Tag Archives: Antiretroviral drug

Anti-HIV drug effort in South Africa yields dramatic results

indinavir-capsules-250x250

An intensive campaign to combat HIV/AIDS with costly antiretroviral drugs in rural South Africa has increased life expectancy by more than 11 years and significantly reduced the risk of infection for healthy individuals, according to new research.

The two studies, published Thursday in the journal Science, come as wealthy Western nations are debating how best to stretch limited AIDS funding at a time of economic stress.

With an annual price tag of $500 to $900 per patient, antiretroviral therapy programs have stirred frequent debate. Critics argue that adherence to the drug regimen is low and social stigma prevents some from seeking care until they are very ill and have infected others. Cheaper remedies, such as condom distribution, male circumcision and behavior modification, deserve more attention and funding, they say.

The new economic analysis of a $10.8-million campaign in KwaZulu-Natal province concluded that the drug scale-up there had been highly cost-effective.

The program was administered by nurses in rural health clinics in an impoverished region of about 100,000 people. Treatment consisted primarily of daily doses of antiretroviral therapy, or ART, drugs, which patients take every day for their entire lives. Patients picked up their medication at a rural clinic once a month.

In 2003, the year before the drugs were available, 29% of all residents were infected with HIV and half of all deaths there were caused by AIDS. Life expectancy in the region was just over 49 years.

By 2011, life expectancy had grown to 60 1/2 years — “the most rapid life expectancy gains observed in the history of public health,” said study senior author Till Barnighausen, a global health professor at the Harvard School of Public Health.

Based on that increase in longevity, researchers determined just how many years of life were effectively “gained” among residents as a result of ART intervention. They used that figure and the total expense of the program to calculate a cost-effectiveness ratio of $1,593 per life-year saved.

The World Health Organization considers medical intervention to be “highly cost-effective” if the cost per year of life saved is less than a nation’s per capita gross domestic product. The program’s ratio was well below South Africa’s 2011 per capita GDP of about $11,000.

“It’s really a slam dunk of an intervention,” said study leader Jacob Bor, a graduate student at Harvard. “These investments are worthwhile.”

The research team noted that the study period coincided with the arrival of electric power and clean water for area residents. But those alone could not explain the dramatic increase in longevity, they said.

“While mortality due to HIV declined precipitously, mortality due to other causes flat-lined,” Bor said. “These changes were almost certainly due to ART scale-up.”

In a second study from the same region, researchers followed nearly 17,000 healthy people from 2004 to 2011 to determine HIV infection rates in areas with active ART intervention programs.

Healthy individuals in those areas were 38% less likely to contract HIV than people in areas where ART drugs were not widely available, researchers found. People in extremely rural areas also fared better than those in more closely populated areas clustered around national roads.

Overall HIV prevalence increased 6% during the seven years of the study, probably because the antiretroviral drugs allowed people with the virus to live longer, according to the report.

It’s not clear how the results of the new study would translate to areas where stable, cohabiting couples were not the norm, said lead author Frank Tanser, an epidemiologist at the University of KwaZulu-Natal.

AIDS researchers who weren’t involved in the studies said they provide strong support for maintaining programs like the President’s Emergency Plan for AIDS Relief, begun by President George W. Bush in 2003.

“These papers present truly remarkable data,” said Dr. Douglas Richman, director of the Center for AIDS Research at UC San Diego.

Original article via Gawker

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HIV positive patients fail to disclose their infection to NHS staff

trustinthenhs

A significant proportion of HIV positive patients may not be disclosing their infection to NHS staff, when turning up for treatment at sexual health clinics.

This is the finding suggested by preliminary research published online in the journal Sexually Transmitted Infections.

If the findings reflect a national trend, this could have implications for the true prevalence of undiagnosed HIV infection in the population, which is based on the numbers of “undiagnosed” patients at sexual health clinics, say the authors.

Currently, it is estimated that around one in four people in the UK who is HIV positive doesn’t know they’re infected with the virus.

The estimate is based on several sources of data, including the GUMAnon Survey, which routinely looks for HIV infection in blood samples taken from patients to test for syphilis at one of 16 participating sexual health clinics across the UK.

The results are then matched with the individual’s diagnostic status—whether they had been diagnosed before their arrival at the clinic, or were diagnosed at their clinic visit, or left the clinic “unaware” of their HIV status.

It is thought that a proportion of patients who do know their HIV status nevertheless choose not to reveal it to NHS staff when attending for services elsewhere.

To test this theory, the researchers analysed all HIV positive samples from one participating GUMAnon clinic in London in 2009 for the presence of very low viral loads— a hallmark of successful drug treatment—and various antiretroviral drugs.

Of the 130 samples which matched clinic records, 28 were from patients who were not known to be HIV positive before their arrival at clinic. Ten had been tested for HIV at their clinic visit.

The remaining 18 did not have a test at the clinic, and were therefore classified as undiagnosed. Yet almost three out of four (72%) of these samples had very low viral loads, indicative of successful drug treatment.

Only eight samples were of sufficient volume to be able to officially test for antiretroviral drugs, but evidence of HIV treatment was found in all of them.

“This is the first published objective evidence that non-disclosure of HIV status as a phenomenon exists in patients attending [sexual health] clinics in the UK,” write the authors.

“Given the high proportion of individuals classified within this study as [non-disclosing], the extent to which these findings can be extrapolated to other clinics, and the degree to which they may influence estimates of the proportion of undiagnosed HIV in the community, warrants further study,” they conclude.

The reasons why they don’t come clean(sic) about their HIV status may be that they don’t want to be “judged,” given that they have come to the clinic with another infection, which implies they are indulging in risky sexual behaviour, suggests lead author Dr Ann Sullivan of London’s Chelsea and Westminster Hospital NHS Foundation Trust.

But by not revealing their HIV status, they could be missing out on the chance to be treated more holistically and discuss other aspects of their health which might be affected by HIV, she says.

Original Article via Onmedica, taking medical information further.

DISCUSSION:

The comment by Ann (above) implies NHS staff are predisposed with attitudes toward sex.  Especially when using phrases like “when they don’t come clean” – However, NHS staff; particularly those within genitourinary medicine should not assume those who wish to have a HIV test participate in “risky sexual behaviour” as for a lot of people, HIV infection can simply occur when the HIV status of a sexual partner is positive, but not known and undiagnosed, then innocently passed to another (which is why is it recommended that condoms are used if the HIV status of the other person is unknown.

Do you have an opinion on this? – Let us know in the comments below.

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HIV research offers hope

Issue 89 - Scaling up treatment guidelines in resource limited settings

Immediate treatment of HIV can slow the progression of the virus, a study undertaken by researchers from the University of Oxford, Imperial College London and the Medical Research Council’s Clinical Trials Unit has shown.

Antiretroviral medication taken during the early stages of infection, over a 48-week period, delays damage to the immune system and can defer the need for long-term treatment.

An estimated 34 million people suffer from HIV worldwide. The virus weakens the immune system, leaving the body vulnerable to infection. In its early stages it often goes unnoticed; left unchecked, it can result in individuals being in danger of life-threatening illnesses.

The study, which took place over five years, took the form of a randomised controlled trial of antiretroviral treatment on 366 adults from Australia, Brazil, Ireland, Italy, South Africa, Spain, Uganda and the UK. It comprised mostly of heterosexual women and gay men and was funded by the Wellcome Trust.

At present, it is unusual for antiretroviral medication to be given to HIV patients in the early stages of infection. The trial randomly allocated the volunteers, who had been diagnosed with HIV no more than six months earlier, medication for 48 weeks, 12 weeks or not at all.

On average, the study found that those receiving no medication required a lifelong course of treatment 157 weeks after infection. Those receiving 12 weeks of antiretroviral medication took an average of 184 weeks before receiving lifelong treatment. Participants on the 48 week course began long-term treatment on average 222 weeks after infection.

Moreover, those receiving medication for 48 weeks had higher CD4 T-cell counts, which can reduce susceptibility to secondary infections such as tuberculosis. Adults on this course recorded lower levels of HIV in the blood, which could help reduce the risk of infection for sexual partners.

Dr Sarah Fidler, leader of the study from Imperial College London said: “These results are very promising and suggest that a year-long course of treatment for people recently infected with HIV may have some benefit on both the immune system as well as helping control the virus.”

Concerns over how cost-effective such treatment would be have been raised by some who do not deem the findings to be tremendously significant. Professor Gita Ramjee, who led the study in South Africa, commented: “We now need to weigh up whether the benefits offered by early intervention are outweighed by the strategic and financial challenges such a change in policy would incur, particularly in resource-poor settings such as Africa, although this may be where the most benefits are seen in terms of TB rates.”

Students at Oxford University have expressed interest in this new study. Fergus Chadwick, a Biologist, said: “It is really fascinating to see how theory that has been outlined in our lectures is being applied in the real world with such promising results.”

Original Article by Elizabeth Pugh at Oxfordstudent.com

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Farewell Spencer

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Spencer Cox, one of the world’s most prominent AIDS activists and a highly respected “citizen scientist” has passed away.

Spencer Cox, the pivotal AIDS activist who co-founded ACT-UP and TAG (Treatment Action Group) and was featured in David France’s recent documentary How to Survive a Plague, has died at Columbia Presbyterian of AIDS related causes, France writes in a note:

 As a very young man fresh from Bennington, where he studied Theater and English Literature, he arrived in NYC after finishing just 3 years. He was diagnosed with HIV soon thereafter. By 1989, at age 20, he had become spokesman for ACT UP during its zenith through the early 90s. A member of its renowned Treatment & Data committee, and later co-founder of TAG (the Treatment Action Group), he schooled himself in the basic science of AIDS and became something of an expert, a “citizen scientist” whose ideas were sought by working scientists. In the end, Spencer wrote the drug trial protocol which TAG proposed for testing the promising protease inhibitor drugs in 1995. Adopted by industry, it helped develop rapid and reliable answers about the power of those drugs, and led to their quick approval by the FDA.

Even before ACT UP, he began work for amfAR (Foundation for AIDS Research), first as a college intern, eventually going on staff as assistant to Director of Public Affairs, responsible for communications and policy).  He left there to co-found the Community Research Initiative on AIDS (now the AIDS Community Research Initiative of America, ACRIA) with Dr. Joseph Sonnabend and Marisa Cardinale (Marisa Cardinale <marisacard@aol.com>). At ACRIA, he ran public affairs and edited all publications.

From 1994 to 1999, he was Director of the HIV Project for TAG, where he did his ground breaking work in drug trials designs. He designed the drug trial adopted in part by Abbott as they were developing Norvir, the first Protease Inhibitor to head into human trials. It had an “open standard-of-care arm,” allowing people on the control arm to take any other anti-AIDS drugs their doctors prescribed, versus the arm taking any other anti-AIDS drugs plus Norvir. It was this study that showed a 50% drop in mortality in 6 months. Norvir was approved in late 1995. Though the results were positive, the proposal sharply divided the community, many of whom thought it was cruel to withhold Norvir on the control arm. Spencer defended himself in a controversial BARON’S coverstory that made him, briefly, the most-hated AIDS activist in America. Ultimately he was vindicated.

Writing for Poz in 2006, Cox wrote:

“Some of my friends lived for almost 20 years through a flood of death, illness, fear and sadness. And when effective treatment came along and the dying slowed—at least in much of the developed world—everyone assumed that things had gotten better, that we didn’t need to think about it anymore.  But I don’t think that’s true. I think those of us who were in the middle of it were deeply affected by what we experienced and that it affects the choices we make today. I wonder if that’s not partly why the depression rate among gay men is about three times higher than among straight men.

“Because of my memories of those times, I try to appreciate life and the people special to me. But I can also see that I have to fight off an ongoing fear that things could go suddenly, terribly wrong, that the worst-case scenario is also the most likely.”

“What I learned from that is that miracles are possible. Miracles happen, and I wouldn’t trade that for anything. I wouldn’t trade that information for anything. I don’t know what’s going to happen. I don’t know what’d going to happen day to day. I don’t know what’s going to happen next year. I just now, you keep going. You keep evolving and you keep progressing, you keep hoping until you die. Which is going to happen someday. You live your life as meaningful as you can make it. You live it and don’t be afraid of who is going to like you or are you being appropriate. You worry about being kind. You worry about being generous. And if it’s not about that what the hell’s it about?”

Farewell Spencer, and thank you for all your hard and contribution

Spencer

Spencer Cox
1968 – 2012

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Information about the effort and influence surrounding HIV/AIDS prominent activists is available here.

Don’t Stop Taking Meds If And When You Drink!

About half of HIV patients on antiretroviral therapy skipped their medications whenever they were drinking alcohol, according to a U.S. study – an ill-advised behavior that researchers say could lead to higher viral loads.

The study, published in the Journal of General Internal Medicine, for a year followed nearly 200 people with HIV who were on antiretrovirals and drank alcohol. It found that 51 percent stopped taking their medications while drinking.

Lapses could be due to forgetfulness while under the influence, but a widespread – and erroneous – belief that mixing alcohol and HIV drugs can be toxic appears to play a role.

“The harms caused by missing their medications far outweigh the harms caused by mixing the two, if the person doesn’t have liver disease,” said Seth Kalichman, a professor at the University of Connecticut and lead author of the study.

Drinking has been known to interfere with people’s adherence to their medications, but researchers said the consequences of inconsistent use of HIV medications can be more severe.

Antiretroviral drugs suppress the HIV virus, and patients must take the medications continuously to prevent the virus from surging. Additionally, going on and off the drugs can lead to drug resistance.

“People living with HIV who deliberately stop their medications when they are drinking are at risk for treatment failure,” the researchers wrote.

Kalichman and his colleagues surveyed 178 people – about four out of five of them men – who were currently using antiretroviral therapy and reported that they drank alcohol.

At the beginning of the study, the researchers asked the participants about their alcohol-related beliefs, such as whether they thought their drugs wouldn’t work as well if the two mixed. They also asked whether people would not take both at the same time, either by avoiding alcohol or the medicines.

Over the following year, the team checked in with patients every month to see how well they were sticking to their prescriptions through a pill count, and every other month they called to ask how often the patient had been drinking recently.

Doctors’ offices measured each patient’s level of virus and measures of immune system health.

They found that 51 percent of the patients would avoid the medications when they drank, and half of the people in this group had poor adherence to their prescriptions. In addition, half of the group that skipped pills said they wouldn’t take them again until the alcohol was out of their system.

People who skipped medications while drinking were also more likely to have higher levels of HIV in their bodies and lower numbers of CD4 cells, a measure of immune system health.

“I think it’s pretty well demonstrated that alcohol use is tied to poor adherence, and I think most people think it’s because they’re impaired in some way or they forget… whereas here it shows they’re (often) intentionally missing their medications,” said Catherine Grodensky, a researcher at the Center for AIDS Research at the University of North Carolina.

“And it looks like it’s having some significant impacts on their treatment.”

Original Article via Reuters

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Faith leaders across England in ‘HIV healing’ claims

Synagogue Church Of All Nations website shows videos of people it claims have been “cured”

Dangerous cases of faith leaders who tell people with HIV to stop taking their life-saving drugs have been identified by African-led community groups in a number of locations across England.

Seven groups said there were instances of people being told by faith leaders they had been “healed” through prayer – and then pressured to stop taking antiretroviral medication, according to the charity African Health Policy Network (AHPN).

Cases were reported to have taken place in Finsbury Park, Tottenham, and Woolwich, in London, as well as in Manchester, Leeds and at a number of churches across the North West.

Last year, BBC London identified three people with HIV who died after they stopped taking antiretroviral drugs on the advice of their Evangelical Christian pastors.

AHPN, which tackles health inequalities for Africans living in the UK, called on the government to do more to prevent faith leaders encouraging people with HIV to stop taking their drugs.

“The government, the department of health, and local authorities are not doing enough to respond to this,” said Jacqueline Stevenson, AHPN’s head of policy.

Multiple cases
A Department of Health spokesman said: “Prayer is not a substitute for HIV treatment and we would be very concerned if people are not taking their medication on the advice of faith leaders.”

AHPN said the cases reported to it by community groups showed:

Most respondents were aware of more than one case of faith healing claims and pressure to stop taking medication. One member was aware of five cases
Many followers believed the testimony of pastors who claimed they could heal them
The majority of cases reported involved Evangelical or Pentecostal Christian pastors
In some cases treatment has been restarted, in others the health and mental health of clients has declined.
Although community groups said they were aware of multiple cases, the members who reported being exposed to faith healers were unwilling to name the churches involved.

AHPN’s Ms Stevenson said: “People were reluctant to name the churches and pastors.”

Cancer ‘cure’

Synagogue Church Of All Nations says: “Never a disease God cannot cure.”

Last year AHPN said it believed the Synagogue Church Of All Nations (SCOAN), which has UK headquarters in Southwark, south London, may be one of those involved in such practices.

The church is headed by Pastor T B Joshua, who the Forbes richlist named as Nigeria’s third richest clergyman.

SCOAN’s website, which was set up in Lagos, Nigeria, now shows videos of people the church claims have been “cured” of HIV through prayer.

One video shows a woman Agnes Agnote visiting the church in Nigeria saying: “I am HIV positive. I went to the hospital and they confirmed it was HIV/Aids.”

The video then shows Pastor Joshua blessing her, saying “everyone is healed”.

It goes on to show Ms Agnote apparently showing a more recent medical report, with a narrator saying, “it clearly states that Agnes tested negative to HIV Aids”.

Videos on the website also depict people being cured of “cancers” and “disabilities”.

‘Anointing sticker’ tour
The church’s British website now gives accounts of people reporting to be healed from conditions including arthritis and a lung blood clot after being a sprayed with “anointing water” by SCOAN in the UK.

It promotes a monthly “anointing water prayer line” in London “for any health issues” and advertises an “anointing sticker” tour of the UK and Ireland, which begins on Monday.

Last year, when asked by the BBC if it claimed its pastors could cure HIV, SCOAN responded: “We are not the healer. God is the healer. Never a sickness God cannot heal. Never a disease God cannot cure.”

But it added: “We don’t ask people to stop taking medication. Doctors treat – God heals.”

Ms Stevenson warned: “Often faith groups and churches spring up and nobody really knows they are there or what they are doing.”

“There needs to be investment in taking some action at national and local levels to address this issue.”

She added that AHPN wanted to see faith groups and churches “having the same responsibility in terms of safeguarding and respecting individuals as any other organisation would be expected to have”.

But AHPN warned that criminal sanctions would not be an appropriate solution and would risk “pushing the problem underground”.

“We call for local authorities to work with faith groups and ensure these negative messages are not put out.”

The Department of Communities and Local Government refused to respond to these comments.

But the Department of Health said faith organisations “can make a positive contribution to raising awareness of HIV” by “highlighting the benefits of testing and effective antiretroviral treatment”.

Original article By Andy Dangerfield
BBC News, London

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Together We Will End AIDS

Entitled Together we will end AIDS, the new UNAIDS report contains the latest data on numbers of new HIV infections, numbers of people receiving antiretroviral treatment, AIDS-related deaths and HIV among children. It highlights new scientific opportunities and social progress which are bringing the world closer to UNAIDS vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths.

The report also gives an overview of international and domestic HIV investments and the need for greater value for money and sustainability.

Calling for global solidarity and shared responsibility, the UNAIDS report contains commentaries from global and community leaders as well as people living with and affected by HIV.

Download here

Link to UNAIDS Campaign 

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