Second-line HIV drugs availability expanded in India

Medical centres across eight states in India are soon to receive antiretroviral treatment for HIV positive people who have become resistant to first-line ARV’s. Previously only Mumbai’s J. J. Hospital and Chennai’s Tambaram ART Centre offered the service. According to Sujatha Rao, the director general of India’s National AIDS Council:

“Bangalore and Hyderabad are rolling out second line therapy from next week. The other six centres have already started recruiting patients who are eligible for the therapy. Doctors have been specially trained to administer second line treatment and viral load testing kits have been put in place.”

For more information AVERT has pages discussing the AIDS epidemic in India and continuing antiretroviral treatment.

(The Times of India 05.01.09)

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Michel Sidibé replaces Peter Piot as UNAIDS Executive Director

The appointment of Michael Sidibé as the new executive director of UNAIDS, the joint UN programme for HIV/AIDS, came into effect on 1st January 2009. He succeeds UNAIDS’ first executive director Dr. Peter Piot who stood down at the end of 2008 having worked in the role for 11 years.

Malian born Michal Sidibé has worked for the UN for over twenty years, the last two as deputy to Dr Piot. The choice by UN Secretary General Ban Ki-moon to appoint Sidibé from the six other candidates comes from recommendations made by the Program Coordinating Board and the Search Committee, however Deborawork Zewdie, current director of the Global HIV/AIDS Programme at the World Bank was also named as a preference. Therefore it could appear although the search to find a successor was widespread, a fairly safe choice was made in the end.

In a speech to the UNAIDS Program Coordinating Board Sidibé’s loyalty to Dr Piot was clearly evident as he stated his intentions to build on his “extraordinary legacy”. As his main goal as Executive Director, he stated:

“I will do everything in my power to bring about an AIDS reversal- where less people become infected than are put on treatment.”

AVERT has an introduction to the AIDS epidemic and information on AIDS treatment targets worldwide.

(UNAIDS 1.1.09, The Lancet 18.10.08)

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Clinton Foundation donor list shows dwindling support for HIV

Former President Clinton has released a list of more than 200,000 donors to the AIDS foundation set up by the Clintons in 2001. The list was made public as part of a deal with President elect Obama in order that Hillary Clinton could not be accused of a conflict of interests in her new role as Secretary of State. Substantial contributions to the fund have been made by; UNITAIDS, the Bill and Melinda Gates Foundation, the Elton John AIDS foundation, the MAC AIDS fund and AIDS-life. However, compared to the overall number of contributors it seems few are AIDS specific, and as there are no dates it is not clear how much funding is currently in place for HIV/AIDS. Tackling the AIDS epidemic was a major priority at the fund’s conception but HIV is now coupled with Malaria and is one of seven initiatives including child obesity and climate change.

$ 500 million has been raised in total since the foundation began and 1.4 million people with HIV are now on treatment as a result. The foundation has been successful in leading negotiations of HIV drug price reductions particularly for expensive fixed-dose combination therapy for children with HIV. However, indications from the newly released list of contributors suggest HIV is no longer a priority of the foundation.

Read more about funding for the HIV and AIDS epidemic. 

(Clinton Foundation, Wall Street Journal 19.12.08)       

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New study shows women at greater risk of HIV infection than previously thought

A new study has challenged common opinion regarding the risk of HIV transmission in unprotected heterosexual sex. Scientists previously thought that due to the protective lining of the vagina the only route of transmission was through damaged skin or cuts and sores in the vaginal tract.

This new study has shown that in fact HIV is capable of moving between the skin cells themselves breaching healthy vaginal tissue and thus causing infection.  As skin cells are about to be shed they no longer are as tightly bound, allowing the virus to then go between these cells. Once the virus has reached a fraction of a millimetre below the surface it is able to invade the immune cells it needs to establish itself in the body.

Lead Professor of the research study said: “This is an important and unexpected result – we have a new understanding of how HIV can invade the female vaginal tract.”

The findings show that new prevention strategies are urgently needed to block the entry of HIV through this route. It serves also to strengthen the argument that condoms are a vital part of safer heterosexual sex and that governments and HIV practitioners worldwide need to do more to advocate the use of them. The findings could also potentially help in the development of new microbicides to protect women against HIV.

(BBC 17.12.08, Washingtonpost.com 17.12.08)

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New indicators for predicting rate of progression from HIV to AIDS in patients

Comparison of HIV infected people in a large US cohort study showed variations in mitochondrial DNA affected their rate of progression from HIV to AIDS. The mitochondria are a cell’s energy generator and this research supports previous theories that cells with mitochondria variations that produce less energy are more susceptible to HIV. Two of the variations predisposed patients to develop AIDS faster whereas three variants were associated with slowing the development of HIV to AIDS.

Screening the mitochondrial genes of HIV infected patients may gave an indication to the susceptibility of a person to AIDS progression. Knowing this could lead to a more accurate prognosis of when patients should start treatment and which drugs will be most effective.

To read more information on HIV science and the evidence HIV causes AIDS follow the links. 

(New Scientist 14.12.08, AIDS 30.11.08)

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HIV transmission rates down in the US

Researchers from the CDC and Johns Hopkins School of Public Health have reported a consistent decline in the rate of HIV transmission in America since 1984. Lead author David Holtgrave said, “for every 100 persons living with HIV today five or fewer will transmit the virus to an uninfected person in the given year”. This is a decrease of almost ninety percent since 1984. The study suggests a success in HIV prevention; however around 56,000 new infections occur in America annually.

The rates of HIV infections are still increasing among minority groups in the US such as African Americans and Latinos, injecting drug users and men who have sex with men. A previous CDC report produced recently showed that recommendations for HIV testing were not being followed and consequently late diagnoses are on the rise. A National Strategy to tackle HIV & AIDS in America is intended to be a priority of President-elect Obama in the coming year. 

For further information AVERT has a section of pages on HIV/AIDS in the USA and HIV prevention in America.

(Washington Post 9.12.08, JAIDS 22.11.08)

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Bush announces two PEPFAR targets achieved ahead of schedule

The results so far of the US President’s Emergency Plan for AIDS Relief (PEPFAR), set up in 2003, have been described as “promising”. Speaking on World AIDS Day George Bush declared two of the initiative’s targets as having been achieved ahead of the 2010 deadline.

The US has fulfilled its promises of providing access to antiretroviral treatment to over 2 million people globally and supporting care for 10 million people affected by the epidemic, including orphans and vulnerable children. Access to treatment in sub-Saharan Africa has increased to forty times what was provided prior to PEPFAR’s inception. A further $ 48 billion has been authorised by the US Congress for HIV/AIDS, Tuberculosis and Malaria over the next five years to continue global relief.

To read more about International Funding for HIV and AIDS click on the link.

(PEPFAR 1.12.08)

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Failure of South Africa’s Health department leaves HIV/AIDS organisations underfunded.

The Department of Health in South Africa has failed the Treatment Action Campaign (TAC) and twelve other HIV/AIDS organisations by not channelling Global Fund donor money meant for them.

The TAC said in a statement recently that they have hit a financial shortfall that was in part, but not exclusively, due to several million rand of their Global Fund grant not being paid to them. Because of this they have had no choice but to retrench approximately 20% of their staff and cut back their treatment literacy program. They believe the responsibility lies with the Department of Health in South Africa.

Nathan Geffen of the TAC told AVERT that the Department of Health has failed to meet any of the conditions precedent for the grant set out by the Global Fund. In a report released in August the Global Fund gave the South African grant a rating of ‘inadequate but potential demonstrated’. The grant was still delivered to the Department of Health around mid-November; since that time the principal recipients have yet to receive their share.

While a number of things are being discussed to try and resolve the situation, there are worries that the Department of Health will again be responsible for delays in the future.

The Global Fund acknowledge that this should not be happening in South Africa and along with the TAC, AVERT are calling for the Department of Health to work quickly to resolve this mess and make themselves function effectively.
The Global Fund and the South African Department for Health were unavailable for comment on this issue.

For more go to AVERT’s pages on HIV/AIDS in South Africa and The Global Fund.

(IRIN, 08.12.08. TAC, 09.12.08)

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Severe ARV shortages in South African province

Life saving AIDS drugs are currently being withheld from hundreds of patients in South Africa’s Free State Province. Emails from Dr Mvula Tsahbala, head of the province’s HIV and AIDS management programme were leaked to the TAC in early November describing “an acute shortage of antiretroviral drugs” and advising doctors to cease putting new patients on to treatment. Priority has been given to those already on treatment and pregnant women and children and there have been no interruptions to treatment as yet, however there are fears there are not even enough supplies to continue treatment of these groups for very long.

The shortfall in the Free State has been attributed to a lack of funding, as the National treasury had allocated R63 million below the state’s budget for treatment, however the TAC has accused the provincial government of financial mismanagement by conducting an HIV programme without adequate funds in place. Even with R9.5 million emergency money provided by the CDC there are concerns that this only delays inevitable shortages and some doctors are worried the money may not be used on ARV supply.

On top of this the TAC have reported a national condom shortage has been declared, emergency supplies have been released by the department of health but only 7 million condoms for one month have been supplied compared to the usual 33 million. With arguably the most efficient HIV prevention method in South Africa in short supply and ART not reaching the people who need it the AIDS situation looks bleak in Free State.

 To read more about HIV and AIDS in South Africa and the government response follow the links.

(TAC 26.11.08)

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Advocates call for change in HIV drug administration for the prevention of MTCT

Michael Weinstein, President of the AIDS Health Foundation has written a letter backed by dozens of  organisations urging the WHO (World Health Organisation) to change its guidelines that recommend single-dose Nevaripine and/or Zidovudine as a safe treatment to prevent HIV being passed from positive mothers to their children. This is a standard treatment in resource poor settings whereas in high-income countries a full course of Highly Active Antiretroviral Therapy (HAART) is used.

Single-dose has been proven to be less effective, with the possibility of viral resistance in the mother after its use. This affects the effectiveness of future HIV treatment and can lower the chance of survival; as has been acknowledged by the WHO.

AVERT supports the aim of more effective prevention of Mother to Child Transmission. However with 370,000 children becoming infected with HIV through mother-to-child transmission in 2007 it is clear even single dose therapy is not reaching all mothers who need it.

Join AVERTs Stop AIDS in Children Campaign to see what you can do!

(AHF 25.11.08)

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Cholera outbreak illustrates lack of healthcare and increasing HIV/AIDS epidemic

President Robert Mugabe has tried to cover up a cholera outbreak in Zimbabwe that, according to the WHO, has killed at least 294 people and infected around 6000 so far. While Mugabe refuses to declare a state of emergency, the HIV epidemic in the country must also be suffering as a result of the neglect and subsequent lack of infrastructure that is present.

Many hospitals have been shut as a result of the country’s extremely high inflation rate and people infected with cholera and HIV are suffering. The lack of drugs must also be affecting people with AIDS who need a daily supply.

For more go to AVERTs pages on HIV/AIDS in Zimbabwe.

(BBC, 26.11.08)

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CDC HIV-testing recommendations ignored by doctors in America

Recommendations for routine HIV testing made by the CDC in 2006 have not reached the doctor’s office according to several studies presented this week at a US conference. Routine testing has been advised for the last two years in everyone from the ages of 13 to 64 in all medical encounters unless they opt out. No more than two percent of US emergency rooms routinely test for HIV in patients not in a critical state. Co-chair of the Forum, Dr John Bartlett also announced that forty percent of pregnant women are not tested for HIV, potentially risking the health of the baby, even though mother to child transmission is entirely preventable.

The obstacles seem to be a perception that testing takes too much time and money, with some insurers unwilling to pay for the tests. With trained councillors rapid testing can be done in around five minutes, some test kits cost as little as $ 15. Routine testing means earlier detection of HIV in patients before it has progressed to a symptomatic stage or AIDS, and is therefore much more treatable.

For more follow the link to AVERT’s HIV testing in America.

(Associated Press 21.11.08)

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Study showing rapid drug treatment cuts baby mortality prompts change in guidelines

The study, which appears in the New England Journal of Medicine, found that by starting antiretroviral therapy (ART) immediately after diagnosis of new born HIV positive babies, the risk of death from AIDS dropped 76%. This significant reduction of mortality in infants has provoked the World Health Organisation, US government, and PENTA (Paediatric European Network for Treatment of AIDS) to change current guidelines advising delay of therapy for infants until symptomatic.

In order to start treatment, and save children who otherwise would have died, the importance of early testing is highlighted so that children can be diagnosed and treated straight away. Treatment was given to 377 HIV positive South African babies in the study, up until the age of two, however questions remain over what happens after this age. Once through this early risk period should infants be taken off ARV treatment? Adherence to a drug regime in children is already problematic however if a break is recommended will this affect the child’s resistance to therapy? Will this be a personal matter discussed with a doctor or lead to further revisions to child treatment guidelines? All these will have to be answered at some point in the future.

For more information look at AVERT’s pages on the issues of HIV & AIDS Treatment in Children or sign up to our Stop AIDS in Children Campaign.

(BBCNEWS 19.11.08, New England Journal of Medicine 20.11.08)

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Transplant patient shows HIV’s “Achilles heel” or just a fluke AIDS ‘cure’?

German doctors claim a bone marrow transplant given to a patient being treated for leukaemia and HIV has “cured” the man, who has shown no trace of HIV the two years since the procedure. The doctors selected a bone marrow donor with genetic resistance to the majority of strains of HIV for the transfer.

The patient was taken off antiretrovirals and his immune system was suppressed with radiation and powerful drugs in the treatment of his leukaemia. This may have allowed his immune cells to be replaced with HIV-resistant cells produced by the donor marrow. Two years later, at a press conference in Berlin, his doctors claim him “functionally cured of HIV” and hint at the result encouraging further efforts into gene therapy for a cure for AIDS.

Researchers are urging caution over the results as HIV may have only been suppressed to low levels, or may be latent but not eradicated completely from the man’s system. Therefore there are calls for further testing before accepting the doctors’ claims even of a fluke “cure”.

Even if this operation was successful in ridding the man of HIV, the amount of bone marrow donors are not sufficient to treat all HIV patients in this way. This type of transplant is a risky procedure and fatal in 20 to 30 percent of patients; therefore it is often regarded as a ‘last option’.

This is not the first time bone marrow transplants have been looked at for a possible HIV/AIDS treatment; two cases of an HIV cure by this method were reported prior to 1996. However the researchers involved said it was too risky and would never be a standard treatment for HIV.

More likely is further research on the CCR5 mutation responsible for HIV immunity in this case, however research into gene therapy is still a long way from a cure.

(The Associated Press 13.11.08, The Daily Telegraph 13.11.08)

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Global Fund for AIDS approves $ 2.75 billion worth of new grants

The Global Fund to fight AIDS, TB and Malaria announced on Monday 10th Nov, in New Delhi, the approved funding for 94 new grants totaling $ 2.75 billion, to be used over two years. This is the highest amount of new financing ever approved by the board and will be significant in achieving the 2012 global targets. Of the funding, half is going to combat Malaria, ten percent to TB and the rest to HIV/AIDS. This is in contrast to last year’s funding in which HIV gained the bulk of the budget.

India, the host of the meeting and one of the Fund’s larger beneficiaries has been turned down for a grant of $ 128 million because, as Nicholas Demey, a spokesman for the Global Fund said; “the soundness of approach was not as it should have been”.

Recently there has been some controversy over misuse of $ 7.3 million funding for AIDS in Zimbabwe, which were subsequently confiscated by the Global Fund. Despite this, the board has decided to donate $ 168 million of new grants to Zimbabwe; however the Global Fund made clear that this is dependent on much tighter regulations and agreements over the channeling of money so that there is no “interference by the government”.

The next round of funding will be in November 2009.

 (The Global Fund press release 10.11.08, Reuters 11.11.08)

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Calls for Mbeki to face consequences for allowing AIDS deaths

Former President of South Africa Thabo Mbeki is being blamed for causing the deaths of 330,000 people due to his decision to block HIV medication whilst in power. Mbeki should face a judicial inquiry and has “blood on his hands” says TAC leader Zackie Achmet.

Mbeki has been widely criticised for his stance on HIV whilst President of South Africa. He ignored scientific evidence that HIV causes AIDS and made a decision in 1999 to declare available HIV drugs toxic and dangerous.

A study has calculated that as a result of Mbeki’s failure to roll out drugs that could have prevented mother-to-child transmission of HIV, around 35,000 babies were born HIV positive.

The damage caused under the Presidency of Mbeki will undoubtedly be felt in South Africa for some years to come. However, the country must look forward now and with new Health Minister Barbara Hogan and a renewed approach to tackling the epidemic it is hoped that the neglect to HIV and AIDS that was present under Mbeki is now a thing of the past.

For more about AIDS in South Africa go to AVERT's HIV and AIDS in South Africa page.

(BBC, 07.11.08)

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