God, AIDS, Africa & HOPE

Reflections / Gedanken

POZ Magazine: New Study Challenges Assumptions About HIV Treatment as Prevention

A new Chinese study conducted among heterosexual couples of mixed HIV status found that antiretroviral (ARV) therapy does not substantially reduce the risk of HIV transmission in a real-world setting. The study, published October 1 in the Journal of Acquired Immune Deficiency Syndromes, and reported by aidsmap, suggests that more data might be needed before rushing to roll out HIV treatment-as-prevention programs around the globe.
Treatment-as-prevention rests on a fairly well-established theory that when ARV therapy reduces an HIV-positive person’s viral load, he or she will be less likely to transmit the virus to sex partners. While this has been noted for nearly a decade, the strategy has received increasing attention in light of recent studies showing a reduction in HIV transmission in both San Francisco and Vancouver, two cities where an increasing number of HIV-positive people have received ARV therapy and the average community viral loads have dropped substantially.

To test this theory further, researchers looked at HIV transmission rates among 1,927 mostly monogamous couples in the Henan province of China, where one of the partners had HIV and the other did not. Many people in this province became infected from tainted equipment used for blood donations.
Surprisingly, the researchers found that there was no statistically meaningful difference in the rate of transmission in the couples whose HIV-positive partner was on ARV therapy (3 percent transmission) compared with couples where the HIV-partner was not on treatment (5 percent transmission).
The study’s authors acknowledge that poor adherence could have contributed to the failure to find that ARV therapy reduced transmission risk. Nevertheless, aidsmap reports that Myron Cohen, MD, from the University of North Carolina in Chapel Hill said in an accompanying editorial that the study results “demand a giant pause.”
“Will ART suppress transmission of HIV under ‘real life’ conditions?” he asks. “[I]t seems wise to try and answer this question before we fully deploy a ‘Test and Treat strategy,’ expecting to detect a benefit to the general population.”

Source:  http://www.poz.com/rssredir/articles/hiv_china_prevention_761_19254.shtml

Filed under: HIV and AIDS, HIV Prevention, HIV Treatment, Medical and Research, , , ,

POZ Magazine: Forecasting the Future of HIV

As much as $722 billion might be needed to tackle HIV by 2031, if no cure or vaccine is found, according to new research published in The Lancet and reported by PlusNews. Study authors predict that in the next 20 years, annual HIV infections will be halved to about 1.2 million. However, new treatment guidelines will raise costs by 43 percent, and about one third of funding must be spent in Africa to stop the epidemic.  Researchers noted that the amount of money needed could drop to $400 billion if countries restructured their AIDS funding policies now.

To read the PlusNews story, click here.

Source: http://www.poz.com/rssredir/articles/Future_OF_HIV_1_19243.shtml

Filed under: HIV and AIDS, HIV Prevention, HIV Treatment, Medical and Research, Politics and Society, , , , , ,

POZ Magazine: New Computer Modeling System Predicts Which HIV Combos Are Best

Researchers in London announced October 6 the launch of a free-of-charge, online computer modeling system to help providers choose the antiretroviral (ARV) combinations that will most likely work for their patients.

For people starting their first ARV regimen, the choices are usually pretty clear. Given that all of the combinations recommended by the Department of Health and Human Services HIV treatment guidelines panel have proved effective at controlling HIV, the choice usually comes down to which combination will be easiest to take and have the least troubling side effects.

For people who are on their third, forth or fifth regimens, however—or those who are infected with drug-resistant HIV—treatment decisions can be challenging. Currently, providers must sort through the often complex results of genotype tests, which identify the drug-resistant mutations a person’s HIV carries, along with a person’s treatment history to determine what combinations are most likely to work. In the most complex cases, providers often consult with resistance experts at university academic centers.

Now, a group of researchers belonging to a non-profit group called the Response Database Initiative has launched a new online computer modeling program to help providers make more accurate predictions about the best regimens for their patients. Called the HIV Treatment Response Prediction System (HIV-TRePS), the system uses computer simulations based on the medical records of over 70,000 people with HIV around the world to determine which treatments will be best for a specific individual.

To use the system, a provider enters a person’s genotypic test results, viral load, CD4 count and treatment history. Within seconds, the system returns to the provider a list of potential combinations, sorted by their potency and tolerability.

“This is a very exciting development—the system literally puts the experience of treating thousands of different patients at the doctor’s fingertips,” commented Julio Montaner, MD, from the BC Centre for Excellence in HIV & AIDS in Vancouver. “This has the potential to improve outcomes for people living with HIV and AIDS around the world, particularly where resources and expertise are scarce.”

HIV-TRePS is only about 78 percent accurate in its predictions, and its developers caution that it should not be substituted for expert medical guidance. It has, nevertheless, proven more effective than other available methods, which have about 54 percent accuracy, for predicting which regimens will be most likely to work.

“We are really excited about the launch of this system, which is a milestone for us, our research partners around the world and also for the use of bioinformatics in medicine,” said Brendan Larder, PhD, scientific chair of RDI. “We believe this approach can make a significant difference in a variety of settings and diseases.”

Source: http://www.poz.com/rssredir/articles/hiv_resistance_treps_761_19217.shtml

Filed under: HIV and AIDS, HIV Treatment, Medical and Research, , , ,

POZ Magazine: New Strategy Could Eradicate Latent HIV-Infected Cells

Researchers report that they have taken the first step toward killing cells that are latently infected with HIV—cells that serve as a reservoir of persistent HIV reproduction and that current antiretroviral (ARV) drugs can’t reach. Their findings have been accepted by the open-access journal AIDS Research and Therapy.
Combination ARV therapy is incredibly potent. Numerous studies have shown that the therapies in widest use today can suppress all but the tiniest amount of HIV. However, the miniscule amount of HIV that remains—likely coming from reservoirs, such as resting CD4 cells, that aren’t always reached by ARV therapy—can completely reseed the body with virus as soon as a person stops taking his or her treatment.
Those resting cells have snippets of HIV DNA integrated into their own DNA, but they aren’t actively making new virus. Unfortunately, ARVs don’t affect cells that aren’t actively reproducing, and the amount of HIV DNA in the CD4s is so small that it doesn’t trigger the cell’s natural self-protection mechanism, which causes cells to self-destruct when their DNA gets altered too much.
Now, a group of Israeli researchers believes they have developed a method for getting to those latent cells and killing them. The group, led by Abraham Loyter, PhD, of Hebrew University in Jerusalem, is looking at ways to force the virus to integrate in multiple places in the cell’s DNA, triggering the cell’s chemical panic button and causing it to kill itself, a process called apoptosis.
Loyter and his colleagues developed two chemicals—dubbed INS and INrs peptides—that can prompt this process and combined them with an experimental protease inhibitor. The group then treated HIV-infected human immune cells for two weeks with the compounds, which they called the “mix.” Loyter’s group then allowed the remaining cells to grow out for an additional two weeks. HIV DNA levels were measured at three time points: before treatment with the mix, after two weeks of treatment, and then again two weeks after treatment was stopped.
Loyter’s team found that the “mix” worked as they’d hoped. After two weeks of treatment with the combination, no HIV DNA could be found, and this remained the case for an additional two weeks after the last dose of the treatment was added to the cells. The authors caution it is possible that some residual integrated HIV DNA was still present in the cells. Nevertheless, their results are encouraging.
“Stimulation of viral integration by the INS and INrs peptides, combined with the prevention of virion production by the protease inhibitor, not only resulted in blocking of HIV-1 infection but also in extermination of the infected cells by invoking apoptosis,” the authors concluded.
“Whilst this research is promising, a major caveat with these studies is that they are preliminary,” Loyter cautioned. “So far these experiments have only been shown to ‘cure’ HIV from small dishes of cultured cells in the authors’ laboratory, but the findings are an exciting development in the quest to eradicate this devastating global pandemic.”

Source: http://www.poz.com/rssredir/articles/hiv_mix_dna_761_18978.shtml

Filed under: HIV and AIDS, HIV Treatment, Medical and Research, , , ,

23.07.2010 Cutting the money

During the World AIDS Conference in Vienna, more news broke that amongst others Germany intends to cut the money contribution to the Global AIDS Fund.
According to Prof Jeffery Sachs from the Earth Institute of the Columbia University, Germany has broken several promises in the past and for him, the decision to cut donations would be shocking. In an interview published in “Die Welt” (Friday, 23.July 2010 page 4) he reminded the reader that Germany has promised in 2002 to donate for developing aid 7% of the GDP. In 2005 Germany promised with the G8 to double the aid for Africa until 2020 and to allow access for all to the HAART treatment. The Global Funds are organised to put the promises into practise. We know by know that the promises not materialize.
Prof. Sachs put it into perspective: The Global Fund would need 3 billion US Dollar – a lot of money; but compared to the 15 billion spend by the NATO in Afghanistan it seems to be a decent amount.

It the news of cutting down the donations towards are true, there is a second threat coming from the responsible German Minister Niebler. He favours bi-lateral assistance instead of multilateral fonds. I am sure every activist with some internal knowledge about bi-lateral assistance knows that this is tricky and very subjective. Prof. Sachs maintains that only global fonds guarantee optimal and objective use of the funds distributed.

I must admit knowing and reading about the amounts our politicians used and use to help the financial institutions, to support the war in Afghanistan or to bail or Greece it is an ethical disgrace to cut funding in the moment when we are on the way to reach treatment access for all and so add a preventive tool to our arsenal assisting to combat HIV/AIDS. And it seems that the lives of those in the developing countries once again count for nothing. Or as Prof. Sachs coins it: If Germany would cut funding it would be ” unscrupulous” .

Filed under: HIV and AIDS, HIV Treatment, Politics and Society, , , , , , ,

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