The Global Pulse Journal Blog

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.

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.

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.

In commemoration of World AIDS Day, this slide show helps emphasize that prevention is the best medicine against the spread of AIDS.

As part of World AIDS Day efforts to educate the public about the HIV/AIDS pandemic, Global Fund Ambassador for the protection of mothers and children against AIDS and first lady of France, Carla Bruni-Sarkozy released a series of interviews “talking about and letting the world know that a woman who is expecting a child can make sure that this child can have a healthy life,” Ms Bruni-Sarkozy told the BBC. She recalled her experience meeting mothers in Burkina Faso and cited this experience as showing her that progress can and must occur in the fight against mother-to-child transmission of HIV. She renewed a call to eliminate mother-to-child transmission of HIV by 2015 through a focus on educating women and increasing their access to means to fight and prevent the disease. This has been a focus area of the Global Fund, UNAIDS, UNICEF, WHO and UNFPA.

This is an important effort given the impact of mother-to-child transmission of the virus.

• Currently, over 45% of HIV-infected pregnant women receive ARV prophylaxis (up from 10% in 2004)
• Only 15% of children born to mothers infected with HIV in reporting low- and middle-income countries were tested for the virus within the first two months of life
• Only 38% of the over 730,000 children in low- and middle-income countries in need of ARV treatment in 2008 received these medications

For more on these efforts, see press coverage of the Global Fund’s World AIDS Day activities.

Much of the focus on HIV in medicine has been on finding better treatments and a cure for those who have it and developing a vaccine to prevent its further spread.  The journal Science recently published  a French study where the lead investigators mixed gene therapy and cell therapy to treat a deadly brain disease. The scientists used HIV as a vector to correct a sample of stem cells from two patients who had adrenoleukodystrophy; the study had  positive outcomes.

Full story here:

and here

On October 30, 2009 President Obama announced the end of a 22-year ban on travel to the United States by people infected with the HIV virus. The President made good on an earlier promise, acting to eliminate a restriction he said was “rooted in fear rather than fact.” The new rule will take effect after a routine 60-day waiting period, ending the US’s position as one of only about a dozen countries that bar people who are infected with HIV. Read the rest of this entry →