The Friends of AIDS Foundation Community Journal: July 2012

Monday, July 30, 2012

HIV Vaccine Trial Seeks Participants

Men who have sex with men - ages 18-50, HIV-negative and circumcised - and transgender women are being recruited for an HIV vaccine trial at Case Western Reserve/University Hospitals AIDS Clinical Trials Unit.

Cleveland is one of 18 sites nationwide taking part in the research, which began in early 2011 and is being conducted by the HIV Vaccine Trials Network. The trial is testing the safety and efficacy of a combination of two HIV vaccines to see if they stimulate an immune response or decrease the viral load of participants who later become infected. Neither vaccine can cause HIV infection.

For more information, telephone Outreach Coordinator Bob Bucklew at 216-844-4444, e-mail info@case.edu, or visit www.hopetakesaction.org.

The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals and empowering people to make healthy choices to prevent the spread of the HIV virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.

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Call for Syringe Programs in Prisons to Curb Swell of Virus

A man is preparing to sue Victoria for failing to protect him from hepatitis C while he was incarcerated in one of the state’s prisons.

More than 40 percent of prisoners have hepatitis C, and drug use continues behind bars. Philip Lynch, director of the Human Rights Law Center, said it is only a matter of time before an inmate prevails in a suit saying prisons and the government exposed him or her to infectious diseases. Inmates could argue that a failure to provide clean needles and syringes violates the state’s common-law duty of care and obligations under the Victorian Charter of Human Rights and Responsibilities, he said.

“These are not frivolous arguments,” Lynch said. “We’ve been advised by leading senior barristers and law firms on the merits of this.”

“It’s a big problem ... prisons are basically a hot-bed for viral transmission,” said John Ryan, chief executive of Anex, a group working on harm reduction with prominent scientists Sir Gustav Nossal and Professor Peter Doherty.

Victorian prison officials provide bleach for inmates to clean syringes. But Dr. Mark Stoove, head of HIV, AIDS and STI research at the Burnet Institute, called this inadequate, noting studies show bleach only reduces the risk of hepatitis C transmission by 65 percent.

“The provision of bleach acknowledges drugs are entering prisons and that injecting is occurring ... so the question is do you provide this half-measure to protect people’s health, or do you provide the evidence-based response, which is clearly prison-based needle and syringe programs,” said Stoove.

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AIDS Rise in Uganda Shows Need for More Resources

Almost 260,000 people with HIV/AIDS in Uganda are being treated by the US President’s Emergency Plan for AIDS Relief program launched by President George W. Bush in 2003 - treating nearly half of the 600,000 in need of antiretrovirals there. PEPFAR, said Dr. Stella Talisuna, has enabled thousands of Ugandans to “get back on their feet.”

Concurrently, however, new government data show HIV prevalence in Uganda has risen from 6.4 percent in 2004 to 7.3 percent in 2011. The number of Ugandans with HIV has increased two-fold since 2004, from 1.2 million to 2.4 million.

Critics say Uganda’s past success in reducing the HIV infection rate has been undermined by a shift in focus from prevention to treatment. Ugandans “now see AIDS as much more like diabetes, one of these chronic diseases you can live with indefinitely,” said well-known social critic Timothy Kalyegira. Official figures show Uganda’s rate is rising primarily because people are having multiple sex partners.

Years ago, Uganda rolled out the “ABC” HIV prevention policy: abstain, be faithful, or use condoms. A generation of students watched videos on how AIDS ravages the human body, and they were encouraged to postpone first intercourse.

“There is need for continuous dissemination of information,” said Joshua Musinguzi, head of the country’s AIDS control program. “Individuals have the power to make the correct decision if they want to. The menu is there: ABC.”

Meanwhile, US officials are pressing Uganda to devote more of its own resources to AIDS and other health issues, noting that dependency on foreign donors is unsustainable in the long term. Country coordinator Michael Strong said PEPFAR is scheduled to transition from service delivery to technical assistance, and Ugandan officials must step up their role going forward.

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Study Cites Benefits of Early AIDS Treatment

Starting antiretroviral therapy (ART) earlier rather than later is cost-effective and helps prevent AIDS-related illnesses, according to two studies presented at the 19th International AIDS Conference in Washington. The studies add to a body of evidence that already suggests early treatment initiation improves patient health outcomes and can help prevent onward transmission.

The first study followed HIV patients in South Africa and India over a period of five years or longer. One group began treatment early, when the immune system CD4 cell counts were 350-550. The other group began treatment later, once the CD4 count dipped below 250.

Over the long term, starting treatment earlier was cost-effective in both countries, researchers found. That meant the cost to save one life was less than one time the gross domestic product per capita.

“Early ART is a triple winner,” said study leader Rochelle Walensky of the Harvard Center for AIDS Research. “HIV-infected patients do better, their partners are protected and it is very cost-effective.”

The second study found that patients treated earlier also had fewer cases of TB and other AIDS-related illnesses, such as certain bacterial infections and herpes. Those conditions that did turn up were not as quick to develop as in the delayed-treatment group.

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Clinton Tells HIV Activists to Press On: Cites More Research, Financing for Effort

Former President Bill Clinton rallied activists to press on and not give up as he delivered closing remarks Friday at the 19th International AIDS Conference in Washington.

“You should be really excited by this moment,” Clinton said. “We will do well as long as we refuse to let what we don’t have slow us down.” Eight million people are now receiving HIV drugs, and the ability exists to treat millions more, he said.

Clinton launched the Clinton Health Access Initiative in 2002 to help address HIV/AIDS in the developing world. On Friday, CHAI reported on a study showing that HIV treatment costs in four African countries have dropped to about $200 per patient per year - a figure that includes expenses for testing, drugs, and health care staff. These results indicate that universal access to high-quality HIV treatment is “achievable, sustainable, and within our means,” the former president said.

UNICEF Goodwill Ambassador Whoopi Goldberg warned of the global threat of TB, particularly for those co-infected with HIV. “To end AIDS, we have to join together to tackle TB and HIV as one disease,” she said.

Rep. Nancy Pelosi (D-Calif.), the House minority leader, warned that it is a “false economy” to cut AIDS funding because “it costs us more in the future.” She said she will fight to maintain AIDS resources, and she added that the US Affordable Care Act will provide significant protection to those living with HIV.

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Most HIV-Positive Americans Lack Regular Care

Only 25 percent of Americans with HIV have their virus under control, according to a CDC report released Friday at the 19th International AIDS Conference in Washington. African Americans and younger people are least likely to be in regular care and treatment, CDC said.

[PNU editor’s note: Among African Americans with HIV, 81 percent have been diagnosed; 34 percent are retained in care; 29 percent have been prescribed antiretroviral therapy; and 21 percent are virally suppressed, CDC reported.]

Among Americans ages 25-34 who have HIV, 72 percent have been diagnosed; but only 28 percent receive regular care and 15 percent are virally suppressed.

“We’ve got to do better,” said Dr. Jonathan Mermin, director of CDC’s Division of HIV/AIDS Prevention. More widespread HIV testing is critical, and it needs to be easier to link those infected directly to care and make sure they stay there, he said: “I want to make the healthy choice the easy choice.”

Programs to retain patients are not working or are not plentiful enough, the report said.

“We need to reverse-engineer; we understand how many other countries are doing this better and often with US tax dollars,” said Nancy Mahon, chair of President Barack Obama’s Advisory Council on HIV/AIDS and global executive director of the MAC AIDS Fund (MAF).

Toward that end, MAF announced its support of joint efforts with the US Department of Health and Human Services to improve retention in HIV care. These efforts include UCARE4LIFE, a two-year mobile texting pilot program in the South sending disease-management reminders and tips. Another is a forum to explore successful programs, including US overseas efforts.

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Saturday, July 28, 2012

Cancer Drug Flushes Out Lurking AIDS Virus: Study

In a tentative first step toward a possible AIDS cure, US researchers have used the cancer drug vorinostat to revive and unmask latent HIV in clinical trial patients’ immune cells. The ability of the HIV genome, or reproductive code, to hide out in cells only and revive after decades has posed a major obstacle to a cure. Exposing the virus in its hiding place would allow scientists to target and destroy its host white blood cells: CD4+T cells.

According to David Margolis, co-author of the study, “This is proof of the concept, of the idea that the virus can be specifically targeted in a patient by a drug, and essentially opens up the way for this class of drugs to be studied for use in this way,” he said in an interview at the 19th International AIDS Conference.

The eight patients in the clinical trial were also on antiretroviral drugs, which stop HIV from multiplying but have to be taken for life because they do not kill the hidden cells. “After a single dose of the drug, at least for a moment in time, [vorinostat] is flushing the virus out of hiding,” Margolis said. It is the first drug to do so.

Although the virus would die without a host cell, Margolis added, “If it is only 99 percent true and 1 percent of the virus escapes, it won’t succeed. That is why we have to be careful about our work and what we claim about it.”

In published comments, HIV researcher Steven Deeks said that while promising, the study raises ethical concerns about giving potentially toxic drugs to HIV-infected people who are otherwise healthy. Also, HIV immunologist Quentin Sattentau said other types of reservoir cells, including those in the brain, may not respond to this treatment.

The study, “Administration of Vorinostat Disrupts HIV-1 Latency in Patients on Antiretroviral Therapy,” was published in Nature (2012;487:482-485).

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Studies Back Circumcision, but Obstacles Remain

Three studies have shown that male circumcision can reduce female-to-male HIV infection by 60 percent, but barriers remain to the procedure’s adoption in Africa, where it would do the most good.

Circumcision itself is simple and getting simpler. Research shows nurses can perform it safely after three days of training, and it can be done assembly-line-style with devices requiring no scalpels or stitches. However, some countries forbid task-shifting from doctors to less-expensive medical workers. In Uganda, it would take an act of parliament to authorize nurses to do it, said Angelo Kaggwa, a Ugandan working with AVAC, an advocacy organization.

In addition, many ethnic groups have cultural traditions against male circumcision and, for adult men, healing requires sexual abstinence for six weeks. Since circumcision is only partially protective, preventive measures - such as using condoms - are still necessary.

Circumcision efforts are increasing in 14 African nations, where international health agencies hope to reach 80 percent of males ages 15-49 by 2015, or 20 million men. Just 1.5 million circumcisions have been conducted in the five years since the World Health Organization recommended the procedure in countries hard-hit by AIDS.

The costs are $65-$95 per procedure, in addition to about $60 for health system overhead.

Studies show men are willing, and circumcision uptake has boomed at trial sites: Of men not randomly assigned to be circumcised in a trial in Nyanza province, Kenya, 50 percent opted to have the surgery within five years after the study, and follow-up since shows it reduced their infection risk by 65 percent. In Orange Farm, South Africa, circumcision prevalence grew from 17 percent to 54 percent in the past three years. Researchers estimate HIV prevalence there would be 20 percent higher without such uptake, and that more than 1,000 infections were averted.

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Scientists Making Progress on AIDS Vaccine, but Slowly

On Wednesday at the 19th International AIDS Conference, the director of the Duke University School of Medicine’s Human Vaccine Institute reported on the discovery of a series of “Achilles heels” on the surface of HIV - developments that have reignited the search for an AIDS vaccine.

“We know the face of the enemy now,” Bart Haynes said. “We have some real clues about how to approach the problem.” He detailed several key challenges that have made developing a vaccine so difficult.

Because HIV is a retrovirus, Haynes said, it does not simply infect the body: It inserts itself into a cell’s genome. “An HIV vaccine must totally prevent infection,” he said. “Once infection occurs, the virus inserts into the genome, and the immune system can’t kill it.”

In addition, though the body tries to defend itself, it cannot keep up with rapid pace at which HIV mutates. To be effective, an HIV vaccine would have to stimulate the production of broadly neutralizing antibodies to attack the virus regardless of its mutations.

Haynes said scientists have discovered potential weak points on HIV that appear to stay the same, even as the virus mutates. These could become the targets for vaccines.

Another issue, according to Wayne Koff, chief scientific officer of the International AIDS Vaccine Initiative, is HIV’s ability to hide itself and confuse the immune system. This raises the risk that a vaccinated person’s body would produce the proper antibodies, but that these would be unrecognized by the immune system and marked for elimination.

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Research Studies Renew Hope for a 'Functional Cure' for AIDS

Studies detailing three different approaches are offering hope that a cure for AIDS is on the horizon. All involve procedures or treatments that are already in use, but await further research to see if they can deliver as a cure.

Stem-cell transplantation, an expensive procedure with its own risks, was the method used for the only person believed to have been cured of HIV infection. Timothy Brown received the treatment in Germany for leukemia. His physician purposefully chose a donor who carried a rare mutation that made cells resistant to HIV infection. When Brown recovered, he had no detectable virus.

In research presented Thursday to the 19th International AIDS Conference (IAC) in Washington, two other similar cases involved lymphoma patients. The chemotherapy they had received was less aggressive than that given Brown, and more of their immune cells remained. The transplanted cells appear to have tracked down these cells, some of which were HIV-infected, and destroyed them in a reaction called “graft vs. host disease.” No HIV could be grown out of one patient’s blood 3.5 years later, or from the other patient’s blood almost two years later, reported Timothy J. Henrich and Daniel R. Kuritzkes of Harvard Medical School.

A second strategy involved treatment immediately after infection. In a study presented at IAC by Charline Bacchus and Asier Saez Cirion of the Pasteur Institute in France, 14 patients had initiated a standard three-drug HIV treatment regimen within weeks of infection, then stopped taking them three years later on average. After an average of six years off the drugs, the patients still have little or no detectable HIV in their blood.

The patients do have virus in some sleeping immune cells, but not the long-living type. The patients also lack the usual genetic profile of “elite controllers.” One theory is that treatment had begun so early the infection did not have enough time to take residence in various tissues.

A third strategy is called “shock and kill” and involves flushing HIV from sleeping cells with an existing cancer drug, destroying the reservoirs of the virus.

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Aging AIDS Epidemic Raises New Health Questions

Numerous studies presented at the 19th International AIDS Conference (IAC) show that as people live longer with AIDS, they may confront other health challenges, such as premature aging and an increased risk of heart disease. Also, older people are being newly diagnosed, a trend US health officials say is small but slowly growing.

One-third of the nearly 1.2 million people living with HIV in the US are over 50, and by 2020 half will be, said Dr. Kevin Fenton, director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention. People 50 or older accounted for 17 percent of new HIV diagnoses in 2009, up from 13 percent in 2001, according to CDC data.

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases said that people who are currently diagnosed and treated early can expect a near-normal life span. However, studies suggest that people with HIV/AIDS may be at higher risk for the chronic illnesses of aging, or may experience them earlier.

For example, scientists at Massachusetts General Hospital found evidence linking HIV and higher risk of heart disease due to artery inflammation - increasing the risk for blood clots that trigger heart attacks, even when the virus was well-controlled and patients were not very old.

Fenton explained: HIV triggers body-wide inflammation to help fight the virus, a process that persists and can quietly damage organs even with good medication. Dr. Amy Justice of Yale University pointed to data from a Veterans Affairs study that showed older people with HIV use more medications for other diseases than their counterparts without HIV.

At the IAC, some older people living with HIV participated in a web-based project called “The Graying of AIDS” to share their knowledge and stories.

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L.A. County Voters to Cast Ballot on Condoms in Porn

In a 3-1 vote Tuesday, the Los Angeles County Board of Supervisors approved a ballot initiative that will let voters decide whether adult-film actors must wear condoms during sex scenes.

The measure would require porn producers to get county-issued health permits; the fees from the permits would be used to cover enforcement costs.

More than 371,000 signatures were gathered to get the initiative, which has the backing of the AIDS Healthcare Foundation, on the ballot in November.

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$2M Slated for Puerto Ricans with HIV/AIDS

More than $2 million in federal funds is headed to Puerto Rico to help patients on a waiting list for AIDS drug assistance.

More than 44,000 people among the island’s nearly 4 million residents have been diagnosed with HIV/AIDS; it is unclear exactly how many are waiting for medication. Resident Commissioner Pedro Pierluisi said Tuesday the money will go to help individuals who lack health insurance.

The US territory recently received $17 million to expand HIV treatment and prevention programs in metropolitan areas.

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B.C. AIDS Doctors Join International Chorus Targeting the 'War on Drugs'

In an international campaign launched during the 19th International AIDS conference, two Canadian doctors are calling on world leaders to stop the spread of AIDS by ending the so-called “war on drugs.”

The British Columbia-based AIDS specialists, Drs. Evan Wood and Julio Montaner, joined British billionaire Richard Branson and former presidents of Brazil and Columbia, among others, in asking world leaders to show “leadership,” “courage” and “to do the right thing.” Wood said that while HIV infections rates are falling globally, they appear to be rising in countries with aggressive policies for prosecuting drug-related crimes.

The campaign is endorsed by supporters of the 2010 Vienna Declaration, which urges governments to craft evidence-based drug policies.

Injection drug use accounts for one-third of new HIV infections outside sub-Saharan Africa, according to the B.C. Center for Excellence in HIV/AIDS and the International Center for Science in Drug Policy.

“I think globally we’re seeing a real shift in terms of public opinion and a recognition that addiction should be treated more as a health issue rather than a criminal justice issue,” Wood said.

Wood argued that the war on drugs spreads HIV by forcing addicts into hiding and away from health officials. He noted that HIV is spreading among prison inmates who inject drugs.

Discussions about law enforcement and drugs, including such issues as mandatory minimum prison sentences and the decriminalization of marijuana, have been active in Canada recently. At the Summit of the Americas in April, Canadian Prime Minister Stephen Harper agreed the current approach is not working.

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AIDS Experts: Focus on Pregnant Women Not Enough

Specialists told the 19th International AIDS Conference Wednesday that efforts to address AIDS among females must expand beyond the current focus on pregnant women.

“These adolescent girls and young women, our sisters and daughters, represent an unfinished agenda in the AIDS response,” said Geeta Rao Gupta, UNICEF’s deputy executive director. Women account for half the world’s HIV infections, and teenage girls are at especially high risk in countries hit hardest by the virus.

A key global goal is stopping mother-to-child (MTC) HIV transmission, and the number of babies infected by this route has been dropping steadily for several years. The UN reported that 57 percent of HIV-positive women last year received drugs while pregnant and nursing to protect their babies.

The drop, however, has not been happening rapidly enough to meet the goal of virtually eliminating MTC infections by 2015, said Dr. Chewe Luo, an HIV adviser to UNICEF. Few nations continue providing mothers with AIDS drugs after their babies are weaned, unless the woman’s condition worsens or she becomes pregnant again, Luo said.

New World Health Organization guidelines recommend starting lifelong treatment for all pregnant women. Luo praised Malawi for being the first low-income nation to adopt this strategy, which she said is under consideration by Botswana, Rwanda, South Africa, and Zambia.

Rao Gupta highlighted an innovative approach in Kenya, in which poor families receive a few dollars a month to help support AIDS orphans and other vulnerable children. Research showed that teens in these households stayed in school longer, rather than quitting to go to work, and that they reported fewer risky sexual behaviors, possibly because they were not exchanging sex for money.

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Women with HIV Too Often Unseen: US Advocate

Heterosexual African-American women are being disproportionately affected by the HIV/AIDS epidemic, attendees were told on Wednesday at the 19th International AIDS Conference (IAC) in Washington. These women comprise 60 percent of new cases among US women and face infection rates 15 times the rate of white women, according to C. Virginia Fields, president of the National Black Leadership Commission on AIDS.

CDC data for 2009 show that black women represented the next-largest group of new infections, after men who have sex with men (MSM) of all races, with 5,400 cases. One in 32 black US women can expect an HIV diagnosis in her lifetime, according to CDC.

At the IAC, Linda Scruggs, an African-American woman, explained how she was first diagnosed with HIV 22 years ago when she became pregnant. Her doctors expressed little hope, but her son was born HIV-negative and recently turned 21. Scruggs recounted being molested and raped multiple times; she does not know which attack may have caused her infection.

In Washington, the HIV prevalence rate of 2.7 percent exceeds that of many developing countries. Among the city’s black residents, who make up about half of the population, the prevalence rate is 4.3 percent.

AIDS advocates say healthcare reform could turn the tide on the AIDS epidemic by extending coverage to more people, especially those who are poor or minorities. “This is an epidemic of communities of color,” said Daniel Montoya, deputy executive director of the National Minority AIDS Council.

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Changes to Massachusetts Law on HIV Testing

Supporters hope a new state law that took effect Thursday will lead to more HIV testing in Massachusetts.

The state was one of only two that required patients to provide written consent for the test; under the new policy, doctors need obtain only verbal consent.

Written consent is still required before physicians can share a patient’s HIV test results with other health care providers.

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HIV Test Wins Award

A CD4 test developed by researchers at Melbourne’s Burnet Institute has received an international award for innovation.

The test, to be manufactured by Omega Diagnostics Group, uses a blood drop from a finger-prick to track the damage caused by HIV; it delivers results in less than an hour and is much cheaper and more efficient than existing tests.

The money accompanying the award will be used by Professor Stanley Luchters of the Institute’s Center for International Health to validate the test among HIV-positive pregnant women in sub-Saharan Africa.

The test was one of 15 projects funded through Saving Lives at Birth, an initiative support by USAID, Norway, the Bill & Melinda Gates Foundation, Grand Challenges Canada, and the UK Department for International Development.

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Mozambique Launches Brazil-Funded Drugs Plant to Battle HIV

A pharmaceutical plant funded by Brazil opened Saturday in Mozambique, where more than 2.5 million people are living with HIV but only 300,000 are receiving antiretrovirals (ARVs).

The factory initially will package drugs from Brazil but will begin producing its own pills by year’s end. It was built with $23 million in aid from Brazil and $4.5 million from Brazilian mining giant Vale.

“There is an excellent partnership between the Brazilian and the Mozambican people, and there is an absolute integration between the two countries in both public and private sectors,” Michel Temer, Brazil’s vice president, said at the opening event.

Brazil’s 1996 announcement that it would offer free ARVs to HIV-positive citizens sparked concerns over drug resistance and copyright violations. Since then, however, the program has won praise as a model for the developing world. The World Bank estimates the free drugs have saved more than a half-million lives.

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Fewer Americans Suppressing HIV Virus, Study Finds

According to a new study, many US HIV patients are not effectively controlling their infection, mostly due to a lack of drug adherence. Young adults, African-Americans, injection drug users, and the uninsured are particularly affected.

The researchers looked at 100,000 blood tests from more than 30,000 patients over a decade - believed to be the longest review of its kind. They found 72 percent were controlling their viral loads well, which was lower than the 87 percent previously found. Still, these numbers are significantly better than 2001, when only about 45 percent had well-controlled viral loads, noted Dr. Kelly Gebo, senior study investigator and infectious-disease specialist at Johns Hopkins University.

The researchers pointed to concerns of drug resistance and putting others at risk. Dr. Baligh Yehia, a postdoctoral fellow in Pennsylvania’s School of Medicine, said, “An individual who misses one day’s worth of drugs is at risk of becoming resistant.” Also, “When you consider that over a large population, that’s how people spread the virus. ... And they may be spreading the resistant kind. It’s a dangerous spiral.”

Most people can now take one daily, multi-drug pill; however, if they become resistant to one of the drugs, they must take different medications in multiple pills, causing potential drug adherence problems. More efforts are needed to ensure drug adherence; the researchers plan additional research.

The study may increase concerns about using an antiretroviral drug for prevention among HIV-negative people, despite FDA’s recent approval for that purpose, according to Gebo. Yehia noted, “We’ve made progress, but being able to take a pill every day is a lot harder than previously thought.”

[PNU editor’s note: The study, “Sustained Viral Suppression in HIV-Infected Patients Receiving Antiretroviral Therapy,” was published in the Journal of the American Medical Association (2012;308(4):339-342).]

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Vancouver Ups War on HIV: Wants to Expand Testing in Bid to End the Disease

Vancouver public health officials want to expand HIV/AIDS testing to every sexually active person who visits a family physician or is admitted to a hospital emergency department. Vancouver is the first Canadian city to advocate routine HIV testing in these settings; the push for it comes in the final year of a four-year program.

Dr. Patricia Daly, chief medical officer for Vancouver Coastal Health, said a goal is to convince family doctors to give HIV tests as routinely as other blood tests, even if people are not considered high-risk.

Daly said HIV testing is considered cost-effective if it identifies one in 1,000 cases. The stepped-up testing in Vancouver has increased the identification of HIV cases to one in 100. Almost everyone offered an HIV test accepts, and testing pregnant women has dramatically decreased the rate of infection from mothers to newborns.

Ken Buchanan, with the AIDS advocacy group Positive Living, voiced his concern that widespread testing will not give patients sufficient privacy. “But we do encourage people to be tested and the sooner they know whether they’re HIV-positive, the sooner they can get on medication,” he said.

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A Shift in Strategy to Treatment as Prevention for HIV/AIDS

Organizers called for big increases in HIV testing and treatment as the 19th International AIDS Conference (IAC) took place in Washington this past week. Testing-and-treating is now central to the US AIDS prevention strategy, and experts say treatment-as-prevention has the potential to dramatically alter the epidemic. In addition to improving a patient’s health, treatment can help prevent further transmission of the virus.

Diane Havlir, the US co-chair of the IAC, said, “We can save millions of lives with the knowledge we have today if we fully implement the proven strategies we now have to treat those living with HIV and prevent new infections.”

In line with new national guidelines, the District of Columbia announced last month that health care providers will start treatment at once for those newly diagnosed with HIV instead of waiting to see evidence of advanced immune system damage. With free testing offered at a Department of Motor Vehicles branch and more than 20 other locations, the District’s HIV screening program is among the most aggressive in the nation.

Since 2006, the District has followed an opt-out HIV screening policy, meaning patients get the test unless they choose not to. Health department surveys of high-risk individuals show that about 70 percent recently diagnosed as HIV-positive had seen a doctor in the previous year but had not been offered the test, said Gregory Pappas, senior deputy director of the department.

In response, D.C. Council member David A. Catania (I-At Large) authored legislation incorporating HIV/AIDS education into requirements for medical professionals’ license renewals; the council passed this in May.

The District is the only jurisdiction with a law requiring insurers to cover HIV testing in the emergency room. Doctors say, however, that in practice some insurers may not reimburse physicians if patients show no signs of the disease.

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Voices on HIV/AIDS and the Black Church

As the 19th International AIDS Conference began in Washington, several faith leaders and others were interviewed about the black church’s handling of the HIV/AIDS epidemic.

The Rev. Anthony Evans, president of the D.C.-based National Black Church Initiative, is about to unveil a controversial recommendation that people “take a year off of sex and deal with who they are.”

Evans acknowledged that talking about AIDS “goes against historic and deep-seated folkways and norms of the black community, that you are to be silent about your personal life.” However, he wants people to get tested and share the results.

The Rev. Tony Lee launched Community of Hope, a nightclub-turned-church in Hillcrest Heights, Md. that does HIV testing during services four times a year. Lee himself has been tested at the pulpit and said, “What better place to be than in the House of the Lord, to find out where you stand? And who you can stand on?” When people get their results during the service, they receive health and spiritual support.

Pernessa Seele’s group, the Balm in Gilead, is co-sponsoring a conference on faith and AIDS at Howard University this weekend. She said, “The role of the church is unique for the African-American community. It’s where we disseminate information on anything. ...The role of faith is to dismantle stigma. We do that by speaking truth around people’s lives.”

Alton B. Pollard III, dean of Howard Divinity School, said HIV/AIDS awareness is growing in the black church. “Instead of pointing fingers at behaviors, it should be an ethical challenge. ...It’s a turn, to look at yourself, the man in the mirror.”

Joe Madison, a Washington radio talk show host on WOL-AM, said HIV/AIDS issues remain “basically ignored” in the black community because of homophobia, ignorance, and embarrassment.

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Elton John Says Compassion Can Conquer AIDS

Speaking Monday at the 19th International AIDS Conference in Washington, singer Elton John called for more love for those affected by HIV. “I have just been to the AIDS quilt, and I have seen so much love for the dead,” John said of the panels of the AIDS Memorial Quilt on view in the capital. “What we need is more love for the living.”

John praised the US initiative that has helped millions of people in developing nations access HIV treatment, but he noted that more than 1.1 million Americans have the virus.

“Do you want to end the epidemic in America? Then show some compassion for those who can’t afford treatment. Show compassion for those with HIV in Washington, D.C., most of whom are poor and black,” John said. “Americans have shown so much love for those living with HIV in the developing world. If Americans wanted to show compassion for those living with HIV here at home, then it could do so in a heartbeat.”

“Millions of people around the world feel ashamed because of who they are. They feel subhuman, worthless, like they don’t matter at all,” John said. “We have to replace the stigma with compassion.”

Phill Wilson, founder of the Black AIDS Institute, agreed that some risky behavior seen among young people results from their feeling unloved and hopeless. “When you have young men who have been denied love their entire life, they will give anything to be loved, including their lives,” he said.

Noting that young people who feel accepted and respected are more likely to form healthy relationships, Wilson said families can help stop the AIDS epidemic simply by supporting their children.

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US Pledges More Funding to Fight AIDS World-Wide

At the 19th International AIDS Conference in Washington on Monday, US Secretary of State Hillary Clinton pledged additional funding for a number of overseas initiatives toward the goal of what she called “an AIDS-free generation.” The Obama administration late last year called for boosting efforts to eliminate mother-to-child (MTC) HIV infections, reducing the risk of HIV infection among adults, and ensuring treatment access.

“We will not back off, we will not back down, we will fight for the resources necessary to achieve this historic milestone,” Clinton told attendees.

The United States added 600,000 people over a six-month period this fiscal year to the number of patients receiving antiretroviral therapy in poor countries, Clinton said. That is up from 700,000 added in all of fiscal 2011, she said. The United States is treating about half of all developing-world patients receiving ARVs, and is on target to provide them to 6 million people by the end of 2013.

Of the $157 million in additional funding announced, $80 million will go toward eliminating MTC infections by 2015, with a focus of reaching mothers in remote areas, Clinton said. Another $40 million will be used to ratchet-up medical male circumcisions in South Africa, offering the procedure to nearly half-a-million men and boys over the next year, she said. The United States has since December supported more than 400,000 male circumcisions, a procedure that reduces a man’s risk of acquiring HIV by more than 60 percent. The remaining $37 million will be used for HIV prevention research and services for populations at the highest risk of infection.

“If we want to save more lives, we need to go to where the virus is and get there as quickly as possible,” Clinton said.

TOGETHER WE REMAIN STRONG!

International Group Urges Prompt HIV Treatment for All

The International Antiviral Society (IAV) released new guidelines for AIDS treatment on Sunday, calling for all adults to begin antiretroviral treatment as soon as they test positive, rather than waiting for their immune systems to weaken.

The IAV recommendations for prompt treatment are the first by a global group; they were released at the 19th International AIDS Conference in Washington. Currently the World Health Organization and other groups urge treatment after the CD4 count reaches or falls below the level of 350 cells/mm3.

The IAV guidelines are based on new clinical trial data and drug regimens, which warrant an “update to guidelines for antiretroviral treatment in HIV-infected adults in resource-rich settings.”

“These guidelines are aspirational,” said Dr. Melanie Thompson, with the AIDS Research Consortium of Atlanta, a group advocating for increased testing and better care of those with HIV/AIDS. Thompson noted that most people seek care too late, when they already have progressed to AIDS. “Unfortunately most people in the world are not going to benefit from our guideline recommendations,” she said.

Asked about current global funding issues for care and treatment, Thompson responded, “I think it is a matter of political will. I think it is a matter of prioritizing and recognizing that treatment of HIV is cost-effective. It may be cost-saving as well.” She added, “The science should drive the allocation of resources, and guidelines can play an important role in that respect.”

[PNU editor’s note: “Antiretroviral Treatment of Adult HIV Infection - 2012 Recommendations of the International Antiviral Society - USA Panel” was published in the Journal of the American Medical Association (2012;308(4):387-402). To access the full recommendations, visit http://jama.jamanetwork.com/article.aspx?articleid=1221704#.

TOGETHER WE REMAIN STRONG!

Gates Urges More Tools, Vaccine to End AIDS

Speaking Monday as part of a panel on improving the efficiency of AIDS funding, Microsoft’s Bill Gates told the 19th International AIDS Conference that treatment alone cannot end the epidemic.

Gates said more prevention tools and a vaccine are needed, because no amount of money will be adequate to treat everyone infected. “It is clear that even if you take the most efficient way of doing this work - the number of people who will eventually need to be on treatment, the amount of money we have is not enough to treat those people. The world will make a decision how much those lives matter. And we are in a period of incredible uncertainty right now. Just the uncertainty alone creates a certain instability.” Gates’

Bill & Melinda Gates Foundation has committed more than $2.5 billion in HIV-related grants to organizations around the world, as well as more than $1.4 billion to the Global Fund to Fight AIDS, TB and Malaria.

TOGETHER WE REMAIN STRONG!

AIDS Conference Unites Protesters in March to the White House

On Tuesday in Washington - site of the 19th International AIDS Conference - thousands of protesters converged on the White House to raise issues related to health care, AIDS, and sexuality.

Many activists wore pointy green hats with red feathers and green masks as they called for a “Robin Hood tax” on financial institutions, which would raise money for HIV/AIDS.

Protests also have been held on the floor of the IAC, where hundreds marched Tuesday to protest the US policy banning those who said they were sex workers and drug users from receiving visas to attend the meeting.

TOGETHER WE REMAIN STRONG!

Scientists: Novel TB Drug Combo Passes First Test

An experimental three-drug combination to treat tuberculosis shows promise and does not include either of two standard TB drugs that cause most cases of drug resistance, according to research reported Monday at the 19th International AIDS Conference. The study was funded by the Bill & Melinda Gates Foundation and other groups.

Standard TB treatment requires taking four medications for six months. Cases of multidrug-resistant TB are largely the result of TB bacteria not responding to two of the standard drugs: isoniazid and rifampicin. Treating drug-resistant TB can take more than two years and does not always work.

In the study, scientists in South Africa divided 85 newly diagnosed TB patients into different groups who got combinations of standard or experimental TB drugs. Fifteen received a trio of drugs that included an experimental antibiotic, PA-824, along with the pneumonia drug moxifloxacin and an older TB drug, pyrazinamide. In a two-week test, the drug trio worked as well as the standard four-drug therapy and possibly worked a bit faster, said Dr. Mel Spigelam of the nonprofit TB Alliance, the Global Alliance for TB Drug Development.

Lead researcher Dr. Andreas Diacon of South Africa’s Stellenbosch University stressed that these patients were not cured in two weeks; however, a two-week test is a standard first step in new drug development. A larger study has begun in South Africa, Tanzania, and Brazil that will last two months.

If the drug trio bears out its promise, it could offer a much-needed alternative for multidrug-resistant TB as well, according to Spigelam. Also, it might be useful for TB patients with HIV/AIDS who are not tolerating their current TB medications.

The study also showed that testing novel combinations of drugs - rather than adding drugs onto standard treatment - might be a way to shorten the drug development process, according to Mario Raviglione of the World Health Organization.

[PNU editor’s note: The study, “14-Day Bactericidal Activity of PA-824, Bedaquiline, Pyrazinamide, and Moxifloxacin Combinations: A Randomized Trial,” was published in the Lancet (2012;doi:10.1016/S0140-6736(12)61080).]

TOGETHER WE REMAIN STRONG!

Aussie Research Part of HIV Cure Effort

Working with about 20 HIV patients in Victoria, Australian researchers are launching an effort to eradicate the virus by reactivating it in the cells where it lies dormant, beyond the reach of current drug treatments. In theory, the reawakened virus would be destroyed by killing the cell it inhabits, said Professor Sharon Lewin, director of the Infectious Diseases Unit at the Alfred Hospital.

“We know from the first 10 patients that the treatment was safe and relatively well tolerated and didn’t cause any harm to people,” Lewin said. “Now we are doing more detailed studies to see whether we have woken up the virus.”

The drug under investigation, Vorinostat, is already licensed to treat cancer. It belongs to a drug class called histone deacetylase inhibitors. Other partners in the research are Monash University and the Burnet Institute.

The huge economic costs of keeping HIV patients on antiretroviral drugs for life are driving the push for an AIDS cure, Lewin said. Unlike other more expensive approaches under investigation, Lewin’s therapy involves simply taking a pill, potentially making it an affordable option in the developing nations hit hardest by AIDS.

TOGETHER WE REMAIN STRONG!

Researchers to Test Monthly Vaginal Ring for HIV Prevention

Two large clinical HIV-prevention trials in Africa will test the safety and effectiveness of a vaginal ring containing the antiretroviral drug dapivirine. Both studies are being conducted in partnership with the US National Institutes of Health-backed Microbicide Trials Network.

If effective, the ring will add “a long-acting, female-initiated technology to the existing toolkit of HIV prevention options,” said Dr. Zelda Rosenberg, CEO of the International Partnership for Microbicides (IPM), a nonprofit group that is developing the ring. Because it only needs to be replaced once a month, the ring may help address some of the problems with getting women to use vaginal gels consistently each time they have sex, Rosenberg said during the 19th International AIDS Conference.

The IPM study will enroll 1,100 women ages 18-45 at four sites in South Africa; they will be randomly assigned to use the ring or a placebo. Researchers plan to expand the trial to Rwanda and Malawi.

The other study, called ASPIRE, will test the ring in 3,476 women ages 18-45 in Malawi, South Africa, Uganda, Zambia, and Zimbabwe.

Dapivirine is part of a class of antiretroviral drugs that have long been used to treat HIV and prevent mother-to-child HIV transmission.

Results are expected in 2015. Both trials are seeking at least a 60 percent reduction in HIV risk, but researchers hope for an even better outcome.

“Because the vaginal ring is a long-acting intervention, it has a potential added benefit in that women may find it relatively easy to use,” said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.

Women in the studies will be offered condoms and HIV prevention counseling. Women who become pregnant will discontinue use of the ring and will continue to be monitored.

TOGETHER WE REMAIN STRONG!

HIV Rates Are High for Gay, Bisexual Black Men

Young black gay and bisexual men under age 30 are acquiring HIV at a rate of 5.9 percent annually, three times the rate for white men who have sex with men, according to a US study presented Monday at the 19th International AIDS Conference in Washington. The HIV infection rate for black MSM over age 18 was 1.5 times that of their white MSM peers. The study enrolled 1,533 black MSM participants and was conducted from 2009 to 2011.

Of the 88.8 percent who reported being HIV-negative or of unknown HIV status, 12 percent tested HIV-positive at the study’s beginning. The study sites were Boston, Atlanta, Los Angeles, San Francisco, New York, and Washington.

“People are much more likely to practice safer sex if they know that they’re infected,” said Dr. Kenneth Mayer, a study leader with the Fenway Institute in Boston. “So if you have a lot of people who are assuming they’re not infected or unwilling to deal with it, these are people who are much more likely to transmit HIV to their partners.”

During the study, participants acquired HIV at a rate of 2.8 percent per year, while the younger MSM got infected at a rate of 5.9 percent annually. People with HIV had higher rates of poverty and unemployment, and newly diagnosed MSM were six to seven times more likely to have multiple untreated STDs, which can increase the risk of transmitting and acquiring HIV.

“The rates of infection that we’ve documented in this study are higher than the rates of many countries in Africa,” Mayer said. “What emerges is a picture of people who are alienated from the health care system.”

A continuing focus is increasing testing and treatment among more black MSM and addressing underlying socioeconomic issues that may put these men at risk, said Dr. Kevin Fenton, director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention.

TOGETHER WE REMAIN STRONG!

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Monday, July 30, 2012

HIV Vaccine Trial Seeks Participants

Call for Syringe Programs in Prisons to Curb Swell of Virus

AIDS Rise in Uganda Shows Need for More Resources

Study Cites Benefits of Early AIDS Treatment

Clinton Tells HIV Activists to Press On: Cites More Research, Financing for Effort

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Saturday, July 28, 2012

Cancer Drug Flushes Out Lurking AIDS Virus: Study

Studies Back Circumcision, but Obstacles Remain

Scientists Making Progress on AIDS Vaccine, but Slowly

Research Studies Renew Hope for a 'Functional Cure' for AIDS

Aging AIDS Epidemic Raises New Health Questions

L.A. County Voters to Cast Ballot on Condoms in Porn

$2M Slated for Puerto Ricans with HIV/AIDS

B.C. AIDS Doctors Join International Chorus Targeting the 'War on Drugs'

AIDS Experts: Focus on Pregnant Women Not Enough

Women with HIV Too Often Unseen: US Advocate

Changes to Massachusetts Law on HIV Testing

HIV Test Wins Award

Mozambique Launches Brazil-Funded Drugs Plant to Battle HIV

Fewer Americans Suppressing HIV Virus, Study Finds

Vancouver Ups War on HIV: Wants to Expand Testing in Bid to End the Disease

A Shift in Strategy to Treatment as Prevention for HIV/AIDS

Voices on HIV/AIDS and the Black Church

Elton John Says Compassion Can Conquer AIDS

US Pledges More Funding to Fight AIDS World-Wide

International Group Urges Prompt HIV Treatment for All

Gates Urges More Tools, Vaccine to End AIDS

AIDS Conference Unites Protesters in March to the White House

Scientists: Novel TB Drug Combo Passes First Test

Aussie Research Part of HIV Cure Effort

Researchers to Test Monthly Vaginal Ring for HIV Prevention

HIV Rates Are High for Gay, Bisexual Black Men

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