New York Times hits 2 key issues, in B1 cover page stories, 2 days back to back:

The problems with clinical practice guidelines: Turns out one size doesn't (and never did) fit all. And the problem is only compounded by tainted panel members

"Diabetes Case Shows Pitfalls of Treatment Rules"

by Barry Meier

The epidemic of ghostwritten medical 'research' papers in esteemed medical journals continues unabated

"Ghosts in the Journals"

by Natasha Singer

Friend, mentor and comrade in arms, Dr. Joe Sonnabend, has been ahead of the curve on this clinical practice guidelines nonsense, as he has been on most everything, for a long time now. It's a shame nobody seems to listen. Check out Joe's new Poz blog. I hope people everywhere will read (and heed) it!!

Which comes first? The wrists & ankles snapping like kiln-dried twigs? Or the early mid-life, out-of-the-blue stroke & heart attack?

(I have heard of two new heart attacks, friends of friends in their early 40s, in just the past month. And yet another friend dropped to the sidewalk unconscious in Tribeca last summer after suffering a stroke. He is not even 40!! He had blacked out, didn't know who or where he was -- and still cannot speak properly or use his right hand.)

Someone really has to find a better way to manage this infection or, at the very least, help us to protect ourselves against all these nasty side effects.

Where have all the community-based research institutes and amFARs (oh, sorry, Amfar recently dropped the 'Am' in order to reposition itself to tap into the boondoggle of international HIV/AIDS funding and recently re-branded itself the "Foundation for AIDS Research" aka FAR) gone??

We all know the answer: picking the low-hanging fruit (big reward for only somnambulant effort) by signing up for Big Pharma "me too" trials that any lobotomized blind monkey could do with one hand tied behind her back.

Where are the activists?

Loss of Bone Mineral Density After Antiretroviral Therapy Initiation "Independent of Antiretroviral Regimen"

Source: JAIDS, August 2009 - Volume 51 - Issue 5 - pp 554-56

Free abstract here.

From Conclusion: "Similar decreases in BMD over 96 weeks occurred in ART-naive subjects receiving either EFV-based regimen or LPV/r-based regimen, which was not altered by simplification to LPV/r monotherapy and was unrelated to markers of tumor necrosis factor-α activity."

Comment: But if, as many of my smartest and longest serving HIV care providers believe & observe in their (very large) practices, the biggest CULPRIT here (in terms of loss of BMD) is TENOFOVIR (as in Viread, Truvada, Atripla), this study's conclusions are not all that helpful-- as both PI and NNRTI based regimens are very likely to have included TDF+FTC (or TDF+3TC). Still, we cannot be certain until we have seen the full paper or spoken with the investigators. -MB

See also: AIDS 17-July-09 editorial, "Metabolic Bone Disease in HIV Infection"

Decreased bone mineral density with off-label use of tenofovir in children and adolescents infected with HIV-1. J Pediatr. 2008 Apr; 152(4):582-4. (link)

Clinical Trial: Bone Mineral Density Substudy - An Ancillary Study to MTN-003 (link)

from AIDSmeds.com: "Viread may cause bone problems. In one clinical trial conducted by the manufacturer involving HIV-positive patients who were new to HIV therapy, Viread [combined with Sustiva and Epivir] caused decreases bone in mineral density (osteopenia) at the hip and spine."

Clinical Trial: Switch From Tenofovir to Raltegravir for Low Bone Mineral Density (link)

from aidsinfonet.org: "Tenofovir can reduce bone mineral density (see fact sheet 557). Calcium or vitamin D supplements may be helpful. This is especially true for people with osteopenia or osteoporosis." and "Use of tenofovir can also result in a loss of bone mineral." (link)

and finally, from my heroes at aidsmap.co.uk: "Vitamin D supplementation may help with tenofovir-related bone hormone deficiency" (link)