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Feature Story and notes that future messages must be culturally and age appropriate. The reality is that PWAs aren’t on the national aging radar, and the time to change that is now. By 2015, the majority of PWAs in Canada will be over the age of 50. Some preliminary work has been done. In October 2009, the Canadian Working Group on HIV and Rehabilitation (CWGHR) received funding to prepare a background paper on HIV and aging. The paper framed the dialogue at their 2010 Partners in Aging National Forum, held in early March as a satellite meeting at the 6th Canadian HIV/AIDS Skills Building Symposium in Montreal. The symposium brought together Canada’s leaders in the HIV/AIDS and gerontology communities for the first time to discuss emerging trends and priorities, exchange information and experiences, consider best practices, and pave a strategic and collaborative way forward. The Partners in Aging forum included community representatives from geriatrics and HIV, doctors, service providers, and representatives from the research community. Senator Sharon Carstairs, chair of the Special Senate Committee on Aging and a member of the forum’s national advisory committee, gave a keynote address. Senator Carstairs has been a tireless champion for end-of-life palliative care and seniors issues. While the forum raised a lot more questions than answers, it did play an important role in getting this issue into the forefront and getting it into the overall national discussions. Taking charge of the issues One of the important issues raised by the forum was very clear: if we don’t start to address the issues faced by those aging with HIV now, the issues will be addressed for us, since we’re only a small subpopulation in a much larger pool of aging Canadians. Having to hide our HIV status in long-term care facilities, or receiving inadequate care without medications and income security is already a reality, and it will worsen if not addressed. The HIV/AIDS community can have a huge impact on the direction of our future care if we’re at the table. From our activist roots and track record of demanding patient and citizen voice in all aspects of our care for over two decades, we have a lot to offer to our partner groups. We must start now to build bridges with existing organizations that are dealing with seniors and aging issues and get HIV on the table. These will include prevention issues for the aged, as well as ensuring care facilities are stigma- and discrimination-free, if and when PWAs need to go into care facilities. Also, more research is needed to ensure we remain healthy as we live with HIV and other co-morbidities. CWGHR is well positioned with the Episodic Disabilities Network to build on its existing relationships among the various national partners and bring other groups of interest together at the table; this will be key to moving HIV issues on the larger aging platform. In addition to its involvement in various research projects on HIV and rehabilitation issues, CWGHR is also focusing on the issue of aging. All levels of government, private industry, the health community, community leaders, and special interest groups must work together effectively if we want to have the necessary services and supports in the future. Affecting change in public policy and service provisions takes years, and within the next 15 to 20 years many of our membership at BCPWA will be retired or very close to it. 5 Future updates and videotapes of previous sessions are online CWGHR will be holding a second forum on aging and HIV in Toronto before its annual general meeting in June 2010. Information on the upcoming forum is available at the Canadian Working Group on HIV and Rehabilitation website at www.backtolife.ca. As well, links to the videos of the speaker panels and discussion of the Partners in Aging Forum held in March are available at the website. Glyn Townson is the chair of BCPWA. Sarah Burdeniuk is the communications coordinator at the Canadian Working Group on HIV and Rehabilitation. 22 living5 MayqJune 2010
Treatment Research GS Phase II results for the new GS 9350 booster hold promise for a four-in-one pill by Nicole Lewis 9350 may look like just a bunch of letters and numbers, but it could be the next big drug released to help treat HIV. Gilead Sciences, a US-based pharmaceutical company, is currently working on an experimental drug known as GS 9350 (generic name cobicistat), which boosts the effectiveness of other HIV drugs. The drug just completed Phase II of clinical trials and it’s being tested with Gilead’s existing antiretrovirals with hopes that a four-in-one—or quad— pill can be developed. This new product would be used in place of the current drug, ritonavir (Norvir), manufactured by Abbott Laboratories. Ritonavir is a protease inhibitor—it prevents HIV-infected cells from producing new HIV, therefore limiting the number of doses a person needs to take of their existing medications. However, ritonavir can be quite pricey and has side effects such as weight gain and gastrointestinal problems; it may also cause drug-resistant HIV, as it always provides anti-HIV activity, even at a very low dose. These concerns about ritonavir have driven the development of replacement drugs from other companies such as Gilead. The primary function of GS 9350 is to boost the blood levels of other anti-HIV drugs. For example, the experimental integrase inhibitor elvitegravir, when taken with GS 9350, is more effective in blocking the enzymes that normally allow HIV to integrate into the DNA of an infected cell. In 2009, a Phase I study showed promising results when comparing ritonavir to GS 9350. GS 9350 acted in a similar way to ritonavir at both 100 mg and 200 mg doses. Study participants experienced few side effects from either the daily or twice a day doses. The Phase I trial also tested how well GS 9350 worked when combined with the three other medications that Gilead is hoping to combine into the quad pill: elvitegravir; emtricitabine (Emtriva), which helps to lower the overall viral load; and tenofovir (Truvada), which blocks enzymes that are crucial to viral production. The 150 mg tablet of GS 9350 boosted levels of elvitegravir in the MayqJune 2010 living5 23 blood and maintained regular levels of the other two drugs. Participants experienced few side effects from the f ixed-dose tablets, with only one case of moderate increases in liver enzymes. In recently released data from the Phase II trials, efavirenz/emtricitabine/tenofovir (Atripla) was compared to GS 9350. GS 9350 was also studied on its own to get a better idea of how it will work compared to ritonavir. The main difference between efavirenz/emtricitabine/ tenofovir and the proposed new quad pill is that the quad pill would include elvitegravir in the place of efavirenz (Sustiva). Efavirenz is known to cause central nervous system side effects such as dizziness. In the Phase II trial, only 35 percent of participants taking the GS 9350-boosted combination experienced adverse events compared to 57 percent of participants taking efavirenz/emtricitabine/tenofovir. Only 10 percent of participants taking the quad pill experienced CNS side effects. The Phase II results also demonstrated that GS 9350 doesn’t impact the kidneys, which can be a problem with drugs like GS 9350. Any changes in serum creatinine levels—which would indicate kidney problems—aren’t related to the f iltration problems caused by the drug but to tubular secretion instead. These strong results hopefully mean that GS 9350 will progress quickly through Phase III clinical trials, where any lingering questions around its effect on kidney function can be answered. Fingers crossed that GS 9350 is eventually approved, which would pave the way for a new cost-saving and less labour-intensive quad pill. Pill burdens for PWAs could become a thing of the past. 5 Nicole Lewis is a recent graduate of the University of Victoria Writing Department and a volunteer with BCPWA’s Treatment Information Program.
Page 1 and 2: inside 333 features q treatment inf
Page 3 and 4: Canada cuts funding to internationa
Page 5 and 6: The FIGHTING WORDS Fighting back Th
Page 7 and 8: Jennifer Evin Jones For the past 15
Page 9 and 10: Cover Story BCPWA is changing with
Page 11 and 12: Cover Story just some of the progra
Page 13 and 14: HIV-positive status to his partners
Page 15 and 16: Pain and anguish—and bliss One HI
Page 17 and 18: treatment *nformation TREATMENT INF
Page 20 and 21: Feature Story When old is new The i
Page 24 and 25: Antiretrovirals Whatever happened t
Page 26 and 27: Please phone 604.893.2239 or email
Page 28 and 29: Nutrition Nutrition and HIV, revisi
Page 30 and 31: Wednesdays • 5:30 PM • Training
Page 32 and 33: Let’s clinical! get Clinical tria
Page 35 and 36: New BCPWA AGM voting procedure Now
Page 37 and 38: Volunteering at BCPWA Profile of a
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