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Thanks to improving anti-HIV treatment, people with HIV, in the first five years after diagnosis with HIV, now have mortality rates similar to those seen in the general population, according to a large European study published in the July 2nd edition of the Journal of the American Medical Association. Aidsmap has a story on the study.

Changes in the Risk of Death After HIV Seroconversion Compared With Mortality in the General Population

Krishnan Bhaskaran, MSc; Osamah Hamouda, MD; Mette Sannes, MLabTech; Faroudy Boufassa, MD; Anne M. Johnson, MD; Paul C. Lambert, PhD; Kholoud Porter, PhD; for the CASCADE Collaboration

JAMA. 2008;300(1):51-59.

Abstract

Context Mortality among human immunodeficiency virus (HIV)–infected individuals has decreased dramatically in countries with good access to treatment and may now be close to mortality in the general uninfected population.

Objective To evaluate changes in the mortality gap between HIV-infected individuals and the general uninfected population.

Design, Setting, and Population Mortality following HIV seroconversion in a large multinational collaboration of HIV seroconverter cohorts (CASCADE) was compared with expected mortality, calculated by applying general population death rates matched on demographic factors. A Poisson-based model adjusted for duration of infection was constructed to assess changes over calendar time in the excess mortality among HIV-infected individuals. Data pooled in September 2007 were analyzed in March 2008, covering years at risk 1981-2006.

Main Outcome Measure Excess mortality among HIV-infected individuals compared with that of the general uninfected population.

Results Of 16 534 individuals with median duration of follow-up of 6.3 years (range, 1 day to 23.8 years), 2571 died, compared with 235 deaths expected in an equivalent general population cohort. The excess mortality rate (per 1000 person-years) decreased from 40.8 (95% confidence interval [CI], 38.5-43.0; 1275.9 excess deaths in 31 302 person-years) before the introduction of highly active antiretroviral therapy (pre-1996) to 6.1 (95% CI, 4.8-7.4; 89.6 excess deaths in 14 703 person-years) in 2004-2006 (adjusted excess hazard ratio, 0.05 [95% CI, 0.03-0.09] for 2004-2006 vs pre-1996). By 2004-2006, no excess mortality was observed in the first 5 years following HIV seroconversion among those infected sexually, though a cumulative excess probability of death remained over the longer term (4.8% [95% CI, 2.5%-8.6%] in the first 10 years among those aged 15-24 years).

Conclusions Mortality rates for HIV-infected persons have become much closer to general mortality rates since the introduction of highly active antiretroviral therapy. In industrialized countries, persons infected sexually with HIV now appear to experience mortality rates similar to those of the general population in the first 5 years following infection, though a mortality excess remains as duration of HIV infection lengthens.

In Thailand, people co-infected with HIV and tuberculosis who receive antiretroviral therapy are six times as likely to survive as those who do not, according to a study reported in the June 1st issue of the Journal of Acquired Immune Deficiency Syndromes. See Aidsmap's report on the study.

Antiretroviral therapy for HIV-infected tuberculosis patients saves lives but needs to be used more frequently in Thailand.

Sanguanwongse N, Cain KP, Suriya P, Nateniyom S, Yamada N, Wattanaamornkiat W, Sumnapan S, Sattayawuthipong W, Kaewsa-ard S, Ingkaseth S, Varma JK.

Bob Ostertag writes on the Huffington Post on the parallels between climate change denialism and AIDS denialism:

As with climate change denialists, AIDS denialists piece together their arguments from misinterpretations of valid scientific papers, from the comments of respected scientists venturing out of their specialty and writing in non-peer reviewed journals, and the political support of conservative institutions. And again, as with climate change denialism, the whole package gets its momentum and false air of rigor from being endlessly circulated on the Internet.

Recreational drug use and T lymphocyte subpopulations in HIV-uninfected and HIV-infected men.

Chao C, Jacobson LP, Tashkin D, Martínez-Maza O, Roth MD, Margolick JB, Chmiel JS, Rinaldo C, Zhang ZF, Detels R.

The effects of recreational drugs on CD4 and CD8 T cells in humans are not well understood. We conducted a longitudinal analysis of men who have sex with men (MSM) enrolled in the Multicenter AIDS Cohort Study (MACS) to define associations between self-reported use of marijuana, cocaine, poppers and amphetamines, and CD4 and CD8 T cell parameters in both HIV-uninfected and HIV-infected MSM. For the HIV-infected MSM, we used clinical and laboratory data collected semiannually before 1996 to avoid potential effects of antiretroviral treatment. A regression model that allowed random intercepts and slopes as well as autoregressive covariance structure for within subject errors was used. Potential confounders adjusted for included length of follow-up, demographics, tobacco smoking, alcohol use, risky sexual behaviors, history of sexually transmitted infections, and antiviral therapy. We found no clinically meaningful associations between use of marijuana, cocaine, poppers, or amphetamines and CD4 and CD8 T cell counts, percentages, or rates of change in either HIV-uninfected or -infected men. The regression coefficients were of minimum magnitude despite some reaching statistical significance. No threshold effect was detected for frequent (at least weekly) or continuous substance use in the previous year. These results indicate that use of these substances does not adversely affect the numbers and percentages of circulating CD4 or CD8 T cells in either HIV-uninfected or -infected MSM.

PMID: 18180115 [PubMed - in process]

Internet company Google has said that advertisements supplied by its AdSense service to websites across the country should not have included ones that claim to "cure" HIV. – Pinknews.co.uk

Today a South African court handed down a landmark judgment in a case initiated by Treatment Action Campaign (TAC) and the South African Medical Association (SAMA) against Matthias Rath and the Government of South Africa.

This judgment unequivocally establishes the duty of the state to enforce the scientific governance of medicines as defined in the country's Medicines Act. The case demonstrated how the South African Minister of Health wilfully obstructed the rule of law and promoted pseudoscience, resulting in the unnecessary deaths of many people.

The judgment is effectively a stern warning to all purveyors of untested and unregistered medicines, especially those selling so-called “cures” for HIV/AIDS. (AIDSTruth has reported on a number of such cases, including the Minister of Health's support for the untested "Ubhejane" treatment.)

• Read a summary of the judgment and the TAC's statement here.
• Read the full judgment here.
• Read background on the case.

Here is some media coverage of the court victory:

• BBC – S Africa bans Aids vitamin trials
• Reuters – South African court bans AIDS vitamin trials
• IRIN PlusNews – TAC prevails over Rath
• Health-e – It's all over for Rath
• Health24.com – Fire Manto over Rath: TAC
• The Times – TAC calls for Manto’s head over Rath

The World Health Organisation and UNAIDS issued this statement on 12 June.

Correction to AIDS story in Independent article 8 June 2008

We wish to clarify misinterpretations concerning WHO and UNAIDS positions on the status of the AIDS epidemic in recent media articles. The story in the Independent on Sunday titled: “Threat of world AIDS pandemic among heterosexuals is over, report admits” contained a few seriously misleading statements that have led to inferences and conclusions that bear no relation to the highly complex realities of the HIV epidemic.

First and foremost, the global HIV epidemic is by no means over. At the end of 2007, an estimated 33.2 million people were living with HIV. Some 2.5 million people became newly infected that year, and 2.1 million died of AIDS. AIDS remains the leading cause of death in Africa.

The International AIDS Society has published a list of fake AIDS "cures" on their website. While there are unfortunately more "cures" that could be added to this list, it is important that the IAS as the representative body of HIV/AIDS scientists has taken a strong stand against this dangerous and exploitative form of pseudoscience.

In the article Unproven AIDS "cures" they say:

The IAS urges its worldwide membership to hold their governments to account for unproven claims of AIDS cures. We advise health care workers and policy makers throughout the world to continue to implement ARV treatment programmes for all who need them, and to clarify the proven dangers of stopping ARVs, including the risk of disease progression and the development of drug resistance.

Mortality in HIV-infected Ugandan adults receiving antiretroviral treatment and survival of their HIV-uninfected children: a prospective cohort study.
doi:10.1016/S0140-6736(08)60345-1

Mermin J, Were W, Ekwaru JP, Moore D, Downing R, Behumbiize P, Lule JR, Coutinho A, Tappero J, Bunnell R.

BACKGROUND: Antiretroviral therapy (ART) is increasingly available in Africa, but physicians and clinical services are few. We therefore assessed the effect of a home-based ART programme in Uganda on mortality, hospital admissions, and orphanhood in people with HIV-1 and their household members.

The South African Sunday Times newspaper ran an exposé today about a meeting of quacks in the port city of Durban, the major city in the epicentre of SA's HIV epidemic. The meeting was attended by the provincial health minister for KwaZulu-Natal Peggy Nkonyeni and addressed by the national Minister of Health, Manto Tshabalala-Msimang.

The Sunday Times reports:

The KwaZulu-Natal Health Department is actively promoting Aids denialists and quack Aids cures — with the blessing of Health Minister Manto Tshabalala-Msimang. Last Friday, the department hosted an “information workshop on HIV treatment” at a Durban hotel, where speakers condemned antiretroviral drugs and called for traditional medicine to be promoted instead. The meeting was opened by the KwaZulu-Natal Health MEC Peggy Nkonyeni. Tshabalala-Msimang delivered the keynote address. Read full story.

Also see the editorial in the same newspaper Manto, people are dying.