • have or have had cancer • have diabetes • are breastfeeding or plan to breastfeed. It is not known if EGRIFTA® passes into your breast milk. The Centers for Disease Control and Prevention (CDC) recommends that HIV-infected mothers not breastfeed to avoid the risk of passing HIV infection to your baby. Talk with your healthcare provider about the best way to feed your baby if you are taking EGRIFTA® • have kidney or liver problems • have any other medical condition Tell your healthcare provider about all the medicines you take, including prescription and nonprescription medicines, vitamins, and herbal supplements. EGRIFTA® may affect the way other medicines work, and other medicines may affect how EGRIFTA® works.

Know the medicines you take. Keep a list with you to show your healthcare provider and pharmacist when you get a new medicine.

– hives – swelling of your face or throat – shortness of breath or trouble breathing – fast heartbeat – feeling of faintness or fainting • Swelling (fluid retention). EGRIFTA® can cause swelling in some parts of your body. Call your healthcare provider if you have an increase in joint pain, or pain or numbness in your hands or wrist (carpal tunnel syndrome).

WORLD AIDS DAY 2011

It Takes A Village

to stop hiv In honor of World AIDS Day on December 1, we look at six individuals, from activists to scientists, working to end HIV in their own singular way

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WORLD AIDS DAY 2011

Africa’s Leila Lopes, recently crowned Miss Universe 2011, is a British-educated 25-year-old Angola native who says she cherishes inner strength over outer beauty. Hailing from the town of Benguela, Lopes is first woman from Angola—and only the fourth black woman—to be crowned Miss Universe. After winning the pageant, held in Brazil in September, the outspoken Lopes slammed racism and plastic surgery, telling reporters, “Any racist needs to seek help. It’s not normal in the 21st century to think in that way.”

She also pledged to expand her philanthropic missions—especially her involvement with HIV prevention, treatment, and visibility.

“I’ve worked with various social causes. I work with poor kids, I work in the fight against HIV,” she said to reporters after the competition. “I think now as Miss Universe I will be able to do much more.” Angola, specifically, needs Lopes’s help—the recently war-torn nation is very poor and antiretroviral medications are hard to come by for many.

Lopes told Time magazine she was up to the challenge: “I have acquired many wonderful principles from my family and I intend to follow these for the rest of my life.”

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The Fighter

New York congressman Jerrold Nadler revels in being on the progressive side of history. In 1976 the New York City Democrat started a 16-year run in the state Assembly, where he became an early advocate for people with AIDS. During the height of fear and ignorance around the disease, Nadler championed a state program to fund AIDS meds and helped pass a ban on discrimination against New York’s HIVers.

After Nadler entered Congress in 1992, he fought for AIDS funding under the Ryan White CARE Act and other laws, helping to support AIDS Drug Assistance Programs and other services.

Nadler is optimistic when looking at overall HIV research and funding. Nadler recalled a point in the mid 1990s when Beltway fights often broke out over funding for government programs, a scenario not unfamiliar now. For instance, Republicans wanted to end all financing for the National Endowment for the Arts, but Democrats agreed to cut funding in the near term and gradually phase the agency out.

“I said, ‘This is a great victory!’

Everyone thought I was crazy, but a couple of years later, the Republicans were out, and, we saved the program,” Nadler says. “So after this next election, we’ll live to fight another day.”

The Fund-raiser

If you raise a dollar for AIDS causes, you’re doing more than most folks.

Bill Shopoff does more than that.

The Irvine, Calif., businessman has raised over a quarter-million dollars for HIV services as a cyclist in AIDS/ LifeCycle’s Ride to End AIDS. Every year in the AIDS/LifeCycle, 2,350 bicyclists and 600 volunteer “roadies” complete a seven-day, 545mile bike ride from San Francisco to Los Angeles as part of the world’s most successful AIDS fund-raiser.

Over the past decade the event has raised more than $80 million for the HIV/AIDS services of the Los Angeles Gay and Lesbian Center and San Francisco AIDS Foundation—and Shopoff has been a big part of that.

Shopoff has completed the journey six times, taking up the cause to honor the many friends he lost to AIDS. Crediting his fund-raising success to personal outreach, especially to those directly affected by the disease, Shopoff says of the LifeCycle, “There’s nothing I’ve done that’s been more rewarding.”

That’s saying a lot considering Shopoff, when he’s not cycling, is president and CEO of Shopoff Group and has more than 25 years of real estate investment experience.

ge t t y images (4); redmann & shopoff: courtesy subjec ts

The Queen

The Visionary

A former television producer and assistant to President Gerald Ford, Mary Fisher travels the globe promoting awareness and compassion in the fight against HIV/AIDS. The daughter of a wealthy GOP power broker, Fisher made news in 1992 with a historic speech at the Republican National Convention in which she aimed “to lift the shroud of silence which has been draped over the issue of HIV/ AIDS.” Of that landmark address, Norman Mailer wrote “When Mary Fisher spoke like an angel that night, the floor was in tears, and conceivably the nation as well.” HIV-positive for two decades now, the Arizona-based artist “fuses artistry to advocacy and passion to purpose” in her creation of powerful works and has tirelessly rallied people around the world with her messages of hope and urgency. She has served as an ambassador for the Joint United Nations Programme on HIV/AIDS as well as on the Leadership Council of the Global Coalition on Women and AIDS. In addition, she founded the Mary Fisher CARE (Clinical AIDS Research and Education) Fund.

The Scientist

When Yale University biochemistry professor Thomas Steitz first started working on the science of HIV/AIDS, he was quoted in the New England Monthly as saying, “There are a lot of people willing to work on these problems who are just sitting on their hands.” Steitz didn’t want to be one of them. In 1992 he and a team of scientists at Yale created a picture of an HIV protein, reverse transcriptase, interacting with an anti-HIV drug, a breakthrough that led to further development of such medications.

And in 2000 he completed a highresolution image of an uncharted cellular protein molecule that could assist in the creation of new antibiotics. For that discovery and others, he won the Nobel Prize in chemistry in 2009, along with a handful of other awards and distinctions.

Today, Steitz is a professor of chemistry and the Sterling Professor of Molecular Biophysics and Biochemistry at Yale, where he’s been on the faculty since 1970. He’s also an investigator at the Howard Hughes Medical Institute, a nonprofit medical research organization that ranks as one of the nation’s largest philanthropies and plays a powerful role in advancing biomedical research and science education in the U.S.

The Advocate

Novelist and activist Jean Redmann is known for her mystery writing and HIV work, both interests connected by the allure of New Orleans. Much of her fiction focuses on Big Easy– based private investigator Micky Knight, the protagonist of books such as Water Mark, and Redmann writes Micky’s stories when not doing her full-time work: serving as the director of prevention at NO/AIDS Task Force, a New Orleans–based AIDS awareness, prevention, and service group.

The organization serves a region that desperately needs comprehensive HIV care and preventive measures, especially for high-risk groups like black adolescents and gay men. New Orleans and the state of Louisiana consistently rank high in new HIV infections each year.

The current economy leaves the organization making due with the limited resources it has. NO/AIDS receives most of its funding through federal grants—not the GOP-run state government. “Fortunately, or perhaps unfortunately,” she says, “HIV programs have been flat-funded, meaning they have not been cut, but not added to either.”

The possibility of federal budget cuts does not deter Redmann: “We want our clients to receive the services they need. It doesn’t matter if we are the only ones doing the work.

What matters most are the people.”

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HIV 28 | H I V P L U S n o v e m b e r / d e c e m b e r 2 0 1 1

10

Greatest Discoveries of 2011 Here’s a look at some of the year’s bigger medical breakthroughs that could leave you feeling even better in 2012 and beyond

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2

Researchers discover breast-feeding is an option. Many mothers

prefer breast-feeding their infants to using formula, but that option is not always available to HIV-positive women. However, a study presented at March’s Conference on Retroviruses and Opportunistic Infections in Boston found that giving infants a daily dose of nevirapine for the first six months of life halved their risk of contracting HIV from their mothers (compared with a shorterterm regimen), and among HIV-positive women with higher T-cell counts, there was a 75% reduction in transmission rates. Moreover, while mother-to-child HIV transmission is still possible through breast-feeding, another study indicated that antibodies found in breast milk, when isolated, can neutralize HIV and kill HIV-infected cells. While incorporated into breast milk, the antibodies do little to block the virus, because of IgG, another antibody, but scientists are evaluating how to enhance the HIVcombating antibodies.

3

A vaccine may have been found.

Scientists in Spain are testing an HIV vaccine that has proved more powerful than previous ones that have gone to trial. After a year of testing in humans, 95% of the 24 patients built an immune-system defense against the virus, and 85% of them sustained that for a year. Past vaccine trials had shown only 25% of those developed such a defense. The vaccine is specialized to protect against a subtype of HIV that is more prevalent in Europe, North America, and South America.

A prevention treatment for couples is successful.

One of the more notable breakthroughs of the year concerned a study that was so successful, it ended early. A total of 1,763 relatively healthy HIVers were treated with antiretrovirals, and they avoided transmitting the virus to their HIV-negative partners in 96% of cases.

The study was composed mostly of heterosexual couples, so there are no conclusive numbers for serodiscordant gay couples.

4

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Glowing cats may help solve kitty version of HIV.

Researchers at the Mayo Clinic have found a colorful way to develop a gene-based strategy to fight the feline immunodeficiency virus, or FIV, the feline version of HIV. A gene that provides a green fluorescent protein in jellyfish was used to mark for cells carrying a second gene, which confers resistance to FIV. The fluorescent gene causes the cats to glow and therefore allows scientists to track cell movement and tissue function.

pre vious spread: photos.com; this page (clock wise from top lef t ): courtesy gilead sciences, courtesy mayo clinic , photos.com (2) opposite page: photos.com (3)

1

Two major new drugs promise to make life easier for HIVers. In January pharmacies began offering Egrifta, a daily injection that reduces the deep belly fat that surrounds organs like the liver and stomach as a side effect of anti-HIV drugs.

Complera, which combines Edurant, Viread, and Emtriva in a single pill and is meant for first-time HIV medication users, was approved by the U.S. Food and Drug Administration in August.

10

Turns out, the truth is in the hair. Researchers found that

6

Computer mapping and other technologies help target HIV in the U.S. Studies presented at

the annual National HIV Prevention Conference in August showed health agencies using technology to enhance prevention and care efforts. Los Angeles County health officials used computer mapping to identify HIVers receiving inadequate treatment, while a Cleveland hospital system used electronic health records to remind doctors to routinely screen patients for HIV. Jonathan Mermin, director of the division of HIV/AIDS Prevention at the Centers for Disease Control and Prevention, said the findings will be incorporated into national AIDSfighting strategy.

7

Remove the cholesterol, treat the virus? A team of scientists from the U.S. and Europe found in September that removing cholesterol from the membrane of an HIV particle can keep the virus from damaging the immune system.

8

Gene therapy gets turned on its head. Many have looked how gene therapy can change the way HIV affects a person’s immune system, but a new theory is exploring the role of gene therapy in HIV transmission. In March researchers published a study, based on computer simulations, postulating that HIVers receiving gene therapy to suppress viral load would be less likely to transmit HIV to a sexual partner but would transmit the therapeutic material, weakening the virus’s effect if the partner did contract it.

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Doctors discover HIV helps treat cancer.

When chemotherapy failed to treat William Ludwig’s leukemia, doctors tried a new method: They removed a billion of his T cells, infused them with a disabled form of HIV that allowed them to carry cancer-fighting genes, and placed them back in his body. The risky move essentially taught his immune system to kill cancer cells. His doctors are not willing to go so far as to say he is cured, but his leukemia remains in remission.

measuring the levels of Reyataz in people’s hair may be the best way to see how well they are sticking to their treatments. In a recent study, 77% of women who had previously had problems adhering to their drug regimen said they had taken at least 95% of their Reyataz doses. A quick sampling of their hair proved the opposite: Fewer than 20% had actually stuck to the regimen.

The Hunt For a Cure Thirty years into the AIDS crisis, two of the top leaders at the AIDS Research Alliance tell us how close they are to ending HIV—and what a mysterious Samoan tree has to do with their work

T

by Neal Broverman

has been at the forefront of HIV treatment and prevention for 22 years, but the Los Angeles–based nonprofit is now focused primarily on finding a cure. Carolyn Carlburg, ARA president and CEO, and Stephen Brown, its vice president and medical director, talked to HIV Plus about their work for a cure and why you’ll be hearing the words “prostratin” and “reservoirs” much more in the coming years. he aids research alliance

HIV Plus: We just passed the 30th year of the first diagnosed case of AIDS. We hear a lot about prevention and treatment. Why aren’t we hearing more about a cure?

Stephen Brown: For many years a cure seemed too difficult a goal to pursue, and there didn’t seem any widespread support for research in the area. When grants came out about 10 years ago and they identified the areas of science where research really needed to be done, there was a spot on the list for persistent infections including HIV, but it really wasn’t followed up with funding. The funding in this area has always been difficult to obtain and some of these [research] institutions have been under the financial pressures. When you have situations like that, what gets funded tends to be safe research that will produce the expected results or insights. So it was only really two years ago that National Institutes of Health began to entertain the possibility of a research program in this area.

So much government funding is put toward treatment. Do politicians understand the savings that could be achieved should a cure be found?

Carolyn Carlburg: The funding for research, whether for treatment, vaccine, or cure, almost 100% of it is going to come from NIH; there’s not a whole lot of it right now that’s going to come from pharmaceutical companies. But NIH, I think their focus is more on the science—other departments like Health and Human Services or maybe even the White House would be greatly influenced by achieving that kind of savings. I think NIH

is focused primarily on science. I don’t mean to sound critical of government, but I think different departments or agencies think about their own areas of responsibility.

Much of your work involves targeting HIV reservoirs through something called prostratin. What exactly is prostratin?

Brown: When we’re talking about the reservoirs we’re talking about cells holding just the information to make HIV. For most of these cells, there are no HIV particles or pieces, all of that is integrated into the person’s DNA and exists purely as the information for making HIV. These cells are programmed to remain silent, but we activate it, and once it’s reactivated, instructions are followed and the cell begins making HIV again.

Prostratin is related to several other chemicals that have been used frequently in scientific experiments in order to activate T cells, and it’s this activation process that actually causes the information to be changed into virus. The important part about prostratin is while it does cause activation, it doesn’t cause these cells to proliferate or replicate, and that’s very pretty important because if you give someone something that could replicate, that’s often the beginning of something like a cancer. But prostratin is very closely related to something that’s been already been given clinical trials for some other diseases. We think prostratin is safer then those chemicals.

Carlburg: The way the anti-HIV drugs work is they primarily block and suppress the replication of virus. The irony is that you can’t get rid of the reservoirs because the virus has become latent. So if it’s not replicating, then we can’t kill it. We want to find a safe way to attack it.

You’re trying to find a way to cure it without it advancing from HIV to AIDS. Carlburg: Exactly. In a way we want to do the opposite of what antiretrovirals do. We want to drive HIV to the point where it can’t replicate, but we want to make it visible so we can attack it.

Brown: So the immune system sees [HIV], and the cells keeping it there in a reservoir latent stage are activated and are either killed

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by the immune system or killed by the replication of the virus…similar in what you might do in a cancer protocol if you’re trying to get rid of a certain number of tumor cells. You might do something that might get rid of 15%20% with each round.

How was it first developed?

Brown: The traditional use for prostratin is in Samoa, where it’s given as a tea to treat hepatitis. It’s derived from the mamala tree. We went to Samoa and observed healers prepare samples of the tea. They cut off a piece of the tree and basically scrape off the outer part, which is the very thin bark of the tree. Then there’s this stuff underneath before you really get to the wood, and that’s the part that they scrape off and use to make the tea.

How did you first find out about it?

Brown: It first came to my attention in 1999.

The information was being presented by Dr. Michael Boyd from the National Cancer Institute. We had been looking for potential drugs that did precisely what prostratin did, so when I saw the information at the conference I was very excited and spoke to the presenter. We were able to obtain a significant amount [of prostratin samples], which we then began using primarily by funding other researchers [to work with it]. It was hard to get anyone interested in looking at this, so we had to fund them to do the initial experiments. But when [scientists] saw the results, suddenly everyone was excited.

In 2010 you were granted the rights to the technology used to synthesize prostratin.

What’s the latest?

Carlburg: [At the time], we pulled together hundreds of pages of data and information on prostratin.

Brown: We felt quite encouraged by the Food and Drug Administration’s response [to the documents], but they did have a series of experiments that they wanted us to conduct.

So we are currently in the beginning stage of doing those experiments.

For more information on the ARA’s work, go to www.aidsresearch.org.

mamal a pl ant: paul al an cox

(Above) The mamala tree, which contains the chemical prostratin— and possibly an AIDS cure. Pictured at left is ARA research assistant Leo Borjon in the ARA’s new laboratory, funded with $250,000 from the Pepsi Refresh Project and built specifically for work on prostratin.

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DIONNE LENDING HER VOICE As she celebrates her golden anniversary in show business, Grammy award–winning singer and activist Dionne Warwick reflects on her commitment to the fight against AIDS and expresses hope that more young African-Americans will take responsibility when it comes to HIV

By Julie Bolcer

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the “5 Years, 5 Heroes” contest—a search for five people who’ve made a difference in the fight against HIV/AIDS in the last half decade.

(ATRIPLA will be making a documentary about the winners, to debut in March 2012.)

Warwick lost her assistant to AIDS in the 1980s before the disease even had a name and before Rock Hudson had put a face to it.

Her assistant, initially thought to be suffering from cancer, would be the first of many among her colleagues to face the disease.

“I’m a performer. The industry I am in has lost a multitude of talented people,” says Warwick, who appeard on The Celebrity Apprentice earlier this year. “That’s when I had a very strong message sent to me to stop talking and start doing, and as a result of it, my advocacy started getting known throughout the country.”

These days, Warwick’s advocacy continues in communities like Harlem. The rates of HIV infection in some American cities rival those in sub-Saharan Africa, with young African-Americans hit particularly hard, according to the latest statistics for the Centers for Disease Control and Prevention.

“Economics, nothing more than that,” said Warwick, when asked for her thoughts on the cause of the disproportionate impact. Still, she said that services have multiplied and improved over the years, and she encouraged young people to take responsibility, as she and other pioneering celebrities did 30 years ago.

“Prior to that, there was no place for African-Americans to go, which gave me even more strength to combat this thing,” she said. “[Today] there is help on every corner you turn. Take your butts in there and get some testing done and get some information.”

One thing she refused to do is blame the music industry. Performers’ involvement seems lack-

ing today compared to 1985, when “That’s What Friends Are For” hit the charts, but Warwick said responsibility should be shared.

“I really wish people would get a handle on that,” she said. “Although we do have a loud voice, and a multitude of audiences that we can relay information to, I think it’s the responsibility of mankind, period.

Everybody has to play a part in this issue, as they do with cancer, as they do with heart disease, as they do with diabetes, as they do with any other devastating disease.”

A part-time resident of Brazil, Warwick’s globe trotting brought attention to the fight against AIDS and world hunger. President Ronald Reagan appointed her the United States ambassador of health in 1987 and in 2002, she became the goodwill ambassador of the Food and Agriculture Organization of the United Nations.

“The Hunger Project and my position with FAO concentrate on feeding and teaching those countries abroad how to potentially feed themselves,” she said. “I do speak of AIDS during any of the times that I am actively involved with these hunger issues.”

She credits belief in the power of prayer for guiding her work.

Warwick thinks faith can play a key role in the fight against AIDS. “I was always told—my grandfather was a minister—that the reason we are on Earth is to be of service to each other,” she said. “I’m not fanatical about my religion. I believe in God and prayer, and I think that it’s brought me a long way. So yes, I’m religious.”

As she enters her second halfcentury in show business, she plans on keeping up her philanthropy.

She owes it to her fans.

“I think that our celebrity is predicated upon the communities that support us,” she said. “If they’re going to support your career, the least that can be done is that you support and give back.” ✜

pre vious spread: ge t t y images; opposite page: filmmagic

A

lmost 30 years have passed since Dionne Warwick and her friends— Elton John, Gladys Knight, and Stevie Wonder— recorded their smash hit, “That’s What Friends Are For.” The song generated over $3 million for the American Foundation for AIDS Research and heralded a new era of celebrity-driven fund-raising and activism. Warwick became one of the first African-American celebries to align herself with the fight against the epidemic.

Some things have not changed for the New Jersey native whose career has spanned five decades of hits such as “Don’t Make Me Over,” “Alfie,” and “Walk On By.” “Lyrically, it’s the same message of I’m going to be there for you,” said Warwick, 70, before a September town hall she organized on HIV/ AIDS in New York City. “Friends are the ones who are there for you.

That’s exactly what this is all about.

Being human. Having humanity.”

The town hall, presented with Harlem United Community AIDS Center, drew nearly 200 audience members, most of them AfricanAmerican, to ask questions and hear perspectives from leaders in health, policy, advocacy, and religion. Panelists included Warwick, actress Sheryl Lee Ralph—a member of the original Broadway cast of Dreamgirls and founder of an HIV charity, the Diva Foundation—and Rae Lewis-Thornton, the first African-American woman to tell her story of living with AIDS to a major publication, Essence, in 1994.

“Education is really the key,” Warwick said. “We have to know what we’re fighting in order to be able to fight it.”

Warwick recently joined actor Wilson Cruz and screenwriter Dustin Lance Black in judging

Model

INDICATIONS ISENTRESS is a medicine used to treat the human immunodeficiency virus (HIV). ISENTRESS must be taken with other HIV medicines to improve your chances of fighting the virus. You must remain under your doctor’s care.

ISENTRESS has not been studied in children.

ISENTRESS will not cure HIV or reduce your chances of passing it on to others.

IMPORTANT RISK INFORMATION A condition called Immune Reconstitution Syndrome can happen in some patients with advanced HIV infection (AIDS) when anti-HIV treatment is started. Signs and symptoms of inflammation from opportunistic infections may occur as the medicines work to treat the HIV infection and strengthen the immune system.

Call your doctor right away if you notice any signs or symptoms of an infection after starting ISENTRESS. Contact your doctor immediately if you experience unexplained muscle pain, tenderness, or weakness while taking ISENTRESS. This is because on rare occasions muscle problems can be serious and can lead to kidney damage.

When ISENTRESS has been given with other anti-HIV drugs, side effects included nausea, headache, tiredness, weakness, trouble sleeping, stomach pain, dizziness, depression, and suicidal thoughts and actions.

Mild rash occurred more often in patients taking ISENTRESS plus Prezista than with either drug alone.

You are special, unique, and different from anyone else.

And so is your path to managing HIV. When you’re ready to start HIV therapy, talk to your doctor about a medication that may fit your needs and lifestyle.

In clinical studies lasting 96 weeks, patients being treated with HIV medication for the first time who took ISENTRESS plus Truvada: Had a low rate of side effects — The most common side effect of moderate to severe intensity (that interfered with or kept patients from performing daily activities) was trouble sleeping — This side effect occurred more often in patients taking ISENTRESS plus Truvada (4%) versus Sustiva plus Truvada (3%) Experienced less effect on LDL cholesterol (“bad” cholesterol) — Cholesterol increased an average of 7 mg/dL with ISENTRESS plus Truvada versus 21 mg/dL with Sustiva plus Truvada — When they began the study, the average LDL cholesterol of patients on ISENTRESS plus Truvada was 96 mg/dL versus 93 mg/dL for those on Sustiva plus Truvada

Ask your doctor about ISENTRESS. Not sure where to start? Visit isentress.com/questions People taking ISENTRESS may still develop infections, including opportunistic infections or other conditions that occur with HIV infection.

Tell your doctor about all of your medical conditions, including if you have any allergies, are pregnant or plan to become pregnant, or are breast-feeding or plan to breast-feed. ISENTRESS is not recommended for use during pregnancy. Women with HIV should not breast-feed because their babies could be infected with HIV through their breast milk.

Tell your doctor about all the medicines you take, including prescription medicines like rifampin (a medicine used to treat infections such as tuberculosis), non-prescription medicines, vitamins, and herbal supplements.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

For more information about ISENTRESS, please read the Patient Information on the following page.

Need help paying for ISENTRESS? Call 1-866-350-9232 Copyright © 2011 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc. All rights reserved.

INFC-1011810-0000 09/11(112) Sustiva is a registered trademark of Bristol-Myers Squibb Truvada is a registered trademark of Gilead Sciences, Inc. Prezista is a registered trademark of Tibotec, Inc.

Patient Information ISENTRESS ® (eye sen tris) (raltegravir) Tablets Read the patient information that comes with ISENTRESS1 before you start taking it and each time you get a refill. There may be new information. This leaflet is a summary of the information for patients. Your doctor or pharmacist can give you additional information. This leaflet does not take the place of talking with your doctor about your medical condition or your treatment.

What is ISENTRESS? • ISENTRESS is an anti-HIV (antiretroviral) medicine used for the treatment of HIV. The term HIV stands for Human Immunodeficiency Virus. It is the virus that causes AIDS (Acquired Immune Deficiency Syndrome). ISENTRESS is used along with other anti-HIV medicines. ISENTRESS will NOT cure HIV infection.

• People taking ISENTRESS may still develop infections, including

opportunistic infections or other conditions that happen with HIV infection.

• Stay under the care of your doctor during treatment with ISENTRESS. • The safety and effectiveness of ISENTRESS in children has not been studied.

ISENTRESS must be used with other anti-HIV medicines.

How does ISENTRESS work?

• ISENTRESS blocks an enzyme which the virus (HIV) needs in order to make more virus. The enzyme that ISENTRESS blocks is called HIV integrase.

• When used with other anti-HIV medicines, ISENTRESS may do two things:

1. Reduce the amount of HIV in your blood. This is called your “viral load”.

2. Increase the number of white blood cells called CD4 (T) cells.

• ISENTRESS may not have these effects in all patients.

Does ISENTRESS lower the chance of passing HIV to other people?

No. ISENTRESS does not reduce the chance of passing HIV to others through sexual contact, sharing needles, or being exposed to your blood.

• Continue to practice safer sex.

• Use latex or polyurethane condoms or other barrier methods to lower the chance of sexual contact with any body fluids. This includes semen from a man, vaginal secretions from a woman, or blood.

• Never re-use or share needles.

Ask your doctor if you have any questions about safer sex or how to prevent passing HIV to other people.

What should I tell my doctor before and during treatment with ISENTRESS? Tell your doctor about all of your medical conditions. Include any of the following that applies to you: • You have any allergies.

• You are pregnant or plan to become pregnant.

- ISENTRESS is not recommended for use during pregnancy.

ISENTRESS has not been studied in pregnant women. If you take

ISENTRESS while you are pregnant, talk to your doctor about how

you can be included in the Antiretroviral Pregnancy Registry.

• You are breast-feeding or plan to breast-feed.

- It is recommended that HIV-infected women should not breast-feed

their infants. This is because their babies could be infected with HIV through their breast milk.

- Talk with your doctor about the best way to feed your baby.

Tell your doctor about all the medicines you take. Include the following: • prescription medicines, including rifampin (a medicine used to treat some infections such as tuberculosis) • non-prescription medicines • vitamins • herbal supplements Know the medicines you take.

• Keep a list of your medicines. Show the list to your doctor and pharmacist when you get a new medicine.

How should I take ISENTRESS? Take ISENTRESS exactly as your doctor has prescribed. The recommended dose is as follows: • Take only one 400-mg tablet at a time.

• Take it twice a day.

• Take it by mouth.

• Take it with or without food.

Do not change your dose or stop taking ISENTRESS or your other anti-HIV medicines without first talking with your doctor.

If you fail to take ISENTRESS the way you should, here’s what to do: • If you miss a dose, take it as soon as you remember. If you do not remember until it is time for your next dose, skip the missed dose and go back to your regular schedule. Do NOT take two tablets of ISENTRESS at the same time. In other words, do NOT take a double dose.

• If you take too much ISENTRESS, call your doctor or local Poison Control Center.

Be sure to keep a supply of your anti-HIV medicines.

• When your ISENTRESS supply starts to run low, get more from your doctor or pharmacy.

• Do not wait until your medicine runs out to get more.

What are the possible side effects of ISENTRESS? When ISENTRESS has been given with other anti-HIV drugs, side effects included: • nausea • headache • tiredness • weakness • trouble sleeping • stomach pain • dizziness • depression • suicidal thoughts and actions Other side effects include: rash, severe skin reactions, feeling anxious, paranoia, low blood platelet count, diarrhea, liver failure.

A condition called Immune Reconstitution Syndrome can happen in some patients with advanced HIV infection (AIDS) when combination antiretroviral treatment is started. Signs and symptoms of inflammation from opportunistic infections that a person has or had may occur as the medicines work to treat the HIV infection and help to strengthen the immune system. Call your doctor right away if you notice any signs or symptoms of an infection after starting ISENTRESS with other anti-HIV medicines.

Contact your doctor promptly if you experience unexplained muscle pain, tenderness, or weakness while taking ISENTRESS. This is because on rare occasions, muscle problems can be serious and can lead to kidney damage.

Rash occurred more often in patients taking ISENTRESS and darunavir together than with either drug separately, but was generally mild.

Tell your doctor if you have any side effects that bother you.

These are not all the side effects of ISENTRESS. For more information, ask your doctor or pharmacist.

How should I store ISENTRESS? • Store ISENTRESS at room temperature (68 to 77°F).

• Keep ISENTRESS and all medicines out of the reach of children.

General information about the use of ISENTRESS Medicines are sometimes prescribed for conditions that are not mentioned in patient information leaflets.

• Do not use ISENTRESS for a condition for which it was not prescribed.

• Do not give ISENTRESS to other people, even if they have the same symptoms you have. It may harm them.

This leaflet gives you the most important information about ISENTRESS. • If you would like to know more, talk with your doctor.

• You can ask your doctor or pharmacist for additional information about ISENTRESS that is written for health professionals.

• For more information go to www.ISENTRESS.com or call 1-800-622-4477.

What are the ingredients in ISENTRESS? Active ingredient: Each film-coated tablet contains 400 mg of raltegravir.

Inactive ingredients: Microcrystalline cellulose, lactose monohydrate, calcium phosphate dibasic anhydrous, hypromellose 2208, poloxamer 407 (contains 0.01% butylated hydroxytoluene as antioxidant), sodium stearyl fumarate, magnesium stearate. In addition, the film coating contains the following inactive ingredients: polyvinyl alcohol, titanium dioxide, polyethylene glycol 3350, talc, red iron oxide and black iron oxide.

IMPORTANT: Take ISENTRESS exactly as your doctor prescribed and at the right times of day because if you don’t: • The amount of virus (HIV) in your blood may increase if the medicine is stopped for even a short period of time.

• The virus may develop resistance to ISENTRESS and become harder to treat.

• Your medicines may stop working to fight HIV. • The activity of ISENTRESS may be reduced (due to resistance).

Distributed by: Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc. Whitehouse Station, NJ 08889, USA

Registered trademark of Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc. Copyright © 2007, 2009 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc. All rights reserved.

Revised February 2011 9795112 U.S. Patent Nos. US 7,169,780 INFC-1011810-0000 09/11(112)

1

HAART BEATS

The Trouble With ADAP

photos.com

What do you do when your state can’t help you obtain the medication that you need? nearly 10,000 people in 11 states across the country are already being turned away from AIDS Drug Assistance Programs due to underfunding, but for some there are other ways to get help.

The most viable alternative for people who have been cut off from these programs can be to simply go directly to the source:

the pharmaceutical companies. Be prepared, though: Ged Kenslea of the Los Angeles– based AIDS Healthcare Foundation cautions that doing so may mean more legwork for people looking for medications.

“In a sense, ADAP provides one-stop shopping if you’re taking more than one medication,” Kenslea says. When it comes

to the drug company-run patient assistance programs, he warns that complications may begin on a basic level—for instance, when an HIVer needs three different medicines that come from three different companies.

“Some have efficient patient assistance programs,” he says, “but if you can’t get the other two drugs that you need, in order to take the one pill that you were able to get, it might throw out your plans.”

In addition to ensuring that all medications come in at the right time, Kenslea says HIVers should plan for the different types of time-consuming requirements like sending medical requests via fax that some companies require.

The AIDS Healthcare Foundation has also been lobbying states not to make eligibility changes that would shut people out of ADAPs, which are jointly funded by each state and the federal government. “What has been even more odious than a waiting list has been that some states with waiting lists are considering changing eligibility criteria completely,” he says.

The result inevitably means lower income cutoffs for people who are employed but still need help to afford costly anti-HIV drugs. “The criteria is based on the federal poverty level, which is $11,000 [for a single person], and it’s usually a multiple like 400% of the poverty level,” Kenslea explains. “So if you make more than $44,000, you’d be cut off. Some states were looking into cutting it off if you make more than $22,000.”

Florida is among the states considering such a reduction, while Illinois and Ohio have reduced their cutoff from 500% to 300% of the poverty level.

In the meantime, the U.S. Senate Appropriations Committee in September recommended that federal funding to states for ADAPs be boosted by $15 million in 2012.

That increase, however, won’t have a vast effect on the number of people waiting for ADAPs. According to the AIDS Institute, it would reduce waiting lists nationally by only about 1,300 individuals—just 15%.

“This is extremely disappointing since we have the drugs to keep people alive,” says Carl Schmid, the institute’s deputy executive director. President Obama asked Congress for a $55 million increase in ADAP funding, and the AIDS Institute lobbied for a $106 million increase to eradicate waiting lists.

“Our nation,” Schmid says, “is not going to reduce new HIV infections or provide adequate care and treatment to low-income people living with HIV/AIDS without new resources.” —Michelle Garcia

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HAART BEATS

HIV+ Smokers Are at Double Risk

Protein Power

A new study could expand upon the powerful properties in saliva that prevent HIV transmission two medical institutions will share $3.2 million to study whether a particular protein found in saliva can prevent HIV transmission. The study’s results could lead to the development of new anti-HIV drugs.

While it has been established that proteins found in saliva can protect against HIV transmission, it’s not quite clear how that process works. New York University College of Dentistry professor Daniel Malamud has been studying proteins, including gp340, for more than 25 years. He and professor Min Lu of the University of Medicine and Dentistry of New Jersey are planning to see how the protein affects immune-deficient mice.

They and their team plan to generate particles of the portion of gp340 that is known to curb HIV infection. Those particles will be injected into the mice’s salivary glands. Once the proteins work their way into their new glands, the team will expose the mice to HIV. Then the mice will be compared to another set of HIV-exposed mice that did not receive the protein to see if it made any difference. They researchers will also study the effect of gp340 on HIV transmission in the reproductive organs of female mice. —Michelle Garcia

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from top: Stockby te, Photodisc; opposite page (from top): Jupiterimages

Highly active antiretroviral therapy has increased the life expectancy of people with HIV, but as they grow older they are encountering other health complications—among them, chronic obstructive pulmonary disease. But there’s one obvious way to prevent or lessen COPD, say researchers: Don’t smoke.

COPD, a condition that interferes with breathing and is not fully reversible, is more common among HIV-positive individuals than those not infected. This led a group of French scientists to examine the factors that link HIV to COPD. They reviewed previous studies of the relationship between the virus and COPD and concluded that HIV itself likely affects lung function, as do various opportunistic infections associated with the virus. Some studies also indicated that drugs used to treat HIV caused obstruction of the bronchial tubes.

But in their findings, published in the journal Respiratory Research, one fact particularly stands out. “The prevalence of smoking among HIVinfected patients ranges from 40% to 70%, compared to about 25% in the general population in the United States,” they wrote.

Before HAART became available, some studies indicated smoking or not smoking made little difference in death rates among people with HIV, the researchers noted. “Since the advent of HAART,” they said, “smoking has been identified as a significant risk factor for mortality among HIV-infected patients. More prolonged survival likely allows tobacco smoke to exert its deleterious effects and gives time for the corresponding diseases to become symptomatic.”

Because of this, researchers say it’s crucial that doctors and other care providers discourage their HIV-positive patients from smoking.

They added that any HIVer with ongoing respiratory problems, whether a smoker or not, should undergo pulmonary function tests and lung imaging.

—Trudy Ring

Chewed Out A common—but little-discussed— habit could be putting babies at risk

Antiretrovirals & Cholesterol New research provides information about how HIV treatment affects cholesterol levels

two recently published studies suggest that HIV-positive children undergoing antiretroviral drug treatment experience increased levels of cholesterol and other lipids. Doctors have advised that specific guidelines are needed to help these kids better control their levels in order to minimize the risks for cardiovascular disease.

In one study Denise L. Jacobson and colleagues at the Harvard School of Public Health monitored the cholesterol and lipid levels in 240 children living with HIV. Over two years lipid levels persistently increased in all subjects, putting them at a higher risk of heart disease and other health problems, while approximately one third of the patients experienced a decrease in cholesterol. Among the roughly 80 children in the latter group, only 15 were taking cholesterol-lowering medicine, while all underwent some sort of change in their HIV drug regimen, leaving researchers to believe the cholesterol decrease was related to that change.

The other study, by Margaret P. Rhoads, MD, of London’s Imperial College School of Medicine, compared the effects of various

antiretroviral drugs on lipid levels in 449 children with HIV. While all classes of the drugs were thought to increase cholesterol, the most significant boosts occurred in children taking protease inhibitors.

During a five-year follow-up period, 10% of the children studied experienced LDL or so-called bad cholesterol levels above the 95th percentile, but only three had levels high enough to require treatment.

One way to combat the cholesterol increase would be to find a “lipid-friendly” drug regimen—drugs that don’t increase fats in the blood—and combine it with nondrug treatments like diet and exercise, wrote physicians Allison Ross and Grace McComsey in an editorial accompanying the studies in the Journal of Acquired Immune Deficiency Syndromes. However, both doctors say more research is needed on these strategies.

Meanwhile, a separate study on adults with HIV, which was published by PLoS One, noted that participants taking cholesterollowering medication along with antiretroviral therapy reduced their risk of death by 67%. —Winston Gieseke

Most people, in 2011, have an idea what can and cannot spread HIV. But a new study shows there could be a conduit for transmission that has crossed few minds, namely pre-chewed food.

Over 150 South African child caregivers, mostly mothers, were recently asked if they pre-chew food before feeding it to infants. The practice, also known as premastication, is often used as a way to test the temperature and consistency of food for young mouths. More than 100 of the respondents reported pre-chewing food for babies and young children—and half of the caregivers had common oral problems such as bleeding gums or mouth sores. Adding to the risk, many of the children fed pre-chewed food were teething or had oral issues, meaning blood could be mixing with blood.

While the study, led by officials at a South African university and a Cape Town children’s hospital, is cause for concern, it didn’t offer evidence that premastication spreads HIV; the researchers didn’t test the caregivers or ask them if they were HIV-positive.

The next step is more conclusive studies that could lead to counseling for those using the surprisingly widespread practice.

Feeding babies pre-chewed food isn’t limited to Africa, though, so the question of risk for children of HIV positive parents persists in other countries as well. The Centers for Disease Control notes 14% of American caregivers have reported pre-chewing food for their kids.

Like its South African counterparts, the CDC recently conducted studies on the practice but hasn’t come up with anything more conclusive than confirming the danger involved.

“Public health officials and healthcare providers should educate the public about the risk for disease transmission via premastication and advise HIVinfected caregivers against the practice,” the CDC warned in a March issue of its Morbidity and Mortality Weekly Report.

—Neal Broverman

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RubberBall Produc tions

MIND + MOOD

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Gary McClain, Ph.D.

Serenity Now

Feeling exasperated is easy when you have HIV, but getting over it doesn’t have to be an ordeal “i am so frustrated!” Have you said this lately?

When was the last time you were irritated enough to cry, scream, shout, overeat, flip off passing motorists, or (insert your own reaction to extreme aggravation)?

These days, daily life gives us any number of reasons for our frustration button to be pushed hard, with money, jobs, and relationships at the top of the list. And facing the day-today challenges of managing HIV— dealing with managed care, co-pays, scheduling checkups, and those nagging concerns about the future—multiply the aggravation.

It’s only human to feel thwarted when life has thrown you some major curveballs and leaves you at a loss about how to get back to good feelings. Lingering frustration can be an unwelcome gift that keeps on giving—it can bring up strong emotions and make you wonder if there is anything you can do to fix things, what you should fix first, or if you should even bother to try. Major aggravation can leave you with a pretty bleak view of your future.

Here are some ideas to consider the next time you feel perturbed: Talk it out. Sometimes it can help to just sit down with someone who can be a nonjudgmental listener and ask them to just let you vent about your feelings. It can be helpful to release those pent-up emotions, to let them out rather than keeping them bottled up. You might want to let that person know that you just want to talk and aren’t asking them for advice, unless you really do want their suggestions.

Put a lid on it at some point. There is a very fine line between express-

ing yourself in a way that can provide some release and doing so in a way that becomes unproductive. In the process of going over and over whatever is frustrating you, you may also feel more and more helpless and hopeless. This can affect your compliance with your medication regimen, your lifestyle, and your relationships, and it will increase your stress level.

See if you can make changes. Frustration results from feeling that some part of your life is out of control. You might want to use some mindfulness here. Stand back and take a look at the situation as if you were an uninvolved observer. What’s making you frustrated? Then ask yourself, What can I change and how? By taking a more objective look at what’s bothering you, you can begin to sort out what you can actually do something about and what is simply out of your control. Acceptance of what you can and can’t change is the beginning of a more peaceful attitude.

Show some compassion. Frustration can result in beating up on yourself, which will, for most people, eventually affect your self-image. Go easy on yourself. Recognize that you are facing a lot, doing the best you can under the circumstances, and that you will find a way to face this challenge as you have faced others in the past. Turn your compassion outward. First stop expecting perfection from yourself; then stop expecting it from others.

Reach out. Get involved in activities you enjoy and find people you enjoy them with. Take time for things that give you pleasure and keep you calm.

Get together with friends or family members you enjoy. Basically, distract yourself from all that frustration. Reach out and celebrate what’s going well in your life.

Don’t neglect your spirit. If you have religious or spiritual practices that are part of your life or that you want to make a part of your life, there is no time like the present. Faith can be a great source of resilience in the face of frustration.

Be patient. The world doesn’t run on your personal clock. Bumps along the road don’t have to mean that the road can’t be traveled. Ask yourself, What’s the rush? While you wait for change, don’t neglect your self-care— this is a time to give yourself some extra attention.

Reach out to a mental health professional. If you are feeling overwhelmed by frustration, if it is affecting your attitude, causing self-doubt or conflict with people in your life, or interfering with your self-care in any way, this may be a good time to consult with a mental health professional. A counselor can help you to look at things objectively, consider things from various angles, and open up to what’s possible.

And remember: Vent. Relax. Accept.

Repeat. The flip side of frustration is empowerment, which is something we all deserve.

Gary McClain is a counselor in New York City with a specialty in coping with chronic health conditions. His books include The Complete Idiot’s Guide to Breaking Bad Habits and Empowering Your Life With Joy.

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LADY IN RED

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Shana Cozad

Facing the Fear Factor

Paul Austring Photography

Teaching her kids not to be afraid goes hand in hand with explaining why the neighbors are worried about a PTA mom with HIV.

my 8-year-old daughter is pulling her hair out trying her darndest to learn new spelling words. In her tantrum and tears, she confesses she hates spelling, she hates the boy on the bus who makes fun of her hair, and she hates it when the other neighborhood girls question her about her HIV-positive mom. I ask gently prodding questions and offer her oodles of emotional support (along with plenty of Kleenex).

Once her wailing subsides, we get to the meat of her frustration and talk about how weird people truly are. Not us, of course— other people.

An 8-year-old’s understanding of discrimination situations is really quite astounding. She gets it that there are people out there who can’t eat the crust on their PB&J sandwiches or who don’t like gays or are fearful of AIDS. Those things are easy to understand.

What the two of us can’t fathom is why we are unable to change some people’s perceptions in this world.

Why can’t that one neighborhood girl come over and play at our house? What is her mother so afraid of? Of course it goes without saying that I would never participate in any high-risk acts with a child. Nor do I walk around the house randomly spouting blood or other bodily fluids. So why do some people insist on harboring the same ugly AIDS fears people experienced decades ago? Some folks are in love with their fears—it’s true, they can be addicting. Some folks just refuse to drop them, even when they know full well that they’re illogical. Some people have been taught since childhood that fear is a great motivator. But fear needs to be managed.

When it comes to AIDS, I do my best to maintain a healthy fear of it rather than a disabling one.

Popcorn and chocolate, not always in that order, help get the wheels turning in my family’s brains. I often ask my kids if they think

I’m a good mommy and they usually reply with bland enthusiasm and verbal wishes for less school and more Christmas toys.

I explain that parenting—like life—doesn’t come with a manual and is often fraught with fears and uncertainty.

The issue of fear comes up a lot in our household. My kids ask how they can stop being afraid. Attempting to teach fearlessness is one of the more challenging aspects of being a parent. I don’t want them to fear my death, but I do want them to be afraid of sex without condoms. I don’t want them to be afraid of standing up and being themselves, but I do want them to fear ignorance and hate. I don’t want them to be afraid of saying “HIV” out loud or talking about AIDS, no matter where we are. Yet I do want them to be afraid of a backward-operating society in which some have reverted to caveman-style communication and problem solving.

Some fears are worthwhile; others are not. But fears that keep you prisoner or powerless are not conducive to dealing with HIV in a healthy way, regardless of whether you’re a parent living with it or a child living with a parent who has it. I am—and always will be—a human being first, a mother second, and a person with a disease third.

The neighborhood girl’s mother may not have given me the chance to explain AIDS or provide any factual information to her. And although I don’t like it, I have to accept it.

In the end, my best piece of wisdom chalks up to, “Today we will shine brightly and beautifully. Who knows what tomorrow brings, but it’s not here yet, so I can’t practice being fearless until then.”

Shana Cozad has been living with an AIDS diagnosis for 19 crazy years. A full-blooded Native American, she shares her jam-packed life with one almost-husband, three children, and a pack of dogs.

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STATUS SYMBOLS ASK + TELL

die, is what I thought. That was 1991.

Did you begin treatment at that point?

No. I was in a state of denial for a long time.

By late ’98, I had developed full-blown AIDS. I had lost a lot of weight, and one of my band members, Tommy Shaw, said to me, “I’m afraid I’ll never see you alive again.” That was a gigantic wake-up call. I knew [then] I had to see a physician. I had every opportunistic illness that full-blown AIDS can give you.

I was putting everything before my health until the realization came to me that without health, there will be no future. There was a clinic in Chicago giving out protease inhibitors. That was a salvation. I was a guinea pig for about a year and a half.

Since going public with your status, you’ve been active in AIDS charities.

Yes, I did some benefits for the Human Rights Campaign, and I was asked to be part of the Elizabeth Glaser Pediatric AIDS Foundation.

My partner and I did a painting, which was sold for a thousand dollars. Locally here in Florida, we do a thing called the Smart Ride [TheSmartRide.org], which is a bicycle ride from Miami down to Key West. I was very involved in that last year. I also performed at one of our local clubs and auctioned off guitars. I’m more than happy to give my time in service. I feel an obligation to do that. I got a second chance in life.

over the course of styx’s 39-year career, the iconic ’70s rock band has sold more than 30 million albums worldwide and spawned numerous top 10 hits, including 1979’s “Babe” and 1990’s “Show Me the Way.” The group’s cofounder and original bassist, Chuck Panozzo, a 20-year HIV survivor, has worked to raise awareness of the research needed to develop a vaccine for the virus. He’s also active with the Human Rights Campaign and has helped generate funds for the Elizabeth Glaser Pediatric AIDS Foundation.—Winston Gieseke How did you become involved in the fight against HIV and AIDS? In my 30s, I was a professional pallbearer. I went to one of our health clinics [in Chicago] and gave them a check for $5,000 for what I called “this STD that had no cure” because [in the early 1980s] there wasn’t a name for it yet. A progressive part of me said, Yes, I have a feeling I’m positive. And maybe one day I’ll need the same help that research might provide. And

ironically, I had to take advantage of that.

What led to you being tested for the virus? I had a cold and I went to a local community clinic. The doctor asked if I wanted to get tested for HIV, and I said sure.

The test came back positive. I said, “Is there anything you can give me?” She said, “I don’t know.” I asked if she had any prognosis. She said, “I don’t know.” Go home and get ready to

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You’ve credited your attitude for being a big part of what’s kept you healthy. I think that’s a big part of it, to have a positive attitude. You have to decide if you’re going to sit in the corner and feel sorry for yourself or if you’re going to just get through what you have to get through. Feeling sorry for yourself is not going to get you better. And all of a sudden, what I thought was going to kill me ended up empowering me. And now I’m HIV healthy. I’m not detectable; I’m able to work almost as much as I want to. It’s not easy doing 170 shows, but I’m on tour again this year. I can’t say I’m glad I have HIV, but since I do, I’ve got to make the best of it. ✜

wireimage

The Best of Times

What sort of advice do you give people with HIV? When somebody who’s 18 or 25 walks up to me and says, “I’m infected and I’m frightened to death,” my first reaction is [to say], “Give me a hug.” Then I say, “Now is the time not to be frightened. Be smart and learn everything you can about it.

Don’t isolate yourself. But don’t be frightened.

If I can do it, you can do it, too.”

250

475 500

750

500 T-CELLS

OR LESS. IT’S TIME

TO TAKE ACTION.

Talk with your doctor and consider all the factors about starting treatment.

HIV treatment is now recommended for everyone with a T-cell count of 500 or less and should be considered when T-cells are higher than 500, according to the DHHS* and the IAS-USA†. Starting treatment early may help protect your immune system and vital organs. Today’s medicines may have fewer, more manageable side effects. They may help you live a longer, healthier life. Receive helpful information about living with HIV that you should know. Call toll free 1-888-451-5723, or visit TREATHIVNOW.COM. *DHHS = Department of Health and Human Services †IAS-USA = International AIDS Society USA. ©2011 Gilead Sciences, Inc. All rights reserved. UN9722 07/11