Monthly Archives: March 2015

Today is World Tuberculosis Day. What could this mean for you?

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World Tuberculosis Day is marked every year on 24 March, highlighting one of the world’s top health challenges. With nine million new cases and 1.5 million deaths each year, tuberculosis is an ongoing epidemic.

For World TB Day 2015, the United Nations, the Stop TB Partnership and the World Health Organization are calling on all governments and health organisations to mobilise political and social commitment for further progress towards eliminating the disease as a public health burden. The theme this year is “Reach the 3 Million: Reach, Treat, Cure Everyone” – aimed at securing care for the three million who fail to be treated every year.

The date commemorates the day in 1882 when Dr Robert Koch, the German physician and pioneering microbiologist, announced to the University of Berlin’s Institute of Hygiene that he had discovered the cause of tuberculosis. His discovery marked a turning point in the story of the virulent human infectious disease.

Yet over a century on, the disease continues to be a public health problem, with the highest rates in Sub-Saharan Africa. A report by the European Centre for Disease Prevention and Control and WHO found that 1,000 people a day throughout Europe develop the disease and although the continent has experienced an annual 6% decline, Europe will not be TB-free until the next century.

There has been a sustained decline in cases over the last decade but rates of multi-drug resistant tuberculosis, MDR-TB, remain at very high levels.

WHO regional director for Europe, Zsuzsanna Jakab, said only 50% of an estimated 75,000 multi-drug resistant TB patients were found in 2013 and just half were successfully cured.

“Multi-drug resistant TB is still ravaging the European region, making it the most affected area of the entire world,” he said.

TB & HIV Co-infection

When people have a damaged immune system, such as people with HIV who are not receiving antiretroviral treatment, the natural history of TB is altered. Instead of there being a long latency phase between infection and development of disease, people with HIV can become ill with active TB disease within weeks to months, rather than the normal years to decades.

The risk of progressing from latent to active TB is estimated to be between 12 and 20 times greater in people living with HIV than among those without HIV infection. This also means that they may become infectious and pass TB on to someone else, more quickly than would otherwise happen. Overall it is considered that the lifetime risk for HIV negative people of progressing from latent to active TB is about 5-10%, whereas for HIV positive people this same figure is the annual risk.

Many people living with HIV are now taking antiretroviral treatment for their HIV infection. This helps their immune system, but the risk of developing active TB is still higher than in people without HIV infection. Also, there are reports from some African countries that people are starting to become infected with drug resistant HIV. This makes it much more difficult to provide them with effective antiretroviral therapy, and this in turn could result in millions more, of the estimated 40 million people thought to be living with HIV worldwide, developing active TB in the next few years.

Find out how the body reacts to tuberculosis here

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Living with HIV: six very different stories

 ‘I don’t know how I survived’: Jonathan Blake at home in London. Photograph: Antonio Olmos for the Observer

‘I don’t know how I survived’: Jonathan Blake at home in London. Photograph: Antonio Olmos for the Observer

Since HIV was first diagnosed in Britain 30 years ago, the reality of having the virus has changed dramatically. From a survivor of the 1980s epidemic to a recently diagnosed mother in her 60s, Eleanor Tucker hears six life-affirming stories

Story via The Observer (@obsmagazine)
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Jonathan Blake, 65

Lives in London with his partner. He was one of the first people to be diagnosed with HIV in this country

The only thing that stopped me committing suicide was that I couldn’t bear the thought of someone clearing up my mess. It was 1982, and I’d been to my GP with the kind of swollen glands that hurt when you shook hands with someone. Tests showed I had HTLV3, the original name for HIV. At the time there was all this news filtering in from the US about a mystery illness – that it was terrifying, and terminal. If I can’t kill myself, I thought, I’d better just get on with it.

They wanted to put me on AZT, later revealed to be a failed chemotherapy drug. I refused – I didn’t trust the drug companies; still don’t. But saying no might have saved me. I saw so many people die – of the virus, but also from the drugs. In the back of my mind was always: “It doesn’t matter, I’m going to die soon anyway.” So I got out there and lived my life.

Not long after my diagnosis I met my partner, Nigel, then got involved with LGSM: Lesbians and Gays Support the Miners. I thought we’d take the story of what we did, raising money for the mining families of a town in Wales, to the grave. But a film about it, Pride, came out last year. I like the way my character [played by Dominic West] is portrayed: he’s neither a victim or tragic – HIV is just part of who he is.

I managed with no medication until 1996 and then tried different combinations until I found the one I’m on now. My health is not perfect, but I’m here 30 years later. I don’t know how I survived. The funny thing is, this life I’ve had with HIV, I wouldn’t have missed it for the world. It’s taken me on some amazing adventures.

Lizzie Jordan, 33

Was diagnosed in 2006. She lives with her 10-year-old daughter

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‘My only reference point was Mark Fowler in EastEnders’: Lizzie Jordan. Photograph: Antonio Olmos for the Observer

I had been with my partner Benji for four years and our daughter Jaye was just 13 months old. One day Benji came home feeling unwell. We thought it was just a sinus infection, but within four days he was dead.

Postmortem examinations showed that he had something compromising his immune system. That something was HIV. I was tested soon afterwards – as was Jaye, who I was still breastfeeding. Her result was negative. Mine was positive. At that point I was in shock. My only reference point was Mark Fowler in EastEnders. But I’m a mother and I had Jaye to think of, so I just had to keep going.

Although my first thought was to keep my diagnosis a secret, I realised there were women Benji had slept with before me who needed to know. So I decided to be as open as I could. It was hard, though, and his family refused to believe that he’d had Aids. Some of them even blamed me.

That was eight years ago. Today I am happy, healthy and symptomless. I started taking medication last year, and it’s just one pill a day.

Jaye is 10 now and I have told her age-appropriate things. To start with, it was as simple as “Mummy has bugs in her blood.” Now she understands a lot more.

I have never come up against negativity, which I think is partly because I’m open about my situation. I’ve dated other HIV-positive people, but recently I met someone on Twitter who isn’t. It says on my profile that I write for beyondpositivemagazine, but I had to check he knew what that meant. He did. It’s a relief when it doesn’t matter to people, but there’s still a lot of work to be done.

Steve Craftman, 58

Lives in Dyfed, Wales. He was diagnosed in 1987

There are three epidemics, in my view: the newly diagnosed, who are going to lead pretty normal lives; those who recovered from the early days – the 80s and 90s; and then there are the people like me, who survived but with a lot of health problems.

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‘I’ve done a lot of grieving’: Steve Craftman. Photograph: Antonio Olmos for the Observer

Back then they gave us five years at the most. I made it through, but I’ve got many health problems, mainly due to the medication I took. I have osteopenia [the stage before osteoporosis] in my ankles and hips, which means I feel unsafe riding a motorbike now. The damage to my body is nobody’s fault – the doctors didn’t know what they were dealing with, and the drugs were so strong. You could say I fell out of the side-effect tree and hit every branch on the way down.

I’ve done a lot of grieving, lost a lot of friends and lovers. It’s not easy and it’s often lonely. In America they’ve come up with a name for it: Aids survivor syndrome – a bit like PTSD. I’m still here, though, nearly 30 years on. Am I tough? Not really. I think I’ve just been lucky.

I’ve had my fair share of prejudice over the years. I was living in Bristol 10 years ago with my partner, John. We had abuse and threats shouted at us, and our car was vandalised. The police advised us not to pursue it – they said we’d be better off moving on. We set up home in a tiny village in Wales, where we were more accepted than in the city. John died there, from Aids, in 2007.

I’m open about my situation. At a hospital appointment recently, the doctor asked if I was “out” about the fact that I have Aids. I turned round and showed her the “biohazard” symbol I had tattooed on the back of my neck last year. “I’m guessing that’s a ‘yes’ then,” she said.

Matthew Hodson, 47

Lives in London with his husband. He was diagnosed in 1998

0942344e-8d7e-47eb-a218-b9a4c2ff1daa-620x516‘If I can’t be upfront about it, who can?’: Matthew Hodson. Photograph: Antonio Olmos for the Observer

I was tested in 1998 after they announced at the International Aids Conference in Vancouver that combination therapy was effective. I suppose I needed to know that there was some treatment that would work first before I wanted to know. Back then, you were told that HIV might take five or 10 years off your life. Now, your life expectancy is the same: they call it “life altering”, not “life limiting”.

I didn’t take it very well and for a while I stopped having sex and felt dirty, diseased. But people go in different directions, and after I’d thought all the worst-case scenario stuff, about not making it to 50, I took control.

Starting new relationships was hard. There are more interesting things about me than the presence of a virus, but I can see that someone would want to know. Thankfully I’m married now, so I don’t need to worry about disclosure. If I wasn’t, I think I’d tell people straightaway. I have a job, I’m secure and I’m comfortably off – if I can’t be upfront about it, who can? In a way, it’s my responsibility.

As part of my job with I’m chief executive of the gay men’s health charity GMFA, so I often speak to recently diagnosed young men. They picture themselves wasting away like Tom Hanks in Philadelphia. We need to remember these images are part of history now – but there’s still a lot of bad information around. It’s because HIV is largely sexually transmitted and it’s often gay men who have it. There are still the remnants of deeply homophobic attitudes in this country. They’re not the prevailing voices any more, but it’s hard to drown them out completely.

It’s frightening to look back. If you were a young gay man in the mid-80s, you would have experienced a loss comparable to someone who survived the First World War. I knew 30 people who died during that period, but many men knew many more.

Jo Josh, 66

Lives in Reigate. Diagnosed in 2008. She has a 25-year-old daughter

fb5c366f-73a0-4e1e-9dc2-091bbe486cb5-620x426‘I’ve become a kind of pin-up for ageing with HIV’: Jo Josh. Photograph: Antonio Olmos for the Observer

HIV infection conjures up an image in people’s minds. Most infection is via unprotected sex and for a lot of people that means there’s something nasty about it. I hate the word “disclosure”. I don’t feel I have to “disclose” if I don’t want to. I didn’t tell my daughter until I’d come to terms with it myself. She was 18 at the time, and I was in shock. It takes a couple of years. To start with you don’t know much about HIV, how much better the medication is these days. Then you start to realise it’s going to be OK.

I “came out” by going on BBC News for Body & Soul, an HIV charity I’m involved with. Afterwards the phone wouldn’t stop ringing. My friends were supportive, but very emotional. A lot of them used the “death voice”, telling me how brave I was. “No, really, I’m fine,” I’d say. There were a few silences though.

I’m just wrong for HIV: female, 60s, middle class. Some people can’t deal with it. I don’t yet need any medication and I feel like a fraud sometimes. I’ve become a kind of pin-up for ageing with HIV. I don’t talk about how I was infected, though. It starts to become a bit of a soap opera, and I’m more interested in being open about life with HIV than how I got it. That’s the only way we’re going to change perceptions.

Becky Mitchell, 40

Diagnosed in 2012. She lives in Bristol

I can’t say I was delighted when I was diagnosed, but I wasn’t totally freaked out. As part of my job with the Environment Agency I saw a lot of our former chairman, Lord Chris Smith, a high-profile HIV-positive man. He always seemed so active. I thought: maybe it’s not so bad these days.

60a69668-6fc0-469f-8d31-6df53cf50caf-400x600‘There’s no shame. I just crossed paths with someone selfish’: Becky Mitchell. Photograph: Antonio Olmos for the Observer

I’d had a test when I found out my partner was HIV positive. He’d chosen not to tell me, so that was the end of our relationship. I wasn’t showing any symptoms, and I’d actually only been infected about two or three months before. With my CD4 count [the white blood cells that fight infection] still at a safe level, I wouldn’t normally take medication at this stage, but I volunteered for a clinical trial where they wanted people with good counts and low levels of the virus. So I’m taking one pill a day.

Because of the medication, and the fact that I look after myself, my health is really good. I’m more careful, too: I used to push myself too hard when I was exercising – now I allow myself recovery time. Being open about my HIV is really important to me. There’s no shame. I’m a normal woman – I didn’t do anything risky; I just crossed paths with someone selfish. That could happen to anyone, and I want people to realise that. The only stigma I’ve ever come up against was actually within the NHS. I’d had a cycling accident and a young doctor asked me, in front of my mother, if I was an intravenous drug user. I was stunned, but it’s just ignorance, a lack of education.

I don’t feel any different physically, but HIV has been a wake-up call. I feel a sense of urgency: life is for living and I don’t want to waste time sweating the small stuff.

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What happens in your consultations?

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Story via NAM (@aidsmap)

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NAM is an award-winning, community-based organisation, which works from the UK. They deliver reliable and accurate HIV information across the world to HIV-positive people and to the professionals who treat, support and care for them.

Do you work in health care in Europe, or are you living with HIV, or both? Please help us to understand communication between healthcare professionals and people living with HIV in Europe.

We’re running two anonymous online surveys, one for people living with HIV and one for healthcare professionals. Both surveys are available in English, French, Italian, Portuguese, Russian and Spanish.

The surveys are investigating what happens in HIV care appointments; such as the type of topics patients and healthcare professionals prioritise.

If one of the surveys applies to you, we would really appreciate your help.

Related links
Take part in the online survey for healthcare professionals in Europe
Take part in the online survey for people living with HIV in Europe

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No HIV transmission in gay couples study

Andrew Grulich at CROI 2015. Image by The Kirby Institute (http://kirby.unsw.edu.au).

Andrew Grulich at CROI 2015. Image by The Kirby Institute (http://kirby.unsw.edu.au).

Story via NAM (@aidsmap)

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NAM is an award-winning, community-based organisation, which works from the UK. They deliver reliable and accurate HIV information across the world to HIV-positive people and to the professionals who treat, support and care for them.

An early analysis of an Australian-based study of gay male couples of opposite HIV status (serodiscordant couples) has so far seen no transmissions from the HIV-positive partner within the couple. These observational data from the Opposites Attract study concur with the interim analysis of the larger PARTNER study that was released at CROI one year ago. PARTNER reported no episodes of transmission during 16,400 episodes of anal sex (including condom-protected episodes) in gay men.

Recruitment to the new study began in late 2013 in three Australian cities (Sydney, Melbourne and Brisbane), and now also includes Bangkok in Thailand and Rio de Janeiro in Brazil. Most of the HIV-positive partners are on treatment and have an undetectable viral load.

During the study’s first year, 152 couples provided data. A total of 5905 episodes of anal sex were reported. No transmissions between couples (linked transmissions) have so far been seen in the study.

Because of the relatively small numbers enrolled so far, there is some uncertainty to these findings. Although there have been zero transmissions, this does not necessarily mean a zero chance of transmission. The researchers have calculated that in this population, the highest-likely figure for the chance of transmission during condomless anal sex with an HIV-positive partner (regardless of viral load) is 4%. The highest-likely figure when the HIV-negative partner was receptive (bottom) is 7%.

But as with PARTNER, these estimates are likely to get closer to zero as the researchers collect more data.

Related links
Read this news story in full on aidsmap.com

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New tenofovir formulation equally effective but safer

Paul Sax presenting at CROI 2015. Photo by Liz Highleyman, hivandhepatitis.com.

Paul Sax presenting at CROI 2015. Photo by Liz Highleyman, hivandhepatitis.com.

Story via NAM (@aidsmap)

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NAM is an award-winning, community-based organisation, which works from the UK. They deliver reliable and accurate HIV information across the world to HIV-positive people and to the professionals who treat, support and care for them.

Tenofovir alafenamide (TAF), a new formulation that has lower concentrations in the blood but reaches higher levels in cells, is as effective as the currently available version, tenofovir disoproxil fumarate (TDF). Furthermore, it has less detrimental effects on the kidneys and bones compared with TDF.

Tenofovir disoproxil fumarate (Viread) is one of the most widely used antiretroviral drugs. It is a component of the Truvada coformulation and the single-tablet regimens Atripla, Eviplera/Complera and Stribild. TDF is highly potent and generally safe and well-tolerated, but can cause kidney and bone problems in some patients.

TAF is a new pro-drug that delivers the active agent, tenofovir diphosphate, more efficiently to cells infected with HIV. TAF produces adequate intracellular levels with lower doses, which means lower concentrations in the blood plasma and less drug exposure for the kidneys, bones and other organs and tissues.

Whereas cheaper, generic versions of tenofovir disoproxil fumarate will be available in many Western markets soon, TAF will be a new product exclusive to Gilead and protected by patent.

Data were presented comparing the Stribild coforumulation (elvitegravir, cobicistat, emtricitabine and TDF) with an alternative coformulation replacing TDF with TAF. Around 1700 previously untreated people took part in the studies in Europe, North America, Latin America and Asia.

After 48 weeks, the two regimens had similar high efficacy, showing that the TAF coformulation is non-inferior. Rates of viral suppression were over 90% in both arms of the study, irrespective of age, sex, race, HIV-1 RNA and CD4 cell count. Fewer than 1% had evidence of primary resistance mutations in either arm.

Overall rates of side-effects and serious adverse events did not differ.

Kidney-related adverse events were examined in more detail. Compared with TDF, TAF had no discontinuations due to renal adverse events, significantly smaller decreases in eGFR and significantly less proteinuria, albuminuria and tubular proteinuria.

In relation to bone health, TAF has significantly less impact on spine bone mineral density (26% lost at least 3%, compared to 45% in the TDF group) and on hip bone mineral density (17% lost at least 3%, compared to 50% in the TDF group).

The coformulation studied here has been submitted to regulators in the USA and Europe for licensing.

Gilead is also developing a coformulation of TAF and emtricitabine, to replace Truvada. This may also be considered for use as pre-exposure prophylaxis (PrEP).

Related links
Read this news story in full on aidsmap.com
View a webcast of this presentation

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PEPFAR-funded abstinence work had no impact

Image from the presentation by Nathan Lo, at CROI 2015.

Image from the presentation by Nathan Lo, at CROI 2015.

Story via NAM (@aidsmap)

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NAM is an award-winning, community-based organisation, which works from the UK. They deliver reliable and accurate HIV information across the world to HIV-positive people and to the professionals who treat, support and care for them.

Nearly US$1.3 billion spent on US-funded programmes to promote abstinence and faithfulness had no significant impact on behaviour in 14 countries in sub-Saharan Africa, a preliminary analysis of sexual behaviour data has shown.

The President’s Emergency Plan for AIDS Relief (PEPFAR) was launched in 2004 with a Congressional requirement for a fixed proportion of PEPFAR prevention funds to be spent on programmes promoting abstinence from sexual relations, delaying sexual activity and faithfulness to one partner. Programmes supported by this funding stream also promoted partner reduction. But while there may be epidemiological grounds for thinking that delaying sexual debut and reducing sexual activity might reduce opportunities for acquiring HIV, especially in young women, there is limited evidence for interventions that are effective in achieving these objectives.

The researchers compared trends in sexual behaviour derived from national Demographic and Health Surveys in 14 PEPFAR focus countries and eight other African countries where PEPFAR funding was not determining the content of HIV prevention interventions.

While there was a trend for men to have fewer sexual partners in both sets of countries, the researchers could not identify any impact associated with PEPFAR funding. Higher levels of PEPFAR funding in specific countries didn’t seem to be associated with differences in sexual behaviour either.

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Two interferon-free regimens have high hepatitis C cure rates for people with HIV

David Wyles and Susanna Naggie presenting at CROI 2015. Photo by Liz Highleyman, hivandhepatitis.com.

David Wyles and Susanna Naggie presenting at CROI 2015. Photo by Liz Highleyman, hivandhepatitis.com.

Story via NAM (@aidsmap)

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NAM is an award-winning, community-based organisation, which works from the UK. They deliver reliable and accurate HIV information across the world to HIV-positive people and to the professionals who treat, support and care for them.

A pair of two-drug, 12-week regimens containing neither interferon nor ribavirin cured hepatitis C for more than 95% of people with HIV and hepatitis C co-infection, according to two studies presented to CROI this week.

The first regimen was sofosbuvir plus ledipasvir (Harvoni coformulation), produced by Gilead. The second was sofosbuvir (Sovaldi) plus daclatasvir (Daklinza), with the latter drug produced by Bristol-Myers Squibb. Ledipasvir and daclatasvir are both NS5A inhibitors.

In both studies, the response rates in people with HIV and hepatitis C co-infection were as high as those for people with hepatitis C mono-infection in other trials. This supports recent hepatitis C treatment guidelines recommending that HIV-positive and HIV-negative people should be treated in the same way for hepatitis C.

For sofosbuvir plus ledipasvir (Harvoni), 335 people with co-infection took part in the open-label, non-randomised study. The trial had broad inclusion criteria and included more difficult-to-treat groups such as prior non-responders and people with liver cirrhosis than many other studies. Almost all had genotype 1, more than half were treatment-experienced and three-quarters had unfavourable IL28B gene variants. All were taking HIV treatment and most had an undetectable viral load.

Participants took a once-daily tablet for twelve weeks, with an additional twelve weeks follow-up to assess sustained virological response (SVR12), or continued undetectable hepatitis C. The overall SVR12 rate was 96%, similar to that in people with mono-infection. Having taken treatment before, having liver cirrhosis or NS5A resistance variants made little difference to the cure rate.

However, SVR12 rates were slightly lower in participants who were black. This had not been observed in mono-infection studies. One possible explanation, which will be explored, is an influence of genetics on drug response when both ledipasvir and antiretrovirals are used.

For sofosbuvir (Sovaldi) plus daclatasvir (Daklinza), 151 previously untreated individuals with co-infection were randomised to either eight or twelve weeks of the regimen, while 52 treatment-experienced individuals all took it for twelve weeks. Almost all participants were taking HIV treatment and had an undetectable viral load.

While two-thirds had hepatitis C genotype 1a, people with genotypes 2 to 6 were included – an advantage of daclatasvir is that it is active against multiple genotypes whereas ledipasvir is primarily active against genotype 1.

Participants randomised to take the once-daily tablets for eight weeks had poorer results (SVR12 76%), but the twelve-week course worked well – an SVR12 of 96% in people who had never taken treatment before and 98% in treatment-experienced individuals. Rates were similar across genotypes.

Both regimens studied were generally safe and well-tolerated.

Related links
Read this news story in full on aidsmap.com
View a webcast of Susanna Naggie presenting
View a webcast of David Wyles presenting

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