Tag Archives: medicine

Even without a cure, the end of the AIDS pandemic is in sight

A very bold statement to make in the run up to AIDS 2012, none the less, this is the view of Dr. Anthony Fauci, director of the National Institute of Allergy and Infections Diseases (NIAID )

NIAID director Dr. Anthony Fauci addressing the United Nations General Assembly special session on HIV/AIDS on 10June 2008.

Dr. Fauci was appointed Director of NIAID in 1984. He oversees an extensive research portfolio of basic and applied research to prevent, diagnose, and treat infectious diseases such as HIV/AIDS and other sexually transmitted infections, influenza, tuberculosis, malaria and illness from potential agents of bioterrorism. NIAID also supports research on transplantation and immune-related illnesses, including autoimmune disorders, asthma and allergies.  Dr. Fauci serves as one of the key advisors to the White House and Department of Health and Human Services on global AIDS issues, and on initiatives to bolster medical and public health preparedness against emerging infectious disease threats such as pandemic influenza.

Dr. Fauci has made many contributions to basic and clinical research on the pathogenesis and treatment of immune-mediated and infectious diseases. He has pioneered the field of human immunoregulation by making a number of basic scientific observations that serve as the basis for current understanding of the regulation of the human immune response. In addition, Dr. Fauci is widely recognized for delineating the precise mechanisms whereby immunosuppressive agents modulate the human immune response. He has developed effective therapies for formerly fatal inflammatory and immune-mediated diseases such as polyarteritis nodosa, Wegener’s granulomatosis, and lymphomatoid granulomatosis. A 1985 Stanford University Arthritis Center Survey of the American Rheumatism Association membership ranked the work of Dr. Fauci on the treatment of polyarteritis nodosa and Wegener’s granulomatosis as one of the most important advances in patient management in rheumatology over the previous 20 years.

AN END TO NEW INFECTIONS?

Three decades into the AIDS pandemic an end to new infections is in sight, according to Dr. Fauci.

“We don’t even know if a cure is possible. What we know is it is possible that we can end this pandemic even without a cure,”

Fauci told AFP in an interview ahead of the International AIDS conference 22nd -27th July in Washington DC, America.

Some 34 million people around the world are living with human immunodeficiency virus, which has killed 25 million since it first emerged in the 1980s.

The theme of this conference, which is held every two years, is “Turning the Tide Together,” and is based on experts sharing knowledge of the latest advances and how to best implement them in order to halt new cases of HIV/AIDS.

“We have good and effective treatments but we have to keep people on the treatments indefinitely in order to keep them well,” said Dr. Fauci, referring to antiretroviral drugs which have transformed a deadly disease into a manageable condition.

“When you have a very marked diminution of the number of new infections then you reach what we call and AIDS-free generation.”

Dr. Fauci said he did not expect any staggering breakthroughs to be announced at the conference, but that the gain would come though collaborating on ideas to speed progress by using the tools that practitioners have already at hand.

Otherwise, if progress continues at the present rate of reducing new infections worldwide by about 1.5 percent per year, the goal becomes too distant, he said.

Recent studies that tested antiretroviral drugs in healthy people as a way to prevent getting HIV through sex with infected partners have shown some promise, though getting people to take their medication daily had proven a challenge.

“The important thing is you have to take your medication,” Fauci said, noting that average HIV risk reduction in a study of men who have sex with men was just 44 percent.

The approach of treating healthy people with antiretrovirals is known as pre-exposure prophylaxis, and “is not for everyone,” Fauci said. “We have to selectively use it.”

The US Food and Drug Administration on Monday approved the first pill for HIV prevention, Truvada, despite concerns by some in the health care community that it could encourage drug resistance and risky sex.

Novel ways to boost testing are also good news, particularly with the recent US approval of the first at-home HIV test.

“It is so important in the quest to ending the AIDS pandemic to get as many people tested as possible. You can link them to care and get them on treatment. Anything that makes that goal easier would be an important advance.”

As far as an AIDS vaccine, Fauci said researchers have made “good progress” but “still have a long way to go.”

Experts are examining a trial done in Thailand that showed in 2009 modest efficacy of just over 30 percent, but is still considered a breakthrough and offers clues for future study into why some were helped and others were not.

Dr. Fauci also said he did not expect much concern to be raised over upcoming reports of the extent of drug resistance to antiretrovirals.

“People may think I am taking it lightly but quite frankly it is not a serious problem,” Fauci said.

He added that overall, AIDS research is “going well” even though “funding is restricted right now.”

And he expressed pride in the United States’ President’s Emergency Plan for AIDS Relief (PEPFAR), “which has really transformed how you can get people in low income countries to get on treatment care and prevention.”

The United States provides almost half the world’s funding for international HIV assistance, according to UNAIDS.

The International AIDS Conference is returning to the United States after more than two decades away due to a ban on travel and immigration by people with HIV that was lifted in 2008 and signed into law in 2009.

Fauci called those restrictive laws “unfortunate” and “embarrassing.”

STAY UPDATED
Follow LASS on Twitter
or subscribe via email
Advertisements

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

STAY UPDATED
Follow LASS on Twitter
or subscribe via email

The quest for a HIV vaccine

Credit: UNAIDS

There is broad scientific consensus that getting to zero new HIV infections will require an HIV vaccine. Modelling shows that even a partially effective HIV vaccine can save many lives and dollars over time.

Although a vaccine to prevent HIV could be the tool to quicken the pace to reach the end of AIDS, the quest for an effective vaccine has until now proved elusive. The very nature and variety of the human immunodeficiency virus has meant that it has resisted most attempts to quell its spread and scientists and vaccinologists the world over are focusing efforts on finding solutions.

Exciting recent developments in HIV vaccine research are instilling hope around finding an effective vaccine. In 2009, results from a trial in Thailand—RV144—showed a 31.2% vaccine efficacy in preventing HIV infections. Although only modestly protective, the results instilled new hope that an HIV vaccine could be found and made available for populations around the world most in need of a vaccine.

The results represented a significant scientific advance, and were the first demonstration that a vaccine can prevent HIV infection in a general adult population. It was a discovery of great importance and has been followed by more encouraging data in the last couple of years.

Data presented in the past year has been presented on the protective immune responses that were stimulated by the Thai vaccine trial.  Trials are now planned to see if an RV144-like regimen will protect against a strain of HIV infection found in South Africa and against HIV acquisition by people at higher risk of exposure, specifically men who have sex with men.

UNAIDS and the US Centers for Disease Control worked closely with modelling teams to estimate the impact of the RV144 regimen in different countries and with different populations and found that 10% of infections could be prevented if the same 31% efficacy was found in people who receive the vaccine. This shows that a modestly effective HIV vaccine could add to the prevention toolbox of partially effective methods, hastening the decline of the HIV epidemic.

These and other advances in HIV vaccine development—including the design of new tools and technologies for vaccine delivery—have boosted optimism in the field about the prospects for the development of a safe and effective AIDS vaccine.

However, early data from the HIV Vaccines and Microbicides Resource Tracking Working Group is showing that a downturn in HIV vaccine funding that began in 2008 continued through 2011. The quest for effective HIV vaccines is a long-term investment in both the product (vaccines) and in the people who will develop, produce, market and support them. Investments in research and trials are essential and can bring benefits far beyond the AIDS field.

The need for a vaccine to prevent HIV is clear.  There are in excess of 34 million people living with HIV, and every day more than 7000 people are becoming newly infected with the virus. Although a vaccine may not provide the magic bullet to end the AIDS epidemic, it would provide an additional tool to add to the robust package of HIV prevention options which are now available.

UNAIDS will continue to work with multiple partners––scientific communities, national and international AIDS research agencies, the pharmaceutical industry, private foundations, member states, and affected communities––to push the HIV vaccine agenda forward and ensure that the quest for a safe and effective HIV vaccine continues.

Original Article via UNAids

STAY UPDATED
Follow LASS on Twitter

or subscribe via email
Related articles

Aging & HIV

There’s no denying the life-extending benefits of antiretroviral therapy. While it has allowed many people living with HIV to plan for their golden years, it has also meant preparing to face age-related health problems. According to the CDC, 25 percent of those living with the virus are over 50 years old.  In turn, there’s a growing need for comprehensive  care to prevent and manage typical age-related maladies, such as heart disease, cancer, diabetes and osteoporosis—all of which can be complicated by HIV and its treatment.
You can find comprehensive information about treatment options from your GP and the people over at http://www.aidsmeds.com have written an excellent report into HIV & Ageing covering:
  • What is aging, and why do we become ill as we get older?
  • How does HIV affect the aging process?
  • Are people with HIV aging more rapidly?
  • Is it possible to slow down the aging process?
  • Are there experimental treatments to slow aging in people with HIV?

The good news is that most HIV-positive people can do quite a lot to slow the aging process and guard against the onset of age-related illness. So why not head over there and understand how aging works in the first place, and what you can do to help yourself..

STAY UPDATED
Follow LASS on Twitter

or subscribe via email
 Related articles

A History of HIV & AIDS – 1990

As we prepare to enter our 25th year, we are reflecting on the global HIV events from the last three decades.  HIV has swept across the globe and support touching communities on every continent.  Here’s an introduction to some of the key moments in the early global history of HIV.  Catch up on the story using the ‘Recent Posts’ link to the right.

One of the primary routes of HIV transmission is through direct contact between your blood and HIV infected blood. Although the majority of HIV infections via blood occur through injecting drug use, medical settings still account for a significant number of new HIV infections.  Across the world numerous cases of HIV transmission through blood transfusions, medical injections, medical waste and occupational exposure, are both reported and unreported.

There are an estimated 250,000 new infections per year as a result of the reuse of needles and syringes,1 and in Africa 250 to 500 people are newly infected with HIV each day as a result of unsafe blood transfusions.2 3 Testing of blood is essential but remains absent in many low and middle-income countries.

In 1990, at the beginning of the year, it was reported that a large number of children in Romanian hospitals and orphanages had become infected with HIV as a result of multiple blood transfusions and the reuse of needles.

In China, 146 people in Yunnan Province near the Burmese border were found to be infected with HIV due to sharing needles.

In June, a TV programme called ‘The AIDS Catch’ was screened in the UK, questioning whether HIV caused AIDS and whether AIDS was infectious. It was felt the programme caused significant distress among people with HIV and undermined the efforts carried out in the field of HIV/AIDS prevention.

Prime Minister John Major announced that the Government would pay £42 million compensation to haemophiliacs infected with HIV and their dependants.

British actor Ian Charleson was a Scottish stage and film actor best known internationally for his starring role as Olympic athlete and missionary Eric Liddell, in the Oscar-winning 1981 film Chariots of Fire. He is also well known for his portrayal of Rev. Charlie Andrews in the 1982 Oscar-winning film Gandhi.

Charleson was a noted actor on the British stage as well, with critically acclaimed leads in Guys and DollsCat on a Hot Tin RoofFool for Love, and Hamlet, among many others. Over the course of his life Charleson performed numerous major Shakespearean roles,  dies on January 6, 1990 from AIDS at the age of 40.  His death marked the first showbusiness death in the United Kingdom openly attributed to complications from AIDS.

Later, in 1991, the annual Ian Charleson Awards are established in his honour in to reward the best classical stage performances in Britain by actors aged under 30.

Teenager Ryan White, who in 1987 had surgery to remove two inches off his left lung and believed this was the moment of his infection, dies on April 8, 1990 at the age of 18 from pneumonia caused by AIDS complications.

Congress enacted The Ryan White Comprehensive AIDS Resources Emergency (CARE) Act or Ryan White Care Act, the United States’ largest federally funded health related program (excluding Medicaid and Medicare).

STAY UPDATED
Follow LASS on Twitter

or subscribe via email

A History of HIV & AIDS – 1989

As we prepare to enter our 25th year, we are reflecting on the global HIV events from the last three decades.  HIV has swept across the globe and support touching communities on every continent.  Here’s an introduction to some of the key moments in the early global history of HIV.  Catch up on the story using the ‘Recent Posts’ link to the right.

1989: On February 7th, the FDA announced that it was going to approve an aerosol form of the drug Pentamidine for the treatment of PCP (Pneumocystis Pneumonia) AIDS Patents.  It’s still in use today for some people with PCP.

By March 1st, 145 countries had reported 142,000 cases of AIDS to the World Health Organisation (WHO). The WHO regarded this as under-reporting, and estimated the actual number of people with AIDS around the world to be over 400,000. It was predicted that this figure would rise to 1.1 million by 1991. It was also estimated that 5-10 million people were already infected with HIV.

Click to read Hans Paul’s letter to the US Government

A Dutch man, Hans Paul Verhoef, was imprisoned in Minnesota, USA because did not declare that he had HIV when he entered the country.  Mr. Verhoef landed at Minneapolis St. Paul International Airport en route to a gay and lesbian health conference in San Francisco in April 1989.

After his medicine was found (AZT) in his luggage he was detained under a 1987 law that allows the Immigration and Naturalization Service to deny entry to visitors with AIDS or the AIDS virus. (sic)

Supporters intervened in his behalf, and Mr. Verhoef was released after five days and allowed to attend the conference.

In August, results from a major drug trial known as ACTG019 were announced.  The trial showed that AZT could slow progression to AIDS in HIV positive individuals with no symptoms.  These findings were thought to be extremely positive; on August 17th a press conference was held, at which the Health Secretary, Louis Sullivan said:

“Today we are witnessing a turning point in the battle to change AIDS from a fatal disease to a treatable one.”

The initial optimism was short-lived when the price of the drug was revealed. A year’s supply for one person would cost around $7,000, and many Americans did not have adequate health insurance to cover the cost.  Burroughs Wellcome, the makers of AZT, were accused of ‘price gouging and profiteering’.  In September, the cost of the drug was cut by 20 percent.

By this time, 100,000 people diagnosed with AIDS had been reported to the CDC.  The proportion of AIDS diagnoses among women had increased, and smaller cities and rural areas were increasingly affected.

The television movie “The Ryan White Story” aired. It starred Judith Light as Jeanne, Lukas Haas as Ryan and Nikki Cox as Sister Andrea. Ryan White had a small cameo appearance as Chad, a young patient with AIDS.

Another AIDS-themed film, The Littlest Victims, also debuted in 1989, biopic-ing James Oleske, the first U.S. physician to discover AIDS in new born children during the early years of AIDS when many thought it was only spread by homosexual sex and drug use.

STAY UPDATED
Follow LASS on Twitter
or subscribe via email

A History of HIV & AIDS – 1988

As we prepare to enter our 25th year, we are reflecting on the global HIV events from the last three decades.  HIV has swept across the globe and support touching communities on every continent.  Here’s an introduction to some of the key moments in the early global history of HIV.  Catch up on the story using the ‘Recent Posts’ link to the right.

The first World AIDS Day was observed on 1 December 1988 after being first conceived in August the previous year by James W. Bunn and Thomas Netter, two public information officers for the Global Programme on AIDS at the World Health Organization.

Bunn and Netter took their idea to Dr. Jonathan Mann, Director of the Global Programme on AIDS (now known as UNAIDS). Dr. Mann liked the concept, approved it, and agreed with the recommendation that the first observance of World AIDS Day should be 1 December 1988.

Bunn, a broadcast journalist recommended the date of 1 December believing it would maximize coverage by western news media.  Since 1988 was an election year in the U.S., Bunn suggested that media outlets would be weary of their post-election coverage and eager to find a fresh story to cover.  Bunn and Netter determined that 1 December was long enough after the election and soon enough before the Christmas holidays that it was, in effect, a dead spot in the news calendar and thus perfect timing for World AIDS Day so as to maximise awareness and to battle stigma.

The aim, simply put is to exploit the best weapon governments have against the ever-growing AIDS epidemic: “information”.

One of the first high profile heterosexual victims of the virus was Arthur Ashe, an American tennis player.  He was diagnosed as HIV positive on 31 August 1988, having contracted the virus from blood transfusions during heart surgery earlier in the 1980s.  Further tests within 24 hours of the initial diagnosis revealed that Ashe had AIDS, but he did not tell the public about his diagnosis until April 1992.

May, C. Everett Koop sends an eight-page, condensed version of his Surgeon General’s Report on Acquired Immune Deficiency Syndrome report named Understanding AIDS to all 107,000,000 households in the United States, becoming the first federal authority to provide explicit advice to Americans on how to protect themselves from AIDS.

The first intake of volunteers are trained by LASS, as we begin to offer services to people who have HIV and AIDS and their families.  The David Manley fund – named after the first person known to have died from AIDS is implemented.  The fund provides financial support for people affected by HIV/AIDS in the county.  It was launched on 1st December 1988 and is still in operation today.  (Click here to support the David Manley fund)

STAY UPDATED
Follow LASS on Twitter
or subscribe via email