The Global Pulse Journal Blog

With heavy flooding covering much of the country and leaving millions of people homeless in Pakistan, concerns over the potential for a major outbreak of cholera are growing. With continuing rains throughout the region, Dr. Michael Merson, the founding director of the Duke Global Health Institute believes that ”Basically there is no question” there’s a major risk of an outbreak. With a lack of adequate aid to the area to ensure a consistent, clean water supply, the risk of this diarrheal illness is immense. While the flood has already killed over 1,500 people thus far, even more are at risk from a potential cholera outbreak with 3.5 million people in Pakistan lacking access to clean water. In the past year, cholera epidemics in Zimbabwe killed over 4,000 people with over 350 killed by the disease in Nigeria over the last three months, demonstrating the deadliness of this disease. Without adequate rehydration therapy, victims can die within a day or two from overwhelming dehydration secondary to extreme diarrhea with up to a liter of stool output every hour. But with adequate rehydration therapy to replace fluids and restore electrolytes, death rates can be lowered to less than one percent.

A  new survey from the Centers for Disease Control and Prevention (CDC) suggests that  heterosexuals living in impoverished communities are as much as five times more likely to be HIV-positive than the general U.S. population, regardless of race or ethnicity. In the US, the overall HIV prevalence rate for African Americans is eight times the rate for whites, and the rate for Latinos is three times the rate for whites. Yet in very-low income areas this CDC study found that these disparities do not exist. The study examined 9,000 people in 23 cities, finding that 2.1% of heterosexuals living in high-poverty urban areas were infected with the HIV virus, including 2.4% of those living below the poverty line and 1.2% of those living above it. This is in comparison to the 0.45% rate of HIV infection in the general US population. The authors hypothesize that the findings could account for many of the ethnic and racial disparities in HIV infections in this country, since African Americans are 4.5 times as likely and Latinos four times as likely as whites to live in poverty.

The International AIDS Society in partnership with the Kaiser Family Foundation is providing online access to various developments taking place at the XVIII International AIDS Conference (AIDS 2010),  in Vienna, Austria.

Selected sessions are webcast live each day with past sessions also available for viewing. Find the complete guide-to-coverage as well as the webcasts already available for viewing including the Opening Session, Monday’s plenary with former President Bill Clinton, and Tuesday’s session on the study which found Microbicides containing HIV drugs lower the infection risk in women.

Today’s schedule includes:

This week at the International AIDS Conference in Vienna, Austria, the World Health Organization announced that 5.2 million people in low- and middle-income countries received antiretroviral drugs for their HIV infections in 2009. This represents the largest increase in the number of people accessing treatment in a single year, with an additional 1.2 million people added to the four million who received antiretroviral therapy in 2008. While the increasing access to antiretrovirals is encouraging, over 10 million people infected with the HIV virus worldwide are still in need of therapy.

The WHO is calling for earlier treatment of those infected with the HIV virus, suggesting that if people are treated before their immune systems become weakened by the virus, HIV-related mortality can be reduced by 20% between 2010 and 2015. In addition, early therapy also has a benefit in preventing transmission of the virus. These new guidelines expand the number of people eligible for antiretroviral therapy from around 10 million to about 15 million people. The Joint United Nations Programme on HIV/AIDS (UNAIDS) estimates that the cost needed for HIV treatment in 2010 will be about US$ 9 billion.

Figure 1.

For the first time in the 15 year-long search for an HIV prevention method that women can control, a vaginal microbicide gel called Viread has been shown to decrease the risk of HIV infection by as much as 54%.  Even though the microbicide does not prevent transmission in every woman who uses it, this is the first promising tool that women are able to use without the cooperation of the male partner.  This is an important consideration most of the new HIV infections in women living in Africa were acquired through forced sex with infected men who refuse to wear condoms. Women and girls represent 60 percent of the 22 million people infected with HIV living in Africa.

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Researchers at the Vaccine Research Center at the National Institute of Allergy and Infectious Diseases have identified three naturally occurring monoclonal antibodies that are able to kill 91% of strains of the HIV virus. One of these antibodies, named VRC01, has a high affinity for the virus and works by mimicking the HIV receptor. This discovery makes the development of an effective vaccine against the virus a real possibility.

Scientists at the APOPO Research Center in Tanzania have been training representatives of the African Giant Pouched Rat species, Cricetomys gambianus, to sniff out sputum samples from TB patients. In a study published recently in the International Journal of Tuberculosis and Lung Disease, the researchers report that 18 out of 20 trained rats had success rates with sensitivity of 72%-100% and false negative rates of under 9% (abstract; full text here).  (For comparison, the acid-fast staining method widely used for TB detection in low-resource settings has significant problems with sensitivity, with values reported from a low of 53% to an imperfect high of 93%.) ”The use of multiple rats significantly increased sensitivity and negative predictive value.”

The rats have some intensive training requirements, but in the global fight against the disease, they can be a useful tool.  Plus, they are kind of cute.  Read this excellent blog post at Take Part (includes pictures and a video of Cricetomys gambianus in action).

Story on BBC News here.

Cricetomys weigh 1-1.5 kg and can be raised for food or as a pet.  They can also detect land mines: link and video.  Now, why hasn’t Pixar made a movie about them?

Home to over 400 million people, the Ganges river winds through India’s history, culture and countryside. Unfortunately, rapid industrialization and urbanization has left an unholy mark on the Ganges as dangerous amounts of untreated industrial pollution and human excrement enter the river every day.  These conditions are all too common in rivers worldwide  and create an environment ripe for diseases ranging from schistosomiasis to Cryptosporidium.

But long time advocacy is finally paying off as the WSJ reports that World Bank and the Indian government are set to spend $4 billion to “to ensure that by 2020 no untreated municipal sewage or industrial runoff enters the 1,560-mile river.”.  The methods proposed also have the benefit of being less carbon and electricity intensive than traditional wastewater treatment plants – key aspects for a country with chronic brownouts in a warming world.  In order to reach their goal, the government and partners will need to engage the most neglected slums which, if done right,  has the potential to create environmental justice at the same time as cleaning the river.

Of course, governments have a tendency of announcing lofty environmental goals which are then forgotten in the next election cycle. The Ganges also had a previous cleanup effort that failed to reach its goals, partly because of lacking public participation. Hopefully things will be different this time, but GP would love to hear from anyone with on the ground insight.

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

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.