http://www.aidsmap.com/en/news/3369C722-D439-4EE2-A13F-D6F373EE36EF.asp
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
Circumcision has been one of the most important topic not only in Africa where circumcision lowered the spread of HIV among heterosexuals also in western countries.
Circumcision is thought to protect men from HIV infection because foreskin tissue appears particularly susceptible to the virus, and may serve as an entry point for it. However, circumcision would not affect HIV risk from receptive anal sex — and that, again, could outweigh any protective effect of circumcision during insertive sex.
A review in journal of Urol on three randomized, controlled trials concluded that “circumcising adult males reduces the incidence of HIV by 50% to 60%. Adult male circumcision does not seem to have an adverse impact on sexual function. Epidemiological and economic modeling suggests that adult male circumcision can potentially be a highly cost-effective strategy for HIV prevention. ” (The impact of male circumcision on HIV transmission, Doyle,S.M.; Kahn,J.G.; Hosang,N.; Carroll,P.R.)
A report from CDC consultation published in this year Public Health Rep.
suggested that (1) sufficient evidence exists to propose that heterosexually active males be informed about the significant but partial efficacy of MC in reducing risk for HIV acquisition and be provided with affordable access to voluntary, high-quality surgical and risk-reduction counseling services; (2) information about the potential health benefits and risks of MC should be presented to parents considering infant circumcision, and financial barriers to accessing MC should be removed; and (3) insufficient data exist about the impact (if any) of MC on HIV acquisition by MSM, and additional research is warranted.
Abbott, a leading HIV/AIDS research company announced on 28th. April that The US Food and Drug Administration (FDA) has approved once-daily dosing of lopinavir/ritonavir tablets and oral solution (Kaletra; Abbott Laboratories) for adult patients with HIV-1 who have previously taken antiretroviral therapy and have 2 or fewer key mutations in the virus’ protease gene.
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.
Gary Pratt et.al reviewed HIV in older people last year and documented that there were several reasons why older people were at risk.
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.
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