Monthly Archives: May 2011

HIV Replication 3D Medical Animation

This is a very excellent animation which explains the hiv replication very clearly.

For more medical animations (not all of them are HIV related) please visit his YouTube page.

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Drugging Our Way Out of the HIV Epidemic

When antiretroviral drug cocktails hit the scene in 1996, they were so effective they became known as ‘the Lazarus drug.’ Many AIDS patients recovered seemingly overnight. Over the past 15 years, these drugs have saved the lives of millions of people infected with HIV. Several new studies suggest antiretrovirals could save millions more if we start using them for prevention as well as treatment.

Last July, researchers reported that a vaginal gel laced with an antiretroviral called tenofovir reduced HIV acquisition among South African women by 39% overall and by 54% in women who used the gel faithfully. Then, in November, a separate team of researchers reported that an oral antiretroviral pill taken daily reduced the risk of HIV infection among men who have sex with men by 44%. This year, on May 11, researchers announced the results of another study. They found that HIV-infected individuals — both men and women — who took antiretroviral drugs were a whopping 96% less likely to pass the virus on to their partners than individuals who didn’t take the drugs. The results are preliminary, but Myron Cohen, the HIV researcher who led the study and spoke on Monday at the New York Academy of Sciences, said he is confident that the large effect will hold.

These fantastic results beg the question: Can we drug our way out of the HIV epidemic?

Researchers have long suspected that people who take antiretrovirals are less likely to pass HIV on to their sexual partners. The idea makes a lot of biological sense. Antiretroviral drugs stop HIV from replicating, which means fewer copies of the virus floating around in HIV patients’ blood and, presumably, their genital secretions. But the hypothesis had never been proven in a randomized clinical trial. So in 2005, Cohen began a study to test the hypothesis.

He and his colleagues recruited 1,763 discordant couples—meaning one person was infected with HIV and the other wasn’t—in Botswana, Brazil, India, Kenya, Malawi, South Africa, Thailand, the US, and Zimbabwe. They randomly assigned each couple to one of two groups. In the first group, HIV-infected individuals received antiretrovirals right away. In the second group, the researchers more or less followed the standard treatment guidelines, delaying treatment until the disease progressed.

On April 28, the independent committee charged with overseeing the trial met at the National Institutes of Health for their tenth meeting. At each meeting, the committee members would review the data and decide whether the trial should continue. After this most recent meeting, they told Cohen they had a recommendation, but they couldn’t yet tell him what it was. Cohen, who has never been allowed to see the results, assumed the worst—that the early treatment hadn’t worked. Then he received a phone call. The committee told him they had seen such a dramatic benefit that they wanted to release the results.

On May 11, Cohen held a press conference to announce the results. During the study, 28 individuals had become infected with their partner’s strain of virus. But only one of those infections occurred in the early treatment group. The other 27 infections occurred in couples not taking antiretrovirals.

Ever since the press conference, Cohen has been inundated with media requests. The success is well deserved. HIV prevention researchers have been working long and hard for decades with little to show for it (One notable exception: The 2007/2008 circumcision trials, which found that male circumcision can cut a man’s risk of contracting HIV by 50%).

On Monday, Cohen compared the trial to “pushing a boulder up a hill.” But I think the most daunting challenge lies ahead. How do you take all these positive results – not just from Cohen’s study, but from the others as well – and develop an effective public health strategy?

Cohen found that early treatment can prevent new infections. So putting everyone who has HIV on treatment immediately should dramatically curb the spread of HIV. But antiretrovirals are expensive. Advocate for earlier treatment, and you dramatically increase the number of people who need pills. According to the World Health Organization, roughly 33 million people are infected with HIV. Of those, five million are receiving treatment. Another 10 million aren’t taking antiretrovirals but should be. So to prevent new infections, we need provide treatment to between 10 million and 28 million people. Who will pay for their medicine? Many of the people infected with HIV barely earn enough to feed themselves, let alone purchase expensive drugs.

And what about all the individuals who are infected with HIV but don’t know it? People seem to be most infectious right after they become infected themselves. Studies suggest that anywhere between 8% and 40% of new infections are caused by people who are in this “acute” stage. But people with acute infections often test negative for the virus because they haven’t yet developed antibodies. So how do you find these people?

Here’s another issue. Millions of people infected with HIV depend on antiretrovirals for their survival. So if we want to use antiretrovirals for prevention, we need to find a way to do it without creating more drug resistance. How?

Although answering these questions may prove challenging, I’m [sic] not suggesting we should throw in the towel. Science is giving us the data, now it’s up to us to decide how to use it. Antiretrovirals aren’t the long-awaited magic bullet that will end the HIV epidemic — we can’t drug our way out of this — but they can save lives and prevent new infections. It’s a start.

Via: http://www.lastwordonnothing.com/2011/05/18/drugging-our-way-out-of-the-hi-epidemic/
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HIV/AIDS: Drug price cuts secured amid growing funding fears

Three international organizations have negotiated reductions on key first- and second-line, and paediatric antiretrovirals (ARVs) that will help countries save at least US$600 million over the next three years.

The Clinton Health Access Initiative (CHAI), the international drug purchasing facility UNITAID and the UK Department for International Development (DFID) made the announcement on 18 May.

The deal expected to affect most of the 70 countries comprising CHAI’s Procurement Consortium, features notable reductions in the prices of tenofovir (TDF), efavirenz, and the second-line ritonavir-boosted atazanavir (ATV/r) used in HIV patients who have failed initial, or “first-line”, regimens.

As part of the deal, the three bodies set price ceilings for more than 40 adult and paediatric ARVs with eight pharmaceutical manufacturers and suppliers, including Cipla Ltd, Matrix Laboratories and Autobindo Pharma.

Together these eight companies account for most ARVs sold in countries with access to generic drugs, according to David Ripin, scientific director of CHAI’s Drug Access Programme.

As a result, the cost of ATV/r is down by two-thirds from just three years ago. Meanwhile, a once-a-day fixed-dose combination (FDC) pill containing TDF and efavirenz will now cost countries less than US$159 per patient per year. In 2008, low-income countries paid about $400 per patient per year for the same pill.

How did they do it?

According to UNITAID and CHAI, this success is a product of increased demand for these drugs and more efficient manufacturing of the active ingredients, which are estimated to account for as much as 75 percent of generic ARV costs.

“When you make an active ingredient, you use a multistep chemical process, to reduce costs, you can look for a less expensive source of raw materials of which there are a few examples, including TDF … or you can tinker with the chemical process used to make the product to make them more efficient.” -Ripin.

But Ripin added that doing either comes at a cost for pharmaceutical companies, for whom a change in raw material suppliers or manufacturing processes means re-applying for approval of the drug with regulatory bodies.

“Any time you change anything with the way you make a drug, you need to get regulatory approval,” he said. “You have to do a fair amount of work to prove that your product works just as well now as it did before. “The pharmaceutical companies and generic manufacturers are fantastic at making these types of improvements… [but] they have a limited set of research and development resources available to them.  They often need to make a decision where they are going to get a higher return on that research and development, and typically that comes from the introduction of new products on the market.”

According to Ripin, the key is providing companies with data on the large and growing markets for ARVs.

“We help companies evaluate for themselves whether it’s a worthwhile business opportunity, the second key factor they have to consider is the competitive marketplace for their drugs, where there is an incentive for lower [production] costs and lower-priced products as they want to maintain their market share.”

CHAI also provides countries with data on best market prices for drugs to help inform national procurement, as was the case with South Africa’s recent ARV tender. Although South Africa is not expected to benefit from the new price cuts, the country has the largest ARV tender in the world, and could secure the drugs at competitive prices. In terms of the CHAI agreement, lower prices are available to members of the Procurement Consortium but are dependant on volumes ordered.

How low can we go?

TDF has become an important drug for many countries, including South Africa, hoping to implement the 2009 World Health Organization (WHO) HIV treatment guidelines, which recommend starting HIV patients on treatment sooner but also a shift away from more toxic ARVs to TDF.

However, the high cost of earlier treatment and better drugs has prohibited many countries from fully implementing the WHO recommendations. According to a recent report released by Médecins Sans Frontières (MSF), both Malawi and Zimbabwe reversed their move to WHO guidelines due to financial constraints.

While new price reductions bring TDF’s price closer to that of the long-time and widely adopted first-line ARV Zidovudine, further drops in TDF’s price will have to be logged to ensure widespread uptake, said Brenda Waning, coordinator of market dynamics for UNITAID.

For Waning and others like MSF, the issue of sustainable funding for the HIV response looms large ahead of the June UN meeting on HIV/AIDS in New York, rumoured to be the last for years to come, according to MSF’s report.

“There has been a lot of attention on commodities and not at other major drivers of cost,” she told IRIN/PlusNews. “We have to look at other places in the health system where we can capture cost-effectiveness.”

In particular, Waning pointed to the potential savings associated with the roll-out of new point-of-care diagnostics, which, although not high on the global agenda, will help countries task shift such testing away from scarce doctors.

Although the cost remains high, introducting FDC would help governments save on ARV shipping, transportation and storage, while improving adherence and patient outcomes.

Source: http://www.plusnews.org/Report.aspx?ReportID=92760
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Love matters: Internet hookups for men don’t always mean unsafe sex

If a gay or bisexual man seeks sex or dating online, the type of partner or relationship he wants is a good indicator of whether he’ll engage in safe sex, a new study suggests.

Gay men seeking long-term romance online are more likely to engage in safe sex than men who want a sexual encounter only, the study shows. This is valuable information because it helps HIV-prevention counselors design more effective sexual health interventions, says Jose Bauermeister, assistant professor at the University of Michigan School of Public Health and director of the Sexuality and Health Research Lab.

June marks the 30th anniversary of the discovery of the pneumonia-like illness that later emerged as HIV/AIDS.

Bauermeister says that dating sites for gay men are no longer reserved only for sexual hookups and that many sites today exist for men who also seek love, intimacy and long-term romance. Unfortunately, even today the assumption is that gay men use the Internet solely to find sex, and that HIV-prevention counselors don’t talk with clients about love and relationships, he says.

A pair of papers from Bauermeister’s research group are among the first to identify and look at four categories of online dating, ranging from hookups only to long-term romance, and the risk behavior associated with each category.

“The takeaway here is just because I go online doesn’t mean I’m engaging in risk,” Bauermeister said. “It’s what kind of partner I’m looking for (that matters), so for HIV prevention purposes if I were going to try to develop an intervention, I need to take that into account.”

Much of the literature about online dating looks at the sex-only encounter, which is “predictably unsafe,” Bauermeister says. Not much research exists about the other categories of online dating and how they associate with risk behavior.

In one study, men who reported seeking hookups only engaged in more unprotected sex than men who reported only looking for romance online.

“It’s interesting because as a test counselor if you have five or 10 minutes, you need to talk about how to include conversations about love,” Bauermeister said. “If you aren’t hooking up very often and looking for Mr. Right, you may be engaging in very particular behaviors that decrease your risk of HIV.

“The bigger question is should we include components about romantic relationships into HIV prevention. Those components are not usually included now.”

A second paper looks at different dimensions of love, passion, intimacy and commitment to see if different configurations of love could be correlated to different risk behaviors. Young men who think about their future and their love in the future are less likely to engage in risky sex in the present, Bauermeister says.

“This is important because counselors, rather than assuming young men only seek hookups, can make a point to discuss the role that romance plays in their lives,” Bauermeister said. “For counselors testing for HIV, one of the ways to decrease the risk is by reducing the number of partners. One of the ways to do this is emphasize relationships in HIV prevention.”

The University of Michigan School of Public Health has been promoting health and preventing disease since 1941, and is ranked among the top public health schools in the nation. Whether making new discoveries in the lab or researching and educating in the field, SPH faculty, students and alumni are deployed around the globe to promote and protect our health.

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Simian Immunodeficiency Vaccine Update

A post we made last week suggested a new vaccine can protect macaques against the monkey equivalent of HIV, however the vaccine using the common virus cytomegalovirus (CMV) as the vector or container of proteins from the simian immunodeficiency virus (SIV) protected none of a group of 24 rhesus macaques from infection. But in 13 of the monkeys vaccinated, it did produce infections characterised by an undetectable viral load.

This profound viral suppression led to an apparent decline in the number of SIV-infected cells over a period of two years after infection to the point that SIV-infected cells were undetectable in 72% of monkeys with controlled viremia. Despite this, there was no apparent waning of immune responses to SIV in the all-important effector-memory CD8 and CD4 lymphocytes over this time in twelve of the 13 monkeys.

The researchers comment that their vaccine seems to have produced “an unprecedented level of SIV control and even the possibility of progressive clearance of SIV infection over time.”

The question now is how to make a safe analogue of this vaccine for use in humans.

Continue reading

Meditate To Live Longer

The benefits of meditation are many, as anyone who meditates knows and a good study from a meditation centre in Colorado, US, suggests that the practice can actually add years to your life.

Reported effects of meditation include lowering blood pressure, healing psoriasis, boosting immunity in those who are vaccinated or have cancer, preventing relapse into recurrent depression, plus slowing down the progression of HIV.

What’s more, it seems that meditation can now actually help our cells to survive in the body for longer.

The answer lies in our telomeres – a vital component of every cell. They play a key role in the ageing of cells. Every time a cell divides, they get shorter unless an enzyme called telomerase builds them up again.

People with short telomeres are at greater risk of heart disease, diabetes, arthritis, depression and osteoporosis. They also die younger.

The study shows after a meditation course, people had significantly higher levels of the enzyme present suggesting their telomeres were ­being protected. This changes our view of meditation as simply a state of relaxation. It’s a lifesaver.

Brain studies show that meditation can even trigger physical changes in brain centres involved in learning, memory, emotional regulation, thinking and mood control.

It just so happens that chronic stress will shortern our telomeres causing cell ageing.

The action of meditation is to de-stress us and in doing so, protect our telomeres.

The two kinds of meditation that have been studied are mindfulness meditation, where you become acutely aware of your thoughts and your surroundings, and compassion meditation, where you focus on feelings of love and affection for others.

Both of these types cut down on the stress hormone cortisol. Most of us don’t have time to spend months meditating, but there are mini-meditations we can do like focusing on breathing and being aware of our surroundings several times a day.

While meditation may be effective in reducing stress and in protecting your telomeres, there are other ways if you have no interest in meditation. Exercise can buffer the effects of stress on telomeres and so do stress management programmes.

Psychologists would say that meditation gives you an increased sense of control and purpose in life, and these two things are more important than meditation itself.

Just doing something we enjoy and love – be it meditating, gardening, listening to music or painting – will go a long way to protect us from stress and even help us to live longer.

Source: http://www.mirror.co.uk/advice/miriam/2011/05/19/meditate-to-live-longer-115875-23139547/
Further reading: http://www.learn-meditation-techniques.org/
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Criminal Prosecutions – Useful Information

Since 2001, people living with HIV in the UK have been prosecuted for the reckless transmission of HIV. There are real concerns that these prosecutions are undermining efforts to stop the spread of HIV in the UK and are increasing stigma around HIV.

The National AIDS Trust are campaigning for an end to prosecutions of reckless transmission of HIV through consensual sex. This is because of the need to affirm the individual’s responsibility for his or her own sexual health; the human rights of those people living with HIV and the difficulties of disclosure; the public health considerations and the potential for further discrimination against people living with HIV and disadvantaged groups such as migrants.

Whilst prosecutions continue, they are working to ensure that the best possible guidance is available to prosecutors, lawyers, police, support organisations, healthcare workers, people living with HIV and the organisations which support them.
Latest information

As a result of pressure from NAT, the Crown Prosecution Service (CPS) carried out a public consultation on its ‘Policy for Prosecuting Cases Involving Sexual Transmission of Infections which causes Grievous Bodily Harm’ in 2006. In 2008 the CPS published new guidance for prosecutors to explain how it deals with cases involving the intentional or reckless transmission of an infection.

The full CPS guidance can be read on the CPS Website.

h3. Police Investigation of HIV Transmission: A guide for people living with HIV in England, Wales and Northern Ireland

The Association of Chief Police Officers (ACPO) published ‘Investigation Guidance Relating to the Criminal Transmission of HIV’.

NAT has produced a leaflet for people living with HIV in England, Wales and Northern Ireland explaining key points of the ACPO Guidance and what to expect and do if you find yourself involved in a police investigation.

Access this document using this link

UPDATE: 08/08/11

Changes have been proposed to legal aid and will remove whole areas from the scheme, leaving many people little choice but to go it alone.  Make sure you know how to represent yourself in court if you ever need to.

Via NAM

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