ScienceDaily (Dec. 1, 2008) — Universal and annual voluntary testing followed by immediate antiretroviral therapy treatment (irrespective of clinical stage or CD4 count) can reduce new HIV cases by 95% within 10 years, according to new findings based on a mathematical model developed by a group of HIV specialists in WHO.

Authors of the study also report that the universal voluntary testing followed by immediate ART could have additional public health benefits, including reducing the incidence of tuberculosis and the transmission of HIV from mother to child. Additionally, the model suggests that there could be a significant reduction of HIV-related morbidity and mortality in resource-limited countries with generalized HIV epidemics.

The current WHO policy on treatment involves voluntary testing and clinical and/or immunological evaluation (e.g. CD4 count) to determine eligibility for treatment with antiretrovirals.

The authors emphasize the theoretical nature of the exercise based on data and raise a number of concerns regarding feasibility, including the protection of individual rights, drug resistance, toxicity and financing challenges.

The paper does not signal a change in WHO guidance. WHO-recommended preventive interventions need to be maintained and expanded. This includes male circumcision, partner reduction, correct and consistent use of condoms, and interventions targeting most-at-risk populations, also known as “combination prevention.”

WHO will convene a meeting early next year bringing together ethicists, funders, human rights advocates, clinicians, prevention experts and AIDS programme managers to discuss this and other issues related to the wider use of antiretroviral therapy for HIV prevention.

Journal reference:

1. Granich et al. Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: a mathematical model. The Lancet, November 26, 2008; DOI: 10.1016/S0140-6736(08)61697-9

(Adds remarks on new class of drugs, new paragraphs 9-14)

By Stephanie Nebehay

GENEVA, Nov 28 (Reuters) - HIV infections could surge if countries pinched by the global financial crisis cut AIDS prevention programmes, a United Nations agency said on Friday.

Paul De Lay, a senior official at UNAIDS, said that economic turmoil was a threat to development programmes as cash-strapped governments start to pare back on international aid.

The world must maintain current assistance levels, he told a briefing before World AIDS Day on Monday.

“(Or) what we’ll find in the next four or five years is a resurgence in new incident infections and we won’t be able to scale up the treatment that is clearly going to be needed as more and more people become symptomatic and need access to drugs,” he said.

An estimated 33 million people worldwide were living with the HIV virus, mostly in sub-Saharan Africa, at the end of 2007. AIDS has killed 25 million since being identified in 1981.

An estimated 2.7 million people become infected each year.

Treatment programmes which provide life-extending drugs have expanded and now reach nearly 4 million people — short of the estimated 9.7 million in need of antiretrovirals — De Lay said.

Five new people are infected each year for every two put on treatment, he said. But antiretrovirals have come down in price and are getting easier to take, De Lay said.

“We are all expecting that the roll-out of a new category of drugs, the integrase inhibitors, will continue to improve patients’ response and make it easier and easier to take the drug regimens,” he said.

Isentress, made by Merck and Co. is the such first drug on the market. Researchers reported last month that it worked slightly better than an older HIV drug called efavirenz in suppressing levels of the AIDS virus.

A year ago, the U.S. Food and Drug Administration cleared Isentress for use in HIV patients whose infection has begun to resist the effects of other drugs.

The drug could compete with another integrase inhibitor called elvitegravir being tested by Gilead Sciences.

De Lay said clinical trials now using integrase inhibitors are mainly looking at how they can fit into combination drug regimens and ultimately reduce how often pills need to be taken.

He expected them to be rolled out in a more general way in the near future, “probably about a year to two years”. (Editing by Laura MacInnis)
View article at Reuters

By Susan Watts
BBC Newsnight

Aids hopes of SA’s new health minister

The UK is to give South Africa’s new Health Minister Barbara Hogan £15m to help combat Aids in the country.

Ms Hogan was appointed health minister in September to help shake up a health service in crisis.

South Africa has one of the most severe HIV/Aids epidemics in the world, with 800 people a day dying a day from Aids-related disease.

The policy of former President Thabo Mbeki has been directly blamed for 330,000 Aids deaths in the country.

President Mbeki denied the scientific consensus that Aids is caused by a viral infection that can be controlled by powerful drugs.

He rejected these drugs and as a consequence most adults and children infected with HIV in the country did not get the drugs that could have helped them.

A team from Harvard University quantified the effect of Mbeki’s stance on HIV/Aids, blaming his policies for hundreds of thousands of deaths.

WHERE UK FUNDS WILL GO
More protection for mothers and babies: Better availability of free tests for mothers during pregnancy, and anti-HIV drugs for pregnant mothers and children
National HIV awareness campaign: Information on safe-sex and HIV health issues will be sent out via radio, newspaper, text messages and street posters
Better nurses, doctors and clinics: Medical staff and managers helped to improve the quality of advice and service to patients, and staff morale improved through stronger incentives for quality care
HIV and Aids watchdog: National Aids Council strengthened and given a clearer remit to hold all parts of government to account

Susan Watts’ blog

The hope is that Ms Hogan will change all that.

On Monday, World Aids Day, she is to announce a return to the National Aids plan, dropped under Mr Mbeki’s rule, at a stadium event designed to mobilise the nation in the fight against the epidemic.

The high-profile media campaign to raise awareness is planned, including persuading famous people to have themselves tested for HIV.

UK International Development minister Ivan Lewis said it was vital that Ms Hogan succeed in overturning myths about HIV/Aids.

He said: “For too long, South Africa has been fighting Aids with its hands tied behind its back.

“Those ties have now been removed and the country has a fantastic opportunity to finally turn the tide in its struggle against this epidemic.

“Barbara Hogan has set a bold and exciting vision on HIV and Aids and that is why the UK is fully committed to working with her as she embarks on this new approach.”

UK Minister Ivan Lewis on why Britain is giving money

There is now a critical window of opportunity before next spring’s elections in South Africa.

Jacob Zuma, leader of the ANC (African National Congress) is widely anticipated to become the new president at those elections, when cabinet positions will once again be up for grabs.

The unspoken fear is that priorities could switch back to the previous position of denying the HIV/Aids link.

Early treatment

Professor Diana Gibb is one of the world’s leading authorities on HIV and its transmission from mother to child in developing countries.

She told Newsnight that getting anti-HIV drugs to babies early is vital in saving lives.

Dr Gibb played a key role in a trial carried out jointly by a British and South African team which found dramatic reductions in mortality in infected babies if they are treated early, rather than waiting until the children show clinical symptoms.

The results, published in the New England Journal of Medicine, were so compelling that they have changed international guidelines on how best to treat HIV-infected babies.

But how to make best use of those findings is a challenge that epitomises the difficulties ahead for South Africa and Ms Hogan.

Hospitals need to find and identify infected babies as early as possible, perhaps by testing as they arrive for immunisations and then administer the necessary drugs.

And there are difficult diplomatic choices too, for example whether to stick with expensive drugs from named drugs companies - sometimes in liquid form that is hard to transport.

The alternative is to opt for cheaper generic versions in tablet or powder form - but that risks upsetting drugs company sensitivities.

It may sound easy, but in practice it is a heavy demand for a health service whose skilled staff are leaving the country and struggling after years of inadequate funding and support.

View article at BBC News

Source: Voice of America (VOA)
By Lisa Bryant
Paris
28 November 2008

A new report by UNAIDS urges countries to adopt flexible policies that reflect how and why the latest HIV infections are transmitted. The report coincides with the 20th anniversary of World AIDS Day. For VOA, Lisa Bryant has more from Paris.

HIV infected patients resting in a hospital in Gitarama, Rwanda (file photo)
HIV infected patients resting in a hospital in Gitarama, Rwanda (file photo)
The overall story of HIV/AIDS is not as bleak as its numbers suggest. While an estimated 33 million people worldwide live with the HIV virus that causes AIDS, the numbers of new infections have been declining since 2001 and more HIV-infected people are getting treatment and living longer.

But a study published Friday by UNAIDS suggests countries have much more to do to fight the epidemic - in large part by adopting combined and flexible HIV/AIDS-prevention policies - particularly since the pattern of the epidemic may change over time. Some countries are also not targeting the most vulnerable populations in fighting the virus - such as intravenous drug users and men having sex with men.

“The message is that countries need to tailor their prevention programs to the epidemics in their own specific countries,” said Karen Stanecki, a senior advisor for UNAIDS in Geneva. “And they need to know where the new infections are occurring in order to do that. And we recommend a combination-prevention process of doing this where one prevention program isn’t going to do it all.”

Stanecki says that message has registered in some countries. Namibia is a case in point.

“They have put various strategies into place and they are now seeing reductions in new infections among young people,” she said. “Young people are delaying sexual activity . They’re reducing the numbers of multiple partners and we’ve seen increase use in condoms.”

The global financial crisis may pose a new threat for cash-strapped countries. But experts warn that cutting corners when it comes to fighting HIV/AIDS will leave the world in worse shape in a few years time than it is now.
View full article at Posted in HIV | AIDS | No Comments »