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 18th 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 46th 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.
