Plasma and rectal viral load correlated in HIV-positive gay men: supports use of treatment as prevention

via European AIDS Treatment Group, by Michael Carter

Viral load in the blood and rectal secretions of HIV-positive gay men are highly correlated, according to US research published in the September 1st edition of the Journal of Infectious Diseases. The study also showed that the presence of sexually transmitted infections did not increase rectal viral load.

Individuals with a plasma viral load above 1000 copies/ml were significantly more likely to have detectable virus in the rectum.

“Our data add substantially to the few published studies of HIV shedding in rectal secretions of MSM [men who have sex with men],” comment the investigators, “we were able to quantify HIV RNA in rectal secretions, demonstrate the linear correlation between increasing plasma load and rectal viral load and determine a threshold plasma viral load that distinguished detectable from undetectable rectal viral load.”

They also believe that their findings have important implications for current debates about the use of HIV treatment as prevention, commenting: “Combination antiretroviral therapy will have a similar effect on reducing HIV transmission in MSM, as seen in studies of heterosexual discordant couples.”

Read the rest.


[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

Early ARV Treatment Will Save Lives in South Africa

Via All Africa.

Government's decision to offer free ARV treatment to people with CD4 counts of 350 or less has been welcomed as a life-saver.

The South African government's announcement that it will give antiretroviral medication to people with HIV who have CD4 counts of below 350 will save lives and prevent infection.

This is according to Medecins Sans Frontieres (MSF), which welcomed the announcement made by Deputy President Kgalema Motlanthe on Friday (12 August).

Until Friday, people were only able to get ARVs if their CD4 count was below 200 unless they were pregnant or had tuberculosis.

"The decision to start people on HIV treatment earlier, before they become sick with diseases like tuberculosis, marks a critical moment for this country that is so hard hit by the epidemic," said Dr Gilles van Cutsem, Medical Coordinator for MSF in South Africa.

"When people are started earlier on ARV treatment, they are less likely to die, less likely to become ill, less likely to need hospitalisation and more likely to stick to their treatment in the long run."

A study conducted by MSF last year in Lesotho found that patients who started treatment above CD4 200 were 68% more likely to survive than patients those who started ARVs when their CD4 count was below 200.

Van Cutsem added that starting people on ARVs earlier was likely to prevent new infections as "ARV treatment dramatically reduces the spread of the virus to others, by making people living with HIV less infectious by up to 96 percent".

Meanwhile, a study published in PloS journal in July predicts that making ARVs available to people from CD4 of 350 would have a dramatic effect on the community of Hlabisa in northern KwaZulu-Natal.

Read the rest here.

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

'Funding gap' imperils science exploits, AIDS forum hears

Via AFP, by Richard Ingham.

"Science is running much faster now than what we can implement and what we can pay for."

The four-day Rome conference, ending Wednesday, heard the outcome of several landmark trials.

The biggest found that giving early drug therapy to people with HIV reduced the risk of infecting others by a massive 96 percent.

Other trials found that giving antiretrovirals to a non-infected partner reduced the risk by around two-thirds.

These amount to two powerful new choices -- "treatment as prevention" and "pre-exposure prophylaxis" (PrEP) -- to brake transmission of the AIDS virus.

They join male circumcision, a proven measure to protect men, to which a vaginal microbicide, still under test, may one day be added for women.

In 2009, more than 33 million people were living with HIV and 2.6 million people became newly infected.

Making inroads into this tally means stumping up more money swiftly, said Julio Montaner, director of the BC Centre for Excellence in HIV/AIDS in British Columbia, Canada.

The higher early cost would lead to dividends, though. Eventually fewer people would ultimately become infected -- and people on treatment contribute to the economy because they are healthy rather than a burden to it through sickness.

"It could pay for itself in about a decade," calculated Jean-Paul Moatti, an economics professor at France's University of the Mediterranean in Marseille, southern France.

The financial outlook, though, is worrying.

Between 2001 and 2009, help for fighting AIDS in low- and middle-income countries rose nearly 10-fold, from $1.6 billion to $15.9 billion each year.

But in 2010, resources declined as Western countries, the mainstay of external funding, tightened the belt in response to their fiscal restraints.

Today, some 6.6 million people in poor countries have grasped the drug lifeline, but another nine million are still in need of treatment.

Reaching them by 2015, in line with the newly stated goal by UN members, will require between $22 billion and $24 billion annually.

Read the rest here.

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

Investment in HIV Prevention Research

A report released yesterday by HIV Vaccines and Microbicides Resource Tracking Working Group at the IAS conference in Rome "found that overall investment in HIV prevention R&D had actually increased, with the modest exception of a one percent decline in vaccine R&D. The report documented a total US$1.19 billion investment in research and development (R&D) for four key HIV prevention options: preventive vaccines, microbicides, pre-exposure prophylaxis (PrEP) using antiretroviral drugs, and operations research related to medical male circumcision.":

"2010 has been a year of retrospection, a time for looking back over the 30 years since the first published report of the mysterious illness that would come to be known as AIDS. As sobering as this anniversary has been, it has also been a time for some optimism and calls to end the epidemic. These calls may not be simply wishful thinking, fueled as they have been by promising research results over the past two years in vaccines, microbicides, pre-exposure prophylaxis using antiretrovirals (PrEP), and antiretroviral treatment as prevention—results that have energized the entire HIV prevention field.

The first good news came at the end of 2009, when researchers in the RV 144 Thai vaccine trial reported that a vaccine combination had reduced risk of infection by 31 percent—the first clinical evidence that a preventive AIDS vaccine would be possible. Then, in July 2010, the CAPRISA 004 trial team announced its findings–that use of 1% tenofovir (TDF, also known as Viread®) vaginal gel reduced women’s risk of HIV infection by 39 percent—providing the first proof that a microbicide would be possible. This news was followed in November 2010 by the announcement from the iPrEx trial team that daily oral tenofovir/emtricitabine (TDF/FTC, also known as Truvada®) had reduced risk of HIV infection by an estimated 44 percent overall in men who have sex with men (MSM) and transgender women, and proved for the first time that HIV prevention using PrEP would be possible. And finally, in early 2011, the HIV Prevention Trials Network (HPTN) 052 trial established that use of antiretroviral therapy (ART) by HIV-positive individuals reduced transmission to their partners"

Source: HIV Vaccines and Microbicides Resource Tracking Working Group

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

IAS 2011: Day 2 Press Release

OFFICIAL PRESS RELEASE – DAY 2

16.30 (CET), MONDAY JULY 18

Antiretroviral Treatment is HIV Prevention: The proof is here

Leading researchers and international experts to discuss the policy and prevention implications of three groundbreaking trial results: the HPTN O52 study, the Centers for Disease Control and Prevention TDF2 study and the University of Washington Partners PrEP Study

Monday, 18 July, 2011 (Rome, Italy) -- A special press conference at the 6th IAS Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2011) will today feature a panel consisting of researchers from the CDC TDF2 study, the Partners PrEP Study and the HPTN 052 study. They will be joined by Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases (NIAID), Gottfried Hirnschall, Director of the HIV Department of the World Health Organization (WHO) and Elly Katabira, IAS 2011 International Chair and President of the International AIDS Society (IAS). The IAS 2011 conference opened yesterday, Sunday 17 July and runs until Wednesday 20 July and is being attended by over 5000 researchers, clinicians and community leaders.

In light of announcements this past week about new data on PrEP effectiveness, both the HPTN 052 abstract session (16.30, SR1) and press conference have been expanded to include presentations on the Partners PrEP Study and the CDC’s TDF2 study, both of which were released on 13 July in the US. The presentation on the CDC study was originally scheduled for a late breaker session at IAS 2011 on Wednesday 20 July.

“Treatment is prevention and these three studies provide the proof,” said Katabira.

“The XI International AIDS Conference in Vancouver in 1996 is remembered as the conference that heralded the arrival of combination antiretroviral treatment. The IAS 2011 Conference will be remembered as the beginning of the treatment as prevention revolution.”

“These studies mark a turning point in HIV science and in HIV prevention,” said Stefano Vella, IAS 2011 Local Co-Chair and Research Director at the Istituto Superiore di Sanità (ISS). “The urgent challenge now is to implement treatment as prevention in the developing world.”


Press conference line up:

Chair: Stefano Vella: IAS 2011 Local Co-Chair and Research Director at the Istituto Superiore di Sanità (ISS)


Myron Cohen: HPTN 052 Protocol Chair and Associate Vice Chancellor for Global Health and Director of the Institute of Global Health and Infectious Diseases at the University of North Carolina

About the HPTN 052 study:

The HIV Prevention Trials Network (HPTN) 052 study found that men and women, who were already infected with HIV, had a reduced risk of transmitting the virus to their uninfected sexual partners by 96% through early initiation of combination antiretroviral therapy (cART). HPTN 052 also found that early initiation of cART benefits the HIV-infected individual.

HPTN 052 was designed to evaluate whether early versus delayed use of cART by HIV-infected individuals would reduce transmission of HIV to their uninfected partners and benefit the HIV-infected individuals as well. During the course of the study, 39 participants who had been HIV-uninfected at the start of the study became infected with HIV. Of those, 29 were linked transmissions, where the virus from the originally-infected partner was confirmed by genetic analysis to be the source of infection in the newly infected sexual partner. Only one of the 29 infections occurred in the early cART arm. Based on the latest analyses, this one transmission most likely occurred close to the time the couple enrolled in the study and before HIV viral replication could have been suppressed by cART in the infected participant.

The new analyses also provide more insight as to how early initiation of cART benefits the HIV-infected person. Individuals who were put on early cART maintained higher absolute CD4 counts than those in the delayed arm, who received treatment when their CD4 counts fell below 250 cells/mm³ or an AIDS-related event occurred. Early cART was also associated with a 41% reduction in HIV-related illnesses or death, a direct benefit for the HIV-infected partner. The reliable suppression of HIV among HIV-infected people in the early treatment arm suggests potential impact on adherence when the infected individual is informed that their cART may also benefit their partner.


Michael C.Thigpen: Principal study investigator and epidemiologist at the Centers for Disease Control and Prevention (CDC), USA

About the TDF2 study:

The CDC TDF2 study was a randomized, placebo-controlled trial examining the safety and efficacy of a once-daily tablet containing tenofovir disoproxil fumarate and emtricitabine (TDF/FTC, known by the brand name Truvada) for reducing the risk of HIV acquisition among heterosexual men and women at two sites in Botswana. In addition to study medication, all participants received a comprehensive package of HIV prevention services. The study provides strong evidence that a daily oral dose of antiretroviral drugs used to treat HIV infection can reduce HIV acquisition among uninfected individuals exposed to the virus through heterosexual sex. The study, conducted in partnership with the Botswana Ministry of Health, found TDF/FTC reduced the risk of acquiring HIV infection by roughly 63 percent overall in the study population (95% CI, 21.5 to 83.4; p= 0.0133) ,and by 78 percent among trial participants believed to be taking study medications (95% CI 41.2 to 93.6, p=0.0053). Adherence (as measured by pill count) was high, both among those receiving TDF/FTC and those receiving placebo (84.1 percent and 83.7 percent, respectively). Reported sexual risk behavior was similar between the two study arms. Consistent with other PrEP studies, preliminary analyses did not identify any significant safety concerns associated with daily use of TDF/FTC.


Jared Baeten: Co-leader of the Partners PrEP Study and epidemiologist at the University of Washington, USA

About the Partners PrEP Study:

This is a phase III, randomized, double-blind, placebo-controlled trial of daily oral tenofovir and emtricitabine/tenofovir for the prevention of HIV-1 acquisition among HIV-1 seronegative partners in heterosexual HIV-1 serodiscordant partnerships. The study is funded by the Bill & Melinda Gates Foundation. The University of Washington coordinated the trial, in collaboration with investigators at nine sites in Kenya and Uganda. The study enrolled 4758 HIV-1 serodiscordant couples; HIV-1 uninfected partners were randomly assigned in equal numbers to one of three study groups: one group received tenofovir, one emtricitabine/tenofovir, and one matching placebo. All study participants received a comprehensive package of HIV-1 prevention services. On 10 July 2011, the Partners PrEP Study independent Data and Safety Monitoring Board (DSMB) recommended, after review of the study data, that the study results be publically reported and the placebo arm be discontinued, because of definitive demonstration of HIV-1 protection from pre-exposure prophylaxis (PrEP) in the study population. Tenofovir reduced HIV-1 risk by 62% (95% CI 34 to 78, p=0.0003), emtricitabine/tenofovir by 73% (95% CI 49 to 85, p<0.0001). Efficacy for tenofovir and emtricitabine/tenofovir were not statistically different. 62% of HIV negative participants were male, 38% were female: both PrEP medications reduced HIV-1 risk in men and women. Adherence to the daily PrEP medication was very high – more than 97% of dispensed doses of the study medications were taken. More than 95% of participants were retained in study follow-up. Safety parameters were comparable across the three study groups.


Anthony Fauci: Director, NIAID, USA

Fauci will remark on the implications for prevention research. He will talk about the collective importance of these studies in finding new HIV prevention methods and the optimism that these combinations when viewed in total will help to end the HIV/AIDS epidemic.


Gottfried Hirnschall: Head of the HIV Department at the WHO, Switzerland

Over the past year, WHO has been developing recommendations for couples HIV testing and counseling. More than half of all people living with HIV do not know their infection status, and therefore, may transmit HIV unknowingly. By partners testing together and mutually disclosing their test results, couples can learn about their options for HIV prevention and treatment.

The findings of the three cited studies above will be reflected in WHO guidelines for couples HIV testing and counseling and also to develop broader guidance on the strategic use of antiretrovirals for treatment and prevention of HIV.


Elly Katabira: International Chair IAS 2011 and IAS President

Katabira will talk about the implications of the three cited studies for HIV professionals


[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

CHINA: CAIDS deaths hit 'peak' as 7,700 die

Via China.org.cn

AIDS deaths are believed to be peaking on the Chinese mainland as many from the large number of people infected with HIV in the 1990s because of unsanitary blood-selling schemes develop full-blown AIDS, a senior health official said on Tuesday.

By the end of last year, the total reported number of AIDS deaths had reached 68,000, according to statistics from the ministry. Since 2008, AIDS has become the country's top infectious killer and it claimed the lives of 7,700 people in 2010 alone.

"As those infected in the 1990s have developed full-blown AIDS, the number of deaths has surged," Hao noted, adding that poor drug compliance largely because of side effects added to the number of deaths. To address the problems, the government cracked down on the illegal plasma-selling schemes, enhanced safety supervision and management of blood collection, and offered free medication to all patients. Currently, China has about 740,000 people living with AIDS/HIV, including 140,000 full-blown AIDS patients, official statistics show.

Hao urged people with the virus to accept the free medication they are entitled to and the first-line antiretroviral regimen, and said the government is making efforts to also provide free second-line drugs to those in need. The first-line antiretroviral regimen has helped reduce the fatality rate of full-blown AIDS patients on medication from 10.8 percent in 2005 to 4.6 percent last year.

In the past few years, men who have sex with men (MSM) have become one of the most vulnerable groups for contracting AIDS/HIV, experts said. Among the 44,000 new HIV infections detected in 2010, nearly 13 percent were infected through gay sex, according to the Ministry of Health. "AIDS/HIV became rampant among the MSM population which has an average HIV prevalence of 5 percent nationwide," Hao said. He noted that the infection rate is 0.05 percent among the general population.

Read the rest

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

Starting HIV treatment when CD4 cell count dips below 500 improves AIDS-free survival

Via aidsmap, by Michael Carter

Patients who start antiretroviral therapy when their CD4 cell count dipped below 500 cells/mm3 are less likely to develop an AIDS-defining illness than individuals who start treatment with a CD4 cell count of 350 cells/mm3, an international team of investigators report in the Annals of Internal Medicine. However, initiating HIV treatment with a CD4 cell count of approximately 500 cells/mm3 did not reduce the risk of all-cause mortality.

“If the goal is to prevent AIDS-defining illness or death, our findings support cART [combination antiretroviral therapy] initiation once the CD4 cell count decreases below 500 cells/mm3,” comment the investigators.

Nevertheless, results of the study will undoubtedly inform the debate about the best time to start antiretroviral therapy.Treatment guidelines in Europe currently recommend that AIDS-free patients should start therapy when their CD4 cell count is in the region of 350 cells/mm3. However, US guidelines advocate treatment when an individual’s CD4 cell count falls under 500 cells/mm3.

Large randomised trials are currently underway to try and determine the optimum time to start HIV therapy. However, their results are not expected for several years. Because of this continuing uncertainty investigators from the HIV-CAUSAL Collaboration undertook a prospective observational study involving approximately 21,000 adult patients enrolled in cohorts in Europe and the US.

Read the rest
 
[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

UGANDA: As food prices bite, HIV-positive people turn to kitchen gardens

Via IRIN, PlusNews

The small 10m by 15m garden behind Agnes Oroma's house in northern Uganda's Gulu district is much more than a hobby garden; according to HIV-positive Oroma, it is one of the main reasons she is in good health. She grows indigenous vegetables and tomatoes to supplement her daily diet of beans, maize meal and silver fish; Oroma also proudly shows off a sisal sack in which she grows onions.

"Do not ignore that little space behind your house, it can do a lot to feed you cheaply and lessen your financial burden that would enable you spend on other essentials to keep you healthy on your daily ARV treatment," 31-year-old Oroma told IRIN/PlusNews.

In the face of rising global fuel prices and a prolonged dry spell, Ugandans are dealing with steep increases in the price of food that have sparked protests in many parts of the country. Oroma and other HIV-positive patients in Gulu town are becoming more self-reliant in an effort to maintain a healthy diet and stay on their antiretroviral medication. Oroma's group of backyard farmers has grown to 30 in the past few months.

"Food was my biggest worry for my treatment; I had become weaker because my body didn't have the strength to withstand the potency of the ARV drugs. Since I started growing these vegetables, producing more food, I feel a lot of improvement and I have the strength to do other things. I now take my medication without worries because I know the food I grow can keep me going for another day,"said Maurine Kilama.

Read the rest


[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

HIV Envelope Discovery Could Reveal New Vaccine Targets

Via hivandhepatitis.com

An international study headed by a UC Davis scientist describes how a component of a potential HIV vaccine opens like a flower, undergoing one of the most dramatic protein rearrangements yet observed in nature.

The finding could reveal new targets for vaccines to prevent HIV infection and AIDS. A paper describing the work was published online this week in the journal Proceedings of the National Academy of Sciences.

In the new study, researchers from the U.S., Sweden and France explored the structure and behavior of the HIV envelope protein complex, which could potentially serve as a component of a vaccine aimed at eliciting the human immune system to generate antibodies against HIV.

"By opening up these less exposed regions, we might be able to raise more broadly cross-reactive antibodies to HIV," said R. Holland Cheng, professor of molecular and cellular biology at UC Davis and senior author of the study.

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[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

Kenya: Counselling, not alarm device, had best effect on ART adherence

Via aidsmap, by Carole Leach-Lemens

Patients in Nairobi, Kenya getting intensive early adherence counselling when starting antiretroviral therapy were 29% less likely to have poor adherence and 59% less likely to have virological failure compared to those getting no counselling Michael H Chung and colleagues reported in a randomised, controlled trial published in the March issue of PLoS Medicine.

The positive effects of counselling on adherence were seen immediately after starting antiretroviral therapy and maintained throughout the18 month follow-up period. Use of an alarm device had no effect on adherence or virological outcomes. Public health concerns that scale-up of antiretroviral treatment in sub-Saharan Africa would lead to poor adherence and widespread drug resistance have been proven wrong, note the authors.

The authors conclude “as antiretroviral treatment clinics expand to meet an increasing demand for HIV care in sub-Saharan Africa, adherence counselling should be implemented to decrease the development of treatment failure and spread of resistant HIV.”

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[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

New recommendations to reach 2015 goals for AIDS response

Via unaids.org

Thirty years into the AIDS epidemic, investments in the AIDS response are yielding results, according to a new report released today by United Nations Secretary-General Ban Ki-moon.

Titled Uniting for universal access: towards zero new HIV infections, zero discrimination and zero AIDS-related deaths, the report highlights that the global rate of new HIV infections is declining, treatment access is expanding and the world has made significant strides in reducing HIV transmission from mother to child.

Between 2001 and 2009, the rate of new HIV infections in 33 countries—including 22 in sub-Saharan Africa—fell by at least 25%. By the end of 2010, more than 6 million people were on antiretroviral treatment in low- and middle-income countries. And for the first time, in 2009, global coverage of services to prevent mother-to-child transmission of HIV exceeded 50%.
 
“World leaders have a unique opportunity at this critical moment to evaluate achievements and gaps in the global AIDS response,” said Secretary-General Ban Ki-moon at the press briefing in the Kenyan capital. “We must take bold decisions that will dramatically transform the AIDS response and help us move towards an HIV-free generation.”  
 
“Thirty years into the epidemic, it is imperative for us to re-energise the response today for success in the years ahead,” said UNAIDS Executive Director Michel Sidibé, who joined Mr Ban for the launch of the report. “Gains in HIV prevention and antiretroviral treatment are significant, but we need to do more to stop people from becoming infected—an HIV prevention revolution is needed now more than ever.”

Mobilizing for impact  In the report there are five recommendations made by the UN Secretary-General to strengthen the AIDS response:

• Harness the energy of young people for an HIV prevention revolution;
• Revitalize the push towards achieving universal access to HIV prevention, treatment, care and support by 2015; 
• Work with countries to make HIV programmes more cost effective, efficient and sustainable;
• Promote the health, human rights and dignity of women and girls; and Ensure mutual accountability in the AIDS response to translate commitments into action.

Read the full report

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

Is Africa ready for PrEP?

Via Incidence0.org, by Adebisi Ademola Alimi

One of the biggest breakthrough in HIV clinical research, since the outbreak of the epidemic 30 years ago, is the recent success in a clinical trial of a new HIV prevention approach based on the daily use of the antiretroviral drug Truvada by HIV negative person to prevent HIV transmission (Called PrEP, for Pre-Exposure Prophylaxis).

The results of the iPrEX trial raised hope but also many questions and concerns as showed by the ensuing debate about what the next step should be. Divergences culminated with the Aids Health Foundation (AHF) petitioning the FDA not to consider Gilead’s request for a licence to use Truvada for the prevention of HIV infection and a joint counter response by a number of HIV advocacy organisations.

But for me as an advocate and an African living in Europe, the most important thing on my mind is “Will Africa be able to access PrEP?” Providing ARV to HIV negative people in Africa needs to be considered in light of the challenge of accessing treatment in Africa, where more than 50% of HIV positive people in the world live (UNAIDS report).

Even if PrEP drugs become available, what are the mechanisms in place to ensure that it will not be tribalized in a continent where there are some indications that access to ARVs is based on political and ethnical loyalty and where there are evidences of bribery at the delivery point, misused of funds and a non-negligible ARVs black market leading to ARVs being dispensed to increasing numbers of patients at the periphery of the health system. One has to be skeptical about the PrEP implementation process in this context.

Read the full article

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

Expanded access to ART has the potential to avert millions of AIDS orphans in Africa

Via aidsmap, by Michael Carter

Universal adult access to antiretroviral therapy compared to current roll-out could prevent over 4 million more children being orphaned because of HIV in the sub-Saharan African countries hardest hit by AIDS, according to published in the online journal AIDS Research and Therapy.


“Results from this study highlight the positive impact that expanded ART [antiretroviral therapy] may have in sub-Saharan countries already burdened with high numbers of AIDS orphans,” comment the investigators. They add, “we found that achieving universal ART uptake among adults may avert over 4 million maternal, paternal and double AIDS orphans over the next 10 years.”

It is estimated that 11.6 million children in sub-Saharan Africa have already lost one or both parents because of HIV. Orphans have greater material, physical, health-related and psychological need, and there is also evidence that they have higher levels of HIV-related risk behaviour. Moreover, HIV-infected orphans often delay accessing essential care and have poor rates of adherence to HIV therapy.

Antiretroviral therapy has significantly reduced rates of HIV-related illness and death. At the end of 2008, it was estimated that 44% of eligible patients in sub-Saharan Africa were receiving HIV therapy.

Read the rest

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

Kenya: Testing the Integration of HIV and public healthcare

Via PlusNews

HIV could lose its "special status" in Kenya's health system if a new pilot programme integrating HIV care and public healthcare proves successful.

Traditionally, public hospitals in Kenya have a "comprehensive care clinic" (CCC) dedicated to people living with HIV; under the new system, these would no longer exist.

For more than six months, the Ministry of Health and its partners have been piloting the move in Western Province; senior government officials say it will not reduce the focus on HIV, but will ease pressure on an already overburdened and understaffed health system.

"Integrating HIV treatment with other outpatient services doesn't mean it has become less important; it only means maximizing on space and reducing the burden on healthcare personnel and to help increase focus on other equally important diseases like malaria," said Ibrahim Mohamed, head of the National AIDS and Sexually transmitted infections Control Programme, NASCOP.

Joshua Omoro likes the new system, stating, "I have come today to pick my [antiretroviral] medicine but nobody can know; people are just guessing what I might be suffering from just like I am also just guessing for other people," he said. "It puts you at ease... before when you went to a specific room, people just knew you had HIV."

"It is not only reducing stigma but is also easing the staff shortages that had been experienced earlier when too much focus was placed on HIV/AIDS," said Beatrice Misoga, HIV/AIDS integration officer for US government-supported AIDS, Population and Health Integrated Assistance II (APHIA II) in Western Kenya.

Read the rest

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

High prevelance of anal pre-cancerous lesions in men with HIV

Via Aidsmap, by Michael Carter



Prevalence and incidence of high-grade pre-cancerous anal lesions in HIV-positive men who are taking antiretroviral therapy are high, Canadian investigators report in the online edition of Clinical Infectious Diseases. A low nadir CD4 cell count and infection with HPV types 16 and 18 were associated with an increased risk of developing high-grade pre-cancerous anal lesions (AIN-2, 3). The investigators hope that their findings will help identify patients who have a higher risk of HPV-associated anal disease.

Rates of HIV-related opportunistic infections have fallen significantly since the introduction of antiretroviral therapy.

However, the incidence of anal cancer is increasing.

Most of the information about the risk factors for this disease in HIV-positive gay men was obtained during the era before effective antiretroviral therapy became available. These include high-grade pre-cancerous lesions, infection with HPV 16 and 18, multiple HPV infections and CD4 cell count.

Investigators from the Canadian Human Immunodeficiency and Papilloma Virus Research Group (HIPVIRG) wanted to establish a comprehensive understanding of the risk factors for progression to AIN 2 and 3. They also wished to see if treatment with anti-HIV drugs had any impact on disease progression.

A total of 247 men who were taking or about to initiate antiretroviral therapy were recruited to the study between 2002 and 2005. The patients had swabs to see if they had anal HPV infection, and if present further tests were conducted to determine whether strains associated with anal cancer were present.

Read the rest
 
[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]