HIV Is Reported Cured in a Second Patient

One of the things one encounters as a gay male is the effort of the far right and Christian extremists to depict all gays as diseased and a health care threat.  While HIV/AIDS is no longer the virtual death sentence it was three decades ago, treatment remains expensive.  Likewise, thanks to the greed of American pharmaceutical companies, preventive medications such as PrEP outrageously expensive in the USA - in contrast to Europe and Canada - and out of the financial reach of the majority of those in need of it.  The result is that a permanent cure remains the hope of many, including in the black community where heterosexuals are increasingly at risk of the disease in part due to the lack of access to preventive health care and the continued homophobia of black churches (much of the support for the anti-gay vote in the United Methodist Church came from African delegations).  Now, the New York Times is reporting on a second time where HIV seemingly has been cured. While the treatment regime is not of a nature making it easily replicated on a wide scale basis, it may give rise to future treatments.   Here are article highlights: 

For just the second time since the global epidemic began, a patient appears to have been cured of infection with H.I.V., the virus that causes AIDS.

The news comes nearly 12 years to the day after the first patient known to be cured, a feat that researchers have long tried, and failed, to duplicate. The surprise success now confirms that a cure for H.I.V. infection is possible, if difficult, researchers said.

Publicly, the scientists are describing the case as a long-term remission. In interviews, most experts are calling it a cure, with the caveat that it is hard to know how to define the word when there are only two known instances.

Both milestones resulted from bone-marrow transplants given to infected patients. But the transplants were intended to treat cancer in the patients, not H.I.V.

Bone-marrow transplantation is unlikely to be a realistic treatment option in the near future. Powerful drugs are now available to control H.I.V. infection, while the transplants are risky, with harsh side effects that can last for years.

But rearming the body with immune cells similarly modified to resist H.I.V. might well succeed as a practical treatment, experts said.

“This will inspire people that cure is not a dream,” said Dr. Annemarie Wensing, a virologist at the University Medical Center Utrecht in the Netherlands. “It’s reachable.”

The new patient has chosen to remain anonymous, and the scientists referred to him only as the “London patient.”  “I feel a sense of responsibility to help the doctors understand how it happened so they can develop the science,” he told The New York Times in an email. Learning that he could be cured of both cancer and H.I.V. infection was “surreal” and “overwhelming,” he added. “I never thought that there would be a cure during my lifetime.”

The London patient has answered that question: A near-death experience is not required for the procedure to work. He had Hodgkin’s lymphoma and received a bone-marrow transplant from a donor with the CCR5 mutation in May 2016. He, too, received immunosuppressive drugs, but the treatment was much less intense, in line with current standards for transplant patients.

He quit taking anti-H.I.V. drugs in September 2017, making him the first patient since Mr. Brown known to remain virus-free for more than a year after stopping.

Although the London patient was not as ill as Mr. Brown had been after the transplant, the procedure worked about as well: The transplant destroyed the cancer without harmful side effects. The transplanted immune cells, now resistant to H.I.V., seem to have fully replaced his vulnerable cells.

Most people with the H.I.V.-resistant mutation, called delta 32, are of Northern European descent. IciStem maintains a database of about 22,000 such donors.

Several companies are pursuing gene therapies but have not yet been successful. The modification must target the right number of cells, in the right place — only the bone marrow, for example, and not the brain — and tweak only the genes directing production of CCR5. Several teams are working on all of these obstacles, Dr. McCune said. Eventually, they may be able to develop a viral delivery system that, when injected into the body, seeks out all CCR5 receptors and deletes them, or even a donor stem cell that is resistant to H.I.V. but could be given to any patient. Mr. Brown says he is hopeful that the London patient’s cure proves as durable as his own. “If something has happened once in medical science, it can happen again,” Mr. Brown said. “I’ve been waiting for company for a long time.”

If one looks to Africa, HIV/AIDS is not a gay disease.  It impacts millions of heterosexuals contrary to the propaganda of the far right and Christofascist.  Let's hope for a successful cure available for widespread use in the near term. 

A Pill to Prevent HIV Goes Largely Unused

A piece in the New York Times looks at the failure of an effective HIV preventative pill to gain wide traction in the LGBT community.  The article recites a number of possible reasons but I suspect that perhaps the largest is the cost - roughly $1,000 per month.  Even with decent insurance, the out of pocket cost is beyond the reach of many.  The phenomenon is part and parcel with America's ass backwards approach to health care: skimp on preventative care and then have to face huge costs once severe conditions have developed.   It's a kin to never maintaining one's house and then being shocked when suddenly huge repair costs become unavoidable.  There is also the possible fear by many with job derived health care coverage that use of the preventative may cause one to be stigmatized.  Lastly, some HIV/AIDS organizations have opposed use of the drug fearing that it may encourage risky practices - a mindset akin to the Christofascists' opposition to reality based sex education in favor of abstinence only programs.  Just like unwanted pregnancies, risky behavior will continue, so why not prepare for it?  Here are article highlights:

[A] daily pill that studies show is highly effective in protecting people from infection. 

The very existence of that option represents a startling turn in the too-long history of the AIDS epidemic. Many health experts hoped that the medication — Truvada, a combination of two antiviral drugs that has been used to treat H.I.V. since 2004 — would be exuberantly embraced by H.I.V.-negative gay men. Instead, Truvada has been slow to catch on as an H.I.V. preventive in the 18 months since the strategy’s approval by the Food and Drug Administration. In some quarters, the idea that healthy gay men should take a medication to prevent infection — an approach called pre-exposure prophylaxis, or PrEP — has met with hostility or indifference. 

“It’s gotten tons of attention at H.I.V. meetings as a new tool for prevention, and I consider it an important option for the right person,” said Dr. Lisa Capaldini, a primary care doctor here who treats many gay men. “And yet there’s been very little interest among my patients. There’s a fascinating disconnect.”

Many experts hailed Truvada as an opportunity to reduce new infections among high-risk groups like young gay men, people in relationships with H.I.V.-positive partners, and prostitutes. The F.D.A. called for prescriptions to be accompanied by counseling, frequent H.I.V. testing, and continued promotion of safer sex, although research suggests that daily use of the pill alone confers close to full protection. 

For many gay men, and for some public health officials, the new option has brought both hope and confusion. 

“We’ve had several decades of the recommendation to use condoms,” said Dr. Kenneth H. Mayer, a professor of medicine at Harvard University and the medical research director at Fenway Health, a community center in Boston with many lesbian and gay patients. “Now we’re saying, ‘Here’s a pill that might protect you if you don’t use condoms.’ So it’s flying in the face of community norms.”

Certainly, fewer people have tried PrEP than many experts had anticipated. . . . So why haven’t more gay men signed up? 

Some men have reported receiving negative reactions from their health care providers when they brought it up. Use of the drug as a preventive can be stigmatizing among gay men as well: the term “Truvada whore” has been bandied about on some social networks. 

And many simply may not know much about the strategy. 

Potential side effects like kidney damage and a loss of bone density, although rare, are also a concern. And Truvada is expensive: more than $1,000 a month. So far, private and public insurers, including state Medicaid programs, have generally covered the drug for prevention. 

But a generational shift in attitudes toward H.I.V. among gay men may also be playing a role, some experts say. With advances in treatment, many younger men who did not experience the worst years of the epidemic are less fearful of the consequences of infection. Moreover, current medications can lower viral levels in H.I.V.-positive people to the point where the risk of transmission is negligible, further reducing the perceived need for PrEP among H.I.V.-negative partners.

Adherence to the drug regimen is another thorny issue. The major trial that confirmed Truvada as an effective H.I.V. preventive among men who have sex with men, also found that many participants did not take the pill every day, leaving them more vulnerable to infection. 

Michael Weinstein, president of the AIDS Healthcare Foundation, warned that drug adherence will continue to be a problem, likely leading to more infections and the emergence of drug-resistant H.I.V. strains. “If you don’t take the medication every day and you don’t use condoms, and you’re highly sexually active, you’re going to get infected,” Mr. Weinstein said.

In any event, the protocol for pre-exposure prophylaxis is itself likely to undergo significant changes as findings emerge from current and upcoming research into other formulations of Truvada such as gels or injectables, less frequent dosing regimens, and the use of other medications altogether. 

“People are not lining up, but I’m not pessimistic,” said Dr. Mayer of Fenway Health. “It’s going to take time. It’s really early days.”

Brandon's Beacon of Hope HIV AIDS Foundation - OBX Pridefest's Featured Non-Profit

This past weekend down at OBX Pridefest offered the boyfriend and me a great time as we had the opportunity to meet new people and also socialize with numerous friends from Hampton Roads who likewise made the trip down.  We drove back this morning and had a wonderful time last night at the cabaret production put on by the cast of The Lost Colony , one of the sponsors of OBX Pridefest, as well as Dame Edna's show. As a group the cast from The Lost Colony included very talented young people and, yes, some of the cast are gorgeous - one young man bore a striking resemblance to Baptiste Giabiconi.  And our stay at the First Colony Inn was most pleasurable and I would recommend the 1932 era Inn without reservation to anyone considering a trip to the Nags Head, North Carolina area. 

But OBX Pridefest did have it's tear jerking moments.  Particularly when Diane Midgett (pictured below), the chairwoman of Brandon's Beacon of Hope HIV AIDS Foundation spoke early on in the Saturday festival portion of the event.  The organization is named for her late son, Brandon Keith Finley, who was born prematurely on February 17, 1983, and who underwent a great number of blood transfusions as medical personnel tried to save his life after his premature birth.  Sadly, through one or more of those transfusions, Brandon contracted HIV/AIDS.   After a heroic battle with little or no help from the federal government in terms of AIDS research and support, Brandon lost his battle and died on  April 15, 1984.  Diane is candidly bitter when she recounts the lack of support from the federal government in the early years of the AIDS crisis with Ronald Reagan avoiding even saying the word for far, far too long.  But, from her family's tragedy, she has vowed to make a difference and to see that Brandon's short life was not in vain.  She is truly a woman on a mission.  During her presentation, Diane stressed that not only is HIV/AIDS present in North Carolina but also the alarming infection rate among those 13 to 24.  That more isn't being done borders in my view on the criminal.  

In her quest to make a difference and to help the lives of others, Diane Midgett founded Brandon's Beacon of Hope HIV AIDS Foundation ("BBH") which was selected by the OBX Pridefest board as the recipient of the net profits from OBX Pridefest 2012.  OBX Pridefest described the non-profit's mission as follows:

[Brandon's Beacon of Hope] is working with the regional medical professions to offer absolute private services and assistance to victims of HIV-AIDS in the Northeast region of North Carolina.  Up until now, those needing assistance had to travel to metropolitan areas to receive care, and thus, the number of victims in Dare County and the surrounding regions has gone unreported.  We are trying to change that and we hope you can help.  Even though people are living much longer lives with HIV, the average cost to these people is $367,000 for the rest of their lives.  Your donation or sponsorship of OBX Pridefest, our biggest fundraiser of the year, will help us help BBH.  Any profits made from OBX Pridefest (after we have paid our bills) will be donated to BBH.

As long time readers know, in 1999 I nearly lost one of my children to bacterial meningitis.  As harrowing and devastating as that experience was, it pales compared to Diane's nightmare.  Moreover, my child recovered and, indeed, was written up as a miracle case by Children's Hospital of the Kings Daughters in Norfolk, Virginia.   Consequently, I truly cannot imagine what Diane and her family went through.  She is a real trooper and so is her youngest son  (also pictured below) - her gay son - who was born after Brandon's death.  As she recounts it, God had a plan for her and gave her a gay son to replace the child she lost.

Please check out BBH and consider making a donation.  Their plan is to be fully operational by fall and to have an operational website and referral service.

Having the Courage to Speak Out and Act Even When It's Unpopular

I have written a number of times about the phenomenon of basically good people failing to act when morality and decency argue for action and speaking out against injustice and prejudice. Too often it is easier - and safer - to do and say nothing. The fact that inaction may even be popular doesn't make it right. The bigotry that needs to be confronted may be racial bigotry such as what Atticus Finch confronted in To Kill A Mockingbird, anti-Semitic bigotry, anti-gay religious based bigotry and hate so widely disseminated by self-congratulatory "godly Christians, or the fear and prejudice of a strange and frightening disease. The truly brave and morally strong will act regardless of the potential negative personal consequences that may be entailed. A post at America Blog Gay looks at one such amazing individual: Elizabeth Taylor. Here are some post highlights:
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In 1986 and again in 1988, hundreds of thousands of Californians signed petitions to place initiatives on the ballot that would have mandated the quarantine of AIDS patients. Such was the homophobic hysteria surrounding AIDS when Elizabeth Taylor began planning her first AIDS fundraiser. Taylor remembered the reactions:
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People … slammed doors in my face and hung up on me . . . [P]eople would say, 'No, I'm not getting mixed up in that!' And, 'You have to get out of this, Elizabeth. It's going to ruin your career.' These reactions only seemed to strengthen Taylor’s resolve. Indeed, the vitriolic homophobia surrounding AIDS motivated her to become involved in the first place. She was quoted as saying:
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"Worse than the virus there was the terrible discrimination and prejudice it left in its wake. Suddenly it made gay people stop being human beings and start becoming the enemy. I knew somebody had to do something. For God's sake, our president didn't even utter the word for years into the epidemic."
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And
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"If it weren't for homosexuals there would be no culture. We can trace that back thousands of years. So many of the great musicians, the great painters were homosexual. Without their input it would be an entirely different, flat world. To see their heritage, what they had given the world, be desecrated with people saying, 'Oh, AIDS is probably what they deserve' or 'it's probably God's way of weeding the dreadful people out,' made me so irate."
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Taylor made AIDS her life’s cause. At a time when the disease was called "the gay plague" and others were afraid to even touch people with HIV, Taylor employed her star power to help humanize those living with the disease. She made headlines throughout the world when she was photographed shaking hands with HIV/AIDS patients in a Thai hospital. She helped found the American Foundation for AIDS Research (amFAR) in 1985, and later, in 1991, the Elizabeth Taylor AIDS Foundation (ETAF).
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An impassioned lobbyist, Taylor was not afraid of taking a swipe at leaders for their inaction. At an international AIDS conference, she criticized the first president Bush, remarking, “I don't think [he] is doing anything at all about AIDS. In fact I'm not even sure if he knows how to spell AIDS.” She testified before Congress in 1986 in support of the Ryan White Act, and then again in 1990, when it finally passed. She also spoke at the United Nations, imploring its members to join in the fight against the disease.
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The Christianists may mock Taylor for her many marriages, but in my view it is she, not the self-anointed pious ones, who understood the real Gospel message and acted when others would not. She was one brave woman.

New Studies Expose Government Lies About Medical Pot

While I am not endorsing the use of illegal drugs, why am I not surprised that the US Government has been lying about the use of medical marijuana? For years it has seemed to me that a disproportionate amount of effort and funding has been wasted on prosecuting and jailing people for minor drug offenses involving marijuana. I mean, if Scotter Libby doesn't have to do time, why do young adults caught with minuscule amounts of marijuana? Here's highlights of a story on new medical research results:

When Connecticut's Republican Gov. M. Jodi Rell vetoed legislation last month that would have allowed citizens with debilitating medical conditions to use medical cannabis under their doctor's supervision, she alleged that there was no proof of pot's therapeutic effectiveness and that legal alternatives are available by prescription. Now, a just-released clinical trial by researchers at Columbia University in New York is making the governor's statements ring hollow.

On June 21, just 24 hours after Gov. Rell's veto, the online database for the National Library of Medicine posted an a forthcoming study from the Journal of Acquired Immune Deficiency Syndromes that reports, "Smoked marijuana … has a clear medical benefit in HIV-positive [patients] by increasing food intake and improving mood and objective and subjective sleep measures."

Clinicians further reported that smoking higher-strength marijuana -- that's the 3.9 percent pot for this study's purposes -- subjectively improved patients' sleep better than oral THC. Perhaps more important, authors reported that HIV patients made far fewer requests for over-the-counter 'rescue' medications while using cannabis. Scientists reported that most of these requests were to treat subjects' gastrointestinal complaints (nausea, diarrhea and upset stomach) -- conditions that have long been reported by patients to be alleviated with medical pot.

The full story appears here: http://www.alternet.org/drugreporter/56753