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Powerful joint pill flying off drug store shelves Clinical trial; remarkable increase in human joint mobility felt in just days  The Denver Post Monday, July 5, 2010.
 
 
    Imagine a pill that can help you  around more easily in just a matter of days.  Then think of how great it would be for your joints to feel better too.  A major breakthrough has occurred when a team of scientists delivered an amazing joint health supplement that's been clinically shown to improve mobility and joint comfort.  Now, after years of development and testing it's hitting the shelves of all major  US. drug stores.The remarkable joint health pill is called Fast acting Trigosamine,.  It has been clinically shown to produce amazing results;  81% of the participants felt better just days after taking the recommended dosage and an incredible l00 % reported their joints felt better just midway through the clinical trial. 
     Dr. Joseph Dietz stated has never seen relief like this before.  The goal of the study was to formulate Trigosamine so that people would feel results quickly, and based on the feedback from consumers along with the clinical data, it appears that Trigosamine works.  National drug store shipments are being delivered, but as of today there is no way to know which stores actually have product on their shelves.  In California Walgreens and CVS pharmacy are know to have the supplement.  There is  Regional Health Hotline at 1-866-941-7632 that people can call to get a significant discount of the supplement.  It appears that people who have joint discomfort want Trigosamine.  The ingredients in trigosamine include hyaluronate, which is building block of human joint oil, and is known by medical professionals as synovial fluid.  The molecule can absorb up to 100 times its own weight in water helping to lubricate the joints which reduces friction while acting as a shock absorber allowing for effortless comfortable mouton.  Synovial fluid is what allows young people to move with fluidity.  As people get over they lose synovial fluid and that causes sore joins and bone on bone grinding.  
     Trigosamine'sl results are all supported by a recent by completed randomized, double-blind placebo controlled clinical study which is considered to be the gold standard for joint health supplements. Everyone who took trigosamine reported improvement in their joint comfort.  The data also shows that their joint comfort just kept getting better the entire time they were taking trigosamine during clinical study.  Placebo patients developed increased joint discomfort and soreness during the clinical study.  The toughest part now will be how to get it. Again the pharmacies that have it are Rite Aid CVS, and Walgreens.  

 

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DNA Drugs come of Age   Scientific American July 2010  PP49-53
 
         After years of false starts, a new generation of vaccines and medicines for HIV, influenza and other stubborn illnesses are now in clinical trials.  l0 years ago scientist at the NIH tested two promising new types of vaccine to see which might offer the stronger protection against HIV.  One vaccine consisted of DNA rings called plasmids, each carrying a gene for one of five HIV proteins.  The goal was to get the recipients own cells to make the viral proteins in the hope they would provide protective reactions by immune cells.  The second type of vaccine used another virus called an adenovirus as a carrier for a single HIV gene encoding a viral protein.  The rationale for this combination was to employ a safe virus to catch the attention of immune cells while getting them to direct their response against the HIV protein.  The DNA recipients however displayed only weak immune response to the five HIV proteins or no response at all, whereas recipients of the adeno-virus-based vaccine had robust reactions.  However with the clinical failure of the adeno-virus based vaccines scientists have gone back to the drawing board to find ways to boost the effectiveness of the plamid-based vaccines.  They are now seeing boosted immune responses with the plasmid-based vaccines while retaining safety and other benefits that make d"N"A vaccines appealing. 
     New vaccine delivery methods namely they get considerable more cells-including immune cells themselves to take up the plasmids in effect open up the cells to take up the plasmids by a process called electroporation, a series of electrical pulses that cause the cell membranes to temporarily open pores and allow the plasmids to enter more easily.  The ability to safely deliver genes into cells in this manner and get those cells to efficiently manufacture the encoded proteins opens avenues to a host of potential treatments.  One vaccine now in human trials, Pennvax-B, contains three HIV viral genes plus genes encoding adjuvant molecules and is delivered with electroporation.  The hope is that a strong neutralizing antibody will result from this method
 
                                                        Affiliate Program for Blue green algae now set up with the Foundation and Simplexity Health
 
     The foundation and Simplexity Health are setting up a program where people who are using Blue green algae can buy their Blue treen algae whole sale thru the Schick foundation web sites and at the same time donate the difference to the foundation clinical trials.  Keep reading the newsletters in the future to see how you can do it.
 
                                                  The IAS Meeting in Vienna Austria July 17-24th
 
      The Peter Schick Foundation will post newsletters and messages and videos from Vienna Austria Starting July 17th from Vienna Austria.  25,000 people plan to
 attend the meeting including President Bill Clinton.  Peter Schick Chairman of the Board will give a presentation of the foundations  work on Blue green algae in clinical trials.   
     

 

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EARLIER AIDS TREATMENT BACKED   UNITED NAGTIONS' AGENCY IN CHARGE OF AIDS POLL ICY   JULY 14 2010
 
 
          The United Nations agency in charge of AIDS policy is lowering the threshold for treating HIV positive individuals in developing countries in the hope that earlier treatment will prevent hospitalizations and reduce related medical care costs.  The report is issued in advance of next week international AIDS conference in Vienna, the biennial meeting at which researchers pore sent the most recent AIDS research and policy decisions The agency currently requires that if patient's CD 4 level, a measure of the severity of the infection, has fallen below 200 cells/mm 3, then treatment should be started.  But at that level, many of the AIDS related symptoms have already started.  The agency now recommends treatment be started when the CD 4 level drops to 350 cells/mm 3.  They state that it is much cheaper to treat them when they are less sick.  They also state that earlier treatment means less likely that transmission will occur to their sexual partners.  They again reflect back to costs stating that the cost of hospitalization is greater than the cost of the medications when starting treatment earlier. 
 
     Thee are several problems with this recommendation now.  It should have come much earlier in the course of the history of HIV/AIDS>  Second of all it is now well recognized that untreated HIV infection is bad, not only for the development of AIDS, but for the occurrence of Heart disease, liver Disease, Kidney disease,and Brain dysfunction.  In fact our foundation has advocated that people should be treated soon after they test positive for HIV, no matter what their CD 4 count is.
Every disease known to man is treated better treated earlier.  The Unites States, with its recommendation governed by the CDC, still holds the old concept that except under special circumstances antiretroviral treatment should be witheld until the patients CD 4 count falls to 200.
 
     Although cost is an issue, health is a more important issue.  When to start treatment has been argued long enough.  The recommendation of all countries governing bodies, should state that treatment should be instituted when a person tests positive for HIV.

 

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Vaccine for AIDS may be a step closer    Internet and LA times, July 9, 2010,
 
 
 
    An effective vaccine against the AIDS virus may have moved one step closer to reality.  Federal researchers have identified a pair of naturally occurring antibodies that are able to kill more than 90% of all strains of the AIDS virus, a finding that may lead to the development of new treatments for HIV infections and to the production of the first successful vaccine against the virus.   The data has shown that HIV-l the virus that causes AIDS, is notoriously mutable, changing the composition of proteins on the surface with ease to escape pressure from the immune system.  This enables it to continue infecting cells even after the appearance of antibodies targeting it--and to avoid the relatively ineffective vaccines developed so far.
There are hundreds of variants of the virus  now in circulation around the world, and the intensification of so called broadly neutralizing antibodies than can block the bulk of them has been the holy grail of HIV researchers .However to date the best antibodies that researchers have found block only 30=40% of all HIV strains.  The identification of antibodies than can block more than 90% of strains could lead to what some researcher are dubbing a renaissance in AIDS prevntion and treatment.
       Nable and his colleagues isolated the antibodies from the blood of a  60 year old African American gay man.  Using newly developed imaging and analytical techniques, they found that the two antibodies, called VRCO1 and VRC02 bind to a spike on the surface of the virus.  This spike interacts with the CD 4 binding site on the surface of CD 4 T cells.  With the binding the virus can't enter the cells, thus it is called an entry inhibitor.  The virus can only use the CD 4 receptor to enter cells and can"t tolerate mutations in the spike.  The composition of the spike is thus pretty much constant in all variants of HIV in circulation.  The antibodies attach to a virtually unchanging part of the virus, and this explain why they can neutralize such an extraordinary range of HIV strains.  With the antibodies in hand, the team was able to determine precisely how the HIV spike and the antibodies interact.  They were then able to produce a synthetic version of the spike that could elicit the production of similar blocking antibodies in animal cells.  They are now testing the synthetic spike in a possible vaccine in animals and hope to expand to human testing in the relatively near future The antibodies can also be reproduced by biotechnology and used as a treatment for someone who is already infected.  Researchers, who are alreeadg testing the antibodies in animals, hope that at the very least the antibodies wilt provide synergistic effects when used in conjunction with antiviral drugs.
     This approach is very much like what we are doing at the Peter Schick foundation.  The likely mechanism of Blue green algae is it blocks the entry site of the virus into the  cell.  But the advantage of blue green algae is it is available now, no toxicity, and also elicits more of the most important cell of the immune system, the stem cell.  Finally it is already undergoing testing in HIV+ patients and has FDA approval for doing the clinical trials.  

 

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Differences in HIV Burden throughout the Gut of Patients on Suppressive ART: Implications for HIV persistence.  Yu et al and the PLUS group Presented at CTOI #98

The gut is a major reservoir for patients receiving antiretroviral therapy.  Distinct immune environment may support various levels of HIV.  To test this hypothesis the authors measured levels of HIV RNA, levels of HIV DNA and T cell activation throughout the gut and in peripheral blood cell mononuclear cells.  The authors studied 8 HIV+ patients.  They measured T cell subsets, viral RNA and DNA levels and biopsied endoscopically different parts of the gut like the duodenum, jejunum and colon.  T cells subsets and activation markers were measured in different part of the gut;and in the peripheral mononuclear cells in the persons blood.

The results showed that HIV RNA was present in all areas of the gut and the mononuclear cells, and HIV DNA was higher in all places in the gut compared to the mononuclear cells.  HIV DNA correlated with T cell activation markers.  In all cases of the gut T cell activation thru HIV DNA was higher in the gut relative to the blood.  The results show that there are different processes that drive HIV persistence in the blood and in the gut.

This article is important to our foundations research for several reasons.

It shows that despite the effective suppressive antiretroviral therapy HIV persists in the gut.  It also shows that any type of eradicating therapy will have to address the gut also even after initial penetration of HIV into the persons GI tract the source of initial infection.  It also shows that in any study like we are proposing, that the markers pro viral DNA and the markers of immune activation will have to be followed.  CD 38 is a measure of activation and CD 28 is a measurement of senescence and will have to measured along with CD 34 a measurement of stem cells in the circulation.  Finally the most important marker of any irradiation medication is measurement of immune activation, which means the measurement of pro-viral DNA.

 

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Article from JAMA  March 23, 2010  posted on line and in the LA Times
 
Study involving over 34,000 women recommends that women work out 60 minutes a day to maintain a normal weight over a lifetime.  This means working out every day for 1 hour not 1 hour a week. This also refers to women who start out at normal weight.  The issue of course  is how much exercise is required to maintain a normal weight  as some experts say  an average of 35 minutes a day, seven days a week is probably sufficient.  This again only refers to women who started out with a normal weight and exercise 1 hour a day to maintain their normal weight.

This article refers to exercise for weight control,  Moderate type of exercise was the exercise referred to in this study,and it talked about walking or hiking, jogging, running, biking, aerobic exercise or dance, use of exercise machines, yoga, tennis, squash, requetball and swimming.  Housework and gardening were not included in the analysis. Of note is the fact that men have consistently shown in studies they require less exercise to maintain body weight.

Of course there are some problems with this study.  Women who decide to be physically active may also decide to eat healthier and do other things to maintain a normal body weight, like sleep less.  This study is really about energy balance.  It takes a very small imbalance to gain a significant amount of weight over many years.  One thing that is certain, all disease prevention starts out with exercise and diet.

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Immune and virological benefits of l0 years of permanent viral control with antiretroviral therapy.  Guihot. et.AIDS 2010 vol 14, NO.4
 
The effects of a l0-year control of HIV replication without viral blips with antiretroviral therapy were examined in progressors, those people that would have progressed without antiretroviral therapy.  CD 4 cell counts did not plateau but showed a continuous increase until the l0th year.  Ultra sensitive techniques showed very low plasma HIV RNA and cell associated DNA levels.  Robust memory T cell responders to HIV-p24 were higher than in 3-year treated patients and comparable to those of elite controllers, whereas interferon gamma producing HIV-specific T cells, were infrequent.  Long-term and efficient antiretrovial therapy provides continuous benefits both on the immune system and on their HIV reservoirs.

The results of this trial is important for several reasons and warrants further questions.  (1) It shows that there is continuums benefit in the T-Cell subsets after long term therapy and even a decrease in immune activation as evidenced by the most sensitive assay cess associated viral DNA. However these patients still did not reach the level of elite controllers and there was immune activation gong on.  The conclusion is that some type of antiretrovirial therapy must continue probably lifetime.  (2)  No immune activation is the hall mark of innate controllers and should be the benchmark that people look for in this disease not viral load.  (3) The reservoirs of HIV, can be effected by long term therapy mainly the memory T-cells.

What this says to our group which is studying blue green algae, is that blue green algae would be an excellent long term supplement probably with an ARV but conceivable down the line without ARV. Blue green algae decreases immune activation by its anticytokine activity, and it is well known that blue green algae effects the memory t-cell, the main reservoir of HIV. Blue green algae is worthy of clinical study for HIV disease.

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Intensive therapy may hurt diabetics   Results of the Accord trial  Published in the Los Angeles Times March 15,2010

The results of the ACCORD were released Sunday.  It seemed like a good idea, for Diabetics who are at an unusually high risk of heart disease, heart attack and stroke, that sharply reducing their blood pressure, cholesterol and blood sugar should be highly beneficial.  However a decade of studies of thousands of patients show that is not the case.  Lowering either blood pressure or cholesterol below current guidelines does not provide additional benefit, and in fact, increases the risks of side effects. A third arm of the study, released two years ago, shows that excessively lowering blood sugar levels actually increases the risk of heart disease.

The results are disappointing, because researchers say that that clinicians may have reached the limit of what they can do for diabetic patients without developing new therapeutic approaches.  The good news is that findings reduce the cost and potential side effects of drug therapy and mean that patients will not have to work as hard at reducing blood sugar levels,lipids, and blood pressure.  The take home message is pretty good and that is that the standard care approaches are pretty good, and if we try to go beyond them, it doesn't provide additional benefit.

Diabetes has  become a tremendous problem to the united States, with at least 1` million people afflicted with type 2 diabetes--in which they do not respond properly to insulin produced by the pancreas-and millions more at risk because of obesity.  Most diabetics also have high blood pressure and high cholesterol,factors that raise their risk of heart attack, and stroke to the same level as that of people who already have suffered a heart attack. Excessive control of high blood pressure and high cholesterol does not lower the risk of thee people developing heart disease.

The fact that stands out in this study and the commentary about is that we have to look for some alternative way of treating these problems and that prevention might be the key.  We are studying a product and have proposed clinical trials to control Type 2 Diabetes without strong medications and also lowering LDL cholesterol and perhaps prevent hypertension.  The product is blue green algae.Preliminary studies in this FDA approved product shows that Blue green algae does just that.  It can control blood sugar and lower LDL cholesterol without significant side effects.  The attention of much of the medical community is on the results of these clinical triials now developed and aproved by the FDA and going thru individual IRB's.

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Immune failure after Suppressive Antiretroviral treatment:  High level CD 4 and CD 8 activation but only memory CD 4 cells are cycling  Letterman et al  Case Western Reserve University  Presented at CROI  471 B

Failure to normalize circulating CD 4 cells despite virological control is seen in up to 25% of antiretroviral treated patients  and is associated with increased morbidity.  The determinants of immune failure in this setting are incompletely understood.  The authors studied 61 immune failure patients who had a CD 4 counts <350 dispute >2 years of suppressive therapy, Clinical characteristics of 188 immune success patients characterized by >500 CD 4 cells after 2 tears of suppressive therapy. called IS patients were compared with the failure patients.

The authors found that immune failure patients are older at the start of therapy, more often male,  often had lower CD 4 count Nadir (the lowest CD 4 count before therapy).  In a multivariate analysis only CD 4 count Nadir was an independent factor associated with immune failure.  While absolute CD 4 maturation subsets were normal in immunologically success patients, all subsets (naive, central memory, and effector CD 4 cell counts) were lower in immune failure patients.  CD 8 cells were all lower in immune failure patients.  Immune failure patients were more frequently in cell cycle,suggesting continued immune activation than in immune success patients.  While in Immune failure patients, CD 8 cells were more frequently cycling than in immune success patients, indicating continued immune activation.
 
The conclusion of this study is that after 2 years of anitiretroiviral therapy, which is suppressive, immune failure is associated with a lower CD 4 nadir, and is more frequently associated with older patients and men.  Diminished numbers of absolute CD 4 and CD 8 cells distinguish immune failure from immune success.  Immune activation of both CD 4 cells and CD 8 cells is indicative of.Immune failure, in treated HIV patients,and maybe a product of total T cell population,  It is linked to immune activation, turnover, and death of memory CD 4 T cells.

The story continues that HIV disease is an immune activating disease.  It is also almost a certainty, that antiretroiviral drugs will not kill the HIV virus.  What will kill the virus is either gene therapy or a stem cell supplement like Blue green algae.  Blue green algae releases the adult bone marrow stem cells in every person's body who takes the supplement 20-30 % after oral ingestion.
This along with the cytokine reducing property of the chlorophyll product in blue green algae, which suppresses inflammation, makes Blue green algae  very promising supplement to study.

The Schick foundation is studying it, has treated one patient whom we call Patient 0 on it, with good results.  A phase 2 study is about to be started.  A pre-IND # from the FDA has been granted and a permanent iND should follow shortly.  The results of this study should be available within 6 months with preliminary findings available in 3 months.

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Elevated D-Dimer but not CRP levels in HIV+ Patients Prior to Incident Myocardial Infarction of Other Cardiovascular Disease Event Ford. et al. From the NAID, NIH, Bethesda Maryland, Presented at CROI  (713), 2010.
 
HIV infection and duration of antiretroviral treatment are associated with an increased risk of Myocardial infarction (MI) in patients who are HIV+.There is evidence that HIV infection contributes independently to cardiovascular mortality, but the mechanism of so doing is unknown.

This study was a retrospective case controlled study of patients with incident cardiovascular disease events (MI, silent MI, acute coronary syndrome, coronary revascularization, stroke, or peripheral artery bypass, were matched 2:1 with HIV+ controls with respect to age, sex, and duration of follow up.  CRP, D-Dimer, pro-inflammatory cytokine and cytokine levels were measured on stored samples from 3 months and 2 years pre-event. Statistical analysis was done mainly by student T-test.

In this study 52 out of 1892 patients enrolled in NIH protocols since l995 had documented cardiovascular events.  The study showed that traditional cardiac risk factors, family history, smoking, and hyperlipidemia, and elevated levels of D-Dimer but not CRP were associated with impending Cardiovascular disease events in HIV+ patients.

Our foundation is initiating clinical trials using Blue green algae in cardiovascular disease patients.  This study shows the importance of not only measuring cardiac factors but markers of HIV infection.

D-Dimer especially turns out to be an important factor to monitor, more important that CD 4 count and viral load the traditional markers of HIV disease.  Again this is showing the importance of immune activation in HIV disease.  Suppressing immune activation is the way to control HIV disease and is probably more important in the final analysis than the traditional markers of HIV infection, CD 4 count and viral load.

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Cardiovascular events, Assessment, Predictors,and Outcomes  Ruhs, et al, Presented at CROI  Feb. 2010 Session 138
 
Recent studies suggest cardiovascular disease is increasing in HIV/AIDS patients.  HIV infection and certain antiretroviral drugs may be significant cardiovascular risk factors.  Additionally, non-randomized risk factors, such as lipodystrophy and chronic endothelial inflammation may impact the development of cardiovascular disease.  The actual risk in assymptomatic HIV+ patients is unknown.  Stress testing with nuclear perfusion imaging may be appropriate for HIV/AIDS patients especially i short-term global cardiovascular risk is intermediate or high.

Nuclear medicine stress testing is HIV/AIDS vs HIV- matched patients was done.  This was done to assess the cardiovascular risk.  The study was done in 80 HIV/AIDS patients and 50 controls.  They underwent fasting metabolic assessments and the nuclear medicine cardiac scan The mean age was 54, and the mean duration of HIV infection was 16.7 years.  HIV patients were more likely to be smokers.

The results of this study showed that assymptomatic HIV/AIDS patients may be at greater than 4.5% increased risk of having significant coronary artery disease  as assess by the cardiac scan as compared to the HIV- controls.  Abdominal hypertrophy and peripheral/facial lipoatrohy were the greatest risk factors in HIV/AIDS patients for developing cardiovascular disease.  This study shows that the nuclear medicine heart scan with stress testing was sufficient to ascertain the actual risk for HIV associate cardiovascular disease.

This study shows another place where Blue green algae can be used in HIV+ patients. It is to prevent cardiovascular disease.  The algae could also prevent some of the complications of cardiovascular disease which were thought in this study to be causative of cardiovascular disease.  The endothelial swelling may be ameliorated by Blue Green algae.  We are developing a protocol testing blue green algae and the role the algae may play in decreasing LDL lipids, the main causative factor of cardiovascular diseases.

Cardiovascular System

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Effect of in the rate of Cd 4 count Depletion during treated HIV infection  Phillips et al from the UK presented at CROI poster 315
 
The relevance of increases in viral load for increases in CD 4 depletion in HIV infection remains to be clearly determined.  The authors considered the CD4/VL measurements from antiretroviral naive patients  measured in the UK.  The extent to which the first base line vl  has to the effect of CD 4 depletion is very important. Time dependent VL measurements were also considered.  5940 patients onsecutive CD 4 counts were measured  from 1169 naive patients.  The average CD4 loss was 66 CD 4 counts per year. The average viral load increase was .09 log copies per year.  The change in CD 4 count was markedly greater in those that had a higher initial viral load.

The authors concluded that increases in viral load in untreated HIV infection is likely to be a significant cause in CD cell depletion.  The ongoing rare of current CD4 depletion can only be determined by the current viral load.  CD 4 depletion can only continue below a certain level if viral load is sufficiently high.

The authors relate to the old theory that viral load is the key factor in fueling HIV infection.  The consensus at CROI is while that certainly the virus initiates the infection the thing that keeps the infection going is immune activation.  Immune activation is the biggest reason why the anitretroviral medications lose their effect and is the reason why HIV infection will not be cured by antiretroviral drugs.

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Urgent Need for Coordination in Adopting Standardized Antiretroviral Adherence Performance Indicators  Chather, MBChb  From the Center for pharmaceutical Management, Management Sciences for Health,  J.Acquir. Immune Defic. Syndr. Vol. 53, Number 2, February 1, 2010
 
In recent years, global health initiatives gave greatly increased the number of patients in low-income countries started on ART' This creates an urgent need to know how well HIV/AIDS programs maintain patients on therapy. The recognized need for monitoring has stimulated donors to craft indices and guidelines to monitor their own ART programs.  To track the abundance of indicators for monitoring HIV/AIDS programs, UNAIDS maintains an indictor register, which in July, 2009 listed 251 indicators.  Surprisingly, not a single indicator in this registry referred to adherence.

Obviously the most common method of monitoring adherence is patient reporting of whether they have taken the ART.  However, self-report tends to overestimate adherence and very high self-repotted adherence rates make it an insensitive indicator for comparing facilities or  evaluation changes in performance over time.  Nevertheless, self reporting remains an efficient way to identify individual patient at risk because any patient reporting less than perfect adherence is likely to need further support.

Pill counts are associated with viral load and CD 4 counts according to some data presented however, they also represent adherence compared with electronic medication monitoring, which records whenever a pill box has been opened.  Pill counts also require an addition recording process.  This has proven unsatisfactory to pharmacists monitoring pill counting.

It is pretty amazing that trials have been successful with the tremendous variability in adherence.  The Schick foundation is studying in its first clinical trial of the substance which has been FDA approved for clinical trials Blue green Algae a supplement which is a bone marrow stem cell stimulator.  Most of our clinical trials in the future will involve the supplement Blue green algae.  In using this substance we do not have to worry about adherence.  Blue green algae in stimulating bone marrow stem cells has a marker in the blood the CD 34 T cell count.  If a patient is taking Blue green algae in the clinical trial the CD 34 cell count will rise.  Although this is not as sensitive as pill counting the combination of the two, patient reporting and the marker in the blood is probably enough to know that adherence is being maintained.

 

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The Association between Alcohol Consumption and Prevalent Cardiovascular Diseases Among HIV-infected and HIV-Uninfected Men  Fresberg, MD, et al, from the VACS Project Team  J. Acquir Immune Deflic Syndr.  Volume 53, No., 2 Feb 1, 2010.
 
The objective of this study is to whether alcohol consumption is associated with cardiovascular disease in HIV-infected veterans.  The authors used established standards for alcohol consumption   They used the NIH guidelines for alcohol use or abuse in that they are categorized into infrequent, moderate, and hazardous alcohol consumption.Infrequent or moderate use of alcohol is defined as consuming< than or + to 14 drinks per week and no binge drinking. Hazardous drinking is defined as > than 14 drinks per week or binge drinking.  Alcohol abuse or dependence was defined by the ICD-9 code for billing which is the documenting of alcohol abuse or dependence.

In the VA population alcohol abuse and dependence were common.  Among HIV infected men hazardous drinking and alcohol abuse and tendencies were associated with a higher prevalence of Cardiovascular disease when compared with infrequent and moderating drinking.  Among HIV-uninfected men, past drinkers had a higher prevalence of Cardiovascular disease.  The authors concluded that among HIV-infected men, hazardous drinking and alcohol abuse and dependence were associated with a higher prevalence of Cardiovascular disease compared with infrequent and moderate drinking even after adjusting to traditional Cardiovascular risk factors, antiretroviral therapy, and CD 4 count.

The factors that have to be considered is that now that HIV+ people are living longer the survivors most likely have been thru a tremendous amount of stress, and stress in an important indicator for alcohol abuse.  Many VA members who were not alcoholics before they got infected became alcoholics after they were infected.  Now that most of them will live longer, that is provided they make lifestyle changes.

Stopping alcohol use, diet and exercise are necessary for all HIV+ people.  They are also the best method along with lipid control and diabetes control for HIV+ people to prevent cardiovascular disease.

 

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Restoration of the antibody response upon rabies vaccination in HIV-infected patients treated with HART.  Luc B.sS. Gelinck et al  AIDS 2009, 23:2451-2458

 

The design of this study was to give Rabies vaccine as a T-cell dependent neo antigen to investigate several aspects of the primary and boosted immune response in vivo in HIV-infected individuals receiving antiretroviral treatment.

Study participants received rabies vaccination twice within a 2 month interval.  Serum samples were taken before and 1,2, and 4 weeks after both vaccinations and 1 and 4 years after the primary vaccination.  Anti rabies antibodies  were determined, antibody activity was measured after both vaccinations, T-cell subsets were characterized by flow cytometry.  18 healthy controls and 30 HIV infected adults were looked at via serum samples taken .The median CD 4 T-cells count was 537 cells/ul per person immunized.  The post vaccination concentration of antibodies IgG and IgM were significantly lower in HIV-inflected individuals as compared with controls.  Higher age was associated with lower post vaccination anti rabies IgG and IgM titers.  Five years after the primary vaccination,63 l% of the HIV-infected individuals still had antibody titers above the protection threshold.

The conclusion of this study was that immune restoration in HIV-infected individuals treated with hAART resulting in a CD 4 cell count greater than 500 cells/ul is incomplete.  However the majority of HIV-infected individuals are capable of mounting a long-lasting immune response, including several pivotal t;celll-depended processes, upon vaccination with a neo antigen such as the Rabies vaccine.

 

Rabies

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HIV treatment reduces risk of death from all causes   HIV Weekly, January 6, 2010
 
Rates of HIV-related diagnoses and deaths plummeted once effective, combination HIV treatment became available in l996.  This very large study involved over 62,000 patients from Europe and the US.  They started HIV treatment between 1996 and l998.  Mortality rates were compared between those who started HIV treatment and those who did not.  Taking combination HIV treatment reduced the risk of death from any cause by 52%.  Treatment was especially beneficial for patients with a low CD 4 cell count.  But a reduced risk of death was also seen if treatment was started when an individual had a CD 4 cell count around 350.  Those who started HIV treatment a CD 4 cell counts around 500 had the lowest overall risk of death.  New US treatment guidelines now recommend HIV treatment with CD 4 cell counts up to this level.

All the data is pointing to starting therapy earlier.  We have believed that once a patient tests positive for HIV he/she should start therapy immediately after counseling.

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Duration of infection with HIV increases risk of hardening of the arteries.  HIV Weekly January 6th 2010
 
Researchers using computerized scanning of the coronary arteries found that hardening of the coronary arteries was more severe in the men with HIV.  It was 34 % higher than HIV- men.  7% of men with HIV were so hardened that the flow of blood was restricted. Looking at many factors associated with hardening of the coronary arteries the only factor that was significant was the longer the duration of HIV infection the greater the risk.  The authors reason for the above data that everyone should have antiretroviral treatment when their CD 4 count is 350.  For those who have other risk factors like genetic factors, smoking, the authors recommend starting treatment earlier. 

Artery

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HIV and Cardiovascular Health  HIV Weekly January 6, 2010
 
Cardiovascular disease such as heart attack and stroke are now an important cause of illness and death in people with HIV.  Recently published research suggest that HIV may be a significant cause. Blue green algae causes less inflammation of the coronary arteries and may ameliorate this condition in HIV patients who take blue green algae under protocols conditions that we are establishing at the Peter Schick Foundation.

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Immune Reconstitution inflammatory Syndrome in the HIV-Infected Patients  Robertson, MD, et al, IAS Web Core activity
 
 
As it pertains to HIV-infected patients, the immune reconstitution inflammatory syndrome (IRIS) is a systematic inflammatory response that may lead to deterioration of the patient's condition.  IRIS in the  setting of HIV infection occurs following initiation of antireteroviral therapy and is caused by the restored ability of the immune system to mount an inflammatory response to  specific pathogen or the occurrence of an inflammatory condition not known to be due to a specific pathogen  (eg. Graves disease).  HIV clinicians should be aware of the diagnosis and manage of this syndrome.

This activity as been substantially updated to reflect recent changes in the guidelines for prevention and treatment of Opportunistic infections in HIV-Infected Adults and Adolescents developed by the national Institutes of Health, the Centers for Disease Control and Prevention, and the HIV Medicine Association of the Infectious Disease society of a/America. 

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High-Dose Seasonal Flue Vaccine Approved for people 65 and Older  Journal Watch Jan.5,2009
 
The FDA has approved a high-dose seasonal influencza vaccine for people 65 and older.  The theory is that immune functions weaken with age and that the elderly are especially vulnerable to complications from seasonal influenze.

The vaccine, marketed as "Fluzone High'Dose" contains four times the total amount of viral hemagglutinin found in other seasonal vacines.  Common side effets were more frequent with the high-dose than with regular-dose size formulations, but the rate of serious adverse events ws no higher. Since the product received accelerated approval, the manufcuter must conduct further studies to verify the higher efficacy of the vaccine among older people.

People with HIV infection should consider taking this vaccine, especially if their immune functions is weakened which is true in all HIV+
patients.

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Smoking Cessation Associated with Short-term increase in diabetes Risk  Journal Watch Jan. 5, 2010. Annals of Internal Medicine
 
 
Adults who quit smoking face increased risk of type 2 diabetes during the first several years after quitting.  Researchers followed nearly 11,000 middle-aged adults for roughly 9 years, during which about 12% developed diabetes.  Compared with adults who never smoked, those who continued smoking during follow-up had a roughly 30% increased risk for diabetes, while those who quit smoking by year 3 had almost a 75% increase in risk.  The elevated risk among these new quitters seemed to be mediated by adverse metabolic changes, including weight gain and system inflammation.
 
The authors write "Of course, smoking cessation has many beneficial health effects that outweigh the short-term risk for diabetes.  Nevertheless,physicians should be aware of this elevated risk and should consider countermeasures like lifestyle counseling, and aggressive without management, especially for heavy smokers."
 
This is an interesting study.We are studying in our foundation the treatment of Type 2 Diabetes with Blue green algae.  We think there are several reasons why HIV+ patients should consider taking Blue green algae.  Blue green algae in our eyes is a treatment for Type 2 diabetes proven in a small phase 2 trial. Why was it successful, because it cuts down the inflammation associated with the small vessel disease associated with Type 2 diabetes and may even improve the blood flow to the Pancreas by increasing the blood flow and decreasing the inflammation in the arteries that feed the pancreas.  We have also developed a protocol for Blue green algae use in obesity.  It help obese patients, and that has got to help diabetic patients also.  In fact Blue green algae as a supplement would seem to help the metabolic syndrome, Obesity, type 2 Diabetes, Hypertension, and cardiac disease.

Breaking cigarette

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High-Dose Seasonal Flue Vaccine Approved for people 65 and Older  Journal Watch Jan.5,2009
 
The FDA has approved a high-dose seasonal influencza vaccine for people 65 and older.  The theory is that immune functions weaken with age and that the elderly are especially vulnerable to complications from seasonal influenze.

The vaccine, marketed as "Fluzone High'Dose" contains four times the total amount of viral hemagglutinin found in other seasonal vacines.  Common side effets were more frequent with the high-dose than with regular-dose size formulations, but the rate of serious adverse events ws no higher. Since the product received accelerated approval, the manufcuter must conduct further studies to verify the higher efficacy of the vaccine among older people.

People with HIV infection should consider taking this vaccine, especially if their immune functions is weakened which is true in all HIV+
patients. 

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Year in Review 2009:  HIV/AIDS Clinical Care Journal Watch AIDS Clinical Care.  January 4, 2009
 
In reviewing the stories for 2009,one is struck by a remarkable sense of progress in the field, especially in prevention.  Unlike last year, when disappointing studies in this area seemed to dominate the headlines, the past year brought first-ever positive signals for vaccines and microbicides (although the latter was tempered by a later negative report), plus a growing appreciation that HIV treatment itself is a remarkable effective way to prevent HIV transmission.  Although there is a relative lack of novel new agents in development, the reason behind this shortage is only positive--our currently available therapies are more effective than ever, so much so that treatment guidelines are moving in the direction of recommending therapy for virtually everyone with HIV infection.  What will the next year bring.  No one can foresee the future. 

There are however much-anticipated studies of pre exposure prophylaxis expected, along with undoubtedly, incremental advances in our understanding of how both HIV infection and treatment influence the increasing number of patients who are growing old due to effective therapy; I say that the latter is the most important to HIV+ patients, and that is to be not stigmatized, not discriminated against, and when they are healthy, mainly because they are living a healthy life, to grow old.

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The Year of 2009 in Review; The top 10 Stories of the year 2009
 
1. The Data Continue to Support Early Antiretroviral Treatment for starting HIV treatment... and now the guidelines do too.
 
2. The ongoing Search for New Prevention Technologies
 
3. Stem-Cell Transplant and the Prospect for an HIV Cure
 
4. HIV treatment as Prevention
 
5. IL-2 does not benefit HIV-infected patients
 
6. Raltegravir--Beauty and the Beast
 
7. Abacavir and Cardiovascular disease---More Data but No Consensus
 
8. Early ART in the setting of Acute OI's
 
9. HIV Drg Pipeline Promises More Fixed-Dose Combinations

10. More Progress on preventing HIV infection in Infants.
 
These were the l0 greatest talked about stories in 2009.  If I were to pick one of these it would be #3.  Stem Cell Transplantand the prospect for HIV cure.  Our foundation is beginning shortly a phase 2 study of blue green algae in HIV+ who are virologically undetectable on antiretroviral therapy;