HIV and Disability Law

The death rates of children living with HIV have decreased ninefold since combination antiretroviral (ARV) therapy became widely available in the mid-1990s, according to results from a large pediatric HIV study published in the December 15 issue of the Journal of Acquired Immune Deficiency Syndromes. But there’s still tremendous room for improvement: Young people with HIV continue to die at 30 times the rate of youth of similar age who do not have HIV.

“A wonderful change has occurred: Most HIV-infected children now reach adulthood,” said Lynne Mofenson, MD, an author of the paper and chief of the Pediatric, Adolescent and Maternal AIDS branch at the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). “Will these children have a normal lifespan? Unfortunately, we don’t have all the answers yet. Currently, we don’t have the means to prevent all the complications of HIV infection.”

Numerous studies have demonstrated that adults with HIV are living longer because of improvements in ARV therapy in the past 15 years. However, limited information has existed about the effectiveness of combination ARV treatment with respect to the survival of children with HIV. The current analysis delineates the effects of ARVs on the rates and causes of death for children and adolescents living with. n See Abstract here:

People with HIV responding well the antiretroviral (ARV) therapy commonly experience at least minor signs of thinking and memory problems, according to a study published online December 7 in AIDS. Most problems were so minor, however, that people didn’t realize they had any dysfunction. The study does not predict whether or how rapidly these problems might worsen.

Researchers studying neurocognitive disorders in people living with HIV—which can encompass problems with thinking, reasoning, memory, emotions and movement—once focused almost predominantly on the most extreme and debilitating version, AIDS dementia complex (ADC). As survival and the risk of AIDS-related diseases have dramatically improved in recent years, researchers are now focusing on HIV-associated neurocognitive disorder (HAND): a cluster of minor but increasingly common central nervous system problems in HIV-positive people.

In the past two years in particular, published studies have shown that HAND might be most common in people who are not on ARV therapy and who have uncontrolled HIV replication. To determine the prevalence of HAND among people responding well to ARV therapy, Samanta Simioni, MD, from the Centre Hospitalier Universitaire Vaudois, in Lausanne, Switzerland, and her colleagues assessed the cognitive function of 100 HIV-positive people who had successfully suppressed their viral loads for, on average, at least three years. Most of the participants were male, and the average age was 46.

HAND was very common. In all, 74 percent were diagnosed with some degree of the disease. The majority of people diagnosed with HAND, however, did not have symptoms severe enough to be noticeable to the participants—though they did have signs of the disorder based on sophisticated assessments.

POZ magazine reports that the XIX International AIDS Conference (AIDS 2012) will be held July 2012 in Washington, DC. As the custodian of the conference, the International AIDS Society (IAS) made the decision because the United States is repealing its HIV travel ban, effective January 4, 2010. The last time the conference was held in the United States was 1990 in San Francisco.

“The return of the conference to the United States is the result of years of dedicated advocacy to end a misguided policy based on fear, rather than science, and represents a significant victory for public health and human rights,” said Elly Katabira, MD, president-elect of IAS and professor of medicine at Makerere University in Uganda, who also will serve as the international chair of AIDS 2012
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The Centers for Disease Control and Prevention approved the

regulation to lift the HIV travel and immigration ban. Now the

regulation just needs to be approved by the White House Office of

Management and Budget (OMB). If and when OMB approves the change, this

will be the final regulatory step in a more-than decade long nightmare. Original story here:

Sean Strub, long-term AIDS survivor, was the subject of a feature in Sunday’s New York Times. Founder of POZ magazine, he mused over the last few decades, friends lost, priorities shifed. Now he’s returned to activism.

“So many contemporaries had died that, at 51, he now has friends who are mostly older or younger. Even sophisticated young men he would meet, like Matthew Vitemb, 21, a recent graduate of Bard College (who prefers “queer” to “gay,” which he considers an outdated boomer term), had never known an H.I.V.-positive person until he met Mr. Strub.

“While AIDS deaths in the United States are the lowest in 20 years — 14,497 in 2007, according to federal figures — and the most affected race has changed from white in 1995 to black today, the biggest single group dying is still gay men. “People don’t understand how easily it can happen again,” Mr. Strub said.

“Somebody has to be the memory, he said.”
See full feature here:

From aidsmeds.com

People with depression were almost twice as likely to have HIV treatment adherence problems as people who were not depressed, according to an article in the Journal of Acquired Immune Deficiency Syndromes.

Depression has been found in several studies to negatively affect the ability of people living with HIV to take their medications on time and as directed. Not all studies have been able to quantify the effect of depression on adherence, however.

As part of a study on nutrition and HIV, Deborah Kacanek, ScD, from Tufts University School of Medicine in Boston, asked 225 HIV-positive volunteers about their adherence to antiretroviral (ARV) medication and evaluated them for depression.

None of the participants were found to have depression upon entering the study. Over time, however, 22 percent
developed depression.

In terms of adherence, 45 percent of those who became depressed ended up having poor adherence compared with 25 percent of those who did not become depressed. As has been seen in previous studies, African Americans were also more likely than non-black participants to have adherence challenges.

The authors call on providers to regularly screen for depression, especially in people who are having trouble adhering to their HIV treatment regimen. Moreover, the authors write, “It is critical to strengthen referral systems to ensure appropriate treatment… for patients with HIV and depression, not only because it may improve adherence and HAART outcomes, but also because of its potential impact on quality of life overall.”

Today’s San Francisco Chronicle reports that for the first time, an experimental vaccine has prevented infection with the AIDS virus, a watershed event in the deadly epidemic and a surprising result. Recent failures led many scientists to think such a vaccine might never be possible.

the World Health Organization and the U.N. agency UNAIDS said the results “instilled new hope” in the field of HIV vaccine research, although researchers say it likely is many years before a vaccine might be available.

The vaccine — a combination of two previously unsuccessful vaccines — cut the risk of becoming infected with HIV by more than 31 percent in the world’s largest AIDS vaccine trial of more than 16,000 volunteers in Thailand, researchers announced Thursday in Bangkok.

Even though the benefit is modest, “it’s the first evidence that we could have a safe and effective preventive vaccine,” Col. Jerome Kim told The Associated Press. He helped lead the study for the U.S. Army, which sponsored it with the National Institute of Allergy and Infectious Diseases.
Read more: http://www.sfgate.com/cgi-bin/article.cgi?f=/n/a/2009/09/23/international/i224743D59.DTL&tsp=1#ixzz0S2oIjuSW
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A new report authored by the Kaiser Family Foundation and the National Alliance of State and Territorial AIDS Directors (NASTAD) shows that the nation’s overall funding for HIV prevention programs has been relatively flat in recent years while an estimated 56,000 people continue to become infected each year in the U.S.

Based on a survey of 65 health departments receiving direct federal HIV prevention funding, including every state and territory, plus six cities, the report provides the first comprehensive inventory of how HIV prevention is delivered across the country. Funding for HIV prevention efforts administered by state and local health departments reached $581 million in fiscal year 2007. More than half ($337 million) of HIV prevention funding comes from the U.S. Centers for Disease Control and Prevention (CDC); 38 state and local governments also contribute ($205 million). Since fiscal year 2004, overall funding has been flat, with the exception of a $35 million increase from the CDC in 2007 to expand HIV testing.

Even among states with some of the largest HIV/AIDS populations, total investment in HIV prevention from federal, state and local funds was relatively small, with only six states with total prevention budgets greater than $20 million in fiscal year 2007. Facing budget shortfalls, states may be forced to cut prevention spending in the year ahead, as has California, which slashed state funding for HIV prevention by more than 80 percent this week.

Health departments generally provide a core set of HIV prevention services, including health education and risk-reduction activities, HIV testing and partner services. Other activities include laboratory testing, community planning and public education and media campaigns. Some jurisdictions also provide post-exposure prophylaxis, syringe access and drug-substitution services.

U.S. Housing and Urban Development Secretary Andrew Cuomo today awarded $23.6 million to programs in 17 states to provide housing and related support services to more than 2,700 low-income people with HIV/AIDS and their families.
The grants are part of HUD’s Housing Opportunities for Persons With AIDS (HOPWA) program, which is distributing about $232 million total in fiscal year 2000.

Ninety percent of the funds are distributed to cities and states by a formula based on the number of AIDS cases reported. HUD uses statistics from the Centers for Disease Control and Prevention in allocating these funds.

The remaining 10 percent of HOPWA grants — the funds announced today — are awarded as competitive grants to test new ways of providing housing, health care and other support services to people with HIV/AIDS. Some 22 such grants were announced today for non-profit groups and state and local government agencies in Alaska, California, Colorado, Georgia, Hawaii, Illinois, Kentucky, Maine, Maryland, Massachusetts, Mississippi, New Jersey, New York, Pennsylvania, Texas, Vermont and Wyoming.

“Finding a safe and affordable home is the single greatest barrier to proper health care for people with HIV or AIDS,” Cuomo said. “At a time when our nation’s economy is soaring, we cannot turn our backs on our neighbors who live with these ailments. These grants are the federal government’s way of partnering with organizations whose selfless work provides hope on a daily basis to the people who need it most.”

In addition to providing housing assistance, the HOPWA program also helps many communities establish strategic AIDS housing plans, better coordinate local and private efforts, fill gaps in local systems of care, and create new housing resources. Full story here:

From aidsmeds.com today:

“Due to a number of recent studies showing detrimental effects of uncontrolled HIV replication—even at fairly high CD4 cell counts—international HIV treatment guidelines may begin recommending that people start ARV therapy when their CD4 counts drop below 500. The current recommendation is to start treatment at 350.”

If HIV treatment guidelines were updated to recommend beginning treatment at 500 CD4 cells, then more than half of all people with HIV would need to initiate antiretroviral (ARV) treatment within two years of becoming infected. This startling finding was presented Monday, July 20, at the Fifth International AIDS Society (IAS) Conference on HIV Pathogenesis, Treatment and Prevention in Cape Town.