Caught on Camera: How HIV Infects Cells

Live Imaging of HIV-1 Transfer across T Cell Virological Synapse to Epithelial cells that Promotes Stromal Macrophage Infection

Real et al. established by live imaging the dynamics of virological synapses formed between HIV-1-infected T cells and the epithelium at the surface of a human reconstructed mucosa. HIV-1 virions formed at the viral synapse cross the epithelium and reach the mucosal stroma, where the virus establishes a latent infection in macrophages.

During sexual intercourse, HIV-1 crosses epithelial barriers composing the genital mucosa, a poorly understood feature that requires an HIV-1-infected cell vectoring efficient mucosal HIV-1 entry. Therefore, urethral mucosa comprising a polarized epithelium and a stroma composed of fibroblasts and macrophages were reconstructed in vitro. Using this system, we demonstrate by live imaging that efficient HIV-1 transmission to stromal macrophages depends on cell-mediated transfer of the virus through virological synapses formed between HIV-1-infected CD4+ T cells and the epithelial cell mucosal surface.

We visualized HIV-1 translocation through mucosal epithelial cells via transcytosis in regions where virological synapses occurred. In turn, interleukin-13 is secreted and HIV-1 targets macrophages, which develop a latent state of infection reversed by lipopolysaccharide (LPS) activation. The live observation of virological synapse formation reported herein is key in the design of vaccines and antiretroviral therapies aimed at blocking HIV-1 access to cellular reservoirs in genital mucosa.

Read more on the research here: https://www.cell.com/cell-reports/pdfExtended/S2211-1247(18)30570-9

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Ramadan, Fasting and HIV

Crescent Moon

Image Credit: Tom Robson

Ramadan is the name of one of the 12 lunar months of the Islamic calendar.  For 29/30 days of Ramadan, Muslims fast from sunrise until sunset.  Many HIV-positive wish to join their community in observing this important month, can they?

During Ramadan, (due to start on Tuesday) Muslims practice the maximum self-control by denying their bodies every earthly pleasure during the daylight.  This means that eating food and drinking (including water).

After sunset, a fasting individual may eat and drink.  Many attend Mosques at night to pray and socialise.  Ramadan ends when the next crescent moon is born and celebrated with Eid ul-Fitr [breaking fast feast].

Fasting is a healthy practice for people with good health; the Quran exempted some categories from fasting – the sick, pregnant, breastfeeding mothers and travellers — and the wisdom behind this waiver is to spare hardship or damage. However, in spite of the Quranic waiver to those who are sick, many Muslims insist on fasting even if they have a minor health condition, justified the rewarding experience and of course to be part of the community.  Of course if you decide not to fast, the Quran says that you are obliged to feed someone who is less fortunate than you.

The question is, can someone or should someone who is HIV positive fast for Ramadan?

The best person to help you decide is your HIV doctor.  To help you and your doctor make the decision, you need to take under consideration some general factors, such as: when you were diagnosed, your overall health, your viral load and T-cell count.  Those in the early period of treatment should not fast, because the body is still trying to adjust to HIV and the treatment which you are having.

If you have been on treatment for some time, and your T-cell numbers are good, with undetectable viral load, and an overall good health then you might consider discussing your wish to observe Ramadan with your doctor.  Explain to her/him that you cannot let any substance go down your mouth to your stomach from sunrise to sunset.

Ask your doctor if your medication regimen could be adjusted with no risk, so you can take it before the sunrise and/or after the sunset.  If you are on a one pill regimen it might be easier for you to fast than if you are on a multiple pill one.

Once you get the green light from your doctor, you still need to take extra steps when fasting Ramadan.

For example, try to prepare good supplements to use on a daily basis during the month if you haven’t been doing so; in Ramadan eating less meals a day could seriously decrease your intake of important minerals and vitamins. Drink plenty of water during the night and avoid salty meals that could make you thirsty. Avoid unnecessary exposure to sun or heat to avoid dehydration. Do not overload your body with work and rest well while fasting.

Medical experts appeal to those who fast and ask them to stay from fizzy or carbonated drinks like cola, lemonade & other flavours even at Lftar (fast-breaking time).  A long day of fasting causes dehydration of the kidneys.  Having cold and fizzy drinks can suddenly cause the kidneys to fail.  Instead, use fresh water and fresh juices.

Ramadan is a good opportunity to quit bad habits; remember that smoking is not allowed while fasting, so if you do smoke maybe this is a good time to quit.

Fasting can also have great health benefits if done the proper way.  According to Mayo Clinic, “Regular fasting can decrease your low-density lipoprotein, or ‘bad,’ cholesterol. It’s also thought that fasting may improve the way your body metabolizes sugar. This can reduce your risk of gaining weight and developing diabetes, which are both risk factors for heart disease.”

Remember: the Quran forbids Muslims to commit acts that could even remotely jeopardise your health.  If your doctor advised against fasting, or if you have any concern that fasting might hurt your health, then don’t fast and invest the month in doing all the other good deeds that you can do; you can delay your lunch meal to be able to join your community in the daily fast-breaking ceremony.

We wish you a joyful and happy Ramadan filled with blessings and generosity.  We hope this Ramadan will enable you explore the great benefits of spirituality while fighting against HIV/AIDS or any other hardship.

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Art Therapy Workshop

You are invited to an Art Therapy Workshop with a focus on mental health & wellbeing on Thursday, 10th May – 11am till 1pm

Light refreshments provided – All are welcome, no previous art experience necessary.

For more information, please see our Facebook Event, or contact contact Rachael (rachael@lass.org.uk) or call us on 0116 2559995

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The Future of HIV and U=U

People all over the world are receiving effective HIV treatments and more treatment options are in the pipeline. Now, global health organisations want to end the AIDS epidemic

Via New Scientist

IN 2015, the Joint United Nations Programme on HIV/AIDS (UNAIDS) launched an ambitious target: to end the AIDS epidemic by 2030. The aim is that no child will be born with HIV and anybody already infected will be treated with medicines that give the best opportunity for healthy living.

This goal is in stark contrast to the early days of the epidemic, when the virus wreaked havoc. In the 1980s and 90s, an HIV infection was almost always fatal. But treatment has come a long way since then.

Today, nearly 21 million people around the world receive life-saving antiretroviral therapies, which can reduce the amount of the virus in the blood to undetectable levels. And scientists have even greater ambitions: some are developing vaccines, others are formulating long-acting treatments and still more are working on a cure. “HIV has changed from a deadly disease to a manageable disease,” says Jens Lundgren at the University of Copenhagen in Denmark, who has been working on HIV care and research for the past 30 years.

Until recently, HIV’s spread was rapid because it is easily transmitted via contact with infected blood and other body fluids. The most common routes of infection are through sex and shared needles.

But the risk of transmission can now be substantially reduced with antiretroviral medicines. Bruce Richman, who was diagnosed with HIV in 2003, says the treatments have changed his life. “For much of the time I had HIV, I isolated myself and had a sense of fear and shame,” he says. “Because I had a fear of transmitting HIV, I feared getting close to romantic partners.”

But that changed in 2012, when Richman’s doctor informed him that his antiretroviral treatment had reduced the amount of HIV in his blood to undetectable levels. The news was a revelation and Richman realised he no longer needed to hide.

Keen to spread the word, he started a campaign to publicise the life-changing effects of antiretrovirals and their impact on transmission rates. He called the campaign U=U (Undetectable = Untransmittable). His aim was to change the way people understand what an HIV diagnosis means, encourage those who are infected to keep up with their treatments and help lift the enduring stigma of HIV. “It improves the lives of people with HIV, and opens up social, sexual and reproductive lives that we didn’t think were possible,” says Richman.

“Eliminating AIDS as a public health threat by 2030 is potentially achievable”

Since 2016, the U=U campaign has teamed up with 570 other organisations in 71 countries to share the message. “In most of these countries people have been taught to fear HIV and people with HIV,” says Richman. “Now we’re turning a corner.”

The impact of this and other prevention strategies and campaigns has begun to reduce new infection rates. In 2016 in London, four sexual health clinics saw a 40 per cent fall in new HIV infections among gay men compared with 2015. And the number of new diagnoses in San Francisco has dropped by more than 50 per cent since 2006, in large part because of this “treatment as prevention” approach, also known as TasP.

But more work is needed, for example, on a vaccine. For some other viruses, vaccines work by mimicking the biochemistry of people who seem to be naturally protected from infection. “For HIV, we don’t have a good naturally protective correlate to work with,” says Lundgren.

Another difficulty is the lack of a good animal model for human HIV infections. Potential vaccines that show promise in monkeys infected with the similar simian immunodeficiency virus (SIV) have not been successful in human clinical trials.

There are also hopes for an HIV cure, but this has been harder to come by than expected. The main problem with trying to cure HIV is that there is a latent reservoir of the virus in the body.

That is why the leading strategy in the hunt for a cure is the “kick and kill” approach. This aims to kick HIV out of cells that act as a reservoir and then kill the virus.

While focusing on such scientific problems to make a cure a possibility in future, researchers at pharmaceutical company Gilead are also making progress when it comes to the potential for longer-acting treatments. At the moment, antiretroviral drugs must be taken on a daily basis and this can prove difficult for some.

Winston Tse, a senior scientist at Gilead, is working on a treatment that looks to be particularly potent and could take the form of a long-acting injection. He and his colleagues have set their sights on a protein that surrounds and protects the HIV RNA genome which is essential to viral life including its ability to infect new cells. The team is developing compounds that interfere with this protein and so inhibit the ability for the virus to replicate.

“Such a treatment could help with compliance, as well as lessening the emotional burden of taking daily HIV treatment,” says Tse.

It is this focus on prevention and treatment that make the UNAIDS goal potentially achievable – eliminating AIDS as a public health risk by 2030. “I would love a cure, but I’m investing my time into the strategy of testing, treating and prevention, because I think that’s the way to end this epidemic,” says Richman.

Lundgren agrees. “We have the tools, we have the drugs, we have the tests,” he says. “If we push resources, we can control it.”

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Female Condoms: Difficult to find in the US, easy to get in UK.

Female condoms are an alternative to regular condoms. They provide pretty much the same great protection from pregnancy and sexually transmitted infections (STIs). What’s different about them? Instead of going on the penis, female condoms go inside your vagina for pregnancy prevention or into the vagina or anus for protection from STDs.

There are hundreds of different kinds of male condoms for sale in the US, but only one female condom and you need a prescription to get it. Female condoms are almost as effective as male condoms, so why are they so hard to find in the US?

At LASS, we’ve been providing female condoms for over 10 years, and when we mention them at our training events or offer them to individuals who test for HIV at LASS, they are often surprised at their existence.

The situation isn’t as bad in the UK compared to America as the above video from Vox describes but publication and awareness of female condoms isn’t as readily available as their male counterparts, (even in the UK) and we want to change that!

Female condoms have been around since the 1980’s, when a Danish doctor named Lasse Hessel came up with a prototype. However, the media ridiculed it, comparing it to a plastic bag.

Female condoms have never been marketed very well and stigma over a sexual health aid still hangs around to the point that in the US last year, the company that manufactures them stopped selling them in stores and changed to a prescription-only model, so indivuals in the states need to see a doctor, just to get a condom.

That’s backwards thinking and we say they are just as valid as male condoms to help prevent STIs (including HIV) Another excellent reason for using female condoms is they’re the only women -initiated method of planning and actively pursuing safer sex. Many say they’re preferable for anal sex too!

How do female condoms work?

Female condoms (also called internal condoms) are little nitrile (soft plastic) pouches that you put inside your vagina. They cover the inside of your vagina, creating a barrier that stops sperm from reaching an egg. If sperm can’t get to an egg, you can’t get pregnant. The female condom also helps prevent sexually transmitted infections.  Female condoms aren’t just birth control — they also reduce the risk of sexually transmitted infections.

Female condoms help prevent STIs by covering the inside of your anus, vagina, and some parts of your vulva. This decreases your chance of coming in contact with semen or skin that can spread STIs.

Unlike in the United States as the above video shows, female condoms are becoming easier to find online, in stores, and at family planning centers. And you don’t need a prescription or ID to buy them. They’re a small, discreet, and portable way to get big protection from pregnancy and STDs.

We provide them freely at LASS, since all the other condoms out there are worn on a penis, many female condom fans love that there’s a condom they can control. Female condoms let you take charge of your sexual health. Even if your partner doesn’t want to wear a condom, you can still protect yourself.

You can also buy them online, here’s a couple of links from Amazon (Pasante) (Velvet)

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Life Insurance & HIV. What’s happening now?

Research published last year revealed that young people receiving the latest HIV drugs now have a “near-normal” life expectancy. [Read that article here]

Yet despite such profound changes in the health of people with the conditions, one in four say they have been refused a financial product or quoted an unaffordable insurance premium in the past five years.

Life insurance customers who are HIV positive are now able to take out longer term policies, with premiums remaining stable, new research has shown.

Figures from Unusual Risks, the medical financial advisers, showed HIV positive men and women were taking out life insurance in the UK and insuring themselves for an average of £125,933.

The average term for policies taken between 2009 and 2013 was only 10 years but it is now possible to get a term of between 15 and 25 years.

“The average sum assured has remained fairly stable for HIV Life Assurance over the last few years, at between £125,000 and £130,000,” said Chris Morgan, lead financial adviser of Unusual Risks, Mortgage & Insurance Services.

“The products have become established and premiums have remained stable. That is due to there being several product providers that now offer life insurance to people living with HIV.

“Due to the complex nature of the underwriting of HIV Life Assurance and the range of different policies, premiums and terms available it is advisable to seek specialist professional advice before taking out HIV Life Assurance. It is not a product that can be bought instantly and directly via online money and insurance websites.”

Alan Lakey from CI Expert, said the number of insurers who will accept customers with HIV had increased hugely in recent years.

“Interestingly, some of the insurers offer cover but don’t shout about it,” he said. “Some big names now offer HIV cover but don’t publicise it until you ask.”

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Greg Louganis,two-time Olympic Gold Champion. On life and HIV.

I sold my life insurance. My insurance policy actually showed up on the show “American Greed”! Which was fascinating. They reached out to me: “Well, this 92-year-old woman in Florida bought your life insurance policy.” Oh my god, I felt so bad. And when I did the interview, they produced a document that was notarized and signed by my previous doctor saying that I only had a maximum of six months to live. It was so devastating. That was a good reason why he’s not my doctor anymore [laughs].

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Getting on Track in Agenda 2030

A new report released today by the Global Forum on MSM and HIV (MSMGF) in collaboration with the Global Platform to Fast Track the Human Rights and HIV Responses with Gay and Bisexual Men and the Free Space Process argues for consistent and robust reporting on HIV in the Voluntary National Reviews on Sustainable Development.

Titled “Getting on Track in Agenda 2030,” the report is released ahead of regional meetings commencing this month in preparation of the annual High Level Political Forum on Sustainable Development. The report calls upon UN agencies, Member States, and members of civil society to collaboratively ensure HIV-related data is included in the framework of Agenda 2030.

The 17 Sustainable Development Goals (SDGs) and accompanying 169 Targets in Agenda 2030 for Sustainable Development include a commitment to end the epidemic of AIDS by 2030. This is monitored by an agreed upon indicator for the number of new HIV infections per 1,000 uninfected population by sex, age, and key population, which includes gay men and other men who have sex with men, people who inject drugs, sex workers, and transgender people. This commitment is aligned with the UNAIDS Fast-Track strategy to end the epidemic by 2030.

The international mechanism for review of progress on the SDGs is the annual High Level Political Forum (HLPF), which includes a thematic review of selected SDGs, side events, the adoption of a Ministerial Declaration, and the Voluntary National Review (VNR) of SDG implementation by Member States. 48 countries will participate in the VNR process this year at the HLPF at UN headquarters in New York from July 9 – 18.

Among the 43 VNR reports submitted by Member States in 2017, only 32 VNR reports included any mention of HIV. Coverage of HIV is inconsistent and uneven across VNR reports, with most reports referring to aggregate HIV prevalence or incidence in the general population. Only nine VNR reports mentioned key populations, and even fewer refer to HIV-related stigma and discrimination. MSMGF believes this is not enough to meet Fast-Track and SDG targets, and more coordinated action and commitment is necessary.

MSMGF Senior Policy Advisor, Stephen Leonelli, commented:

“There remains unfinished business in the global HIV response, including persistent health disparities, stigma, and discrimination. HIV continues to severely impede the ability of countries to achieve development priorities beyond health, and continued visibility and integration of HIV within mainstream development goals has never been more important.”

The report finds that civil society and community representatives were essential in shaping the content around HIV issues in many VNR reports in 2017. Thus, we encourage civil society members to continue advocating during 2018 VNR national consultations.

The report also highlights:

  • HIV-related data and topics included in 32 VNR reports from 2017.
  • Efforts and effective strategies of eight activists across six countries who participated in 2017 VNR national consultation processes.
  • Potential sources of HIV-related data that could and should be utilized by Member States to feed into VNR reports.
  • Main entry points for civil society to participate in national VNR processes, including guidelines for preparing civil society spotlight or status reports, and how to leverage Major Groups and international non-profit organizations to influence the content of VNR reports and the Ministerial Declaration.

In order to end the epidemic, Member States must show the political will to proactively and meaningfully engage civil society and communities, especially key population-led organizations. HIV must be addressed as a cross-cutting a development challenge, and all stakeholders must realize that fulfilling the SDGs and ensuring the principle of “leaving no one behind” will require more effort to include HIV-related data and national HIV priorities.

About MSMGF
The Global Forum on MSM & HIV (MSMGF) was founded in 2006 at the Toronto International AIDS Conference by an international group of activists concerned about the disproportionate HIV disease burden being shouldered by men who have sex with men worldwide. Today, they are an expanding network of advocates and experts in sexual health, human rights, research, and policy, working to ensure an effective response to HIV among gay men and other men who have sex with men. MSMGF watchdogs public health policies and funding trends; strengthens local advocacy capacity through our programs initiatives; and supports more than 120 community-based organizations across 62 countries who are at the frontlines of the HIV response.

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