Tag Archives: Kenya

HIV treatment breaks lead to drug resistance in the female genital tract

Antiretroviral treatment interruptions of 48 hours or more are associated with the emergence of resistant strains of HIV in the female genital tract, investigators report in the online edition of the Journal of Acquired Immune Deficiency Syndromes.

The study included 102 women in Kenya who started first-line antiretroviral therapy based on a non-nucleoside reverse transcriptase inhibitor (NNRTI). Drug-resistant virus was detected in the genital tract of five women in the twelve months after treatment was started. Treatment interruptions were the most important risk factor for this outcome.

“We found that ART [antiretroviral therapy] adherence was a key determinant of genital tract resistance and that treatment interruptions of whatever cause lead to a substantial increase in the hazard of detecting genotypic resistance to antiretrovirals in female genital tract secretions,” write the authors. “Efforts to prevent treatment interruptions by improving program effectiveness, promoting adherence and timely refills, and avoiding the use of more toxic antiretroviral agents could therefore play an important role in reducing transmitted drug resistance.”

First-line HIV therapy often comprises two nucleoside reverse transcriptase inhibitors (NRTIs) combined with an NNRTI. This treatment can have a powerful and durable anti-HIV effect. However, it requires high levels of adherence. Drug-resistant strains of HIV can emerge with poorer adherence. Older drugs in the NNRTI class, nevirapine (Viramune) and efavirenz (Sustiva or Stocrin), have a low barrier to resistance.

Little is currently known about the emergence of drug-resistant virus in the genital tract of women treated with NNRTI-based therapy. This is an important gap in knowledge as drug-resistant virus is potentially transmissible.

Investigators therefore designed a prospective study involving women who started first-line HIV treatment in Mombasa between 2005 and 2008. During the first twelve months after starting therapy viral load was monitored at three-monthly intervals in both plasma and the genital tract. Samples with viral load above 1000 copies/ml were sent for resistance testing. The investigators conducted analysis to see which factors were associated with the emergence of drug-resistant virus in the genital tract.

Overall, the women had high levels of adherence to their antiretroviral therapy. Assessed by pill count, median adherence was 97%. However, there were 40 treatment interruptions. Their median duration was four days. Median pill-count adherence following treatment interruptions was just 83%.

Drug-resistant virus was detected in the blood of nine women (incidence, 10 per 100 person-years) and in the genital secretions of five individuals (incidence, 5.5 per 100 person-years). All five women with resistant HIV in their genital secretions also had resistant virus in their blood.

The investigators’ first set of analysis showed that a number of factors were associated with genital tract resistance. These included treatment interruptions (p = 0.006), pill-count adherence (p = 0.001) and a higher baseline viral load (p = 0.04).

But only treatment interruptions remained significant after controlling for potentially confounding factors. Interruptions were associated with a more than 14-fold increase in the risk of genital tract resistance (aHR = 14.2; 95% CI, 1.3-158.4; p = 0.03).

“The reasons for treatment interruption in this study included both unavoidable discontinuations due to drug toxicity or systemic illness and avoidable interruptions due to late refills, when it is likely that consecutive doses were missed,” note the investigators. “Despite a comprehensive program of adherence support including pre-ART counseling, directly administered therapy during the first month of treatment, a support group, pill boxes and transportation reimbursements, we were unable to prevent these events.”

Transport problems and pharmacy stock-outs have emerged as major barriers to adherence in resource-limited settings. The investigators are concerned that “such barriers may lead to the development of genital tract resistance due to treatment interruptions, suggesting an increased risk for transmission of drug-resistant virus”.

The Aids Library of Philadelphia FIGHT has a video on YouTube which explore the subject of HIV which is resistant to anti-HIV medications. Further information can be found on their website.

Original Article via NAM and Philadelphia Fight’s YouTube Channel

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Yoga Session Brings in £650 for The Global Natural Health Care Trust

It can be easy and pleasurable to generate funds to help support HIV work, both in the UK and Africa.  The following story is an example of how Yoga classes, an Auction and a Barbecue can help raise money for good causes.

The Global Natural Healthcare Trust (GNHCT) are a UK based registered charity founded by Cornish local Annette Montague-Thomas.  Annette has over 25 years experience in Africa where she has worked for UNICEF in Nairobi in Kenya, and in the past 9 years has been assisting young children who are afflicted and affected by the HIV/AIDS pandemic in South Africa.  Overseas, they are based on The Orange Farm informal settlement which is about one and a half hours South of Johannesburg.

The settlement is home to over 4 million Africans of varying tribes. The settlement is not only the largest in South Africa, but in the whole of Africa. It is fair to state that not even one quarter of the residents have any work and many are surviving at near starvation level.  They live in abject poverty with homes that are usually no more than shacks with no sewerage system.  Many of the homes don’t even have running water.

A recent event by “Yoga Rocks” at Lusty Glaze Beach raised £650 for he Global Natural Health Care Trust and this money will help support the charity’s work in Africa to help people affected by HIV.

The evening of yoga classes with some of the UK’s top teachers included a charity auction and a barbecue provided by chefs at Lusty Glaze and enjoyed by more than 150 people.

The charity runs a herbal clinic in the country’s worst-affected area, helping to save lives on a daily basis as well as providing homes for more than 10,000 orphans in its foster care system.

Yoga Rocks’ founders are yoga teacher Rhoda McGivern, Debbie Luffman from Finisterre and Gemma Ford from Love Yoga Online.

Mrs McGivern said: “The atmosphere was so lovely, we can’t believe how many people turned up on a rainy Monday evening to help us to raise money for a charity so close to our hearts.”

They have thanked everyone who volunteered to make the event happen, especially the team from Finisterre whose energy and enthusiasm were “simply amazing”.

The Yoga Rocks’ team is organising future events to be held in various venues around Cornwall, with potential venues also in London and America.

To offer help, please contact rhomcgivern@gmail.com or visit their websites:

Original article compiled from the above sources and thisiscornwall

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HIV Could Spread If Birth Control Injections Increase, Warn Scientists

Researchers call for new guidelines for women using family planning services in Aids-hit areas.  Campaigns to increase the number of women opting for long-lasting contraceptive injections in Aids-hit parts of the developing world could be helping to spread the epidemic, scientists are warning.

New research shows that women who use hormonal contraceptives may double their risk of contracting HIV and of passing it to their male partner, throwing up a new dilemma for global development.

The authors of the large-scale study, published in the journal Lancet Infectious Diseases, call for urgent guidance to be drawn up and given to women using family planning services in HIV-endemic areas. The study showed particularly that the risk of HIV transmission was raised by the long-lasting injections that are most widely used and most popular in the sub-Saharan regions worst hit by the Aids epidemic.

The results present a significant problem for global health and development. Unwanted pregnancy is a threat to a woman’s life and can lead to greater poverty and deprivation for her family. The more children she has, the harder it will be to feed and educate them.

While family planning is still resisted in parts of the developing world, campaigns to promote injectable contraception have met with some success. Many women have sought out the injections that last for months and that they can sometimes get without their husband’s knowledge if he refuses permission.

But the study of 3,800 couples shows that there is a risk which has previously been suspected but unconfirmed. The risk was present for those who took the pill too, but it was not statistically significant because most women in the study had opted for injections.

“These findings have important implications for family planning and HIV-1 prevention programmes, especially in settings with high HIV-1 prevalence”, said Jared Baeten from the University of Washington, Seattle, one of the study’s authors.

“Recommendations regarding contraceptive use, particularly emphasising the importance of dual protection with condoms and the use of non-hormonal and low-dose hormonal methods for women with or at risk for HIV-1, are urgently needed,” said lead study author Renee Heffron, also from the University of Washington.

More than 140 million women worldwide use some form of hormonal contraception.

The study group comprised 3,790 couples where one partner had HIV (usually the woman) although the other did not. They were drawn from two existing studies of HIV incidence in seven African countries – Botswana, Kenya, Rwanda, South Africa, Tanzania, Uganda and Zimbabwe.

The researchers found that women who did not have HIV were twice as likely to be infected by their partner if they were using hormonal contraception. Those who had HIV themselves were twice as likely to give it to their partner. Tests showed that women with HIV using injectable contraception had raised concentrations of virus inside the cervix. Researchers are unclear why and a larger study specifically designed to look at this issue should be carried out, they say.

Meanwhile women should be told there may be an increased risk of HIV infection if they use hormonal contraception and should be counselled that condoms will give them dual protection.

In a comment published by the journal, Charles Morrison from Clinical Sciences, Durham, USA, said: “Active promotion of DMPA [injectable contraception] in areas with high HIV incidence could be contributing to the HIV epidemic in sub-Saharan Africa, which would be tragic. Conversely, limiting one of the most highly used effective methods of contraception in sub-Saharan Africa would probably contribute to increased maternal mortality and morbidity and more low birth weight babies and orphans—an equally tragic result. The time to provide a more definitive answer to this critical public health question is now; the donor community should support a randomised trial of hormonal contraception and HIV acquisition.”

Original Article by Sarah Boseley, health editor at The Guardian

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