Monthly Archives: September 2011

This 90 Percent Successful Vaccine May Be Our Best Chance to Eradicate HIV/AIDS

Dr Esteban

Spanish researchers have completed the first human trial of a new vaccine against HIV. It has been successful in 90% of the HIV-free volunteers during phase I testing. This vaccine brings great hope to eradicate HIV forever.

The team lead by Dr Mariano Esteban, a researcher at the Spanish National Research Council‘s Biotechnology National Centre, has been working on this method since 1999. They are using an attenuated virus called the MVA-B, a variation of the Modified Ankara Vaccinia, which was previously used to eradicate smallpox. The Modified Ankara Vaccinia also forms the base of other vaccines. The B refers to the HIV-B, the most common HIV subtype in Europe.

Dr Esteban’s team inserted the HIV genes Gag, Pol, Nef and Env in MVA’s genetic sequence. In 2008, they tried the resulting HIV nuke on mice and monkeys. It was a complete success.

SUCCESSFUL HUMAN TEST

The first human test results were published in Vaccine and Journal of Virology. In the experiment, scientists injected the vaccine in 24 of 30 HIV-free volunteers. Six volunteers were treated with a placebo vaccine—they didn’t experience any effect. But 90% of the treated subjects developed a very strong immunological response against the HIV virus. 85% kept the immunological reaction for at least one year, which is really good news.

According to their results, there were no significant secondary effects in any of the patients, which was one of the major objectives of to be tested in this clinical trial.

Despite the success, Dr Esteban is cautious:

“The treatment has only been tested on 30 volunteers and, while the vaccine provokes a powerful response in most of the cases, it’s still to soon if the resulting defense would be effective against an actual HIV infection”.

The team will now start another phase I trial, injecting the vaccine in HIV-infected people. The objective of this trial is to test the therapeutical effect of the vaccine in these patients.

According to Dr Esteban, “in principle, the immunological profile of MVA-B satisfies the requirements for a promising vaccine against the HIV, like the creation of antibodies and the activation of key cells in the defense against the virus.” Sadly, it is still far away from commercialization: they need to test this on phase II and III trials, injecting vaccinated volunteers with the actual HIV virus on a larger scale.

Hopefully, one day, this vaccine will nail the HIV nemesis down.

Original Article by Jesus Diaz at Gizmodo

STAY UPDATED
Follow LASS on Twitter
or subscribe via email

HIV Treatment at 500 CD4 Level Would Put Half of Patients in Need of ART Within a Year of Seroconversion

Raising the CD4 cell threshold for the initiation of antiretroviral therapy to 500 cells/mm3 would mean that almost 50% of patients would need to start HIV treatment within a year of their infection with HIV, investigators from an international study of seroconverters report in the October 15th edition of Clinical Infectious Diseases.

A threshold of 350 cells/mm3 would result in approximately a third of patients starting therapy within a year of infection with the virus.

Large numbers of patients with HIV are diagnosed late and the investigators comment: “Our findings provide strong support for public health campaigns to encourage early HIV infection diagnosis and testing.”

US HIV treatment guidelines now recommend that patients should start antiretroviral therapy when their CD4 cell count falls below 500 cells/mm3. European guidelines endorse treatment at a CD4 threshold of 350 cells/mm3, as do World Health Organization (WHO) guidelines for middle- and low-income countries.

The earlier initiation of HIV therapy appears to have several advantages. For instance, the results of observational studies suggest that it reduces the risk of both HIV-related and non-HIV-related illnesses. Moreover, prompt therapy may also have public health benefits, significantly reducing the risk of onward HIV transmission.

But raising the CD4 cell threshold for the initiation of therapy will have cost implications for health systems, many of which are already struggling. An accurate understanding of the length of time between infection with HIV and a fall in CD4 cell count low enough to merit therapy is needed to assist planning.

Investigators from the CASCADE (Using Concerted Action on AIDS and Death In Europe) study analysed the medical records of 18,495 individuals with a known date of HIV seroconversion to predict the amount of time between infection with the virus and a fall in CD4 cell count to below 500, 350 and 200 cells/mm3. They also calculated the proportion of patients who would reach these CD4 cell count thresholds one, two and five years after infection with HIV.

Most of the patients (78%) were men and were infected with HIV through sex with another man (55%). Median age at the time of serconversion was 30 years.

The median length of follow-up was 3.74 years.

According to the investigators’ calculations, median CD4 cell counts one, two and five years after infection with HIV were 510 cells/mm3, 460 cells/mm3 and 315 cells/mm3, respectively.

If guidelines recommended HIV therapy at a CD4 cell count of 500 cells/mm3, then 48% of individuals would need to start treatment within a year of seroconversion. This compared to 26% of patients if the threshold was 350 cells/mm3 and 9% of individuals if the level was 200 cells/mm3.

The estimated median times between seroconversion and a drop in CD4 cell count to below 500, 350 and 200 cells/mm3 were 1.19, 4.19 and 7.93 years respectively.

However, CD4 cell loss differed according to individual patient characteristics. Older age was associated with a lower CD4 cell count at the time of seroconversion and faster loss of CD4 cells during follow-up (p < 0.001). In addition, individuals infected with HIV via injecting drug use or heterosexual contact had a steeper CD4 cell count decrease than gay men (p < 0.001).

The investigators calculated the time between seroconversion and a fall in CD4 cell count to the study thresholds for three groups of patients.

For heterosexual women aged 25 to 30, the median times between seroconversion and a fall in CD4 cell count below 500, 350 and 200 cells/mm3 were 10.71, 5.66 and 1.63 years respectively.

The times for gay men aged 30 to 35 years were 0.95, 3.94 and 7.67 years, and 0.04, 4.08 and 9.15 years for heterosexual men in the same age group.

“These data signify a substantial increase in the number of individuals who require treatment within the first 5 years after becoming infected following the recent changes in [US and WHO] guidelines,” write the authors. “These estimates…will be essential to health care planners estimating the additional costs of increasing the CD4 cell count threshold for cART (combination antiretroviral therapy) initiation.”

The investigations add: “Our data urgently call for a campaign to encourage early HIV testing to ensure that infected individuals receive a diagnosis of HIV infection and access care well before they reach the CD4 cell count threshold at which treatment is indicated.”

Original Article by Michael Carter at NAM

The following video features an excellent 3D animation which explains the HIV replication process very clearly.  Available from Dr Rufus Rajadurai YouTube page

STAY UPDATED
Follow LASS on Twitter
or subscribe via email

 

David Kato: Gay Rights Activist, his Murder and the Vision & Voice Award

The David Kato Vision & Voice Award will be presented annually, on Human Rights Day (10th December), to an individual who demonstrates courage and outstanding leadership in advocating for the sexual rights of lesbian, gay, bisexual, transgender and intersex (LGBTI) people, particuarly in enviroments where these uinduvidual face continued rejection, marginalization, isolation and persecution.

The award will be accompanied by a one time grant of US$10,000.

David Kato, the advocacy officer for Sexual Minorities Uganda was one of Uganda’s most prominent gay rights activists until January, when he was murdered in his home weeks after winning a court victory over a tabloid that called for homosexuals to be killed.

Along with other Ugandan gay activists, Kato had reported increased harassment, when a high court judge granted a permanent injunction against the Rolling Stone tabloid newspaper, preventing it from identifying homosexuals in its pages.

Late last year, Kato had been pictured on the front page of an issue carrying the headline “Hang Them”. He was one of the three complainants in the court case.

“Since the ruling, David said people had been harassing him, and warning they would ‘deal with him,'” Julian Pepe Onziema, a close friend and fellow gay rights activist, said.

“We were due to meet to discuss security arrangements, but he said he did not have money to get to town. A few hours after we spoke, his phone was off.”

Human Rights Watch said it was too early to speculate why Kato had been killed, but added that there were serious concerns about the level of protection of members of the lesbian, gay, bisexual and transgender community in Kampala.

Maria Burnett, the Uganda researcher for Human Rights Watch, urged a “real and substantive investigation” into the murder.

News of Kato’s murder came after a lesbian due to be deported from Britain to Uganda said she feared she would be killed if she was returned.

Brenda Namigadde, 29 – who fled Uganda in 2003 after being threatened over her relationship with her Canadian partner – is being held at Yarl’s Wood detention centre.

She told the Guardian Newspaper: “I’ll be tortured or killed if I’m sent back to Uganda. They’ve put people like me to death there. Most of my friends in Uganda have disappeared.”

Her initial asylum claim was rejected, in part on the basis that there was not sufficient evidence that she is a lesbian.

Ugandan society is, in general, homophobic – but in recent years the anti-gay feeling has been stoked by religious leaders, a group of US evangelicals and politicians.

In 2009, MP David Bahati introduced the anti-homosexuality bill, which calls for gay people to be imprisoned for life. Repeat offenders would face the death penalty, while Ugandans would be required to report any homosexual activity within 24 hours or face police action themselves.

Widely condemned internationally, the bill remains before parliament. Kato, human rights activist, was murdered in his home in Kampala, Uganda on 26 January 2011.

 

In recognition of his life and courage, and the continued struggle of lesbian, gay, bisexual, transgender and intersex (LGBTI) individuals around the world, partners committed to eliminating violence, stigma and discrimination have established the David Kato Vision & Voice Award.

Inspired by his work, the award recognizes the leadership of individuals who strive to uphold the numerous dimensions of sexual rights for LGBTI people. Sexual rights are an evolving set of entitlements related to sexuality that contribute to the freedom, equality and dignity of all people, and are an important aspect of human rights. The realization of these rights is also an integral element to a meaningful HIV response among these marginalized groups.

Why is this important?

The freedom to enjoy and express our sexuality is an integral facet of life, happiness and well-being. Yet, over 70 countries continue to criminalize same-sex sexual acts between consenting adults, adding a complex dimension to realizing the sexual rights of individuals.

Stigma, discrimination and violence towards LGBTI people, and repressive laws that criminalize same sex consensual acts, undermine access to sexual health and HIV-related services and cause many to hide their same-sex relationships. Even where this is not illegal, real or perceived homophobia among health workers can make individuals reluctant to access services.

To find out the situation in your country, visit the International Lesbian, Gay, Bisexual, Trans and Intersex Association (ILGA).

STAY UPDATED
Follow LASS on Twitter
or subscribe via email

Mobile Testing Units Show Success in Linking People to HIV Care

Linkage to facility-based HIV care from a mobile testing unit is feasible, South African researchers report in the advance online edition of the Journal of Acquired Immune Deficiency Syndromes.

In a stratified random sample of 192 newly diagnosed individuals who had received CD4 test results, linkage to care was best among those who were ART eligible, Darshini Govindasamy and colleagues found.

The lower the CD4 cell count the greater the linkage to care: all of those with CD4 counts at or under 200 cells/mm3, two-thirds of those with CD4 counts of 201-350 cells/mm3 and a third of those with CD4 counts over 350 cells/mm3 linked to care.

An estimated two million people died as a result of HIV/AIDS in sub-Saharan Africa in 2008. South Africa now has the largest ART programme in the world, yet half of those in need of treatment do not get it. And a large number of those who do present for care, present late with low CD4 cell counts increasing their risk of early death.

In South Africa traditional HIV counselling and testing (HCT) sites at stationary facilities have increased and consequently so have the numbers tested. Yet this has not resulted in increased numbers on treatment and in care.

Transport costs, being male and having a low CD4 cell count have been well documented as the primary barriers of non-linkage to care.

Successful early diagnosis of HIV has to be accompanied by strategies that assure timely linkage to care and treatment so improving health outcomes.

Mobile testing units offer several advantages: people are often tested at an earlier stage of HIV; it is easier for hard-to-reach and high-risk populations to test; and they are cost-effective. However, maintaining on-going HIV care may prove difficult, requiring referral to stationery facilities.

The authors note no studies have looked at the performance of mobile testing units in linking people diagnosed with HIV to care at public health facilities.

The authors chose to look at whether disease progression as defined by CD4 cell count had an effect on access to care and the associated barriers in a nurse-run, counsellor-supported mobile testing unit.

From August 2008 until December 2009 those diagnosed for the first time with HIV were identified retrospectively from the mobile unit records. Those who got a CD4 cell count were prospectively followed from April to June 2010 to determine linkage to HIV care.

The unit, in the Cape Metropolitan region, Western Cape, South Africa, provides free HCT services to underserved communities.

Along with free client-initiated HCT free screening for other chronic conditions including high blood pressure, diabetes and obesity as well as TB is offered. The population is predominantly black Xhosa-speaking Africans.

Following rapid testing and a positive result and CD4 testing individuals are given detailed referral letters to help their access to care. Individuals are called when results of CD4 counts are available (within 72 hours). Those with no contact number are followed up by home visit or letter. Counselling is provided and patients are encouraged to go to clinics for either pre-ART care or to start ART as appropriate.

Of the 6738 records, overall prevalence of new diagnosis was 6.9% (463), of which 376 met the study’s inclusion criteria.

Because of a higher proportion of patients with CD4 counts at or above 350 cells/mm3 the authors took one-third of patients from this cohort (76), together with all 36 individuals with CD4 cell counts at or below 200 cells/mm3, and the 80 patients with CD4 counts between 201 and 350 cells/mm3.

Of the sample 27% (43) did not get their CD4 test result. Being female, having a CD4 cell count at or under 350 cells/mm3 and having a cellphone improved the likelihood of getting a CD4 count result. These results echo recent studies in South Africa showing a high loss to follow-up prior to receiving a CD4 test result; highlighting the critical need for point of care CD4 testing in both mobile and stationary facilities.

Of the 145 (73%) remaining individuals 10 refused to participate and 56 could not be traced in spite of previously having been contacted and receiving their CD4 counts.

52.5% (49) linked to care, including 100% of those ART-eligible. While the sample size is small, note the authors, the results are considerably higher than in studies of stationary facilities, where rates of post-diagnosis linkage to care varied from 30% to 80% among the ART-eligible.

Over 70% said that the mobile unit’s referral letter helped them access care at a public health facility.

Nonetheless over 30% of those eligible to start ART still had not started two months after their diagnosis but were still in the ART screening process. These results support other studies in sub-Saharan Africa also showing a delay in starting ART after diagnosis.

Having a higher CD4 count, no TB symptoms, not having disclosed and being employed increased the risks of not accessing care.

Not being able to access public health facilities was the most common barrier reported (41%) to linking to care. Other barriers included: 13% worried about ART toxicity and side effects and 9% fearing stigma and disclosure.

Extending hours and opening on the weekends at public facilities and setting up workplace programmes with mobile units could improve linkage to care for the employed, note the authors.

Limitations include the small sample size; the inability to track over 40% of eligible study participants in spite of persistent follow-up so potentially biasing the findings; and incorrect contact information. The study was undertaken 6-18 months after HIV diagnosis makingfollow-up especially challenging.

Strengths include validation of self-reported linkage to HIV care; trained bilingual counsellors assured minimal respondent bias; no incentives were given for participation.

The authors note HIV services at the mobile unit and public health facilities were free so their findings can be generalised to similar settings.

The authors conclude that while linkage to care was best among those ART-eligible, there is an urgent need to design interventions to improve linkage to care for the employed.

Original Article by Carole Leach-Lemens at Nam

STAY UPDATED
Follow LASS on Twitter
or subscribe via email

LASS 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

NHS Has ‘Outdated Attitude’ Towards HIV Patients

HIV positive patients still have to deal with the stigma associated with the disease.

This is the view of Catherine Murphy, head of parliamentary and public affairs at the Terrence Higgins Trust. Ms Murphy believes that the stigma is particularly acute in the healthcare sector.

She said an assortment of research has been conducted and results show HIV patients still experience discrimination by healthcare workers.

“We do know that still happens quite regularly and that people have poor experiences in the NHS, in primary care,” Ms Murphy commented.

She cited the example of dentists telling HIV sufferers that their appointment needs to be the final one of the day so equipment can be sterilised, as well as some dentists rejecting them altogether. According to Ms Murphy, this is a very outdated attitude and people should expect healthcare professionals to know better.

The Terrence Higgins Trust estimated 86,500 people who had HIV were living in the UK in 2009, a 4.2 per cent rise on the previous year.

Via Private Health Care News

STAY UPDATED
Follow LASS on Twitter
or subscribe via email

AGM – Fully Booked

Please note, spaces at the AGM are now fully booked.  We are not open for new delegates.

Members and individuals who have pre-booked will be given given priority, otherwise seats will be given on a first come, first served basis.

Our Annual Report will be released on-line for download following the meeting.

STAY UPDATED
Follow LASS on Twitter
or subscribe via email

LASS – An Investors in People Organisation


  • Excellent strategy, well communicated.
  • Excellent and trusted leadership.
  • Excellent coaching and mentoring across the organisation.

These are just three of the positive statements used to describe Leicestershire AIDS Support Services by Investors in People after our recent assessment.  We are proud to announce that we are now officially recognised as an investor in people organisation.

Three years ago, LASS underwent a diagnostic review against the Investors in People Standard. The findings have been used to help shape a series of changes in support of a strategic review, implemented by our Chief Executive Officer, Jenny Hand.

The revised strategy has made a significant difference to LASS, both in direction and culturally.  Work has been done to create robust performance measures and to improve communications.  As a result there is clear understanding amongst staff and volunteers of the strategic direction of LASS and there is close co-operation and support between departments.

Within the past three years, we have also set up Well For Living, a Social Enterprise in order to expand beyond our current boundaries and to generate income that is not dependent on Government or local authority funding streams.

In order to achieve Investors in People accreditation, LASS was required to meet 39 mandatory evidence requirements which we did and three more in addition.

We are committed to Investors in People because people are at the heart of everything that we do, our success depends on employees, volunteers, service users and members alike.  We chose Investors in People because the framework for accreditation is focused on engagement with people, training and development, and communication.

We are keen to maintain a high standard of work and ensure our employees and volunteers continually work toward professional development.  Investors in People have national credibility and their revised standard really reflects the needs of a charity such as LASS.

During the last three years the changes to the organisation have meant a significant investment in people development. Our strategy has laid down a clear direction and focus for us and, with the training and development, has enabled staff and volunteers to be confident in influencing how our services are delivered.  For example In 2009 LASS successfully introduced a rapid HIV testing programme that can be administered confidentially on site at The Michael Wood Centre, or via our mobile testing which is taken out to communities.

Many of our staff and volunteers are involved in helping people rebuild their lives once they have been diagnosed as HIV positive. This requires a great deal of positive thinking and encouragement and the same skills are utilised in supporting each other.

We have become a top performing voluntary organisation and were recently shortlisted for “National Charity of the Year 2011” competing against large national charities.  We were recognised by the Charities Aid Foundation as:
“One of the best charities in the Country; a small charity punching well above its weight.”

Investment in staff and volunteer development has been a crucial factor in helping the organisation become so successful. We still have to resolve difficulties in getting to those `hard to reach` areas, but we are very creative and recently held a football tournament where we were able to provide rapid HIV tests to people who would not normally come forward for testing.

Our volunteers have also created an advert promoting the value of knowing your HIV status and this informs the audience using 15 languages.  It’s this work that got us nominated to the Charity Awards this year and a lasting “Highly Commended” status from them.  We always look for opportunities to improve, and welcome ideas and feedback.

Investors in People is an assessment to good standards and working practice.  We believe we can continue to “punch above our weight” and we welcome the opportunity to do so, right now and in the future.

We thank our many volunteers, service users and partner organisations who had a part to play in ensuring we continually improve and perform well.