From Paris: Beyond ‘The Mississippi Baby’ and scary news for transgender women

Photo courtesy Pixabay

The latest HIV news is way too impactful not to report.

Longtime followers of my page know that I essentially made a name for myself in health reporting because of my always-first coverage of HIV issues for several national websites from 2013 to 2016.

Over time, clients have changed, and my HIV reporting has fell by the wayside. I plan to do my darndest to change that soon, with or without paid HIV reporting clients.

Today there are several exciting developments to report. It’s all coming out of the International AIDS Society Convention going on right now in Paris.

Beyond ‘The Mississippi Baby’

Conference attendees learned today that a South African child has been in HIV remission, without drugs, for almost a decade.

You might remember the so-called “Mississippi Baby,” which managed to live HIV-free in theory because doctors detected the virus at birth. The child immediately was put on antiretroviral medication, but the virus rebounded once the medication stopped.

But 10 years in remission, without drugs, is a new accomplishment altogether.

“Further study is needed to learn how to induce long-term HIV remission in infected babies,” said Anthony S. Fauci, M.D., director of the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH). “However, this new case strengthens our hope that by treating HIV-infected children for a brief period beginning in infancy, we may be able to spare them the burden of life-long therapy and the health consequences of long-term immune activation typically associated with HIV disease.”

Read more: Hearing Dr. Fauci of the NIAID speak at ACP Convention a huge thrill

According to a news release from Fauci’s office, “Before starting treatment, the child had very high levels of HIV in the blood (viral load), but after beginning ART at about 9 weeks of age, treatment suppressed the virus to undetectable levels. Investigators halted treatment after 40 weeks and closely monitored the infant’s immune health, and the child has remained in good health during years of follow-up examinations. Although it was not standard practice in South Africa to monitor viral load in people who were not on ART, recent analyses of stored blood samples taken during follow-up showed that the child has maintained an undetectable level of HIV.”

In a nutshell, this is huge.

“To our knowledge, this is the first reported case of sustained control of HIV in a child enrolled in a randomized trial of ART interruption following treatment early in infancy,” said Avy Violari, F.C.Paed, in the NIAID news release. Dr. Violari co-led the study of the case reported today.

“We believe there may have been other factors in addition to early ART that contributed to HIV remission in this child,” added Caroline Tiemessen, Ph.D., whose laboratory is studying the child’s immune system. “By further studying the child, we may expand our understanding of how the immune system controls HIV replication.”

Hormone therapy for transgender women may interact with HIV medications

Unfortunately, there is also bad news coming out of Paris today: Hormone therapy for transgender women may interact with HIV medication.

This is particularly alarming given the fact that transgender people already are at tremendous risk for HIV infection.

Read more: Does cannabis slow the spread of HIV? My 2014 report

According to the NIAID news release:

“Despite all indications that transgender women are a critical population in HIV care, very little is known about how to optimize co-administration of ART and hormonal therapies in this population,” said Jordan Lake, M.D., study leader at the University of California, Los Angeles David Geffen School of Medicine, who is currently continuing this research at the University of Texas Health Sciences Center at Houston. “This study suggests this void of information may mean some transgender women forgo life-sustaining HIV medications, identity-affirming hormone therapy, or some combination of the two. By exploring the extent to which this is happening, we can find ways to better serve this population.”

The study included 87 women receiving treatment at a community-based AIDS service organization in Los Angeles.

Says Fauci: “The best thing a person living with HIV can do is to start and stay on safe, effective antiretroviral therapy, both to maintain their own health and to prevent sexual transmission of the virus. We need to ensure we understand the perspectives of groups disproportionately affected by this pandemic to provide the best health care for them. Further study is needed to help determine how health care teams can optimally tailor care and treatment for those living with HIV.”

Read more: My 2014 special report on why supporting the transgender equality movement is a matter of public health

Stay tuned to @DavidHeitzHealth on Facebook, @DavidHeitz on Twitter, and DavidHeitz.com for more news coming out of IAS.

From AIDS to Zika: Dr. Fauci has served six presidents. Great keynote address.

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National Institute of Allergies and Infectious Diseases Director Anthony Fauci has served six presidents over the course of his 33 years in that position.

Not only is his tenure staggering, but so is its framework: He has been our country’s infectious diseases chief from the first day of HIV.

Getting to hear Fauci speak to thousands of doctors Thursday during the opening ceremony and keynote address of the American College of Physicians Internal Medicine meeting was incredible. More than 800 doctors alone are attending this conference from foreign countries, not to mention the hundreds, even thousands of doctors from around the U.S. who are here, most internal medicine specialists. The grand ballroom literally was packed elbow to elbow, seat to seat, people standing, lining the walls.

Fauci is an amazing speaker. He has a way of getting straight to the point and often offers little tips. Tomorrow, he said, an announcement will be coming out of Washington regarding phase II trials for a Zika vaccine. So maybe I just broke that news, right here!

Thus, the title of his address this morning was, “From AIDS to Zika.”

“Extraordinary parts in your life that you never forget,” is how he remembers the first reports of AIDS trickling in, long before we even had a name for the disease. “I was sitting in my office at the NIH clinical center and this came in front of my desk, this report, the MMRW (Morbidity and Mortality Weekly Report issued by the U.S. Centers for Disease Control and Prevention) reporting five gay men from Los Angeles with the strange situation of being otherwise healthy, also strange, curiously all gay men, with (pneumonia).

“I thought this was just a fluke, didn’t make much sense. A month later, when the second MMWR came about, now 26 men, not only from L.A., but from San Francisco, New York, and not just with (pneumonia), but also Kaposi’s sarcoma and other opportunistic infections.”

Little did Fauci know that he had come into one of the most powerful medical positions in the world just at a time when the world needed him. “And it was at that point that I really turned around the entire direction of my career and start to study this extraordinary disease,” Fauci said. “Not every outbreak was (or is) going to have global importance. This is one that was not perceived (as such) at the time, but actually did.”

Zika a new threat as mosquito transmitted or sexual transmissions multiply

Fauci admitted that Zika is now being transmitted in ways other than anyone who ever had traveled to a place where Zika previously had been present. He said “a perfect storm of global health mishaps occurred” to create the Zika crisis. He said details of a phase II Zika vaccine will come out of Washington tomorrow. He said development of the vaccine is an urgent matter.

“There’s basically not health care system in those countries and a distrust of authority,” Fauci said of Liberia, Sierre Leone, and New Guinea, where most of the 28,000 cases of Zika and 11,000 deaths have occurred.

“There are more doctors on K Street (in Washington D.C.) than in the entire country of Liberia,” Fauci said. “Now that is very difficult to swallow, but it is actually the truth.”

A methed up life turned boldly around: A gay man’s inspiring story of recovery

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This piece originally was published June 6, 2016, on Healthline Contributors, which no longer is live. Reprinted here with permission from Healthline. Christopher was a great interview and ought to serve as an inspiration to many, especially for his frankness in sharing his story. His story is not the least bit uncommon and is being played out right here in the Quad-Cities. What is described here is NOT a big-city phenomenon, in the least. I admire frankness. Best to you, Chris!

In the picture shown above, Christopher Interdonato believes he was near life’s end. Addicted to crystal meth, which he shot up, and barely surviving on the streets of Los Angeles as a sex worker, he got to a point where “I felt like I was dying. I could no longer move.”

The picture you see here nearly brings me to tears, not only because of the sad vulnerability expressed on the young man’s face, but because I once was addicted to meth, malnourished, unhealthy, desperate, hopeless about life, and certainly without even an ounce of self-respect. It’s impossible to get sober (or at least sustain sobriety) when you have no self-respect.

Interdonato lay there like that for a few days, his veins so collapsed doctors could not extract blood to get a diagnosis. When they finally did, Interdonato learned he had HIV.

While HIV is a manageable disease these days, there still is no cure, and you’re required to take pills for life (although long-lasting injectable forms of HIV treatment are in the works).

Read more: An injectable HIV treatment could be ready by next year

In a couple of weeks, Interdonato will celebrate two years sober. A far cry from what you see in this picture, he is strikingly handsome, healthy, and works as a house manager and case manager at a rehabilitation center. In August, he will go back to school full-time to become a certified alcohol and drug counselor.

How Interdonato ended up in the abyss

Interdonato moved to Los Angeles in 2011 after living a year in Orange County (the suburbs to the south) first. Ironically, that was the same trajectory I took when moving to Southern California after college in 1992.

Interdonato worked for the circus, Cirque du Soleil. But when his contract ended, he found himself in a frightening position – homeless on the streets of L.A.

Interdonato had tried meth once at a bathhouse in Seattle, but he didn’t like it. In fact, “I hated it at first. I stayed up so long.”

But like so many young men who find themselves homeless on Tinseltown’s streets, the drug’s hyper-stimulating side effects – the power to keep you up for days at a time – offered a bit of safety, the thought process often goes, as opposed to falling asleep in the big city. “I was in a city where I knew no one,” Interdonato said.

The other side effect? Intense sexual arousal that allows already virile young men to perform for hours and hours and hours and hours.

Read more: Hooking up to stay alive: The sexual exploitation of young men and boys

Interdonato says he doesn’t want to be portrayed a victim as it pertains to his days as a sex worker. “I was never forced into anything,” he said. “I made a conscience decision to do what I did to support the lifestyle I had. I never had sex for the drugs. I always had my own drugs. I sold the drugs, too.”

Read more: Six signs that you are ready to get sober

I asked him why, like many sex workers in Los Angeles, he didn’t just hustle the streets sober, and pocket even more of his money as opposed to spending it on drugs. “Prostitution is not something I can do if I’m not high,” he said. “So when the drug use stopped, for myself I was not able to continue doing it because I felt dirty.

“Part of getting sober for me was about my self-esteem. It wasn’t just about rebuilding my body. And today sex is not the only currency I haveI have more to offer than that.”

Meth a huge problem in gay mid America as well

Unfortunately, I understand Interdonato’s story all too well. While I always had a job and never had to hustle to survive, I left Los Angeles in 2000, and a second time (for good) in 2002, horrifically strung out on crystal meth.

When I returned to the Quad-Cities, meth again reared its head a few times. But as I always told people rather frankly, the meth here was crap compared to what I snorted (and smoked) in Los Angeles, so I never slipped way back down the slope. I did, however, abuse cocaine, marijuana, and alcohol. I celebrated two years sober last month. (Editor’s note: It will be three years in May 2017).

And thank God I am sober, and very confident in my sobriety. If you can say, “I’m an alcoholic and an addict,” and know that you can never take another drink, never snort another line, you have won more than half the battle. And I know I am an alcoholic and addict. For me, using again isn’t an option.

So, I’m glad I left behind the party scene and the bar life when I did, as now the methamphetamine problem right here in the Quad-Cities, in mid-America, is as bad as it is in the urban gay meccas.

Headlines beginning in the spring of 2016 in the Quad-Cities illustrated this, so there’s no point of regurgitating it here. People still are talking about it. Indeed, eye-popping stories, and I suspect we will see more of them.

People are quick to point fingers at places like Los Angeles, San Francisco and New York City as hedonistic harbors where young, gay men can go astray. But the Quad-Cities is not one bit different. In fact, I believe it’s worse, as there is a void in terms of affirming support services. Mental health services in the Quad-Cities are wildly substandard, particularly for those who do not have private insurance and/or belong to a minority group.

While the Los Angeles LGBT Center is known for civil rights advocacy and being front and center at flag-waving festivals, it also is a lifeline for people like Interdonato. It absolutely 100 percent supports and helps anyone who is struggling with a drug problem, homelessness, and HIV/AIDS. It is a world-class non-profit organization offering world-class services, including the Jeffrey Goodman ClinicCrystal Meth/Addiction Recovery Serviceslegal services, and pretty much anything else you can think of. Interdonato is living proof of the life-changing work that this amazing organization provides.

It’s why I’m covering AIDS LifeCycle this year for absolutely zero financial gain.

Interdonato said he already was familiar with the services of the Los Angeles LGBT Center even before his hospitalization and HIV diagnosis. He regularly went to the Center for HIV/STI screenings and post-exposure prophylaxis, or PEP, after he believed to have been exposed to HIV in the past.

“I represent that percentage of the population of our community…unfortunately, in the gay community there’s a high incidence of people who struggle with drug and alcohol addiction, and there is a high incidence rate of contracting HIV as part of it,” Interdonato said. “That’s my reason for riding, besides for thanking the L.A. LGBT Center for getting my life on track, but by being an example of a sober young person in recovery, who is HIV-positive, and hopefully I can help someone by showing them you can be as low as you can get and it is possible to recover from drug addiction and live a healthy life. Even as an HIV-positive gay man.”

Sharing my personal story with HIV as I ready for AIDS LifeCycle

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Editor’s note: I wrote this story in April of 2015, but I’m re-posting with permission from Healthline on my own website since Healthline’s Contributors site has gone dark.

I moved to Los Angeles in 1992 after graduating from college. As soon as I got there, I kicked the closet door down and decided to act on three words I never before had been able to say: I was gay.

I called a gay chat line and nervously struck up a conversation with the first guy I was connected with. I can’t remember exactly what I said, but I remember what he said:

“So, let me get this straight. You’re from the Midwest, you’re 22, you have decided you’re gay, and you’re ready to come out to the first person you meet on a chat line and have sex with him?”

I said, “Yes. Well, maybe.”

He said, “I’m not going to have sex with you, but meet me at the Blue Marble Coffee Shop in Costa Mesa.”

Read more: A link to my “celebrity interviews” page

And I did meet him. He was an older man, a professional, and we sat and had coffee. He told me all about HIV, what was safe and what wasn’t safe, and even the best number to call for phone sex at the lowest rate. “You’ll rack up phone and credit card bills otherwise,” he warned.

He told me about the Orange County Center for Gays and Lesbians, where I immediately began attending the young adult support group.

He was just a nice man who expected nothing. He sensed a “fresh off the boat” Midwestern boy about to enter a dangerous world. Sure, he was looking for something. But not sex, at least not from me, someone his junior and a “gay adolescent,” as he described me.

He has been a mentor to this day. You just don’t find those kinds of decent people everywhere.

I Once Was a Circuit Boy And a Meth Head

In my role as a journalist writing about HIV, I don’t think I ever have written about my own experience with the disease. But as I get ready to report from California AIDS/LifeCycle in a couple of months as an embedded reporter, I thought I should share it.

I am HIV-negative despite the fact that I spent a couple of years as a West Hollywood circuit boy and, unfortunately, a couple more years after that simply a strung-out mess. It pains me that crystal meth still is a crisis in Southern California. It is entirely intertwined with HIV. I wrote a little bit about that last summer in this story for Healthline.

I am lucky. From day one I had the best information about HIV prevention available, not only because I worked in the news business, but also because of good people who happened to enter my life at the right time – right down to that first guy I met off a chat line.

But as time went on and I celebrated that joyous feeling of coming out, soon I was hitting the clubs, snorting drugs and being pretty free with love (albeit safely … I used condoms every time … and I would have for sure chosen PrEP back then had it been available to me).

Working as executive news editor of The Advocate and later as executive news editor of the Press-Telegram in Long Beach, I would spin like a top until dawn on Sunday mornings at a nightclub in Hollywood called The Probe. There was a big gang of us who all had met in Orange County and “came out” together. We called ourselves “The Unapproachables.” Boy, we sure thought we were all that!

And then one day came the knock on the door of my West Hollywood apartment. One of the key people in my little gang, the one we called “Julie the Cruise Director” no less, came in with his boyfriend and dropped the news. He was HIV-positive.

Spreading the Word to Those Not as Lucky as Me

Looking back, I worry I sounded insensitive with my reply. “Well, it’s not the end of the world. I’m sure you’ll be fine.” We had been writing a lot at The Advocate at that time about what was then a new breakthrough in HIV treatment: protease inhibitors.

We also were writing stories about the viaticals going out of business. Viaticals were companies that bought out the life insurance policies of dying people so they could enjoy the money while they still were alive.

For the most part, my little group from Orange County has weathered the HIV epidemic well. I think of a core group of about 10 of us who ran around in the 1990s, two, maybe three, became positive. Of course, three is too many, but all three are healthy to the best of my knowledge.

I think it’s honest to say most of us came from pretty privileged backgrounds with access to timely information about HIV and great health care. Living in Southern California, even in the 1990s, there was very little stigma directed at gay people. Most of us migrated from Orange County to Los Angeles a few years after coming out, and life there is about as open as it gets for gay people in the U.S.

Unfortunately, HIV continues to shatter the lives of people who don’t have access to the things we did – basic things like accurate information so they can make informed decisions related to sex and drugs, and places to get tested and treated. Just look at Southern Indiana: Poverty, lack of education, extraordinary stigma and a government that criminalizes HIV. In fact, most states do have HIV criminalization laws, something many people find shocking.

Whether I’m writing about how African-American leaders are tackling HIV in their communities, why you need to get behind the transgender equality movement, or the hazards of HIV and smoking, I try to make sure my stories reach people who will find them useful and on whom they will have a lot of impact. I try to stay on top of how HIV affects all kinds of communities, from women to the Deep South, now considered the epidemic’s epicenter.

When Career and Life Intersect for a Ride

That all of my skills and life experiences have converged into making a living working from home, writing about HIV for various online clients, is pretty awesome. Having the opportunity to work as an embedded journalist for AIDS LifeCycle is just incredible.

Now that I’ve shared my not-so-uncommon story about HIV, I can’t wait to share the stories of others. Everybody rides for different reasons. And as a Los Angeles Times billboard campaign once proclaimed about news in general, “In every person there is a story.”

What is California AIDS/LifeCycle? It is a 545-mile bike ride (not a race) the first week of June down the California coast – from San Francisco to Los Angeles. Nearly 3,000 riders will raise more than $15 million to benefit the San Francisco AIDS Foundation and L.A. Gay and Lesbian Center in their fight against the disease.

In addition to profiling many of these amazing riders, I’ll be shooting videos for Healthline’s You’ve Got This project, which offers support to people newly diagnosed. I’ll be tweeting too, as well as posting updates on Facebook for Healthline, Imstilljosh and my own David Heitz Health.

I’ll be writing more Contributor pieces about AIDS/LifeCycle leading up to the event in the next several weeks. What goes into putting on the event is a column in and of itself. And the experience of camping while traveling down the coast? I can’t even imagine what that’s going to be like. I’m not known for my camping skills!

Please feel free to find me and say hello if you plan on riding this year. I’ll be in a black T-shirt with “MEDIA” stamped on it. Can you believe they had no XLs, and one person actually ordered an XS?

SO L.A.

🙂

This is sure to be the opportunity of a lifetime, and I can’t wait to tell so many inspiring stories.

(Photo courtesy AIDS/LifeCycle … and that perfectly fit man is not me… and I’ll be riding in the media van, not pedaling.)

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Why I briefly stopped writing about HIV, but will get back into it in 2017

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This is a column I have been thinking about writing for so, so long. What better way to clear the air on this subject than to make it my first piece of 2017?

A few days ago, I received a package from Gil Diaz at the Los Angeles LGBT Center. He sent me the T-shirt and “Kleen Canteen” pictured with this piece. God bless you Gil, by the way, for thinking I can fit into a medium.

I served as one of the official journalists of AIDS LifeCycle the past two years, which was an awesome experience even though I was unable to do the ride, both years, due to outrageous, unbelievable-unless-you-live-here events in my personal life that coincided with the ride two years in a row.

I’m going to start posting some of my Healthline Contributors pieces on AIDS LifeCycle beginning tomorrow. Healthline Contributors recently went dark but Healthline gave me permission to re-post my work on my own site. Many thanks to Healthline.

My journalism career essentially was brought back from the dead in 2013 when I began writing for Healthline News, primarily about HIV. I had left the workplace at the end of 2010 to focus on taking care of my dad and myself. When dad went into the hospital, and then a nursing home, and then a memory care facility, I got back to work.

Writing about HIV, for me, was sort of like a duck to water. While I do not have HIV, I certainly once lived the life of someone at extremely high risk of infection. I also worked as executive news editor of The Advocate just as protease inhibitors came out and people with HIV, still alive today, were saying, “Damn! I never should have sold my life insurance policy to the viatical!” It was a positive turning point in the epidemic that continued in that direction of progress for many years, up until recently.

Which is depressing. But that’s not why I stopped writing about HIV. At least not directly.

Watch for more of the same science-based reports I used to write for Healthline

I have a new client, Vital Updates, and I know they want me to start writing more about scientific developments related to HIV. Here’s a piece I wrote just last week regarding people with HIV having double the heart attack risk. I encourage the HIV scientific community to start sending me news releases again.

Many things converged all at once that caused me to stop writing about HIV. I survived a horrifying assault the last night I ever took a drink, Memorial Day 2014. Around the anniversary date of that assault, something traumatic happened to me again. I have written about these things piecemeal rather extensively, and people in the HIV community who worked closely with me around the time that they happened know the details and hopefully understand. I apologize if I ever offended any of them, and I’m sure I probably did.

It all was so traumatic, that I have since “ghosted” anyone, anyplace, or anything that was part of my life when these horrific events went down, simply to avoid triggers. I have stopped short of moving because my dad did not leave me the family home, and I have not sunk a bunch of money into remodeling it, to just up and leave. I’m. Not. Going. Anywhere.

Even though most of the people, places and things in my life (I have changed grocery stores, banks, everything) had NOTHING to do with the traumatic event itself, PTSD doesn’t really differentiate when it comes to triggers. If they were a big part of your life when that bad stuff happened (and in the case of HIV, relate to the trauma in an unfortunate sense because it’s a topic you write about professionally) you must just step aside for a while and catch your breath to move past it.

And what happened to me did have a lot to do with HIV, as far as I’m concerned, even if I am not infected. I thought about getting into that a bit in this piece, but I’ll save that for a later date, if I ever feel comfortable writing about it at all.

Read more: After being raped in 2007 and assaulted in 2014, I finally put down the bottle

Then there is the matter of Danny Pintauro

When Danny Pintauro first told Oprah, and then went on The View, about contracting HIV while high on crystal meth, boy did I ever just want to hug him. I, too, had a RAGING crystal meth addiction when I lived in Los Angeles (and sadly, it’s ravaging the community where I live now, the Quad-Cities, my hometown, all these years later).

Suddenly, several of the bi-coastal gay opinionmakers emerged with fierce nastiness. They attacked Danny for taking personal responsibility for his addiction (he never said he was a “moral failure,” he simply took PERSONAL RESPONSIBILITY. This is what you’re supposed to do if you want to better yourself.)

BUT WORSE, so much worse, is that they began attacking him for saying he contracted HIV from oral sex. Let me tell you something: When you have bleeding, open, oral apthous ulcers, which you get from doing tons and tons of meth (particularly smoking it), it doesn’t take a rocket scientist to know that hell yes you can get HIV from oral sex. These “activists” who blasted him and claimed otherwise were talking out their blowholes. Period!

I, too, had the oral apthous ulcers at one time in Los Angeles. I also had all the symptoms of acute HIV infection and ended up going to the doctor. The doctor was certain I was infected and even surmised I got it through oral sex because of the oral apthous ulcers and my sexual history of the previous month. Danny’s story rang true with me in every. Single. Way. The attack by the bi-coastal gay opinionmakers was unwarranted, irresponsible, and a bunch of poo. Period.

PrEP: A great tool for many, but causing problems, too

That brings me to PrEP, and the “sex positive” campaigns. From day one, I said that I DO NOT think Michael Weinstein is a “nut.” I think he believes what he says, and I understand where he is coming from, even if I don’t always agree with him.

What has happened since PrEP? STIs. THROUGH. THE ROOF. Truth. Period. Many gay men, particularly those already at elevated risk of HIV infection, don’t need encouragement in being promiscuous, especially with crystal meth raining down like confetti all over the U.S. I speak from experience. For many years, I was as promiscuous as they come. For me, it was about my drug and alcohol abuse more than anything else. Once I got sober, the promiscuous behavior just stopped. Because it’s not who I am.

It’s nothing short of a miracle that I am three years sober in May, but miracles do happen, and can happen for anyone who wants to change. There’s a lot of great help out there.

At the same time, the mantra of “impossible to transmit if undetectable” is dangerous, in my opinion, because it largely is based on the trust of your partner, who you may not know very well at all. Let’s face it, in the era of Grindr, Scruff, Craigslist, etc., many gay sexual encounters are with partners people don’t know a whole lot – if anything — about. And “impossible to transmit if undetectable” does not jive with what doctors have told me for years, which is that viral loads can blip. So, for the people who frequently use those platforms, PrEP probably is a good idea if they’re not using condoms (but who really wants a strain of potentially untreatable gonorrhea anyway?)

While even I at one time scoffed at Weinstein’s insistence that condoms shouldn’t be thrown out like the baby with the bath water, let’s face it. He has turned out to be right. I know that is very painful for many people!

I may be sexless and out of touch, but my experience is not unique

Admittedly, the issue of HIV doesn’t directly affect me right now as much as it has in the past. I have not had sex of any kind in over three years, and see nothing but a sexual desert on the current horizon. So admittedly, I am “out of touch.”

I realize that is not “normal” in the view of many gay men, or even healthy. Naturally I hope the “drought” doesn’t last forever, but when you don’t have anyone in your life who you want to have sex with, why would you have it?

Another point I want to make: I have heard numerous reports from people my age and older who told me they stopped using PrEP after suffering bone density loss and kidney problems. I can assure you, these are people who love sex, are not “prudes,” but felt the medication was doing more harm than good. It’s a personal choice.

Please read this excellent Los Angeles Times piece on Truvada if you never have. Outstanding reporting.

I want to end this way-too-long piece with this. Since I stopped writing about HIV, I have lost lots of followers to my Facebook page who used to follow me for HIV news. And that’s understandable. Yet I have more page likes than ever before, because now I write about other things, too.

Here’s my point, and why I fully intend to start writing about HIV more frequently: The stigma and the ignorance about the disease still is SO BAD, that when I do write about HIV these days, I lose page likes. Every. Single. Time.

For sure this piece will cost me plenty of followers. And that’s fine. I believe in authenticity, I still support every effort to encourage HIV testing, access to affordable treatment for all, and the realistic goal of ending the epidemic once and for all. I plan to continue to do my part in helping to accomplish that.

Could an anti-cocaine vaccine help prevent HIV in the process?

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(Photo illustration courtesy of Pixabay)

When I first began to write about PrEP, the HIV prevention pill, I remember someone saying, “Back in my day, we would have been lining up around the block for a pill to prevent HIV. But today’s gay men aren’t.”

Another quipped that gay men “are more interested in ecstasy than a pill to prevent HIV.”

True or not, a brand new medical development raises similar questions. In some ways, it too could be a new tool in HIV prevention. Weill Cornell Medicine and New York-Presbyterian hospitals are now enrolling volunteers for a phase I clinical trial for a cocaine vaccine. That’s right – a vaccine that would prevent you from getting high on cocaine. You could toot up as much as you’d like, but you wouldn’t get high.

Cocaine use among gay men often fuels intense sexual sessions where HIV transmission can become more likely.

“Cocaine addiction is a huge problem that affects more than 2 million people in the United States, and results in more than 500,000 annual visits to emergency rooms,” principal investigator Dr. Ronald Crystal said in a Weill Cornell Medical College news release. “While there are drugs like methadone designed to treat heroin, there aren’t any therapeutics available to treat cocaine addiction. We hope that our vaccine will change that.”

Good cocaine is hard to put down

When I moved back to the Quad-Cities in 2002 to get away from Los Angeles and a raging methamphetamine addiction, and also to care for my dad, for a long time all I did was smoke pot. But when I got back into the bar scene, and was introduced to “good” coke, that became a problem for me too. At one point, most of my paycheck was going to the coke dealer.

At some point in 2012 or 2013, those of us in the coke crowd began to say, “Hey wait a minute. This stuff isn’t coke.”

While dealers often doled out baggies of Calumet, what finally got a lot of us to quit the “coke” wasn’t so much getting ripped off with total crap (as addicts, we were still dumb enough to buy it). Most of us quit using it when it began to keep us up all night, cause us to break down, and generally feel extremely unwell.

It now appears due to certain arrests in the past year or so that we probably were being dealt meth and being told it was coke. Had that good coke continued to flow, I’m not sure I ever would have been able to give it up, and then finally give up cigarettes, alcohol, and marijuana, in that order.

So yay for a potential cocaine vaccine.

How would a cocaine vaccine work?

“While most drugs that target addiction are designed to disrupt some process in the brain, this vaccine, called dAd5GNE, is meant to absorb cocaine in the bloodstream – well before it has had a chance to pass the blood-brain barrier and later produce a dopamine-induced high,” according to the Cornell news release.

The vaccine works by attaching GNE, a cocaine-like molecule, to an inactive virus for the common cold. When the body recognizes the virus and unleashes antibodies, it also will learn to attack cocaine as an enemy, the reasoning goes. The body will respond with a flood of anti-cocaine antibodies, each meant to gobble up cocaine like a Pac-Man, Dr. Crystal said.

While the vaccine has been proven effective on animals, now investigators are looking to enroll 30 active cocaine users. The study is funded by the National Institutes of Health and the National Institute on Drug Abuse.

Before getting the vax, each subject will have to abstain from cocaine for at least 30 days (hard for an addict to do). They’ll be dropped regularly to make sure they are clean during that period.

They’ll get their first vaccine shot in the shoulder, with additional boosters given every four weeks until everyone has had six shots. After the final booster, monitoring will continue for three more months.

“Most people who become cocaine addicts want to give it up, but struggle to kick the habit in the long-term,” Dr. Crystal said. “If this vaccine works, it could represent a lifetime therapeutic for addicts.”

Participants will get $25 per visit – up to $2,400 for those who complete the study. To enroll or for information, contact Aileen Orphilla at 646-962-2672 or email anticocaine@med.cornell.edu.

Pfizer cancer drug may block cocaine memories

Meanwhile, another experimental cocaine addiction treatment recently made headlines. Researchers have found that a drug used in cancer therapy trials treats cocaine addiction “by inhibiting memories responsible for cravings,” according to a Cardiff University news release.

“We have demonstrated that a single administration of a trial drug from the pharmacompany Pfizer can completely obliterate cocaine associated memories and significantly accelerate the end of drug seeking behavior in animals,” said professor Ricardo Brambilla of Cardiff University’s School of Biosciences. “With this drug currently being used in cancer trials, it could be easily repositioned for treatment of cocaine addiction and other drugs of abuse.”

According to the news release, the drug kept mice from progressing to compulsive cocaine users by blocking the creation of long-term memories.

“With drug use recently on the rise, new treatments for breaking addiction are much needed,” said Dr. Stefania Fasano of Cardiff. “The availability of a powerful drug from Pfizer, already validated in humans, could speed up the clinical development of our findings.”

Breaking: Powerful pain reliever works in monkeys without addiction, OD risk

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Followers of my blog and Facebook page, David Heitz Health, ask me all the time: Why aren’t there any alternative to opioids that actually work to relieve pain just as well?

I have been saying there are a few things in the works, and I have promised to follow up when there is news to share. That day finally has dawned.

Research published this week in Proceedings of the National Academy of Sciences showed that a new compound, BU08028, works to relieve pain in monkeys without harmful side effects such as addiction or overdose. In fact, even at doses ten to 30 times larger than what’s needed for pain relief, BU08028 did not slow breathing or cause other cardiovascular problems that lead to overdose deaths.

As for dependency, the National Institute on Drug Abuse reported that the monkeys “found it less rewarding than cocaine and two different opioids.”

BU08028 works by interacting with both opioid and non-opioid receptors in the brain.

Approximately 100 million Americans suffer from chronic pain, the NIH reports. That’s nearly a third of our population, and it has led to a national opioid crisis. Beyond addiction itself, the sharing of needles by addicts who progress to injecting has caused HIV and Hepatitis C rates to spike nationwide in communities that previously enjoyed low incidence of both diseases.

Read more: My Plus interview with Dr. Don Des Jarlais, founder of the modern needle exchange

“A potent opioid analgesic without addictive and respiratory adverse effects has been a predominant goal for opioid national chemistry since the isolation of morphine from opium in the 19th century,” reads the PNAS abstract. “By examining behavioral, physiological, and pharmacologic factors, the present study demonstrates that BU08028 exhibits full antinociception and antihypersensitivity (pain relief) without reinforcing effects (i.e. abuse liability) respiratory depression, pruritus (itching), adverse cardiovascular effects, or acute physical dependence.”

Don’t expect a pharmaceutical company to begin churning out BU8028 for humans anytime soon. The next step would be a phase 1 trial on humans, followed by additional clinical trials. Clinical trials take years and are wildly expensive, but a non-addictive pain reliever in the face of a national opioid epidemic could result in political pressure and a slightly expedited process.

Even under the most hopeful scenarios, such a pharmaceutical opioid alternative would be several years away.

Read more: My Healthline News report on how centipede venom could yield a powerful new pain medicine

Study: Depressed people with HIV at greater risk for heart attack

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We’ve known for quite some time that for a person living with HIV but treating it with modern antiretroviral therapy, a heart attack is a much greater threat than an opportunistic infection.

And now we know that when you put depression into the mix, the heart attack risk is even greater.

While the findings aren’t surprising because they mirror a link between depression and heart attack risk in the general population, the paper published online this morning in JAMA Cardiology is cause for concern. That’s because people with HIV already are at far greater risk of having a heart attack than the general population, due in part to the heightened state of inflammation HIV causes in the body.

“Our findings raise the possibility that, similar to the general population, major depressive disorder may be independently associated with incident atherosclerotic cardiovascular disease in the HIV-infected population,” the authors wrote. “Considering the dearth of research in this area, future epidemiologic and mechanistic studies that include women and non-VA populations with HIV are needed.”

Researchers from Tennessee’s Vanderbilt University followed more than 26,000 HIV-infected veterans without cardiovascular disease at baseline (1998-2003) participating in the U.S. Department of Veterans Affairs Veterans Aging Cohort Study from April 1, 2003 to Dec. 31, 2009. At baseline, 19 percent of them suffered from major depressive disorder as classified by the International Classification of Diseases codes.

“We report novel evidence that HIV-infected adults with major depressive disorder have a 30 percent increased risk for acute myocardial infarction (a heart attack) than HIV-infected adults without major depressive disorder after adjustment for many potential confounders,” the authors wrote.

Depression a problem among people with HIV

The findings are troubling because not only is heart disease far more prevalent among people with HIV than in the general population (one study showed that the risk is increased by 50 percent), so is depression.

Read more: My report for HIV Equal on a “PrEP Against Heart Disease” being studied now among people with HIV

Two years ago, I wrote a story for Healthline News headlined, “People with HIV Suffer from Depression Caused by Pain, Shame, Substance Abuse.” You can read the story by clicking here. I don’t think I ever have received more email from readers than I did for that story, mostly thanking me for bring me the issue to light. People with HIV run twice the risk of depression than the general population, studies show.

Many people with HIV simply are getting older, and older Americans are at greater risk for depression even without a chronic illness. Older people are at greater risk for heart attack, too.

The mean age among people with HIV with major depressive disorder in the Vanderbilt study was 48. The mean age among those without depression was 47.

“It is possible that the presence of major depressive disorder further exacerbates the persistent inflammatory and coagulatory activation already present in HIV, resulting in higher cardiovascular disease event rates,” the authors wrote. “Potential behavioral mechanisms underlying the major depressive disorder incident CVD association are poor health behaviors (eg. smoking and sedentary lifestyle and treatment non-adherence).”

Studies have shown that people who are depressed are less adherent to their HIV medication.

It all adds up to a deadly mix for people with HIV who aren’t taking care of themselves. The authors hope their study stimulates new research for depression treatments among people with HIV.

Read more: My Healthline News report on why people with HIV must stop smoking

Blame for pharma price gouging lies with politicians

Pharma prices

A special communication published online this morning in the Journal of the American Medical Association spells out just why prescription drug prices in the United States are far and away the highest in the world.

In the end, it comes down to two words: Pharma lobby. Our nation’s own laws make it easy for the pharmaceutical industry to gorge consumers, and the power of the seemingly bottomless pharma purse makes it difficult to get them changed.

“High drug prices are the result of the approach the United States has taken to granting government-protected monopolies to drug manufacturers, combined with coverage requirements imposed on government-funded drug benefits,” the authors concluded. “The most realistic short-term strategies to address high prices include enforcing more stringent requirements for the award and extension of exclusivity rights; enhancing competition by ensuring timely generic drug availability; providing greater opportunities for meaningful price negotiation by government payers; generating more evidence about comparative cost-effectiveness of therapeutic alternatives (more NIH-funded scientific research on alternative, non-pharma approaches, such as natural therapies, is sorely needed); and more effectively educating patients, prescribers, payers, and policy makers about these choices.”

The paper is an extensive review of research published in peer-reviewed academic journals from 2005 to 2016. The authors are pharmacoepidemiology and pharmacoeconomics professors from Brigham and Women’s Hospital and Harvard Medical School. The paper is one of the most compelling and easy to understand pieces I ever have read on the topic.

I became interested in pharma pricing while working as a reporter for Healthline News. While I do not have HIV or Hepatitis C, those were my primary beats. The once-a-day pill that cures Hepatitis C (Sovaldi by Gilead) came to market while I was at Healthline News at a staggering $84,000 for a 12-week supply. A second-generation pill, Harvoni, came to market shortly thereafter, and costs more than $90,000. Doctors have reported its tolerability to be far superior to even Sovaldi, which was dubbed “game changing” medication and forever changed the health landscape.

Read more: My Healthline News report when Harvoni came to market

The medications still are priced less than the cost of a liver transplant. While the drugs have a tremendous public health benefit and will result in tremendous cost savings over the course of many years, those savings won’t be realized by today’s payers.

Interestingly, Sovaldi came to market just as Baby Boomers have come of age. Hepatitis C, a disease of the liver, is most common among Baby Boomers and injection drug users. It’s common among Baby Boomers because prior to the advent of the HIV epidemic in the U.S., hospital sterilization techniques and the monitoring of the nation’s blood supply were less thorough than they are today. Many Baby Boomers obtained the disease in those settings.

Some argue that many veterans obtained Hepatitis C while in the military due to unsterile vaccination procedures.

The Prilosec problem

The authors of the JAMA paper make several interesting points:

Since the advent of the Medicare drug benefit in 2006, government entities have accounted for 40 percent of the nation’s total drug expenditure.

“Drug prices are higher in the United States than in the rest of the industrialized world because, unlike that in nearly every other advanced nation, the U.S. health care system allows manufacturers to set their own price for a given product. In contrast, in countries with national health insurance systems, a delegated body negotiates drug prices or rejects coverage of products if the price demanded by the manufacturer is excessive in light of the benefit provided: Manufacturers may then decide to offer the drug at a lower price.”

Read more: My interview with an IMAK executive about Gilead’s decision to curtail its patient assistance program for Sovaldi, Harvoni (they were playing hardball with insurers)

Drug companies receive years-long patents, and then can extend the patents for many more years – decades — through a number of loopholes and legal maneuverings.  “In an example of this strategy, the manufacturer of the proton-pump inhibitor omeprazole (Prilosec) received an additional patent on the drug’s s-isomer, despite the absence of any compelling pharmacologic difference,” the authors reported. “This lead to the creation of esomeprazole (Nexium) as a newly branded product that was sold for $4 a pill, a 600 percent markup over the over-the-counter version of omeprazole.”

Essentially, companies are able to tweak products and move patients from one to the next, “sometimes discontinuing production of older version of the drug,” the authors reported.

Backlogs at the FDA office can delay generic applications for years even when a patent does expire and generics come to market. “Some innovator companies have refused to provide the samples of their products needed for the potential generic manufacturers to conduct bioequivalence studies, slowing or blocking the process,” the authors reported.

Contact your legislators and demand change

What does the pharmaceutical industry have to say about all of this? “The pharmaceutical industry has maintained that high drug prices reflect the research and development costs a company incurred to develop the drug, are necessary to pay for future research costs to develop new drugs, or both,” according to the authors. “It is true that industry often makes expensive investments in drug development and commercialization, particularly through the late-stage clinical trials, which can be costly…. Some economic analyses favored by the pharmaceutical industry content that it costs $2.6 billion to develop a new drug that makes it to market. However, the rigor of this widely cited number has been disputed.”

What needs to be done to lower prices? For starters, patent laws need to be changed, or at least the interpretation of those laws, according to the authors. This would allow for much needed competition. “For example, changes in how the U.S. Patient and Trademark Office interprets ‘novelty’ and ‘non-obviousness’ when issuing patents could help avoid new secondary patents based on clinically irrelevant changes to active drug products.”

Read more: My Healthline News report on the cost of HIV care around the world

And existing laws need to be better enforced.

Drug promotion budgets could be limited, resulting in cost savings. The only other high-income nation in the world that allows direct to consumer advertising by pharma is New Zealand. Of course, this opens up a can of worms about our free market economy, and that’s not a discussion I care to get into. Pharma advertising makes websites such as Healthline possible, and even though I no longer write for them, I remain a big fan.

“In theory, the most effective way for a government to reduce drug prices would be for it to set them for the entire marketplace, as central governments do in countries such as Sweden, or to engage in international reference pricing and set prices at levels similar to those of other countries,” the authors wrote. “Taking such a step in the United States would have major marketplace ramifications and is not at present politically feasible, in part because of the power of the pharmaceutical lobby in Washington, D.C. Nonetheless, the U.S. government can still take steps to help control excessive drug prices by reassessing some existing unusual and overly permissive policies.”

Read more: Yes, pharma reps likely do have a say in which medications you take

Yes, pharma reps likely do have a say in which medications you take

MedsYou probably have seen them in your doctor’s office: Those really nice looking young people in a coat and tie, or a pretty pantsuit, carrying a spiffy briefcase and a bag filled with medicine samples.

They’re pharmaceutical reps. And a new study shows they probably wield just as much influence as the cynical among us always thought they did.

Published today in BMJ, researchers from Yale and the Center for Medicare Services have shown an association between payments to physicians for speaking and consulting fees, food and drink and other perks and written prescriptions for those companies’ drugs – at least when it comes to non-insulin diabetes meds and oral anticoagulants, both common among our booming elderly population.

The study was massive. Researchers examined 46 million Medicare Part D prescriptions written by more than 600,000 physicians to more than 10 million patients. They looked at more than 300 hospital referral regions.

“One additional payment in a region (median value $13) was associated with approximately 80 additional days filled of the marketed drug in the region,” the study concluded. “Payments to specialists and payments for speaking and consulting fees were associated with larger regional changes in prescribing than payments for non-specialists or payments for food and beverages or education.”

We all know what prescription drugs cost. That’s some serious bang for the buck.

Docs got $169 million for these two classes of drugs alone

Just how much money are we talking in terms of the dollars doled out to docs?

Nearly a million payments were given to the physicians in the 300-plus regions in 2013 and 2014. Just for the anti-coagulants, which are used to treat atrial fibrillation (A-fib) and other cardiovascular disorders, payments totaled more than $61 million. For the non-insulin diabetes drugs, approximately 1.8 million payments totaling more than $108 million were showered upon the docs.

Read more: My interview with actor Howie Mandel about his A-fib

How this study, the first of its kind, finally became possible is noteworthy as well. In a word: Obamacare.

“The Open Payments program, enacted as part of the Affordable Care Act, mandated manufacturers of pharmaceuticals and medical devices to report payments to physicians and teaching hospitals to the Centers for Medicare & Medicaid Services (CMS). The resulting data include direct and indirect payments as well as payments in kind, such as the value of food and gifts, and details the manufacturers products associated with the payment.”

Previous studies have shown that doctors do not believe they are influenced by the payments.

Do you think your doctor is prescribing the best drug for you? Or is he or she possibly prescribing a more expensive drug that isn’t necessary, or even a drug that might not be as effective as something else? These are concerns I heard for more than two years as a reporter for Healthline News from patients with all sorts of medical conditions. I hope to someday write a long-form look at such practices as it pertains to HIV medications.

Read more: My infographic report on the cost of HIV medications around the world

Authors admit study has limitations

The study does have limitations, the authors admit.

“Our findings do not necessarily suggest that payments by pharmaceutical manufacturers are harmful for patient care,” they wrote. “Patients may benefit from physicians being made aware of newly approved, effective treatments that may have fewer adverse effects, reduce the need for monitoring tests, or improve adherence. However, our findings support long voiced concerns about the potential influence of even small payments to physicians by pharmaceutical companies, such as for food and beverages.

“This influence on prescribing can potentially negatively affect patients through inappropriate prescribing, or more likely prescribing of more expensive, branded drugs when cheaper, generic alternatives exist. By one estimate, the geographic variance in high cost or low cost drug prescribing cost Medicare $4.5 billion in 2008.”

I always have said I really have no idea whether Obamacare is a good or a bad thing, because I’ve written about it so much I could see it either way. But I will say this: This sort of transparency is good for America any way it comes in our current climate of rampant political and corporate corruption.

“Our study has important limitations,” the authors go on to note. “Firstly, as the study was cross-sectional, we cannot prove the causality that marketing causes prescribing; it is possible that pharmaceutical companies market in regions where prescribing is already higher. Secondly, our results likely underestimate the association between payments by the manufacturers of pharmaceuticals and physician prescribing since we only had data on prescriptions filled, not prescribed, and our analyses were focused solely on Medicare Part D enrollees, who received approximately 25 percent of all the prescriptions written in the United States.”

The researchers report; you decide.

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Read more: My report on how insurers use higher drug costs to discourage sick patients from enrolling