Monday, June 27, 2005

Texas HIV Testing Follow-Up Day

Today is National HIV Testing Day. Since many people who get tested for HIV do not return for their test results, the HIV/STD Division of the Texas State Department of Health Services is sponsoring a Follow-Up Day to encourage people to get those test results. Follow-Up Day is scheduled for July 11. The Division has more information available on its website/

In 2001, there were 106,143 HIV tests reported to the Texas Department of Health. Approximately 33 percent of those persons who received HIV tests did not return for their results. Approximately 67 percent of the persons who tested negative returned to the clinic for their results. Among positive results, the return rate was 83 percent, meaning that 17 percent did NOT return for their test results. Therefore, there were 235 people who tested positive for HIV and did not receive their test results.

The goal of this event is to get HIV test results to EVERY person who is tested for HIV in the State of Texas in order to prevent the further spread of HIV.

Thursday, June 09, 2005

China More Pragmatic than Texas?

ABCNews is carrying an AP story about recent recommendations by the Chinese Health Ministry about ways to combat the spread of HIV in that nation. The recommendations? Needle exchange for drug users, condoms for sex workers and people diagnosed with STDs.

In Texas, we couldn't go that far. SB 127, Senator Jon Lindsay's bill to allow needle exchange programs where local health authorities wanted them, passed on second reading by a 17-9 vote (5 absent) but then couldn't get called back for a third reading. You can see the vote and discussion here. HB 2057, Garnet Coleman's bill to allow condom distribution in prisons and jails, received a committee hearing on April 21, but did not get a favorable vote. Both bills died at the end of the session.

China took a long time to acknowledge that there was any HIV epidemic in that nation. It was slow to reveal the problems with blood infusions. It has penalized health officials for speaking out about the risks for infection. This makes it all the more significant that China is now apparently ready to get serious about fighting HIV. The epidemic has been in the public eye a lot longer in Texas. Too bad our leaders can't seem to learn as fast as those in China.

Wednesday, June 08, 2005

New CME on HAART in 2005 from Medscape

Medscape has posted a new medical education module on Highly Active AntiRetroviral Therapy in 2005, with emphasis on changes from the last 18 months:

Changes in the approach to treatment of HIV infection evolve rapidly, fueled by the approval of new antiretroviral agents (ARVs) and new information on how best to use both new and old agents. For over a decade, the International AIDS Society-USA (IAS-USA) and others have recognized the need for expert recommendations to address 4 key questions: (1) When should antiretroviral therapy be started? (2) What regimen(s) should be used for initial therapy? (3) When should therapy be changed? and (4) What should it be changed to? The IAS-USA consensus guidelines are updated as needed, with the last recommendations published in 2004.[1] The purpose of this review is to consider the developments in antiretroviral therapy over the past 18 months and to examine how new data and new agents affect the treatment of patients with HIV infection.

While technical, the article is clear enough for the knowledgeable layperson to understand. Charts and tables augment the text. Some of the conclusions include:

  • When should we start therapy? We know that there is a continuum of risk associated with viral replication and immune dysfunction. Although the optimum time for initiating therapy remains elusive, it is clear that treatment should be started before irreversible immune dysfunction occurs. As regimens improve with respect to potency and toxicity, earlier therapy will likely become the rule.
  • What should we start with?Not all regimens are equal, and a few are emerging as preferable for initial therapy. Efficacy, toxicity, and long-term strategies remain key considerations in guiding the choice of initial regimens.
  • When should therapy be switched?Switching regimens should be considered for virologic failure or toxicity, and toxicity monitoring should be rigorous.
  • What should therapy be changed to?Drug resistance testing should be incorporated into routine clinical management, and follow-up regimens should be determined on the basis of expected potency, likelihood of adherence, and toxicity concerns. The concept of structured treatment interruptions has not been validated.

Tuesday, June 07, 2005

Bristol-Myers, Baylor Plan AIDS Initiative

The Bristol-Myers Squibb pharmaceutical company and Houston's Baylor College of Medicine are teaming up to work on pediatric AIDS in Africa.

Bristol-Myers Squibb Co. and the Baylor College of Medicine are launching a $40 million initiative to treat children with AIDS in the developing world, an effort that includes a "pediatric AID corps" to send doctors to Africa to treat about 80,000 children over the next five years.

Under the plan, BCM will put up $10m for medical student loans; BMS will put up $30m for physician stipends. The news report includes some criticism of the effort and additional news about BMS' intention to not enforce it patents in Africa.

We are almost 25 years into the epidemic--at least as far as we are aware of the epidemic. AIDS was certainly a factor in Africa before we in the West understood the threat. Sadly, it's only in the past five years or so that the world's--and the U.S.'--attention has turned in any productive way to dealing with the issue in Africa. It's very easy, in that context, to think of anything less than total commitment as "too little, too late."

Nevertheless, it is good to see the efforts that BMS is putting forth in Africa. Not enforcing its patents is no small thing. Building 4 clinics is small in terms of the continent's needs, but will make a big difference in the communities that they serve.

While it's also good to see that BCM is devoting some attention to pediatric AIDS in Africa, it would be encouraging to see that more HIV education were included in the curriculum for all of the physicians that it trains. We could still stand to build more AIDS savvy among physicians in Texas.

Monday, June 06, 2005

Press Conference on Prescriptions from Canadian Pharmacy

We received this message from Rep. Hochberg's staff member, Rachel McClure:

Rep. Scott Hochberg and Sen. Rodney Ellis are holding a joint press conference in Houston this Wed. to urge Governor Perry to sign SB 410 which includes the Canadian pharmacy legislation. The Governor has until Sunday, June 19 to sign or veto the legislation.

Please tell your Houston membership about the press conference. It is open to the
public.

In addition, if your organization would like to help or any of your members - please write Governor Perry and urge him to sign the TX Board of Pharmacy sunset bill (SB 410). Send your letters of support to:

Governor Rick Perry
P.O. Box 12428
Austin, TX 78711

Here's the press release:

Hochberg, Ellis to Hold Press Conference on Reducing Costs on Prescription
Drugs
---

(Austin)// Representative Scott Hochberg (D-Houston) and Senator Rodney Ellis (D-Houston) will hold a press conference in Houston on June 8, 2005, at 11 a.m. to urge Governor Perry to sign the Canadian pharmacy legislation. The legislation will allow the Texas Board of Pharmacy to inspect Canadian pharmacies so that Texans will have safe options for less expensive prescription drugs.

Last month, Representative Hochberg amended SB 410 to establish a program that allows the Texas State Board of Pharmacy to inspect Canadian pharmacies which can later sell and ship prescription drugs directly to Texans once they pass inspection.
Participating Canadian pharmacies would be required to meet the same safety standard as any other pharmacy operating in Texas. Texans consumers would only be allowed to utilize a participating Canadian pharmacy for refill prescriptions.

The amendment was similar to legislation, HB 173 and SB 518, filed by Hochberg and Ellis. The plan is modeled after successful programs in Minnesota and Wisconsin. Illinois, New Hampshire, North Dakota, Rhode Island and Vermont also have programs to help residents obtain less expensive prescription drugs from Canada.

WHAT: Reducing Cost of Prescription Drugs Press Conference

WHO: Representative Scott Hochberg
Senator Rodney Ellis

WHEN: Wednesday, June 8, 2005, 11a.m.

WHERE: Seven Acres Jewish Senior Care Service
6200 North Braeswood
Houston, Texas 77074

(take Hwy 59 South, Beechnut exit, near Memorial Hospital-Southwest)

Here's our earlier post on the subject: Licensing Canadian Pharmacies in Texas.

Friday, June 03, 2005

Hinky marketing of immune boosters

As you may realize from all the references to the Texas AIDS Health Fraud Information Network, Texas AIDS Network is concerned about the fraudulent marketing of useless products to a vulnerable population. As long as treatment for HIV is so expensive and access to that treatment is so limited, there will always be a market for this false hope.

Periodically, I do a test of the Network's website listing in various search engines. I enter assorted key words that I hope that we are associated with and then click "Go" to see whether we show up and how high we rank.

A recent test of our listing for the Yahoo search engine brought some interesting results.

The key words that I used were: Texas, HIV, medications. The Network ranked second after the Texas HIV Medication Program. Pretty good, I'm thinking. But, ever curious, I looked on down the page to see what else might be there. I was surprised to see another site that directly quoted from our website. I had to check it out.

This new page looked like a list of helpful links for HIV medications and just included a link to Texas AIDS Network with a site description lifted from our Access section. This could be a good thing. Links from other sites help bring traffic to the Network's site. The more links, the better our ranking in search engines.

On the other hand, the address for this page included an apparent product name. When that happens, I pretty much go on red alert. It didn't make my alarm bells quit ringing when I saw that the ad at the top of the page was for an immune system product which was also headed as: "Our Top hiv medications Resource." (The punctuation alone was enough to set my teeth on edge, but that's another story.)

Still, I gamely clicked "here" as directed. "Here" was a cornucopia of red flags for anyone who looks out for health fraud, not the least of which was the claim that a dietary supplement is "effective in the fight against" a whole host of diseases including HIV and just about everything but zits.

That was enough to lead me to try to track down the company--which turns out to be located somewhere in the U.S.--and make a report of a questionable product to TAHFIN. (The federal representatives on the task force handle non-Texas reports; the state representatives handle Texas for us. It takes international treaties to do anything about websites that market from other countries. It's possible, but harder.)

None of this is to say that this product is not a totally wonderful thing nor to say that anyone who takes it may not suddenly find themselves able to leap tall buildings. It is to say that making claims to "help in the fight against HIV/AIDS" needs to be backed up by some credible scientific research, which I didn't find. It is also to say that this kind of marketing, which implies endorsement by legitimate organizations, is pretty hinky. (Yes, I learned that word from watching NCIS.)

If you are concerned about a product that you find marketed on the Internet, you, too, can contact TAHFIN to find out whether the product is legitimate. What you will likely be told is only whether the manufacturer is in compliance with the law, but that is a good first step in determining legitimacy. Effectiveness is a whole 'nother question (that's what the scientific research is supposed to be for).

UPDATE: Hmmm. Anybody can sue about anything these days. I removed the product references just to make this a more generic statement, which it is intended to be anyway. I hope that didn't make it vaguer at the same time it made it more generic. [sigh]