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Issue No. 43 | October 23, 2009

News and Features

CDC Updates Interim Recommendations for H1N1 Influenza for HIV-Infected Adults and Adolescents

"HIV-infected adults and adolescents, especially persons with low CD4 cell counts or AIDS, can experience more severe complications of seasonal influenza. Among patients hospitalized with confirmed 2009 influenza A (H1N1) infections in the United States, the prevalence of certain underlying conditions, including immunosuppressing conditions, has been higher than in the general population suggesting HIV-infected adults and adolescents also might be at higher risk for complications related to infection with 2009 influenza H1N1. ...

"This guidance will be updated as more information becomes available, including information on the risk of 2009 H1N1 flu-related complications among HIV-infected adults and adolescents."

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Published Results of Thai HIV Vaccine Study Available

“In a community-based, randomized, multicenter, double-blind, placebo-controlled efficacy trial, we evaluated four priming injections of a recombinant canarypox vector vaccine (ALVAC-HIV [vCP1521]) plus two booster injections of a recombinant glycoprotein 120 subunit vaccine (AIDSVAX B/E). The vaccine and placebo injections were administered to 16,402 healthy men and women between the ages of 18 and 30 years in Rayong and Chon Buri provinces in Thailand. ...In the intention-to-treat analysis involving 16,402 subjects, there was a trend toward the prevention of HIV-1 infection among the vaccine recipients, with a vaccine efficacy of 26.4% (95% confidence interval [CI], -4.0 to 47.9; P=0.08). … In the modified intention-to-treat analysis involving 16,395 subjects (with the exclusion of 7 subjects who were found to have had HIV-1 infection at baseline), the vaccine efficacy was 31.2% (95% CI, 1.1 to 51.2; P=0.04). Vaccination did not affect the degree of viremia or the CD4+ T-cell count in subjects in whom HIV-1 infection was subsequently diagnosed. …This ALVAC-HIV and AIDSVAX B/E vaccine regimen may reduce the risk of HIV infection in a community-based population with largely heterosexual risk. Vaccination did not affect the viral load or CD4+ count in subjects with HIV infection. Although the results show only a modest benefit, they offer insight for future research.”

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Abacavir/Lamivudine and Tenofovir/Emtricitabine Equal in Efficacy, Not in Side Effects

“We compared [tenofovir/emtricitabine] TDF-FTC and [abacavir/lamivudine] ABC-3TC in a randomized, open-label, 96-week trial in which either fixed-dose-combination was substituted for current nucleoside treatments in human leukocyte antigen-B*5701-negative adults with human immunodeficiency virus loads <50 copies/mL. … Of 441 patients who were screened, 357 were treated; 98% were men, the mean age was 45 years, 30% were receiving TDF, 20% were receiving ABC, and 24% were receiving a protease inhibitor. Virological failure was uncommon (5.6% for ABC-3TC and 3.9% for TDF-FTC; difference, 1.7%; 95% confidence interval [CI]). … No participant developed AIDS, whereas 18 (5%) participants developed a serious non-AIDS event (rate, 2.79 events per 100 person-years; 95% CI, 1.76-4.43), of which 4 were fatal. … In this population, TDF-FTC and ABC-3TC had similar virological efficacy, but ABC-3TC was associated with more serious non-AIDS events, particularly cardiovascular events.”

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