By: Maria Lawrynowicz

An end to HIV just screams prestige… awards… maybe even a Nobel prize… (not to mention, a cure for 27.3 million people currently known to be infected with HIV), so why aren’t more world leaders and researchers scrambling for this to become a reality? As so aptly stated by the author of R.I.P. HIV, Regan Hofmann, the real issue is not, “CAN we end AIDS?, but WILL we end AIDS?” With current research on neutralizing antibodies and CCR5 receptor inhibitors, scientists are getting closer to figuring out how to stop this disease, but how to move forward? According to Michel Sidibe, keynote speaker at the UNAIDS conference in Rome, “history will judge us not by our scientific breakthroughs, but how we apply them” and this is the point where we are today. It seems that the current issue boils down to two main points: lack of funding to start the end of HIV and lack of advocacy to get this funding. With so many philanthropic organization to donate to, HIV+ individuals need to let people know WHY to PICK their cause and HOW their money will make a difference.

R.I.P. HIV : Regan Hofmann

POZ magazine, Oct. 2011

http://www.poz.com/articles/RIP_HIV_AIDS_2666_21291.shtml

Hofmann divides the steps needed to defeat HIV into 7 points (as we all know, 7 is a lucky number):

1. POLITICAL WILL

·      In the US, Obama has stepped forward in HIV advocacy during his campaign by providing a framework for action known as the National HIV/AIDS strategy. This may seem like a win for HIV, however, with enormous budget cuts coming in the future, it is questionable whether this project will get funded and move forward.

·      In order to actually get anything done, North America (and the world) needs to focus on bi-partisan support for a cure to HIV/AIDS. Otherwise, each election will just result in the unraveling of the last president’s or prime minister’s plans.

2. MONEY

·      The current challenge facing funding is simple: the global recession. Despite projections that an investment today will save money in the future due to a decrease in money put into treatment of HIV or HIV related infections, most nations do not have liquid capital to invest.

·      Organizations that speak for those HIV+, must engage the private sector to find new investors. These organizations cannot keep relying on the Gates, Elton John, Ford, and MAC AIDS funds, which have raised millions of dollars in the past. HIV needs new supporters!

·      Finally, expanding access to anti-retrovirals around the world and thus, increasing the market for these goods, would give pharmaceutical companies a reason to drop prices. Why hasn’t this moved forward? Because big pharm has no assurance of getting the money back in the future.

3. ADVOCACY

·      Those fighting for HIV to get noticed need government support, but there are many ways to get this. HIV+ voters have the right to get angry when promises are not kept and remind politicians that they have the power to sway an election.

4. MEDIA

·      The support of one celebrity could make a enormous difference in the fight for funding. Just one tweet or post could reignite interest in social issues surrounding HIV.

·      Social media companies like youtube, google, facebook, twitter, tumblr, porn sites (for those open minded) have access to millions of viewers. Why not putting a message out for HIV?

5. THE CHURCH

·      Religious or faith based organizations have the potential to influence many people quickly due to their global outreach.

·      If the church allowed and encouraged believers to use condoms, increased their tolerance of GLBT, and spoke out against HIV stigma, those affiliated may be more likely to support this cause.

·      Finally, believers may be more likely to disclose their HIV+ status to a religious or spiritual leader, thus these people could be critical in determining the course of their treatment and helping them feel included in the community.

6. HUMAN RIGHTS

·      Empowering those HIV+ will increase adherence to medication and encourage people to get tested. These individuals need to know that they are protected by laws and by society so they know that getting a positive HIV test is not the end.

·      HIV discussion must not focus on “higher risk groups” as this kind of jargon encourages stigma and discrimination of many minority social groups.

·      All doctors and nurses MUST know about testing and treatment to successfully diagnose those HIV+ and get them on treatment ASAP. On the other hand, those who are not told of their status at a doctors office need to be aware of treatment, thus the media must make treatment options obvious and easy to find.

7. THE CURE

·      The cliché, “fight for a cure” rings true. The road to a cure is a fight… a fight to get noticed, a fight to get picked, a fight to get support, a fight to find funding. Ready, set…. Fight!

-Maria Lawrynowicz

Anti-retrovirals have had a huge impact on the quality of life of those living with HIV; however, individuals still react differently to treatment leading to a range of outcomes. Why? Some researchers believe that stress may play a large part in this difference. This study looked at meditation techniques and their effect on CD4+ t-cells in HIV+ adults. Because CD4+ cell decline is a marker for progression to AIDS, this is an excellent proxy for overall health in HIV patients.

Mindfulness meditation training effects on CD4+ T lymphocytes in HIV1 infected adults: a small randomized controlled trial

-J. David Creswell, Hector F. Myers, Steven W. Cole, Michael R. Irwin in 2009

http://www.sciencedirect.com/science/article/pii/S0889159108003085

The participants were HIV+ individuals who were diagnosed over 6 months ago and demonstrated minimal psychological stress symptoms. The sample excluded those who currently had AIDS, hepatitis or psychiatric treatment in the last 30 days, as well as, those who already did some kind of mind-body exercise. The chosen participants were put into two groups: the first had one 6 hour day of training in meditation, while the other was enrolled in an 8-week meditation program that included weekly training sessions, daily meditations guided by an audio recording and finally a meditation retreat. Because of the difficulty in standardizing meditation for research purposes, practitioners have developed a standardized ‘mindfulness-based stress reduction program’ (MBSR) to ensure that different studies can be compared.

When circulating CD4+ levels were compared before and after the meditation regimen, researchers noted a significant difference between the two groups. Those in the one day meditation program had a larger drop in CD4+ levels regardless of whether or not participants were on anti-retrovirals. Those participants in the 8 week program buffered their decrease in CD4+ cells in direct proportion to their adherence to the program. This means that the more often the patients went to meditation training, the better their CD4+ levels!

What could account for this difference? This could be due to the effect of meditation on t-cell redistribution in the body or turnover rate (i.e. when new cells are produced and old cells die). And even though this study saw no significant changes in HIV RNA levels, other studies show that stress increases viral replication, so this cannot be excluded as a possibility. One problem with this study is that the researchers did not compare the ‘mindfulness based stress reduction’ program to other stress reduction techniques so it may be possible to get these benefits by other measures, we just don’t know yet.

So why not try it? Meditation has many health benefits, requires limited training at low cost, and has been shown to make you happier! Increasing CD4+ levels while reaching enlightenment… not a bad deal.

-Maria Lawrynowicz

Remember the CATIE article on HIV and aging? It said that more effective anti-retroviral therapy since the 1990s has increased the incidence of dementia in HIV patients and advised HIV+ individuals to seek medical advice when they have memory or focus issues. My question is who DOESN’T have memory and focus issues? How do you draw the line between what is normal and not? This article seems to offer some insight into what we do and do not know (mostly the later), as well as, what we should try to find out…

HIV Infection and Aging Independently Affect Brain Function as Measured by Functional Magnetic Resonance Imaging

Beau M. Ances,
Florin Vaida,
Melinda J. Yeh,
Christine L. Liang,
Richard B. Buxton,
Scott Letendre,
J. Allen McCutchan,
Ronald J. Ellis

available at: http://jid.oxfordjournals.org/content/201/3/336.full

Study presented at Conference on Retroviruses and Opportunistic Infections, Montreal; 8-11 February 2009

Compliant HIV+ patients could be considered a doctor’s dream… they are capable of following complex medication schedules, visit their doctors on a regular basis and lead a relatively healthy lifestyle, while staying mindful of their diet, exercise and so on. Such individuals are no strangers to minor body ailments that may come with a seropositive status and are accustomed to treating these as they come, however, it is much more difficult to perceive the highly camouflaged symptoms of cognitive changes from neuronal degradation with aging and/or HIV. Even the most vigilant people can fail to notice vague things, like forgetfulness or decreased concentration, often passing these off as “one of those days”.

Top 3 points from this article:

1. A group of HIV+/- subjects were examined with a fMRI (functional magnetic resonance imaging is known as “functional” because it measures changes in blood flow while your brain is working) to measure their cerebral blood flow and dissolved O2. The study found that cerebral blood flow of HIV+ subjects was similar to HIV- subjects who were 21 years older, while blood oxygen dependent signals were like those of HIV- individuals 15 years older.

2. What is causing this extra strain on the brain? Scientists believe that the increased metabolic stress due to normal aging compounded with metabolic stress from persistent inflammation that comes with any infection (even in HIV when you have an undetectable viral load), or immune dysfunctions, like reduced t-cell growth/ maturation or increased cytokine release (chemicals released by your immune cells to fight off infections),

3. What is the good news? There is no synergistic effect of aging and HIV infections i.e. they both function independently! What does this mean? Independent risk factors are discrete things that predispose people to a particular condition, in this case, HIV associated neurocognitive disorder. This means that BOTH being HIV+ and aging does not make it any more or less probable that your brain will have a neurocognitive disorder. With this information, future studies should be directed at determining causality (why does blood flow change?) so that researchers can work to find a therapy that could mediate the effects seen in this study. This study opens the door to potentially important changes in HAART in the coming years….

If you are in Montreal, a student at McGill university, and 18+ you can participate in a trial for a rapid HIV test. Call Student Health Services at 514-398-6017 to make an appointment with a nurse.
Participants will be compensated for their time.