We, the UNITAID board members representing non-governmental organisations (NGOs) and communities affected by HIV/AIDS, tuberculosis, and malaria, are writing to you to express our deep concern that Bristol-Myers Squibb (BMS) is to close a factory in France that manufactures a second-line antiretroviral medicine for children with HIV/AIDS who weigh less than 10 kg: buffered didanosine in the 25 mg formulation.
Closing this factory means that 4000—7000 babies currently enrolled in treatment plans in developing countries through UNITAID could be left without the medicines they need. Didanosine is the last therapeutic option for these babies and without it they could die. We understand that closure of the plant will take place in June of this year, with no plans for resumption of production before April, 2011, at the earliest, when a new plant is due to open. Therefore there is likely to be a shortage of about 15 000 packs of didanosine 25 mg across all UNITAID beneficiary countries between now and when production is expected to resume in April, 2011.
Currently, there is no alternative generic product that has been assessed by WHO and prequalified for use by UN agencies. We urge you, as the Chief Executive Officer of BMS, a company that prides itself on its high standards of corporate responsibility, to respond urgently to our concerns, outlining the steps you will take to avoid any treatment interruption. We would also like your confirmation that a BMS plant will resume production of this vital medicine in 2011.

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 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.

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)