A clinical trial of a vaccine against a major cause of pneumonia and meningitis has shown that it can prevent three out of four cases of reinfection in HIV-infected adults in Africa.

http://www.aidsmap.com/en/news/BEF8C8CE-BC45-4DD4-B859-00E42D5F9459.asp

TB Trials

A little bit history here from AIDSInfo: Lopinavir/ritonavir in capsule and oral solution form was approved by the FDA on September 15, 2000, for use with other antiretrovirals in the treatment of HIV infection in adults and children 6 months of age or older. Lopinavir/ritonavir in tablet form was approved by the FDA on October 28, 2005. In March 2006, the capsule form of the medicine was phased out in the U.S. in favor of the new tablet.

once-daily dosing of lopinavir/ritonavir tablets and oral solution means lopinavir/ritonavir can be used noce or twice a day (as recommended before) combining with other therapies. This will be an easiler way of treatment and may reduce further poor adherence among HIV-diagnosed patients, which is critical for immunosupression and virological suppression.

1. The few HIV prevention campaigns that do exist do not target the elderly.
2. Older people may not consider themselves at risk of HIV infection.
3. Health care providers may not consider the diagnosis in older patients and therefore may not undertake HIV testing or may attribute symptoms of HIV to ‘normal ageing’.
4. Despite the stereotypes, many older people lead sexually active lives. Studies of sexual activity in people aged over 50 showed that 81.5% were involved in one or more sexual relationships including sex with prostitutes,and a national US survey suggested that only a small minority of people over 70 consistently used condoms. Older women may be especially at risk because age-related vaginal thinning and dryness can cause tears in the vaginal wall.
5. The increase in foreign travel makes access to countries with thriving sex industries easier.
6. The introduction and usage of potency drugs has extended the sex lives of many elderly males.
7. Injection drug usage, despite our misconceptions, is a contributor to HIV transmission in older people. In the USA, injection drug use accounts for more than 16% of AIDS cases in those aged 50 or over.
8. The stigma of HIV may be perceived to be greater in the elderly population leading them to hide their diagnosis or avoid testing.

The paper is a very good review in Age and Aging. My colleague – Ruth Smith present some important findings at the joint conference of the British HIV Association (BHIVA) and the British Association for Sexual Health and HIV (BASHH) last week. In the United Kingdom, one in twelve HIV diagnoses are of a person over the age of 50. Whilst rates of late diagnosis are high in older adults, just under half of these diagnoses are thought to be of an infection that was acquired when the person was over the age of 50.

It’s a good thing though. We need to bring people together to remove stigma related to HIV. China authority said this change won’t have a significant impact on the HIV epidemic in China. Yes and No. In China, the most serious problem is internal migration. It benefits the economic development a lot but inevitably causes problems such as prostitution, education, transportation, pollution etc etc. Most international population movement is actually emigration instead of immigration. Because of the small proportion of HIV positive individuals of the whole immigration population, it probably won’t make a big difference. However, in an other hand, several factors may effect the epidemic, for example, short-term visitors are likely to engage in risky behaviour, condom use is still not very common in China despite of free provision, many young girls favour foreigners for various reasons, HIV testing requests a lot a lot more efforts to promote, Chinese hold very different attitudes toward testing, treatment, sex and HIV compared to Britain and Americans. ….

If let the whole nation vote, the proposal might wouldn’t get passed. Thanks we are not a democracy country! pros and cons.

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the following informaiton is from http://news.yahoo.com/s/ap/20100428/ap_on_re_as/as_china_aids

China lifts travel ban against people with HIV/中国不再禁止国外艾滋病等患者入境.

BEIJING – China has scrapped a 20-year travel ban that barred people with HIV and AIDS from entering the country, just days ahead of the opening of the Shanghai Expo, which hopes to welcome millions of overseas visitors.

The decision announced by China’s Cabinet, the State Council, follows similar moves by the United States and South Korea to eliminate travel restrictions for people with the HIV virus. Both lifted their bans on visitors with HIV on Jan. 1.

China’s ban had been launched based on “limited knowledge” of HIV at the time and had proven inconvenient for the country when hosting international events, the official Xinhua News Agency quoted the Cabinet as saying. The Shanghai Expo begins Saturday and runs for six months.

The State Council said in a statement posted to its website late Tuesday that the government passed amendments on April 19, revising the Border Quarantine Law as well as China’s Law on Control of the Entry and Exit of Aliens. The changes were effective immediately.

The move also includes scrapping entry restrictions for people with leprosy and sexually transmitted diseases.

The State Council said that the government realized such restrictions had limited effect on preventing and controlling the spread of diseases in the country, according to Xinhua. The Cabinet did not immediately respond to faxed questions.

AIDS was the top killer among infectious diseases in China for the first time in 2008, a fact that may reflect improved reporting of HIV/AIDS statistics in recent years. Despite greater openness, the government remains sensitive about the disease, regularly cracking down on activists and patients who seek more support and rights.

Government statistics show that by the end of October 2009, the number of Chinese confirmed to be living with HIV-AIDS was 319,877, up from 264,302 in 2008 and 135,630 in 2005. But Health Minister Chen Zhu has said the actual level of infections is probably near 740,000.

U.N. Secretary-General Ban Ki-moon welcomed China’s decision and urged other countries that still bar people with HIV to change their laws as soon as possible. “Punitive policies and practices only hamper the global AIDS response,” he said in a statement.

News from the 17th. conference on retroviruses and opportunistic infections
San Francisco has promoted HIV testing so well that only one in seven people with HIV are undiagnosed.

In South Africa, nearly a quarter of patients eligible for HIV therapy died while on the waiting list.
(ref: Montaner j et al. Association of expended HAART coverage with a decrease in new |HIV diagoses, particularly among injection drug users)

Researchers from the DAART trial in Uganda and Zimbabwe found that within a year of starting treatment, 78% of patients had not achieved a CD4 count over 350 cell/mm3 and nearly half had not reached 200.
(ref: Munderi P et al. Immune restoration over 5 years on ART among patients initiating treatment with advanced immune deficiency in the DART trial in Uganda and Zimbabwe)

HIV transmission in long-term hetrosexual relationships could not be prevented by treating herpes. The rate of transimission from a HIV-positive patner was reduced from 2.25% to 0.39% a year when they started treatment.

Partners with CD4 counts under 200 cells/mm3 were five times more likely to transmit HIV than others.

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

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

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)

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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