HIV-related Memory Loss Linked To Alzheimer's Protein

New research published in Neurology suggests that amyloid, one of the proteins associated with Alzheimer's disease, may also play a role in the memory loss of people with HIV.

Researchers examined cerebrospinal fluid (CSF) and found that the amount of amyloid was lower in Alzheimer's patients and HIV patients with memory problems, when compared to HIV patients without memory problems and healthy people. The other protein associated with Alzheimer's, Tau, was unchanged. Lower amounts of amyloid in the CSF suggest that amyloid processing in the brain is also affected.

'Alzheimer's like symptoms experienced by people with HIV can be frightening and confusing but this research builds on our understanding of why these symptoms occur and may help people get a more accurate diagnosis.

'Using spinal fluid techniques to diagnose dementia adds great value to research yet the UK lags far behind other countries who routinely use them. We must invest more in dementia research and increase the use of spinal fluid techniques if the UK is to lead the fight against dementia.'

Dr Susanne Sorensen
Head of Research

Source
Alzheimer's Society

Hospital-Acquired HIV In Africa

PlusNews examines several recent reports that highlight how unsanitary hospital procedures can create an environment conducive to the spread of HIV/AIDS.

"One study of HIV-positive Swazi children aged between 2 and 12, which relied on data from the 2006-2007 Swaziland Demographic and Health Survey, found that one in five of the children had HIV-negative mothers. Discounting the possibility that child sexual abuse could account for such a significant share of paediatric infections, the authors suggested that contaminated needles used to administer vaccinations and injections were to blame," the news service writes. "This argument was supported by evidence from a Kenyan study, which found that HIV-infected children with HIV-negative mothers had experienced more potential blood exposures during malaria treatment, dental surgery and vaccinations than their uninfected siblings."

The news service continues: "Another study in the journal published by the British Association of Sexual Health and HIV, found that clients at voluntary HIV counselling and testing centres run by the University of Calabar Teaching Hospital in southeastern Nigeria, who contracted HIV, were significantly more likely to have had blood tests, vaccinations, blood transfusions or surgical procedures than those who remained negative."

The article includes comments by study researchers, who say HIV prevention programs should improve blood screening and equipment sterilization in addition to addressing sexual behavior, and outside experts who say the studies raise interesting questions, but warn that more research is needed to fully grasp the extent of the problem (12/7).

This information was reprinted from globalhealth.kff.org with kind permission from the Henry J. Kaiser Family Foundation. You can view the entire Kaiser Daily Global Health Policy Report, search the archives and sign up for email delivery at globalhealth.kff.org.

© Henry J. Kaiser Family Foundation. All rights reserved.

Medicare Expands List Of Covered Preventive Services To Include HIV Screening Tests

The Centers for Medicare & Medicaid Services (CMS) today announced its final decision to cover Human Immunodeficiency Virus (HIV) infection screening for Medicare beneficiaries who are at increased risk for the infection, including women who are pregnant and Medicare beneficiaries of any age who voluntarily request the service. The decision is effective immediately.

Under the recently passed Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), CMS now has the flexibility of adding to Medicare's list of covered preventive services, if certain requirements are met. Prior to this law, Medicare could only cover additional preventive screening tests when Congress authorized it to do so.

"Today's decision marks an important milestone in the history of the Medicare program," said HHS Secretary Kathleen Sebelius. "Beginning with expanding coverage for HIV screening, we can now work proactively as a program to help keep Medicare beneficiaries healthy and take a more active role in evaluating the evidence for preventive services."

Under MIPPA, CMS can consider whether Medicare should cover preventive services that Congress has not already deemed as covered or non-covered by law. Among other requirements, the new services must have been "strongly recommended" or "recommended" by the U.S. Preventive Services Task Force. For instance, the Task Force graded HIV screening as "strongly recommended" for certain groups. More information about the Task Force is available online here.

"Every adult should know their HIV status," said Dr. Howard K. Koh, HHS assistant secretary for health. "This decision by Medicare should help promote screening and save lives."

CMS uses the national coverage determination (NCD) process to make decisions on these types of preventive services. This process provides transparency about the evidence that CMS considers when making its decisions and allows opportunity for the public to comment on CMS' proposals.

"Medicare's coverage of HIV screening tests is an important step forward in protecting beneficiaries from the potentially devastating and life-threatening complications of HIV and Acquired immunodeficiency Syndrome (AIDS)," said CMS Acting Administrator Charlene Frizzera.

AIDS is diagnosed when an HIV-infected person's immune system becomes severely compromised or a person becomes ill with an HIV-related infection. Of the more than one million estimated to have the HIV infection, the Centers for Disease Control and Prevention has estimated that about a quarter of them do not realize they are infected. Without treatment, AIDS develops within 8 to 10 years. While there is presently no cure for HIV, screening can help identify infected patients so that they can receive medical treatment that could help delay the onset of AIDS for years.

More information about Medicare's new HIV screening benefit is available in CMS' final decision memorandum. Read the final decision online here.

Source
HHS

Pharma manufacturers have 97 new HIV/AIDS medications in the pipeline

Chemistry World recently highlighted a new report published by the Pharmaceutical Research and Manufacturers of America (PhRMA) that identifies 97 new drugs and vaccines in development for HIV/AIDS and related conditions.

The report found that the 97 products in development include 23 vaccines and 54 antivirals. These drugs are either in human clinical trials or awaiting approval by the U.S. Food and Drug Administration (FDA).

"We are greatly encouraged by these critically important medicines and vaccines in development to treat and prevent HIV infection," said PhRMA President and CEO Billy Tauzin. "Pharmaceutical researchers are continuing their efforts to develop new therapies and vaccines to improve and lengthen the lives of HIV-infected patients."

"As a result of HIV/AIDS medicines, a disease that was once a virtual death sentence can now be controlled and treated as if it were a chronic disease," stated Tauzin. "And the new medicines our scientists are working on right now bring hope for even more promising results in the future."

December 1 marks the 21st anniversary of "World AIDS Day" - a global awareness campaign that originated at the 1988 World Summit of Ministers of Health on Programmes for AIDS Prevention.

Source: Pharmaceutical Research and Manufacturers of America

Chinese AIDS activists demand more access to treatment

A small group of uninvited Chinese activists took over an official World AIDS Day event Tuesday, demanding more government recognition and help.

The action at the Chinese railway's massive South Station in Beijing came as volunteers passed out AIDS leaflets to passengers as part of a campaign by China's Red Cross.

Wearing white face masks scrawled with the words "Infected blood transfusions causes AIDS," the group or 20 or so activists mounted the stage to speak through tears.

"Our fight for free treatment has continued for the past eight years with no luck," one protester, Liu Xiurong, said afterward.

Liu, from northern Harbin, said her son became infected with the HIV virus by tainted plasma several years ago. She received compensation from the Shanghai company that supplied the blood but the money wasn't enough to help her family with its medical costs.

"The money we got is not even close to the amount that we need to live. My son still needs treatment," she told Associated Press Television News.

"Now that we've put ourselves out there, there is a chance that we'll be beaten or arrested in the future," Liu said. "It's OK because we have nothing left to lose and maybe by doing this, we can inspire others who are afraid to come out united for our cause."

The HIV virus that causes AIDS gained a foothold in China largely due to unsanitary blood plasma-buying schemes and tainted transfusions in hospitals.

AIDS was the top killer among infectious diseases in China for the first time last year, a fact that may reflect improved reporting of HIV/AIDS statistics in recent years as the country slowly acknowledges the problem.

By the end of October, the number of Chinese confirmed with HIV-AIDS was 319,877, according to China's Health Ministry, up from 264,302 last year and 135,630 in 2005. Health Minister Chen Zhu said the actual level of infections is probably closer to 740,000.

On Monday, President Hu Jintao publicly pledged to mobilize the whole society in tackling the growing AIDS problem in the China.

State broadcaster China Central Television showed footage Tuesday of Hu, wearing a crimson ribbon pinned to his shirt, talking through a videophone to AIDS patients, doctors and researchers at Ditan Hospital. It was a move aimed at improving awareness and helping reduce stigma for HIV-positive people.

On Tuesday, dozens of railway workers and about 100 volunteers, some with stickers of a red ribbon or a red cross on their cheeks, helped pass out free pamphlets on disease prevention and reducing social stigma. Free condoms were also available to passers-by.

The event, co-hosted by the Railways Ministry, was aimed at promoting AIDS and HIV messages on the country's massive rail network to target the public, in particular migrant workers who crisscross the country in search of jobs.

Globally, there were about 33.4 million people with HIV last year, according to UNAIDS in a report issued last week. About 4.7 million of those were in the Asia-Pacific region.

There were about 350,000 new infections last year across the Asia-Pacific, including 21,000 children. And about 330,000 people died from complications related to AIDS.

The epidemic continues to be fueled in most countries by high-risk groups, such as intravenous drug users, sex workers and their clients. Though China is believed to have the world's largest number of injecting drug users, the main mode of HIV transmission has changed from infected needles from drug use to heterosexual sex.

Data show that 40 percent of new HIV cases diagnosed in China were infected through heterosexual contact, with homosexual sex accounting for 32 percent and the remainder related to drug abuse.

_____

Associated Press Medical Writer Margie Mason in Hanoi contributed to this report.

Important Label Update for Norvir (Ritonavir)

November 23, 2009

On November 23, 2009, FDA approved changes to the Norvir package insert (product label) to include drug-drug interaction information for concurrent ritonavir administration with:

• inhaled medicines such as salmeterol or salmeterol in combination with fluticasone propionate (Serevent, Advair)
• sildenafil (Revatio)

Also other revisions to the Contraindications, Warnings, Precautions: Drug Interactions and Dosage and Administration as follows.

The CONTRAINDICATIONS was updated as follows:
When co-administering NORVIR with other protease inhibitors, see the full prescribing information for that protease inhibitor including contraindication information.
NORVIR is contraindicated in patients with known hypersensitivity to ritonavir or any of its ingredients.
Co-administration of NORVIR is contraindicated with the drugs listed in Table 4 (also see PRECAUTIONS -- Table 5. Drugs that Should Not be Co-administered with NORVIR) because ritonavir mediated CYP3A inhibition can result in serious and/or life-threatening reactions. Voriconazole and St. John's Wort are exceptions in that co-administration of NORVIR and voriconazole results in a significant decrease in plasma concentrations of voriconazole, and co-administration of NORVIR with St. John's Wort may result in decreased ritonavir plasma concentrations.

Table 4. Drugs that are Contraindicated with NORVIR
Drug Class	Drugs Within Class That Are CONTRAINDICATED With NORVIR**
Alpha1-adrenoreceptor antagonist	Alfuzosin HCL
Antiarrhythmics	Amiodarone, bepridil, flecainide, propafenone, quinidine
Antifungal	Voriconazole
Ergot Derivatives	Dihydroergotamine, ergonovine, ergotamine, methylergonovine
GI Motility Agent	Cisapride
Herbal Products	St. John's Wort (hypericum perforatum)
HMG-CoA Reductase Inhibitors:	Lovastatin, simvastatin
Neuroleptic	Pimozide
PDE5 enzyme inhibitor	Sildenafil* (Revatio®) only when used for the treatment of pulmonary arterial hypertension (PAH)
Sedative/hypnotics	Oral midazolam, triazolam
* see WARNINGS - Drug Interactions and PRECAUTIONS -- Table 6. Established and Other Potentially Significant Drug Interactions for coadministration of sildenafil in patients with erectile dysfunction. ** For additional information for these contraindicated drugs, see also PRECAUTIONS -- Table 5. Drugs that Should Not be Co-administered with NORVIR.

The WARNINGS section for Drug Interactions was updated as follows
Drug Interactions
See CONTRAINDICATIONS- Table 4 for a listing of drugs that are contraindicated with NORVIR due to potentially life-threatening adverse events, significant drug interactions, or loss of virologic activity. Also, see PRECAUTIONS -- Table 5 and Table 6 for drugs that should not be co-administered with NORVIR and for a listing of drugs with established and other significant drug interactions.

The PRECAUTIONS section with regard to drug interactions was updated as follows:

Table 5. Drugs that Should Not be Co-administered with NORVIR
Drug Class: Drug Name	Clinical Comment
Alpha Adrenergic Antagonist: alfuzosin	CONTRAINDICATED due to potential for serious reactions such as hypotension.
Antiarrhythmics: amiodarone, bepridil, flecainide, propafenone, quinidine	CONTRAINDICATED due to potential for serious and/or life threatening reactions such as cardiac arrhythmias.
Antifungal: voriconazole	CONTRAINDICATED due to significant decreases in voriconazole plasma concentrations and may lead to loss of antifungal response.
Ergot Derivatives: dihydroergotamine, ergonovine, ergotamine, methylergonovine	CONTRAINDICATED due to potential for serious and/or life-threatening reactions such as acute ergot toxicity characterized by vasospasm and ischemia of the extremities and other tissues including the central nervous system.
GI Motility Agent: cisapride	CONTRAINDICATED due to potential for serious and/or life-threatening reactions such as cardiac arrhythmias.
Herbal Products: St. John's wort (hypericum perforatum)	CONTRAINDICATED as the combination may lead to loss of virologic response and possible resistance to NORVIR or to the class of protease inhibitors.
HMG-CoA Reductase Inhibitors: lovastatin, simvastatin	CONTRAINDICATED due to potential for serious reactions such as risk of myopathy including rhabdomyolysis.
Neuroleptic: pimozide	CONTRAINDICATED due to the potential for serious and/or life-threatening reactions such as cardiac arrhythmias.
PDE5 enzyme inhibitor: Sildenafil* (Revatio®)	CONTRAINDICATED in the treatment of pulmonary arterial hypertension (PAH). A safe and effective dose has not been established when used with ritonavir. There is an increased potential for sildenafil-associated adverse events, including visual abnormalities, hypotension, prolonged erection, and syncope.
Sedative/hypnotics: oral midazolam, triazolam	CONTRAINDICATED due to potential for serious and/or life-threatening reactions such as prolonged or increased sedation or respiratory depression.

Table 6 below was revised to include updated information on coadministration with darunavir, tipranavir, maravoric, voriconazole, PDE5 inhibitor for pulmonary arterial hypertension (sildenafil (Revatio)) and parenteral midazolam

Table 6. Established and Other Potentially Significant Drug Interactions: Alteration in Dose or Regimen Recommended Based on Drug Interaction Studies or Predicted Interaction (see CLINICAL PHARMACOLOGY -- Table 2 and Table 3 for Magnitude of Interaction)
Concomitant Drug Class: Drug Name	Effect on Concentration of Ritonavir or Concomitant Drug	Clinical Comment
HIV-Antiviral Agents
HIV Protease Inhibitor: darunavir	When co-administered with reduced doses of ritonavir ↑ darunavir (↑ AUC, ↑ Cmax, ↑ Cmin)	See the complete prescribing information for Prezista® (darunavir) for details on co-administration of darunavir 600 mg b.i.d with ritonavir 100 mg b.i.d. or darunavir 800 mg q.d. with ritonavir 100 mg q.d.
HIV Protease Inhibitor: tipranavir	When co-administered with reduced doses of ritonavir ↑ tipranavir (↑ AUC, ↑ Cmax, ↑ Cmin)	See the complete prescribing information for Aptivus® (tipranavir) for details on co-administration of tipranavir 500 mg b.i.d with ritonavir 200 mg b.i.d. There have been reports of clinical hepatitis and hepatic decompensation including some fatalities. All patients should be followed closely with clinical and laboratory monitoring, especially those with chronic hepatitis B or C co-infection, as these patients have an increased risk of hepatotoxicity. Liver function tests should be performed prior to initiating therapy with tipranavir/ritonavir, and frequently throughout the duration of treatment.
HIV Protease Inhibitor: fosamprenavir	When co-administered with reduced doses of ritonavir ↑ amprenavir (↑ AUC, ↑ Cmax, ↑ Cmin)	See the complete prescribing information for Lexiva® (fosamprenavir) for details on co administration fosamprenavir 700 mg b.i.d with ritonavir 100 mg b.i.d., fosamprenavir 1400 mg q.d. with ritonavir 200 mg q.d. or fosamprenavir 1400 mg q.d. with 100 mg q.d.
HIV CCR5 -- antagonist: maraviroc	↑ maraviroc	Concurrent administration of maraviroc with ritonavir will increase plasma levels of maraviroc. For specific dosage adjustment recommendations, please refer to the complete prescribing information for Selzentry® (maraviroc).
Other Agents
Antifungal: voriconazole	↓ voriconazole	Coadministration of voriconazole and ritonavir doses of 400 mg every 12 hours or greater is contraindicated. Coadministration of voriconazole and ritonavir 100 mg should be avoided, unless an assessment of the benefit/risk to the patient justifies the use of voriconazole.
Long-acting beta-adrenoceptor agonist: salmeterol	↑ salmeterol	Concurrent administration of salmeterol and ritonavir is not recommended. The combination may result in increased risk of cardiovascular adverse events associated with salmeterol, including QT prolongation, palpitations and sinus tachycardia.
PDE5 Inhibitors: sildenafil, tadalafil, vardenafil	↑ sildenafil ↑ tadalafil ↑ vardenafil	Particular caution should be used when prescribing sildenafil, tadalafil or vardenafil in patients receiving ritonavir. Coadministration of ritonavir with sildenafil is expected to substantially increase sildenafil concentrations (11-fold increase in AUC). Use of sildenafil, tadalafil or vardenafil may result in an increase in associated adverse events, including hypotension, syncope, visual changes, and prolonged erection. Use of PDE5 inhibitors for pulmonary arterial hypertension (PAH): Sildenafil (Revatio®) is contraindicated when used for the treatment of pulmonary arterial hypertension (PAH) because a safe and effective dose has not been established when used with ritonavir (see CONTRAINDICATIONS and PRECAUTIONS -- Drug Interactions, Table 5). Use of PDE5 inhibitors for erectile dysfunction: Sildenafil: The starting does should not, in any case, exceed 25 mg in a 48-hour period in patients receiving concomitant ritonavir therapy (see WARNINGS). Tadalafil: Use tadalafil with caution at reduced doses of no more than 10 mg every 72 hours with increased monitoring for adverse events(see WARNINGS). Vardenafil: Use vardenafil with caution at reduced doses of no more than 2.5 mg every 72 hours with increased monitoring for adverse events(see WARNINGS).
Sedative/hypnotics: Parenteral midazolam	↑ midazolam	Co-administration of oral midazolam with NORVIR is CONTRAINDICATED. Concomitant use of parenteral midazolam with NORVIR may increase plasma concentrations of midazolam. Co-administration should be done in a setting which ensures close clinical monitoring and appropriate medical management in case of respiratory depression and/or prolonged sedation. Dosage reduction for midazolam should be considered, especially if more than a single dose of midazolam is administered.

The DOSAGE AND ADMINISTRATION section was revised to include the following statement.

Adults
Dose modification for NORVIR
Dose reduction of NORVIR is necessary when used with other protease inhibitors: amprenavir, atazanavir, darunavir, fosamprenavir, saquinavir, and tipranavir. Prescribers should consult the full prescribing information and clinical study information of these protease inhibitors if they are co-administered with a reduced dose of ritonavir.

The complete revised labeling will be available at Drugs@FDA.

Norvir is a protease inhibitor, marketed by Abbott Laboratories.

Despite Gains, HIV/AIDS Remains Public-Health Priority, UNAIDS, WHO Say

November 25, 2009

News outlets continued to examine the 2009 AIDS epidemic update released Tuesday by the WHO and UNAIDS:

"The U.N. report said 'AIDS continues to be a major public-health priority' and called for more funds to support efforts to curb the epidemic and to distribute lifesaving drugs," the Wall Street Journal reports. "The U.N. report also suggested that health authorities need to focus resources on those most at risk" (Fairclough, 11/25).

Los Angeles Times: "About 4 million people were receiving AIDS drugs at the end of 2008, compared with 3 million the previous year. Nonetheless, an additional '5 million people need treatment and are not receiving it,' Dr. Teguest Guerma, acting director of the WHO's HIV/AIDS department, said at a Tuesday news conference. She said that about 2.9 million lives had been saved so far by increased access to the drugs as a result of the U.S. President's Emergency Plan for AIDS Relief and other international assistance programs" (Maugh, 11/25).

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VOA News examines the U.S. contributions towards the global fight against HIV/AIDS. The article includes comments by Anthony Fauci, of the National Institute of Allergy and Infectious Diseases, and Michele Moloney-Kitts, assistant coordinator in the office of the global AIDS coordinator. According to Fauci, the National Institutes of Health have "spent about $42 billion from 1982 through fiscal year 2009 on HIV/AIDS research," funding Fauci credited to having helped improve the lives of people living with HIV/AIDS, the news service writes.

"Michele Moloney-Kitts ... said the U.S. government to date has provided about $25 billion, making it the largest donor in the global fight against AIDS, tuberculosis and malaria." The article also includes Moloney-Kitts' comments about the future of PEPFAR under the Obama administration (Butty, 11/24).

"The update cautions that prevention programs often fail to target the populations that are most at risk," Science's "ScienceInsider" blog reports. "Specifically, stigma and local laws prevent many countries from tailoring prevention outreach to highly vulnerable groups like injecting drug users, men who have sex with men, commercial sex workers, and longterm couples in which only one partner is infected. And the sobering bottom line is that five people continue to be infected for every two who start treatment with anti-HIV drugs" (Cohen, 11/24).

Epidemics in Russia, Eastern Europe, China

RIA Novosti examines the findings of the report that "[o]ver 1% of Russian residents are HIV-positive," with the primary route of transmission being injecting drug use. "According to the report, about 37% of Russia's estimated 1.8 million drug users are HIV-infected. Young people account for a considerable number of infections among injecting drug users in the region," the news service writes (11/25).

KyivPost: "'With an adult HIV prevalence of 1.6%, Ukraine has the highest prevalence in all of Europe,' UNAIDS and WHO experts said." The report also found "the estimated number of adults and children living with HIV in Eastern Europe and Central Asia has grown by 66% to 1.5 million since 2001," according to the newspaper (11/25).

The Associated Press examines the report's findings that HIV "is now spreading fastest in China through heterosexual sex, a trend demanding new strategies to stave off a rebound in the epidemic after years of progress in containing it ..." UNAIDS head Michel Sidibe said, "We are seeing a shift in the nature of the epidemic. ... We need to ensure resource allocation is responding to that change."

The article includes details about how "[t]he government remains sensitive about [HIV/AIDS]" and stories of patients living with HIV/AIDS seeking additional support from the government (Kurtenbach, 11/25).

Xinhua/People's Daily Online also reports on the Chinese health minister's response to the UNAIDS report and highlights the efforts of the Chinese government to stop the spread of HIV/AIDS in the country (11/24). In a UNAIDS press release that lauded China's progress on HIV/AIDS Sibide's said, "The world eagerly anticipates China's enhanced role in global governance -- and its leadership in the global response to AIDS" (11/24).

HIV - Up Close and Personal

Since the discovery in 2007 that a component of human semen called SEVI boosts infectivity of the virus that causes AIDS, researchers have been trying to learn more about SEVI and how it works, in hopes of thwarting its infection-promoting activity.

Now, scientists at the University of Michigan have determined the atomic-level, three-dimensional structure of a SEVI precursor known as PAP248-286 and discovered how it damages cell membranes to make them more vulnerable to infection with HIV. The work is described in two new papers. The most recent, describing the structure, was published online Nov. 17 in the Journal of the American Chemical Society. The paper describing how PAP248-286 interacts with cell membranes appeared in the Nov. 4 issue of Biophysical Journal.

PAP248-286 is a peptide---a chain of amino acids not long enough to be considered a protein. Individual PAP248-286 peptides have a tendency to clump together to form amyloid fibers called SEVI (semen enhancer of viral infection). Amyloid fibers are of great interest because they are the calling cards of many neurodegenerative diseases, such as Alzheimer's and Parkinson's, and aging-related diseases like type-2 diabetes. Using NMR (nuclear magnetic resonance) spectroscopy, a technique that not only yields atomic-level details of a molecule's structure, but also shows how the molecule nestles into the membrane with which it interacts, researcher Ayyalusamy Ramamoorthy and coworkers found that the structure of PAP248-286 is unlike that of most other amyloid-forming peptides and proteins.

In solution, SEVI is completely unstructured or has no definite shape and is therefore ineffective. On the other hand, "when bound to the membrane, it's in a spaghetti-like arrangement---a disorganized, loose coil," said Ramamoorthy, a professor of chemistry and of biophysics. In contrast, most other amyloid proteins assume a more ordered, helical configuration. Also unlike other amyloid peptides, SEVI does not penetrate deep into the greasy region of the cell membrane, but is located near the surface. Ramamoorthy and coauthors believe the spread-out, disordered configuration and its location in the cell membrane may explain the ability of SEVI fibers to enhance HIV infection, as the arrangement provides more surface area with which the virus can interact.

A key finding of the second study is that PAP248-286 "shocks" the membrane, inducing a structural change---a kind of dimple that allows HIV to attach to and enter the cell.

Next, Ramamoorthy and colleagues hope to discern more structural details of PAP248-286 and SEVI. They also plan to screen antioxidant compounds such as green tea extract, curcumin and resveratrol (found in red wine) to see if such compounds are capable of blocking SEVI's HIV-enhancing activity.

Ramamoorthy's coauthors on the Journal of the American Chemical Society paper are graduate student Ravi Nanga, post-doctoral fellows Jeffrey Brender and Nataliya Popovych and NMR specialist Subramanian Vivekanandan. His coauthors on the Biophysical Journal paper are Brender, graduate student Kevin Hartman, former post-doctoral fellow Lindsey Gottler, former graduate student Marchello Cavitt and biophysics undergraduate student Daniel Youngstrom.

This research was supported by funds from the National Institutes of Health.

Source: Nancy Ross-Flanigan
University of Michigan

AIDS Virus in this Lifetime?

Experts at an international HIV/AIDS conference in Winnipeg say researchers around the world are closer than ever to finding a vaccine against the virus.

Frank Plummer, director of Winnipeg's National Microbiology Laboratory, said he expects to see a vaccine in his lifetime.

"I'm confident that we will get there eventually," Plummer said. "It's not a simple problem. If it was, we would have done it already."

He said there are cases around the world of people who have had contact with the virus but haven't become infected. Plummer said some of that is luck, but it may also be due to natural immunity.

Case studies shared

Case studies were shared at a gathering of about 75 international experts at the conference.

Researchers at the conference pointed out that many breastfeeding infants who are born to HIV-positive women escape infection. Some groups of sex-trade workers who are repeatedly exposed to the virus also appear to be immune.

'We don't understand it fully yet and that needs to be expanded. We don't understand how to produce it artificially, which is what a vaccine is all about.'—Frank Plummer

"Sometimes that's because of luck but sometimes that's because, I believe, they're immune in some way to HIV," Plummer said. "We don't understand it fully yet and that needs to be expanded. We don't understand how to produce it artificially, which is what a vaccine is all about."

In September, researchers announced that a two-vaccine combination cut the risk of becoming infected with HIV by more than 31 per cent in a trial of more than 16,000 volunteers in Thailand.

Canada's chief public health officer, David Butler-Jones, said some of the greatest vaccine discoveries have come from figuring out natural immunity.

"The original vaccine for smallpox was a recognition that milk maids who had cowpox were not susceptible to smallpox," he said.

Although some of the world's great minds are grappling with the virus, Butler-Jones said it is a very difficult illness to crack. People are capable of developing antibodies to HIV/AIDS but they aren't enough to protect against the virus, he said.

"It is one of the great scientific and medical challenges moving forward. Every day we are one day closer but exactly when that day will come, it's impossible to predict," Butler-Jones said. "The sooner, the better."

According to a 2008 United Nations report on the global AIDS epidemic, 33 million people were living with HIV in 2007. Two million people died of causes related to the disease that year.

© The Canadian Press, 2009

Indian patent laws prevent "Evergreening" of medicine

Indian authorities have rejected patent requests from US pharmaceutical company Gilead Sciences on two life-saving HIV/AIDS drugs, Tenofovir and Darunavir, as they were considered to be in infringement with the patent law. According to the decision, the patents violated section 3(d) of the Indian patent law, which prohibits ‘evergreening’ — the practice of multinational pharmaceutical companies of making small, trivial changes to existing medicines in order to extend the period of patent monopoly on a drug, thereby preventing the entry of generic competitors into the market and keeping drug prices high.

“This is a really important day for HIV patients in developing countries. The rejection of the patents on Tenofovir opens up the market for new generic competitors to drive down the price of this key HIV/AIDS drug,” says Michelle Childs, Director of Policy at Doctors Without Borders/Médecins Sans Frontières (MSF)’s Access to Essential Medicines Campaign and continues “Gilead now needs to remove any remaining contractual provisions that stop some generic companies from supplying Tenofovir to other countries where there is no patent, for example Brazil where the patent on Tenofovir has also been rejected. The decision regarding Darunavir is significant because the drug is one of the newest and most expensive of HIV/AIDS drugs. These decisions highlight the success and importance of Section 3(d) and opposition procedures in India’s patent law to safeguard public health. Other countries which need access to affordable essential drugs should look at India and build similar public health safeguards into their own patent law.”

Tenofovir is a key HIV/AIDS drug recommended by the World Health Organization for improved first-line treatment of HIV/AIDS. Darunavir is a new and expensive HIV/AIDS drug that is needed by patients failing on their existing treatments. Access to both medicines is currently limited by their high price.

http://doctorswithoutborders.org/news/article.cfm?id=3912&cat=field-news

Canada Drops the Ball on its HIV/AIDS Assistance Commitments

Ottawa's Cheshire cat grin to the global AIDS pandemic will vanish in September when the last, small shipment of drugs produced under Canada's Access to Medicines Regime leaves the country for Rwanda.

Virtually no one outside the federal government expects there will be more – a gloomy backdrop to the indictments of the world's wealthiest nations at this week's international AIDS conference in Cape Town, South Africa, for a chain of broken promises on helping poorer countries to obtain life-saving treatment.

In the five years that the Canadian legislation, CAMR – initially dubbed the Jean Chrétien Pledge to Africa Act – has been in place, only one allotment of low-cost medicine has been arranged: for 21,000 Rwandans for one year. The first shipment went last year; the last lot will go at the summer's end.

The consensus among AIDS activists and generic drug manufacturers is that CAMR is so overwhelmingly flawed and cumbersome that no developing country will use it again to apply for assistance, and no generic pharmaceutical company will use it to manufacture anti-retroviral drugs.

“We're still where we were five or six years ago, and the system needs to get fixed,” said Elie Betito, director of public and government affairs for Apotex Inc. in Toronto, which made the Rwandan anti-retroviral product at cost after long and expensive legal negotiations with three pharmaceutical companies holding patents on components of the medication.

“But I don't think this government wants to change [CAMR], because it's not their legislation,” he added. It was introduced by a Liberal government, although passed unanimously by Parliament.

Apotex, one of the world's largest generic drug manufacturers, has said its one and only experience working under CAMR was so bad that it won't seek a new licensing agreement using the legislation, although it's ready to produce a desperately needed pediatric formulation that it says would both meet high Canadian standards and be globally cost competitive.

The CAMR legislation was designed to allow generic pharmaceutical companies to produce and export affordable drugs that are under patent to developing countries facing public health emergencies.

But it requires countries on an approved list to go through a mountain of red tape to apply for assistance and tender for manufacturers, and generic manufacturers to negotiate new licensing agreements with patent holders on each contract and with each country.

Thus, if Apotex was to have won a contract from Rwanda for another year of supplying drugs to the same 21,000 patients, it would have had to go through the same negotiations as before with the patent holders.

“You're looking at 65-page contracts,” Mr. Betito said.

Tony Clement, while national health minister in 2006, told the international AIDS conference, held that year in Toronto, that the legislation was flawed. But since becoming Minister of Industry – with responsibility for the legislation – in 2008, he has not given any intention of amending it.

A government review concluded in 2007 that it would be premature to change the legislation. The patent-holding pharmaceutical manufacturers have said there's nothing wrong with the legislation as it stands, and have lobbied strenuously against changes.

A Senate bill being shepherded by Manitoba Liberal Senator Sharon Carstairs and a House of Commons private member's bill introduced by Manitoba New Democrat Judy Wasylycia-Leis would require only a single licence.

Apotex would prefer the government take over the whole process and simply hand compulsory licences to generic manufacturers.

Laura Esmail, a University of Toronto doctoral candidate in pharmacy whose academic research is on CAMR and affordable AIDS drugs, said the one-licence proposal would allow Canadian companies, such as Apotex, to develop affordable global drugs using economies of scale.

She also said developing countries find themselves pressured by international corporations and other governments not to apply for drugs under legislation such as CAMR, and they need wealthy countries like Canada to make it easier for them to do so.

Michael Valpy
Globe and Mail

AIDS Treatment as a form of Prevention

A lot of people thought Julio Montaner was a little crazy when he first suggested that the best way to eliminate the AIDS epidemic would be a massive scheme to give AIDS medicine to every infected person.

What about the huge financial cost? What about the moral issues, the human-rights issues, the overwhelming number of tests and drugs that would be required? Wouldn't it undermine years of lecturing on monogamy and abstinence? Wouldn't it promote "condom-free sex," as some critics said?

Faced with a host of objections, the Canadian scientist was a lone voice in the wilderness for the past three years, unable to win support from the global AIDS establishment.

But this year, Dr. Montaner's solitary crusade - the controversial notion of "treatment as prevention" - has suddenly become one of the hottest issues in AIDS science. And yesterday, at the International AIDS Society conference in Cape Town, his once-ridiculed idea was endorsed by experts from around the world.

Among the latest support for his proposal is a model by World Health Organization researchers that predicts a 95-per-cent reduction in new HIV cases within 10 years if his idea is adopted.

The proposed new strategy - universal voluntary testing for HIV, combined with immediate anti-retroviral drug treatment for those who have the virus, even in its earliest stages - could save more than seven million lives by 2050, the model says.

The WHO, which had resisted the treatment-as-prevention concept for years, is now organizing a special conference this November to discuss the "feasibility and acceptability" of the concept.

"Treatment as prevention is the topic of the year," Swiss scientist Bernard Hirschel told the AIDS conference yesterday.

"I think Julio deserves a lot of credit for this. Is treatment going to be the answer? We don't know, but we'd better find out."

Dr. Montaner, president of the International AIDS Society and director of the B.C. Centre for Excellence in HIV/AIDS, has been a prominent scientific researcher on AIDS since 1981, before the virus was even identified. A pioneer in the use of anti-retrovirals and other AIDS drugs, he has been campaigning for the treatment-as-prevention strategy since 2006.

Willy Rozenbaum, one of the early discoverers of the AIDS virus and now the president of France's National AIDS Council, was another scientist who lent his support to Dr. Montaner yesterday. Providing proper treatment to those who have the AIDS virus "sharply reduces the chances that they will transmit the virus," he told the conference.

Dr. Rozenbaum acknowledged that researchers must study whether the use of medical treatment as a prevention strategy would encourage "risky" behaviour by those who think that the AIDS virus has been virtually eliminated from their bodies. But medical treatment and condom use can coexist, he said.

In an interview, Dr. Rozenbaum said the notion of treatment as prevention is being resisted by many governments because they are afraid of the cost and reluctant to admit the failure of the traditional prescription of condoms and monogamy. "They've been promoting condoms as the answer for 20 years," he said.

After initial progress in reducing AIDS in the developed world, the condom strategy has failed to make further progress in recent years, he said. "I'm not happy with a plateau. We can't accept just a stabilization of the problem."

As for the short-term financial cost of a massive expansion in AIDS medicine, it would be outweighed by savings within five or 10 years as the transmission rate is swiftly reduced, he said.

The new WHO model of how this strategy could work, presented at the conference by WHO researcher Reuben Granich, says the treatment strategy would drive up costs at first, but "may provide cost savings" in the long run as it increasingly prevents new HIV cases.

Dr. Montaner conceded that some "recalcitrant" people with the AIDS virus will refuse to be tested or treated. His plan would not force them to be tested, but this would not weaken the strategy, he said.

"A person who is appropriately treated becomes dramatically less likely to transmit," he said. "The more you treat, the more you reduce the cases. ... When we first suggested this in 2006, people thought we were a little loony. But it's now fully accepted. We just need to get started."

The notion of treatment as prevention "creates a powerful new rationale" for the expanded use of anti-retrovirals and other AIDS drugs, he said. "We have transformed treatment from being merely a life-saving tool. Now it means we are protecting society, we are protecting our children."

The Harper government in Ottawa is still resisting the proposed new strategy, even as global experts are accepting it, Dr. Montaner said. When he suggested the strategy in a letter to the federal Health Minister, he received only a form letter in response. "It's been increasingly adopted around the world, but where is Canada on this?"

*****

The global AIDS battle

World health leaders are gathering in South Africa to discuss ways to fight the disease

PEOPLE WITH HIV/AIDS AROUND THE WORLD

PERCENTAGE OF WORLD TOTAL/ 2007

Latin America and the Caribbean/ 5.0%

High-income countries/ 5.4%

Eastern Europe and Central Asia/ 3.9%

Asia/ 21.4%

Africa/ 64.4%

The overwhelming majority of people with HIV/AIDS, 95%, live in the developing world.

MONEY AVAILABLE FOR GLOBAL AIDS FIGHT, IN BILLIONS $ US

'05/ $7.9

'06/ $8.8

'07/ $11.3

"08/ $13.8

THE GLOBE AND MAIL / SOURCE: UNAIDS, AVERT.ORG

Engineered antibodies fight AIDS virus

Researchers may have discovered a technique that will eventually lead to a way to vaccinate against the AIDS virus, by creating an artificial antibody carried into the body by a virus.

This synthetic immune system molecule protected monkeys against an animal version of HIV called SIV, the researchers reported in the journal Nature Medicine.

While it will be years before the concept could be tested in humans, it opens up the possibility of protecting people against the fatal and incurable virus.

"Six of nine immunized monkeys were protected against infection by the SIV challenge, and all nine were protected from AIDS," Philip Johnson of Children's Hospital of Philadelphia and colleagues wrote.

Several attempts to create a vaccine against the human immunodeficiency virus that causes AIDS have failed.

AIDS not only attacks the immune cells that usually defend against viruses, but it quickly hides out in an as-yet undiscovered "reservoir" so the immune system must be primed to capture virtually every single virus.

In addition, people do not usually make antibodies against the virus. Antibodies are immune system particles that latch on to invaders so killer cells can destroy them.

Johnson's team engineered an artificial piece of DNA that would make artificial antibodies, called antibody-like proteins or immunoadhesins. They made three different versions.

This stretch of DNA was spliced into a virus, called an adeno-associated virus or AAV, that infects people and monkeys with little effect.

PROTECTED MONKEYS

They injected the monkeys with their lab-engineered AAV, which started cranking out antibodies in the blood of the monkeys. Then they injected the monkeys with SIV.

One injection protected the monkeys -- six never became infected at all -- and the three that did never developed AIDS, the immune system destruction caused by HIV, they reported.

One of the three appeared to work better than the other two but more testing is needed. "To ultimately succeed, more and better molecules that work against HIV, including human monoclonal antibodies, will be needed," they wrote.

"As a concept, I think this is very promising," Dr. Peggy Johnston, head of the HIV Vaccine Research Branch at the National Institute of Allergy and Infectious Diseases, which helped pay for the study, said in a telephone interview.

She said the monkeys had an immune response to the AAV virus and the approach would have to be carefully tested to ensure it was safe. In addition, the monkeys were infected by injection and tests would be needed to show the vaccine protected against HIV acquired sexually.

"We need to make the genes as humanized as possible so that the human body doesn't react to that," she added.

"I don't see this going into humans for years."

Most AIDS experts agree the only hope of controlling the pandemic of HIV is to develop a vaccine. The virus has killed 25 million people since the early 1980s and infects 33 million people now.

Drugs can control infection but often are expensive, have side-effects and often stop working after a time, forcing patients to switch to new drugs.

© Copyright (c) Reuters

HIV Vaccine Ready for Human Tests

An HIV/AIDS vaccine developed in Canada has passed safety tests in animals and the researchers are awaiting approval to begin human trials in the U.S.

"It is a very important milestone for us," said Yong Kang, a professor of microbiology at the University of Western Ontario in London who has been working on the vaccine for 20 years.

Kang said he expects to get the go-ahead soon from the U.S. Food and Drug Administration to begin human toxicology tests and two phases of clinical trials in the United States.

If all three trials are successful, the vaccine should be available within the next decade, Kang told CBC News on the phone while attending a meeting in South Korea.

According to a 2008 United Nations report on the global AIDS epidemic, 33 million people were living with HIV in 2007. Two million people died of causes related to the disease that year.

Dozens of HIV vaccines have already been developed and tested in animal models, but few have been tested in humans, none successfully. A promising trial in 2007 by pharmaceutical giant Merck and Co. was shut down after those receiving the vaccine contracted HIV at a higher rate than those who received the placebo.

Kang has partnered with a Curacom, a South Korean holding company, that has agreed to open an office in London, Ont., to help fund research in Kang's lab and commercialize the vaccine.

A test vaccine is being manufactured in a lab in Maryland near Washington, D.C.

Lab tests showed the vaccine produced no adverse effects or safety risks during immunology tests on animals.

The toxicology tests are expected to include 40 to 50 HIV-positive volunteers in the U.S., and will be designed to test whether the vaccine is toxic in humans.

http://www.cbc.ca/health/story/2009/07/01/health-canadian-aids-hiv-vaccine-kang.html

Chicago Gay Men Unaware of HIV Poz Status

More than 17 percent of gay men in Chicago have HIV, and 39 percent went untested in the last 12 months because of fear of the results, according to a study of nearly 600 gay men in the city by the Chicago Department of Health, the Chi-Town Daily News reports. The study also found that gay black men had an infection rate that was more than twice the rates of gay white and Hispanic men. Jim Pickett, director of advocacy for the AIDS Foundation of Chicago, said the findings indicate that, "We need to incorporate HIV into a broader or more holistic framework (covering) gay men's health needs from top to toe." The city will formally release the study’s results next week (Parker, Chi-Town Daily News, 6/2).

HIV Cases Among Women in Wisconsin Increasing

While the number of new cases of HIV in Wisconsin has stabilized over the last decade, women now represent more of the overall number of cases, the AP/Chicago Tribune reports (AP/Chicago Tribune, 6/2). According to Mike Gifford, CEO of the AIDS Resource Center of Wisconsin (ARCW), 21 percent of new infections are women, compared with 16 percent in the 1990s and 6 percent in the1980s. Gifford says that women need to be better informed about their risk of contracting HIV. Christina Colon, ARCW's associate director of prevention, said the organization is targeting women's health fairs to raise awareness (Simonson, Wisconsin Public Radio, 6/1).

HIV/AIDS Awareness Campaign in Western North Carolina Addresses Stigma

The Western North Carolina AIDS Project recently launched a media campaign that seeks to raise awareness about the stigma associated with HIV/AIDS and its effect on those living with the virus, as well as the community, the Asheville Citizen-Times reports. The "I Need You to Know" campaign, which will include a set of commercials featuring area residents talking about HIV/AIDS, will serve as a starting point for other prevention efforts (Boyd, Asheville Citizen-Times, 6/3).

Washington, D.C. Officials To Boost HIV Awareness Efforts

The Washington, D.C. HIV/AIDS Administration (HAA) will increase its HIV-related media efforts targeting those at risk for the virus amid a recent finding by the agency that 3% of the district's residents are living with HIV/AIDS, the Washington Post reports. Mayor Adrian Fenty recently committed $500,000 annually for a five-year marketing campaign, Shannon Hader, director of HAA said. Advertising experts say that millions more would be needed in order for the agency to have an "effective" campaign, or that local media, billboard companies and the district's Metro system need to provide more free advertising space, according to the Post. Next month HAA plans to announce a campaign targeting heterosexual couples that will encourage HIV testing (Fears, Washington Post, 6/2).

California HIV Services Center Forced To Close

Declining private and public financial support has forced Vital Life Services, an Oakland, Calif.-based nonprofit that provided support, case management, mental health counseling and other services to roughly 400 low-income and homeless clients with HIV, to shut down, the Oakland Tribune reports. According to the Tribune, the 25-year-old center -- which also provided "unique" services such as daily meals and emergency housing assistance -- "has become a victim of the recession" (Burt, Oakland Tribune, 5/30).

New York Lawmakers Should Pass Bill Capping Amount Low-Income Residents With HIV Pay for Housing, Columnist Says

Some New York City residents with HIV pay as much as 70% of their income on housing because of the financial assistance they receive through the New York City HIV/AIDS Services Administration, New York Daily News columnist Errol Louis writes. According to Louis, lawmakers should pass a bill that would cap the rent contribution of low-income people with HIV/AIDS at 30% of their income, "the standard used for most rent-subsidy programs." The bill is currently before the state’s Assembly Ways and Means Committee. Louis adds that ensuring that people living with HIV are in "stable housing … makes them less likely to run up big taxpayer bills by using public hospital emergency rooms for basic health care." He concludes, "Albany has a choice: do what's cheap and quick in the short run, or do what makes long-term sense and saves lives" (Louis, New York Daily News, 5/31).

HIV Cases in Iowa Increasing

Health officials announced recently that the number of newly recorded HIV cases among Iowans ages 15 to 24 increased by 45% in 2008 to 16, despite the widespread availability of condoms and other prevention methods, the Iowa Press-Citizen reports. In 2008, a total of 128 new HIV cases were reported, which is the highest number recorded since reporting began in 1998. The Iowa Department of Public Health reports that people ages 20 to 29 accounted for 25% of new cases in 2008.

According to the Press-Citizen, unsafe sexual practices among the state's young adult population have contributed to the spread of HIV and the number of sexually transmitted infections. Jeff Meier, associate director of the AIDS Clinical Trial Unit at University Hospitals, said that most of the cases among young people are in the non-student population. "HIV tends to run in circles of poverty, drugs and commercial sex," he said, adding, "There is obviously much less of that in the student population." Meier added that promoting condom use is just a part of a necessary comprehensive prevention strategy.

Randy Mayer -- chief of the Bureau of HIV, STD and Hepatitis at the department of public health -- said that HIV testing at publicly funded sites in the state has decreased since 1992, although HIV prevalence has increased over the same time. For 10 years, about 30% of people in the state have reported ever receiving an HIV test. One reason young people might not be getting tested is a lack of information about cost and availability, the Press-Citizen reports. Tricia Kitzmann, deputy director of the Johnson County health department, said that she hopes to see an increase in testing as the department adheres more closely to state recommendations that encourage frequent HIV testing for the entire population, instead of only populations considered to be high-risk (Carney, Iowa Press-Citizen, 5/11).

Africa Should Manufacture Its Own Antiretrovirals

African countries should produce their own generic antiretroviral drugs in order to continue the fight against HIV/AIDS during the global economic crisis, African Union Commissioner for Social Affairs Bience Gawanas said recently during a conference for health ministers in Ethiopia, Reuters UK reports. "Africa shouldn't just import drugs all the time," Gawanas said, adding, "Most of our HIV/AIDS drugs come from sources outside Africa. How can we be sure this will continue during the financial crisis?"

According to Gawanas, economies in Africa would benefit from the local production of generic antiretrovirals. She added although a large portion of HIV-positive people in Africa do not have drug access, a few countries have made progress in terms of treatment. "Some countries in Africa now have 80% of people with HIV/AIDS on antiretroviral drugs," Gawanas said, adding, "But if there are cuts (in support from donor countries) can that progress continue? We need to mobilize local production" (Malone, Reuters UK, 5/7).

Researchers Developing Pasteurization Technique To Help HIV-Positive Women Breastfeed

VOA News on Thursday examined a project to help HIV-positive women in developing countries breastfeed their infants and reduce the risk of mother-to-child transmission. According to VOA News, some HIV-positive women often face a difficult decision of whether to breastfeed their children, especially in resource-limited countries where formula feeding presents health risks.

In an effort to help make breastmilk safer for infants born to HIV-positive women, Sera Young of the University of California-Davis is working with about 100 women in Tanzania and teaching them to pasteurize their milk at home through flash heating, or a double-boiling method. Young said that "as soon as the water boils, the milk has reached a hot enough temperature -- about 70 degrees Celsius -- to kill all of the HIV but maintain most of the integrity of the nutrients and the immunological properties." She adds that she hopes to learn whether women would be willing and able follow every step in the technique. According to Young, she has observed that women are able to follow it but added that women who feared revealing their HIV-positive status had more issues with the process, as people wondered why they were boiling their breastmilk.

According to Young, although the World Health Organization recommends that HIV-positive women self-pasteurize their milk, it previously was not known whether women found it feasible or acceptable to do so. She noted that researchers are planning to conduct a large clinical study that will provide the "statistical power to look at the differences between those children who received flash-heated milk and those who haven't," adding that knowing the health implications is crucial for HIV-positive women and their children (Hoban, VOA News, 5/7).

HIV Cases Increasing in Britain, UNICEF Report Says

Recent figures from UNICEF indicate that Britain recorded 7,734 new HIV cases in 2007 -- almost twice the number of cases recorded around 2000 -- London's Metro reports. According to the report, Britain has double the number of recorded HIV cases than any other Western European country. Metro reports that the country now has a record number of 77,000 HIV-positive people and that more than one-quarter of people living with the virus are unaware of their status. The highest numbers of new cases in 2007 were recorded among men who have sex with men and immigrants from sub-Saharan Africa, according to UNICEF. The group's United Kingdom executive director, Anita Tiessen, said that the increase in cases is not "simply a case of people coming here with HIV -- there's a behavior issue."

One in 10 new HIV cases in 2007 was recorded among young people ages 16 to 24, and this group also accounted for nearly half of the 40,000 new sexually transmitted infection cases recorded that year. More than four in 10 new HIV cases were recorded among MSM, and Metro reports that cases recorded among this group continue to increase. Tiessen said that Britain's "sizeable" immigrant population from sub-Saharan African might be contributing to the country HIV/AIDS figures; however, she added that sexual behavior among young people also is a key factor and urged government officials to lead "youth-friendly" prevention campaigns. The Department of Health said it will continue funding for organizations such as the Terrance Higgins Trust and the African HIV Policy Network, which target at-risk groups such as MSM and immigrants (Attewill, Metro, 5/7).

Eliminate HIV

‘UNIVERSAL VOLUNTARY HIV TESTING WITH IMMEDIATE ANTIRETROVIRAL THERAPY AS A STRATEGY FOR ELIMINATION OF HIV TRANSMISSION: A MATHEMATICAL MODEL’

In November 2008, an article was published in the renowned medical journal, the Lancet. The article is co-authored by Reuben Granich, Kevin de Cock and Charlie Gilks. The authors of the article are leading members of World Health Organization (WHO) HIV and TB team, but the study is an independent work that has not been endorsed by the WHO. Based on computer modeling, the authors argued that universal HIV testing, followed by the immediate initiation of ART for those who were HIV-positive, could virtually eliminate HIV transmission in the future and reduce the number of people developing AIDS by 95%.

The article aroused heated debate amongst HIV activists, healthcare workers, scientists and officials at organizations like UNAIDS and the World Health Organization (WHO). The debate focused on the human rights implications of the implementation of universal mandatory testing, the potential criminalisation of HIV transmission, and the lack of consideration given to the negative outcomes proven to be associated with universal mandatory HIV testing. However debaters agreed that it is essential that new information that presents the possibility of a solution to HIV epidemic must be seriously considered and researched.

The WHO will hold a consultation in Geneva to discuss the implications of the article. From 28 – 30 April, TAC representatives attended a meeting organized by the AIDS and Rights Alliance of Southern Africa (ARASA) and the Open Society Initiative for Southern Africa (OSISA) in Johannesburg to discuss the article and to formulate a position with other Southern African HIV activists. This position will be presented at the WHO meeting in Geneva. TAC’s briefing on the article is being finalized, and district workshops are planned to discuss the contents of the article and the responses of TAC members to the strategies it proposes. Please click here for TAC’s full brief and response.

HIV-Positive People at Increased Risk of New Flu Strain

HIV-positive people worldwide are at an increased risk of the H1N1 flu strain, the World Health Organization said on Saturday in guidelines for health workers published on its Web site, Reuters India reports. According to WHO, people with immodeficiency diseases, such as HIV/AIDS, likely will be vulnerable to complications related to the flu strain, just as they are from the seasonal flu, which results in about 250,000 to 500,000 deaths annually. According to WHO, the H1N1 strain and HIV could prove to be a hazardous combination, similar to HIV and tuberculosis. "Although there are inadequate data to predict the impact of a possible human influenza pandemic on HIV-affected populations, interactions between HIV and A(H1N1) influenza could be significant," WHO said, adding that HIV-positive people "should be considered as a high risk and a priority population for preventive and therapeutic strategies against influenza, including emerging influenza A(H1N1) virus infection."

According to WHO, countries with high HIV/AIDS burdens, many of which are in Africa, should ensure that vulnerable people have drug access, including to medicines such as Tamiflu and Relenza. The agency added that it is best if people with the flu strain take antiviral drugs within 48 hours of the onset of symptoms. In addition, there are no known issues with taking flu medications with antiretroviral drugs, according to WHO (MacInnis, Reuters India, 5/2).

Life Insurance for HIV-Positive People

The insurance company Prudential will begin to offer life insurance policies to HIV-positive people in the United Kingdom, London's Daily Telegraph reports. According to the Telegraph, PruProtect -- a partnership between Prudential and a South African firm -- initially will offer the insurance to 7% of HIV-positive people and hopes to extend coverage to 20% of HIV-positive people. The policy will offer up to 250,000 British pounds -- or about $368,000 -- for a maximum of 10 years. The policy premiums will be higher than standard premiums for life insurance "to accurately and fairly reflect the risks involved." Premiums will be determined on an individual basis and dependent on medical history, the Telegraph reports.

Kevin Carr, director of protection development at PruProtect, said, "We are pleased to be the first mainstream insurer to provide life cover for people living with HIV," adding "I believe it is better to provide some cover for some people than nothing at all." The Terrence Higgins Trust said, "We welcome this move from PruProtect and are glad to see an insurer who recognizes the reality of living with HIV in the U.K. in the 21st century." The group added that it "hope[s]" the program "will be the start of a wider move to offer appropriate financial products to people with HIV" (Simon, Daily Telegraph, 4/29).

Australia Harm Reduction Strategies Serve as Model for Other Countries

The Australian government's efforts to curb the spread of HIV by advocating harm-reduction initiatives, such as needle-exchange programs and drug substitution therapy, for injection drug users serve as a model for other countries throughout the region, UNAIDS Asia Pacific Director Prasada Rao said recently, the AAP/Sydney Morning Herald reports.

Rao said that Australia has called on Asian states to increase harm-reduction programs and examine current drug laws, especially in those states where penalties for drug users can include the death penalty. Rao said, "Australia is a good model for harm reduction programs and also for looking at drug laws and revamping them. In fact, quite a few countries in Asia have learned their harm reduction strategies in good examples from Australia." Parliamentary Secretary for International Development Assistance Bob McMullan said that it is still possible for countries to adopt effective prevention and harm reduction strategies to combat HIV without encouraging drug use. He said that a "very big important part of the Australian government policy" is working "strongly" with drug users. He added that "in terms of reducing the spread of HIV, we have to focus on prevention." Rao's comments came as McMullan announced an additional 640,000 Australian dollars, or about $470,000, for nongovernmental organizations working in Asia (Corben, AAP/Sydney Morning Herald, 5/3).

HIV-Positive People in Wales Denied Treatment

Some HIV-positive people in Wales are being denied medical treatment for common illnesses, Olwen Williams, a physician specializing in sexually transmitted infections, said recently, BBC News reports. Williams noted that primary care physicians often refer HIV-positive people to hospitals or HIV specialists for common conditions, such as colds.

The British Medical Association denied that physicians are discriminating against people living with HIV/AIDS and said that some physicians might be more cautious in referring HIV-positive people to specialists. However, Williams said that HIV-positive people are experiencing "very subtle" discrimination, adding that they might disclose their HIV status to a provider and be told they need to visit their HIV specialist. "If I was someone with cancer and I went to a [PCP] with common cold and I was told, 'Sorry, I can't deal with that' because I've got cancer I'd be so amazed -- that's what our patients our experiencing," Williams said, adding that such practices "den[y]" care to HIV-positive people "at a point where they actually need it." Williams added, "My concern here is that we've still got fear and prejudice and ignorance that's actually driving discrimination and stigma in Wales. And I think this is something major that we have to tackle."

Andrew Dearden, chair of the British Medical Association's Welsh council, said it is "unprofessional and unethical" for physicians to discriminate because of an illness. Dearden added that some physicians might not feel they have adequate training to treat some conditions. "Remember that doctors always refer patients to other doctors ... when they feel there's a need for extra information, diagnosis, tests or treatment," Dearden said. A recent study found that about half of HIV-positive people in the United Kingdom had experience discrimination from a health worker in the previous year, according to a spokesperson from the Terrence Higgins Trust (BBC News, 5/1).

Economic Downturn Likely To Threaten HIV Treatment

IRIN/PlusNews on Wednesday examined a World Bank report published last week that suggests the current economic downturn could threaten antiretroviral treatment access for about 1.7 million HIV-positive people by the end of 2009. According to the report, developing countries could face drug shortages, treatment interruptions and an increase in HIV prevalence as a result of the global economic situation.

According to IRIN/PlusNews, the downturn is likely to have the greatest impact on programs in Southern and Eastern Africa. In addition, many HIV/AIDS programs in this region are heavily reliant on donor funding and have limited support from local governments, IRIN/PlusNews reports.

Joy Phumaphi, World Bank vice-president for human development, said that "[s]ocial services are likely to suffer as governments cut back on spending, currencies devalue and external aid donors come under pressure to maintain existing levels of foreign assistance." Tanzania this year announced plans to reduce its national HIV/AIDS budget by 25%, and similar actions in Kenya and Sudan already have led to medical supply shortages. According to the report, funding reductions might lead countries to reduce emphasis on prevention programs and instead allocate money for treatment initiatives, which produce short-term, easily measurable benefits. According to IRIN/PlusNews, groups such as commercial sex workers, injection drug users and men who have sex with men will likely be the hardest hit by reductions in prevention programs.

Although many countries will face difficult choices during the economic downturn, the report recommends that nations receiving substantial amounts of international assistance use early warning systems to identify any potential drug and funding shortages and avoid treatment interruptions (IRIN/PlusNews, 4/29).

The report is available online (.pdf).

Early HAART Initiation Improves Vaccine Response Among HIV-Positive Children

HIV-positive infants who begin treatment with highly active antiretroviral therapy within the first year of life can develop normal immune responses to childhood vaccines, according to a study published online Monday in the Proceedings of the National Academy of Sciences, Reuters Health reports. Vaccines function by stimulating the production of antibodies for a particular disease, but HIV causes a decline in these antibody-producing cells and therefore reduces immunity. Prior to the new study, researchers were unsure whether the timing of HAART initiation could help preserve these cells and promote normal immune responses to vaccines among children.

For the study, Paolo Rossi of the University of Tor Vergata in Rome and colleagues examined 70 children who contracted HIV through mother-to-child transmission and 50 HIV-negative control participants. Of the HIV-positive children, 13 received HAART during their first year, six received no treatment and the remaining children received therapy later in life. All of the children in the study group received the recommended vaccinations for measles and tetanus. According to the study's findings, children who received HAART during their first year maintained normal levels of antibody producing cells, while children in the other groups had lower levels of these cells.

According to Rossi, the timing of HAART initiation is a key factor in determining whether HIV-positive children will develop normal vaccine responses and how long the response will last. The authors write that their findings support early HAART initiation for the purpose of preserving normal immune responses among HIV-positive infants. However, they add that health officials might need to revise vaccine schedules for HIV-positive children who begin treatment after the first year of life (Reuters Health, 4/29).

An abstract of the study is available online.

HIV becoming more virulent?

A study in the May issue of Clinical Infectious Diseases found a decline in the initial CD4+ T cell counts reported at diagnosis among some HIV-positive people in the U.S. from 1985 to 2007 -- a finding that suggests HIV may be adapting and becoming more virulent -- Reuters reports. The report analyzed data for 2,174 HIV-positive people who were enrolled in the TriService AIDS Clinical Consortium HIV Natural History Study. None of the participants previously had taken antiretroviral therapy, and all had their CD4+ cell counts measured within six months of HIV diagnosis.

The average initial CD4+ cell counts during the periods from 1985 to 1990, 1991 to 1995, 1996 to 2001, and 2002 to 2007 were 632, 553, 493 and 514, respectively. According to the report, the percentage of subjects with initial CD4+ cell counts less than 350 were 12%, 21%, 26% and 25%, respectively, during the same periods. Similar CD4+ cell count reductions were seen in black and white participants, and the report also noted that similar trends were seen in the CD4+ cell count percentage and the total lymphocyte count. Lead author Nancy Crum-Cianflone of the Naval Medical Center-San Diego said the study's findings "agree with those of other investigators" who report that "patients starting HIV care more recently may be presenting with lower initial CD4+ cell counts and requiring antiretroviral therapy initiation earlier in the disease course."

In an accompanying editorial, Maria Dorrucci of Rome's Istituto Superiore di Sanita and Andrew Phillips of London's University College Medical School write that although some current studies suggest that HIV virulence is rising, there have been other studies that report either stable or declining HIV virulence. Dorrucci and Phillips write that the differences may relate to how virulence is determined and that "it is unclear whether simple immunological or virological proxies for virulence can be expected to adequately capture the whole complexity of HIV virulence and host susceptibility" (Reuters, 4/15).

An abstract of the report is available online. A citation of the accompanying editorial is also available online.

Africa Should Manufacture Generic HIV/AIDS Drugs

Africa should produce its own generic antiretroviral drugs in order to fight HIV/AIDS and ensure that the global financial crisis does not hinder treatment access, UNAIDS Executive Director Michel Sidibe said on Wednesday in Addis Ababa, Ethiopia, Reuters reports. "We should facilitate a discussion around how we can build a business case for producing generic drugs in Africa so that it can increase coverage but can, at the same time, be a profitable business," he said, adding, "It's important politically, it's important economically, it's important for the integration of Africa in the global market."

According to Sidibe, increased production of generic drugs in Africa needs to occur soon because most people living with HIV on the continent do not have drug access. He said that during his tenure as UNAIDS executive director, he will focus on ensuring universal drug access worldwide. Sidibe added that the current economic situation could hinder this goal. "Governments need to start anticipating minimum spending on social services so we don't have a breakdown in our respective systems," he said, adding, "My worry about the crisis is that if we are not careful, we could face a breakdown in our caring society"

New Jersey Legislature Examining Ways To Avoid HIV/AIDS Medication Copayments in State Budget

New Jersey lawmakers on Tuesday indicated that they are examining ways to avoid proposed co-payments for some people living with HIV/AIDS who receive medications though the state, NorthJersey.com reports. The copayments are part of Gov. Jon Corzine's (D) $29.8 billion spending proposal for the state's new fiscal year and would collect $1.36 million by creating co-payments for HIV/AIDS drugs based on a sliding scale determined by income (Reitmeyer, NorthJersey.com, 4/21). The copayments would affect 9,000 people living with HIV/AIDS who have obtained no-cost medicine from the state because they do not qualify for other assistance programs. Advocates said that the copayments will hurt patients who are already struggling because of the poor economy (Kaiser Daily HIV/AIDS Report, 3/26).

According to NorthJersey.com, Heather Howard, commissioner of the state Department of Health and Senior Services, met with the Assembly budget committee to review the agency's spending plan and policies. During the meeting, committee Chair Lou Greenwald (D) suggested that state funding for a transportation program that benefits HIV-positive people could be pulled instead of implementing the proposed copayments. Howard said that the department is willing to examine all possibilities. The copayments would not be assessed for the largest group of patients who benefit from the state program because of their low incomes. The proposal is part of a larger effort by Corzine to remove $3 billion in spending from the budget that the Legislature approved in 2008. The Legislature has until June 30 to pass a balanced budget (NorthJersey.com, 4/21).

HIV/AIDS in Washington, D.C., a Critical Issue

The recent report that 3% of Washington, D.C., residents are living with HIV/AIDS "evokes an array of reactions that speak to the complexity of this compelling public health issue," Guy Weston -- former director of Data and Research at the district's HIV/AIDS Administration -- writes in a Washington Informer opinion piece. He adds that the statistic is "'quite serious'" when one realizes that it "translates into life-altering impact on 15,120 district residents," their spouses, partners and family members. The district's HIV/AIDS rate is a "critical issue for a significant proportion of [the city's] population," Weston writes, adding that the report "tells us that the highest rates of HIV are among residents aged 40 to 49 and among African-American male residents."

It also is "critical to confront findings of the city's report that frequently escape public discourse," Weston writes, adding that heterosexual sex "is emerging as the leading mode of HIV transmission in recent years, according to the report's analysis." He notes that this "becomes a sticky subject in the world of HIV funding and politics, where discussions of the dynamics of HIV transmission frequently lead to stigma and blame. The fact that such findings affect resource allocation complicates the discussion further." Weston adds that there is no data to suggest that "one transmission mode ... is the primary transmission mode to the exclusion of all others." Therefore, "HIV prevention messages that exclude potential transmission modes will not effectively protect our communities from HIV," he writes. He adds that there is a "'modern, generalized and critical' epidemic that affects a number of populations, albeit in different proportions," concluding, "In addition to the health department's promotion of early testing and condom availability, we, as affected communities, must deal with the message of statistics frankly, so that persons at risk can feel vulnerable enough to know that the testing and condom messages apply to them" (Weston, Washington Informer, 4/16).

HIV Infection Rates in Minnesota Rising

Minnesota saw an increase in the number of newly reported HIV cases in 2008 to 326, the Minnesota Department of Health reported Wednesday, the Minneapolis Star Tribune reports. According to the Star Tribune, it was the third consecutive annual increase in newly recorded HIV cases. Peter Carr -- director of the sexually transmitted infections and HIV section of the department -- said that Minnesota has had an average of 320 new cases reported for the last three years, up from an average of 300 in 2001.

According to the Star Tribune, the increase in the number of cases among men ages 13 to 24 and men who have sex with men is causing concern among public health officials. Young men accounted for 42 new cases in 2008, up from 18 in 2002. Some health experts point to better HIV treatment, which has led some people to believe that the disease is manageable, and apathy toward the disease as a reason for the increase. According to the report, minorities are disproportionately affected by HIV/AIDS, with minority men, who represent 12% of the male population, accounting for 39% of new cases among all men. Minority women, who make up 11% of the female population, accounted for 70% of new cases among all women, according to the report. Carr said, "Socioeconomic status appears to be the most important factor in communities and neighborhoods where higher rates" of HIV were reported, adding that low economic status could result in a lack of insurance and limited access to health care, among other factors such as homelessness and stigma.

The report also showed that the number of HIV cases among immigrants has increased from 19 in 1990 to 62 in 2008, driven mostly by an increase in African-born immigrants and immigrants from Central and South America, the Star Tribune reports. An estimated 6,220 people are living with HIV in the state, health officials said, adding that there could be an additional 2,000 people who are unaware of their HIV-positive status (Marcotty, Minneapolis Star Tribune, 4/15).

Canadian Prison Tattoo Program Reduced Risk of HIV

A Canadian prison tattoo parlor program that was canceled by the government was cost-effective and successful in raising awareness and reducing the risk of bloodborne diseases such as HIV and hepatitis C, according to a new report from the Correctional Service of Canada, the Alberta Daily Herald-Tribune reports. The 70-page report -- dated January 2009 but just publicly released -- said that early results of the federal pilot program "indicate potential to reduce harm, reduce exposure to health risk, and enhance the health and safety of staff members, inmates and the general public." The program -- which cost about one million Canadian dollars, or about $820,000 -- was launched at six federal prisons across Canada in 2005 but was canceled by then Public Safety Minister Stockwell Day in 2006. According to the Herald-Tribune, the move was hailed by some taxpayers and other groups but condemned by prisoners' advocates, who argued the decision was made based on ideology rather than pragmatism.

Among its 11 key findings, the report said that under the program, there was a reduction in seized tattoo contraband and "illicit" tattooing in medium-security prisons, which suggests a decreased risk of contact with previously used needles. Additionally, the report said that cost of the program was "low" when compared with its potential benefits and that it provided work skills that could be used in the community after inmates are released. Although there are some issues related to the program's implementation -- such as providing sufficient skill level, training and availability for the sessions -- the report concluded that the program was "consistent with the goals and objective of the federal initiative to address HIV/AIDS in Canada." The prevalence of HIV is 10 times higher in Canadian prisons than in the general population, and the prevalence of hepatitis C is 20 times higher, the Canadian HIV/AIDS Legal Network said. Christopher McCluskey, a spokesperson for Public Safety Minister Peter Van Loan, said the federal government has no intention to reinstate the program. He said CSC "continues to provide education and information to inmates on the risks of disease transmission from needles for drugs or any other purpose" (Harris, Daily Herald-Tribune, 4/15).