Update HIV/AIDS situation....March 2009

HIV evolves mutations to counter the immune system

Newsletter March 2009
Rapid HIV evolution avoids attack
HIV is evolving rapidly to escape the human immune system, an international study has shown.
The Nature study highlights just how tough it could be to develop a vaccine that keeps pace with the changing nature of the virus.
The researchers showed HIV was able to adapt rapidly to counter human genes controlling immune system molecules that can target it for destruction.
However, they stressed this would not affect the impact of anti-HIV drugs.
The implication is that once we have found an effective vaccine, it would need to be changed on a frequent basis to catch up with the evolving virus
Professor Philip GoulderUniversity of Oxford
HIV has already killed 25 million people, and an estimated 33 million are currently infected.
However, HIV does not kill all people at the same rate. On average, without treatment it takes 10 years for the infection to progress to Aids, but some people develop the disease within 12 months, while others do not do so for more than 20 years.
The rate of progress is tied to genes which control production of key immune system molecules called human leucocyte antigens (HLAs).
Humans differ in the exact HLA genes they have, and even small differences can have a big impact on how quickly Aids develops.
The researchers examined HIV genetic sequences and HLA genes in over 2,800 people in countries, including the UK, Australia, South Africa, Canada and Japan.
'Escape' mutations
They found mutations that enabled HIV effectively to neutralise the effect of a particular HLA gene were more frequent in populations with a high prevalence of that specific gene.
For example, a HLA gene called B*51 is particularly effective at controlling HIV - unless the virus is carrying an "escape" mutation in its genetic make-up.
The researchers found that in Japan, where the B*51 gene is common, two-thirds HIV-positive people without the gene carry HIV armed with the "escape" mutation.
In contrast, in the UK, where the gene is much less common, just 15%-25% of this group of patients are infected with HIV which carries the same key mutation.
Lead researcher Professor Philip Goulder, of the University of Oxford, said similar effects were seen for every HLA gene examined.
He said: "This shows that HIV is extremely adept at adapting to the immune responses in human populations that are most effective at containing the virus.
"This is high speed evolution that we're seeing in the space of just a couple of decades.
"The temptation is to see this as bad news, that these results mean the virus is winning the battle.
"That's not necessarily the case. It could equally be that as the virus changes, different immune responses come into play and are actually more effective.
"The implication is that once we have found an effective vaccine, it would need to be changed on a frequent basis to catch up with the evolving virus, much like we do today with the flu vaccine."
Big challenge
Jo Robinson, of the HIV charity Terrence Higgins Trust, said: "HIV is a complex virus which is constantly changing.
"This kind of research suggests that if we're able to create a vaccine that works against HIV, the virus will always be one step ahead.
"In that case we'd be in a situation where we need to constantly update the HIV vaccine, a bit like we see with a different flu vaccine each year."
Keith Alcorn, of the HIV information service NAM, said: "These findings indicate the enormous challenge involved in developing a vaccine against HIV.
"People need to be aware that the research required to develop a successful vaccine may take decades, during which the virus will continue to evolve, as this research shows."

Source; http://news.bbc.co.uk/2/hi/health/7907774.stm
Thursday, 26 February 2009

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HIV+ among over 50s 'surprisingly high'

The rate of HIV infection is "surprisingly high" among people aged over 50 years, the World Health Organization said Tuesday, warning that cases among older people may be growing worldwide.
More than 25 million people have died of HIV/AIDS
"The scant data that exist suggest a surprisingly high prevalence and incidence of HIV among individuals 50 years of age and over," said the WHO in its March bulletin.
According to authors of the study, in the United States, the proportion of people aged over 50 with HIV soared to 25 percent in 2006 from 20 percent in 2003.
In Europe, only eight percent of reported cases arise from older people.
In Brazil, the number of people over 50 with HIV doubled between 1996 and 2006 -- from 7.5 to 15.7 cases per 100,000 inhabitants.
"The frequency of infection with HIV in older people is worrying. We need to understand why and when these people are becoming infected so that public health campaigns can be better targeted to prevent such infections," George Schmid, a WHO scientist said.
Public perception of the disease may be part of the reason, with AIDS still being viewed as a "disease of young people." As a result, screening is less common among older people, leading to delayed diagnosis, said the WHO.
"The number of older people with HIV may be increasing worldwide, but doctors seldom consider screening them for HIV so diagnosis is often delayed," added the WHO.
At the same time, older people have lower immunity, which could have led to more rapid deterioration from HIV infection to AIDS, said the study.
The life expectancy of those infected at age 65 or older is just four years, while people who are infected at age five to 14 have life expectancies of over 13 years.
The authors noted that sexual activity remains the most likely mode of transmission for older people.
Potency drugs such as Viagra emerging in the 1990s have extended the sex life of older people, who are also less likely than younger people to practise safer sex, said the WHO.

Source: Bangkokpost, Health
Link: http://www.bangkokpost.com/news/health/137051/hiv-among-over-50s-urprisingly-high
Published: 4/03/2009 at 12:01 AM








HIV 'mutates at high speed' to avoid immune defences

A worldwide team of scientists said the human immunodeficiency virus (HIV) was swiftly evolving to avoid the body's immune defences, a phenomenon that adds to the challenge of crafting an AIDS vaccine.
A researcher extracts fluid from a vial at an AIDS research facility
Mutations in HIV enable it to rapidly sidestep genetic variations that offer a better natural shield against the deadly pathogen, they said in a study released by the journal Nature.
"Even in the short time that HIV has been in the human population, it is doing an effective job of evading our best efforts at natural immune control of the virus," said Oxford University researcher Philip Goulder.
"This is high-speed evolution that we're seeing in the space of just a couple of decades."
Goulder's team analysed the genetic codes and viral strain of 2,800 infected people in North America, the Caribbean, Europe, sub-Saharan Africa, Australia and Japan.
Their big focus was on so-called human leukocyte antigen (HLA) genes.
These control specialised proteins whose job is to act as a signaller against intruders. The proteins present little pieces of HIV to the body's heavy armour, T cells, which then seek out the virus and kill it.
Since HIV was identified as the cause of AIDS, more than a quarter of a century ago, doctors have learnt that even though no-one appears to be naturally immune to the virus, people progress to the full-blown disease at different rates.
Without antiretroviral drugs, some individuals may develop AIDS as little as a year after infection, while others take as long as two decades.
The span depends largely on inherited luck, for there are variants of HLA genes that are far better at combatting HIV than others. A tiny difference in DNA can make a huge difference in holding back the virus.
Goulder's team came across some bad news.
They found that the virus is able to mutate when facing the more successful variants of these genes.
This "escape mutation" is then transmitted on to the viral progeny and then handed on to the human population when another person becomes infected.
"Where a favourable HLA gene is present at high levels in a given population, we see high levels of the mutation that enable HIV to resist this particular gene effect," said co-author Rodney Phillips in a press release issued by Oxford University.
"The virus is outrunning human variation, you might say."
The study adds a further complexity in the quest for an HIV vaccine, say the authors.
Vaccine engineers will have to wrestle with different "escape mutations" in HIV that exist in distinct pools of populations.
For instance, a highly favourable variant of HLA is called HLA-B*51. It is common among people in Japan -- and, as a result, two-thirds of infected people there have a strain of HIV which features the "escape mutation" for this variant.
In Britain and Africa, though, HLA-B*51 is far less common. As a result, only between 15 to 25 percent of HIV-infected people have the "escape mutation" in their version of the virus.
So it means that a successful HIV vaccine may have to take these geographical differences into account, as well as the stealthy, slippery mutability of the virus itself.
"The implication is that once we have found an effective vaccine, it would need to be changed on a frequent basis to catch up with the evolving virus, much like we do today with the flu vaccine," said Goulder.
AIDS first emerged in 1981 as a novel disease that destroys immune cells, exposing the body to opportunistic infections. HIV was identified as its source in 1983. Twenty-five million people have died of AIDS and an estimated 33 million people have HIV.
The new paper focuses only on HIV's ability to sidestep natural immune systems. It did not address the virus' mutability towards anti-HIV drugs.

Source: Bangkok Post, Health
Link: http://www.bangkokpost.com/news/health/136945/hiv-mutates-at-high-speed-to-avoid-immune-defences
Published: 27/02/2009 at 09:40 PM






HIV/AIDS Posing Risks To Economy, Social Development In South Asia, Report Says

Countries in South Asia face serious economic and social development risks from HIV/AIDS, according to a World Bank report released Friday, the Times of India reports. The report, titled "HIV and AIDS in South Asia: An Economic Development Risk," said that even if the overall prevalence of the disease is low, there still could be high and rising prevalence among vulnerable groups, such as commercial sex workers and their clients, and injection drug users and their partners (Times of India, 2/28). The report said, "Without increasing prevention interventions among those at highest risk, these concentrated epidemics can further escalate." Sadiq Ahmed, the World Bank's acting chief economist, said the report's analysis "shows that failure to contain the epidemic at low levels may have serious economic consequences."According to Asia Pulse/Individual.com, the report also said that access to HIV/AIDS prevention and treatment is linked with socioeconomic factors -- such as gender, education and wealth -- and that people's ability to cope with the financial impact of HIV/AIDS differs significantly. For example, the report says that HIV-positive widows face a disproportionate economic impact because of their HIV-positive and low socioeconomic status. In addition, failure to contain the epidemic in South Asia could result in high costs related to treatment, the report said, adding that access to effective treatment is "vitally important to mitigate the health and economic impacts" of HIV/AIDS. The medical costs of treatment can put a significant portion of the HIV-positive population at risk of poverty, "especially in a region where most health services are paid for out of pocket," Asia Pulse/Individual.com reports. The report said that, with the exception of Sri Lanka, 75% or more of health expenditures in South Asia are financed privately and very little are paid for by third-parties like insurance companies.According to the report, although the effect of HIV/AIDS on countries' overall level of economic activity is small, the impact of direct welfare costs because of increased mortality and lower life expectancy are more considerable. In addition, the economic impact of HIV/AIDS on individual households is substantial, the report found. For example, a household survey in India found that 36% of HIV-positive people who were able to retain employment still reported an average income loss of about 9% (Asia Pulse/Individual.com, 3/2).Mariam Claeson, the World Bank's HIV/AIDS coordinator for South Asia, said that there "cannot be any room for complacency," even in countries with low HIV/AIDS prevalence rates. Claeson said that although the impact of HIV/AIDS "on economic growth is small in South Asia, the welfare cost on households is by no means negligible." She added that HIV/AIDS also has an "enormous disproportionate impact on vulnerable and often marginalized people at highest risk of infection, and on poor households with less access to information, preventive services and treatment" (Times of India, 2/28). Reprinted with kind permission from http://www.kaisernetwork.org/. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation.

Source: Medicalnewstoday, HIV/AIDS
Link: http://www.medicalnewstoday.com/articles/141049.php
Article Date: 04 Mar 2009 - 6:00 PST







AFP/MSN.com Examines Hospice For HIV-Positive People In Thailand

Main Category: HIV / AIDSAlso Included In: Palliative Care / Hospice CareArticle Date: 04 Mar 2009 - 5:00 PSTThe Wat Phra Baht Nam Phu temple, a hospice for people living with HIV/AIDS in Thailand, has provided care to more than 10,000 HIV-positive people out of the estimated 610,000 people living with the virus in the country, the AFP/MSN.com reports. People often come to the temple anonymously and without notice, according to AFP/MSN.com. The hospice was founded 17 years ago as a place to care for HIV/AIDS patients, many of whom face discrimination because of the high amount of stigma surrounding the disease. People can access some medical services, and the temple's principles are "steeped in its Buddhist faith," AFP/MSN.com reports.One Indian nurse and one Cambodian doctor -- who is not permitted to prescribe medicines -- care for 120 residents and 300 non-resident patients. In emergency cases, patients are sent to a nearby hospital to receive antiretroviral treatment. The temple's clinic workers attempted to hire more doctors by appealing to nearby hospitals and the health department, but they had no applicants. Ching Thangsing, the nurse who works at the clinic, said, "I think [doctors] are afraid of HIV, they don't want to work with HIV-positive patients." The temple aims to combat the stigma surrounding the disease by welcoming school groups to its museums and monuments, as well as to a shrine that contains the ashes of 10,000 former residents. Japanese volunteer Katsumi Suzuki said, "This is a very unique place. It crosses the area between Buddhism and medicine" (Truscott, AFP/MSN.com, 2/28). Reprinted with kind permission from http://www.kaisernetwork.org/. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation.

Source: Medicalnewstoday, HIV/AIDS
Link: http://www.medicalnewstoday.com/articles/141050.php
Article Date: 04 Mar 2009 - 6:00 PST







U.S. Lutheran Bishops Take Public HIV Tests To Raise Awareness Among Congregations, Support African Counterparts

Bishops from the Evangelical Lutheran Church in America on Thursday publicly took HIV tests in an effort to raise awareness about the virus among their congregations, the Chicago Tribune reports. "We in the U.S. tend to think of this as a global pandemic unrelated to people in the U.S.," ECLA Presiding Bishop Mark Hanson, who also serves as president of the Lutheran World Federation, said, adding, "For me, as a married heterosexual man to be tested is a reminder that all communities are affected, if not infected." According to Hanson, the bishops were following the lead of religious leaders in Africa, many of whom for years have called on their congregations to receive HIV tests and agreed to be screened publicly for the virus.According to the Tribune, although many churches have "long worked to eradicate poverty-related pandemics" and diseases such as malaria, they have been "slow to address" HIV/AIDS, which is "haunted by a moral stigma" because it can be sexually transmitted. Hanson said that the church should take steps to embrace people living with the disease. Bishop Wayne Miller of the Metropolitan Chicago Synod said that taking an HIV test is his way of being closer with the Central Diocese of the Evangelical Lutheran Church in Southern Africa -- Chicago's companion synod. Miller added that he hopes his actions will send a signal to his congregations that they should be proud and not ashamed to be screened for the virus. "There's still so much shame and secrecy, people end up hiding from the treatment and care they need," he said. ELCA's chief legislative authority during its biennial assembly in August is expected to approve a new national church HIV/AIDS strategy (Brachear, Chicago Tribune, 3/6). Reprinted with kind permission from http://www.kaisernetwork.org/. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation.

Source: Medicalnewstoday, Health, HIV/AIDS
Link: http://www.medicalnewstoday.com/articles/141483.php

Article Date: 09 Mar 2009 - 2:00 PDT

Microbicide Containing Natural Compound Provides Protection In Monkeys Against Simian Version Of HIV, Study Says

An experimental microbicide containing a naturally occurring compound provides protection in monkeys against the simian version of HIV by diminishing immune responses to the virus, according to a study published Wednesday in the journal Nature, the Los Angeles Times reports. HIV typically spreads in the body by entering CD4+ T cells, which the immune system sends out to attack the virus after exposure. The compound -- called glycerol monolaurate, or GML -- works by inhibiting immune signals that dispatch the T cells to attack the infection. It is those T cells that HIV infects and uses to proliferate throughout the body (Engel, Los Angeles Times, 3/5). GML occurs naturally in the human body and already is approved for use as an antimicrobial and anti-inflammatory ingredient in cosmetics and toiletries, as well as an emulsifier in foods. In addition, each dose of GML used in the study costs less than one cent. According to the researchers, the study's findings have promising implications for the development of effective microbicides to prevent HIV (AFP/Google.com, 3/4).For the study -- led by Ashley Haase, head of the microbiology department at the University of Minnesota Medical School, and microbiologist Patrick Schlievert -- researchers administered the GML gel vaginally to five rhesus monkeys and then repeatedly exposed them to the simian version of HIV, or SIV. After two weeks, all of the five monkeys tested negative for the virus. However, four out of five monkeys that did not receive the GML gel contracted SIV. According to the researchers, five months after the experiment, they learned that one of the monkeys treated with GML tested positive for the virus. The researchers said they are unsure how this monkey contracted SIV, but they suggested that a small amount of the virus might have spread in the body undetected or the monkey might have been exposed to SIV after the study ended (Lerner, Minneapolis Star Tribune , 3/4).Haase said the current research is "a relatively preliminary study but worth sharing because it establishes a novel approach." The researchers added that a mathematical model suggests that even if the microbicide were 60% effective and used 20% of the time, it still could prevent about 2.3 million HIV cases over a three-year period. According to the study authors, researchers will need to conduct further animal studies to determine whether the microbicide should be administered over a longer period of time to provide long-term protection against the virus (Los Angeles Times, 3/5). Further study also will be needed to demonstrate whether GML prevents HIV transmission among humans, they added. The researchers said they plan to undertake a larger study with monkeys, followed by a study with female volunteers. In addition, the University of Minnesota has applied for patents for the new compound combining GML with a personal lubricant, which currently is not available commercially. According to Schlievert, the ultimate goal will be to develop a gel that can be used for both men and women (Minneapolis Star Tribune, 3/4).According to the study authors, the research "represents a highly encouraging new lead in the search for an effective microbicide to prevent HIV transmission that meets the criteria of safety, affordability and efficacy" (Fox, Reuters, 3/4). Haase said that although the research "sounds counter-intuitive, halting the body's natural defense system might actually prevent transmission and rapid spread of the infection" (AFP/Google.com, 3/4). Charlene Dezzutti, laboratory network director of the Microbicides Trial Network at the University of Pittsburgh, said the research illustrates "a new approach to thinking about microbicides." She added that she believes scientists "definitely" could develop an effective microbicide before developing an HIV/AIDS vaccine. "It's just a matter of getting all the right pieces together," she said (Lauerman, Bloomberg, 3/4). Rowena Johnston, vice president of research for the Foundation for AIDS Research, said that if further studies confirm these results, "then this is really a fabulous new finding." She said that although future microbicide research could encounter setbacks, the study is "absolutely a great beginning to a research project."According to Schlievert, women could apply the GML microbicide "an hour or so before they had sex" to protect against HIV transmission. In addition, the gel might provide protection against other sexually transmitted infections, such as chlamydia, he said (Minneapolis Star Tribune, 3/4). According to AFP/Google.com, Schlievert first identified the microbicidal properties of GML when studying the use of the compound in preventing toxic shock syndrome associated with tampons. He said research repeatedly has found that the compound is safe and has no effect on beneficial vaginal bacteria (AFP/Google.com, 3/4). Lorraine Teel, executive director of the Minnesota AIDS Project, said the gel could provide women with a way to prevent disease transmission in areas of the world where many people do not use condoms because of cultural or other pressures. The research has "absolutely enormous implications" for women worldwide, she said (Minneapolis Star Tribune, 3/4). Anthony Fauci, director of NIH's National Institute of Allergy and Infectious Diseases, said an effective microbicide would "empower women to protect themselves in a sexual situation in which they may not have complete control" (Los Angeles Times, 3/5).An abstract of the study is available online. Reprinted with kind permission from http://www.kaisernetwork.org/. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation.

Source: Medicalnewstoday, Health, HIV/AIDS
Link: http://www.medicalnewstoday.com/articles/141362.php
Article Date: 06 Mar 2009 - 4:00 PST








HIV/AIDS Advocates In Thailand Urge Government To Maintain Compulsory License Program

HIV/AIDS advocates in Thailand plan to meet with officials to urge the government not to restrict its compulsory license program, which allows people in the country to access low-cost, generic versions of drugs such as antiretroviral medications, AFP/Google.com reports. The program suspends patent protections for brand-name drugs to treat HIV/AIDS, cancer and heart disease, thus allowing low-cost, generic medications into the market. According to the HIV/AIDS advocates, Thailand's Ministry of Commerce recently sent a letter to public health officials requesting that they suspend issuing compulsory licenses because the program is posing obstacles for free trade talks with the U.S. The letter said Thailand "should not implement additional compulsory licensing" in order to encourage the U.S. to remove Thailand from its "piracy watch list," the advocates said. Alongkorn Polabutr, Thailand's deputy commerce minister, plans to visit the U.S. later this month to engage in renewed trade discussions, AFP/Google.com reports. Nimit Tienudom, director of Thailand's AIDS Access Foundation, said he will meet with the minister before his departure. "We are totally opposed to the idea that Thailand should not do more compulsory licensing," Nimit said, adding that the program "benefits Thai people as a whole."Panitan Wattanayagorn, a spokesperson for Thailand's government, said officials have no intentions of halting the compulsory license program. "Thailand reaffirms that it has implemented compulsory licensing in line with international practice to allow Thai people access to drugs," Panitan said. He added that Abhisit Vejjajiva, Thailand's prime minister, has asked U.S. business representatives to "send signals to the U.S. administration not to cite the compulsory licensing case to deprive Thailand of trade status or affect our country" (AFP/Google.com, 3/4). Reprinted with kind permission from http://www.kaisernetwork.org/. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation.

Source: Medicalnews
Link: http://www.medicalnewstoday.com/articles/141363.php
Article Date: 06 Mar 2009 - 4:00 PST








Female Migrants From Asia At An Increased Risk Of HIV, U.N. Report Says

Female migrants from Asia have become "highly vulnerable" to HIV during the global financial crisis, according to a United Nations Development Programme report released in Manila, the Philippines, on Tuesday, AFP/Nasdaq.com reports. According to the report, the economic crisis has resulted in widespread job cuts and the "situation of migrant workers is under threat." It added, "When demand for labor wanes, those in the weakest bargaining position, usually temporary migrant workers and particularly the undocumented, will accept almost any conditions to hold on to their jobs."Between 70% and 80% of migrant workers from Sri Lanka and the Philippines to Arab states are women, and 60% of female migrants from Bangladesh were employed in the region between 1991 and 2007, according to the report. It added that these women now face harsh conditions. Many are heavily indebted when they leave their home countries, and others experience sexual abuse by their employers or are kidnapped by human traffickers. "Conditions are expected to become harsher for even the employed migrant workers as they try to hang on to their jobs," UNDP country representative Renaud Meyer said, adding that undocumented workers are among the most vulnerable and might "accept almost any circumstances to hold on to their jobs." Meyer said, "Worst still, during the present turmoil, desperation for work may lead to migration under unsafe conditions, sexual exploitation and increased vulnerability to HIV infections" (AFP/Nasdaq.com, 3/10). Prasada Rao, regional director for UNAIDS, said that although "migration itself is not a risk factor to HIV infection, the conditions under which some workers migrate and their living conditions in the host countries make them highly vulnerable to HIV." Ajay Chhibber, UNDP regional director for Asia and the Pacific, said that migrants found to be HIV-positive often face deportation and that they are unable to find work and experience discrimination once they return to their home countries (AP/MSNBC.com, 3/10). According to AFP/Nasdaq.com, although some countries require HIV/AIDS education for migrants prior to departure, many workers do not receive such education. For example, 96% of Bangladeshi domestic workers in the Middle East said that they did not receive HIV/AIDS orientation before departure. "While half of them have heard of HIV through the media or from co-workers, none had in-depth knowledge of HIV prevention" and safer-sex methods, the report said, adding that the combination of recruitment fees and low wages can force female migrants into "debt traps, which in turn, could lead to sexual exploitation." In addition, workers who "flee abusive working conditions are immediately rendered illegal by host countries, exposing them to greater risk of abuse, including sexual exploitation and increased vulnerability to HIV," the study said. It was based on more than 600 interviews with migrant workers from Bangladesh, Pakistan, the Philippines and Sri Lanka, which supply workers to countries such as Bahrain, Lebanon and the United Arab Emirates (AFP/Nasdaq.com, 3/10). The report is available online. Reprinted with kind permission from http://www.kaisernetwork.org/. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation.

Source: http://www.medicalnewstoday.com/, Women's Health / GynecologyAlso Included In: HIV / AIDS; Sexual Health / STDs
Link: http://www.medicalnewstoday.com/articles/141997.php
Article Date: 12 Mar 2009 - 5:00 PDT






IRIN News Examines HIV/AIDS Awareness Levels Among IDUs In Myanmar

IRIN News recently examined how the "thousands" of injection drug users in Myanmar have "little or no awareness of the risks" associated with the practice, including an increased risk of HIV/AIDS. The government reports that the number of registered IDUs in the country is around 70,000, with a majority of newly registered IDUs using heroin. However, many IDUs do not register, which is required when seeking treatment, for fear of persecution -- meaning that the number of IDUs likely is much higher. Injection drug use, which accounts for about 30% of all new HIV infections in Myanmar, is the main mode of HIV transmission in the country after heterosexual sex, IRIN News reports. The United Nations Office on Drugs and Crime estimates that up to 300,000 people may be addicted to injection drugs in the country. The government estimates that HIV prevalence among IDUs is about 35% and up to 80% in some areas. Sun Gang, country coordinator for UNAIDS, said, "HIV prevalence among injecting drug users is pretty high in this country. One in three injecting drug users is infected with HIV/AIDS." Willy de Maere, country coordinator with the Asian Harm Reduction Network, said that HIV/AIDS awareness among IDUs is critical, adding, "You cannot get behavior change unless you have the correct knowledge." IRIN News reports that additional HIV/AIDS efforts in the country include needle-exchange programs. However, some experts say that because of the high prevalence of injection drug use, existing treatment and rehabilitation services fall short of what is needed. UNODC and its partners -- such as AHRN and the Myanmar Anti-Narcotics Association, a local nongovernmental organization -- are working to curb the spread of HIV among IDU populations by providing HIV/AIDS information, clean needles and condoms through drop-in centers and outreach programs. In addition, they are providing medical care for opportunistic infections and general health care and providing referral services for counseling and testing; prevention of mother-to-child HIV transmission; treatment for HIV, tuberculosis and sexually transmitted infections; and detoxification and methadone treatment (IRIN News, 3/9).

Source: http://www.medicalnewstoday.com/, HIV / AIDSAlso Included In: Alcohol / Addiction / Illegal Drugs; Sexual Health / STDs; Public Health

Link: http://www.medicalnewstoday.com/articles/141998.php
Article Date: 12 Mar 2009 - 4:00 PDT








EU vows to boost AIDS fight
By: AFP
LILONGWE - The European Commission will boost efforts to prevent HIV infections in Southern Africa, the world's worst-hit region that saw 1.5 million new infections in 2007, an EU envoy said on Thursday.
More than 35% of the world's new infections and 38% of AIDS deaths occured in southern Africa
"We have to do more on prevention, and we have to do it better and faster. HIV infections are unacceptably high," Alessandro Mariani, the European Union's ambassador to Malawi, told AFP.
Mariani was speaking at the end of a two-day meeting here for 10 southern African states.
"Prevention, prevention and prevention will be our main objective. We want a new generation which is HIV free," said Mariani, who chairs the EC's regional anti-AIDS group.
Preventing mother-to-child transmission of HIV will be a priority, but the new focus will also aim to stop HIV transmission in the broader public.
Mariani refused to say how much money the EC will pump into the drive, but said the EC will build on "significant European resources dedicated to the fight against HIV and AIDS in the region."
Southern Africa bears a disproportionate share of the global HIV burden, with 35 percent of the world's new infections and 38 percent of AIDS deaths in 2007.
South Africa has the largest HIV epidemic in the world, with an estimated 5.7 million people living with the disease.
The EC action against AIDS group comprises Angola, Botswana, Lesotho, Malawi, Mozambique, Namibia, South Africa, Swaziland, Zambia and Zimbabwe.
Resource: http://www.bangkokpost.com/, Health
Link: http://www.bangkokpost.com/news/health/137369/eu-vows-to-boost-aids-fight
Published: 13/03/2009 at 01:39 AM

Better drugs 'encouraging' AIDS complacency

New Delhi - People are forgetting to practise safe sex because they no longer fear dying from HIV/AIDS, says the doctor who won the Nobel prize for helping to discover the virus.
Treatment advances mean "some people in my country, France, and other Western countries have become complacent -- they see HIV/AIDS as a chronic disease -- not as one that can kill," virologist Francoise Barre-Sinoussi said.
The doctor shared the Nobel Prize last year with fellow French virologist Dr Luc Montagnier for their discovery in 1981 of the human immunodeficiency virus (HIV) that causes AIDS.
Barre-Sinoussi noted there has been a huge leap forward in treatments for HIV/AIDS with a cocktail of drugs that reduces the level of virus in the body and likewise lowers the risk of passing on the pathogen to others.
But she told AFP she worried that people's confidence in retroviral drugs had created a false sense of security, leading to an increase in unprotected sex.
Speaking on the sidelines of a medical conference last week organised by French charity Fondation Merieux in New Delhi, she noted a "frightening" rate of new male-to-male infection in some Western countries such as France.
"We should tell the truth about HIV/AIDS -- that new treatments can be very effective, helping them live years longer," said Barre-Sinoussi.
But she added that HIV/AIDS patients are prone to other illnesses, especially cancers. They can also be resistant to the life-saving drugs, creating "major complications."
Between 2001 and 2006, male-to-male sex was the largest HIV transmission category in the United States and the only one associated with an increasing number of HIV/AIDS diagnoses, according to the US Centers for Disease Control and Prevention.
About 56,300 people were infected with HIV in the United States in 2006, according to the organisation, with gay and bisexual men accounting for about half of all new infections.
In the United States and all around the world, fears of being stigmatised discourage people from being tested, non-governmental bodies say.
In the 1980s in the West gay leaders, dismayed by the deaths of so many from the virus, mounted an aggressive grassroots movement that triggered government action and prevention campaigns among the homosexual community.
HIV infections among gay and bisexual men fell dramatically for a decade but rates have been rising again since the mid-1990s.
The virus is also having a disproportionate effect on men who have sex with men in nations where the epidemic is just getting a foothold.
Professor Mark Wainberg, head of Montreal's McGill University AIDS Centre, echoed Barre-Sinoussi's concerns.
With the advances in treatment "the voices that spoke for safe sex are often silent," he told AFP at the same New Delhi conference.
"People are saying 'look how well the drugs work -- they work for a long time.'"
The public needs to understand the drugs themselves can be toxic and statistics are showing alarming rates of cancer in HIV-affected people, he added.
"The data from our studies indicate the average age of people getting HIV/AIDS is 35 -- these are mature individuals, not kids," he said.
"Some people are throwing caution to the wind."
Around the world, about 33 million people are living with HIV/AIDS and two million die each year. It has killed at least 25 million.
At the same time, Barre-Sinoussi said she was optimistic researchers would find an AIDS vaccine despite many major research setbacks.
"We really have to go back to very basic science and think differently... think out of the box," she said.

Source: http://www.bangkokpost.com/, Health
Link: http://www.bangkokpost.com/news/health/137355/better-drugs-encouraging-aids-complacency-nobel-doctor
Published: 12/03/2009 at 07:20 PM

Progress Toward AIDS Vaccine

Rutgers AIDS researchers Gail Ferstandig Arnold and Eddy Arnold may have turned a corner in their search for a HIV vaccine. In a paper just published in the Journal of Virology, the husband and wife duo and their colleagues report on their research progress. With the support of the National Institutes of Health, the Arnolds and their team have been able to take a piece of HIV that is involved with helping the virus enter cells, put it on the surface of a common cold virus, and then immunize animals with it. They found that the animals made antibodies that can stop an unusually diverse set of HIV isolates or varieties. Some researchers have previously been able to elicit effective antibodies, but usually only against a very limited number of HIV types. With HIV's known propensity to mutate, antibodies developed against one local strain may not recognize and combat mutant varieties elsewhere. These geographic varieties with different mutations constitute one of the great challenges to finding a broad spectrum vaccine capable of protecting against the vast array of HIV varieties. The approach taken by the Arnolds and their colleagues has been to identify a part of the AIDS virus that is crucial to its viability - something the virus needs in order to complete its life cycle - and then target this Achilles heel. "The part that we targeted plays a role in the ability of HIV to enter cells, and is common to most HIV varieties," Gail Ferstandig Arnold said. "That is a mechanism that would not be easy for the virus to reinvent on the fly, so it turns out to be a really helpful target." The Arnolds are both members of the Center for Advanced Biotechnology and Medicine, a joint center of Rutgers, The State University of New Jersey, and the University of Medicine and Dentistry of New Jersey. Also, Gail Ferstandig Arnold is a research professor and Eddy Arnold is a professor, both in Rutgers' Department of Chemistry and Chemical Biology. While most vaccines are actually made from the pathogen itself, employing weakened or inactivated organisms to stimulate antibody production, HIV is just too dangerous to use as the basis for a vaccine vehicle. What the Arnolds have done is to use the relatively innocuous cold-causing rhinovirus and attach the target portion of the HIV. This must be done in a way that maintains the HIV part's shape so that when the immune system sees it, it will actually mount an immune response as it would to the real HIV. "The idea is to trick the immune system into thinking it is acting upon HIV before the virus shows actually shows up on the scene," said Eddy Arnold. To actually accomplish this is a big problem in engineering. The goal was to take a small piece of the HIV out of its native context, put it in a completely different system (rhinovirus), and have it look the same and act the same. Eddy Arnold likens this to taking the Rocky Mountains, putting them on India and having them look exactly right. Using recombinant engineering, the research team developed a method to systematically test millions of varied presentations of the HIV segment with the rhinovirus. They tried millions of different variations on how to graft (or splice) one onto the other, creating what are called combinatorial libraries. "It's like the lottery," Eddy Arnold commented. "The more tickets you buy the better chance you have of winning." "The really exciting part is that we were able to find viruses that could elicit antibodies against a huge variety of isolates of HIV. That is an immense step and a very important step," said Gail Ferstandig Arnold. "However, we need to be careful to not overstate things because the quantity of response is not huge, but it is significant," added Eddy Arnold. "This is actually the first demonstration of this particular Achilles heel being presented in way to generate a relevant immune response. It is probably not potent enough by itself to be the vaccine or a vaccine, but it is a proof of principle that what we are trying to do is a very sound idea."

Source: medicalnewstoday, HIV / AIDS
Link: http://www.medicalnewstoday.com/articles/142203.php
Article Date: 13 Mar 2009 - 6:00 PDT

Female Migrants From Asia At An Increased Risk Of HIV, U.N. Report Says

Female migrants from Asia have become "highly vulnerable" to HIV during the global financial crisis, according to a United Nations Development Programme report released in Manila, the Philippines, on Tuesday, AFP/Nasdaq.com reports. According to the report, the economic crisis has resulted in widespread job cuts and the "situation of migrant workers is under threat." It added, "When demand for labor wanes, those in the weakest bargaining position, usually temporary migrant workers and particularly the undocumented, will accept almost any conditions to hold on to their jobs."Between 70% and 80% of migrant workers from Sri Lanka and the Philippines to Arab states are women, and 60% of female migrants from Bangladesh were employed in the region between 1991 and 2007, according to the report. It added that these women now face harsh conditions. Many are heavily indebted when they leave their home countries, and others experience sexual abuse by their employers or are kidnapped by human traffickers. "Conditions are expected to become harsher for even the employed migrant workers as they try to hang on to their jobs," UNDP country representative Renaud Meyer said, adding that undocumented workers are among the most vulnerable and might "accept almost any circumstances to hold on to their jobs." Meyer said, "Worst still, during the present turmoil, desperation for work may lead to migration under unsafe conditions, sexual exploitation and increased vulnerability to HIV infections" (AFP/Nasdaq.com, 3/10). Prasada Rao, regional director for UNAIDS, said that although "migration itself is not a risk factor to HIV infection, the conditions under which some workers migrate and their living conditions in the host countries make them highly vulnerable to HIV." Ajay Chhibber, UNDP regional director for Asia and the Pacific, said that migrants found to be HIV-positive often face deportation and that they are unable to find work and experience discrimination once they return to their home countries (AP/MSNBC.com, 3/10). According to AFP/Nasdaq.com, although some countries require HIV/AIDS education for migrants prior to departure, many workers do not receive such education. For example, 96% of Bangladeshi domestic workers in the Middle East said that they did not receive HIV/AIDS orientation before departure. "While half of them have heard of HIV through the media or from co-workers, none had in-depth knowledge of HIV prevention" and safer-sex methods, the report said, adding that the combination of recruitment fees and low wages can force female migrants into "debt traps, which in turn, could lead to sexual exploitation." In addition, workers who "flee abusive working conditions are immediately rendered illegal by host countries, exposing them to greater risk of abuse, including sexual exploitation and increased vulnerability to HIV," the study said. It was based on more than 600 interviews with migrant workers from Bangladesh, Pakistan, the Philippines and Sri Lanka, which supply workers to countries such as Bahrain, Lebanon and the United Arab Emirates (AFP/Nasdaq.com, 3/10).

Resource: Medicalnewstoday, Women's Health / Gynecology, HIV/AIDS, Sexual Health, STDs
Link: http://www.medicalnewstoday.com/articles/141997.php
Article Date: 12 Mar 2009 - 5:00 PDT






HIV Vaccines Should Mimic Body's Natural Response Say Researchers

New research led by a US team suggests that vaccines developed from a group of antibodies that occur naturally in the bodies of "slow progressing" HIV patients might be a better way to knock out the virus than focusing on a small number of engineered "super antibodies".The study was led by Michel C Nussenzweig, Sherman Fairchild Professor and head of the Laboratory of Molecular Immunology at the The Rockefeller University in New York and is published in the 15 March advanced online issue of Nature.For the last 25 years, scientists have tried to develop a "magic bullet" HIV vaccine that rely on a small number of engineered "super antibodies" to stop the virus taking hold.Nussenzweig, who is also a Howard Hughes Medical Institute investigator, and colleagues showed that patients infected with HIV in whom the virus progresses much more slowly, have a diverse group of antibodies produced naturally in dynamic response to the infection, that behave like a co-ordinated hunting pack to knock down the virus more effectively than their super antibody cousins fighting on their own.They suggest that a "shotgun" approach, based on these naturally produced antibodies, might be a better way to develop an effective HIV vaccine than trying to engineer a super antibody "magic bullet". As Nussenzweig explained, looking for a different approach, they tried to reproduce what happens in the patient:"What's in the patient is many different antibodies that individually have limited neutralizing abilities but together are quite powerful," he said, adding that "this should make people think about what an effective vaccine should look like."HIV's primary survival advantage is the ability of virus strains to mutate rapidly and thus stay one step ahead of the immune system and vaccine developers. However, all HIV strains share one feature, they have a surface glycoprotein called gp140 that helps them to infect host cells. Earlier studies have shown there are four engineered antibodies that can stop the virus infecting human cells by blocking the action of gp140 in culture, but so far attempts to get the human body to produce these antibodies have failed.In about 10 to 20 per cent of people infected with HIV, the virus progresses very slowly to disease because the memory B cells in their immune system produce high levels of antibodies specific to the virus. But nobody knows much about these antibodies and how effective they are.Lead author Johannes Scheid, who was a visiting student in Nussenzweig's lab and is now a doctoral candidate, started examining naturally produced antibodies in six HIV infected patients whose immune systems appeared to be putting up a strong fight against the virus.With the help of David D Ho and Jeffrey V Ravetch from the Rockefeller Center for Clinical and Translational Science, Scheid and colleagues took blood from these patients and isolated 433 antibodies that targeted gp140. The researchers then mass-produced these 433 antibodies by cloning them, and then mapped which part of the gp140 protein each one attacked and how effective it was against the virus.As a result, they found a new structure within the gp140 protein that is a potential new target for the antibodies. They called this new structure the "gp120 core", because it is in the same region as the CD4-binding site of another envelope glycoprotein gp120. "It's the first time that anyone has defined what is really happening in the B cell response in these patients," said Scheid.Nussenzweig said that what Sheid and colleagues did was find that each of the 433 antibodies had some way of attacking HIV, but each on its own did not do enough to knock it out.Individually, these antibodies are not as strong as the four engineered super-antibodies, which Nussenzweig described as the "Famous Four" that vaccine developers are using.But in high concentrations, and used as a group, the cloned antibodies appeared to act as a team, and just as able to knock out HIV in cell cultures as any single antibody studied to date, said Nussenzweig.The natural antibodies alos recognized a range of HIV strains, suggesting another reason why used as a group, they may be more effective than a single super-antibody that only recognizes one part of a virus with a high rate of mutation.The researchers believe their findings make a strong case for investigating potential vaccines that mimic the body's natural immune system response to HIV."Broad diversity of neutralizing antibodies isolated from memory B cells in HIV-infected individuals."Johannes F. Scheid, Hugo Mouquet, Niklas Feldhahn, Michael S. Seaman, Klara Velinzon, John Pietzsch, Rene G. Ott, Robert M. Anthony, Henry Zebroski, Arlene Hurley, Adhuna Phogat, Bimal Chakrabarti, Yuxing Li, Mark Connors, Florencia Pereyra, Bruce D. Walker, Hedda Wardemann, David Ho, Richard T. Wyatt, John R. Mascola, Jeffrey V. Ravetch & Michel C. Nussenzweig.Nature Published online 15 March 2009.doi:10.1038/nature07930

Source: Medicalnewstoday, HIV / AIDS, Immune System / Vaccines
Link: http://www.medicalnewstoday.com/articles/142354.php
Article Date: 16 Mar 2009 - 1:00 PDT

New Technology Opens Gateway To Studying HIV-specific Neutralizing Antibodies

Many scientists believe a vaccine that prevents HIV infection will need to stimulate the body to make neutralizing antibodies, infection-fighting proteins that prevent HIV from entering immune cells. Previous research has shown that some individuals who control HIV infection without medication naturally produce antibodies able to neutralize diverse strains of HIV. Until now, however, scientists were hampered in studying the way effective HIV-neutralizing antibodies arise during natural HIV infection because scientists lacked the tools to obtain more than a few HIV-specific antibodies from any given individual. A new research endeavor has assembled a group of state-of-the-art techniques for the first time to study the phenomenon of natural antibody-mediated HIV neutralization. The project demonstrates how this system can isolate dozens of HIV-specific antibodies from a single HIV-infected individual, something never accomplished before. Applied prospectively to a large group of HIV-infected individuals, the system will enable scientists to identify and define the diverse set of neutralizing antibodies that arise during natural HIV infection, information that may prove important in vaccine development. John R. Mascola, M.D., Richard T. Wyatt, Ph.D., and Mark Connors, M.D., all of the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, participated in the research, which NIAID co-funded. Michel C. Nussenzweig, M.D., Ph.D., of The Rockefeller University led the team of 22 co-investigators in this collaboration. The process begins with collecting memory B cells, which produce antibodies, from HIV-infected individuals previously screened for strong neutralizing antibody responses. These B cells are incubated with a specially flagged protein from the outer shell of an HIV virus particle. The HIV-specific memory B cells bind to the flagged protein, enabling researchers to identify these cells, isolate and store them. Then, for each of the HIV-specific memory B cells, a pioneering technique expresses the genes that code for HIV-specific antibodies. Finally, assays help scientists determine which of these antibodies can effectively neutralize HIV.

Source: Medicalnewstoday, HIV/AIDS
Link: http://www.medicalnewstoday.com/articles/142502.php
Article Date: 17 Mar 2009 - 3:00 PDT

In HIV-Infected Individuals Combination Therapy Restores T Cell Numbers

White blood cells known as CD4+ T cells are the main target of HIV. The virus hijacks these cells and replicates within them, which ultimately destroys the cell. This depletion of the T cell population represents a major blow to the immune system and puts HIV-infected individuals at increased risk of opportunistic infections. Treatment of HIV-infected individuals with a cocktail of drugs called combination antiretroviral therapy (c-ART) is able to restore the T cell population and help fight HIV infection, however not all patients respond to this therapy. The growth factor interleukin-7 (IL-7) is known to stimulate T cell production and survival, suggesting that IL-7 may help restore the T cell population during HIV infection. In a new study published in the JCI, Yves Levy and colleagues at the University of Paris undertook a clinical trial to evaluate the safety and efficacy of repeated IL-7 therapy over a 16-day period in 13 c-ART-treated, HIV-infected patients that possessed low T cell counts despite successful suppression of virus levels with c-ART. In these individuals, IL-7 was well tolerated and boosted the number of CD4+ and CD8+ T cells, which were able to mount an immune response against HIV. These effects were observed for 48 weeks. The data suggest that HIV-infected patients may benefit from intermittent therapy with IL-7 in combination with c-ART.

Source: Karen Honey Journal of Clinical Investigation

View the PDF of this article at: https://www.the-jci.org/article.php?id=38052