Human Rights for HIV+

December 16th, 2009 by zheng No comments »

Geneva, 10 December 2009 – On Human Rights Day UNAIDS is calling on all countries to
uphold the human rights of people most affected by the AIDS epidemic.

Criminalization of consensual adult sexual behaviour and violation of human rights of people
living with HIV are hampering HIV responses across the world. UNAIDS urges all countries
to remove laws and policies that make it difficult for people to access HIV services. UNAIDS also calls upon countries to enforce laws that protect people living with and affected by HIV from discrimination.

Although important progress has been made in creating legal environments conducive for
HIV prevention in many countries, UNAIDS is concerned about an apparent trend towards
criminalizing consensual adult sexual behaviour.

In Uganda, for example an ‘anti-homosexuality’ bill has been proposed which if passed into
law, would represent a serious setback to achieving universal access to HIV prevention,
treatment, care and support in Uganda by driving men who have sex with men underground
and away from HIV services. If passed, the bill would greatly increase stigma and
discrimination against people living with and affected by HIV, as well as putting lives at risk.

from UNAIDS website

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Vaginal HIV gel fails to cut risk

December 14th, 2009 by zheng No comments »

Vaginal HIV gel fails to cut risk

Many women in Africa are vulnerable to HIV
A major trial of a vaginal microbicide has produced no evidence that its use reduces the risk of HIV infection in women.

The gel, PRO 2000, is intended for use before sexual intercourse to help reduce HIV infection.

It was tested in a trial involving 9,385 women in four African countries.

The risk of HIV infection was not significantly different among women supplied with the gel than in women given a placebo gel.

It was hoped microbicide gels would prove to be an effective way to limit the spread of HIV, as experts admit that condom promotion alone has not controlled the epidemic.

New ways of curbing the spread of HIV are badly needed, particularly in sub-Saharan Africa, where nearly 60% of those infected with the virus are women.

Women are often forced to take part in unsafe sex, and are biologically more vulnerable to HIV infection than men – so in theory a gel they could apply themselves could be effective.

A previous, smaller trial suggested PRO 2000 could reduce the risk of HIV infection by 30%.

But the latest study, carried out by the Microbicides Development Programme, a not-for-profit partnership of 16 African and European research institutions, failed to find any positive effect.

And the researchers say the trial was large enough to provide conclusive results.

The women who took part were given the gel together with free condoms and access to counselling about safe sex.

Important result

Lead researcher Dr Sheena McCormack, of the Medical Research Council, which part-funded the study, said: “This result is disheartening.

“Nevertheless, we know this is an important result and it shows clearly the need to undertake trials which are large enough to provide definitive evidence for whether or not a product works.”

Professor Jonathan Weber, from Imperial College London, who also took part in the study, said: “It is unfortunate that this microbicide is ineffective at preventing HIV infection, but it’s still vital for us as scientists to continue to look for new ways of preventing HIV.

“Now that we know this microbicide is not the answer, we can concentrate on other treatments that might be.”

from http://news.bbc.co.uk/1/hi/health/8408108.stm

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HIV TB

December 14th, 2009 by zheng No comments »

Washington, July 1 (ANI): Ending one of the biggest mysteries, Harvard scientists have found out why HIV patients are more susceptible to tuberculosis (TB) infection.

In their study paper, a team of researchers led by Dr. Naimish Patel have described how HIV switches off the immune response to Mycobacterium tuberculosis.

The researchers have detailed how HIV interferes with the cellular and molecular mechanisms used by the lungs to fight TB infection.

With this discovery, the researchers have taken an important first step toward the development of new treatments to help people with HIV to prevent or recover from TB infection.

“HIV/TB co-infection is a critical global health problem, especially in developing countries. We hope that these findings will lead to further studies and possible new therapies for treating or preventing tuberculosis in HIV disease,” said Patel.

For their study, the researchers extracted immune cells called “alveolar macrophages” from the lungs of otherwise healthy, asymptomatic HIV-positive patients as well as from people who did not have HIV.

In people who are HIV-positive, the macrophages have a decreased response to the TB bacterium when compared to people who did not have HIV.

To know why this happens, the scientists examined lung specimens from the HIV-positive patients, and found increased levels of a molecule called IL-10.

IL-10 elevated the amount of a protein called “BCL-3″ in alveolar macrophages, which in turn reduced their ability to ward off TB infection.

“HIV and TB represent two of the most significant health challenges in human history and the combination of the two infections is particularly devastating because HIV dramatically increases the severity of TB infection,” said Dr. John Wherry, Deputy Editor of the Journal of Leukocyte Biology,

He added: “There are still many unknowns about how HIV reduces the ability of the body to combat other infections. This study sheds light on co-infection with HIV and TB, which up to this point, has perplexed scientists and physicians alike.”

The study has been published in the Journal of Leukocyte Biology. (ANI)

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HIV treatment at CD4 counts 350-500

December 2nd, 2009 by zheng 2 comments »

USA-guidelines
New US treatment guidelines favour the initiation of HIV treatment by patients with a CD4 cell count between 350 and 500 cells/mm3, earlier than current European and British recommendations.

The guidelines panel was evenly split on whether to start HIV treatment when a patient’s CD4 cell count is above 500 cells/mm3.

Issued on World AIDS Day, December 1st, the US Department of Health and Human Services guidelines for the use of antiretroviral drugs include a number of important revisions, most notably about when HIV treatment should be started.

Earlier treatment favoured
Retained in the guidelines is a recommendation that HIV treatment should be started by all patients with an AIDS-defining illness, or a CD4 cell count below 350 cells/mm3.

Starting treatment at a CD4 cell count of this level has been shown to reduce the risk of HIV-related illnesses and some other serious diseases such as those of the heart, kidney and liver, as well as some cancers.

There has been debate about the value of starting treatment at higher CD4 cell counts. Some research has shown that this can have benefits, but not all studies have confirmed that there is an additional benefit to starting treatment at a CD4 count above 500.

The guidelines panel was persuaded that therapy should be recommended for patients with a CD4 cell count between 350 and 500 cells/mm3 but disagreed on the strength of the recommendation. 55% of the panel said this should be a strong recommendation, while the remaining 45% supported a `moderate` recommendation for treatment in this CD4 range.

It’s the first time that the US guidelines panel has issued a split recommendation of this sort, and the split verdict indicates the divergent views about the strength of the evidence for earlier treatment.

The panel was evenly split on whether treatment should be started by individuals with a CD4 cell count above 500 cells/mm3 or whether it should be considered optional.

However, certain groups of patients are recommended to start antiretroviral therapy regardless of their CD4 cell count. These include pregnant women, those with HIV-associated nephropathy (kidney disease), and patients co-infected with hepatitis B virus when therapy for hepatitis B is necessary.

Also included in the guidelines are recommendations for first-line antiretroviral therapy.

Raltegravir “preferred” for first-line therapy, but Kaletra dropped
A combination of raltegravir (Isentress) plus Truvada (FTC and tenofovir) joins Atripla (efavirenz, FTC and tenofovir), ritonavir-boosted atazanavir (Reyataz) with Truvada, and ritonavir-boosted darunavir (Prezista) plus Truvada as preferred first-line regimens.

Notably, Kaletra (lopinavir/ritonavir) is no longer “preferred” for first-line therapy and is only listed as an “alternative” drug. Some study results have shown an independent association between treatment with Kaletra and an increased risk of heart attack.

However, Kaletra has been shown to effectively prevent mother-to-child transmission of HIV and it remains a preferred option for use during pregnancy when it should be used with Combivir (3TC and AZT).

Best use of resistance tests
More specific recommendations about the use of genotypic and phenotypic resistance testing are also provided.

Genotypic testing is recommended as the preferred test for patients with a suboptimal response to their first or second antiretroviral combination.

Additional phenotypic testing is supported for patients with known or suspected complex resistance patterns, especially to protease inhibitors.

aidsmap resources
Resistance news

* Transmitted drug-resistant HIV stabilising in Europe
* Etravirine, darunavir/ritonavir and raltegravir very effective in highly treatment-experienced patients
* Delays in switching treatment: NRTI resistance can be slower to emerge than expected

Side-effects news

* Long-term HIV treatment doesn’t damage kidney function
* Standard heart disease risk factors may underestimate risk in people with HIV
* Low bone mineral density common in HIV-positive men

Starting treatment news

* WHO recommends earlier treatment and phase-out of d4T
* Protease inhibitor monotherapy as a maintenance regimen: are we edging towards acceptance?
* New EACS guidelines address co-morbidities and diseases of age

Michael Carter from AidsMAP

Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services. December 1, 2009; 1-161. Available at http://www.aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf.

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