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Posts Tagged ‘HIV’

Mark Harrington is the Executive Director of the Treatement Action Group.

The International AIDS Conference starts this coming weekend. ScienceSpeaks sat down with Mark Harrington (right), executive director of the Treatment Action Group (TAG), to get his thoughts on the meeting.

TAG is an independent AIDS research and policy think tank fighting for better treatment, a vaccine, and a cure for AIDS. TAG’s programs focus on antiretroviral treatments, HIV basic science and immunology, vaccines and prevention technologies, hepatitis and tuberculosis.

Tell me about the IAS pre-meeting you are attending in Vienna, on potential functional and sterilizing cures to HIV/AIDS?

This 2-day meeting is a collaboration between IAS and TAG which will bring together both scientists as well as some community activists who are interested in the science of HIV.  The pre-meeting will look at both functional and sterilizing cures. A functional cure doesn’t mean you’ve gotten rid of all of the virus in the body, but it does mean long-term absence of detectable virus without therapy, so you wouldn’t have to take medication every day.   We’ll also look at sterilizing cures, which would therapeutically eradicate the virus. The discussion and research are preliminary, and not ready for standardized trials. But there is a need for targeted studies and we will be addressing that.

Why is it a priority for you to attend that meeting?

Part of TAG’s mission is to ensure that research is done to end the epidemic, and that will be through a cure and a vaccine. So it’s natural that we would be a part of this.

Some research recently presented at CROI in February showed that adding the integrase inhibitor raltegravir to an already suppressive triple Highly Active ART (HAART) regimen did not further reduce viral burden. This is because current HAART suppresses all full cellular replication of HIV, so the only HIV expressed during effective HAART is coming out of latently infected CD4 T cells which are reawakening from latency. HAART is fully effective in preventing these new viruses from infecting new cells. This led researchers to reopen the search for therapies which could awake the virus out of latency so they could be killed by HAART, which would be one approach to a cure.

HAART or combination antiretroviral therapy, on the other hand, has set the stage for revival of eradication research. We’ve reached the limits of what we can do with HAART in terms of what it’s able to do about virus population, so new research is needed because HAART does not affect HIV DNA resting in latently infected CD4 T cells. (more…)

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Daniel R. Kuritzkes, MD, Professor of Medicine at Harvard Medical School

The International AIDS Conference starts up in less than a week in Vienna, Austria.  ScienceSpeaks is gathering thoughts from leaders in the field HIV/AIDS treatment, research and advocacy in the question and answer series “Looking toward Vienna.”

Daniel R. Kuritzkes, MD, is a Professor of Medicine at Harvard Medical School. He is also the Head Director of the AIDS Research section of Retroviral Therapeutics at Brigham & Women’s Hospital in Boston.  Dr. Kuritzkes also serves as Vice Chair of the Executive Committee of the Adult AIDS Clinical Trials Group (ACTG) and is the Director and Principal Investigator of the Harvard Adult AIDS Clinical Trials Unit.

What are your expectations for the conference?

I hope that the conference will be another opportunity for networking and for inter-disciplinary discussion, particularly for people that have been developing therapeutics and those charged with rolling out ART in developing countries where there is high demand for these medicines.

I’m looking forward to dialogue about the intersection of therapeutics and prevention. The results of the first PrEP trials will be fostering much discussion, with the presentation of the CAPRISA trial results.

Any sessions you are particularly looking forward to?

President Clinton is going to be speaking again on Monday and that’s always interesting and exciting. Also, the sessions on therapeutics and drug resistance are a particular interest of mine. The discussions on the intersection of therapeutics and prevention, and discussions of the ongoing roll-out of HIV treatment in developing countries, are what this meeting especially helps to foster.

I do expect to hear news about novel antiretroviral regimens, HIV drug resistance, the role of immune activation in disease pathogenesis, HIV prevention, and of course HIV and TB.

The pivotal trial for rilpivirine (TMC278) will also be presented.  This drug potentially provides an alternative to efavirenz (EFV), lacking the CNS toxicity and the teratogenicity of EFV.  In addition, the AIDS Clinical Trials Group will be presenting data on bone effects of NNRTI- and PI-based regimens.  Lastly, before the actual conference gets underway there is an IAS-sponsored workshop dealing with viral persistence and eradication (Friday-Saturday) that I will be attending.

Are you aware of any new research in Vienna being released on HIV drugs?

(more…)

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`A Scandal’ – Children Issues Not On Agenda

Peter McDermott is the Managing Director of the Children’s Investment Fund Foundation (CIFF), one of the largest charities in the United Kingdom. He previously had worked at UNICEF for 21 years, serving as Chief of the HIV/AIDS section in the program division at UNICEF headquarters in New York, as well as holding positions in Africa and Europe. After the Pacific Health Summit in London last week, where he laid out an ambitious agenda for advancing efforts to prevent the transmission of HIV from mother to child and to treat HIV-positive children, John Donnelly interviewed McDermott about his expectations for the International AIDS Conference in Vienna, starting July 18.

Peter McDermott, Managing Director, Children's Investment Fund Foundation

 

McDermott said he will reply to any questions posed in the Comments section and that he welcomes any suggestions for CIFF’s work in these areas.


Q: What are your goals for the AIDS conference?

A: My mind goes back to the AIDS conference where Stephen Lewis was chairing a session with Bill Clinton and Bill Gates, and one of the themes was we would address and eliminate the transmission of HIV from mother to child. That was four years ago. There’s an element of, `We’ve been here before.’ But there’s never progress in the interim. We need to be very sober about what we are trying to do, a little less self-congratulatory, and a little more self-critical.

Q: So what’s realistic? (more…)

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For the last few months, those advocating for a more robust fight against AIDS have been growing increasingly concerned about the stagnant funding levels from the President’s Emergency Fund for AIDS Relief and the Global Fund to Fight AIDS, Tuberculosis and Malaria.

But what about the years ahead? What’s the epidemic going to look like in 20 years, how much funding will be needed, and how are the choices today going to impact on the epidemic in the years to come?

To get a glimpse at future scenarios, Robert Hecht, managing director at Results for Development Institute, a two-year-old group of development experts based in Washington, D.C., will launch a report, “Costs and Choices,’’ on Monday at the Global Health Council conference in Washington, D.C. The report was done under the auspices of aids2031, a group of AIDS specialists headed by Peter Piot, former executive director of UNAIDS, and Stefano Bertozzi, the HIV director for the Bill & Melinda Gates Foundation’s Global Health Program.

Hecht will present a range of findings from the group’s research, including this surprising statistic: Some 50 percent of the Global Fund’s AIDS funding now goes to middle-income countries, as does roughly 20 percent of PEPFAR’s funding. Hecht has advocated in the past that middle-income countries start to assume the bulk of that cost, and that donors, including PEPFAR, should shift those funds to countries truly in need.

Monday’s session – 2-3 p.m in the Palladian Ballroom at the Omni Shoreham Hotel – also will feature Paul Bouey, deputy global AIDS coordinator, and Rifat Atun, director for Strategy, Performance and Evaluation Cluster at the Global Fund. Also giving an on-the-ground perspective will be David Apuuli, director general of the Uganda AIDS Commission,and Benson Chirwa, director general of the National AIDS Council in Zambia.

It should shed some light not only on the future needs in funding AIDS, but also give a glimpse into policymakers’ thinking in how they can meet those needs. We will be posting after Monday’s session.

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Below is a sampling of reading material here at Science Speaks that you might find interesting. Let us know your thoughts!

  • A study released this week found that the mining industry may be a driving force in the TB epidemic in Sub-Saharan Africa.  From lead author Dr. David Stuckler of Oxford University: “It’s well known that miners have the highest risk of tuberculosis of any occupational group in the world, especially in sub-Saharan Africa.  But the striking finding of our study was that not just miners are at risk…these risks are spread to their families, communities and entire countries.”

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This post is by Center Director Christine Lubinski, who is in Almaty, Kazakstan this week for a meeting of the HIV/TB core working group of the Stop TB Parternship.

We visited an NGO run by the International Federation of the Red Cross with an on-site HIV clinic.  The small staff, consisting of two social workers, a coordinator, a lawyer and a psychologist, was joined by a number of clients of the group who welcomed the opportunity to tell us about the challenges they face in Kazakhstan.  They also made it clear that this site provides a safe haven where they feel respected and supported and where the clinical staff also treat them well.

There are approximately 15,584 persons living with HIV infection in Kazakhstan, with about 1100 persons receiving HIV therapy. There are fewer than 130 on ART in Almaty, this city of 2 million people.  Sixty-percent of HIV cases are among injection drug users. 

The group provides services for 120 clients co-infected with HIV/TB and 500 injection drug users living with HIV infection.  Many of the individuals receiving services here were formerly incarcerated, adding to the stigma and barriers they face to accessing services.

The challenges facing this population are numerous.  One huge hurdle is a requirement that they report to the authorities every six months to register their “permanent residence.”   No certificate of residency means no services, including medical care such as TB treatment, HIV treatment, or drug treatment.  TB treatment is supposed to be free to all, notwithstanding residency status, but those without adequate paperwork are nevertheless denied care by many clinics.  Many of the marginalized individuals living with HIV infection cannot establish permanent residency; they don’t have appropriate paper work for a variety of reasons.  The lawyer spends a great deal of her time advocating for this group.  When one member of our group asked what options individuals who cannot establish residency have, one of the clients replied: “Prison or the cemetery.”

Drug treatment is largely religious in nature , in other worlds controlled by Christian or Muslim groups, and it is frequently not free. There are very few 12-step programs and methadone is not available in this part of the country. Currently only 50 persons have access to substitution therapy nationally.  Finally, a number of drug treatment centers refuse to admit persons with HIV infection.  Advocating for HIV infected clients with these treatment programs is one of the activities of this client-centered NGOs.

Gainful employment can be virtually impossible for this population.  Despite laws that prohibit such discrimination, it is commonplace for prospective employers to require job applicants to provide documentation from the office of the prosecutor showing that they have no criminal record, and documentation from a physician certifying their TB and their HIV status.  Even though this practice is patently against the law, law enforcement authorities have no interest in taking action against these employers.

Tuberculosis, including MDR-TB, is a much bigger problem in Kazakhstan than HIV infection, although the numbers of individuals who are co-infected is growing. A visit to a TB clinic illustrated the very different approach to TB treatment in this region.  Twenty percent of all cases of tuberculosis in Kazakhstan are drug resistant and the percentage of retreatment cases that are MDR is 45 percent.  Generally speaking, tuberculosis is treated on an in-patient basis, requiring patients to spend very long periods of time in the hospital.  The average length of stay is 103 days for drug-susceptible pulmonary TB. This is not likely to change soon, since budget allocations for TB are based on numbers of hospital beds occupied.  However, there is a growing acknowledgement that this treatment of TB in congregate settings has real implications for infection control and for perpetuating high MDR-TB rates.  One government representative noted that while laws specify inpatient treatment for tuberculosis, they do not specify length of stay, providing some opportunity to reduce inpatient stays under current regulations.  Those with MDR can be hospitalized as long as two years. 

All patients with TB are automatically tested for HIV infection.  Persons with HIV infection without active tuberculosis are placed on isoniazid preventive therapy (IPT) for 6 months.

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What does flat funding for PEPFAR and other global AIDS programs mean on the ground in places like the Democratic Republic of Congo? Fewer new treatment slots. Uncertainty about access to lifesaving drugs. An unfolding crisis.

That’s one snippet in a bigger, disturbing picture painted by a new report from Doctors Without Borders, or MSF. The medical humanitarian group conducted an in-depth field analysis in 8 countries to determine the ramifications of an international pullback from the global AIDS fight.

“The findings confirm our concerns in terms of donor backtracking on commitments to scale up the fight against the HIV/AIDS epidemic,” the report states. “Today, this disengagement is starting to become visible in the field and the level of HIV care is beginning to deteriorate.”

The situation in the DRC is one of MSF’s case studies. The report notes that currently, only about 12 percent of HIV-infected persons in that country are getting the lifesaving drugs they need. And that’s according to the old WHO guidelines, which have been updated to recommend earlier initiative of HIV therapy. Furthermore, only 2 percent of pregnant women in the DRC have access to prevention of mother-to-child HIV transmission services.

Despite the clear need, many donors now working in the DRC are cutting back. For example, the report says that PEPFAR is going to stop purchasing drugs for opportunistic infections, needed by those with HIV due to their compromised immune systems, and hand over this expense to the Global Fund. But the Global Fund may not be equipped to take on this and other burdens as PEPFAR, the World Bank, and others seek to transition their roles.

“In 2009, the Global Fund was supporting 1,000 new initiations per month,” the report says. “now the revised availability of funds for initiation has been cut six-fold to 2000 per year. The consequence is that in DRC—in spite of the acute crisis situation—dramatically fewer patients can start ARV.”

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