HIV Cures Come At A Price

Also published on Bilerico.com

Today, amfAR grantee Dr. Timothy Henrich announced two HIV-positive patients who have undetectable levels of HIV after undergoing stem-cell transplants at the 7th annual International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention in Kuala Lumpur, Malaysia.

Money

Money (Photo credit: 401(K) 2013)

We’ve had some excellent news about the curing of HIV-infected people in the past year. But it comes at a price.

It’s important to note that the individuals involved received intensive care and went through extreme discomfort in order to eradicate the virus from their bodies. It’s not something that we’ll be able to replicate for the general population anytime soon.

And I think we need to remember that people are still dying of HIV-related causes every day- thousands of people. And new infections aren’t really slowing down- even in the First World where there is convenient access to safe sex supplies. There’s still a disconnect. There’s still ignorance and apathy out there.

It’s still good news however.

From amFAR:

The patients had been on long-term antiretroviral therapy for HIV when they developed lymphoma. To treat the cancer, the patients underwent reduced intensity chemotherapy followed by stem-cell transplants. Since the transplants, Dr. Henrich has been unable to find any evidence of HIV infection.

Dr. Henrich was awarded a grant through the amfAR Research Consortium on HIV Eradication (ARCHE) after presenting preliminary findings on these patients at the International AIDS Conference last July. With support from amfAR, he conducted a clinical study in which his research team withdrew the patients’ antiretroviral therapy and performed several sophisticated assays looking for signs of viral rebound in blood and other tissues. One patient has been off treatment with no detectable virus for approximately 15 weeks, and the second patient for seven weeks, with similar results. However, it is too soon to draw any definitive long-term conclusions.

It is also unclear how long viral rebound might take in a patient whose viral reservoirs have been dramatically depleted, but not eradicated. According to amfAR/ARCHE grantee Dr.Robert Siciliano of Johns Hopkins University, it may take over a year. Previously a patient in a study by the National Institutes of Health had gone 50 days after treatment withdrawal without viral rebound. Dr. Henrich’s patients are at or beyond this threshold, and more definitive answers will emerge as these patients continue to be closely monitored.

“These findings clearly provide important new information that might well alter the current thinking about HIV and gene therapy,” said amfAR CEO Kevin Robert Frost. “While stem-cell transplantation is not a viable option for people with HIV on a broad scale because of its costs and complexity, these new cases could lead us to new approaches to treating, and ultimately even eradicating, HIV.”

The first person to be cured of HIV, Timothy Brown (“the Berlin patient”), also underwent a stem-cell transplant to treat his leukemia. These new cases differ significantly, however, in that the stem-cell donors lacked the genetic mutation (CCR5 delta32) that renders a person virtually resistant to HIV infection. Nor did Dr. Henrich’s patients undergo the intensive chemotherapy or total body irradiation that preceded Timothy Brown’s stem-cell transplant.

“Dr. Henrich is charting new territory in HIV eradication research,” said amfAR Vice President and Director of Research Dr. Rowena Johnston. “Whatever the outcome, we will have learned more about what it will take to cure HIV. We believe amfAR’s continued investments in HIV cure-based research are beginning to show real results and will ultimately lead us to a cure in our lifetime.”

I still can’t help but think we’ve not done our best in response to this epidemic- especially in the last decade. I wonder if, as a community, we settled for simply not dying as a substitute for true health.

If so, what does that say about our self-esteem, self-care and community spirit? Have we lost interest in each other beyond the obvious?

That’s a heavy price to pay.

Banning Same-sex Marriage Has Psychological Toll

Fascinating stuff from Shankar Vadantam at NPR:

As the country awaits two important Supreme Court decisions involving state laws on same-sex marriage, a small but consistent body of research suggests that laws that ban gay marriage — or approve it — can affect the mental health of gay, lesbian and bisexual Americans. When several states passed laws to prohibit same-sex marriage, for example, the mental health of gay residents seemed to suffer, while stress-related disorders dropped in at least one state after gay marriage was legalized.

Here’s the research trail:

Beginning around 2004, several states banned gay marriage. Just before that series of bans, the National Institutes of Health happened to conduct a massive survey of 43,093 Americans. The questions elicited detailed information about respondents’ mental health. (To validate what people reported about themselves, psychiatrists also interviewed samples of the people in the survey, and their medical diagnoses closely matched the findings of the survey.)

Soon after the wave of state bans on gay marriage, in 2004 and 2005, the NIMH conducted a second round of interviews, managing to reach 34,653 of the original respondents. (That’s a high rate compared with most polls and surveys.)

Mark Hatzenbuehler, a psychologist at Columbia University who studies the health effects of social policies, analyzed the data gathered before and after the bans to determine how the mental health of people who identified themselves as gay, lesbian or bisexual had changed in those states.

Hatzenbuehler and his colleagues Katie McLaughlin, Katherine Keyes and Deborah Hasin published their analysis in 2010 in the American Journal of Public Health.

“Lesbian, gay and bisexual individuals who lived in the states that banned same-sex marriage experienced a significant increase in psychiatric disorders,” Hatzenbuehler says.

“There was a 37 percent increase in mood disorders,” he says, “a 42 percent increase in alcohol-use disorders, and — I think really strikingly — a 248 percent increase in generalized anxiety disorders.”

To put those numbers in perspective, although Hatzenbuehler did find more than a doubling in the rate of anxiety disorders in states that eventually banned gay marriage, in absolute numbers he found that anxiety disorders went from being reported among 2.7 percent to 9.4 percent of gay, lesbian and bisexual people.

The million-dollar question is whether the laws, and the debates around them, were responsible for the change in mental health. To help answer that question, Hatzenbuehler and his colleagues looked at comparable groups and experiences.

“We showed the psychiatric disorders did not increase in lesbian, gay and bisexual populations in states that didn’t debate and vote on same-sex marriages,” Hatzenbuehler says. “There were also no increases — or much smaller increases — among heterosexuals living in the states that passed same-sex marriage bans.”

Hatzenbuehler has also found, in a study conducted in Massachusetts, that gay men experienced fewer stress-related disorders after that state permitted gay marriage.

In a study tracking the health of 1,211 gay men in Massachusetts, Hatzenbuehler found that the men visited doctors less often and had lower health treatment costs after Massachusetts legalized same-sex marriage. When the researchers examined the diagnostic codes doctors were giving the men, they saw a decrease in disorders that have been linked to stress, such as hypertension, depression and adjustment disorders.

Hatzenbuehler says he thinks stress associated with gay-marriage debates was the “X factor.” He says the quantitative data is backed by what gays, lesbians and bisexuals told the surveyors. “They reported multiple stressors during that period,” Hatzenbuehler says. “They reported seeing negative media portrayals, anti-gay graffiti. They talked about experiencing a loss of safety and really feeling like these amendments and these policies were really treating them as second-class citizens.”

Today, about three-dozen states ban gay marriage and about a dozen have passed laws thatapprove it. Some states have laws that permit civil unions but ban gay marriage.

It’s unclear how or whether the upcoming Supreme Court decisions involving the constitutionality of same-sex marriage will affect the mental and physical health of gays and lesbians nationally.

It’s likely that many gay, lesbian and bisexual people would see an upholding of same-sex marriage bans as an example of prejudice. But it’s also possible the debate around the Supreme Court decisions could have different effects on gays than a local debate involving friends and neighbors.

Hatzenbuehler says his larger point is really that policymakers, judicial leaders and ordinary citizens need to remember that social policies are also health policies.