byline: Larry: Monkeys Shine.

byline: Larry: Monkeys Shine.: "You can’t make a monkey out of me. Or, can you? Like HIV/AIDS, HCV has a simian brother, the chimpanzee. They are the only animal bes..."

Monkeys Shine.

You can’t make a monkey out of me.  Or, can you?  Like HIV/AIDS, HCV has a simian brother, the chimpanzee.  They are the only animal besides man that can be infected by HCV.  A research foundation in San Antonio uses 35 animals as test subjects, and they do it as humanely as possible.  They applied a gene based therapy called blocked nucleic acids to chimps infected with HCV.  The therapy does not target the virus, instead it blocks molecules necessary for virus replication.  It essentially starves the invader.  The results were astounding.  A 350-fold viral drop lasted up to three months after therapy was ended.  Better yet, no antiviral resistance was demonstrated.  Even better, the liver begins to heal itself rather rapidly during therapy.  Researchers claim this is a major breakthrough.  You must view the CBS-news video.  Looks like Cheetah could come to the rescue of Tarzan yet again. 

Now it’s time for a disclaimer.  Last episode I cited a recent EASL conference report on the interactions of HIV meds and HCV meds.  The report stated that there was little interaction.  Sources deep inside a major national health care provider now cite a later report.  The report found that interactions are a great deal more serious than initially thought.  In fact, some HIV meds would need to be dropped or changed entirely during HCV treatment.  The HIV protease inhibitor, Darunavir (prezista), for instance appears to be entirely incompatible with both telaprevir and boceprevir.  Other compounds for HIV, i.e. tenofovir, may experience rises or depressions in the drugs’ blood levels in the presence of HCV meds that may require dosing adjustments.    

Family Health International (FHI) announced disappointing news about women and HIV.  The so-called FEM-PrEP trial of emtricitabine and tenofovir disoproxil fumarate for preventing HIV infection in at risk women will be stopped after an interim review indicated its effectiveness was unlikely.  Once again the ladies get the short straw. 

Bavituximab is an investigational monoclonal antibody that targets a certain phospholipid component on the membrane of virus-infected cells. Preclinical studies have shown that this type of antibody can inhibit viral replication and enhance immune response.  The phospholipid component expressed on cells infected with a variety of viruses, including HCV, HIV, influenza, and herpes viruses, suggesting that targeted antibodies could be beneficial in a number of diseases.  An experimental monoclonal antibody that inhibits HCV replication was safe and well-tolerated in a clinical trial of HIV positive people coinfected with chronic hepatitis C.  Earlier studies found that twice-weekly intravenous infusions of Bavituximab of up to 6mg were well tolerated and showed antiretroviral activity in people with HCV. 

Say, let’s not abandon the Bavituximab story just yet.  Another EASL study released on April 15, found that Bavituximab is well tolerated and safe for co infected HIV’ers.  I think we’ll be hearing a good deal more about this compound very soon.

For my final word I’ve selected ‘HCV and the arts’.  Is this a co infection issue?  Well, yes it is because if you search for films, plays, still-art, etc. for themes on HIV/AIDS, you’ll be overwhelmed with the number of hits.  For instance, since 1984 there have been over 120 films with significant or main themes concerning HIV/AIDS from almost two dozen countries. The first known documentary HIV/AIDS film was the United Kingdom’s 1984 release called Bright Eyes.  The first American film was titled Buddies released by New Line Cinema, 1985.  How about television?  NBC did it first in 1985 with its premiere of An Early Frost, which began a series of AIDS as disease-of-the-week movies that presented fictionalized and true stories on such notables as Liberace, Ryan White, and Roy Cohn.   

Counter that with a search on the arts and HCV.  You’ll find practically nothing, except some very short YouTube informational videos.  It’s not for a lack of subject matter.  After all Natalie Cole, Naomi Judd, Larry Hagman, and Pamela Anderson all battle HCV.  Just in the U.S., more people infected with HCV are alive today than have been diagnosed with HIV – ever.  And, HCV is older than AIDS.  Discovered in 1988, scientist had been searching for the elusive virus they dubbed hepatitis non-A, non-B since 1975.  It begs the question, why has HCV been virtually ignored in the dramatic arts? 

One of the things art does is illuminate and inform.   Illumination quantifies a difficult subject and informs us on an entirely different, visceral level about it.  I don’t have an answer to the question of why one virus is well covered in the arts and the other, cousin virus, is not.  So, I won’t ask.  That doesn’t mean I can’t speculate.  HIV/AIDS was a crash disease in the beginning.  Wham, bam, gone!   HCV ambles along slowly for many years before reaching another long, drawn out process leading to end stage.  One is sensational in its impact, the other not so much, though the paths of each lead to the same destination.

AIDS is sensational because it happens today.  HCV is not because it happens tomorrow.  HCV remains fairly regular looking for a very long time.  With AIDS the downfall was swift and could be readily seen on the faces and bodies of HIV people.  Plus, HIV is considered sexual, giving it a certain cachet. Yet, HCV should be included in the conversation that the dramatic arts empower.  Is there not a talented play-write, screenwriter, paint artist, or just some bloke novelist with an ear to the obscure out there who can see the ripeness of the HCV struggle?  Or, for that matter, HCV and HIV together.   What we call co infection.

It’s too much.  I think I’ll just go have another banana.  Cheetah, who is still alive and living in my town, has offered to be my designated driver.

Where the hell is Harry?

The train to Disneyland seems to have gotten off rail somewhere ending up in Congress instead.  No one from the Mad Hatter’s Tea Party has noticed the mix up.  They apparently believe it really is a party where everybody ought to grab what they can for themselves.  They keep passing the mad hat of responsibility around from one unlikely nutcake to the next.  For those who went there specifically to rant and rave it’s one thing.  For the President who promised to protect us from corporations and Wall Street it’s another Tinkerbell altogether. 

We’ve used Harry as a dubious homage to Irving Berlin’s Call Me Madam!  Ethel Merman plays a Perle Mesta type who is appointed to an ambassadorship by Harry Truman.  Harry kicked butts and the buck stopped with him.  For this President, where does the buck stop?  Does he even know what the buck is?  We knew Harry (from afar).  Harry was a friend of ours (from afar).  Mr. President, you are no Harry.

We’re continually amazed by how he’s quick to acquit himself of any responsibility.  No, it’s those pesky corporations and everyone knows they aren’t really people.  They’re dispassionate entities, automatons. We believe, however, that if you follow the string tied to corporations, somewhere along the string you’ll find people not only attached to it, but pulling it.  What Washington needs is a little more Harry and a lot less Goofy.  There are evil people up on that Capitol Hill.  Their agenda is to steal your future.  The President doesn’t seem to get it.  He thinks, we guess, that it’s ‘to the loser go the spoils.’  So, what do you think he’s going to do now?  We’re betting he’s going to Disneyland. 

Time to stand up, folks.  It’s your government and it’s your life.  Make a difference.  Now! 

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Now, two recent conferences are providing some very encouraging news for HIV/HCV coinfection.  First, the 18^th annual Conference on Retroviruses and Opportunistic infections (CROI 2011) reports the two new protease inhibitors for HCV, telaprevir and boceprevir, demonstrate minimal adverse interactions with most basic HIV meds.  Researchers believe that those interactions can be mitigated by simple dose adjustments.  That means there is a more than a reasonable expectation that those who are co infected can be safely treated.  One central question remains, however.  Will there be a resistance factor in HIV patients who are treatment experienced and very likely already resistant to several protease inhibitors?

The second conference, the 46^th annual European Association for the Study of the Liver (EASL 2011) says that Vertex’s telaprevir increased sustained response in all HCV people, regardless of IL28B status.  A whopping 90% SVR is associated with the best gene status, CC, with 78% able to cease treatment after 24 weeks.  Also, a nearly threefold improvement rate was observed among IL28B gene types CT and TT regardless of prior treatment experience. 

Ribavirin was approved more than ten years ago.  It remains the last med approved for treatment of HCV.  EASL reports that, in all likelihood, the coming decade in HCV research should be as wet as the last decade was dry.  There will very likely be, however, little impact upon the global incidence of HCV due to barriers of treatment access, ignorance, and stigma. 

Perhaps you heard that Johns-Hopkins researchers are arguing against a decade’s old law forbidding harvesting of healthy organs for transplantation from HIV positive people.  Of course, HIV positive patients would be the recipients of those organs.  South Africa has done HIV positive transplants with excellent results, but thus far, none have been performed in the U.S. due to this law.  HIV is now a manageable disease with medications.  HIV-infected donor organs may be transplanted into HIV infected patients. Doctors can call on the lessons and experience of transplanting HCV patients with organs from people with the same disease. This practice, which has not always been the standard, has substantially shortened the waiting list for these recipients without significantly compromising patient or graft survival. The decision of whether or not to use these organs is not a legal one, but one made by the clinician.

And last, it’s fairly well known that HCV infection may result in bone loss.  HIV also causes bone loss.  Put the two together and you have bone loss on steroids.  As time goes on, we will see more hip and spine fractures in our affected populations.  It won’t be pretty.  No sure fix for this problem is yet on the table because it is, by its nature, a complicated set of incidences that could be rooted in nutrition, metabolic systems, or other yet unknown causalities.   It is, however, interesting to note that almost all HIV and HCV people are Vitamin D deficient.   Some clinicians are advising Vitamin D3 supplementation.  Vitamin D3 is readily available over the counter.  Some caution should be exercised since overdose is possible.  One, 1000 mg of Vitamin D3 per day should be safe.  Resist the temptation to overdo this vitamin until more research is published.  Ask your doctor to check your Vitamin D3 levels at your next blood draw.

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Well, we’re going to Disneyland.  We’re taking Helena Handbasket along. 

byline: Larry: This is your brain on HIV and HCV.

byline: Larry: This is your brain on HIV and HCV.: "There was tough news out of the 2011 Conference on Retroviruses and Opportunistic Infections (CROI) concerning HIV and the brain. In t..."

This is your brain on HIV and HCV.

There was tough news out of the 2011 Conference on Retroviruses and Opportunistic Infections (CROI) concerning HIV and the brain.  In the study, HIV was found in the brains of all participants.  There is a strong belief among researchers that HIV causes systemic inflammation.   HIV damage in the brain appears in the second and third of the four stages (Freiberg Stages) prior to seroconversion to AIDS, when there is a peak in inflammation.  Brain changes were demonstrated as early as two months into infection, usually before seroconversion.  While the changes are subtle, cognitive function declined as much as 13% in the first year and 35% in the second.  Much of this brain harm is associated with <350 T4 helper count and increased inflammation.  The good news is that age and length of infection are not associated with cognitive decline.

Apropos to that, a Canadian research team at the University of Montreal believes they’ve found a long elusive reservoir where HIV hides out.  It has been a long held theory that it might be the brain, but viral levels in the cerebral-spinal fluid are significantly lower than that found in the brain. That doesn’t disprove the brain reservoir theory.  It is an indication, however, that the theory could be flawed. The Canadians believe they’ve discovered a true reservoir in certain long term immune system memory cells.  These cells tend to hang around sleepily for a very long time, activating only when they encounter an old foe, such as the mumps or measles.   

In HCV, cognitive implications were identified early on mostly by patients who termed it “brain fog”, describing the come and go disorientation and confusion they experience.  It is a condition associated with HCV that tends to worsen over time. It becomes especially problematical with such complications as hepatic stents (essentially, an in-liver bypass), asciites, and other associations where toxins build in the blood.  A distinction was, at one time, drawn between brain fog and hepatic encephalopathy (HE) as was noted in an HCVAdvocate article as far back as 2002.  Today, however, it appears that the only real distinction is in severity.  It’s noteworthy that patients view brain fog in an almost humorous manner, but hepatic encephalopathy is nothing to joke about.  Hepatitis-Central posts an extensive overview in very simple format that may be helpful for those dealing with any stage of HE. 

Researchers already knew that HCV affects the brain.  New studies show that even when serious liver damage hasn’t occurred, patients still suffer memory loss, have trouble concentrating, apathy, and depression.  HCV gets in the brain where it infects and replicates.  A build up of HCV proteins in the cell eventually kills it, drowning it in its own refuse, so to speak.  U.S. Centers for Disease Control and Prevention picked up this study from Canadian researchers and The Body issued a report on it last October. 

We know that the brain is a wondrous entity.  It has an uncanny ability to work around deficits and injuries if it’s taught to do so.  Look at Representative Gabrielle Giffords.  She took a high caliber bullet through her brain in January.  It is now April and she’s singing Twinkle, Twinkle Little Star, talking on the telephone, and making noises about running for the senate next time.  That’s completely awesome.  And we know some really cool strategies for exercising the brain so that we might avoid Alzheimer’s.  Those methods work.  They can divert Alzheimer’s completely, or delay its onset. 

Could it be that brain implications are cross dimensional regardless of the underlying disease or injury that cause them?  It begs the question, Are there strategies that might aid in at least slowing the rate of mental deterioration found in both HIV and HCV, separate disorders that share many similarities?  There are very long term survivors of HIV/AIDS who must have suffered HIV infection in the brain very early in the disease process.  Some are completely nuts, but most of us function fairly normally in society.   How do we determine why that is and if it can be applied to disease across a spectrum?

Living itself is like a virus.  It kills brain cells.  Given enough time there will be cognitive decline.  Deep research into this barely addressed phenomenon might bring positive results not only for those who suffer.  Would doing crosswords or learning a new language open heretofore unseen pathways to good brain health, and does anyone know a four letter word meaning ‘mentally competent”?