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Baby Cured of HIV – Here’s the real message..

Posted on March 8, 2013 by | Comments Off

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Late Sunday night, the world media started to report about a baby, born with HIV had been cured.  Everybody got talking; scientists, people of faith, doctors, the public, HIV experts, me, you!

It’s easy to get caught up in the excitement of a cure, I honestly didn’t think I’d be writing the phrase ‘HIV Cure’ for at least a few more years yet, but as it were, we were given a flurry of media reports about how this case was set to change the HIV treatment paradigm, prevent babies from being infected, and, to quote the principal author of the study, Dr Deborah Persaud, “transform our current treatment practices in newborns worldwide”.

There are reports that parents and guardians are asking if this means that children who are infected at birth can stop their drugs.  People are very over-optimistic, and have been calling their doctors and specialists raising the question of whether they, or their child could also be cured!

More Data Needed

We need to slow down, and get some perspective.  The news was only announced five days ago.

To quote a famous professor of HIV pharmacology: “We need more data.” We need to take stock, get the facts right, and allow for scrutiny of the case by the scientific community.

There are many questions to be asked of the case. For instance, was the baby truly infected in the first place? From reviewing the data presented at the conference, it certainly seems possible. But how established was this infection? Had it established itself in so-called long-lived memory T cells?

Furthermore, when was the actual point of infection? This is not clear. Could it have been just prior to delivery? If so, it is possible that by serendipity the doctors intervened with drugs just as the virus was trying to become established.

A Cure, or PEP?

It’s imperative, then, that we attempt to understand when exactly this baby was infected. Was it just before birth, or several months before birth? The longer the period of time, the more interesting the case becomes.

However, if the intervention simply aborted the establishment of infection then Dr Persaud’s results are less exciting.

If drugs were introduced very shortly after infection, the treatment may have actually acted as PEP (post-exposure prophylaxis) – a strategy already used by HIV doctors to try and avoid establishment of infection

Think of a fire which has just caught alight, but has yet really to take hold. Pouring a bucket of water on it at this point may kill the fire dead. Was there actually a flame, or the presence of detectable virus, in this case? Yes, of course. But this bucket of water may not have worked had you allowed the ‘fire’ to become properly established.

The case being described by many as a ‘cure’ may in fact be like this bucket of water – effective, but only because it was delivered so early.

Taking the fire analogy further, after we have put out the flames we may still see the residues it left behind. It might even reignite at a later point in time. The Mississippi baby has been off anti-retroviral drug treatment [ARVs] for less than a year – there are currently no flames, but we are waiting to see if the embers are truly burned out.

Currently, and beyond this headline case, we have no way to completely put out the fire of HIV once it has caught hold. Our current ARV treatments, then, are the firemen who keep the flames of HIV at bay. As long as they are there, you can begin to rebuild the house – a fact born out by the fact that hundreds of thousands of our patients have been on totally suppressive regimens for up to twenty years.

Currently, it is a truth that, if you stop therapy, the virus inevitably rebounds when you –cease medication usually within two weeks. Admittedly, there are a very few rare cases where the virus may simply smoulder away at very low levels for many years (so-called “post treatment controllers”).

All of these considerations and unanswered questions mean that we have a long way to go yet before we fully understand this case. We must fully explore the baby’s immune make-up. What about the characteristics of the mother’s virus, which was curiously low for someone not on treatment? There are so many questions before we should really call this a cure.

Other than the potential of Dr Persaud’s research to stimulate further investigations, then, what is the best thing that can come of all this media frenzy?

The great hope is that this moment represents the greatest mass HIV awareness campaign since the Don’t Die of Ignorance ‘tombstone’ campaign of the 1980s. Rarely does HIV make such headlines, and we have a real chance to educate people whilst their interest is piqued.

We must tell people that the story of HIV is very different now, and we must take this opportunity to communicate new messages through the media whose attention we currently have – messages which can correct people’s out-dated misconceptions.

  • Let’s talk about testing, and the importance of early diagnosis.
  • Let’s talk about effective drugs, which when prescribed early enough can help a patient live a long and full life.
  • Let’s talk about condoms and prevention.
  • Let’s tackle stigma!

Today there is no reason for any baby to be become HIV positive, if the mother is tested and diagnosed early in pregnancy – and if she and the baby have access to effective treatments which can prevent transmission. Sadly, 590,000 babies every year are still born HIV-positive in the developing world: an unnecessary tragedy.

We can do something about that right now, with the tools we have – If we increase testing and make it more regular and consistent. In the UK, 95% of women take the HIV tests during pregnancy. And with effective treatment the chance of the baby being born positive is less than 0.5%. We should be aiming for the same success all over the world

Above and beyond a media storm about a supposed ‘cure’, there are good news stories we can make happen today.

Is the ‘cure’ story exciting? Yes. Is it scientifically plausible? Yes. Will it stimulate more research? Almost certainly. But it is extremely premature to hail it as a cure that will translate into routine clinical care any time soon. We need much more data.

So if you or your child are HIV-positive, then please… don’t stop taking your tablets. And if you have had unprotected sex, take the test. Condoms, education, testing, and access to treatment are our real weapons against HIV, and we need to learn to use these correctly if we want to make a real impact today.

When was your last HIV test?

We offer offer a completely free and confidential rapid HIV test (results within 60 seconds from a simple finger prick test)!  We use the Insti HIV test produced by BioLytical laboratories. The test is 99.96% accurate from 90 days after  contact for detecting HIV 1 and 2 antibodies.  We also have a mobile testing van which is often out in communities providing mobile rapid HIV tests. Appointments are not necessary, call us (0116 2559995) we’re here to help.

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MEDICAL HISTORY – Child Born with HIV Cured!

Posted on March 3, 2013 by | 3 Comments

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It’s all over the internet.. click here to see for yourselves…

Doctors in the US have made medical history by effectively curing a child born with HIV, the first time such a case has been documented.

The infant, who is now two and a half, needs no medication for HIV, has a normal life expectancy and is highly unlikely to be infectious to others, doctors believe.

Though medical staff and scientists are unclear why the treatment was effective, the surprise success has raised hopes that the therapy might ultimately help doctors eradicate the virus among newborns.

Doctors did not release the name or sex of the child to protect the patient’s identity, but said the infant was born, and lived, in Mississippi state. Details of the case were unveiled on Sunday at the Conference on Retroviruses and Opportunistic Infections in Atlanta.

Dr Hannah Gay, who cared for the child at the University of Mississippi medical centre, told the Guardian the case amounted to the first “functional cure” of an HIV-infected child. A patient is functionally cured of HIV when standard tests are negative for the virus, but it is likely that a tiny amount remains in their body.

“Now, after at least one year of taking no medicine, this child’s blood remains free of virus even on the most sensitive tests available,” Gay said.

“We expect that this baby has great chances for a long, healthy life. We are certainly hoping that this approach could lead to the same outcome in many other high-risk babies,” she added.

The number of babies born with HIV in developed countries has fallen dramatically with the advent of better drugs and prevention strategies. Typically, women with HIV are given antiretroviral drugs during pregnancy to minimise the amount of virus in their blood. Their newborns go on courses of drugs too, to reduce their risk of infection further. The strategy can stop around 98% of HIV transmission from mother to child.

In the UK and Ireland, around 1,200 children are living with HIV they picked up in the womb, during birth, or while being breastfed. If an infected mother’s placenta is healthy, the virus tends not to cross into the child earlier in pregnancy, but can in labour and delivery.

The problem is far more serious in developing countries. In sub-Saharan Africa, around 387,500 children aged 14 and under were receiving antiretroviral therapy in 2010. Many were born with the infection. Nearly 2 million more children of the same age in the region are in need of the drugs.

In the latest case, the mother was unaware she had HIV until after a standard test came back positive while she was in labour. “She was too near delivery to give even the dose of medicine that we routinely use in labour. So the baby’s risk of infection was significantly higher than we usually see,” said Gay.

Doctors began treating the baby 30 hours after birth. Unusually, they put the child on a course of three antiretroviral drugs, given as liquids through a syringe. The traditional treatment to try to prevent transmission after birth is a course of a single antiretroviral drug. The doctor opted for the more aggressive treatment because the mother had not received any during her pregnancy.

Several days later, blood drawn from the baby before treatment started showed the child was infected, probably shortly before birth. The doctors continued with the drugs and expected the child to take them for life.

However, within a month of starting therapy, the level of HIV in the baby’s blood had fallen so low that routine lab tests failed to detect it.

The mother and baby continued regular clinic visits to the clinic for the next year, but then began to miss appointments, and eventually stopped attending all together. The child had no medication from the age of 18 months, and did not see doctors again until it was nearly two years old.

“We did not see this child at all for a period of about five months,” Gay told the Guardian. “When they did return to care aged 23 months, I fully expected that the baby would have a high viral load.”

When the mother and child arrived back at the clinic, Gay ordered several HIV tests, and expected the virus to have returned to high levels. But she was stunned by the results. “All of the tests came back negative, very much to my surprise,” she said.

The case was so extraordinary, Dr Gay called a colleague, Katherine Luzuriaga, an immunologist at Massachusetts Medical School, who with another scientist, Deborah Persaud at Johns Hopkins Children’s Centre in Baltimore, had far more sensitive blood tests to hand. They checked the baby’s blood and found traces of HIV, but no viruses that were capable of multiplying.

The team believe the child was cured because the treatment was so potent and given swiftly after birth. The drugs stopped the virus from replicating in short-lived, active immune cells, but another effect was crucial. The drugs also blocked the infection of other, long-lived white blood cells, called CD4, which can harbour HIV for years. These CD4 cells behave like hideouts, and can replace HIV that is lost when active immune cells die.

The treatment would not work in older children or adults because the virus will have already infected their CD4 cells.

“Prompt antiviral therapy in newborns that begins within days of exposure may help infants clear the virus and achieve long-term remission without lifelong treatment by preventing such viral hideouts from forming in the first place,” said Dr Persaud. “Our next step is to find out if this is a highly unusual response to very early antiretroviral therapy or something we can actually replicate in other high-risk newborns.”

Children infected with HIV are given antiretroviral drugs with the intent to treat them for life, and Gay warned that anyone who takes the drugs must remain on them.

“It is far too early for anyone to try stopping effective therapy just to see if the virus comes back,” she said.

Until scientists better understand how they cured the child, Gay emphasised that prevention is the most reliable way to stop babies contracting the virus from infected mothers. “Prevention really is the best cure, and we already have proven strategies that can prevent 98% of newborn infections by identifying and treating HIV-positive women,” she said.

Genevieve Edwards, a spokesperson for the Terrence Higgins Trust HIV/Aids charity, said: “This is an interesting case, but I don’t think it has implications for the antenatal screening programme in the UK, because it already takes steps to ensure that 98% to 99% of babies born to HIV-positive mothers are born without HIV.”

Original Article via The Guardian

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HIV positive patients fail to disclose their infection to NHS staff

Posted on February 18, 2013 by | 1 Comment

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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.

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Why are we afraid to get tested for HIV?

Posted on February 13, 2013 by | Comments Off

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For some people the idea of being tested for HIV is as simple as making a note in a calendar, an entry which sits comfortably beneath a dentist appointment and above a mother’s birthday. For others, the idea of making that appointment, or taking that long walk to the clinic, is one of the most nerve-wracking experiences they can imagine. However, in an age where the numbers of people diagnosed with HIV are increasing, has our natural fear of the unknown become a luxury we simply can’t afford?

Many years ago it was a scary disease. We called it AIDS and it became a name associated with sin and death. The massive number of infections, particularly in the gay community, were staggering, and as the death toll slowly crept up, nations across the world panicked. It’s impossible for any society to come through such a dark time and emerge unscathed, and so the fear of a silent killer left a scar on our cultural memory which has never really healed, and the mere mention of HIV and AIDS still has a way of stopping conversations.

Thankfully, things have changed since then and treatment for HIV and AIDS is better now than it has ever been. People who have the condition are now finding that their lives have not changed completely, and they are still able to live as long and do all the same things they could before. It’s true that they now have a few additional concerns to think about but with the help of medication, HIV is now manageable. However, it seems that attitudes have not moved on as much as the treatment, with people still finding themselves afraid, ashamed and worried that their lives will never be the same again.

HIVTo try and get a better understanding of the feelings and attitudes behind the diagnosis, I spoke with Sona Barbossa, a counselling team leader with the GMI Partnership. Over the course of our conversation, Sona revealed that the anxiety surrounding being tested and anxiety about the results is something which does prevent people from being tested regularly. ‘I don’t think it’s so much a fear about the test itself, but more fear of what the results might be and having to deal with that. There is still a stigma around it and I see many guys who have not been tested for years because they’re afraid of finding out the results and having to make decisions upon learning their results. Also, there’s still a lot of thinking around where people believe that it won’t happen to them, so they don’t see the point in being tested.’ When I asked Sona if she thought attitudes have changed much since HIV first came to public attention, she told us she didn’t think so. ‘People still connect HIV with promiscuity, the gay scene and with drugs. There’s also still a lot of shame and guilt that surrounds the condition, which I think plays a large role in whether people want to be tested or not and can prevent people from making those all important first steps to be tested.’

The fear of the condition is more than understandable. Even with new treatments being developed every day, HIV is still a lifelong condition which also has lifelong consequences. There’s also a very real stigma still attached, which has always been associated with homosexuality, promiscuity and intravenous drug use. This forces a lot of people who have HIV into a double life to keep it a secret from their friends and family. Sona herself pointed out during our conversation that a lot of people still feel like they will be shunned by their loved ones. ‘The fear of being judged and being looked at differently does form a large part of why people may keep this condition from their loved ones. They think that people may change towards them, and worry that their friends won’t accept them any more, and obviously the worry that their families won’t accept them any more. With this kind of attitude pervading society, it’s little wonder that people would be put off from learning their status, as it forces people to think about a lot of things before they even go to have the test done.’

According to statistics gathered by the gay men’s health charity GMFA, 59,000 gay men were tested for HIV last year. While this seems like a large figure, I was later informed by Carl Burnell, the CEO of GMFA, that this figure may only make up 15-25% of the estimated gay population. This becomes all the more worrying when GMFA’s recent statistics uncovered that 82% of new HIV infections are actually passed on from people who have not been checked themselves. The organisation has consistently fought to encourage people to learn their status and  to be checked at least once a year, however in the course of their work, they find that anxiety about HIV is having a definitive effect on preventing people from being checked. When they examined the reasons for not going to be tested, they found that 30% of those asked noted that nerves about their results were a factor, with a further 10% going on to say this was the main thing stopping them from taking the test. Burnell also noted that though people are still keen to avoid becoming HIV positive, their awareness that the condition is all around them is decreasing, and this can potentially lead people to take risks with their sexual health. He also commented that there is still a popular misconception among young gay men that HIV is not something they need to worry about, as it’s still considered by some to be a disease that only harms older people.

However, it isn’t just methods of treatment which have moved on, but also methods of detection. Time was, that if you wanted to have an HIV test you would have to go to your GP and ask for the test specifically and then be referred to have your blood taken and examined. The process would take anywhere between 3 days and 2 weeks depending on the area, and the very idea of waiting for the results could be described as hell-on-earth for people who were brave enough to be tested in the first place. Now people are able to walk in and be tested within half an hour and have their results the same day, sometimes within minutes. Similarly, thanks to the work of organisations like the Terrence Higgins Trust (THT), people are now able to order and administer the test in the privacy of their own home, send off a small vial of blood and have their results sent to them via email or even text. The sad fact is that even with all these different ways to be diagnosed, not enough people are going out and being regularly checked.

An HIV test in progressHere at So So Gay we like to practice what we preach, so when it came to writing a feature that dealt with being fearless and going to get tested, I decided to go out and take the test myself. Having been in a long-term relationship and suddenly single again, it seemed like the right time to know my status, since I was back on the dating scene. I picked the 56 Dean Street clinic in London for its walk-in service and quick results. The staff were amazing and they made me feel reassured every step of the way. They made me feel like, even though I may have been nervous to be there, I was doing the right thing by being tested. I must admit I was scared – after all the idea of drawing blood at the best of times is scary, especially for a needle-phobe like me –  but I felt that whatever the result, it would all be OK. It’s impossible to be in that situation and not wonder about what happens if you get a bad result and I was no different as I sat in the waiting room. However, I was seen by the nurse extremely quickly and within a few minutes of me sitting down in the private room, we were ready to draw blood. The nurse was a saint and kept me calm, and reminded me that even if I was HIV+, then I would still be the same person I was when I walked in, and that there are services out there to help me every step of the way. When my result came back, I was thankfully HIV-. Although I was relieved, I also knew that being tested was only half the battle, so I went and made an appointment to come back in 6 months to be checked again. I felt like it was a responsible thing to do, not just for my own health, but also for the benefit of anyone I might come to know in the future.

The truth is that it’s very easy to get ‘caught short’ in life and sometimes that leads us to take risks when we know we shouldn’t. The true test is when we make these mistakes, we have to make sure that we take the time to know our own status, since it doesn’t just affect us, but also the people we care about. HIV is no longer the death sentence it used to be and people are able to live normal, healthy and happy lives like they did before. However, this is thanks to the amazing progress we have made in treating the condition and we can only begin to do that when we make the decision to get tested and keep on top of our health. It’s a scary prospect to some and no one takes that for granted, but by taking the chance to be tested, you could be buying yourself years of life. Speaking to Carl at GMFA, he even proclaimed that we could well see the cure to HIV in our lifetimes, so let’s all make sure we are all there to see it.

Some key facts to remember:

  1. HIV is a disease which is transmitted by the sharing of bodily fluids, i.e. blood and semen. It does not discriminate against people who are older, more sexually active or people who use drugs.
  2. There is currently no cure for HIV, so people with the condition have it for the rest of their lives.
  3. With an early diagnosis people are able to live long lives. If it is left untreated, then it becomes harder to fight.
  4. People who have HIV are still the same people they have always been, and it is wrong to judge people or treat them differently because of their status.
  5. Condoms are not 100% effective. There is still a chance you can get HIV if you are safe, so you need to get tested at least once a year to know if you have the condition or not. The only ‘safe’ sex, is no sex.

Above all, remember that we have a responsibility to care for each other as well as for ourselves because, regardless of positive or negative, we are still united as a community. Be brave, go out and get tested so you know your status. There is an old saying which says ‘knowledge is power’, but in this instance it would be more accurate to say ‘knowledge is life’, whatever your status may be.

Via So So gay

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HIV incidence in gay men unchanged in England and Wales, despite more testing

Posted on February 11, 2013 by | Comments Off

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A paper in The Lancet Infectious Diseases by scientists from the UK’s Medical Research Council and the Health Protection Agency (HPA) has calculated that the number of gay men in England and Wales who become infected with HIV each year remained unchanged between 2001 and 2010. This is despite a considerable increase in testing and, they estimate, a 40% reduction in the proportion of gay men with HIV who are undiagnosed.

The paper concludes that, in England and Wales at least, the proportion of gay men with HIV who are on treatment and with undetectable viral loads is currently too low to bring about a decline in annual HIV incidence in this population. This is in contrast to declines in diagnosis, and claims of declines in incidence, seen in places such as San Francisco, the province of British Columbia in Canada, and some locales in South Africa.

As well as extending HIV testing to non-traditional settings and urging gay men to test more frequently, the authors conclude that “the initiation of treatment on diagnosis, regardless of CD4 count might well be necessary to achieve control of HIV transmission”, and welcome the new BHIVA treatment guidelines’recommendation “that clinicians discuss the benefits of early treatment uptake as a prophylaxis to protect sexual partners” as a step towards this.

Calculating incidence

The paper is a mathematical model. It uses available data on diagnoses, CD4 counts at diagnosis, and the proportion of people on antiretroviral therapy (ART) to make estimates of the true annual number of infections (annual incidence) in gay men, the number undiagnosed, average time gap between infection and diagnosis, the distribution of CD4 counts among diagnosed and undiagnosed men and the proportion who are on treatment and with an undetectable viral load.

Although mathematical models are always estimates, in this case surveillance data from the UK are of good enough quality to make them quite robust, though because by definition fewer very recent infections are diagnosed, incidence estimates for the last two years are less certain than for previous years.

The incidence rate is not the same as the new diagnosis rate in HIV, because of the time lag between infection and diagnosis. If the number or frequency of HIV tests go up, the number of diagnoses will tend to go up, since more long-term undiagnosed infections will be identified. The researchers got round this problem by using CD4 count at diagnosis – available for the majority of diagnosed people in England and Wales – as a surrogate for the time delay between infection and diagnosis, given that CD4 counts in people with untreated HIV tend to decline at an even rate over time.

Results – diagnosed and undiagnosed

The number of diagnoses in gay men in England and Wales increased from about 1800 in 2001 to 2600 in 2010. However by adjusting this for CD4 count at diagnosis, the researchers estimated that the true annual total of HIV infections in gay men had remained virtually unchanged, from 2200 in 2001 to about 2300 in 2010. There was an increase in incidence to about 2700 a year in 2003-4, due to increased rates of sex without condoms in gay men, but this has reduced since.

This reduction is due, the researchers say, to more gay men taking tests and to a shorter period between HIV infection and diagnosis. The number of HIV tests taken by gay men in sexual health clinics has grown nearly fourfold, from 16,000 in 2001 to 59,300 in 2010. As a result, the estimated time between infection and diagnosis has shrunk from four years to 3.2 years during this time, and the proportion of gay men with HIV who are undiagnosed from 37 to 22%.

The reason it has not shrunk more, say the authors, is due to gay men not testing often enough. Last year, study co-author Valerie Delpech of the HPA told the IAPAC Prevention Summit that only an estimated 10 to 15% of gay men took an HIV test every year, and that two-thirds of gay men who had had a test at a clinic had, two years later, not returned to that clinic for another one.

Because there are (as of 2010) 3.2 years’ worth of undiagnosed infections in the population, the total number of gay men with HIV who are undiagnosed in England and Wales was estimated as 7690 in 2010. This was only a small increase from 7370 in 2001 and represents a 16% decline from 9140 in 2004-5, again due to more testing.

The proportion of gay men with HIV who are undiagnosed has gone down by 40% while the number has scarcely changed because total HIV prevalence and the number of UK gay men living with HIV has grown over the same period.

Results – implications for treatment

In 2001, at HIV diagnosis, about 65% of gay men had a CD4 count under 500 cells/mm3, 40% under 350 cells/mm3, and 18% under 200 cells/mm3. Ten years later, the proportion in these three categories had only fallen by about 5%. This means that less than 40% of gay men would currently be advised, under treatment guidelines, to begin taking antiretroviral therapy (ART) for treatment reasons as soon as they are diagnosed.

The researchers calculated that, because more undiagnosed infections are recent ones, only 20% ofundiagnosed gay men had a CD4 count under 350 cells/mm3 and only 45% under 500 cells/mm3. Further decreasing the proportion of gay men with HIV who are undiagnosed, and raising or abolishing the CD4 threshold for treatment initiation, would therefore have considerable cost implications for the National Health Service in England and Wales.

Conclusions

In many ways, the UK’s response to HIV has been excellent. The proportion of gay men with a CD4 count under 350 cells/mm3 who are on ART has increased from 75% in 2001 to 84% in 2010; 65% of all patients in care, including the untreated, have undetectable viral loads; and annual loss to follow-up of those attending care is under 5%.

In the US, in contrast, it is estimated that there are more gay men who are diagnosed but not taking ART than there are undiagnosed, and that only 28% of people with HIV are virally suppressed. But gay men in other countries test more frequently: as an accompanying editorial by Reuben Granich of UNAIDS points out, the 22% of gay men who remain undiagnosed in the UK is not as good as an estimated 14% in Vancouver and only 6% in San Francisco.

Because most of those with detectable viral loads in the UK are undiagnosed, it is estimated by the HPA that up to 50% of HIV infections in gay men here could be being transmitted by men in primary HIV infection and another 35% by undiagnosed men with long-term infection. The authors conclude that treatment initiation at diagnosis, earlier, more targeted testing, and better primary HIV prevention all need to be part of any national HIV prevention plan for England and Wales.

References

Birrell PJ et al. HIV incidence in men who have sex with men in England and Wales 2001-2010: a nationwide population study. The Lancet Infectious Diseases, early online edition:http://dx.doi.org/10.1016/S1473-3099(12)70341-9. See abstract here. 2013.

Granich R HIV in MSM in England and Wales: back to the drawing board? The Lancet, early online edition: http://dx.doi.org/10.1016/S1473-3099(13)70035-5. See first few lines here. 2013.

Original Article by Gus Cairns at aidsmap

HAVE YOU EVER HAD A HIV TEST?

If you’re interested in having a HIV test, we offer a completely free and confidential rapid HIV test and you’ll get the results within 60 seconds from a simple finger prick test. We use the Insti HIV test produced by BioLytical laboratories. The test is 99.96% accurate from 90 days post contact for detecting HIV 1 and 2 antibodies. We also have a mobile testing van which is often out in communities providing mobile rapid HIV tests. Appointments are not always necessary, if you would like a test, please contact us on 0116 2559995

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“…and it won’t go away.” 25 Years of Leicestershire AIDS Support Services

Posted on November 30, 2012 by | 1 Comment

 

The LASS History Project records the changing experiences of people affected by HIV over the years, while highlighting the extent to which HIV continues to disproportionately affect the most marginalised. It documents and celebrates the way people in Leicester came together to respond to the then, new virus and captures changes in attitudes, demography and health outcomes over the past 25 years.

LASS formed in 1987 as a telephone helpline for the people of Leicester, Leicestershire and Rutland, at a time when it was almost impossible to find premises because of fear and stigma. 25 years later, we support over 500 people affected by HIV, we run a community rapid HIV testing service and work across communities to increase understanding and knowledge about HIV.

We received funding from the Heritage Lottery Fund to develop a history project to mark our 25th anniversary year. This project has created a publication and currently developing an archive, and will continue to produce mobile exhibition materials to capture the stories and experiences of people involved in LASS’s work over the past 25 years.

We highlight the distinctive characteristics of LASS, which include our location in the ethnically and culturally diverse city of Leicester and changes in our client group over the years.

While we show that HIV remains a significant local issue – with Leicester experiencing the 6th highest rising rate of infection in the country – we also celebrate the improved life expectancy of people with HIV, and show how LASShas evolved to meet changing needs and demands on our services.

It is our hope, that our history will inspire others and continue to raise awareness of the changing issues in responding to HIV and to challenge persistent myths and stereotypes.

Download your copy here

(PS: Celebrate World AIDS Day with us tomorrow night)! Click here for more details!

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Record numbers of UK gay men test positive for HIV

Posted on November 29, 2012 by | 1 Comment

 

  • Almost half of new cases are gay or bisexual males
  • Up to 10,000 unaware of their infection, says study

The number of gay men being diagnosed with HIV has reached a record high in the UK, according to the Health Protection Agency (HPA).

One in 20 gay men and men who occasionally have sex with men are HIV positive in the UK – and in London, the ratio is as high as one in 12. Part of the reason for the observed rise is increased testing, but, says the HPA, it is also clear that too many men are unaware that they have HIV and are unknowingly infecting others.

“About 8,000 to 10,000 gay men are HIV positive and unaware of their status,” said Dr Valerie Delpech, the HPA’s head of HIV surveillance.

According to the HPA’s annual report, released on Thursday in advance of World Aids Day on Saturday, 3,010 men who have sex with men were newly diagnosed with HIV in 2011 – 47.9% of all new diagnoses in the UK. The numbers have remained high since 2007.

Men who have tested positive and been put on drug treatment, which can keep them healthy and give them a normal lifespan, are unlikely to be infectious. Trials have shown that treatment has a role to play in preventing the spread of the epidemic – the drugs reduce the levels of virus in somebody with HIV to such a low level that they are unlikely to transmit the infection to a sexual partner.

The HPA and organisations for those diagnosed with HIV are all advocating regular testing for anybody at risk. Gay men and other men who have sex with men should take an annual test, they say – and if they have new or casual partners, they should be tested every three months.

Living a long and healthy life with HIV depends on starting treatment early. “People are still starting late: they are infected for three to five years before they are diagnosed,” said Delpech. People who are diagnosed as HIV positive late are at 10 times the risk of dying within a year of discovering they have the infection. They are also more likely to infect people while they remain unaware of their status.

The black African community in Britain also faces a higher risk than average, with 37 out of every 1,000 living with HIV last year. Far more men and women in the black African community are diagnosed late than gay men – 68% and 61% respectively, compared with 35%.

The HPA is recommending safe-sex programmes promoting condom use and annual HIV testing as a priority for this community as well as for men who have sex with men. They want NHS clinicians to take every opportunity to offer testing to those at higher risk.

The total number of people in the UK living with HIV climbs steadily every year because treatment is keeping more people alive. Including both diagnosed and undiagnosed cases, it has now reached 96,000, with a total of 6,280 new diagnoses in 2011.

Nearly half of all new diagnoses were acquired heterosexually. More than half of all new UK infections were acquired while the subject was in Britain, compared with 27% in 2002: the small drop in new infections last year, from 6,400 in 2010 to 6,280 last year, was because of the drop in the number of people who had been infected abroad.

Deborah Jack, chief executive of the National Aids Trust, said: “What is striking about the HPA’s data is how it really shows both our successes and our shortcomings in tackling HIV in the UK. On the one hand, we can hail treatment as a real success story. Treatment is effective, people diagnosed with HIV can access it easily and it is working in keeping the virus under control.

“However, when it comes to increasing the uptake of testing – the gateway to treatment – our services are patchy, inconsistent and ultimately we are still failing to make any significant headway in tackling the high rates of undiagnosed HIV.

“A quarter of people living with HIV are unaware they have the virus. As long as this figure remains high, new infections will continue to occur. We must increase our efforts in encouraging people to test and making sure that the health service is taking advantage of every single avenue in offering an opportunity to test – something that isn’t happening at the moment.”

Sir Nick Partridge, the chief executive of the HIV/Aids charity the Terrence Higgins Trust, spoke up for safe sex and said that testing could add 40 years to a person’s life. “HIV is an entirely preventable condition, yet each year we see thousands more people across the UK receive this life-changing diagnosis,” he said. “While there is still no cure and no vaccine, that doesn’t mean we need to accept its continuing march.”

Original Story via Sarah Boseley, health editor at The Guardian

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Archbishop Tutu, LASS International Patron, gives 3 key messages for World AIDS Day

Posted on November 23, 2012 by | 1 Comment

Archbishop Desmond Tutu has sent a special video message from Cape Town to mark 1st December, World AIDS Day, and the 25th Anniversary of a Leicester charity providing support for HIV positive people and HIV education and awareness across the communities.

The Archbishop, who earlier this year became International Patron of LASS (Leicestershire AIDS Support Services), has three key messages for the people of Leicester and around the world. Firstly he says that you should put your mind at ease and know your HIV status. Secondly he says that together we can all reduce the stigma about HIV. Finally he gives a special message for everyone living with HIV that ‘We thank God for the medical practitioners and researchers and carers who are seized with the task of supporting, loving and healing. We place our faith in God to maintain our spirit. And we place our trust in our medical and support services to keep our bodies well.’

Jenny Hand, CEO at LASS, says: “These messages from such a globally renowned leader will help us so much to make a difference to the lives of many people, locally and further afield. It is our 25th year and we still have so much to do to change people’s attitudes and understanding about HIV, to make it possible for people living with HIV to have lives free from stigma and discrimination. National HIV testing week is 23rd to 28th November this year – when everyone working in the field of HIV is encouraging people to get tested and know their HIV status. Archbishop Tutu’s message will provide encouragement and support to this campaign.”

LASS, HIV 25 years on …. And it won’t go away

LASS is marking its 25th anniversary with a project funded by the Heritage Lottery Fund to create an archive and to publish a history of the organisation – “…and it won’t go away” – 25 Years of Leicestershire AIDS Support Services – based on interviews with founders, volunteers, staff, Trustees and people living with HIV from across the 25 years of its existence. “This is a ground breaking publication of national significance,” said Jenny Hand. “It charts the response of the people of Leicestershire to the arrival of HIV and AIDS and reveals the significant changes for HIV locally and nationally as well as for LASS, and people living with HIV. We hope that our publication and the work we continue to do does justice to the lives of the many people who died with AIDS in the early years.”

The book is being launched on 30 November and copies will be available to download free from the website http://www.lass.org.uk after that date. Hard copies can be ordered from reception@lass.org.uk at a cost of £2.50 to cover postage and packing. (Update, it’s launched! Click here)

LASS will also be celebrating World AIDS Day with a fundraising concert at the Leicester YMCA on Saturday 1st December with four live bands including the multicultural UK dub and roots band CounterAction, Multimorph, Sleeping through Rapture and George Sandersun. More details are available here

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New HIV Test is 10 Times More Sensitive and a Fraction of the Price

Posted on October 29, 2012 by | 1 Comment

Scientists have developed a HIV test which is ten times more sensitive and a fraction of the cost of existing methods.

The test uses nanotechnology which alters chemicals to give a visual result by turning a sample red or blue, according to research from scientists at Imperial College in London published in the journal Nature Nanotechnology.

Molly Stevens who led the research said “Our approach affords for improved sensitivity, does not require sophisticated instrumentation and it is ten times cheaper,”.

Simple and quick HIV tests that analyze saliva already exist but they can only pick up the virus when it reaches relatively high concentrations in the body.

“We would be able to detect infection even in those cases where previous methods, such as the saliva test, were rendering a ‘false negative’ because the viral load was too low to be detected,” she said.

The test could also be reconfigured to detect other diseases, such as sepsis, Leishmaniasis, Tuberculosis and malaria, Stevens said.
Testing is not only crucial in picking up the HIV virus early but also for monitoring the effectiveness of treatments.

“Unfortunately, the existing gold standard detection methods can be too expensive to be implemented in parts of the world where resources are scarce,” Stevens said.

According to 2010 data from the World Health Organisation, about 23 million people living with HIV are in Sub-Saharan Africa out of a worldwide total of 34 million.

The virus is also spreading faster and killing more people in this part of the world. Sub-Saharan Africa accounted for 1.9 million new cases out of a global total of 2.7 million in the same year, and 1.2 million out of the 1.8 million deaths.

The new sensor works by testing serum, a clear watery fluid derived from blood samples, in a disposable container for the presence of an HIV biomarker called p24.

If p24 is present, even in minute concentrations, it causes the tiny gold nanoparticles to clump together in an irregular pattern that turns the solution blue. A negative result separates them into ball shapes that generate a red color.

That sensor used tiny gold stars laden with antibodies that latched onto the marker in a sample and produced a silver coating that could be detected with microscopes.

Stevens and her collaborator on the new test, Roberto de la Rica, said they plan to approach not-for-profit global health organizations to help them manufacture and distribute the new sensor in low income countries.

Original Story via Reuters

HAVE YOU EVER HAD A HIV TEST?

If you’re interested in having a HIV test, we offer a completely free and confidential rapid HIV test and you’ll get the results within 60 seconds from a simple finger prick test. We use the Insti HIV test produced by BioLytical laboratories. The test is 99.96% accurate from 90 days post contact for detecting HIV 1 and 2 antibodies. We also have a mobile testing van which is often out in communities providing mobile rapid HIV tests. Appointments are not always necessary, if you would like a test, please contact us on 0116 2559995

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Doctors are ‘missing HIV signs’

Posted on October 8, 2012 by | Comments Off

Many doctors are missing the signs that patients could be infected with HIV, researchers said after they found that one in four people with the disease could have been diagnosed at an earlier stage.

The British HIV Association (BHIVA), the body that represents HIV care professionals, said that patients with HIV are being denied longer life expectancies because they are being diagnosed too late.

A quarter of patients missed an opportunity for their HIV infection to be detected earlier because they were not offered a HIV test, according to BHIVA’s audit of HIV testing and diagnosis in the UK.

Researchers said late diagnosis of the condition is a growing problem.

People who are diagnosed with more advanced HIV have a tenfold increased risk of death in the first year compared to those diagnosed with earlier stages of infection, they said.

The author of the report, Dr Ed Ong said: “Our data shows one in four people living with HIV could have had their condition diagnosed earlier.

“This is a serious wake-up call, and shows we need a pro-active and widespread testing programme which is tailored to those people who are most at risk.”

BHIVA chair Professor Jane Anderson added: “Late diagnosis is the single biggest cause of death from HIV in the UK. It increases the risk of HIV related ill-health, of HIV being acquired by others, and significantly increases the costs of treatment.

“HIV is treatable, and if diagnosed in time, people with HIV can expect to have long and healthy lives. Sadly, opportunities for longer life expectancy for people with HIV are being thrown away by late diagnosis.”

The research, which examined the records of more than 1,000 patients at HIV treatment centres in the UK, was published today in the Clinical Medicine Journal.

Original Article via the Telegraph

HAVE YOU EVER HAD A HIV TEST?

If you’re interested in having a HIV test, we offer a completely free and confidential rapid HIV test and you’ll get the results within 60 seconds from a simple finger prick test. We use the Insti HIV test produced by BioLytical laboratories. The test is 99.96% accurate from 90 days post contact for detecting HIV 1 and 2 antibodies. We also have a mobile testing van which is often out in communities providing mobile rapidHIV tests. Appointments are not always necessary, if you would like a test, please contact us on 0116 2559995

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