Tag Archives: hiv

Prestigious GlaxoSmithKline IMPACT Award, Awarded to LASS

 

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Leicestershire AIDS Support Services has won a prestigious GlaxoSmithKline IMPACT Award for its outstanding contribution to improving health in Leicestershire, GSK and The King’s Fund announced last night at the award ceremony held at London’s Science Museum. LASS provides rapid HIV testing, support, information and advocacy to people affected by HIV and AIDS in one of the most diverse areas in England. Leicester has many different communities and an above average population of HIV positive people.

To slow down the spread of HIV and help people to access treatment, LASS invests in rapid testing services in community settings. There is particularly low uptake in some African communities, so LASS trains volunteers from these communities to carry out testing and provide information. They provide testing at a range of events and venues including African football tournaments to reach people who otherwise wouldn’t be tested. LASS also provides services for people with the virus and maybe coping with other issues like poor mental health, and they provide healthy living training.

The GSK IMPACT Awards, GSK’s flagship UK corporate responsibility programme organised in partnershop with The King’s Fund, is seen as a ‘seal of excellence’ in the sector. As well as as receiving £30,000 in funding during a difficult financial climate, the winners can take part in a training programme hosted by The King’s Fund that provides training, development and networking opportunities. Feedback has shown that this opportunity is as important to the winning charities as the funding as it helps them develop the skills to carry on building their organisation.

Katie Pinnock, Director of UK Corporate Contributions at GSK, OR Lisa Weaks, Third Sector Programme Manager at The King’s Fund said:
‘Congratulations to LASS, a strong winner in these awards. Their work providing, support for people with HIV and bringing testing into local communities, is making a real difference tobpeople lives in hard-to-reach groups. It is sharing best practice to further improve outcomes for its service users as well.’

Patrick Bowe, Chair of LASS Board of Trustees , said:

We are absolutely delighted to be recognised at this high level for the impact of our local work supporting and empowering people living with HIV, and challenging and breaking down stigma and discrimination. Our community HIV testing programme is contributing to government public health targets and has already saved the health service more than £3million through encouraging more people to have an HIV test and know their HIV status.
This huge achievement for Leicester, Leicestershire and Rutland is due to the continued commitment by a great team of staff and volunteers. They are determined to deliver the highest standard of services possible and make a significant diference in HIV provision locally with a relatively small budget. This award will make a significant difference to the profile of our work and the reputation of LASS and our new social enterprise.

The calibre of award is reflected in its judging panel who chose the winners, which this year includes Professor Steve Field, Deputy National Medical Director at NHS England (health inequalities); the journalist, Fiona Philips; Peter Wanless, CEO of The Big Lottery; Gilly Green, Head of UK Grants at Comic Relief; Sir Christopher Gent, Chairman of GSK; and, Sir Chris Kelly, Chair of The King’s Fund.

Please note that case studies and spokespeople are available for interview, along with photographs. For further information or interviews, please contact Saskia Kendall at The King’s Fund press office on 020 7307 2603 or by email on s.kendall@kingsfund.org.uk.

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Early HIV drugs ‘functionally cure about one in 10′

HIV Medicine

Rapid treatment after HIV infection may be enough to “functionally cure” about a 10th of those diagnosed early, say researchers in France.

They have been analysing 14 people who stopped therapy, but have since shown no signs of the virus resurging.  It follows reports of a baby girl being effectively cured after very early treatment in the US.  However, most people infected with HIV do not find out until the virus has fully infiltrated the body.

The group of patients, known as the Visconti cohort, all started treatment within 10 weeks of being infected. The patients were caught early as they turned up in hospital with other conditions and HIV was found in their blood.

They stuck to a course of antiretroviral drugs for three years, on average, but then stopped.  The drugs keep the virus only in check, they cannot eradicate it from its hiding places inside the immune system.  Normally, when the drugs stop, the virus bounces back.

Control

This has not happened in the Visconti patients. Some have been able to control HIV levels for a decade.

Dr Asier Saez-Cirion, from the Institute Pasteur in Paris, said: “Most individuals who follow the same treatment will not control the infection, but there are a few of them who will.”  He said 5-15% of patients may be functionally cured, meaning they no longer needed drugs, by attacking the virus soon after infection.

“They still have HIV, it is not eradication of HIV, it is a kind of remission of the infection.”

Their latest study, in the journal PLoS Pathogens, analysed what happened to the immune system of the patients.  Early treatment may limit the number of unassailable HIV hideouts that are formed. However, the researchers said it was “unclear” why only some patients were functionally cured.

Dr Andrew Freedman, a reader in infectious diseases at Cardiff University School of Medicine, said the findings were “certainly interesting”.

“The presumption is that they’ve started treatment very early and the virus hasn’t spread to so many of the long-term reservoirs and that’s why it works.  Whether they’ll control it forever, or whether it’ll be for a number of years and subsequently they will progress and the virus will reappear, we don’t know.”

However, he cautioned that many patients would be diagnosed much later than in this study.

Deborah Jack, the chief executive of the National AIDS Trust said it was “exciting times” in progress towards an HIV cure, but the key was early treatment.

“This just underlines the importance of people being testing and diagnosed early. Currently half of people living with HIV in the UK are diagnosed late – indicating that they are likely to have been infected for five years.”

Analysis

There have been two stories about HIV ‘cures’ in two weeks now – yet the latest developments offer little to the majority of people living with HIV.

In the Mississippi baby case and in the Visconti cohort the infection was caught very early, within weeks, at a vulnerable stage.

This suggests that by hitting the virus hard when it first infects the body, it might be possible to live for years without needing treatment – a functional cure.

However, these patients were the lucky few who were detected in the days and weeks after infection. Most cases are detected years later. For these patients a cure looks, at best, distant.

The hope is that by investigating how patients treated early, and a group of people who are genetically resistant to HIV, can combat the virus – it will give scientists clues for developing cures for everyone else.

Original Article by James Gallagher
Health and science reporter, BBC News

WHEN WAS YOUR LAST HIV TEST?

If all the recent news about the importance of an early HIV diagnosis is persuading you to think about having a HIV test, you should know we offer offer a completely free and confidential rapid HIV test.  This means you will get your test results within a couple of minutes, and it’s a simple simple finger prick test.  (We don’t collect blood and send it off, we do it there with you)!

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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Another Major HIV Breakthrough

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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.

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MEDICAL HISTORY – Child Born with HIV Cured!

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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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Can Blood Transfusions Cure HIV?

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In a different take on health and HIV related questions, Gawker reader, Michael, asks the question, “can massive blood transfusions be used to treat HIV”?

THE QUESTION:

Is it possible to cure, or at a minimum delay the effects of, HIV by simultaneously drawing infected blood and transfusing in ‘clean’ blood into the patient? You would still have tainted blood in the system, but wouldn’t this turn the clock back a bit in regard to how much of the virus is in the person’s blood stream?”

Here’s what doctors say on EXTREME blood transfusions as a fix for HIV

Dinesh Raoassistant professor, David Geffen School of Medicine at UCLA:

Not a bad question actually. The issue is that the virus infects T cells and these reside both in the blood and in tissues, such as the lymph nodes and the gastrointestinal tract. So even if one were to entirely rid the blood of the virus (which would be really difficult to accomplish), there would be other sites such as those I mention that would still have “reservoirs” of virus. Add to this the difficulty and potential complications of doing the blood exchange, which is done for certain other conditions… And you have a sufficiently bad benefit/harm ratio to make the procedure untenable.

Michael SaagDirector, Center for AIDS Research, University of Alabama at Birmingham:

Evidence for most infectious disorders is detected in the blood. This does not mean that the blood is the location of the infection. In the case of HIV, most / all of the virus replication occurs in lymphoid tissue (gut, spleen, lymph nodes), NOT in the bloodstream. Blood is simply a place were we can readily detect it. And while blood can transmit HIV, it is because the virus is present in blood not because it is replicating there. Therefore, removing ‘infected’ blood and replacing it with ‘clean’ is like taking a cup of water from the ocean and then pouring in a cup of fresh water in the hopes you would make the ocean a very large freshwater lake!

Michael Polesassociate professor, NYU School of Medicine:

The short answer is that it wouldn’t work. HIV is a retrovirus and, as such, integrates it’s reverse transcribed DNA into the host cell genome. That DNA will sit dormant in a lymphocyte until the cell dies. as such, there will be plenty of cells that contain HIV DNA sitting around, not just in the blood stream, but in the tissues, most notably the intestines. Even if you could replace all of the peripheral blood through transfusion, additional lymphocytes would be in the tissues and would continue to produce virus, which would just infect the cells that you have transfused in.

Patrick Fogartyassistant professor of medicine, University of Pennsylvania:

I can think of a few reasons why the approach you mentioned would not work, including that HIV infection is not a process that is confined to the intravascular space (meaning inside the blood vessels). The tissue through which the infection gained access to the body (needle stick, mucous membrane) would be contaminated with virus as would the regional lymph nodes, which drain these tissues. So exchanging the blood volume wouldn’t purge the body of the virus.

Ian Frankprofessor of medicine and Director, Clinical Core, University of Pennsylvania Centre for AIDS Research:

There is no way to delay the effects of AIDS by removing infected blood and transfusing in uninfected blood. HIV replicates predominantly in a type of lymphocyte called a CD4+ T cell, or a helper T cell. About 2% of the CD4+ T cells in our bodies are circulating in the blood. The rest are in our intestines or in lymph nodes scattered around our body. Therefore, even if we could remove all of the HIV infected lymphocytes in our blood, the vast majority of the cells infected by HIV would not be removed, and HIV would still be reproducing in those cells.

Hope that is understandable. [Ed.: lol]

THE VERDICT: No, you can’t cure (or even ameliorate) HIV/ AIDS with blood transfusions, because the virus hangs out elsewhere in the body, and would just reinfect the new blood.

Original article via Gawker

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Discussion:

Have you read any interesting articles about measures to halt, or cure HIV/AIDS.  Why do you think the answer has baffled scientists for so long.  Do you think they’ll ever be a cure, or a vaccine for HIV, and when do you think HIV will begin to become part of history, rather than a current medical condition.  Comments are open for two weeks.

You may also be interested in:

 

HIV positive patients fail to disclose their infection to NHS staff

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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?

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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

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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Researchers Work on Developing New HIV Vaccines

lymphocyte with HIV cluster

Scanning electron microscope image of a lymphocyte with HIV cluster. (Image: National Cancer Institute)

With the recent launch of MIT’s Institute for Medical Engineering and Science, MIT News examines research with the potential to reshape medicine and health care through new scientific knowledge, novel treatments and products, better management of medical data, and improvements in health-care delivery.

Studying infectious diseases has long been primarily the domain of biologists. However, as part of the Ragon Institute, MIT engineers and physical scientists are joining immunologists and physicians in the battle against HIV, which currently infects 34 million people worldwide.

The mission of the Ragon Institute — launched jointly in 2009 by Massachusetts General Hospital (MGH), MIT and Harvard University — is to develop new HIV vaccines through better understanding of how the immune system responds to infection. Bruce Walker, the MGH physician who directs the institute, says it was important to enlist engineers and physical scientists, who have usually been excluded from traditional HIV research, to help in this effort.

“It seemed to me that if we could break down some of those silos, there were probably tools in the toolbox that could be applied to the problem right now that weren’t being applied,” Walker says. “MIT has brought a lot to the table — not only expertise, but also a different way of thinking about approaching problems.”

The Ragon Institute also encourages its researchers to develop new technology and pursue ideas that might not be funded through traditional channels. These include new materials for vaccine delivery and new technology for studying the virus’s interactions with the immune system.

“It has encouraged people, like the engineers here, to start working in areas that they wouldn’t have worked in otherwise,” says Christopher Love, an MIT associate professor of chemical engineering and an associate member of the Ragon Institute. “That kind of momentum can sometimes be hard to establish. The Ragon has been a catalyst for new research innovations and a very effective one at that.”

Single-cell analysis

Love is now helping in the search for a new vaccine using technology he developed to study immune responses of individual cells. His system allows thousands of immune cells to be studied at once: The cells are placed into tiny wells on a plate, and secretions from each cell are imprinted on a glass slide placed over the wells. The slide is then tested for the presence of specific proteins such as cytokines, which provoke inflammation.

Because each cell has its own “address” on the slide, the secretions can be traced back to individual cells. This technology generates a huge amount of data for each cell under study. “You can now make measurements on 10,000 cells and generate 20 to 30 parameters of data on each cell that’s present in that sample. That kind of data density hasn’t really been feasible previously,” says Love, who is a member of MIT’s David H. Koch Institute for Integrative Cancer Research.

Love first used the system to study immune-cell responses to food allergens and infectious agents, and began using it to study HIV responses after becoming part of the Ragon Institute in 2009.

In a study published in 2011, Love and his colleagues analyzed the cytokines secreted by T cells from HIV-infected patients, as well as the cells’ ability to kill HIV-infected cells. Previous studies had suggested that high levels of a cytokine called interferon gamma might correlate with cell-killing ability, but the MIT team found that while the percentage of T cells that secrete interferon gamma is similar to the percentage of those that kill infected cells, the populations do not entirely overlap.

Love is now searching for biomarkers that do reveal which T cells are most effective at killing HIV-infected cells. He also hopes to scale up the device so it could be used to rapidly monitor the immune responses of participants in vaccine trials.

New vaccine targets

Arup Chakraborty, director of the Institute for Medical Engineering and Science (IMES) and a professor of chemical engineering, chemistry, physics, and biological engineering at MIT, who uses computational models to study the immune system, had never studied HIV until meeting Walker in 2008. He is now using his computational approaches to seek better HIV vaccine targets.

So far, the virus has proven very difficult to target because it mutates so rapidly. In recent years, scientists have tried targeting amino acids in HIV proteins where mutations appear to weaken the virus. However, this approach has had limited success because compensatory mutations elsewhere in the viral protein can overcome the harmful effects of the vaccine-induced mutation.

To overcome this, Chakraborty’s lab identified groups of amino acids in HIV proteins that evolve independently of those in other groups. In a subset of these groups, computer models predicted the virus to be vulnerable to multiple simultaneous mutations. By targeting amino acids in such groups, vaccine designers may be able to cut off the virus’s escape route.

In 2011, Chakraborty and Walker showed that a particularly vulnerable group exists in a subunit of the Gag protein, which forms the envelope that surrounds the virus’s genetic material. They also found that T cells in patients who can fight off HIV on their own disproportionately target the amino acids identified in the study. HIV strains with multiple mutations in these amino acids are rare, offering further evidence that these could make good vaccine targets.

Special delivery

Darrell Irvine, an MIT professor of materials science and engineering and member of the Koch Institute, is working on alternative ways to deliver vaccines. Most vaccines used to protect against diseases such as chicken pox and influenza are made from deactivated forms of the virus. That approach is thought too risky for HIV, so many researchers are instead pursuing vaccines made from protein or sugar molecules that the virus produces, known as antigens. Another possible approach is injecting DNA that codes for viral proteins.

However, injecting those molecules on their own doesn’t always produce a strong-enough immune response in the vaccine recipient, so Irvine and his lab are seeking ways to elicit stronger responses, using two strategies: delivering antigen along with another type of molecule, known as an adjuvant, that helps to provoke the immune system, and delivering the antigen directly to the target cells, using nanoparticles or polymer films.

Recently, Irvine and his colleagues developed a new polymer film that can deliver DNA vaccines under the skin. DNA vaccines were first tested about 20 years ago, and found to elicit strong immune responses in rodents. However, DNA vaccines have thus far failed to provoke any protective response in human clinical trials.

With the new polymer film developed by Irvine and his colleagues, DNA vaccines are embedded in layers of polymer films that gradually degrade, releasing the vaccine over days or weeks. The film also includes an adjuvant consisting of a strand of RNA similar to viral RNA. This molecule provokes inflammation in the target tissue, which helps to recruit immune cells to the area, so they can encounter the antigen encoded by the DNA.

The vaccine-delivering film showed success in tests of mice, and the researchers now hope to test it in nonhuman primates.

Much of this work would probably never have happened without both funding from the Ragon Institute and the interdisciplinary collaborations that have arisen because of the institute.

“It’s been absolutely fantastic for me and many of the MIT faculty that have been involved,” Irvine says. “There are really two paths being followed at all times: a very focused mission to try and get an HIV vaccine developed, but also an interest in making sure that we don’t miss new opportunities in the basic science that might bring totally new vaccine concepts forward.”

via mit.edu

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

gayhug

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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HIV research offers hope

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

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