The Global Pulse Journal Blog

We are very proud of GP editor Jennifer Weinberg, who was the theme editor for the current issue of the AMA’s Virtual Mentor journal!   The theme for the March 2010  issue is global health ethics in practice.  Read the full issue here, or start with any of the following:

• Jennifer’s introduction: Global Health Ethics at Home and Abroad
• The WHO Staging System for HIV/AIDS by Jennifer Weinberg and Carrie Kovarik
• The Physician-Researcher’s Dilemma by Hana Akselrod
• Global Health Ethics and Professionalism Education at Medical Schools by Sujal Parikh

After over 20 years of research, scientists believe that they have discovered a breakthrough that will allow for more effective treatments for HIV/AIDS. In a recent article in Nature, scientists from Imperial College London and Harvard University report success at elucidating the structure of integrase, an enzyme which the HIV virus uses insert a copy of its genetic material into host DNA. Researchers hope that this new knowledge will lead to a better understanding of how integrase inhibitors work, how they can be improved and how we can prevent HIV from developing resistance to them.

For more see http://www.reuters.com/article/idUSTRE6101AQ20100201

From Science Speaks, an excellent blog from the staff of the Infectious Diseases Center for Global Health Policy, comes an interview with Dr. Eric Goosby, the U.S. Global AIDS ambassador.

Q: Roxana Rogers, USAID’s South Africa health team leader, said recently in South Africa that, “US government funding is going to come down dramatically over the next five years.” True?
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For the past seven years, the United States has supported and expanded its program to fight HIV/AIDS in developing nations, underwriting almost half of the world’s AIDS relief. But some are concerned by recent setbacks in the global campaign to fight disease in the developing world. At a time when the numbers of people infected with HIV is beginning to increase after stabilizing in countries like Uganda and the number of people in need of treatment is rapidly expanding, the US funding has not kept pace. With updated World Health Organization guidelines, the number of HIV-infected people eligible for treatment has expanded to 14 million, a large increase from the only 4 million people current in treatment.

In the face of this expanding pool of people in need, US government funding seems to be staying stable. For example, at the same time that the Obama administration has announced plans to expand HIV treatment to at least 4 million by 2013, they have also signaled no increases in funding budgets through fiscal 2011. Defending the administrations commitment to fight the global pandemic, Eric Goosby, the President’s AIDS czar, stated that “our commitment to universal coverage hasn’t wavered.”

For more on the global fight on AIDS and particularly the fight in Uganda, check out the Wall Street Journal’s January 30th article and slideshow.

A lovely animation explaining why patent pools will help fight the HIV/AIDS epidemic. Please refer to earlier post on GPJ by Hana Akselrod regarding the approval of patent pools by UNITAID.

According to recent data from the WHO and UNAIDS, the number of people infected with the HIV virus has remained relatively stable, around 33 million around the globe, for the last two years. The data suggests that the number of cases probably peaked in 1996 with the disease stablizing in most regions since then.  The WHO/UNAIDs report suggests that their were 17% fewer new infections worldwide in 2008, compared with 2001. A notable exception is the number of HIV infections in many parts of Africa which remains alarming. Although the rate of new infections has decreased worldwide, only two out of five of those newly infected begin treatment. While around 4 million people were receiving antiretroviral medications at the end of 2008 compared to 3 million in 2007, an additional 5 million people in need of antiretrovirals were not receiving treatment.

It has long been established that high adherence to antriretroviral therapy is associated with slowed progression of HIV infection and increased survival, but a recent study by researchers at the Johns Hopkins Bloomberg School of Public Health suggest that high antiretroviral therapy adherence is also associated with lower health care costs. Their study suggests that improved health outcomes associated with high adherence to HIV therapy results in an overall median monthly health care cost savings of $85 per patient in a cohort of 6,833 HIV-infected adults in South Africa. A large component of this cost savings resulted from a decreased need for hospitalization in patients with high adherence to antiretroviral therapy. These results suggest that effective, practical strategies are needed to encourage and actively monitor antiretroviral therapy adherance in order to improve patient outcomes and, in the process, save much need health care resources.

More details on the study can be found in the January 5, 2010 issue of Annals of Internal Medicine.

In its meeting yesterday, the board of UNITAID voted to approve the Patent Pool for HIV/AIDS drugs, opening the door for greater development and production of desperately needed antiretrovirals. Lowering intellectual property barriers on ARVs and allowing for the production and sales of generic versions of the drugs in resource-poor countries will help make the drugs affordable to the people who need them the most, and has the potential to save millions of lives. According to its sponsors, the Patent Pool could also save over $1,000,000,000 a year.

Want to know what the Patent Pool is all about? Read the very recent Global Pulse interview with Ellen ‘t Hoen, Senior Advisor for the Patent Pool at UNITAID.
(PDF)

There has been significant concern over efforts by drug companies to keep middle-income countries out of the patent pool. If such limits are imposed, millions of impoverished HIV patients in India, China, and Brazil will remain unable to afford the drugs.

Read on for more on UNITAID, AIDS, intellectual property, and the Patent Pool.

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Britain’s Medical Research Council (MRC) announced that the Pro 2000, a vaginal microbicide gel, was ineffective in preventing the spread of HIV infection in a trial conducted in four African counties. PRO 2000 works by inhibiting the entry of HIV into cells .The trial was sponsored by the Microbicides Development Program (MDP), a not-for-profit partnership of 16 African and European research institutions took place between September 2005 and September 2009, involved 9,385 women .

Sheena McCormack, who led the trial, was disappointed in the results because a smaller trial held earlier, indicated that that the results for the current larger trial would be different from what they were. The smaller trial included more than 3,099 women and was funded by the National Institute of Allergy and Infectious Diseases (NIAID), part of the NIH. The sites include 6 countries in sub-Saharan Africa and one site in the United States. The results of the smaller trial were presented at the Conference on Retroviruses and Opportunistic Infections in Montreal, Canada in February. These results indicted that the Pro 2000 gel would reduce transmission rated by 30 %. Earliers this year, ENDO Pharmaceuticals purchased the PRO 2000 from Indevus Pharmaceuticals.

Currently, women make up half of all people worldwide living with HIV and in sub-Saharan Africa, women represent nearly 60 percent of adults living with HIV.

In most cases, women become infected with HIV through sexual intercourse with an infected male partner. Manufacturers were hoping that this microbicide would be a potential solution for hose whose partners refuse to use condoms and could have empowered women with a prevention method they could initiate. Even though this microbicide failed to prevent the spread of HIV, scientists have not given up hope, as here are currently dozens of microbicides being tested. A previous post on the Global Pulse Blog discusses the debates that have taken place about the role of microbicides on HIV prevention.

Medical students from the University of Michigan gathered yesterday for World AIDS Day to rally Representative John Dingell’s support regarding several key issues surrounding global health and health care reform. Students sang modified versions of Christmas carols, whose words were replaced with language describing the necessity of: 1) accessible and affordable essential medicines for HIV/AIDS patients worldwide and 2) continued backing of PEPFAR, which currently only has $366 million of the $48 billion as promised by former President George W. Bush in 2008.

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