BETA : bulletin of experimental treatments for AIDS : a publication of the San Francisco AIDS Foundation最新文献

Two decades after the approval of the first antiretroviral drugs, combination HAART has dramatically lowered the risk of illness and death for people with HIV. The year 2007 was another milestone, witnessing the approval of the first agents in two new anti-HIV drug classes--CCR5 antagonists and integrase inhibitors--that provide new options for treatment-experienced patients. Today, however, the anti-HIV drug pipeline is relatively sparse, with no blockbusters in the foreseeable future. While the first HIV maturation inhibitor, bevirimat, continues to slowly make its way through clinical trials, another once-promising agent that works by a completely novel mechanism, Koronis Pharmaceuticals' KP-1461, was recently put on hold after laboratory tests indicated that it did not demonstrate the expected antiviral activity.

The decision about when to start antiretroviral treatment is among the most vexing puzzles in the field of HIV management.HIV begins killing CD4 T-cells--key players in the body's immune response--from the time of initial infection, yet many HIV positive people go for years without experiencing clinical symptoms. Antiretroviral drugs effectively suppress viral replication and enable CD4 cell recovery, but also can lead to side effects that are at best bothersome and at worst debilitating or even fatal. While the optimal time to begin treatment for many diseases is as soon as possible after infection, in the case of HIV the decision involves balancing the benefits of preventing immune system decline--as well as other harmful effects of HIV infection that are only beginning to be understood--against the inconvenience, expense, and health risks associated with antiretroviral therapy.

Recent years have witnessed the increasing adoption of an evidence-based public health approach in HIV prevention science, yet this approach is limited by lack of consensus about what counts as "evidence." In 2007, the San Francisco AIDS Foundation (SFAF) launched an initiative to engage HIV/AIDS organizations, researchers, program implementers, policy makers, and funders in a robust discussion of what really constitutes "evidence" in evidence-based HIV prevention. The core of this initiative is a series of panel discussions about the gathering and interpreting of evidence for establishing efficacy and effectiveness in HIV prevention--evidence that is then used to inform decisions about which interventions to implement, fund, and scale up.

There is a growing need for research about the effects of HIV on the menstrual cycle and menopause. HIV positive women and their care providers need to know what to expect at all life stages, and need strategies for optimal long-term care in the HAART era. Once the impact of HIV on menopause is better understood, clinical management can be individually tailored to avoid long-term complications such as osteoporosis and cardiovascular disease.

A new class of antiretroviral drugs came on the scene in 2003 with the approval of the first entry inhibitor, enfuvirtide (T-20, Fuzeon). Considerable research has been directed toward discovery of additional drugs that target the cell-entry stage of HIV replication, and CCR5 inhibitors--agents that block viral entry via a novel mechanism of action--are poised to join the antiretroviral armamentarium this year.

Serosorting guides partner selection and may also inform choices about condom use. As public health and media attention increasingly focus on serosorting as a form of risk reduction for both HIV positive and HIV negative individuals, it has become increasingly important to understand this phenomenon. Lately, serosorting has been thrust into the mainstream media because it is thought to be partly responsible for the recent decrease in new HIV infections in San Francisco. As part of its newfound celebrity, serosorting is being considered as one of the possible next steps in behavioral HIV prevention for both negative and positive individuals. Yet while some endorse the strategy as a safer way to have sex without condoms, the impact of serosorting on the lives and health of HIV positive individuals has yet to be fully explored.

Skin and soft tissue infections (SSTI) are a source of significant illness and accounted for over 2 million visits to emergency room departments in the United States in 2004. While most infections are minor and do not require hospitalization, some can be life-threatening--particularly for people living with HIV.