31 October 2008
Source: VOA News
In many parts of the world, patients with HIV arrive at a clinic not because they’re sick with HIV, but because they are sick with tuberculosis. As VOA’s Rose Hoban reports, some new research is revealing the best way to treat these patients.

Tuberculosis is epidemic in many poor countries that have high rates of HIV. But Dr. Salim Abdul Karim from the University of KwaZulu-Natal in South Africa says there has been no general agreement on how to treat the two diseases when a patient has them together.

“If you had to ask 10 medical practitioners how you would treat this patient, you would get 10 different answers,” Karim says.

Anti-retroviral drugs used for treating HIV were created and tested in Western countries where there are few people with tuberculosis. As a result, researchers never studied the best way to treat HIV and TB together and the possible interactions among different drugs.

Treatments for HIV, TB Interact

But in places such as southern Africa, patients frequently do have both diseases simultaneously. Doctors struggle to treat them and manage the many problems associated with treating TB and HIV together. To begin with, Karim says, medications for tuberculosis and HIV frequently interact with one another.

“The TB drugs induce some key enzymes in the liver that result in the anti-retroviral drugs being metabolized more quickly,” Karim says. He explains this has the result of making the anti-retrovirals less effective.

In particular, the TB drug called rifampicin causes this liver reaction.

“Rifampicin is a key drug in TB, so you cannot exclude it from TB treatment,” Karim says.

Another problem is that some patients actually get sicker once they start taking TB drugs. Karim explains this occurs because the body’s immune system goes into overdrive once it gets some help from medication. This kind of immune reaction can be so serious that patients need to be hospitalized.

The third problem is that patients getting treated for TB and HIV simultaneously end up taking a lot of pills - up to 30 per day - each with its own side effects.

“So we have a lot of concern that when you put patients on anti-retrovirals that they might then stop taking their TB drugs because of side effects they’re getting from the anti-retroviral drugs,” Karim says. “It’s just the process of having to take seven drugs… I mean, handfuls of medication.”

Patients Who Delay Treatment More Likely to Die

Karim and colleagues from Columbia University in the United States started a study to determine the best way to treat these patients. They recruited more than 600 people to try different ways of taking the drugs. Some would complete six months of TB treatment, then get HIV medications; some would take the first two months of TB medications and then start HIV drugs while completing TB treatment. A third group would get the two kinds of medications together. The trial is still going on.

In August, Karim and his colleagues reviewed the preliminary data. They found that patients waiting to complete TB treatment before getting HIV drugs were 50 percent more likely to die than patients being treated for both diseases simultaneously. Immediately, they altered the study so that all patients were getting some TB treatment.

“We should encourage all patients who have both tuberculosis and HIV to receive both therapies, both sets of drugs, at the same time,” Karim says.

“TB therapy… they have to start because they won’t die from HIV. They’ll die from the TB,” he warns. “Don’t wait for them to finish their TB treatment. Start the antiretroviral drugs.”

The study results were announced in a press release, rather than the usual publication in a medical journal. Karim says in the time it would take to publish these results, 10 thousand people in South Africa alone could die from being treated for TB before getting any anti-retroviral drugs. So he says they’re urging doctors who see these patients to get them started on anti-retrovirals before completing the six-month course of TB medications.

By Li Aoxue (China Daily)
Updated: 2008-10-31 07:32

A survey taken in six major cities in China shows that most adults discriminate against HIV/AIDS sufferers.

The survey, from February to March, was conducted by Renmin University of China with financial and technical support from UNAIDS.

The survey covered 6,000 people and 30 percent said children suffering from HIV/AIDS should not be allowed to attend school, 65 percent were not willing to stay in the same room as a sufferer, and 48 percent would not share a meal with them.

“HIV/AIDS discrimination must be eliminated in order to encourage sufferers to seek treatment,” Edwin Cameron, a South African AIDS prevention expert, said.

Bernhard Schwartlander, United Nations country coordinator on HIV/AIDS in Beijing, said the virus is not unmanageable medically, and people seeking treatment can keep it under control.

However, some people refuse to seek treatment, because they are afraid to let others know of their illness.

“People I have encountered in China have told me they suffer from discrimination, and some of them have stopped in the middle of treatment,” Cameron said.

“People die from it and I think it is a tragedy as the Chinese government provides good programs.”

The treatment in China covers all 31 provincial regions.
[...]
Read full article at China Daily

Uganda has lost 25bn Ugandan shillings ($12m) of Global Fund money due to concerns over poor accountability, according to reports this week.

The Global Fund has refused to release a second $10m instalment from the $36m pot it allocated for HIV/Aids activities in Uganda in 2003 because it was not satisfied with how initial payments have been spent, reported New Vision.

A further $2m is yet to be disbursed from the $24m allocated for malaria work under the Global Fund in 2004.

In 2005 Uganda was suspended from the Global Fund over irregularities in the administration of funds. This year, the Ugandan government began proceedings to prosecute those accused of embezzling Global Fund money, including two former health ministers.

Aidspan, the independent watchdog that monitors Global Fund activities worldwide, said Uganda failed to satisfy the fund that the arrangements put in place after its suspension were robust enough to protect its money from misuse.

In an interview with New Vision, an Aidspan representative said the $12m grants were now so far behind schedule that they “become irredeemable”.

The news comes in the same week that the Uganda Aids Commission said Uganda requires an estimated 1.3tr Ugandan shillings ($700m) over the next 18 months to finance vital HIV/Aids activities.

The commission said that 25% of this sum should go towards prevention and 50% towards treatment, care and delivery of drugs and services.

This week has also seen groups representing people living with HIV and Aids reject Uganda’s new draft HIV/Aids prevention and control bill 2008.

The draft bill criminalises the intentional transmission of HIV. The National Forum of People Living with HIV/Aids Networks in Uganda said that the country should avoid creating scenarios where people living with HIV/Aids are looked on as criminals.
[...]
Read full article at guardian.co.uk

NAIROBI, 29 October 2008 (PlusNews) - Kenya will have to find new sources of funding to keep more than 200,000 people on antiretroviral (ARV) treatment after the country’s latest bid for support from the Global Fund to fight AIDS, Tuberculosis and Malaria was rejected, a senior government official said.

“We are too dependent on donor funding for programmes like these [related to HIV, malaria and tuberculosis], which are vital to the health of our people - we must start becoming more self-reliant,” Danson Mungatana, Assistant Minister for Medical services, said on 27 October.

Although the Global Fund’s Technical Review Panel recommended that Kenya’s proposal be rejected, the final decision lies with the Fund’s board of directors, due to meet in India in November; however, the board has never disagreed with the review panel.

Mungatana noted that the rejection in the Fund’s eighth round of funding was unlikely to have an immediate effect, as the money from the previous round of funding would last until 2010. Kenya had applied for US$130 million for HIV programmes, $100 million for malaria and $70 million for tuberculosis.

An estimated 98 percent of Kenya’s AIDS programmes are donor funded; no funds were set aside for HIV and AIDS in the country’s national budget announced in July.

“For us as a country, we need to ask ourselves, is this sustainable? It is not,” Mungatana said. “We are making a direct appeal that the treasury now must start to prioritise our issues.”
[...]
IRIN

Wednesday, October 29, 2008 6:57 PM
By Misti Crane
mcrane@dispatch.com
Infectious diseases, from deadly drug-resistant staph infections to the re-emergence of measles, are of grave worldwide concern and demand more attention from political and scientific leaders, a national advocacy group said today.

Concerns including shrinking domestic public-health dollars and weak infrastructure in countries plagued by malaria and tuberculosis prompted the nonprofit Trust for America’s Health to call for greater focus on infectious disease.

An increasingly mobile society means that diseases in one corner of the world will inevitably find their way elsewhere, said Jeffrey Levi, executive director of the organization.

Already, newly emerging and re-emerging infectious diseases - many of which originate overseas - kill about 170,000 Americans a year, according to national data included in the report.

“I think there has not been nearly enough attention and, perhaps more importantly, resources to handle the ongoing crisis as it relates to infectious diseases,” said Dr. Larry Schlesinger, who directs Ohio State University’s division of infectious disease and the Center for Microbial Interface Biology.

A quarter of hospitalizations are directly related to infectious diseases, and 10 to 20 percent of people who go into American hospitals without infections leave with one, he said.

And an aging population is only likely to push those numbers higher, Schlesinger said.

Meanwhile, the pipeline for vaccines and antibiotics isn’t exactly robust, in large part because they aren’t as lucrative as new drugs that treat such things as heart disease and high blood pressure.

The drama associated with isolated problems such as bird flu prompts attention, but it’s hard to get people, including those who pay for research, excited about day-in-day-out infections that affect many more people, said Schlesinger, a tuberculosis expert who leads a team of researchers focused on diseases found here and abroad.

[...]
View full article at The Columbus Dispatch