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Posts Tagged ‘HIV/AIDS’

The Center’s Rabita Aziz describes a visit to Livingstone General Hospital’s antiretroviral therapy (ART) ward in Zambia during a recent Congressional delegate trip to Africa.

In a dark room so small and cramped that the door won’t even close, Ndabila Singango, a provincial clinical mentor employed by the Center for Infectious Disease Research of Zambia (CIDRZ), tests and counsels HIV/AIDS patients at the Livingstone General Hospital. The hospital, built more than 60 years ago and used only by white colonists before Zambia gained independence, is the only hospital in all of Southern Province, which has a population of 1.6 million. With an HIV prevalence rate of 30 percent in Livingstone, it is not surprising that 80 percent of admissions to the hospital are HIV-related.

Gertrude, an HIV positive mother with newborn twins, explained that the lesions on her face appeared two weeks ago.

The ART ward of the hospital sees an average of 70 patients daily, and provides ART to 3500. When we met one such patient, Gertrude, she was breastfeeding one of her three-month old twins while the other – strapped to her back – slept peacefully.

Gertrude learned that she was infected with HIV/AIDS three years ago when she felt ill and was advised to take an HIV test. She had not disclosed her HIV status to her husband as she feared reprisal from him and the community. Like many African women, Gertrude was unable to negotiate the terms of sex, and therefore did not use protection.

When she started ART in November of 2008, Gertrude’s CD4 count was at 129. Six months of therapy later, it rose to just 130. (more…)

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As we head into the International Aids Conference next week, here are a few stories and posts to get your wheels turning. Stay tuned for live blogging from the Conference.

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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 piece in last week’s Science Magazine argues for universal access to prevention and treatment for HIV/AIDS. Looking back to the 2006 pledge made by all UN member states to make universal access a reality by 2010, the article states that the global community has failed to deliver and calls for more resources and attention to the problem.

From the piece:

“A retrenchment on AIDS today would seriously jeopardize the substantial progress made to date, at the cost of untold human sacrifice and billions of dollars in economic resources.  Furthermore, the increasingly recognized benefit of ART in reducing HIV transmission dramatically enhances the value of the longstanding universal access pledge. As the deadline for universal access looms, greater investment in HIV is a necessary, evidence-based, economic, and moral choice.”

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The strongest scientific-journal rebuttal yet to the Obama Administration’s proposal to shift resources to maternal and child health at the expense of HIV/AIDS treatment scale up comes from two medical students, who in a commentary just published in AIDS make a clear and convincing case that such a move would actually undermine the health of women and children around the globe, not improve it.

“While we welcome the Mother and Child Campaign in a diverse portfolio of global health strategies funded by the United States, we are troubled by the ‘either/or’ mentality that places HIV/AIDS funding in direct opposition to initiatives to improve MCH,” write Sarah Leeper and Anand Reddi, who are studying medicine at Brown University and the University of Colorado respectively.

Referring to a JAMA article by Colleen Denny and Ezekiel Emmanuel that first outlined this proposal, they write: “We do not accept the premise by Denny and Emmanuel that the proportion of child deaths due to AIDS is ‘small,’ nor do we support the characterization of highly active antiretroviral therapy (HAART) as ‘new, complex, and expensive.’ We would argue that policies based on misrepresentations such as these threaten to undermine rather than support MCH worldwide.”

Leeper and Reddi take apart the Denny-Emmanuel argument piece by piece. For starters, they note that in the five countries with the highest HIV adult prevalence, HIV is the No. 1 cause of mortality for children under 5 years old. “One-thousand children were born with HIV everyday in 2007, due in part to the fact that <25% of all HIV-positive women worldwide have access to prevention of mother-to-child transmission,” they write.

The article also notes that all children born to HIV-positive mothers, whether they have HIV themselves or not, are at a much higher risk of death if maternal HIV is not treated. Leeper and Reddi point to a study of 3,468 children of HIV-positive mothers in Africa found that uninfected children with HIV positive mothers who gave birth “at an advanced disease stage” were at significantly higher risk of death. “This may be attributable in part to the fact that children with HIV-positive caregivers reside in food-insecure households more often than their unaffected peers, putting them at higher risk for malnutrition and death from diarrhea and acute respiratory infection,” they write.

Leeper and Reddi detail how HIV therapy is a cost-effective intervention and highlight the opportunities to build on PEPFAR and other global AIDS initiatives to improve maternal and child health, rather than doing the latter at the expense of the former. They note that clinical studies in Rwanda and Haiti have shown how PEPFAR has led to better maternal and child health outcomes.

“Confronting illness in isolation–whether by funding PEPFAR at the expense of programs that target MCH or vice versa–cannot be our way forward. Integrated health service delivery models that address the well-being of both HIV-positive and HIV-negative families, without prioritizing one at the expense of the other must be developed, funded, and implemented,” they conclude. “The complex and interrelated challenges of MCH against the devastating global backdrop of HIV require comprehensive models of care that combine HIV/AIDS and MCH initiatives.”

You can find their article here. It has been published online ahead of print.

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This video chronicles the true story of Selinah, an HIV/AIDS patient in South Africa who experiences the ravaging effects of her disease being reversed through ARV treatment over a period of three months.  Produced by the advertising agency Ogilvy Johnannesburg for the HIV/AIDS relief organization, the Topsy Foundation, the short film won the coveted Cannes Gold Lion award at the 57th Cannes Lions International Advertising Festival last week.

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