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Young, British, and Living With HIV

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“I remember not getting out of bed other than to use the loo. My friend had to stay with me just to make sure I was eating,” says ​Niyi Maximus Crown, a 25-year-old man who was diagnosed HIV positive in December 2011. “I didn’t even recognize my own thinking voice. I felt like I was going to be single for the rest of my life. The feelings of worthlessness made me angry and I started to hate myself.”

Last week, ​Public Health England (PHE) released its ​latest report on HIV. “In the UK there are 107,800 people living with HIV,” says Eleanor Briggs, Assistant Director of Policy and Campaigns at National AIDS Trust. In London, almost one in eight gay and bisexual men are HIV positive. Based on the stats from PHE, Briggs adds, “We can say about a third of people living with HIV infection, both diagnosed and undiagnosed, were resident in London.”

What’s more frightening is that PHE estimates that 24 percent of the people in the UK with HIV are currently undiagnosed.

Brandon Wardell Is a 22-Year-Old Comic Who’s Already Done an Album with Bob Odenkirk

Early diagnosis of HIV is crucial. Briggs states that a late diagnosis can mean treatment becomes less effective, reducing a person’s lifespan. Medication also helps stop the spread of HIV by lowering the amount of HIV virus in a positive person to undetectable levels so they are ​unlikely to pass it on.

And yet few people are talking honestly about HIV. In terms of everyday knowledge on the gay scene, HIV exists somewhere in limbo between the grim ​tombstone adverts of the 80s, statistics that get bounced around annually from numerous health organizations and the raw realities of chemsex-fuelled bareback sessions. The subject usually makes an appearance in the media once a year when ​World AIDS Day rolls around. A leading HIV consultant ​told the BBC that there’s a “complete lack of awareness” of the risks among many gay men in the UK.

As gay venues up and down the country prepare to mark World Aids Day (on December 1) with fundraising events for various LGBT charities, though, how many people do you know are comfortable with talking openly about being HIV positive? Do you even know anyone that’s openly HIV positive?

The truth is that, as a community, we still drive people who live with HIV into the closet. It’s not surprising that most gay men feel they want to keep their status private. Many struggled during their lives to come out as gay to their friends, families or work colleagues, and they may not even be out in all aspects of their lives. Having to then deal with the stigma that still exists around being HIV positive is akin to having to deal with a second coming out and, once again, another round of judgement and shame.

A few HIV negative people share their thoughts. “If you get HIV from unprotected sex you deserve it,” said one. Many might privately agree with him. But does that mean they deserve to feel forever alienated by society?

Niyi is better known in London’s gay clubs as Maximus Crown. He is one of the only DJs that is publicly out about being HIV positive, which is a big deal. The UK gay scene has very few openly HIV positive DJs, drag queens or promoters. But Niyi didn’t really have the choice of whether he should put his status out there—his best friend at the time decided to go public with it on Facebook for him.

“My best friend stayed with me every day to make sure that I wasn’t alone, didn’t starve or try and kill myself,” Niyi recalls. “Six months later I decided to distance myself from him because I started to notice things about our friendship that I wasn’t OK with. To get back at me he went onto the Facebook event page for a party I was booked to DJ at and posted a series of comments about me being HIV positive.”

The comments included accusations that Niyi had been having unprotected sex while aware he was HIV positive. “When it happened I wasn’t angry, I just wanted to log out of the universe. If I could have closed my eyes and stopped existing I would have, but it forced me to own my status, which in turn made me more comfortable discussing it publicly.”

If you are old enough to remember ​the campaigns of the 80s, then safer sex and the issues around HIV would have been drummed into your consciousness. But with the advent of combination therapy and the dramatic development of antiretroviral drugs that revolutionized care over the last fifteen years, AIDS-related deaths dropped substantially. Between 2001 and 2011, the rate of new infections ​dropped by 20 percent.

As the number of deaths fell, though, so too did government resources that educated people about HIV. Schools barely touched on the subject. To most people, it was seen as a disease that only affected poorer countries. It’s no wonder that the number of infections in young people has risen comparatively steeply compared to other age groups. As the ​United Nations Population Fund say, young people remain at the centre of the HIV epidemic in terms of rates of infection, vulnerability, impact, and potential for change. The young have grown up in a world changed by AIDS, but so many still lack the correct knowledge about how to prevent HIV infection. ​

For many recently infected guys, getting their head around living with HIV is one of the biggest challenges.

James Hanson-McCormick, 24, who was 18 when he was diagnosed with HIV said “I had no idea what HIV was or how it was contracted. I have had six years to think about my status, and not a single day goes by without me thinking about it. It’s so hard. I wish I knew more [then], I wish I had been better educated and that I knew enough to try and prevent it happening.”

It might sound naïve, but James isn’t alone in his experience. ​Luke Alexander is from Oldbury, a small town outside Birmingham, and was diagnosed HIV positive in June 2013. He was 18. “If I was in a sexual relationship with a guy when I was 15 or 16 it was monogamous,” he tells me. “When I hit 18 I treated myself to a fancy phone and discovered these apps and clubs. You’re new to everything and people say ‘download this’ and you find people want to hook up with you. It’s validation. You become quite promiscuous.”

Luke’s candidness took me aback. “I became incredibly egotistical and quite narcissistic,” he admits. “Add drugs and alcohol into the equation and it becomes quite a habit. One thing led to another and I didn’t take any precautions.”

Will Harris, Head of Media for ​Terrence Higgins Trust, says that while research shows that most gay men use condoms most of the time, it only takes one instance of unprotected sex for HIV to be passed on. “Condom use has to be consistent… It’s basic human nature to under-estimate risk, so our community needs to keep finding ways to reinforce the message that ‘He looks fine, it’ll probably be OK’ won’t give you the protection that a condom will.”

Earlier this year, Luke ​made headlines when he went on ITV’s This Morning to discuss his HIV status. “I never heard anything about HIV in school,” he said. “You can become a bit reckless when you come of age, but it’s far worse if you have no basis of knowledge to refer to.”

Like James, Luke’s ​sex and relationship education in school was virtually non-existent. “It lasted a few hours. If people weren’t there, they didn’t receive it. While they stressed the importance of contraception, it was for pregnancy. When I asked about anal sex, they said, ‘We don’t recommend it.’ I felt embarrassed. I just wanted to hear their perspective.”

Harris agrees that the education system has failed in this regard, saying that:

“Young gay men are generally frozen out by the current approach to sex education in schools.”

“The past is the past, though, and you can’t change that,” James reasons. “The great thing now is I’m healthy and happy. I’ve been on meds for five years now and doing so well. My health, in general, is alright.”

But living with HIV isn’t just about monitoring your physical wellbeing. The emotional strain of the constant check-ups and coming to terms with the virus can also present its own psychological strain.”Physically I’m fine,” James says. “I do suffer with depression, but that’s down to several things—not just my HIV. Sometimes it’s difficult juggling lots of meds every day. Often my depression gets bad and tells me I’m worthless and to not take it. But I have faith in medicine that one day there will be a cure.” His biggest wish is more altruistic still: “More knowledge and understanding around HIV and AIDS.”

For many recently infected guys, getting their head around living with HIV is one of the biggest challenges. Stigma is a major issue.

“Robert,” 29, (not his real name), has been HIV positive since 2007. A casual partner sexually assaulted him when he was passed out after a heavy drugs session. Only his closest friends and immediate family are aware of his status. He puts this down to the assumptions that people make about those who are positive. “It’s not the fact that it’s an unattractive quality [to be HIV positive], it’s that people think you had a choice. You hear a lot about bareback parties and people who think that those who have a lot of condom-less casual sex ‘deserve’ to get HIV. I don’t judge anybody but I don’t want to be put in that category. I’m not ashamed of being HIV positive, but it does affect how people perceive you if they don’t know you.”

Robert has told around ten partners about his status when they’ve asked about barebacking. “I don’t have unprotected sex unless we are both aware of our status,” he says. Even so, he says it’s still common for HIV positive guys to be afraid to disclose their status to others in the same position: “I’ve even met positive guys who I’ve been honest with, but they have lied about being positive because they don’t want to say they are.”

It’s upsetting to think that we are forcing so many thousands of gay men into a situation where they feel alienated by their own community. It takes a strong person to rise up against a tide of possible condemnation and be among the first to speak up.

Luke lost friends after going public about his diagnosis. People stopped answering his calls. He believes it was because they were afraid to be associated with somebody that was openly HIV positive. Similarly, when he confided in a friend about his status, she was more concerned that she’d shared his wine glass than how Luke was feeling. (Incidentally, if you labor under similar misconceptions, HIV cannot and ​will not be spread by sharing glasses.)

Sadly, despite it now being considered to be a very manageable long-term health condition, HIV is still widely misunderstood. “You can sit on a park bench and talk for two hours with someone about your diabetes,” Luke says. “But you can’t do that with HIV because you’ll often get a look of fear and shock.”

Niyi eventually reached a point when he had enough of feeling ashamed. “I woke up one day and was like, life isn’t always going to be easy. Self-pity isn’t fierce and it isn’t fun. Doing things and being around people that encouraged me to feel good about myself was such a big help.”

There is one hurdle that remains for him, though, and that’s relationships. He’s been single for seven years. “The thought of being rejected by a guy because of it terrifies me. I feel that it will always hold me back until I am able to get past that final fear.”

James has been luckier in love. He met his boyfriend 18 months ago and they married last August.

Niyi, Luke and James are heroes!  They have decided that it’s time to challenge the stigma that looms around HIV for no other reason than people are not talking about an issue that affects us all. The education system is broken, so they’ve taken it upon themselves to speak out about it. They have taken a situation that could have stripped them completely, that could, if they let it, absolutely define them, but instead have turned it into something powerful.

As his fears subsided, Luke was inspired by another HIV activist and started blogging about his experience. “It got a lot of attention. I wanted to help people understand and it was a feeling of empowerment. The good reactions that followed confirmed it was the right thing to do,” he says. He now also writes monthly about the subject for Gay Times.

Niyi agrees. “There are so many people suffering unnecessarily because they feel that being HIV nullifies everything good about who they are, but it really doesn’t. Everybody deserves to wake up feeling like they are of value and if all I have to do is talk about my situation in order for people to see that, then that’s what I will do. People need to know that someone’s HIV status is not an indication of what kind of person they are.”

Story via Vice

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HIV in the UK: 76% diagnosed, 90% on treatment, 90% undetectable

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UK achieves two out of three UNAIDS targets, but undiagnosed infection remains a major problem

The UK’s annual epidemiological report, released yesterday, shows that the country already provides HIV treatment to 90% of people attending clinical services and that 90% of those on treatment have an undetectable viral load. But the country has a long way to go in ensuring that people with HIV are aware of their HIV status – only 76% of people living with HIV have been diagnosed. The problem is particularly acute in black African communities, as only 62% of African heterosexual men and 69% of African heterosexual women living with HIV have been diagnosed.

The figures can be compared to the ambitious targets announced by UNAIDS (the Joint United Nations Programme on HIV and AIDS) earlier in the year: for 90% of all people living with HIV to know their status, 90% of those to be on treatment and 90% of those to have an undetectable viral load. If these figures could be achieved by 2020, the global AIDS epidemic would be over by 2030, UNAIDS said.

The UK appears to have achieved two out of three of the targets, but has a significant problem due to the high rates of undiagnosed infection. Overall, 61% of all people living with HIV in the UK have an undetectable viral load. This contrasts with the 73% that would be achieved if all three of UNAIDS’ 90/90/90 targets were accomplished.

New diagnoses, overall prevalence

Public Health England reports that 6000 people were newly diagnosed with HIV in the United Kingdom in 2013. The overall figure is lower than that seen a decade ago, due to fewer diagnoses among heterosexual men and women born in high-prevalence African countries. Among gay men, the number of diagnoses is as high as ever, with 3250 cases reported in 2013. An estimated 30% of the gay men diagnosed in 2013 were recently infected with HIV (within six months of their diagnosis).

There are now almost 110,000 people living with HIV in the country, including 26,000 who don’t know they have it. This can be broken down into risk groups:

  • Gay, bisexual and other men who have sex with men (43,500 people; prevalence of 5.9%).
  • Black African heterosexual women (25,100 people; prevalence of 7.1%).
  • Black African heterosexual men (13,600 people; prevalence of 4.1%).
  • Heterosexual women of other ethnicities (10,300 people; prevalence of 0.06%).
  • Heterosexual men of other ethnicities (10,200 people; prevalence of 0.06%).
  • People who inject drugs (2400 people; prevalence of 0.7%).

High rates of undiagnosed infection, especially in black African communities

Overall, 24% of people living with HIV are unaware that they have it. The rates of undiagnosed infection are lowest among gay men (16%) and people who inject drugs (10%).

In relation to black African people, it’s worth noting that in previous epidemiological reports the description of a person as ‘black African’ primarily depended on whether they were born in an African country. In contrast, the new report focuses on a person’s ethnicity, so that someone born in the UK to Nigerian parents is considered in the ‘African’ category. As a result of this and other methodological changes, some of the figures for undiagnosed infection are not directly comparable to previous years’ – and paint a more worrying picture.

In 2013, 31% of black African heterosexual women and 38% of black African heterosexual men who had HIV were unaware of their infection. Rates of undiagnosed infection were somewhat lower among heterosexual people of other ethnicities: 27% in men and 23% in women.

The report also shows that rates of undiagnosed infection are far worse outside London, compared to the capital. Outside London, 41% and 49% of African men and women were undiagnosed. In London, 10% and 13% were undiagnosed. There is some fuzziness to these estimates: the true values could be up to 10% higher or lower than the figures given here. But a clear geographic difference would still be observed. This could reflect stronger community networks and more accessible health services, including targeted prevention, in the capital.

Another way to consider undiagnosed infection is to look at rates of late diagnosis – people diagnosed with a CD4 cell count below 350 cells/mm3. Rates of late diagnosis were highest among heterosexual men (62%) and heterosexual women (51%), with black Africans especially likely to be diagnosed late. The lowest rate of late diagnosis was seen in gay men (31%). Across all groups, older people and non-Londoners were more likely to be diagnosed late.

But progress has been made over the past decade – the overall rate of late diagnosis has gone down from 57 to 42%.

A higher uptake of HIV testing, including more frequent testing, is needed to improve the figures on undiagnosed infection and late diagnosis. The report shows that, at sexual health clinics, 86% of gay male patients take an HIV test, but only 77% of heterosexual men and 67% of heterosexual women do so. Whereas guidelines recommend that all people attending sexual health clinics are offered an HIV test, only one-in-seven clinics test at least 80% of their heterosexual patients. Public Health England recommends that clinics review their policies and training protocols.

But while PHE has been able to collect data on HIV testing in sexual health clinics, none are available for testing in GP surgeries, in other medical settings, or in community settings. A significant improvement in the proportion of people living with HIV who are diagnosed is thought unlikely to occur without improved provision of testing in non-specialist settings, as recommended in guidelines. The report notes that less than one in five of the black-African population attended a sexual health clinic in the previous five years.

“Reductions in undiagnosed infection can be achieved through increasing testing coverage in STI clinics, the introduction and consolidation of HIV testing in a variety of different medical services, in addition to further development of community testing, including self-sampling,” PHE comment.

Quality of care for people living with HIV

Considering the next stages of the ‘treatment cascade’ and the National Health Service’s performance in relation to UNAIDS’ targets, the report shows that 90% of people were linked to care within a month of their diagnosis (98% within three months). Moreover, 95% of those who received care in 2012 were retained in care in 2013. Results did not vary according to age, gender, ethnicity, sexuality or geographical area.

Further, 90% of people in care received antiretroviral therapy (up from 69% in 2004). This includes 92% of those with a CD4 cell count below 350 cells/mm3. Of all people taking treatment, 90% had an undetectable viral load, below 200 cells/ml.

Generally there was equality in treatment outcomes, although younger people were less likely to be taking therapy. Moreover, people in both the youngest (15-24 years) and the oldest (over 50) age groups were less likely to have an undetectable viral load.

Guidelines recommend that clinicians discuss treatment as prevention with patients, and give them the option to start treatment early for this reason. Probably as a result, average CD4 cell counts when starting treatment have risen in recent years. In 2013, 25% began treatment with a CD4 cell count between 350 and 500 cells/mm3, and a further 26% did so above 500 cells/mm3.

Article via NAM

For your full copy of the report, click here

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Human Genome Tinkering Could Be Our Best Bet to Beat HIV

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The human immunodeficiency virus (HIV) is a crafty little beast, constantly mutating to mask itself from our body’s defenses, but always entering cells through the same molecular door. The design of that cellular door is governed by our DNA, so why not change the lock by modding our genetic code?

In 2006, a minor medical miracle occurred. HIV-positive leukemia patient Timothy Ray Brown—the second Berlin Patient—received a bone marrow transplant that saved his life in more ways than one. The marrow that he received was from a donor with a unique double mutation to a gene on the 3rd chromosome known as CCR5. This gene codes for the surface protein that the HIV virus uses to gain entry into our white blood cells (specifically, CD4+ T-cells); however the double mutation shuts down these sites and provides a natural immunity to HIV. This mutation is exceptionally rare, only occurring in about one percent of Caucasians and nowhere else. It’s been hypothesized that it’s this same natural immunity that allowed a small portion of Europeans to make it through the Black Plague unscathed.

While that was fantastic news for Brown, who nearly a decade later remains off of his retroviral drug regimen and maintains an undetectable level of the virus in his system, it’s not of much use to the rest of us. With both the mutation prevalence and bone marrow compatibility matches in general being so rare, there was no effective means of using transplants as delivery vectors for this beneficial genetic condition. And it’s worth noting that the very process of becoming HIV-free nearly killed Brown. But that’s where Professor Yuet Kan’s team at UCSF comes in.

Kan figured that if integrating this double mutation wouldn’t work on the macro level—that is, replacing a patient’s bone marrow with that of a naturally HIV-immune person’s—maybe it would at the molecular level, thereby allowing researchers to confer the benefits while cutting out the marrow donation. To that end, he and a team of researchers from the University of San Francisco are employing cutting-edge genetic editing techniques to snip out the beneficial length of DNA coding and integrate it with a patient’s own genome.

The technique they’re using is known as CRISPR (Cas9) genome-editing. CRISPRs, (clustered regularly interspaced short palindromic repeats) are DNA delivery vectors that replace the existing base codes at a specific part of a specific chromosome with new base pair sets. Cas9, on the other hand are the “molecular scissors” that Kan’s team employs to first cut out the offending DNA. It sounds easy, sure—just find the string of DNA you want to replace, then snip it out with Cas9 DNA scissors, and install some new DNA using a CRISPR—however the nuts and bolts of the process are far more technically challenging.

The patient’s own blood cells would be employed as a precursor. Researchers would then have to convert those cells into induced pluripotent stem (iPS) cells by modulating a number of genetic switches, thereby instigating their regression to more basic stem cells. After that, the offending CCR5 gene would need to be knocked out and replaced with the better, double-mutated version before the now fortified blood cells were transfused back into the patient. Not only is there no chance of the body rejecting the new cells (they are the patient’s own after all), the technique also neatly sidesteps the whole embryonic stem cell issue.

While the technique is still in its early stages of development and no human trial dates have yet been set, it holds huge promise. Not just for the 35 million people annually infected by HIV, but also sufferers of sickle cell anemia and cystic fibrosis—two deadly diseases caused by a single protein deformation—could benefit from similar techniques. By figuring out which genes do what on our iPS cells, we could even theoretically grant everyone on Earth immediate immunity to any number of diseases.

Of course, being able to update and augment our genetic code opens up a whole slew of potential concerns, objections, and abuses. Just look at the ire raised over the use of embryonic stem cells in the early 2000s. People were lost their minds because they thought scientific progress was being built on the backs of fetuses. Researchers had to go and invent an entirely new way of making stem cells (the iPS lines) just to get around that one moralized sticking point, so you can bet there will be plenty of chimera, master race, and Island of Dr. Moreaureferences bandied about should we ever begin seriously discussing the prospect of upgrading our genes. And could certainly slow progress in this specific research.

That’s not to say that the hysteria that accompanies seemingly every news cycle these days is completely off base. Like cars, styrofoam, pressure cookers, and thermonuclear bombs, this technology can be used for evil just as easily as it can be for good. And while we’re not nearly as genetically complex as, say, an ear of corn, wrangling the myriad of interactions between our various genes is still an incredibly complex task and one with severe consequences should something go awry—even if we can avoid creating unwanted mutations through stringent testing and development methodology as we do with today’s pharmaceutical development. So why not turn ourselves into the ultimate GMOs? It certainly beats everyone becoming cyborgs.

Article via Gizmodo

Want more? – Read this..

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Another Major HIV Breakthrough

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Yesterday, the world was taken by storm when it was announced that a baby, born with HIV had been cured.  On the same day, it was announced a team from The Alfred hospital have uncovered HIV’s genetic hiding place and found a drug able to wake it up so that it can be destroyed.

The Alfred’s director of infectious diseases, Prof Sharon Lewin, said waking up HIV with doses of a highly toxic cancer drug was a huge step in curing a disease that has already claimed an estimated 30 million lives.

“What we thought would happen happened: the virus woke up, and we could measure it,” Prof Lewin said. “That is a big step.

“There are more possibilities of getting rid of it by making it visible to drugs and visible to the immune system (and) that we now know we can do.  Now the big challenge is working out, once it is visible, what are the ways to get rid of that infected cell.”

Traditional antiviral medications have been able to stop the virus infecting cells, giving patients a greater life expectancy.

But the virus remained “sleeping” in their DNA, unable to be found or treated, so patients had to take expensive medication daily to suppress its effects.

“It jumps in, buries itself into the DNA and sits there lurking. At any time, if the cell becomes active, the virus then becomes active,” Prof Lewin said.

“It is like having the embers of a fire sitting there . . . the minute you take away the anti-HIV drugs, the embers relight the fire and the whole thing gets going again.”

But by using cancer drug, Vorinostat, for two weeks, Prof Lewin had been able to turn on sleeping HIV-infected cells so they could be detected.

Researchers at The Alfred were able to bring the virus to notice in 18 of 20 HIV patients in a trial that concluded in January.

Prof Lewin hopes a new generation of drugs able to kick-start the immune system may now be able to kill the virus.

Prof Lewin and her team — which included collaboration with Monash University, the Burnet Institute, the Peter MacCallum Cancer Centre and the National Association of People Living with HIV/AIDS — will soon publish their full results.

For David Menadue, who has lived with HIV for almost 30 years, the results bring a new hope.

“Just having the existence of HIV in your body does do damage to your body every day. It puts pressure on your organs, your heart, your kidney, your liver.

“People with HIV would just love to get rid of this and go back to a normalised life. We are never really going to be able to get on top of the virus in developing countries without some sort of magical cure.”

Original Article via Herald Sun

Channel 4 news interviewed Professor Lewin yesterday, click here to see. (Sorry, we can’t embed this video)

Professor Lewin’s news isn’t new, she spoke about this at the 2012 CROI (Conference on Retroviruses and Opportunistic Infections)  – He she speaks with Matt Sharp about HIV Latency and Eradication using Vorinostat.

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MEDICAL HISTORY – Child Born with HIV Cured!

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It’s all over the internet.. click here to see for yourselves…

Doctors in the US have made medical history by effectively curing a child born with HIV, the first time such a case has been documented.

The infant, who is now two and a half, needs no medication for HIV, has a normal life expectancy and is highly unlikely to be infectious to others, doctors believe.

Though medical staff and scientists are unclear why the treatment was effective, the surprise success has raised hopes that the therapy might ultimately help doctors eradicate the virus among newborns.

Doctors did not release the name or sex of the child to protect the patient’s identity, but said the infant was born, and lived, in Mississippi state. Details of the case were unveiled on Sunday at the Conference on Retroviruses and Opportunistic Infections in Atlanta.

Dr Hannah Gay, who cared for the child at the University of Mississippi medical centre, told the Guardian the case amounted to the first “functional cure” of an HIV-infected child. A patient is functionally cured of HIV when standard tests are negative for the virus, but it is likely that a tiny amount remains in their body.

“Now, after at least one year of taking no medicine, this child’s blood remains free of virus even on the most sensitive tests available,” Gay said.

“We expect that this baby has great chances for a long, healthy life. We are certainly hoping that this approach could lead to the same outcome in many other high-risk babies,” she added.

The number of babies born with HIV in developed countries has fallen dramatically with the advent of better drugs and prevention strategies. Typically, women with HIV are given antiretroviral drugs during pregnancy to minimise the amount of virus in their blood. Their newborns go on courses of drugs too, to reduce their risk of infection further. The strategy can stop around 98% of HIV transmission from mother to child.

In the UK and Ireland, around 1,200 children are living with HIV they picked up in the womb, during birth, or while being breastfed. If an infected mother’s placenta is healthy, the virus tends not to cross into the child earlier in pregnancy, but can in labour and delivery.

The problem is far more serious in developing countries. In sub-Saharan Africa, around 387,500 children aged 14 and under were receiving antiretroviral therapy in 2010. Many were born with the infection. Nearly 2 million more children of the same age in the region are in need of the drugs.

In the latest case, the mother was unaware she had HIV until after a standard test came back positive while she was in labour. “She was too near delivery to give even the dose of medicine that we routinely use in labour. So the baby’s risk of infection was significantly higher than we usually see,” said Gay.

Doctors began treating the baby 30 hours after birth. Unusually, they put the child on a course of three antiretroviral drugs, given as liquids through a syringe. The traditional treatment to try to prevent transmission after birth is a course of a single antiretroviral drug. The doctor opted for the more aggressive treatment because the mother had not received any during her pregnancy.

Several days later, blood drawn from the baby before treatment started showed the child was infected, probably shortly before birth. The doctors continued with the drugs and expected the child to take them for life.

However, within a month of starting therapy, the level of HIV in the baby’s blood had fallen so low that routine lab tests failed to detect it.

The mother and baby continued regular clinic visits to the clinic for the next year, but then began to miss appointments, and eventually stopped attending all together. The child had no medication from the age of 18 months, and did not see doctors again until it was nearly two years old.

“We did not see this child at all for a period of about five months,” Gay told the Guardian. “When they did return to care aged 23 months, I fully expected that the baby would have a high viral load.”

When the mother and child arrived back at the clinic, Gay ordered several HIV tests, and expected the virus to have returned to high levels. But she was stunned by the results. “All of the tests came back negative, very much to my surprise,” she said.

The case was so extraordinary, Dr Gay called a colleague, Katherine Luzuriaga, an immunologist at Massachusetts Medical School, who with another scientist, Deborah Persaud at Johns Hopkins Children’s Centre in Baltimore, had far more sensitive blood tests to hand. They checked the baby’s blood and found traces of HIV, but no viruses that were capable of multiplying.

The team believe the child was cured because the treatment was so potent and given swiftly after birth. The drugs stopped the virus from replicating in short-lived, active immune cells, but another effect was crucial. The drugs also blocked the infection of other, long-lived white blood cells, called CD4, which can harbour HIV for years. These CD4 cells behave like hideouts, and can replace HIV that is lost when active immune cells die.

The treatment would not work in older children or adults because the virus will have already infected their CD4 cells.

“Prompt antiviral therapy in newborns that begins within days of exposure may help infants clear the virus and achieve long-term remission without lifelong treatment by preventing such viral hideouts from forming in the first place,” said Dr Persaud. “Our next step is to find out if this is a highly unusual response to very early antiretroviral therapy or something we can actually replicate in other high-risk newborns.”

Children infected with HIV are given antiretroviral drugs with the intent to treat them for life, and Gay warned that anyone who takes the drugs must remain on them.

“It is far too early for anyone to try stopping effective therapy just to see if the virus comes back,” she said.

Until scientists better understand how they cured the child, Gay emphasised that prevention is the most reliable way to stop babies contracting the virus from infected mothers. “Prevention really is the best cure, and we already have proven strategies that can prevent 98% of newborn infections by identifying and treating HIV-positive women,” she said.

Genevieve Edwards, a spokesperson for the Terrence Higgins Trust HIV/Aids charity, said: “This is an interesting case, but I don’t think it has implications for the antenatal screening programme in the UK, because it already takes steps to ensure that 98% to 99% of babies born to HIV-positive mothers are born without HIV.”

Original Article via The Guardian

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Anti-HIV drug effort in South Africa yields dramatic results

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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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Treating TB, HIV at same time found to save lives

Diane Havlir, MD poses for a portriat on the hallways of the AIDS ward at San Francisco General Hospital on Nov. 25, 2008.

Treating tuberculosis and HIV infections at the same time can be a challenge for patients and their doctors, but attacking both diseases early and aggressively isn’t harmful and could save the lives of those who are sickest, according to a global study led by UCSF researchers.

Tuberculosis is the main cause of death among people with HIV and AIDS worldwide, killing about 400,000 people every year. But how to best treat both conditions has been unclear, because of worries about how the drugs will interact and the burden that dual treatment puts on patients, who must take dozens of pills every day with some gruelling side effects.

The study, published last month in the New England Journal of Medicine, found that patients whose immune systems have been most damaged by HIV benefited by beginning antiretroviral drugs two weeks after starting TB treatment, instead of waiting eight to 12 weeks, as is commonly done now. Those patients were 40 percent less likely to die or develop AIDS.

“Clinicians have been completely unsure of the best time to start HIV therapy in these patients. It was important to know whether we should start HIV therapy early, and now we know it’s worth it,” said Dr. Diane Havlir, chief of the UCSF HIV/AIDS division at San Francisco General Hospital and lead author of the study.

“It’s a tough treatment, but it gives significant medical benefits and it’s lifesaving,” Havlir said.

Tuberculosis is a global epidemic, with more than 9.4 million new cases worldwide every year. HIV-positive people, whose weakened immune systems leave them vulnerable to secondary infections, are especially at risk for contracting the disease.

Almost a quarter of people with HIV infections have tuberculosis, and they are more than 20 times more likely to contract active forms of tuberculosis – meaning they’re symptomatic, and not just harbouring the latent bacteria – than healthy individuals.

TB isn’t nearly as common in the United States as it is in other parts of the world, but it’s enough of a concern that HIV-positive people are tested regularly for tuberculosis, and people diagnosed with TB always get tested for HIV right away.

Tuberculosis is curable, but the regimen used to treat it requires strict adherence to several different medications for at least six months. Patients who don’t stick to the treatment plan run the risk of developing drug-resistant TB, which is far more difficult to cure and can be spread to others. They also remain infectious for a longer period of time.

Treating multiple infections

Meanwhile, antiretroviral drugs, while very effective at suppressing HIV infections and allowing the immune system to rebuild and strengthen, can also be brutal to take. Doctors have worried about the two drug therapies counteracting each other or causing serious side effects in combination.

Plus, if it’s difficult for patients to stick with the drug regimen for one disease, it would be even more challenging for two diseases, public health experts say. So health care providers have been reluctant to tackle both HIV and TB at the same time, usually opting to treat the TB first – because it’s so infectious – and add the antiretroviral drugs several weeks or months later.

The UCSF study, along with two similar studies also published in the New England Journal of Medicine on Wednesday, makes it clear that patients are better off aggressively treating their HIV infection soon after starting TB therapy.

“The default position has been ‘let’s get the active infection under control and worry about HIV later,’ and that’s the wrong answer,” said Dr. Andrew Zolopa, director of the Stanford Positive Care Clinic. He has studied how best to treat HIV and other infections, although not tuberculosis, and found similar results.

The UCSF study followed 809 patients on five continents, mostly in Africa, for 48 weeks. Each of the patients was newly diagnosed with HIV and had not yet started antiretroviral therapy, and had either a confirmed or suspected case of tuberculosis.

Similar side effects

Patients were randomly assigned to start antiretroviral therapy either two weeks after beginning TB treatment or eight to 12 weeks after. Patients aren’t started on both therapies at the same time because the side effects of TB treatment can be severe, although they usually fade after one to two weeks.

Study subjects who started therapy earlier were more likely to develop an inflammatory condition that required additional treatment, but otherwise they had roughly the same number and types of side effects as patients who received the later therapy.

At the end of the study, healthier patients who started HIV treatment earlier were no better off than those who started later. But among the sickest patients, 16 percent of those who were treated earlier had died or developed AIDS within a year, compared with 27 percent of those who got the later treatment.

The sickest patients had T-cell counts – a measure of the strength of the immune system – below 50 at the start of the study; a healthy individual will have a T-cell count of at least 600.

“It might be safe to wait for treatment in some cases,” said Dr. Warner Greene, director of the Gladstone Institute of Virology and Immunology. “But if the (T-cell) count is too low, you’re obligated to treat early now.”

Original Article by Erin Allday via SFGate.com

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