Tag Archives: Antiretroviral drug

Another Major HIV Breakthrough

Posted on March 5, 2013 by | 1 Comment

ProfLewin

Yesterday, the world was taken by storm when it was announced that a baby, born with HIV had been cured.  On the same day, it was announced a team from The Alfred hospital have uncovered HIV’s genetic hiding place and found a drug able to wake it up so that it can be destroyed.

The Alfred’s director of infectious diseases, Prof Sharon Lewin, said waking up HIV with doses of a highly toxic cancer drug was a huge step in curing a disease that has already claimed an estimated 30 million lives.

“What we thought would happen happened: the virus woke up, and we could measure it,” Prof Lewin said. “That is a big step.

“There are more possibilities of getting rid of it by making it visible to drugs and visible to the immune system (and) that we now know we can do.  Now the big challenge is working out, once it is visible, what are the ways to get rid of that infected cell.”

Traditional antiviral medications have been able to stop the virus infecting cells, giving patients a greater life expectancy.

But the virus remained “sleeping” in their DNA, unable to be found or treated, so patients had to take expensive medication daily to suppress its effects.

“It jumps in, buries itself into the DNA and sits there lurking. At any time, if the cell becomes active, the virus then becomes active,” Prof Lewin said.

“It is like having the embers of a fire sitting there . . . the minute you take away the anti-HIV drugs, the embers relight the fire and the whole thing gets going again.”

But by using cancer drug, Vorinostat, for two weeks, Prof Lewin had been able to turn on sleeping HIV-infected cells so they could be detected.

Researchers at The Alfred were able to bring the virus to notice in 18 of 20 HIV patients in a trial that concluded in January.

Prof Lewin hopes a new generation of drugs able to kick-start the immune system may now be able to kill the virus.

Prof Lewin and her team — which included collaboration with Monash University, the Burnet Institute, the Peter MacCallum Cancer Centre and the National Association of People Living with HIV/AIDS — will soon publish their full results.

For David Menadue, who has lived with HIV for almost 30 years, the results bring a new hope.

“Just having the existence of HIV in your body does do damage to your body every day. It puts pressure on your organs, your heart, your kidney, your liver.

“People with HIV would just love to get rid of this and go back to a normalised life. We are never really going to be able to get on top of the virus in developing countries without some sort of magical cure.”

Original Article via Herald Sun

Channel 4 news interviewed Professor Lewin yesterday, click here to see. (Sorry, we can’t embed this video)

Professor Lewin’s news isn’t new, she spoke about this at the 2012 CROI (Conference on Retroviruses and Opportunistic Infections)  - He she speaks with Matt Sharp about HIV Latency and Eradication using Vorinostat.

STAY UPDATED
Follow LASS on Twitter

or subscribe via email

→ 1 Comment

Posted in Uncategorized

Tagged , , , , , , , , , , , ,

Anti-HIV drug effort in South Africa yields dramatic results

Posted on February 25, 2013 by | 1 Comment

indinavir-capsules-250x250

An intensive campaign to combat HIV/AIDS with costly antiretroviral drugs in rural South Africa has increased life expectancy by more than 11 years and significantly reduced the risk of infection for healthy individuals, according to new research.

The two studies, published Thursday in the journal Science, come as wealthy Western nations are debating how best to stretch limited AIDS funding at a time of economic stress.

With an annual price tag of $500 to $900 per patient, antiretroviral therapy programs have stirred frequent debate. Critics argue that adherence to the drug regimen is low and social stigma prevents some from seeking care until they are very ill and have infected others. Cheaper remedies, such as condom distribution, male circumcision and behavior modification, deserve more attention and funding, they say.

The new economic analysis of a $10.8-million campaign in KwaZulu-Natal province concluded that the drug scale-up there had been highly cost-effective.

The program was administered by nurses in rural health clinics in an impoverished region of about 100,000 people. Treatment consisted primarily of daily doses of antiretroviral therapy, or ART, drugs, which patients take every day for their entire lives. Patients picked up their medication at a rural clinic once a month.

In 2003, the year before the drugs were available, 29% of all residents were infected with HIV and half of all deaths there were caused by AIDS. Life expectancy in the region was just over 49 years.

By 2011, life expectancy had grown to 60 1/2 years — “the most rapid life expectancy gains observed in the history of public health,” said study senior author Till Barnighausen, a global health professor at the Harvard School of Public Health.

Based on that increase in longevity, researchers determined just how many years of life were effectively “gained” among residents as a result of ART intervention. They used that figure and the total expense of the program to calculate a cost-effectiveness ratio of $1,593 per life-year saved.

The World Health Organization considers medical intervention to be “highly cost-effective” if the cost per year of life saved is less than a nation’s per capita gross domestic product. The program’s ratio was well below South Africa’s 2011 per capita GDP of about $11,000.

“It’s really a slam dunk of an intervention,” said study leader Jacob Bor, a graduate student at Harvard. “These investments are worthwhile.”

The research team noted that the study period coincided with the arrival of electric power and clean water for area residents. But those alone could not explain the dramatic increase in longevity, they said.

“While mortality due to HIV declined precipitously, mortality due to other causes flat-lined,” Bor said. “These changes were almost certainly due to ART scale-up.”

In a second study from the same region, researchers followed nearly 17,000 healthy people from 2004 to 2011 to determine HIV infection rates in areas with active ART intervention programs.

Healthy individuals in those areas were 38% less likely to contract HIV than people in areas where ART drugs were not widely available, researchers found. People in extremely rural areas also fared better than those in more closely populated areas clustered around national roads.

Overall HIV prevalence increased 6% during the seven years of the study, probably because the antiretroviral drugs allowed people with the virus to live longer, according to the report.

It’s not clear how the results of the new study would translate to areas where stable, cohabiting couples were not the norm, said lead author Frank Tanser, an epidemiologist at the University of KwaZulu-Natal.

AIDS researchers who weren’t involved in the studies said they provide strong support for maintaining programs like the President’s Emergency Plan for AIDS Relief, begun by President George W. Bush in 2003.

“These papers present truly remarkable data,” said Dr. Douglas Richman, director of the Center for AIDS Research at UC San Diego.

Original article via Gawker

STAY UPDATED
Follow LASS on Twitter

or subscribe via email

→ 1 Comment

Posted in Uncategorized

Tagged , , , , , , ,

HIV positive patients fail to disclose their infection to NHS staff

Posted on February 18, 2013 by | 1 Comment

trustinthenhs

A significant proportion of HIV positive patients may not be disclosing their infection to NHS staff, when turning up for treatment at sexual health clinics.

This is the finding suggested by preliminary research published online in the journal Sexually Transmitted Infections.

If the findings reflect a national trend, this could have implications for the true prevalence of undiagnosed HIV infection in the population, which is based on the numbers of “undiagnosed” patients at sexual health clinics, say the authors.

Currently, it is estimated that around one in four people in the UK who is HIV positive doesn’t know they’re infected with the virus.

The estimate is based on several sources of data, including the GUMAnon Survey, which routinely looks for HIV infection in blood samples taken from patients to test for syphilis at one of 16 participating sexual health clinics across the UK.

The results are then matched with the individual’s diagnostic status—whether they had been diagnosed before their arrival at the clinic, or were diagnosed at their clinic visit, or left the clinic “unaware” of their HIV status.

It is thought that a proportion of patients who do know their HIV status nevertheless choose not to reveal it to NHS staff when attending for services elsewhere.

To test this theory, the researchers analysed all HIV positive samples from one participating GUMAnon clinic in London in 2009 for the presence of very low viral loads— a hallmark of successful drug treatment—and various antiretroviral drugs.

Of the 130 samples which matched clinic records, 28 were from patients who were not known to be HIV positive before their arrival at clinic. Ten had been tested for HIV at their clinic visit.

The remaining 18 did not have a test at the clinic, and were therefore classified as undiagnosed. Yet almost three out of four (72%) of these samples had very low viral loads, indicative of successful drug treatment.

Only eight samples were of sufficient volume to be able to officially test for antiretroviral drugs, but evidence of HIV treatment was found in all of them.

“This is the first published objective evidence that non-disclosure of HIV status as a phenomenon exists in patients attending [sexual health] clinics in the UK,” write the authors.

“Given the high proportion of individuals classified within this study as [non-disclosing], the extent to which these findings can be extrapolated to other clinics, and the degree to which they may influence estimates of the proportion of undiagnosed HIV in the community, warrants further study,” they conclude.

The reasons why they don’t come clean(sic) about their HIV status may be that they don’t want to be “judged,” given that they have come to the clinic with another infection, which implies they are indulging in risky sexual behaviour, suggests lead author Dr Ann Sullivan of London’s Chelsea and Westminster Hospital NHS Foundation Trust.

But by not revealing their HIV status, they could be missing out on the chance to be treated more holistically and discuss other aspects of their health which might be affected by HIV, she says.

Original Article via Onmedica, taking medical information further.

DISCUSSION:

The comment by Ann (above) implies NHS staff are predisposed with attitudes toward sex.  Especially when using phrases like “when they don’t come clean” – However, NHS staff; particularly those within genitourinary medicine should not assume those who wish to have a HIV test participate in “risky sexual behaviour” as for a lot of people, HIV infection can simply occur when the HIV status of a sexual partner is positive, but not known and undiagnosed, then innocently passed to another (which is why is it recommended that condoms are used if the HIV status of the other person is unknown.

Do you have an opinion on this? – Let us know in the comments below.

READ MORE:

STAY UPDATED & JOIN THE CONVERSATION
Follow LASS on Twitter
or subscribe via email

→ 1 Comment

Posted in Uncategorized

Tagged , , , , , , , , ,

HIV research offers hope

Posted on January 27, 2013 by | Comments Off

Issue 89 - Scaling up treatment guidelines in resource limited settings

Immediate treatment of HIV can slow the progression of the virus, a study undertaken by researchers from the University of Oxford, Imperial College London and the Medical Research Council’s Clinical Trials Unit has shown.

Antiretroviral medication taken during the early stages of infection, over a 48-week period, delays damage to the immune system and can defer the need for long-term treatment.

An estimated 34 million people suffer from HIV worldwide. The virus weakens the immune system, leaving the body vulnerable to infection. In its early stages it often goes unnoticed; left unchecked, it can result in individuals being in danger of life-threatening illnesses.

The study, which took place over five years, took the form of a randomised controlled trial of antiretroviral treatment on 366 adults from Australia, Brazil, Ireland, Italy, South Africa, Spain, Uganda and the UK. It comprised mostly of heterosexual women and gay men and was funded by the Wellcome Trust.

At present, it is unusual for antiretroviral medication to be given to HIV patients in the early stages of infection. The trial randomly allocated the volunteers, who had been diagnosed with HIV no more than six months earlier, medication for 48 weeks, 12 weeks or not at all.

On average, the study found that those receiving no medication required a lifelong course of treatment 157 weeks after infection. Those receiving 12 weeks of antiretroviral medication took an average of 184 weeks before receiving lifelong treatment. Participants on the 48 week course began long-term treatment on average 222 weeks after infection.

Moreover, those receiving medication for 48 weeks had higher CD4 T-cell counts, which can reduce susceptibility to secondary infections such as tuberculosis. Adults on this course recorded lower levels of HIV in the blood, which could help reduce the risk of infection for sexual partners.

Dr Sarah Fidler, leader of the study from Imperial College London said: “These results are very promising and suggest that a year-long course of treatment for people recently infected with HIV may have some benefit on both the immune system as well as helping control the virus.”

Concerns over how cost-effective such treatment would be have been raised by some who do not deem the findings to be tremendously significant. Professor Gita Ramjee, who led the study in South Africa, commented: “We now need to weigh up whether the benefits offered by early intervention are outweighed by the strategic and financial challenges such a change in policy would incur, particularly in resource-poor settings such as Africa, although this may be where the most benefits are seen in terms of TB rates.”

Students at Oxford University have expressed interest in this new study. Fergus Chadwick, a Biologist, said: “It is really fascinating to see how theory that has been outlined in our lectures is being applied in the real world with such promising results.”

Original Article by Elizabeth Pugh at Oxfordstudent.com

STAY UPDATED
Follow LASS on Twitter
or subscribe via email

Comments Off

Posted in Uncategorized

Tagged , , , , , , ,

Farewell Spencer

Posted on December 19, 2012 by | Comments Off

spencercox

Spencer Cox, one of the world’s most prominent AIDS activists and a highly respected “citizen scientist” has passed away.

Spencer Cox, the pivotal AIDS activist who co-founded ACT-UP and TAG (Treatment Action Group) and was featured in David France’s recent documentary How to Survive a Plague, has died at Columbia Presbyterian of AIDS related causes, France writes in a note:

 As a very young man fresh from Bennington, where he studied Theater and English Literature, he arrived in NYC after finishing just 3 years. He was diagnosed with HIV soon thereafter. By 1989, at age 20, he had become spokesman for ACT UP during its zenith through the early 90s. A member of its renowned Treatment & Data committee, and later co-founder of TAG (the Treatment Action Group), he schooled himself in the basic science of AIDS and became something of an expert, a “citizen scientist” whose ideas were sought by working scientists. In the end, Spencer wrote the drug trial protocol which TAG proposed for testing the promising protease inhibitor drugs in 1995. Adopted by industry, it helped develop rapid and reliable answers about the power of those drugs, and led to their quick approval by the FDA.

Even before ACT UP, he began work for amfAR (Foundation for AIDS Research), first as a college intern, eventually going on staff as assistant to Director of Public Affairs, responsible for communications and policy).  He left there to co-found the Community Research Initiative on AIDS (now the AIDS Community Research Initiative of America, ACRIA) with Dr. Joseph Sonnabend and Marisa Cardinale (Marisa Cardinale <marisacard@aol.com>). At ACRIA, he ran public affairs and edited all publications.

From 1994 to 1999, he was Director of the HIV Project for TAG, where he did his ground breaking work in drug trials designs. He designed the drug trial adopted in part by Abbott as they were developing Norvir, the first Protease Inhibitor to head into human trials. It had an “open standard-of-care arm,” allowing people on the control arm to take any other anti-AIDS drugs their doctors prescribed, versus the arm taking any other anti-AIDS drugs plus Norvir. It was this study that showed a 50% drop in mortality in 6 months. Norvir was approved in late 1995. Though the results were positive, the proposal sharply divided the community, many of whom thought it was cruel to withhold Norvir on the control arm. Spencer defended himself in a controversial BARON’S coverstory that made him, briefly, the most-hated AIDS activist in America. Ultimately he was vindicated.

Writing for Poz in 2006, Cox wrote:

“Some of my friends lived for almost 20 years through a flood of death, illness, fear and sadness. And when effective treatment came along and the dying slowed—at least in much of the developed world—everyone assumed that things had gotten better, that we didn’t need to think about it anymore.  But I don’t think that’s true. I think those of us who were in the middle of it were deeply affected by what we experienced and that it affects the choices we make today. I wonder if that’s not partly why the depression rate among gay men is about three times higher than among straight men.

“Because of my memories of those times, I try to appreciate life and the people special to me. But I can also see that I have to fight off an ongoing fear that things could go suddenly, terribly wrong, that the worst-case scenario is also the most likely.”

“What I learned from that is that miracles are possible. Miracles happen, and I wouldn’t trade that for anything. I wouldn’t trade that information for anything. I don’t know what’s going to happen. I don’t know what’d going to happen day to day. I don’t know what’s going to happen next year. I just now, you keep going. You keep evolving and you keep progressing, you keep hoping until you die. Which is going to happen someday. You live your life as meaningful as you can make it. You live it and don’t be afraid of who is going to like you or are you being appropriate. You worry about being kind. You worry about being generous. And if it’s not about that what the hell’s it about?”

Farewell Spencer, and thank you for all your hard and contribution

Spencer

Spencer Cox
1968 – 2012

STAY UPDATED
Follow LASS on Twitter
or subscribe via email

Comments Off

Posted in Uncategorized

Tagged , , , , , , , , ,

Don’t Stop Taking Meds If And When You Drink!

Posted on November 2, 2012 by | Comments Off

About half of HIV patients on antiretroviral therapy skipped their medications whenever they were drinking alcohol, according to a U.S. study – an ill-advised behavior that researchers say could lead to higher viral loads.

The study, published in the Journal of General Internal Medicine, for a year followed nearly 200 people with HIV who were on antiretrovirals and drank alcohol. It found that 51 percent stopped taking their medications while drinking.

Lapses could be due to forgetfulness while under the influence, but a widespread – and erroneous – belief that mixing alcohol and HIV drugs can be toxic appears to play a role.

“The harms caused by missing their medications far outweigh the harms caused by mixing the two, if the person doesn’t have liver disease,” said Seth Kalichman, a professor at the University of Connecticut and lead author of the study.

Drinking has been known to interfere with people’s adherence to their medications, but researchers said the consequences of inconsistent use of HIV medications can be more severe.

Antiretroviral drugs suppress the HIV virus, and patients must take the medications continuously to prevent the virus from surging. Additionally, going on and off the drugs can lead to drug resistance.

“People living with HIV who deliberately stop their medications when they are drinking are at risk for treatment failure,” the researchers wrote.

Kalichman and his colleagues surveyed 178 people – about four out of five of them men – who were currently using antiretroviral therapy and reported that they drank alcohol.

At the beginning of the study, the researchers asked the participants about their alcohol-related beliefs, such as whether they thought their drugs wouldn’t work as well if the two mixed. They also asked whether people would not take both at the same time, either by avoiding alcohol or the medicines.

Over the following year, the team checked in with patients every month to see how well they were sticking to their prescriptions through a pill count, and every other month they called to ask how often the patient had been drinking recently.

Doctors’ offices measured each patient’s level of virus and measures of immune system health.

They found that 51 percent of the patients would avoid the medications when they drank, and half of the people in this group had poor adherence to their prescriptions. In addition, half of the group that skipped pills said they wouldn’t take them again until the alcohol was out of their system.

People who skipped medications while drinking were also more likely to have higher levels of HIV in their bodies and lower numbers of CD4 cells, a measure of immune system health.

“I think it’s pretty well demonstrated that alcohol use is tied to poor adherence, and I think most people think it’s because they’re impaired in some way or they forget… whereas here it shows they’re (often) intentionally missing their medications,” said Catherine Grodensky, a researcher at the Center for AIDS Research at the University of North Carolina.

“And it looks like it’s having some significant impacts on their treatment.”

Original Article via Reuters

STAY UPDATED
Follow LASS on Twitter
or subscribe via email

Related articles

Comments Off

Posted in Uncategorized

Tagged , , , , , , ,

Faith leaders across England in ‘HIV healing’ claims

Posted on September 24, 2012 by | Comments Off

Synagogue Church Of All Nations website shows videos of people it claims have been “cured”

Dangerous cases of faith leaders who tell people with HIV to stop taking their life-saving drugs have been identified by African-led community groups in a number of locations across England.

Seven groups said there were instances of people being told by faith leaders they had been “healed” through prayer – and then pressured to stop taking antiretroviral medication, according to the charity African Health Policy Network (AHPN).

Cases were reported to have taken place in Finsbury Park, Tottenham, and Woolwich, in London, as well as in Manchester, Leeds and at a number of churches across the North West.

Last year, BBC London identified three people with HIV who died after they stopped taking antiretroviral drugs on the advice of their Evangelical Christian pastors.

AHPN, which tackles health inequalities for Africans living in the UK, called on the government to do more to prevent faith leaders encouraging people with HIV to stop taking their drugs.

“The government, the department of health, and local authorities are not doing enough to respond to this,” said Jacqueline Stevenson, AHPN’s head of policy.

Multiple cases
A Department of Health spokesman said: “Prayer is not a substitute for HIV treatment and we would be very concerned if people are not taking their medication on the advice of faith leaders.”

AHPN said the cases reported to it by community groups showed:

Most respondents were aware of more than one case of faith healing claims and pressure to stop taking medication. One member was aware of five cases
Many followers believed the testimony of pastors who claimed they could heal them
The majority of cases reported involved Evangelical or Pentecostal Christian pastors
In some cases treatment has been restarted, in others the health and mental health of clients has declined.
Although community groups said they were aware of multiple cases, the members who reported being exposed to faith healers were unwilling to name the churches involved.

AHPN’s Ms Stevenson said: “People were reluctant to name the churches and pastors.”

Cancer ‘cure’

Synagogue Church Of All Nations says: “Never a disease God cannot cure.”

Last year AHPN said it believed the Synagogue Church Of All Nations (SCOAN), which has UK headquarters in Southwark, south London, may be one of those involved in such practices.

The church is headed by Pastor T B Joshua, who the Forbes richlist named as Nigeria’s third richest clergyman.

SCOAN’s website, which was set up in Lagos, Nigeria, now shows videos of people the church claims have been “cured” of HIV through prayer.

One video shows a woman Agnes Agnote visiting the church in Nigeria saying: “I am HIV positive. I went to the hospital and they confirmed it was HIV/Aids.”

The video then shows Pastor Joshua blessing her, saying “everyone is healed”.

It goes on to show Ms Agnote apparently showing a more recent medical report, with a narrator saying, “it clearly states that Agnes tested negative to HIV Aids”.

Videos on the website also depict people being cured of “cancers” and “disabilities”.

‘Anointing sticker’ tour
The church’s British website now gives accounts of people reporting to be healed from conditions including arthritis and a lung blood clot after being a sprayed with “anointing water” by SCOAN in the UK.

It promotes a monthly “anointing water prayer line” in London “for any health issues” and advertises an “anointing sticker” tour of the UK and Ireland, which begins on Monday.

Last year, when asked by the BBC if it claimed its pastors could cure HIV, SCOAN responded: “We are not the healer. God is the healer. Never a sickness God cannot heal. Never a disease God cannot cure.”

But it added: “We don’t ask people to stop taking medication. Doctors treat – God heals.”

Ms Stevenson warned: “Often faith groups and churches spring up and nobody really knows they are there or what they are doing.”

“There needs to be investment in taking some action at national and local levels to address this issue.”

She added that AHPN wanted to see faith groups and churches “having the same responsibility in terms of safeguarding and respecting individuals as any other organisation would be expected to have”.

But AHPN warned that criminal sanctions would not be an appropriate solution and would risk “pushing the problem underground”.

“We call for local authorities to work with faith groups and ensure these negative messages are not put out.”

The Department of Communities and Local Government refused to respond to these comments.

But the Department of Health said faith organisations “can make a positive contribution to raising awareness of HIV” by “highlighting the benefits of testing and effective antiretroviral treatment”.

Original article By Andy Dangerfield
BBC News, London

STAY UPDATED
Follow LASS on Twitter
or subscribe via email

Comments Off

Posted in Uncategorized

Tagged , , , , , , , ,

Together We Will End AIDS

Posted on July 23, 2012 by | Comments Off

Entitled Together we will end AIDS, the new UNAIDS report contains the latest data on numbers of new HIV infections, numbers of people receiving antiretroviral treatment, AIDS-related deaths and HIV among children. It highlights new scientific opportunities and social progress which are bringing the world closer to UNAIDS vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths.

The report also gives an overview of international and domestic HIV investments and the need for greater value for money and sustainability.

Calling for global solidarity and shared responsibility, the UNAIDS report contains commentaries from global and community leaders as well as people living with and affected by HIV.

Download here

Link to UNAIDS Campaign 

STAY UPDATED
Follow LASS on Twitter
or subscribe via email
Related articles

Comments Off

Posted in Uncategorized

Tagged , , , , , , , , , , , , , ,

Even without a cure, the end of the AIDS pandemic is in sight

Posted on July 19, 2012 by | 1 Comment

A very bold statement to make in the run up to AIDS 2012, none the less, this is the view of Dr. Anthony Fauci, director of the National Institute of Allergy and Infections Diseases (NIAID )

NIAID director Dr. Anthony Fauci addressing the United Nations General Assembly special session on HIV/AIDS on 10June 2008.

Dr. Fauci was appointed Director of NIAID in 1984. He oversees an extensive research portfolio of basic and applied research to prevent, diagnose, and treat infectious diseases such as HIV/AIDS and other sexually transmitted infections, influenza, tuberculosis, malaria and illness from potential agents of bioterrorism. NIAID also supports research on transplantation and immune-related illnesses, including autoimmune disorders, asthma and allergies.  Dr. Fauci serves as one of the key advisors to the White House and Department of Health and Human Services on global AIDS issues, and on initiatives to bolster medical and public health preparedness against emerging infectious disease threats such as pandemic influenza.

Dr. Fauci has made many contributions to basic and clinical research on the pathogenesis and treatment of immune-mediated and infectious diseases. He has pioneered the field of human immunoregulation by making a number of basic scientific observations that serve as the basis for current understanding of the regulation of the human immune response. In addition, Dr. Fauci is widely recognized for delineating the precise mechanisms whereby immunosuppressive agents modulate the human immune response. He has developed effective therapies for formerly fatal inflammatory and immune-mediated diseases such as polyarteritis nodosa, Wegener’s granulomatosis, and lymphomatoid granulomatosis. A 1985 Stanford University Arthritis Center Survey of the American Rheumatism Association membership ranked the work of Dr. Fauci on the treatment of polyarteritis nodosa and Wegener’s granulomatosis as one of the most important advances in patient management in rheumatology over the previous 20 years.

AN END TO NEW INFECTIONS?

Three decades into the AIDS pandemic an end to new infections is in sight, according to Dr. Fauci.

“We don’t even know if a cure is possible. What we know is it is possible that we can end this pandemic even without a cure,”

Fauci told AFP in an interview ahead of the International AIDS conference 22nd -27th July in Washington DC, America.

Some 34 million people around the world are living with human immunodeficiency virus, which has killed 25 million since it first emerged in the 1980s.

The theme of this conference, which is held every two years, is “Turning the Tide Together,” and is based on experts sharing knowledge of the latest advances and how to best implement them in order to halt new cases of HIV/AIDS.

“We have good and effective treatments but we have to keep people on the treatments indefinitely in order to keep them well,” said Dr. Fauci, referring to antiretroviral drugs which have transformed a deadly disease into a manageable condition.

“When you have a very marked diminution of the number of new infections then you reach what we call and AIDS-free generation.”

Dr. Fauci said he did not expect any staggering breakthroughs to be announced at the conference, but that the gain would come though collaborating on ideas to speed progress by using the tools that practitioners have already at hand.

Otherwise, if progress continues at the present rate of reducing new infections worldwide by about 1.5 percent per year, the goal becomes too distant, he said.

Recent studies that tested antiretroviral drugs in healthy people as a way to prevent getting HIV through sex with infected partners have shown some promise, though getting people to take their medication daily had proven a challenge.

“The important thing is you have to take your medication,” Fauci said, noting that average HIV risk reduction in a study of men who have sex with men was just 44 percent.

The approach of treating healthy people with antiretrovirals is known as pre-exposure prophylaxis, and “is not for everyone,” Fauci said. “We have to selectively use it.”

The US Food and Drug Administration on Monday approved the first pill for HIV prevention, Truvada, despite concerns by some in the health care community that it could encourage drug resistance and risky sex.

Novel ways to boost testing are also good news, particularly with the recent US approval of the first at-home HIV test.

“It is so important in the quest to ending the AIDS pandemic to get as many people tested as possible. You can link them to care and get them on treatment. Anything that makes that goal easier would be an important advance.”

As far as an AIDS vaccine, Fauci said researchers have made “good progress” but “still have a long way to go.”

Experts are examining a trial done in Thailand that showed in 2009 modest efficacy of just over 30 percent, but is still considered a breakthrough and offers clues for future study into why some were helped and others were not.

Dr. Fauci also said he did not expect much concern to be raised over upcoming reports of the extent of drug resistance to antiretrovirals.

“People may think I am taking it lightly but quite frankly it is not a serious problem,” Fauci said.

He added that overall, AIDS research is “going well” even though “funding is restricted right now.”

And he expressed pride in the United States’ President’s Emergency Plan for AIDS Relief (PEPFAR), “which has really transformed how you can get people in low income countries to get on treatment care and prevention.”

The United States provides almost half the world’s funding for international HIV assistance, according to UNAIDS.

The International AIDS Conference is returning to the United States after more than two decades away due to a ban on travel and immigration by people with HIV that was lifted in 2008 and signed into law in 2009.

Fauci called those restrictive laws “unfortunate” and “embarrassing.”

STAY UPDATED
Follow LASS on Twitter
or subscribe via email
Related articles

→ 1 Comment

Posted in Uncategorized

Tagged , , , , , , , , , , , , , ,

HIV treatment breaks lead to drug resistance in the female genital tract

Posted on May 28, 2012 by | Comments Off

Antiretroviral treatment interruptions of 48 hours or more are associated with the emergence of resistant strains of HIV in the female genital tract, investigators report in the online edition of the Journal of Acquired Immune Deficiency Syndromes.

The study included 102 women in Kenya who started first-line antiretroviral therapy based on a non-nucleoside reverse transcriptase inhibitor (NNRTI). Drug-resistant virus was detected in the genital tract of five women in the twelve months after treatment was started. Treatment interruptions were the most important risk factor for this outcome.

“We found that ART [antiretroviral therapy] adherence was a key determinant of genital tract resistance and that treatment interruptions of whatever cause lead to a substantial increase in the hazard of detecting genotypic resistance to antiretrovirals in female genital tract secretions,” write the authors. “Efforts to prevent treatment interruptions by improving program effectiveness, promoting adherence and timely refills, and avoiding the use of more toxic antiretroviral agents could therefore play an important role in reducing transmitted drug resistance.”

First-line HIV therapy often comprises two nucleoside reverse transcriptase inhibitors (NRTIs) combined with an NNRTI. This treatment can have a powerful and durable anti-HIV effect. However, it requires high levels of adherence. Drug-resistant strains of HIV can emerge with poorer adherence. Older drugs in the NNRTI class, nevirapine (Viramune) and efavirenz (Sustiva or Stocrin), have a low barrier to resistance.

Little is currently known about the emergence of drug-resistant virus in the genital tract of women treated with NNRTI-based therapy. This is an important gap in knowledge as drug-resistant virus is potentially transmissible.

Investigators therefore designed a prospective study involving women who started first-line HIV treatment in Mombasa between 2005 and 2008. During the first twelve months after starting therapy viral load was monitored at three-monthly intervals in both plasma and the genital tract. Samples with viral load above 1000 copies/ml were sent for resistance testing. The investigators conducted analysis to see which factors were associated with the emergence of drug-resistant virus in the genital tract.

Overall, the women had high levels of adherence to their antiretroviral therapy. Assessed by pill count, median adherence was 97%. However, there were 40 treatment interruptions. Their median duration was four days. Median pill-count adherence following treatment interruptions was just 83%.

Drug-resistant virus was detected in the blood of nine women (incidence, 10 per 100 person-years) and in the genital secretions of five individuals (incidence, 5.5 per 100 person-years). All five women with resistant HIV in their genital secretions also had resistant virus in their blood.

The investigators’ first set of analysis showed that a number of factors were associated with genital tract resistance. These included treatment interruptions (p = 0.006), pill-count adherence (p = 0.001) and a higher baseline viral load (p = 0.04).

But only treatment interruptions remained significant after controlling for potentially confounding factors. Interruptions were associated with a more than 14-fold increase in the risk of genital tract resistance (aHR = 14.2; 95% CI, 1.3-158.4; p = 0.03).

“The reasons for treatment interruption in this study included both unavoidable discontinuations due to drug toxicity or systemic illness and avoidable interruptions due to late refills, when it is likely that consecutive doses were missed,” note the investigators. “Despite a comprehensive program of adherence support including pre-ART counseling, directly administered therapy during the first month of treatment, a support group, pill boxes and transportation reimbursements, we were unable to prevent these events.”

Transport problems and pharmacy stock-outs have emerged as major barriers to adherence in resource-limited settings. The investigators are concerned that “such barriers may lead to the development of genital tract resistance due to treatment interruptions, suggesting an increased risk for transmission of drug-resistant virus”.

The Aids Library of Philadelphia FIGHT has a video on YouTube which explore the subject of HIV which is resistant to anti-HIV medications. Further information can be found on their website.

Original Article via NAM and Philadelphia Fight’s YouTube Channel

STAY UPDATED
Follow LASS on Twitter
or subscribe via email

Comments Off

Posted in Uncategorized

Tagged , , , , , , , , , , , , ,