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Gisborne Genealogical Group
- P.O. Box 818, Gisborne, VIC 3437
- Gisborne Genealogical Group
- Goldfield Library Corporation
- Gisborne and Mount Macedon Districts Historical Society
Library Charges
- Members - Free. Visitors - Gold Coin Donation.
Open Hours
- Visitors are welcome to use the genealogical reference resources in the Family History Room whenever the Gisborne Library is open. Refer to the Goldfield Library Corporation website for the opening hours of the Gisborne Library. Gisborne Genealogical Group volunteers are available to assist members and visitors on Thursday afternoons from 2.00pm to 5.00pm from February to November inclusive. The Gisborne Genealogical Group does not undertake research for people. Our aim is to foster interest in family history research and to continue to build our collection of resources.
Approximate Membership
- 60
Membership Cost
- Refer to our website (www.ggg.org.au) for current membership fee.
- Genie-Allergy. Quarterly.
The Gisborne Genealogical Group brings together people from across the Macedon Ranges with a shared interest in family history research.
The Group holds monthly informative talks and maintains a collection of family history resources in the Gisborne Library.
Our Family History Library is a reference library that contains a growing collection of over 800 books, thousands of fiche, data CDs and DVDs, journals and maps.
Monthly meetings of the Gisborne Genealogical Group are held at 7.30pm on the 4th Thursday of each month in the Family History Room of the Gisborne Library from February to November (except July) unless notified otherwise. Either a guest speaker or one or more members present a subject of interest to family history researchers.
Visitors are welcome to attend our meetings. Gold coin donation requested.
Full details of our activiies are presented on our website: www.ggg.org.au
Researchers seeking information about individuals or families who may have previously lived in the Gisborne or Mount Macedon Districts should contact the Gisborne and Mount Macedon Districts Historical Society.
- Location:


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Many better-than-half price deals on fabric remnants and cut-offs! Here you will find our selection of cheap fabric remnants on sale - the last few metres of fabric left on a roll, all available at last-chance, discount prices. This is where you can bolster your fabric scraps and cut-offs collection with beautiful, value-for-money fabrics, ready for you whenever you need them! This collection is always changing as remnants come and go, so keep checking back for new lines. Don't forget, on top of huge discounts we offer free UK delivery on orders over £200 and free international delivery on orders over £250! Please note that all remnants are priced by the piece.
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11 Reviews
And you thought camping was relaxing before.
Get fully outfitted for hammock camping in any conditions with the Eagles Nest Outfitters OneLink Hammock Shelter System. This comprehensive kit contains a ENO hammock, hanging straps, a Guardian BugNet, a waterproof rain tarp, and aluminum tent stakes for securing the whole thing. Everything packs together in the included stuff sack for easy transport.
- SingleNest and DoubleNest includes Atlas Straps and Pro Fly Rain Tarp
- ProNest includes SlapStrap Pro Straps and ProFly Rain Tarp
- Colors ship at random
- Item #EGN0009
Tech Specs
Gearhead Help
Tech Specs
- Reviews
What do you think about this product?
Have questions about this product?
Hang out in style
- Familiarity: I've used it once or twice and have initial impressions
I used this hammock setup over a long weekend on a backpacking trip into the Uintah mountains and was very happy with the experience. Setup is a breeze and consists of looping two straps to two trees, then linking the hammock to the straps using built in carabiners. After the hammock is hanging you can use the included bug net and rain fly to stay dry and bite free, I ended up using the net but opted to hang out under the stars since rain wasnt an issue. I also purchased the Hotspot for this hammock which provides a way to keep your pad and sleeping bag in place while you snooze soundly suspended between the trees, and also provides a bit of insulation on the sides and bottom of the hammock where chill winds are liable to penetrate through. This is a bit heavier then my bivy setup, but because it is off of the ground, it has little to no impact and flat ground isnt required for setup, just two trees. I would definitely recommend this setup for anyone looking for a tent or bivy alternative
Hammocks, so hot right now
- Familiarity: I've put it through the wringer
This is a great hammock that is very comfortable for a tall person. You could easily fit 2 people in here. I use it with the Slap Strap Pro and would recommend buying those to go with this hammock. This hammock is lightweight and easy to set up with the Slap Straps. If you can get used to sleeping in a hammock this is a great lightweight alternative to a tent when backpacking. Otherwise it is a great way to relax while camping or in your backyard.
Difference in the pro
What's different about the pro setup?
Excellent lightweight camping option
- Familiarity: I've put it through the wringer
I love camping and traveling with my ENO system. I get some of the best sleep I can remember when I'm hammock camping. Set up is pretty easy IF you're around good trees. I've camped out in the cold and a few rain storms and I manage to stay dry and warm with the rain fly and a sleeping bag.
Bought this set-up from Backcountry for a X-mas present, but own one myself. I car camp and hike with it. Still going strong after a couple of summers.
Almost perfect
I ordered this hammock over the others because of the versatility and the price. I like that I can hang it just about anywhere I go. It is nice to be able to choose whether you want the bug guardian on or not, some brands have it permanently sewn into the hammock. I can just use the hammock for lounging in the yard, or the whole kit for those stormy nights in the backcountry. The Slap Strap Pros are so stretchy though I will not use them. I am 170lbs and I have to hang it as high as my head so I don't hit the ground when I have been in it for a couple hours, even that high I end up being only a few inches off the ground. It is not so bad when you have trees that are the perfect distance, but when you have the straps all the way out they stretch WAY too much. I purchases some cheap tie downs, took the hooks off, and use them instead and it is perfect now. When I called they said that the only color they come in is navy blue and olive, which I like anyways. This would be the perfect system if they just changed the straps to something other than nylon.
hanging out over Russell Lake in the Quetico.
had to put the rain fly up later that evening due to torrential downpours and 50mph wind gusts. no adjustments needed over the course of the night...
What about the south side, hot, bugs, rain?
Components that come with the Onelink: All in the included stuff sack.
if you take everything out of its individual stuff sack and cram it all into a compression sack it will be less bulky.
Components that come with the Onelink: Slapstrap Pros
you can fit the stakes in here with the Slapstraps
Components that come with the Onelink: Stakes
Components that come with the Onelink: ProFly
Components that come with the Onelink: Guardian Bug Net
Components that come with the Onelink: Singlenest
off the ground, now there's an idea
having problems finding the right pad(s) to make it comfortable enough to get a good night's sleep on the ground? here's an idea...don't sleep on the ground!
borrowed a doublenest system sans the rainfly for a couple months from a buddy. when he asked for it back, i went back to my tent. I finally had to break down and buy this guy. i weigh 208 right now and this thing has never hinted at failing. i primarily use it for its intended purpose, sleeping off the ground in the backcountry, but it is great to hang up at a backyard grill out type thing as well. when i bought my own, i went from the double-nest to the single-nest. i found that the double was too uncomfortable for 2 (you roll on top of each other). and the double made it difficult to hang my legs out the sides when they were searching for a breeze. this whole system weighs about 4lbs, but excluding the winter, i dont have to pack a pad(s)...and in the winter i can leave the bug net at home. slap-strap pro system works great. easy set up easy tear down, made easier by the attached stuff sacks. the one link system comes with its own stuff sack. it is decent. it doesnt have compressions straps, but i am not sure that the system would compress much anyway. measurements and weight are accurate. i have gotten some of the best sleep of my life in this thing. love it. the only way i see it failing is due to misuse or exceeding the weight limit.
i havent used the rainfly yet. i used my tent's footprint with some extra cordage and added a loop when i borrowed my buddy's and still do the same. its much lighter and serves the same purpose (although i will use it in the winter because the footprint wont block the wind). the only complaint i have is with backcountry, but its not really a complaint at all. they told me in a live chat window that it only comes in one color, black. it showed up in the khaki and olive color, which is fine. if it showed up in purple and pink i might have to complain a bit...not my style. also, they told me it came with the dry fly, but it came with the pro-fly. good stuff. much easier to set up and more comfy for me than the a-sym and the others you climb in from underneath that i have tried. i am a side-sleeper and have no problems. never felt like i was gonna roll out of it...its plenty deep. got this on sale at backcountry.com for 159. get it.
Fast and Tough...
Trial run in the back yard.
Conditions: Chilly that night: 33 and a wind.
Accompaniaments: Cats Meow 20 degree synthetic, thermarest pro lite pad, street clothes, jacket, dog, and an extra blanket for him.
Speed: First time (and even read the directions) - took only a few minutes to set it up sans bug net.
Durability: My Weim River decided to join, but wasn't confident about the whole set up so he stood up and moved around ALOT. I thought for sure his toenails bearing all his 90 pounds punctured the material more than once, but the next morning I couldn't even find a scuff.
Warmth: I slept toasty when I wasn't squished up against the sides of the hammock, which was only the first couple of hours because the dog quickly realized it was much warmer if HE layed on the thermarest. Otherwise (and I'm cold ALL THE TIME) I think I would have been comfortable all night.
Next time I'll: put the tarp closer to hammock to help shed the wind. Also, I'll switch out the supplied stakes with lighter, "stickier" ones from my tent. We bailed and went inside about 2am (for the record, the dog cried uncle first) and the next morning 4 of the stakes were pulled, the tarp was flapping hard in the wind and 3 ropes were ruined. (not a tear though - like I said - tough) Also - I'm pretty sure I'll order River his own hammock to hang below me and to stash all my gear in on rainy nights - I ordered the doublenest hammock, but I wouldn't reccomend sharing it with man or beast if your intent is a solid night's sleep.
Backcountry service is excellent and expedient - and an extra shout out to the wish fulfilling backcountry gurus who somehow knew I had my fingers crossed for the olive/blue combo.
It's been a year...how have things gone with the dog? I have a very spoiled and very active wheaten terrier, and whatever shelter I take into the backcountry has to accomodate us both. I'm worried that she'll be unhappy swinging in the trees...and when she's not happy ain't no one happy. Has River become any more comfortable? Any thoughts on hammock and dog compatibility?
River actually prefers the hammock to the tent, he seems to like to be able to just poke his head out and see what's going on. Also, whatever your dogs gotten into for the day (examples: covered in mud, poison ivy, etc) you're going to be sleeping with very up close and personal during the night. But as far as comfort goes, plenty of room, he's comfortable enough with it to get up and move around to reposition during the night, and it's been great in rain, wind and especially hot days. The only thing I wish I could change is that I have to hang it low enough for him to be able to get in - (you shouldn't have that problem with your terrier:)
Trial Run before using it for real
Very pretty dog!!!
Pros and Cons Over a Tent
I'll start with the pros. It's lighter than the average tent, and it packs much better than a tent. It is quicker to set up than a tent. You can usually find a campsite in the woods much easier for a hammock than for a tent. In the summer, you can save extra space and weight by not having to bringing a Thermarest, and in the winter you can save weight and space by not bringing the bugnet. I also think that it is more comfortable than sleeping on the ground.
Now for the cons. It is harder to stay warm in the winter, because you don't have the insulation of the ground, the cold air just surrounds you in a hammock.(For this reason, I recommend bringing your Thermarest in the hammock with you to help add some insulation in cold temperatures.) You definitely can not stay as dry in the rain and the fog in this system as you can in a tent. The wind is much more of a factor when you're swinging in the air than on the ground in a tent. And if you like to toss and turn in your sleep, you will defiantly feel more restricted sleeping in a hammock. And clearly you are limited to camping in an area with trees to hang from.
So the bottom line is: This is a great three season system for mostly dry weather, But I would take a tent for extremely cold, wet, or windy conditions.
I completely agree with your pros list, I love my hammock. I would suggest using a thicker pad than normal, I personally use a 2" pad in the colder months. However I would disagree that you cant use this hammock in rain/wind, I do so without issue. It is only a matter of staking the rain fly well and setting your self closer to the ground in the wind. Also tie a shoelace or small piece of rope at the ends of the hammock so that the water that comes down the hanging straps/ropes drips off of that instead of continuing to your hammock, this will keep you much drier.
I'm quite comfortable sleeping in mine
My experience is that these hammocks are quite comfortable to sleep in and that I do not...as I thought I might...wake up looking like Kokopelli. The key is to string your hammock up tight using the included "slapstraps" then toss your sleeping pad, bag, and a pillow inside. I find I can toss and turn all night and still be comfortable. The nylon material cuts the wind nicely and having that thermal pad in there really helps as well. I'd highly recommend Eagles Nest Hammocks. Once you get the hang of it (...bad I know)...you'll never go back to sleeping on the ground.
not for me, but maybe for you
First off, I do like to relax in a hammock. On a lazy day they are great to lay in. However, if you are a tosser/turner when you sleep I would not recommend this or any other hammock shelter for camping. They are extremely restricting and Unless you are able to sleep in one position all night, I would stick with another form of shelter. If you don't mind being in one position, then by all means go ahead and enjoy being off of the hard ground. The only drawback besides that is the wind, it will cut right through the shelter, which can lead to a cold night. I would recommend this for warm weather camping.
If you put up a rain fly, the wind is a non-issue, and it is a good idea for those overnight showers.
I'm normally a tosser/turner while sleeping but get my best night's sleep in an ENO. Sure you can't do a full rotation but I have plenty of room in my double to turn to either side.
Is double nest two separate hammocks or...
Is double nest two separate hammocks or just a larger hammock?
The double nest is just one large hammock.
If i already have a double ENO hammock is...
If i already have a double ENO hammock is there a way to get this kit minus the hammock?
The only way I know is to buy each separately
Looking for an all terrain hammock, w/add...
Looking for an all terrain hammock, w/add on's
whats the difference between the pronest...
whats the difference between the pronest and the singlenest?
Size and weight are the main differences. The pro is a bit smaller than the single and uses custom carabiners to reduce weight. However, both are constructed from the same material and will hold up to 400 lbs.
how i wash it
how i wash it
In a clawfoot bathtub is what I would do.
hahahahaha! nice...
hmmm u guys are smart dont go into the wild by urselves
Directly from ENO.
Our hammocks are machine washable. We suggest you use a mild detergent and just hang it up to dry. Treat all other ENO products like you would a tent or similar camping gear-wash only when absolutely necessary and by hand.
What is the difference between the pro and...
What is the difference between the pro and the single? Is it just size?
The pro is slightly smaller than the single, it wont be as easy to fit a sleeping pad in, but for a 3 season deal it might be acceptable, I personally have a Double ENO and use it all year round.


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Nassau finances an easy pre-election target
Yesterday, a federal appeals court panel heard arguments on whether Nassau's fiscal control board had authority enough to impose a 2-year-old wage freeze.
Meanwhile, two former county officials seeking re-election to their old posts took after the county's current comptroller, who is promising to release a report Wednesday showing that Nassau ended 2012 in "positive" numbers.
All this came just days after the county attorney threatened to sue the Nassau Interim Finance Authority, the state control board, because it would not approve more than $100,000 in contracts for two Albany lobbyists.
Such is to be expected during an election season, when candidates use anything that might garner an advantage.
At a news conference Monday, former County Executive Thomas Suozzi and former Comptroller Howard Weitzman, both Democrats, found an easy target in Nassau's finances.
The county budget hasn't been sound in years -- and that includes some of their tenure.
One of their complaints Monday was that GOP Comptroller George Maragos had yet to close out the county's 2012 budget.
A few hours later, Maragos sent out a release announcing a news conference Wednesday, when -- well before a reporting deadline -- he is slated to release unaudited results of how the county fared last year.
There was a time when NIFA would have been the arbiter here. No matter how any side tried to slice it, NIFA could be relied upon to offer up a dose of reality over political expediency.
Those times -- thanks to a series of attacks on the authority by the administration of Republican County Executive Edward Mangano -- are almost gone.
NIFA can be good for Nassau's budget, as it was when the authority, at Mangano's request, froze wages for county workers.
The county's police unions, taking the lead for others, filed suit. They won a round when a federal trial judge ruled that NIFA's authority under its enabling legislation had expired.
During Monday's arguments, the two-judge federal appeals panel asked why U.S. District Judge Leonard Wexler hadn't left the issue to a state court, since NIFA was created under state law.
The question sets up another potential wrinkle for Nassau residents wondering what's up with county finances.
Should the wage-freeze case ultimately go to state court, it will get in line behind other anti-NIFA lawsuits.
The other court actions challenging NIFA's authority, however, are coming from Nassau County, rather than its unions.
Last week, County Attorney John Ciampoli threatened to file yet another lawsuit against the control board after NIFA refused to sign off on the contracts for Albany lobbyists. NIFA chairman Ronald Stack said, essentially, that the county couldn't afford the contracts.
But here's the county's continuing conundrum: Nassau wants and needs NIFA to remain strong enough to impose the wage freeze.
But Nassau also wants it weakened enough so the county can spend what it wants rather than what NIFA deems necessary.
With recent bond-rating downgrades, however, Nassau can't expect to keep doing both.
With Maragos, Weitzman and Suozzi mixing it up Monday, county finances became a more prominent part of the county executive campaign, in which Suozzi faces a Democratic primary from East Hills businessman Adam Haber.
All the office seekers must lay out aggressive plans for fixing the county's finances -- and all of them ought to include a closer partnership with NIFA.
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The federal government has allowed barely a week for Australians to help shape the terms of reference for a royal commission into child sexual abuse.
The tight deadline reflects Prime Minister Julia Gillard's wish for the inquiry, which is likely to take years and involve thousands of individuals, to be established by the end of this year so it can begin its work in early 2013.
Ms Gillard last week announced the planned a royal commission to investigate how child sex abuse allegations have been handled by religious, community and state institutions.
Labor on Monday released a consultation paper asking for public submissions on the scope of the terms of reference, the form of the commission, the number of commissioners and reporting arrangements, by close of business on November 26.
Ms Gillard told reporters in the Cambodian capital Phnom Penh on Monday that she hoped people would respond in the time but would receive submissions "beyond that timeframe".
Attorney-General Nicola Roxon and acting families minister Brendan O'Connor, who are leading the work to set up of the commission, want all stakeholders, especially child sexual abuse survivors and their families and advocates, to take part.
"Getting the groundwork right is essential as it ensures that the royal commission will be able to effectively investigate responses to instances and allegations of child sexual abuse in institutions," the ministers said in a statement.
The consultation paper says the royal commission should find ways to identify any policy or reforms "to ensure the safety and wellbeing of children is central to the policies and practices of all organisations who engage with children".
It notes the royal commission is not a substitute for criminal investigations and any statements made during the inquiry could not be used in court proceedings.
But it can refer any relevant matters to police and wants to give victims the opportunity to share their experiences.
The government says the states and territories have already signalled their willingness to co-operate with the commonwealth during the inquiry to ensure the commission has access to any government information it needs.
Earlier on Monday, Opposition Leader Tony Abbott said the federal government should fund the lion's share of the commission's costs.
"This is going to be a national royal commission, and I think that does make it first and foremost the responsibility of the national government," he told reporters in Canberra.
Asked whether the states should contribute, Mr Abbott said it was an issue the prime minister would need to discuss with the premiers.
Ms Gillard played down questions of funding on Monday.
"I don't think any of this should be bogged down on questions of financing or money," she said.
"What I've got in my mind is how we can best make this work."
Cabinet minister Chris Evans said some victims may benefit from sharing their stories, despite suggestions testimony from a large number of victims could make the commission unwieldy.
"Individual submissions and stories will be a necessary part of understanding of what has gone wrong in the past," he told the Senate on Monday.
"In addition, it may be that sharing these stories will be helpful for some survivors of child sexual abuse."
A government call centre established on Friday to take details of those wanting to participate has already logged 170 calls. Names and contact details will be added to a register to be given to the commission's secretariat.
The consultation paper is available on the Department of Prime Minister and Cabinet's website (www.pmc.gov.au)


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Table of Contents
- Introduction
- The Importance of Treatment
- When to Start Treatment
- The Drug Pipeline
- Longer-Term Study Data on Antiretrovirals
- Sustiva Versus Kaletra
- NRTI-Only Regimens and Monotherapy
- Uncovering What's Behind Low-Level Viral Loads
- Boosting CD4 Counts
- Boosted Versus Unboosted Drugs
- Viramune Versus Reyataz
- Vitamin D Deficiency
- Ziagen and the Risk of Heart Disease
- HIV, Gender and Race: The GRACE Study
- FOTO: Five Days on a Sustiva-Based Regimen and Two Days Off
- Conclusion: HIV and the Developing World
- References
I'm here today with Dr. Joel Gallant. Dr. Gallant has been treating people with HIV since the beginning of the pandemic. He's also a leading HIV researcher and a professor at Johns Hopkins University School of Medicine in Baltimore, Md. He just returned from the 5th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention (known as IAS 2009), which was held in July in Cape Town, South Africa. This international meeting featured presentations on a wide assortment of subjects, but in this review we'll focus on HIV treatment research as it pertains to the resource-rich world. I asked Dr. Gallant to provide some of the treatment highlights from the meeting.
Welcome, Dr. Gallant. What was new at Cape Town? Was this an exciting conference, or not so exciting?
I think it was pretty exciting. It exceeded people's expectations. There was a lot of grumbling before the conference that there wasn't going to be much new research, and that people were saving their data for CROI 2010 [the 17th Conference on Retroviruses and Opportunistic Infections]. But in the end, I think it turned out to be a great conference.
I think it also was especially good because it was back in Africa again. It's been nine years since the conference has been held in Africa. The Durban international AIDS meeting in 2000 was really a landmark meeting, because it brought attention to the developing world. I think that this conference brought attention back there, as well, especially to sub-Saharan Africa. There was a lot of participation by people from Africa. I thought it was a really great meeting.
The Importance of Treatment
"The answer to a lot of the problems we face with HIV is _treatment_ -- treatment, in terms of what's beneficial for the individual who is infected, and what's also beneficial for the _prevention_ of HIV transmission from one person to another, or from mother to infant. On a population level, what is going to help us the most in trying to reduce the epidemic is _treatment_."
Before we review various research categories, what do you think was the study that stands out, above all else?
I don't know if I would pick a single study. When I go to these meetings, I try to come away thinking: Was there a theme? Was there a kind of buzz? With respect to the best conferences over the years, you could always say, "I know the theme of that conference was such-and-such."
For this meeting, if there was a theme, it was the idea that the answer to a lot of the problems we face with HIV is treatment -- treatment, in terms of what's beneficial for the individual who is infected, and what's also beneficial for the prevention of HIV transmission from one person to another, or from mother to infant. On a population level, what is going to help us the most in trying to reduce the epidemic is treatment. [To hear the plenary webcast discussing HAART (highly active antiretroviral therapy) as HIV prevention and possible need for early treatment, click here.]
We've known this for a long time, of course, and there has been a lot of attention in the developed world -- the United States, Europe and other places like that -- on the benefits of early treatment. We're moving closer and closer to the idea of treating people much more broadly.
I think, at this meeting, we heard a lot about trying to apply this in developing countries. Of course, it's a huge task, and hard to know where the money's going to come from. But there was a lot of attention paid towards treatment as the most effective form of HIV prevention, and as a way of preventing death due to HIV.
Was there also talk about PrEP [pre-exposure prophylaxis], i.e., the idea of treating someone at high risk with HIV medications, and how that could be used?
There was talk about PrEP. Not a lot of data yet, but the studies are ongoing. We are beginning to see an interesting battle, or controversy, arise between the proponents of treatment as prevention versus the proponents of PrEP.
In other words:
Do we prevent HIV transmission by treating the people who have HIV so that they don't spread HIV?
Or do we prevent HIV by giving drugs to people who don't have it, so that they don't become infected?
It will be an interesting controversy, because they both probably work. But you have to wonder -- is it better to treat the people who have a disease, or to treat the people who don't? It will be interesting to see what happens.
When to Start Treatment
"I think, more and more, people are convinced that in the ideal world, if you have the money, and you have patients who are willing to take medications, that there's really a benefit to treatment at essentially _any_ stage of disease, and that we, perhaps, have been focused for too long on CD4 thresholds."
Let's quickly go through a few research categories. The first on my list is: when to start HIV treatment. There's still a lot of talk about what's the right CD4 count for initiating treatment. Is it 500? Is it 350? Was there more information at this conference?
There was some information, although there was more attention on resource-limited settings than there was on the developed world.
We've seen so much data in recent conferences, including the NA-ACCORD data1 and data on inflammation and immune activation2,3 and the consequences of not treating.
I think, more and more, people are convinced that in the ideal world, if you have the money, and you have patients who are willing to take medications, that there's really a benefit to treatment at essentially any stage of disease, and that we, perhaps, have been focused for too long on CD4 thresholds.
In fact, there are bad things that happen to you with HIV, regardless of what your CD4 count is. And they are not necessarily due to immunosuppression, but due to the consequences of viral replication, which include chronic inflammation and chronic immune activation.
I think that that was less of a priority here in Cape Town. Instead, we were looking at data on when to start HIV treatment in developing countries.
Probably the most important study was the study that had gotten a lot of press right before this conference. It was the CIPRA HT 001 study that showed that people in Haiti, when randomized to start treatment at CD4 counts from 200 to 350, were less likely to die, and less likely to develop tuberculosis [TB] and serious complications, than those who waited until their CD4 counts were below 200, which was the standard in much of the developing world.
Now, of course, in developing countries, we're not at that point. [Editor's note: Current World Health Organization guidelines have not changed since 2006 and recommend treatment before someone's CD4 count falls below 200.] We have been advocating treatment at higher CD4 counts for some time. But I think it was really important that, for the first time, we saw a randomized trial that demonstrated this benefit in the developing world.
It's odd that anyone would wonder if there's a difference with respect to the developing world. We're all human beings, so why would there be any difference?
The issue, of course, is cost.
People hate to see double standards, but there are clearly a lot of double standards that were really brought to attention at this meeting -- not just with respect to the when-to-start question, but the fact that in developing countries, most people are using d4T [stavudine, Zerit] or AZT [zidovudine, Retrovir], which have almost been abandoned in developed countries.
In the developing world, they are not using viral load monitoring. They're using less frequent CD4 monitoring. They may have very limited options for second-line therapy, and almost no options for therapy beyond second line.
So, like it or not, we've got serious double standards. There was a lot of attention paid to how can we eliminate these double standards. How can we eliminate these discrepancies? But, at the same time, acknowledging that this is all being talked about in the setting of an economic crisis that's affecting the world and the money is not easily found.
I think in places like Haiti and Africa, where there's a lot of tuberculosis, in fact, you could argue that it's even more important to treat people early because tuberculosis is such an important cause of death, and tuberculosis can occur at relatively high CD4 counts, in contrast to the opportunistic infections that people in the U.S. tend to get at normally lower CD4 counts. So if cost weren't an issue, there would be a strong motivation to treat much earlier in places where TB is a highly endemic disease.
Were there other when-to-start-treatment trials?
No, not trials. Trials are, of course, few and far between. In fact, the START trial, which is being conducted in the U.S. and elsewhere, is still kind of controversial. [For information about the START trial, visit its Web site. If you're in the U.S., and want to join the trial, click here.] Some people feel that we need that trial to decide when to start HIV treatment. Others feel that the question has essentially been answered, that we don't need the trial.
Trials are obviously big and very expensive, and so a lot of our opinions and recommendations have been based, not so much on clinical trials, but on observational data, on scientific data about inflammation and immune activation, and also now on the growing data to support the idea that treatment decreases transmission of HIV.
The Drug Pipeline
Let's discuss the next category on my list: clinical trials of new and current antiretrovirals. I've noticed from the last few conferences that there doesn't seem to be that many drugs in the pipeline.
Not as much as we used to see, but it was encouraging that there still is a bit of a pipeline. The drug that got the most attention was the new integrase inhibitor from GlaxoSmithKline and Shionogi.4
It was a very short, 10-day monotherapy trial, but it showed really superb viral suppression at 10 days, with a well-tolerated drug that has a long half-life at a fairly low dose, and doesn't require ritonavir [RTV, Norvir] boosting, and is likely to be able to be co-formulated with other products. So that was pretty exciting.
But there weren't a whole lot of other drugs that were talked about at the same level.
Are there other drugs currently being studied that will be presented at future conferences?
Yes. There are still other nucleoside analogs [NRTIs], other non-nukes [NNRTIs], other CCR5 inhibitors. So there is still a pipeline. But I do continue to think that it will be several years before we see drugs that could rescue people who have resistance to the currently available options.
The next few drugs that are likely to be approved are:
rilpivirine [TMC278], which is going to be a first-line drug, not a salvage drug
elvitegravir [GS 9137, JTK-303], which is an integrase inhibitor from Gilead, but that has cross-resistance with Isentress [raltegravir, RAL]
- vicriviroc [SCH 417690; SCH-D], which is a CCR5 inhibitor, but that's not going to work in people who can't take Selzentry [maraviroc, MVC, Celsentri]
So the next few drugs are going to be good drugs, but not drugs that are going to get us out of any messes or resistance that we might have developed. It will be longer than that before we see sort of rescue drugs, if you will. [For more on HIV drugs in development, click here.]
More reason to be adherent to therapy.
Yes. Take your meds and make sure you're on the right choice of drugs.
Longer-Term Study Data on Antiretrovirals
I noticed when looking at the IAS program, that there were a lot of drug trials for which longer-term data was presented.
Yes. Of course, this is important, but not always exciting, because you're seeing just longer-term data on studies that have already been presented. But these trials are important because they help establish the durability of drugs as well as the long-term safety.
For example, we saw data from a smaller, phase 2 study of Isentress for treatment-naive patients.5 We now have 144-week data (or essentially, three-year data) for this drug. It continues to be good. This was studied in combination with Truvada [tenofovir/emtricitabine, TDF/FTC], in comparison with Truvada plus Sustiva [efavirenz, EFV, Stocrin]. Since then there's been a larger phase 3 trial,6 but they don't have the same kind of long-term data that they have for this smaller study.
So Isentress still seems to be very tolerable.
Yes, very well tolerated and highly effective, with durability clearly demonstrated.
There was also longer-term data for both the ARTEMIS study7 and CASTLE study.8
ARTEMIS is a study of the once-a-day Prezista [darunavir, TMC114] plus Norvir combination for treatment-naive patients, and CASTLE is a study of Reyataz [atazanavir, ATV] plus Norvir for treatment-naive patients. They continue to look good, with better lipid profiles and better tolerability, compared to Kaletra [lopinavir/ritonavir, LPV/r].
We've seen more with Selzentry, the CCR5 inhibitor, with the longer-term follow-up of the MERIT study. This was a study where Selzentry plus Combivir [zidovudine/lamivudine, AZT/3TC] was compared with Sustiva plus Combivir.9
In that study, Sustiva plus Combivir actually looked better, initially, but that was due, in part, to the fact that they were using the old Trofile assay, and thereby missing some people who really shouldn't have been on Selzentry, because of the tropism of their virus.
When they redid the analysis using the updated Trofile assay, a lot of the differences disappeared. We're not widely using Selzentry for first-line therapy, but the data continue to support the idea of it.
Sustiva Versus Kaletra
On to a study by Heiner Bucher10 that I thought was really interesting. It showed that people on Sustiva were less likely to experience treatment failure than people who were on Kaletra.
It showed that you were less likely to have virologic failure with Sustiva, compared to Kaletra. But that's been shown before in head-to-head trials. We have the ACTG [AIDS Clinical Trials Group] 5142 study that was presented some time ago that showed the same thing11 -- i.e., that you were less likely to fail on Sustiva, compared to Kaletra. But if you did fail with Sustiva, you were more likely to develop resistance. So there was a trade-off.
But I think it's pretty well accepted now that nothing has really beat Sustiva in clinical trials. The only possible exception to that could be Isentress; in a study of Isentress plus Truvada versus Atripla [efavirenz/tenofovir/emtricitabine, EFV/TDF/FTC], the results looked as good, but with better tolerability.12
In all other cases, a combination with Sustiva generally has been a hard combination to beat. So this Swiss cohort data just confirmed that.
NRTI-Only Regimens and Monotherapy
There used to be a lot of interest in an all-NRTI regimen. At IAS, I noticed there was a study that said that a quad-NRTI regimen didn't seem to be very good. Was this a new study?
This is a study of Trizivir [zidovudine/lamivudine/abacavir, AZT/3TC/ABC] plus Viread [tenofovir, TDF]. So, the regimen consists of four nucleosides. I won't go into the details, but it did not look to be as good as our standard therapy.
People have lost interest in this idea. When the idea first came out it was attractive, because it meant relatively few pills, and you didn't have to deal with all the protease inhibitor [PI] side effects and that kind of thing. Subsequently, our standard treatments have become much simpler: once a day, with fewer side effects. We're trying to avoid drugs like AZT. When you use Trizivir plus Viread, you're stuck with the AZT, and all of its side effects.
The one advantage that this does have is that it's relatively free of drug interactions. So in places where there's a lot of TB, and where you have to use TB drugs like rifampin [Rifadin, Rimactane] that are very hard to use with protease inhibitors and non-nucleosides, this could be an attractive option. But I don't think this study has a lot of relevance for most of the people listening to this interview.
Another interesting treatment strategy that has been looked at in the past is the use of a single HIV drug, such as Kaletra, instead of a combination of three drugs. There used to be so many studies about Kaletra monotherapy. I noticed at IAS there was a presentation of a study looking at Prezista monotherapy. Any thoughts on this?
It's interesting, because there have been so many Kaletra monotherapy studies. But they have all been pretty small studies. None of them have been big trials. In almost every case, Kaletra monotherapy has looked pretty good, but never quite as good as Kaletra plus two nucleosides. No one's gotten too excited about it, because these small studies always had some kind of a flaw in them.
In contrast, this MONET study from Spain was a much larger study, comparing boosted Prezista once a day as monotherapy versus boosted Prezista with nucleosides.13 In this study, it looked just about as good, or as good, as using it with the nucleosides.
In those patients who didn't respond as well, they could quickly be suppressed by simply adding nucleosides. And as we saw with the Kaletra monotherapy studies, the consequences of not doing well on this were pretty minimal. I mean, you didn't see people developing resistance. So it's interesting.
This trial, because it is larger, is a more definitive one than we've seen with Kaletra. In addition, it's a much easier combination to give as monotherapy, because you're talking about three pills, once a day, as opposed to two pills, twice a day.
I don't know how widely this will be used, but it certainly has relevance in places, especially in the developing world, where you're looking for low-cost alternatives, and where you can't do resistance testing to find out whether the nucleosides are active. It's very nice to know that a second-line regimen with a boosted PI is going to work, regardless of what you combine it with.
So I think that this is certainly an interesting study, and also may have relevance for people who have a lot of nucleoside side effects, or reasons not to be able to take nucleosides.
So monotherapy is back.
Well, it's here. It's not standard of care. I wouldn't recommend it right now. But, at least with the boosted Prezista, I think these are the best results we've seen yet for monotherapy.
They also did a study in treatment-experienced patients, with twice-a-day boosted Prezista monotherapy, compared to standard of care.14 It didn't look quite as good. It wasn't bad, but as we say, it was not non-inferior. So I definitely wouldn't recommend this for a treatment-experienced group of patients, or people who have PI resistance.
Uncovering What's Behind Low-Level Viral Loads
Another interesting study that I noticed looked at using Isentress in a different way to see if it would reduce low-level residual viremia.15
Yes, that was interesting. There have been several studies like this -- not all of them with Isentress; some of them using other drugs.
The idea here is not to come up with a treatment strategy. These are essentially pathogenesis studies. The idea behind this is to try and figure out whether the reason people have low-level viral loads (I'm talking about below 50 -- viral loads too low to measure by standard tests) is because the virus is replicating at a very low level. In this case, you would worry about long-term consequences, such as resistance. Or whether this is due to something else. Is it just that the virus is randomly being released by resting CD4 cells, and that's what's causing it?
If this is due to viral replication, then by adding an additional active agent, you should further drive the viral load down. If the viral load is 20, and you add a new active drug, it should go down. Whereas, if it's not viral replication, if it's just release of virus that isn't replicating, then adding an additional drug shouldn't make any difference.
In fact, most of these intensification studies, including the one presented in Cape Town, showed no difference. So you take somebody with a viral load below 50, but greater than 1, you add another drug, such as Isentress, and you really don't see any difference in the viral load -- which, to a lot of people, suggests that your virus is not replicating when it's suppressed.
The interesting thing, I think, about this study was not the major point of the study, it was the fact that patients who added Isentress had a rise in CD4 count that was higher than those who didn't.
In all of the patients they switched over -- so, patients who added Isentress then switched to placebo, and patients who were on placebo then were switched to Isentress -- the people who added Isentress experienced a rise in CD4 count, despite the fact that their viral loads were no different.
There may be something to that. It will be interesting to look at this idea in larger trials to see if we can stimulate a CD4 increase with the addition of another drug. Isentress is certainly one of the ones that will be looked at.
Boosting CD4 Counts
"By waiting until your CD4 is very low, you run the risk that you've exhausted your immune system's ability to recover, and that -- with the possible exception of these intensification ideas -- there may simply be not much that you can do about it. The answer probably _isn't_ more drugs; it's _earlier_ treatment."
Some patients can get their viral load undetectable with a regimen, but their CD4 count does not budge. It's been a frustrating issue for both people living with HIV and their health care providers. Is Isentress one of the few drugs that might work?
It may be. I wouldn't have said so until this meeting. When I saw the intensification study, it was interesting that the CD4 count increased, even though there was no obvious virologic benefit. I think it's worth pursuing this in a larger intensification study for people who are having poor CD4 count responses.
There's currently an ongoing ACTG study using Selzentry for that purpose. We'll see what that shows.
It's interesting that despite the fact that Sustiva always seems to do the best virologically, it doesn't do the best from a CD4 standpoint. Almost everything that you compare it with has a better CD4 response. This has been shown for protease inhibitors, for Isentress, for Selzentry.
It's not a huge difference, and probably not a meaningful enough difference to make a change in what regimen you would decide to start with. But it could have relevance for those people who have poor CD4 responses on antiretroviral therapy. There may be something to this idea of intensification, at least with certain drugs.
I would point out, though, that this is only a problem for people who wait until their CD4 is very low to start therapy. If we would diagnose and treat people at much higher CD4 counts, we wouldn't have to deal with this issue.
By waiting until your CD4 is very low, you run the risk that you've exhausted your immune system's ability to recover, and that -- with the possible exception of these intensification ideas -- there may simply be not much that you can do about it. The answer probably isn't more drugs; it's earlier treatment.
Boosted Versus Unboosted Drugs
On to trials that looked at using unboosted drugs versus boosted drugs.
The ARIES study, presented by Kathleen Squires,16 was a study where everybody initially got Epzicom [abacavir/lamivudine, ABC/3TC, Kivexa] with boosted Reyataz; later, half of them dropped the Norvir because their viral load was suppressed.
Maybe a little surprising to me was that people with unboosted Reyataz did just as well as -- in fact, they did a little better than -- the people on boosted Reyataz. Perhaps that was because those on boosted Reyataz missed more doses due to side effects. But that didn't appear to be the case. So this study suggests that unboosted Reyataz is an acceptable option -- at least if you're taking it with Epzicom.
If you are one of those people -- I call them "ritonophobes" -- who just can't tolerate Norvir, even at 100 mg a day, Reyataz is probably the best PI to use.
With some of the other PIs, you either can't use them unboosted -- and that would be the case with Prezista, for example -- or you can use them unboosted, but you probably shouldn't. Lexiva [fosamprenavir, FPV, Telzir] is a good example, where unboosted Lexiva can lead to cross-resistance to Prezista.
I would point out, though, that you can't apply these ARIES data to the use of Truvada with Reyataz. With Truvada -- because of the drug interaction -- you have to boost it. So this study only applies to Epzicom plus Reyataz combinations.
What about using it with Combivir, or something like that?
You could extrapolate it to Combivir, because there's no drug interaction. It's just that people are less willing to use Combivir because of side effects. The nice thing about Epzicom plus Reyataz is it's a once-a-day regimen, where you take everything all at once.
Viramune Versus Reyataz
I noticed there was a study about pitching Viramune [nevirapine, NVP] against Reyataz.17
It was specifically looking at Viramune plus Truvada, versus Truvada plus boosted Reyataz. The reason this is interesting is because there have been three very small studies that all showed that when people took Truvada and Viramune together, they had a poor response. They had a lot of early treatment failure and resistance. Nobody could figure out why that would be. On the surface it seems like it's a perfectly reasonable combination.
This is a much larger study attempting to look at that. Their overall conclusions were that Truvada plus Viramune was as good as Truvada plus boosted Reyataz.
I still have some concerns about the study, because although the overall conclusion came out that way, there was more discontinuation of therapy in the Truvada plus Viramune arm early on. And there was more virologic failure that was due to the investigators' decision that the combination wasn't working.
It's possible that what we're seeing is something very similar to what we'd seen in these earlier studies. I need to see the published results before I would recommend this as a standard regimen.
We have pretty much covered all of the antiretroviral trials. Am I right?
There are probably more, but these are the ones on my radar screen.
Vitamin D Deficiency
Let's go on to some complication trials. There was a surprising one about vitamin D deficiency, wasn't there?
Yes. Vitamin D deficiency is becoming a hot topic these days, especially if you live in a place where during much of the year you're not getting a lot of sun exposure. When we see vitamin D studies, we're finding huge rates of deficiency, sometimes serious deficiency, and it's very clear that blacks are more likely to be deficient than whites. That probably has to do with the fact that their skin protects them from both the benefits of the sun, and the risks of the sun. Fortunately, blacks tend to have denser bones, and so they are less likely to get osteoporosis than whites.
But one of the long-term complications of having vitamin D deficiency is loss of bone density, and softening of the bones. This has become a very hot topic. This study was done in London where, of course, they never see the sun.18 There were very high rates of vitamin D deficiency in this population -- with blacks being more likely to experience it than whites. The highest rates were during the winter months.
What was interesting was that they found that another significant risk factor for vitamin D deficiency was the use of Sustiva or Atripla. This is not something that's been observed before. I'm not sure if anybody's ever looked for it.
They had a hypothesis of why it might be that Sustiva could do it, based on its metabolism and its effect on drug metabolizing enzymes. That's just a hypothesis. Of course, this doesn't mean you shouldn't use Sustiva or Atripla. But I do think that there's growing evidence that we should be supplementing vitamin D, probably checking levels more often than we have been, and especially being aware of it in older people, who are at greater risk for loss of bone density.
What sort of supplementation would be necessary?
It depends on what test you're using. We usually measure 25-hydroxy vitamin D. In our particular lab, if it's below, say, 32, we consider that deficient. When you have fairly serious deficiency, you often have to use more than just an over-the-counter supplement. You have to use very high-dose vitamin D supplements, which you take maybe weekly, or twice weekly, for a few months. Then you can switch over to a standard supplement.
I have to say that I'm increasingly coming around to the idea that just about everybody -- unless you're in the sun a whole lot -- should be on a standard vitamin D calcium supplement and those with a more serious deficiency need to have supplementation done at a higher dose.
Sorry to belabor the point, but I think this is something that our audience is interested in. What would you consider a standard vitamin D calcium supplement?
They have the over-the-counter kind that often have about 400 units of vitamin D, with some calcium. If you took one of those twice a day, that would be a decent dose. If you're taking vitamin D by itself, maybe 1,000 units a day.
I think people are realizing that our old recommendation for what a standard amount of vitamin D is, was probably not enough. So, roughly 1,000 units a day. Of course, dairy products are a good source of vitamin D, as is modest sun exposure.
Ziagen and the Risk of Heart Disease
Now, on to a drug that has been talked about so much this year, that is Ziagen [abacavir, ABC,]. The big question remains: Does it pose a heart disease risk or not? Every scientific meeting held during the last year or so seemed to bring us a new take on this. Dr. Gallant, what was the news from IAS?
This has been a very interesting controversy. We first heard the data from the D:A:D study, and then the SMART study, and then the French Hospital Database study, saying that abacavir increased the risk of heart attack.19-21
The data became so overwhelming that people finally said, "Well, I guess it does." But everybody acknowledged that the data came from these observational cohort studies that have their limitations. They weren't randomized trials. But it just seemed like study after study after study was showing this association. You just couldn't ignore it.
The DHHS [U.S. Department of Health and Human Services] guidelines reacted, in part, to that information and switched abacavir from a preferred nucleoside to an alternative nucleoside.22 It was also based on ACTG 5202, which suggested that Epzicom was less effective than Truvada at high viral loads.23
But at this conference, now we have some data going the other way. There's a very large study from the Veteran's Administration database, which initially did find a higher rate of MI [myocardial infarction] with the use of abacavir.24 What they found was that if you controlled for two things, standard cardiac risk factors and chronic kidney disease, then that association between abacavir and heart attack essentially went away.
Their argument was that people with chronic kidney disease are much more likely to get abacavir because they can't take tenofovir, and people with chronic kidney disease are much more likely to have heart attacks. Thus, the reason you see this association between abacavir and MI is because you're taking the people at highest risk for heart attack and giving them abacavir.
At the same time, the investigators from the French Database study, which was presented at CROI in Montréal,21 also found an association but said if you corrected for things like substance abuse and injection drug use, the association went away.
I don't think this means that we have the answer. I don't think it invalidates the results of the other observational studies. We have to keep in mind that the methodology is different. The D:A:D study did, in fact, look at kidney disease. Even after adjusting for that, they still found an association. But they had a lot less kidney disease in their cohort.
I think this just reinvigorates the debate. It means that we don't know the answer yet. I'll be interested to see further analyses from the original studies, to see what kind of light that can shed on this controversy.
So it's not over yet.
No, I don't think it's over yet. I'm sure there will be a defense of the original studies. We'll have to see the publication of this VA [U.S. Department of Veterans Affairs] study. I would also point out that the VA study did not look at exactly the same thing as the D:A:D study. The D:A:D study found an association with recent abacavir use, but the VA study didn't look at exactly that. Because their data is different, they don't necessarily have the ability to look at exactly the same analysis.
But I think it throws a little cold water on this. It means that we're a lot less certain about this association than we were a few months ago, after the Montréal conference.
But the recommendations remain the same: If you have a preexisting risk for heart disease, then abacavir would not be the right choice.
It's not if you have a risk, but generally, multiple cardiac risk factors. The cardiac risk factors are high LDL [low-density lipoprotein] cholesterol, smoking, diabetes, hypertension, a strong family history of early heart disease -- things like that. If you have a number of those risk factors, the current recommendation is to try to avoid abacavir. But I think we just have to acknowledge that at this point we can't be certain whether what we've seen so far is a true risk with abacavir, or whether it's just a phenomenon of observational database analysis.
HIV, Gender and Race: The GRACE Study
On to gender and race: Researchers presented the 44-week results for the GRACE study, correct?25
Yes. GRACE was an interesting study. It was using a Prezista-based regimen. But the point of the study was not what drugs you're taking. It was trying to enroll the types of people who don't tend to get enrolled in standard clinical trials -- specifically, women, inner-city women.
This study actually had a target goal trying to enroll a lot of women. More than men. If you look at most clinical trials, they are mostly comprised of men. They actually had rules at the various sites that did the study that you couldn't enroll a man until you had enrolled several women -- that kind of thing.
Unfortunately, what they found is that women did not do as well as men in responding to therapy. They talked about the reasons for the poorer response. They were reaching a group of patients who are very hard to enroll in trials, and often very hard to maintain in care. These were often inner-city clinics, with a lot of minorities, poor people, people with substance abuse issues.
The investigators are to be commended for the enormous efforts they went to, to recruit and try to retain these patients in care. But it demonstrates what a lot of people are up against.
I will say this: There is a potential for what we call selection bias in this study -- selection bias meaning that because of the way you select people for a study, you have results that aren't equal.
To try to explain this in the context of the GRACE study: If you're trying harder to enroll women than to enroll men, you may enroll more women who are not great study candidates than men.
In other words, you're going to really work hard to get women in, even if you have your doubts about whether a particular woman is likely to show up for visits and take her medications.
Whereas for the men, you're not making any extra efforts. You're just enrolling the men who show up and appear to be motivated. So this may be saying more about that process of candidate selection than it is about real differences between men and women.
On the other hand, there have been other studies that have shown similar results. Of course, women have issues with child care, with pregnancy, and sometimes with just less ability to make decisions for themselves. So some of this could be reflecting very real-life situations.
In terms of the treatment response in the women, what was the specific issue?
It was a greater rate of virologic failure. Interestingly, despite the poor virologic response, women seem to have better CD4 count responses, which was an interesting observation.
How soon after did the virologic failure occur?
Over time, the curves began to separate. So there's not any one particular time. The longer the study goes on, the more of a difference you saw in the study.
This wasn't related to adherence or anything like that?
I'm sure it was related to adherence, because there's no biological reason why a woman would not respond as well as a man. In other clinical trials, where you're enrolling a much more typical study population, you don't see differences between men and women.
I think that what this study is telling us is not that women are less likely biologically to respond to treatment, but that in real world settings -- where HIV is happening in disadvantaged populations -- there are enormous challenges for adherence for both men and women, but that women, in many cases, have more of those challenges that get in the way of their ability to remain on medications.
So it's a sociological finding.
Yes, I think it's sociological. It's very important. But I don't think it's important because of what it's telling us about the drugs, or about biology, but just about the obstacles to good adherence.
Then for women who are living with HIV and listening to this, it doesn't mean that they are more likely to fail as long as they're adherent?
Absolutely not. No. And we've seen that now in many, many other studies, where women do just as well as men if they're taking their medications at the same rate of adherence.
FOTO: Five Days on a Sustiva-Based Regimen and Two Days Off
On to another interesting study, the FOTO study, which evaluates a treatment strategy involving five days on, two days off a Sustiva-based regimen.26 It's one of the few treatment interruption studies still around.
Yes. The argument, I think, the investigators make is that it's not really treatment interruption because adequate levels of the drugs remain in the blood during the two days you are off treatment. It's using Atripla, essentially, and the drugs that are contained in Atripla have such long half-lives that over the course of a weekend, you've still got adequate drug levels in your blood.
When you resume taking the drugs on Monday, you may have interrupted your dosing, but you really haven't interrupted your drug levels.
In this study, they found that people did as well with this five day on, two day off schedule as they did if they took it all week long.
Now, personally, I don't think this means you should do this. It's a relatively small study, and so they could have easily missed differences in effectiveness that would have been seen if a much larger study had been done.
But I do think that what it tells us is that, when you're using drugs like the ones in Atripla, which have long half-lives, you're protected against the occasional late or missed dose. It's probably one of the important reasons why Atripla always looks so good in clinical trials; it maintains really good drug levels, even when people don't have perfect adherence.
Think back to the old days of Combivir and Crixivan [indinavir, IDV], when perfect adherence was really what it took to succeed. It's just not that way anymore. I would not at all use this as an argument for taking five, out of seven, days of therapy, or even of intentionally missing doses. But I think what it means is that this is a pretty forgiving regimen if someone occasionally misses a dose.
It's ironic that you say it's a forgiving regimen, because when HIV drug resistance happens, it really happens.
That's exactly right. But I think that has to do more with how you miss doses than whether you miss doses. FOTO tells us that if you miss a dose here and there, it's probably not the end of the world. Where you see resistance is with a pattern of missed doses, where it's almost like a treatment interruption. People who go away for vacation and forget their meds for a week, or people who don't refill their meds and show up in clinic two months later. That pattern of repeated, sequential missed doses, where you get slowly declining levels of the Sustiva, such that your virus has a chance to learn how to become resistant. Then it's very, very easy to become resistant to this.
We've seen this. There was a Spanish treatment interruption study, where they stopped therapy for periods of time in patients taking Sustiva. They found that with every interruption, more and more people developed resistance. So a missed dose is one thing, but a missed week is a very different thing.
Conclusion: HIV and the Developing World
That just about wraps up the treatment-related research presented at IAS. Dr. Gallant, were there any other studies presented that you think were important for our audience?
I think we've hit on the ones that have the most relevance to the developed world. There are a lot of other studies about the prevention of transmission from mother to child, treatment during breastfeeding, and the effect of HIV therapy on TB that were probably some of the most important studies presented at this meeting, but are of less relevance to an audience here in the U.S.
When I was looking over the program, I noticed that there were more studies presented about developing world issues than in any other IAS conference that I've ever seen.
Yes, I think that's true. Part of it was because of where it was being held. This is the first IAS meeting being held in sub-Saharan Africa. The previous one was actually an International AIDS Conference. With every year, we see more and more research being done, more research money being available for resource-limited countries. And there's more data to be presented.
Because it was in South Africa, a lot of us said, "Oh, it's too far to go. It's too expensive. It takes too long to get there." That may be true for us, but it made it a lot easier for people in sub-Saharan Africa to go -- much cheaper than it would have been if it had been in Europe or the U.S. or Australia. So I think that really enriched the conference, and enhanced the value of it -- because there was so much data from Africa and so much participation from Africa.
I wonder too if many of the researchers from the resource-rich countries felt intimidated being in South Africa. After all, only 30 percent of the millions of people who need treatment can access it in South Africa. Was there discussion of this in the research community?
There was a lot of discussion of that. One of the other concerning things that came up repeatedly in this conference was the issue of interruption of supply of drug, and of the non-sustainability of some treatment programs, especially now with the global economic crisis -- with cutbacks in funding from both local governments, from resource-rich governments, and from other sources of drugs and money for treatments.
There is a real concern that we may see backsliding; we may see a loss of many of the gains that we've seen over the years in patients who have been on therapy. Then of course, there's the fact that, although we're doing better at getting people treatment, the rate of increase, the rate of spread of HIV, is still faster than the rate of increase in treatment. So we're always falling backwards, even in the best of economic times.
This is a real concern because, of course, the situation in places like Africa has always been tragic. But at least there's been this glimmer of hope that we're getting more and more people on treatment. To think that some of those people will not be able to stay on treatment, for economic reasons, is just heartbreaking, especially if you've been to these places and see what antiretroviral therapy has brought to these communities -- a new hope for survival and for health. It's heartbreaking to think that we may see a loss of that.
So, even as the news gets better and better in the United States, and in developed situations, it's also sad to see what's going on there.
Yes. I hope we'll continue to prioritize this. People say it's just one disease, and that there are lots of other diseases. There are all sorts of health issues in resource-limited countries -- everything from diarrheal disease, to malaria, to TB, to just the lack of clean water and basic health care provision. But I don't think it's fair to put HIV on the same level as those things.
First of all, HIV is a transmitted infectious disease that is causing one of the worst global pandemics in our time -- and in history. To just talk about it as another disease is to deny its potential for spread, and for global catastrophe.
The other thing is -- and we saw this in a lot of studies presented at IAS -- just how much HIV affects all of those other things I mentioned. It increases risk of malaria. It certainly has had a devastating impact on tuberculosis epidemiology. We're seeing that so much of the tuberculosis epidemics around the world are directly related to HIV. It's the underlying cause for so many other health problems that are devastating a lot of these countries.
Unless we can control, prevent and treat HIV, we're not going to have any hope of dealing with the TB epidemic, or of dealing with a lot of these other medical conditions.
Thank you so much for this great wrap-up.
This transcript has been lightly edited for clarity.
Kitahata M, Gange S, Moore R, and the North American AIDS Cohort Collaboration on Research and Design. Initiating rather than deferring HAART at a CD4+ count >500 cells/mm3 is associated with improved survival. In: Program and abstracts of the 16th Conference on Retroviruses and Opportunistic Infections; February 8-11, 2009; Montréal, Canada. Abstract 71.
Kuller LH, Tracy R, Belloso W, et al, for the INSIGHT SMART Study Group. Inflammatory and coagulation biomarkers and mortality in patients with HIV infection. PLoS Med. October 21, 2008;5(10):e203.
Neuhaus J, Jacobs D, and the INSIGHT SMART, MESA and CARDIA Study Groups. Markers of inflammation, coagulation, and renal function in HIV-infected adults in the strategies for management of ART study and in 2 large population-based studies, coronary artery risk development in young adults and multi-ethnic study of atherosclerosis. In: Program and abstracts of the 16th Conference on Retroviruses and Opportunistic Infections; February 8-11, 2009; Montréal, Canada. Abstract 740.
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Lalezari J, Sloan L, Dejesus E, et al, and ING111521 Investigators. Potent antiviral activity of S/GSK1349572, a next generation integrase inhibitor (INI), in INI-naive HIV-1-infected patients. In: Program and abstracts of the 5th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention; July 19-22, 2009; Cape Town, South Africa. Abstract TUAB105.
Gotuzzo E, Nguyen B-Y, Markowitz M, et al, and the Protocol 004 Part II Study Team. Sustained antiretroviral efficacy of raltegravir as part of combination ART in treatment-naive HIV-1 infected patients: 144-week data. In: Program and abstracts of the 5th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention; July 19-22, 2009; Cape Town, South Africa. Abstract MOPEB030.
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Steigbigel R, Cooper D, Eron J, et al, and BENCHMRK-1 and 2 Study Groups. 96-week results from BENCHMRK 1 and 2, phase III studies of raltegravir in patients failing ART with triple-class-resistant HIV. In: Program and abstracts of the 16th Conference on Retroviruses and Opportunistic Infections; February 8-11, 2009; Montréal, Canada. Abstract 571b.
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Fourie J, Flamm J, Rodriguez-French A, et al. ARTEMIS: week 96 safety and efficacy of darunavir/r by gender, age and race. In: Program and abstracts of the 5th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention; July 19-22, 2009; Cape Town, South Africa. Abstract CDB072.
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Uy J, Yang R, Wirtz V, Sheppard L, Absalon J. Efficacy and safety of atazanavir/r vs. lopinavir/r in treatment-naive patients with advanced disease: CASTLE study 96-week results. In: Program and abstracts of the 5th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention; July 19-22, 2009; Cape Town, South Africa. Abstract MOPEB041.
Nelson M, Lazzarin A, Di Perri G, et al. Virologic suppression on maraviroc in treatment-naive patients with R5 HIV-1 is similar to efavirenz at high baseline viral load, and maraviroc discontinuations for adverse events are less likely to show drug resistance: 48-week results from the MERIT study. In: Program and abstracts of the 5th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention; July 19-22, 2009; Cape Town, South Africa. Abstract MOPEB040.
Bucher HC, Young J, Günthard H, et al, and the Swiss HIV Cohort Study. Virologic and immunologic responses to efavirenz or boosted lopinavir as first therapy for patients with HIV in the Swiss HIV Cohort Study (SHCS). In: Program and abstracts of the 5th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention; July 19-22, 2009; Cape Town, South Africa. Abstract MOPEB051.
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Riddler SA, Haubrich R, DiRienzo AG, et al, for the AIDS Clinical Trials Group Study A5142 Team. Class-sparing regimens for initial treatment of HIV-1 infection. N Engl J Med. May 15, 2008;358(20):2095-2106.
Markowitz M, Nguyen B-Y, Gotuzzo E, et al, and the Protocol 004 Part II Study Team. Sustained antiretroviral efficacy of raltegravir as part of combination ART in treatment-naive HIV-1 infected patients: 96-week data. In: Program and abstracts of the XVII International AIDS Conference; August 3-8, 2008; Mexico City, Mexico. Abstract TUAB0102.
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Arribas J, Horban A, Gerstoft J, et al. The MONET trial: darunavir/ritonavir monotherapy shows non-inferior efficacy to standard HAART, for patients with HIV RNA <50 copies/mL at baseline. In: Program and abstracts of the 5th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention; July 19-22, 2009; Cape Town, South Africa. Abstract TUAB106-LB.
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Katlama C, Valentin MA, Algarte-Genin M, et al. Efficacy of darunavir/ritonavir as single-drug maintenance therapy in patients with HIV-1 viral suppression: a randomized open-label non-inferiority trial, MONOI-ANRS 136. In: Program and abstracts of the 5th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention; July 19-22, 2009; Cape Town, South Africa. Abstract WELBB102.
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Gandhi R, Zheng S, Bosch R, et al, and the AIDS Clinical Trials Group A5244 Team. Raltegravir (RAL) intensification does not reduce low-level residual viremia in HIV-1-infected patients on antiretroviral therapy (ART): results from ACTG A5244. In: Program and abstracts of the 5th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention; July 19-22, 2009; Cape Town, South Africa. Abstract WELBB104.
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Squires K, Young B, DeJesus E, et al. Similar efficacy and tolerability of atazanavir (ATV) compared to ATV/ritonavir (RTV, r), each in combination with abacavir/lamivudine (ABC/3TC), after initial supression with ABC/3TC + ATV/r in HIV-1 infected patients: 84-week results of the ARIES trial. In: Program and abstracts of the 5th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention; July 19-22, 2009; Cape Town, South Africa. Abstract WELBB103.
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Soriano V, Köppe S, Mingrone H, et al. Prospective comparison of nevirapine and atazanavir/ritonavir both combined with tenofovir DF/emtricitabine in treatment-naive HIV-1 infected patients: ARTEN study week 48 results. In: Program and abstracts of the 5th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention; July 19-22, 2009; Cape Town, South Africa. Abstract LBPEB07.
Welz T, Childs K, Ibrahim F, Poulton M, Post F. Efavirenz use is associated with severe vitamin D deficiency in a large, ethnically diverse urban UK HIV cohort. In: Program and abstracts of the 5th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention; July 19-22, 2009; Cape Town, South Africa. Abstract TUPEB186.
D:A:D Study Group, Sabin CA, Worm SW, et al. Use of nucleoside reverse transcriptase inhibitors and risk of myocardial infarction in HIV-infected patients enrolled in the D:A:D study: a multi-cohort collaboration. Lancet. April 26, 2008;371(9622):1417-1426.
Lundgren J, Neuhaus J, Babiker A, et al, and the SMART/INSIGHT and D:A:D Study Groups. Use of nucleoside reverse transcriptase inhibitors and risk of myocardial infarction in HIV-infected patients enrolled in the SMART study. In: Program and abstracts of the XVII International AIDS Conference; August 3-8, 2008; Mexico City, Mexico. Abstract THAB0305.
Lang S, Mary-Krause M, Cotte L, et al, and the Clinical Epi Group of the French Hosp Database on HIV. Impact of specific NRTI and PI exposure on the risk of myocardial infarction: a case-control study nested within FHDH ANRS CO4. In: Program and abstracts of the 16th Conference on Retroviruses and Opportunistic Infections; February 8-11, 2009; Montréal, Canada. Abstract 43LB.
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Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents (PDF). Washington, DC: US Dept of Health and Human Services; November 3, 2008.
Sax P, Tierney C, Collier A, et al. ACTG 5202: shorter time to virologic failure (VF) with abacavir/lamivudine (ABC/3TC) than tenofovir/emtricitabine (TDF/FTC) as part of combination therapy in treatment-naive subjects with screening HIV RNA > 100,000 c/mL. In: Program and abstracts of the XVII International AIDS Conference; August 3-8, 2008; Mexico City, Mexico. Abstract THAB0303.
Bedimo R, Westfall A, Drechsler H, Tebas P. Abacavir use and risk of acute myocardial infarction and cerebrovascular disease in the HAART era. In: Program and abstracts of the 5th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention; July 19-22, 2009; Cape Town, South Africa. Abstract MOAB202.
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Squires K, Currier J, Bridge D, et al, on behalf of the GRACE Study Group. GRACE (Gender, Race And Clinical Experience): 48-week results of darunavir/r-based therapy in the largest trial in North America focused on treatment-experienced women. In: Program and abstracts of the 5th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention; July 19-22, 2009; Cape Town, South Africa. Abstract MOPEB042.
Cohen C, Colson A, Pierone G, et al. The FOTO study: the 48 week extension to assess durability of the strategy of taking efavirenz, tenofovir and emtricitabine Five days On, Two days Off (FOTO) each week in virologically suppressed patients. In: Program and abstracts of the 5th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention; July 19-22, 2009; Cape Town, South Africa. Abstract MOPEB063.


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* Obama makes list based on fame, publicity, book sales
* Top four spots held by women, with Angelina Jolie No. 1
* J.K. Rowling, Johnny Depp cut from list of 100
By Jui Chakravorty Das
NEW YORK, June 3 (Reuters) - U.S. President Barack Obama is the first sitting head of state to make the Forbes Celebrity 100 Power List, with his many magazine covers and best-selling books blurring the line between politics and celebrity.
The president came in at No. 49 on the annual list released on Wednesday — which ranks celebrities based on their earnings and mentions in the media — after he made $2.5 million last year from his two best-selling books.
"Obama is hands-down the most famous person in the world," said Lacey Rose of Forbes magazine. "His historic presidential run helped him sell more than a million copies of his books; he landed on many magazine covers."
"There is a real interest in him as a president, a family man, a celebrity," she said.
Obama is the first African American to be elected U.S. president.
Former President Bill Clinton, who left office in 2001, appeared on the Forbes list in 2002, 2003, 2004, 2005 and 2007.
Topping the list is actress Angelina Jolie, followed by talk show host Oprah Winfrey, then singers Madonna and Beyonce Knowles, making this the first year all top four spots were taken by women, Forbes said.
During the past year, Jolie made $27 million, Winfrey $275 million, Madonna $110 million and Knowles $87 million. While Jolie's earnings pale in comparison to the other women's, her constant presence in magazines propelled her to the top spot.
"She is in the dialogue of pop culture nearly every day," Rose said. "There is such an appetite for her relationship with Brad Pitt, her children, her philanthropic activity."
Madonna rose from No. 21 last year, after her 'Hard Candy' tour was the top-grossing international tour of 2008. She also remained in the media spotlight due to her divorce from director Guy Ritchie and her bid to adopt a second child from Malawi.
Golfer Tiger Woods came in at No. 5 with estimated earnings of $110 million, singer Bruce Springsteen nabbed No. 6 with an income of $70 million and director Steven Spielberg took seventh place after bringing in $150 million, Forbes said.
Actress Jennifer Aniston jumped to the No. 8 spot from No. 17 last year, after earning an estimated $25 million from two Hollywood movies, endorsement deals and royalties from her syndicated TV series Friends. She was also a regular in the media due to her former relationship with singer John Mayer.
Brad Pitt, who has six children with Jolie, came in at No. 9, with estimated earnings of $28 million.
Basketball player Kobe Bryant, who saw his popularity soar after making the 2008 Olympic basketball team, came in at No 10. Bryant raked in an estimated $45 million in the past year, padding income from his Los Angeles Lakers basketball contract with endorsements, Forbes said.
Among those dropped from the list are British author J.K. Rowling, who released her final Harry Potter book in 2007. Actor Johnny Depp, who placed sixth last year following the third installment in the movie series Pirates of the Caribbean, also fell off the list.
The full list can be seen at www.forbes.com/celebrities. (Editing by Michelle Nichols and Eric Walsh)


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"Thanks be unto God for His unspeakable gift" (2 Corinthians 9:15).
We who have known and sought to follow the Lord for many years have received many, many blessings for which to thank Him. "Blessed be the Lord, who daily loadeth us with benefits" (Psalm 68:19), we can pray again and again.
But there is one blessing which is so great that it cannot even be put into words--it is unspeakable! That gift is so great that when we try to comprehend it, the sense of awe and gratitude becomes so overwhelming (or at least should become so overwhelming) that our joy is also unspeakable--indescribable! That gift, of course, is the gift of the Lord Jesus Christ as our Redeemer and Savior, "Whom having not seen, ye love; in whom, though now ye see Him not, . . . ye rejoice with joy unspeakable and full of glory" (1 Peter 1:8).
It is significant that the Greek word translated "unspeakable" occurs only these two times in the entire New Testament. God's unspeakable gift to us produces unspeakable joy in us. We who deserve nothing but eternal separation from God in hell, instead will enjoy eternal life with God in heaven, and all because of that amazing and truly inexpressible gift!
To think that the mighty Creator, God the Son, would not only humble Himself to become His own creature, man, but then also suffer the unimaginable agony of the cross and separation from God the Father in order to deliver us from the just penalty of sin! This act speaks of such love and grace that all we can do is whisper softly, "Thank you, Lord, for this unspeakable gift," and then shout it over and over again in our hearts wherever we go, and share its unspeakable joy and blessing with whomever will listen to its message. "The Lord hath done great things for us; whereof we are glad" (Psalm 126:3). Thank you, Lord! HMM


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LANSING (WILX)-- Will a new Volkswagen auto plant be the newest addition to Lansing? Republican lawmakers in Tennessee have threatened to take away VW's tax incentives if the workers vote to join the UAW.
Lansing mayor Virg Bernero says Volkswagen can just pack up and come to Lansing. The capital city is ready to welcome more UAW workers anytime.
When he heard about Tennessee lawmakers threatening Volkswagen over a union vote, Bernero didn't hesitate to insert himself into the argument.
"The legislature, the governor, they have the nerve threaten the support for expansion based on unionization? I was amazed by it, and then I smelled opportunity," said Bernero.
He posted on his facebook Monday saying "come to a real car town, leave Tennessee behind."
On Tuesday he sent out the formal request, and plans work with LEAP to send a whole packet of information to VW later this week.
"It's a little wild, but stranger things have happened. We're a car town. We have no problem with the unions, and we welcome all manufacturers."
Volkswagen plans to invest $7 billion dollars in North America to build mid-size SUVs.
More than 15,000 workers at the VW plant in Chattanooga will vote later this week on joining the UAW.
Tennessee republicans are accusing VW working arm-in-arm with the union, and are threatening to pull tax incentives
Billboards saying "UNITED OBAMA WORKERS" have been popping up all over the city trying to discourage workers.
UAW members here in mid-Michigan call it blackmail.
"It's a right to work state just like they made Michigan. It's supposed to be about people having choices. People should have a choice," said Mike Green, President of Local UAW 652.
If Tennessee politicians can't play nice with the UAW, Green also thinks VW should pack up and move North.
"Bring them up today. I'll go down and talk with them," said Green.
Bernero says he's already talked with GM, and says it wouldn't have a problem with Volkswagen building a plant in Lansing.
"If they don't want you in Tennessee believe me we'll lay down the red carpet. Our arms are wide open and we'd love to have you in Lansing," said Bernero.
In Chattanooga anti-union groups got a powerful ally Tuesday. One of Tennessee's two US senators got involved.
Republican Bob Corker urged workers to vote against unionization. He said it would hurt the pro-business culture in Chattanooga, and make it tougher to bring new jobs to the city.


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Under the Chuppah creates custom Chuppahs for rental or sale. Within the Northern California area, the full service wedding package includes chuppah delivery, set-up and dismantling. Under the Chuppah also rents nationally, shipping chuppahs to all parts of the United States.
A wide selection of styles and fabrics is available. Designs range from traditional to contemporary. Carol sometimes incorporates lights in the layers of fabric, creating dramatic and romantic effects. Brides have described her chuppahs as "magical".
Although based in Jewish tradition, Carol's chuppahs have become popular with non-Jewish couples, as well. Canopies have been placed over head tables, to highlight the wedding party, or over sweetheart tables, to create a charming ambience. They also look beautiful over cake tables, framing a glorious wedding cake.
A variety of bridal accessories are available. These include personalized items as well as aisle and table decor.


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ABC News' Mosheh Gains and Sandra Petrykowski report:
Two Gonzaga University students are on indefinite probation for pulling out a gun when an intruder allegedly tried to force his way into their university-owned apartment.
Erik Fagan and Dan McIntosh were notified Sunday in a letter from the Spokane, Wash., university they had been placed on indefinite probation for violating the school's weapons policy Oct. 24 when a six-time felon knocked on their door and allegedly demanded money.
Fagan said he answered the door to their apartment when he confronted John Taylor, a repeat offender who told him he'd just gotten out of jail.
"I just kind of popped up and opened the door and see Mr. Taylor standing there and he starts explaining how he's homeless and needs money," Fagan told ABC News.
Fagan said Taylor tried to barge in and he called out to his roommate for help. McIntosh entered the room and brandished his gun.
"I drew my pointed weapon at him and at which time he sees me and takes off," McIntosh said.
McIntosh, an electrical engineering major, said he and Fagan called police after the incident and Taylor was arrested.
McIntosh has a concealed weapons permit for his gun but campus police confiscated the weapon and told the seniors they had violated school policy and could be suspended or even expelled.
Even though the incident took place off campus, the building that houses the apartment is owned by Gonzaga and school officials say their rules on no weapons is clearly stated.
"The university policy prohibits the possession of weapons in residential facilities. We also have a similar prohibition on the rest of campus," Vice President of Gonzaga Dr. Earl Martin said.
Fagan and McIntosh say they didn't know anything about the policy, but they wouldn't change a thing as they wonder what would have happened to them if they hadn't been armed.
"Because we were just defending ourselves there is no reason that we should be punished for it," Fagan said.
The seniors said they plan to appeal the school's indefinite probation ruling.


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Connect an external display to an eGPU
You can get additional graphics performance in Final Cut Pro X by using an eGPU to connect your Thunderbolt 3-equipped Mac to an external display. In addition, viewing 360° video is more responsive when connecting an HTC VIVE VR headset to the HDMI output on the eGPU.
Use the Prefer External GPU setting with Final Cut Pro X in macOS Mojave
In macOS Mojave, you can get accelerated graphics performance in Final Cut Pro X when you turn on the Prefer External GPU option. When you turn this option on, some graphics processing is transferred to the eGPU, which results in improved performance for some graphics-related tasks:
- Improved playback of projects with color correction and video effects.
- Improved performance when working with 3D titles.
- Faster analysis for effects including stabilization and optical flow retiming.
- Faster rendering of complex project timelines.
- Faster export of complex project timelines.
To get this improved performance, turn on Prefer External GPU for Final Cut Pro X in the Finder:
- Quit Final Cut Pro X if it's open.
- In the Finder, choose Go > Applications, or press Shift-Command-A.
- In the Applications folder, click Final Cut Pro to select it, then choose File > Get Info, or press Command-I.
- In the General section of the Info window, select Prefer External GPU. You won't see this option if an eGPU isn't connected or if your Mac isn't running macOS Mojave.
- Open Final Cut Pro to use it with the eGPU.


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New to Bullseye? Subscribe to our podcast in iTunes or with your favorite podcatcher to make sure you automatically get the newest episode every week.
And if you're looking for a particular segment to listen to or share, check us out on Soundcloud.
Our guest host this week is the author and The New Yorker staff writer Susan Orlean. You can find more from Susan at her website or follow her on Twitter. Thanks, Susan!
Jack Black always seems to be on the verge of breaking into song. Whether he's a slacker substitute teacher in School of Rock, an earnest funeral director in Bernie, or a snobby record store clerk in High Fidelity, music has a way of seeping into his performances. Maybe that's because Black's portrayals often possess an unbridled joy that's difficult to capture with spoken dialogue.
Although he's known for his comedic strengths and has often played the "shlubby loser", Black has showed that he's capable of much more. For Peter Jackson's King Kong, he played a 1930s filmmaker intent on creating an epic narrative, no matter how far into the heart of darkness he has to travel. In Noah Baumbach's Margot at the Wedding, he was a disappointing groom prone to occasional bursts of anger. Most recently, he played the titular character in Richard Linklater's Bernie, a film based on the true story of a kind, gentle mortician accused of murder in a small Texas town. It's the subtlety of performances like these mixed with the intensity of a man who also headlines the rock band Tenacious D that truly make Black a unique performer.
Guest host Susan Orlean gets to the bottom of Black's career, from his early days performing one-man shows in his living room to working with some of the biggest names in show business. They'll talk about some of his early childhood performances, dissecting musical tastes, a new HBO pilot, and why seeing him on Broadway wouldn't be entirely out of the question.
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He suggests a listen to two new records: Government Plates by experimental hip hop and noise group Death Grips, and Iron Chic's The Constant One.
You find Ian's writing at Pitchfork and Grantland, or follow him on Twitter.
If you liked this, let someone know! Click here to share this segment.
Bun B was half of UGK and still is one of the South's greatest hip-hop lyricists. Alongside partner Pimp C, he spent two decades rhyming and recording classic hip-hop and helped establish Texas as a force to be reckoned with in the national hip-hop scene. Pimp C died six years ago this month, but Bun has continued to record and release music as a solo artist. His newest album, Trill Og the Epilogue, was released in November.
Jesse sat down with Bun B in 2009 to talk about underwriting a music career with street crime, rhyming with Jay-Z, and his reaction to Pimp C's frequent arrests, setbacks, and untimely passing.
If you liked this, let someone know! Click here to share this segment.
Guest host Susan Orlean goes under the spell of "Franco" Luambo Makiadi, The Sorcerer of the Guitar.
If you liked this, let someone know! Click here to share this segment.


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On this site you will find free event planning tips, resources and templates.
Your tips are always welcome, just hit the "send a note" button, visit the SHARE section or leave a comment on a posting. Afterall, great ideas are meant to be shared.
Visit our sister site a la Reg to create custom online event registration forms and donation forms.
Bon Voyage!


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Information Technology
A connected campus for your connected life.
William & Mary Information Technology is a service-based organization, first and foremost. Whether you're a student, faculty member, or an administrator, that means we'll always be ready with creative solutions for all your technology needs.
As you know, the world is becoming a more "connected" place with each passing day. We are a dynamic group of highly trained and hard working individuals, dedicated to providing secure and reliable technologies that will help you make new connections and get the most out of the ones you already have.
No matter what you're doing on campus--learning, teaching, researching--IT will be right there with you, enhancing that experience.
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