Breaking News
September 25, 2018 - Lung cancer patients treated with invasive surgery more likely to become chronic opioid users
September 25, 2018 - Oxford VR raises £3.2m to boost innovation in VR for mental health problems
September 25, 2018 - Gene therapy approach could help treat mitochondrial diseases
September 25, 2018 - Few Yogurt Products Qualify As Low-Sugar
September 25, 2018 - Eye disease can cause blindness, and it’s on the rise
September 25, 2018 - Pawnshop density linked to gun-related suicides, Stanford study finds
September 25, 2018 - Pioneering procedure for common prostate condition offered by The London Clinic
September 25, 2018 - Number of people with respiratory diseases likely to increase if UK air pollution remains unchecked
September 25, 2018 - FARXIGA receives positive results in Phase III DECLARE-TIMI 58 cardiovascular outcomes trial
September 25, 2018 - New program to reduce harmful stress effectively improves mood in cancer patients
September 24, 2018 - Florence’s Lingering Threat: Mold – Drugs.com MedNews
September 24, 2018 - For professional baseball players, faster hand-eye coordination linked to batting performance
September 24, 2018 - Bill for later school start times is defeated, but Stanford sleep specialist isn’t
September 24, 2018 - For Heart Failure Patients, Mitral Valve Procedure Improved Outcomes
September 24, 2018 - Successful recovery from addiction means more than achieving abstinence
September 24, 2018 - New nanoplatform technology may reverse drug-resistance in renal cell carcinoma
September 24, 2018 - October 1918 marks the centenary of Spanish Flu that claimed more lives than World War I
September 24, 2018 - LGBT community reports more number of poor mental health days than general population
September 24, 2018 - New research suggests power of zebrafish as tool for cancer drug discovery
September 24, 2018 - New study finds height as possible risk factor for developing varicose veins
September 24, 2018 - Researchers compare weight loss results of online and in-person diabetes prevention program
September 24, 2018 - New HER2 PET Study Uses Affibody’s ABY-025 Tracer to Individualize Breast Cancer Treatment
September 24, 2018 - Drug combination offers more effective care for patients suffering miscarriage
September 24, 2018 - Tallness linked to varicose veins, Stanford study says
September 24, 2018 - For Heart Failure Patients, Mitral Valve Procedure Improved Outcomes
September 24, 2018 - Ecstasy drug makes octopuses more social
September 24, 2018 - Immediate compression therapy could cut risk of complications after deep-vein thrombosis
September 24, 2018 - Transcatheter mitral valve repair reduces mortality for patients with mitral regurgitation
September 24, 2018 - First intracranial aneurysm patients treated with BRAVO Flow Diverter after CE mark approval
September 24, 2018 - ‘Physicians of the mouth’? Dentists absorb the medical billing drill
September 24, 2018 - People more likely to believe those with confident tone of voice than with accent
September 24, 2018 - Harmony Biosciences Presents 5-Year Data On Pitolisant At International Narcolepsy Symposium
September 24, 2018 - Blood test may identify gestational diabetes risk in first trimester
September 24, 2018 - Height may be risk factor for varicose veins | News Center
September 24, 2018 - King’s commemorates opening of new NMR facility with one-day symposium
September 24, 2018 - Eisai receives approval for partial label change of DC Bead device for transcatheter arterial embolization
September 24, 2018 - High-resolution genomic map gives scientists unprecedented view of brain development
September 24, 2018 - Researchers find impact of neurobehavioral symptoms on employment in adults with TBI
September 24, 2018 - Alexion announces positive results from Phase 3 PREVENT study of Soliris in patients with NMOSD
September 24, 2018 - First evaluation of benefits, harms of Alzheimer’s screening for family members of older adults
September 24, 2018 - Ancora Heart announces positive data of study evaluating AccuCinch Ventricular Repair System
September 24, 2018 - Children of mothers using cannabis may start using it at an earlier age, finds study
September 24, 2018 - Gilead Sciences plans to launch authorized generic versions of Epclusa and Harvoni in the US
September 24, 2018 - Most patients who underwent transcatheter valve replacement experience prosthesis-patient mismatch
September 24, 2018 - Lumos acquires license for LUM-201 drug that promotes secretion of growth hormone
September 24, 2018 - New study provides basis for Air Canada to change its facial hair policy for aircrew
September 24, 2018 - Infant walkers lead to thousands of emergency visits for babies
September 24, 2018 - Genes predicting person’s height may provide clues about causes of varicose veins
September 24, 2018 - EPA Plan Will Maintain Carbon Emissions From Power Plants
September 24, 2018 - Characterizing pig hippocampus could improve translational neuroscience
September 24, 2018 - Element3 Health reports social and mental engagement play key role in overall health
September 24, 2018 - Paralympic medalists support Fight for Sight’s unique virtual event
September 24, 2018 - ADCETRIS drug receives approval in Japan as frontline treatment option for Hodgkin lymphoma
September 24, 2018 - Public awareness of urological conditions found to be alarmingly low across Europe
September 24, 2018 - Fitter Folks Suffer Milder Strokes: Study
September 24, 2018 - Novel botulinum toxin compound relieves chronic pain
September 24, 2018 - CHMP recommends approval of Gilenya for treatment of multiple sclerosis in children, adolescents
September 24, 2018 - National Friendly’s private medical insurance is a hit with women living in the South East
September 24, 2018 - Academics receive prestigious awards for achievements in blood pressure research
September 24, 2018 - Obese pregnant women can restrict weight gain safely with proper nutrition guidance
September 24, 2018 - CHMP adopts positive opinion of Takeda’s ALUNBRIG for treatment of ALK+ non-small cell lung cancer
September 24, 2018 - China NMPA approves LENVIMA for treatment of unresectable hepatocellular carcinoma
September 24, 2018 - A new approach for finding Alzheimer’s treatments
September 24, 2018 - USC research uncovers previously unknown genetic risk factor for dementia
September 24, 2018 - Study examining mental health among students finds significant disparities in treatment across race
September 24, 2018 - Breakthrough discovery paves way for future test to identify drowsy drivers
September 24, 2018 - Transcatheter mitral-valve repair in patients with heart failure
September 24, 2018 - Study opens new avenues for treatment of Laing distal myopathy
September 24, 2018 - Stroke Facts | cdc.gov
September 24, 2018 - Sarcolipin tricks muscle cells into using more energy, burning fat
September 24, 2018 - Enrollment in opioid controlled substance agreement reduces primary care visits
September 24, 2018 - UTA researchers patent new smart seat cushion technology that helps prevent painful ulcers
September 24, 2018 - Second HPV-Related Primary Cancers Common in Survivors
September 24, 2018 - How a virus destabilizes the genome
September 24, 2018 - Old letters provide insight into Spanish flu pandemic horror
September 23, 2018 - Smart textile-based soft robotic exosuit helps wearers save energy and traverse difficult terrain
September 23, 2018 - New research hub to drive radical change in development and manufacturing of vaccines
September 23, 2018 - AHA: For Hispanics, Neighborhood May Be Key Factor in Heart Disease Risk
September 23, 2018 - Excessive airway nerves tied to more severe asthma symptoms, study finds
September 23, 2018 - Study highlights need to remain vigilant in maintaining key infection control processes
World AIDS Day Picture Mixed

World AIDS Day Picture Mixed

image_pdfDownload PDFimage_print

On World AIDS Day 2017, the picture of the pandemic is somewhat brighter — but with some ominous shadows.

On the bright side, more people than ever are on anti-HIV therapy and work continues apace on improving medications and developing new preventive methods, including two important vaccine trials. In the U.S. the CDC reported this week that delays in HIV diagnosis — an important factor in propagation of the virus — are shrinking.

In the shadows, new data suggests that HIV resistance to some drugs is rising rapidly in low- and middle-income countries, which might affect the success of therapy. In many countries, men with HIV are less likely than women to be diagnosed, on therapy, and in control of their virus. And in one developed country, the Russian Federation, the epidemic is expanding, rather than contracting.

The theme of this year’s World AIDS Day is “Let’s End it” but that’s easier said than done, according to three well-known researchers.

“The aspirational slogan … suggests that the goal of ending the epidemic is in our grasp and hinges only on our collective commitment to do so,” argued Steven Deeks, MD, of the University of California San Francisco, Sharon Lewin, MD, of the Peter Doherty Institute of Infection and Immunity in Melbourne, Australia, and Linda-Gail Bekker, MBChB, PhD, of the Desmond Tutu HIV Centre in Cape Town, South Africa.

“However, the remarkable progress, activism, resources, ingenuity, and sheer fortitude that have brought us this far will be needed in at least equal measure to take us to the end,” they concluded in a special HIV issue of PLoS Medicine.

That “remarkable progress” includes the largest-ever number of people with HIV who have access to therapy — some 20.9 million people in July, according to the Joint United Nations Programme on HIV/AIDS (UNAIDS). That’s about 53% of the estimated 36.7 million people living with HIV around the world.

The latest data from UNAIDS also suggests that the rate of new infections is down and — a reflection, perhaps, of the increasing numbers on treatment — so is AIDS-related mortality.

“The significance of these achievements cannot be overstated,” Deeks, Lewin, and Bekker wrote. “In the past three decades, global biomedical and public health programs not only discovered how HIV causes disease and developed effective strategies to prevent and treat the infection, but also built a global public health response that is unprecedented in its scale and effectiveness.”

But many gaps remain, including an important “blind spot,” according to UNAIDS Executive Director Michel Sidibé, speaking in Ottawa today. “Men are not using services to prevent HIV or to test for HIV and are not accessing treatment on the scale that women are,” he said in a statement.

In a report released on World AIDS Day — dubbed “The Blind Spot” — the UN agency said that fewer than half the men living with HIV are on treatment, compared to 60% of women, and there is evidence that they are more likely than women to start therapy late, to interrupt treatment, and to be lost to follow-up.

Health officials have found ways to reach women at risk of HIV — in antenatal clinics, for instance — but have struggled to find similar ways of reaching men, the report says. Some results of that gap:

  • Men and boys accounted for about 58% of the estimated 1.0 million AIDS-related deaths in 2016. The imbalance was worse in sub-Saharan Africa, where men and boys accounted for 41% of people living with HIV and 53% of AIDS-related deaths.
  • Outside of eastern and southern Africa, 60% of all new HIV infections among adults are among men.
  • Men who have sex with men (MSM) are 24 times more likely to catch HIV than men in the general population; HIV prevalence among MSM is 15% or higher in some two dozen countries.
  • Some 80% of injection drug users are men and in several countries HIV prevalence among people who inject drugs exceeds 25%.
  • In prisons, HIV prevalence is estimated at between 3% and 8%; some 90% of inmates are men.

In general, HIV epidemics grow in marginalized and vulnerable groups that lack society’s attention and are often denied access to important healthcare interventions. A current case in point is the Russian Federation, according to Chris Beyrer, MD, of Johns Hopkins Bloomberg School of Public Health in Baltimore, and colleagues.

While it’s difficult to pin down the numbers, the Russian Federation is thought to have the largest number of HIV infected citizens of any country in Europe, Beyrer and colleagues reported in PLoS Medicine.

“Actual infections, including those that remain undiagnosed and/or unreported, are doubtless substantially higher,” they wrote, and the epidemic in Russia “continues to expand significantly.” More than 103,000 new HIV diagnoses were reported in 2016, up 5% from the previous year and AIDS deaths are also rising: 14,631 were reported from January to June 2017, up 13.5% over the previous six months.

Official figures for 2016 suggest that injection drug use accounts for 48.8% of infections, followed by heterosexual sex at 48.7% and homosexual sex at 1.5%, with a handful of perinatal infections.

“These proportions are of uncertain validity, however,” Beyrer and colleagues noted. In particular, laws that ban the sharing of information related to homosexuality, as well as official support for stigma towards MSM, are “highly likely to affect these results,” they wrote.

The range of interventions that have been shown to reduce the spread of HIV includes opioid agonist substitution therapy (such as methadone), needle and syringe exchanges, HIV treatment as prevention, and pre-exposure prophylaxis (PrEP), among others, they wrote.

But in Russia, “all of these interventions are either not available or are unavailable at the scale necessary to control HIV,” they concluded, adding that the Russian epidemic is “a true public health crisis and one that could largely have been avoided.”

Another issue that has experts concerned is HIV drug resistance.

Anti-HIV medications attempt to prevent viral replication but the virus, which is highly adaptable, can quickly evolve ways around the drugs unless they are consistently taken as directed — so-called acquired resistance.

Especially worrisome is what is called pretreatment resistance, meaning a new HIV infection is already resistant to some drugs even before the patient has begun therapy.

In an analysis of data from low- and middle-income countries, researchers found that pretreatment resistance to one class of drugs — the non-nucleoside reverse transcriptase inhibitors (NNRTIs) — has been rising sharply.

The issue is particularly important because the NNRTIs are part of most first-line anti-HIV regimens in those countries, according to investigators led by Ravindra Gupta, MD, of University College London in England.

In a systematic review and meta-regression analysis of 358 datasets, representing 56,044 adults in 63 countries, Gupta and colleagues estimate pretreatment NNRTI resistance in 2016 at about 10% in most regions — 11% in southern Africa, 10.1% in eastern Africa, 7.2% in western and central Africa, and 9.4% in Latin America and the Caribbean.

Importantly, they reported online in The Lancet Infectious Diseases, the yearly odds of pretreatment resistance have been rising: 23% in southern Africa, 17% in eastern Africa, 17% in western and central Africa, 11% in Latin America and the Caribbean, and 11% in Asia.

“Treatment resistance indicators have turned to red in several countries,” increasing the risk that first-line therapy with NNRTIs will no longer be effective, commented Sabine Yerly, PhD, and Alexandra Calmy, MD, PhD, both of Geneva University Hospitals and Faculty of Medicine in Switzerland.

Changing the guidelines for first-line therapy will likely reduce the rates of pre-treatment resistance, but by itself will not be enough to prevent its recurrence, they argued in an accompanying commentary.

They argued that different drugs must be used and health authorities must ensure treatment for all people who need it, including those now excluded or disengaged from care, to prevent the emergence of resistance in the first place.

Meanwhile, the National Institute of Allergy and Infectious Diseases reported, just in time for World AIDS Day, that a new vaccine candidate is under test in Africa — the second major trial looking for what is regarded as the keystone of HIV prevention.

The so-called Imbokodo trial, a phase IIb proof-of-concept study, will enroll 2,600 HIV-negative women in sub-Saharan Africa to evaluate both safety and efficacy of the vaccine candidate. Earlier studies have shown it is safe in healthy volunteers.

The vaccine candidate being tested in Imbokodo is based on “mosaic” immunogens — vaccine components designed to induce immune responses against a wide variety of HIV strains.

That’s different from the so-called HVTN 072 efficacy trial, which is currently testing a tweaked version of the vaccine regimen tested in the RV144 Thai trial — the only candidate HIV vaccine ever shown to provide some protection against the virus.

That candidate is actually two vaccines — a modified canarypox virus called ALVAC carries the HIV gag, env, and pro genes, while a second vaccine targets the HIV gp120 protein. In its first iteration, that vaccine reduced the risk of HIV infection by about 30%, although with wide confidence intervals; the HVTN investigators are hoping the changes they’ve made, including an adjuvant and an extra shot, will increase its efficacy.

While all this is going on, other investigators are investigating the potential of what are called “broadly neutralizing antibodies” to prevent HIV, although that work is in the early stages.

Adding an effective vaccine to current prevention strategies would have “potentially transformative benefits” in the fight against HIV, Deeks and colleagues argued.

2017-12-01T12:00:00-0500

Tagged with:

About author

Related Articles